Do you care enough to help?
Via Hot Air
The mammoth Congressional expansion of SCHIP is such a bad idea, even the normally big spending President Bush vetoed the bill. I wrote a piece titled, “Abandon SCHIP: Big Government Returns,” which is now available on the Acton Website.
The political posturing concerning the program has reached a troubling level. Supporters are using using kids as props to usher in socialized medicine and government expansion. But one of the main problems with the bill is the regressive characteristic of the expanded version. Money will be transfered from poorer states and citizens to fund a permanent middle to upper-middle class entitlement. While the growing cost of health care is a serious problem, we need to find solutions that provide affordable private coverage outside of the impending bureaucratic and regulatory nightmare.
Another growing frustration is a lack of conservative leadership on explaining the consequences of expanding this program. In general it seems, in the last few years political and moral leadership on government expansion has been largely vacant. Conservatives use to fight the expansion of these programs and point out the unintended consequences of such measures. Do we really want a permanent entitlement for the well to do?
There are a number of problems with Paul Krugman’s NYT piece earlier this week, “A Socialist Plot.” Krugman compares the American educational system to its healthcare system, arguing that because Americans aren’t inclined to disparage the former as a socialist threat, we likewise shouldn’t consider universal healthcare as a “socialist plot.”
“The truth is that there’s no difference in principle between saying that every American child is entitled to an education and saying that every American child is entitled to adequate health care. It’s just a matter of historical accident that we think of access to free K-12 education as a basic right, but consider having the government pay children’s medical bills ‘welfare,’ with all the negative connotations that go with that term,” says Krugman.
Krugman assumes that a defense of private versus public education is indefensible. After hypothesizing about making a case for abolition of public education, he purrs to his NYT audience who have never considered any practical option besides the government administration of education, “O.K., in case you’re wondering, I haven’t lost my mind.” Clearly to even consider getting rid of public education is insane.
First, let’s make a basic distinction between government mandates and government provision. The government mandates that I have car insurance before I take my car out for a spin, but I don’t sign up with the government for that car insurance. In the same way, drawing my own analogy, government could mandate K-12 education without being the primary provider of said education.
And as far as socialists plots go, government provided education should be ranked right up there. Even social observers who are largely sympathetic to socialism see the administration of public education primarily in terms of its utility as a means of social control rather than as a means of inculcating truth. Thus says Reinhold Niebuhr: “While education is potential power, because it enables the disinherited to protect their own interests by organised and effective methods, the dominant classes have suppressed their fears about education by the thought that education could be used as a means for inculcating submissiveness.” Whether the dominant class is the bourgeois or a politburo, public education as social control is a real concern.
Kristoff concludes, “We offer free education, and don’t worry about middle-class families getting benefits they don’t need, because that’s the only way to ensure that every child gets an education — and giving every child a fair chance is the American way. And we should guarantee health care to every child, for the same reason.” Socialism, apparently, is the American way. And middle-class families that send their kids to private schools aren’t “getting benefits they don’t need,” they are paying via taxes, often dearly, for education they don’t want.
There is an analogy between health insurance, car insurance, and education. It may be that the government mandate that all Americans have health insurance (although I doubt such a policy’s prudence), and yet not become the primary provider of such health insurance. Where market forces fail, nonprofits, charities, community groups, and churches must fill the gap. BlueCross and BlueShield is a nonprofit health insurance association providing coverage for about 1/3 of the American population. If need be tax credits and other incentives could be extended to promote private financing of such initiatives.
For more on the push for socialized health care in the US, check out this week’s commentary, “What’s Wacko about Sicko.”
Bush has lots to say about encouraging what he calls “capitalism for the campesinos.” He ties this to “social justice,” by which he means, above all, “meeting basic needs” to education, health care, and housing so that people can “realize their full potential, their God-given potential.” But social justice, thus conceived, doesn’t require massively redistributive government action; rather, it requires unleashing the potential of individual initiative, sowing some seeds, and leveraging the efforts of non-governmental organizations, especially faith-based ones.
