Coyote Blog

I posted the other day that one explanation of rising health care expenditures in the US is rising wealth.  As we are wealthier than other Western nations, doesn't it make sense we would spend more on our health than other nations.

James DeLong adds:

Robert Fogel, in his NBER paper, which has more detail than his American article (and will cost you $5), looks at changes in U.S. consumption patterns from 1875 to the present. A striking number is the reduction in the costs of the basics -- food, shelter, clothing took 74% of income in 1875; 13% in 1995. This has freed up a lot of income, and one of the great gainers has been health. In 1875, it took only 1% of consumption, largely because there was little to be bought, except for patent medicines loaded with alcohol and opiates, or a saw to lop off an injured limb. By 1995, it was 9%.Leisure was another big gainer -- 17% in 1875; 68% in 1995.

So if improvements in medical technology lead people to reallocate money toward health, fine.

From Joe Biden, in the debates:

"No one making less than $250,000 under Barack Obama's plan will see one single penny of their tax raised, whether it's their capital gains tax, their income tax, investment tax, any tax."

Oops:

Under the plan, people who earn between 100% and 300% of the poverty level (or between about $22,000 a year and $66,000 a year for a family of four) would face fees ranging from $750 to $1,500 a year.

For taxpayers with incomes above 300% of poverty, the penalty starts at $950 a year and reaches as high as $3,800 for families. Nearly 12 million people fit in this category, according to the National Institute for Health Care Management.

The idea behind the penalty is that those who can afford insurance but don't buy it are imposing costs on the entire health system. Under the proposal, nearly 12 million people who currently have no insurance could be subject to such fines, according to figures compiled by the National Institute for Health Care Management.

People focus too much on the penalty itself being a new tax.  But the new tax is actually the requirement that individuals buy a product (in this case a health insurance policy) that they feel has no value (or else they would purchase it of their own free will today).  The government stopped pretending long ago that these younger middle class families will get much value from such a policy.  In fact, if they did get value commensurate with the premiums they will be paying, the mandate would not be achieving its purpose.  The whole point is that healthy people pay more into the insurnace system than they get back to support sick people.  If that payment is mandatory, then it is a tax, even if it is called an "insurance mandate" instead.

In fact, this is made all the more clear when politicians also suggest that cheaper high deductible health insurance plans be banned, as they were in Massachusetts.  Again, the whole point is to get young healthy people to overpay for insurance, and allowing them to buy sensible, cheaper, high deductible insurance defeats the whole purpose.

This is a tax on middle America, and Obama knew he was going to propose it way back in the campaign.  This is not something he just thought up or was a victim of changing circumstance.  This is an out and out lie on his part.

This is awesome, from Carpe Diem:

On a purchasing power parity basis, France, Japan, and Germany would all be the poorest states in the United States, based on per capita GDP.  People on the coasts don't benchmark their education or health care spending against Mississippi, except perhaps to make the case that Mississippi is spending too little.  So why do they benchmark their spending against Germany or France.  Of course we spend more on health care per capita - we spend more than these countries per capita on everything from TV's to cars to movie tickets.

Via Steve Chapman at Reason:

[President Obama] says though the United States spends more per person on medical care than any other nation, "the quality of our care is often lower, and we aren't any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do."

That's one of the favorite rationales for a government-led overhaul. But it gives about as realistic a picture of American medicine as an episode of Scrubs.

It's true that the United States spends more on health care than anyone else, and it's true that we rank below a lot of other advanced countries in life expectancy. The juxtaposition of the two facts, however, doesn't prove we are wasting our money or doing the wrong things.

It only proves that lots of things affect mortality besides medical treatment. Heath Ledger didn't die at age 28 because the American health care system failed him.

One big reason our life expectancy lags is that Americans have an unusual tendency to perish in homicides or accidents. We are 12 times more likely than the Japanese to be murdered and nearly twice as likely to be killed in auto wrecks.

In their 2006 book, The Business of Health, economists Robert L. Ohsfeldt and John E. Schneider set out to determine where the U.S. would rank in life span among developed nations if homicides and accidents are factored out. Their answer? First place.

That discovery indicates our health care system is doing a poor job of preventing shootouts and drunk driving but a good job of healing the sick. All those universal-care systems in Canada and Europe may sound like Health Heaven, but they fall short of our model when it comes to combating life-threatening diseases.

I have seen several folks of late testing out a meme that opposition to health care reform is mostly about churlish unwillingness to help people.  My sense is that this is dead wrong.