In comparison to a speech from President Kennedy in 1961, Knippenberg concludes, “If you compare GWB to JFK, you’ll see that the goals aren’t all that different, but the thought put into the methods is.”
Go to this page to watch a short video highlighting the story of one man’s fight against Canada’s health system.
The film is focused on the defects of socialized medicine and so, naturally, does not deal with the serious problems existing in other systems (such as the United States). But it is an effective display of a problem that every attempt to manipulate prices encounters: how to make supply meet demand.
Transparency International is a group devoted to exposing corruption of all kinds. One of the most sickening forms of corruption in many poor countries is health care corruption. One sort of corruption is absentee-ism: medical personel bill for their services even when they aren’t at work, but are doing another job.
The increasingly large and legal market for pharmaceutical drugs is attracting criminal activity. Pharmaceuticals are high value and easily portable, and the penalty for stealing or smuggling them is far lower than for narcotics, so trade is brisk. This is especially the case in Africa where borders are porous to those prepared to pay bribes. Furthermore pharmaceutical markets are segmented internationally since companies recouping research and development costs want to charge efficient prices in vastly different settings for products with very low marginal costs. Antiretrovirals (ARVs) to treat HIV have 20-fold price differentials between western and African countries, which mean illegal but massive arbitrage possibilities exist for smugglers.
Once again, lack of virtue retards economic development.
Along the same lines as my earlier post, The Weekly Standard argues that putting the needs of parents first, can form a more stable foundation for an alliance between fiscal and social conservatives.
Both fiscal and social conservatives should put themselves in the shoes of the parenting class and focus on advancing competition and choice while also encouraging the growth and strength of the two-parent family. In health care, for instance, conservatives have consistently failed to approach things from that point of view….Conservatives should also look beyond the horizon and see that long-term care for the aged is about to become the next major concern of the parenting class…. In education, it is well past time to have another serious go at school choice, which can appeal to the parenting class both as a solution in their own children’s lives and as a call to conscience.
A Free and Virtuous Society needs to respect autonomy and importance of the social sphere, especially the family. Kudos to Yuval Levin of the Ethics and Public Policy Center for writing this article, and to the Weekly Standard for publishing it.
Susan Stabile, a law professor at St. John’s University and a contributor to Mirror of Justice, analyzes the current state of health coverage in the United States in light of Catholic social teaching in this article. I have quibbles here and there along the way, but on the whole the approach and the conclusions are sound. She is probably right that Health Savings Accounts (HSAs) have limited value, though my reasoning would be a little different. I would say that, in principle, they represent a helpful idea—increase the operation of the market within health care—but they are such a small foray into a vast and complicated world beset with market distortions on every side, that they end up exhibiting the deficiencies that Stabile identifies.
The verdict is obviously still out on the Massachusetts plan but I am willing, with Stabile, to give it the benefit of the doubt as a generally well-conceived step to try to solve a difficult problem.
One issue that Stabile and so many others writing on this subject fail to take into account is distinguishing between necessary and elective health care. This is a critical issue that simply must be a part of our ongoing debate about health coverage. She rightly insists that Catholic social teaching views health care as a right. But does that right imply a monthly medical check-up? An annual one? Plastic surgery to make wounds less noticeable? Botox treatments to take the lines out of one’s aging countenance?
Probably we could come to consensus that the last item in that list is not a right. But what about the others? It’s not an easy distinction and there will be a lot of different views about where to draw the line. As soon as we take health care out of the realm of the market (where every person gets just what he is willing to pay for personally), it seems to me that we have to answer not only the question, How is the community going to ensure that everyone receives health care?, but also the question, Which forms of health care will the community pay for? To think that everyone can have every bit of medical treatment he or she wishes is pie-in-the-sky utopianism. Health care is a scarce commodity like anything else, and its distribution at some level must somehow be tied to market pricing.
I think we need to stop thinking about health care as a special case and think about it more as just another basic good necessary for human wellbeing. Take nourishment as an example. No one (or nearly no one) advocates that any person be left to starve to death. And no (or nearly no one) argues that everyone must have access to five-star restaurants. Instead, people take up positions along a spectrum. Some argue that private charity can provide the needed safety net; some insist that government programs are necessary; some say that a mixture of the two is best. But with health care, it seems that many people believe that everyone must be able to afford the equivalent of the five-star restaurant; otherwise there is unconscionable inequity. It’s an impossible goal.
Jim Aune, blogger-in-chief at The Blogora, complained yesterday about his health care treatment. He says, “I have been in constant pain for 36 hours. I actually used a cane to go to the office yesterday for some meetings. The problem? I have a trapped nerve in my abdomen from a double hernia repair a year ago. I got shot up with steroids about 3 weeks ago, and that worked for about 5 days, but I still can’t walk without a ripping sensation (as if my right leg were being separated from my side).”
That sounds horrible. He continues: “I’m about to go see the doctor again today (he’s a nice guy, as family practice doctors usually are, as the anesthesiologist at the pain clinic), so I decided to read up on the Internets about this condition. Now, a little learning, especially online, is a dangerous thing, but it appears that entrapped nerves have gone from happening in 1% of hernia repair patients to closer to 40%, and the speculation is that the new use of plastic mesh is a possible cause.”
It seems that Aune somehow associates John Stossel with his problem. “Enter the biggest jackass on television: John Stossel of 20/20, who believes that the market solves all problems, and that any government intervention in that frictionless market creates no end of bad ‘unintended consequences.’”
What is Aune’s argument against Stossel? After citing a Daily Kos item, Aune contends, “markets are wonderful things, but they only work in cases of ‘symmetric information.’ That is,they work efficiently when both parties to an exchange have nearly similar information.” (Last night’s episode of ER dealt with a very similar issue).
Markets only work in cases of symmetric information. Is this true? Or is the opposite true? Hayek’s observations about the nature of diffuse and unequal information are the basis for his arguments against the practicality of state intervention. As Steven D. Levitt and Stephen J. Dubner put it in their book Freakonomics, “We accept as a verity of capitalism that someone (usually an expert) knows more than someone else (usually a consumer).” Medical care isn’t the only example of information asymmetry, of course. Typical ones include car sales, or especially car repair, but they can apply in any instance where there is particular expertise involved.
Levitt and Dubner go on, “But information assymetries everywhere have in fact been mortally wounded by the Internet.” Now it is true that in practice, as in Aune’s experience, there are all kinds of limits on the potential for the Internet to even out information. It takes time, access, and a certain amount of patience to educate oneself about certain medical conditions, for example. Thus Levitt and Dubner go on to admit, “The Internet, powerful as it is, has hardly slain the beast that is information asymmetry.”
Aune later asserts, “markets do not work efficiently when information is asymmetric.” Maybe they don’t work as efficiently as they might otherwise, but they still seem to work, and perhaps better than any other option available to us. And there are methods for the sharing of information and such that does not necessitate government involvement (independent ratings, consumer reviews, and the like).
It’s not clear what Aune’s solution is (if there is one in his complaint), but I take it that Aune is arguing at least implicitly that the government needs to be the entity that solves the problem of information asymmetry. Would he rather have no choices, even the limited ones he is inadequately informed about, and instead have the government decide for him? Why don’t we just make doctors government employees? Then they can enforce the course of treatment they deem best.
Yes, I realize that no one likes the current version of the Comprehensive Immigration Reform bill. But it is possible to make constructive changes without being comprehensive. Here are a couple of recent examples:
1. Assimilation needs to be a priority. The Administration just formed a Task Force on New Americans to help legal immigrants become more fully Americanized. Whether the Task Force will do anything substantial remains to be seen. But it is encouraging that someone in the Adminstration understands that this is an important issue.
2. New rules requiring documentation of legal status for Medicaid go into effect on July 1. There will be problems of course. (The story linked is basically all about how difficult it will be for people to come up with the required documentation, even for people who are here legally and are entitled to Medicaid.) But the principle is sound: enforce the law we already have. The documentation problems can and should be addressed.