As a strong libertarian, that may well be my motivation.  But the vast majority of Americans accept and support the government safety net and generally will support reasonable expansions of it to address true need.   I think most Americans would be willing to help people who honestly need financial aid to pay the health care bills.  This is particularly true for children -- you don't remember people going ballistic over SCHIP, do you?

I am not representative.  The vast center of this country is willing to accept, even embrace, increased government interventions in the right cause.  I forgot to blog on it, but remember that poll a few weeks ago that a majority of Americans think the government should required that women take their husbands last name after marriage?  I think the notion that there is any kind of sizable block of small government libertarian type folks out there is simply a myth.

So health care intervention and spending can be sold - again remember SCHIP but also the prescription drug bill.  I think the Administration is having trouble selling it in this case for two reasons:

• They are having difficulty showing people who truly are not getting care.  Sure there are a lot of people who are uninsured, but I think that meme has been around enough for people to deconstruct.  Who isn't getting care?   Sure, for some folks getting care is a real hassle, but there are arguments to be made that accepting charity should not be that easy (remember the old Welfare?)  And sure, some folks have financial straights and can even face bankruptcy over health care bills, but our bankruptcy laws are incredibly generous and when tens of thousands are facing bankruptcy because they bought too many TV's on their credit cards, it almost seems honorable to face bankruptcy over your wife's cancer treatment.
• The second problem is what I call the public housing problem.  In the late 1960s, Americans were concerned about the poor and homeless and spent billions to build housing projects for them.  It turns out that this doesn't work out so well, but that is not my point.  My point is that Americans could be convinced to spend money to build poor people government homes.  BUT their position would have been very different if investments in public housing required the rich and middle class who were paying for the program to move out of their homes and into public housing as well.That is the fear that I think much of America has today.  If asked, they would likely pay to provide government health care in an instance where it was demonstrated that health care was entirely lacking.  They would likely suspect that such care, like much of public housing, would suck, but as it was being offered to someone who supposedly had nothing, it would represent a net improvement.  But they don't want to move into the projects themselves, and frankly don't understand why agreeing to help poor people afford more health care also means they have to move into the government system themselves.

The whole "health care rationing" debate is reaching new levels of absurdity.  In part, this is because the very term "rationing" is a confusing misnomer.

So here is what it boils down to:  For every product or service purchase, someone makes a price-value trade-off to determine if that product or service should be purchased for a given price in that particular instance.

One option for making this decision is to have the person who actually will consume the product or service -- and whose money will also be used to complete the transaction -- make this price-value tradeoff.  This is how we make these decisions for just about, um, absolutely everything that gets purchased.  Since it is your money and you are the one who will enjoy whatever is being purchased, it makes sense that you make the decision - is the price worth it?  Do you buy a cheaper substitute?  Do you do without?

A second way to do this would be to have someone who has you specifically in mind make the price value tradeoffs for you.  This might be like your wife volunteering to go out to buy you some new underwear.  While results may be superior for this approach in a few cases (e.g. my wife buying me clothes), in most cases this approach is fraught with information asymmetries that will likely lead to a suboptimal purchase.  Consider, for example, my wife buying me the cheap 28" TV when I had wanted to drop the big bucks on a 60" beauty.

If one were sloppy, he might say that this second approach is the role that exists with insurance companies or is being proposed for the government.  But this isn't the case.  Because these third parties are NOT making the decision with me and/or my personal preferences in mind.  They can't.  While my wife may have an imperfect understanding of my preferences, a government health board has none.

So a third model, and almost certainly the worst in terms of individual satisfaction, is to have a third party make price-value tradeoffs for me only with some notion of average preferences for average people, or worse, with an incentive system that has absolutely nothing to do with my satisfaction at all.  This is clearly the case for the government, and is probably the case for many private insurers today -- though at least in the latter case one could imagine a regulatory regime that allowed for much more competition and a range of offerings with different service levels and pricing, such that I was more likely to find a pairing close to my preferences than I would in a one-size-fits-no-one government regime.

Skeptics worry that such a range of choices would not exist under private competition, but in fact it does in every single market where the government allows it.  Take grocery stores, since the President of Whole Foods has come into so much criticism from government health care promoters.  The choices in grocery shopping are simply staggering -- just think what different price/value points Wal-Mart, Whole Foods, Safeway, AJ's, and the farmers market offer.

I am constantly amazed when people say that government health care is no different than private competitive models because there will always be rationing.  If you cannot see the difference between "rationing" for yourself based on your own budget and preferences and "rationing" by government committee, well I suppose you deserve what you get.  Except for the problem that unfortunately, I will be forced to take it too.

Here are some notes on the health care bill from one person who plowed all the way through it.  Some of the interpretations are a bit over the top, but I find it a useful index to help me find relevent sections I want to read in more detail.

Previously, I thought I was on the hook to pay 8% of wages only if I did not offer a health care option.  But it turns out that even if our company offers a health care option, we STILL owe the 8% if the employee chooses not to avail him or herself of the company plan.  From the legislation, page 145:

Beginning with Y2, if an employee declines such  offer but otherwise obtains coverage in an Exchange participating health benefits plan (other than by reason of being covered by family coverage as a spouse or dependent of the primary insured), the employer shall make a timely contribution to the Health Insurance Exchange with respect to each such employee in accordance with section 313.

Beyond the costs, the record-keeping requirements are staggering.  I have to keep track of how every employee chooses to get their health care, and have to pay different private and public agencies based on these individual decisions.  Beyond this, for my part time employees (which is everyone), the maximum amount I have to pay varies by the hours worked, meaning the legal requirement for employer health care contribution will vary from employee to employee, and may be different, and change year to year, for all 500 of my employees.

Most of my employees are either on Medicare (which presumably has been paid for with their lifetime Medicare taxes) or on a private retirement health plan.  I have been reading the plan for hours and have not figured out if I will owe money for employees on either of these programs.  Anyone with an insight into this is welcome to email me.

I have been trying to find a word to describe the legislative style we have seen prominently over the last 9 months (though it was used long before this administration -- the Patriot Act comes to mind).   Unable to think of any other name, an in homage to "murder-death-kill" in "Demolition Man,"  I am going to call it Crisis-Emergency-Rush.

TARP was a Crisis-Emergency-Rush.  As was the Stimulus bill, Waxman-Markey, and now Health Care.  (The last two are particularly hilarious when one needs to evaluate the need to rush.   Waxman-Markey is implemented over decades, and the health care bills as currently written don't really begin to take effect until 2013).

So here is my prediction for the next Crisis-Emergency-Rush:  Raising taxes.  Obama already has his boys out sending trial balloons about new taxes, even beyond those required in Waxman-Markey and to fund the health care bill.  Having spent over a trillion dollars on useless spending to support favored political constituencies, Obama will now declare a fiscal crisis that can only be solved by increased taxes on his non-favored constituencies.

One of the burning reasons we apparently need a government takeover of health care is that it is "expensive," or more precisely, we spend a lot of money on it.

So what?  In everything else I can think of, rising per capita spending and higher spending in the US than elsewhere is a sign of wealth and prosperity, not a "problem."  We spend a lot of money on a lot of sometimes trivial sh*t, and no one blinks.  We spend more money because we have more beyond what we need to keep ourselves alive.  Or we spend more money because technology provides us new options and frontiers.  But when we spend a lot of money on our health and well-being and longevity, its a problem requiring massive government intervention?

There are a lot of problems with the health care bills in Congress.  At the end of the day, I will endure most of them, as I have every other indignity thrown at me by the Feds.  If they charge me 8% of my company's payroll as a health care tax, well, we can probably raise prices, particularly in the inflationary spiral the Fed has set us up for.  I will be sad to see the most successful in this country punished with high new taxes, but these taxes mostly won't apply to our family.  And I will find some way to get my family the health care it needs, even if we have to fly to India to do it.

But my biggest fear is for individual liberties, with the effect I have called "the health care Trojan Horse for fascism."  We all know that the government has developed a taste for meddling in the smallest details of our lives.  But as more of the nation's health care spending flows though government hands, nearly every decision you make will suddenly affect the government's budget.  What you eat, how heavy you are, whether you smoke, whether you play an athletic sport where you can get hurt, whether you pursue dangerous hobbies like rock climbing or skiing, whether you wear a bike or motorcycle helmet, whether you have a seat belt on, whether you drink alcohol, whether you like to use dangerous power tools -- all these become direct inputs into government spending via medical bills the government is paying.  And if you think that Congress will avoid legislating on these activities once it inevitably gets in financial trouble with health care, you have not studied much history.

And all this avoids discussion of other powerful individual liberty-related topics, such as the ability to get the end of life care you want or whether the government will even allow you to go "off plan" with your own money if you disagree with its Commissar's rulings on what care you should and should not receive.

It's fascinating for me to watch all these children of the sixties in the Democratic Party, most of whom screamed (rightly) at George Bush continuing to implement new plans where we give up individual liberties for security.  But here come those exact same people, with the exact same message - because this is what health care reform is about, at its core - giving up individual liberties in exchange for a (perceived) increase in security.

The NY Post has a very good editorial on the health care bills (HT:  Q&O).  Too much good stuff to excerpt, it includes even more crazy provisions in the House and Senate bills I had not seen yet (its like a scavenger hunt as people go through the 1000 pages, or maybe more like searching for landmines).

But since the bill doesn't even start taking effect until 2013 (except for the higher taxes, which come earlier, of course), we have to really really rush and make sure its approved before the August recess (and before critics are able to actually read the thing - no chance those in Congress will read it, ever).  Also, its such a burning problem, it just must be solved now, as evidenced by...

The most recent ABC News/Washington Post poll (June 21) finds that 83 percent of Americans are very satisfied or somewhat satisfied with the quality of their health care, and 81 percent are similarly satisfied with their health insurance.

They have good reason to be. If you're diagnosed with cancer, you have a better chance of surviving it in the United States than anywhere else, according to the Concord Five Continent Study. And the World Health Organization ranked the United States No. 1 out of 191 countries for being responsive to patients' needs, including providing timely treatments and a choice of doctors.

I have written a number of times, the fact that we spend more on health care is not a bug, its a feature.  We are the wealthiest nation on earth, and there is only so much we can spend on food, clothing, shelter, plasma TV's and other necessities.  We choose to spend a lot of that extra money on our health and longevity.  Why is that a bad decision?

Not much I even need to add to this, via Riehl World View:

On Tuesday, the Senate health committee voted 12-11 in favor of a two-page amendment courtesy of Republican Tom Coburn that would require all Members and their staffs to enroll in any new government-run health plan. Yet all Democrats -- with the exceptions of acting chairman Chris Dodd, Barbara Mikulski and Ted Kennedy via proxy -- voted nay.

In other words, Sherrod Brown and Sheldon Whitehouse won't themselves join a plan that "will offer benefits that are as good as those available through private insurance plans -- or better," as the Ohio and Rhode Island liberals put it in a recent op-ed. And even a self-described socialist like Vermont's Bernie Sanders, who supports a government-only system, wouldn't sign himself up.

Does anyone else find this reminiscent of Obama's decision to send accept a scholarship for his own education, send his kids to private school in DC, and then, nearly as his first action as President, kill the voucher program that let other African American kids in DC go to private school.

It is often said that one of the "problems" with American health care is that we spend far more on health care as a percent of GDP than other nations.  But why is this necessarily a problem?

The US is the wealthiest nation on Earth, top to bottom.  At every level of society, except perhaps for a few recent immigrants, people in this country are wealthier than their peers in a similar income quintile in another country, even Europe.  So it is not surprising that basic needs, like food and housing, might represent a smaller percentage of GDP here than in other nations.  Despite all the efforts of McDonalds and the Country Buffet to change things, there is only so much food we can consume, only so much living space we need, only so many cars we can drive at one time.

As these basics fall as a percentage of our income, something must gain.  It could be savings, but it could also be other spending where incremental outlays return percieved incremental benefits.  And so, why not health care?  What could possibly be more important than extension of our lives and/or the improvement of the quality of our living?  If we as a nation choose to spend our extra wealth on such things, is this really a bug, or a feature?

Update: Yes, I know, the problem is that we aren't really always able to make this decision as individuals optimizing our own tradeoffs.  We are too often forced to accept someone else's tradeoff.  Unfortunately, this problem is only going to get worse under any plan Congress is currently considering.  Someone else who is not you and doesn't even know you will decide how much a procedure is worth for you.

OK, maybe not all, but there is really one critical issue at the heart of almost all the issues in health care.  It drives whatever cost problems might exist in the system, drives many of the quality problems, and is a source of much of the current dissatisfaction (at least from the middle class) with the current health care system.

For every proposal, you should make sure you understand 1) Who is choosing the amount and quality of the care and 2) who is paying the bills and is therefore trying to pay attention to the cost of care.

What the hell does that have to do with anything, Coyote?  What are you getting at?  Well, perhaps I can begin my explanation by talking about something, practically anything, other than health care.

Take purchasing a car.  When I need a new car, who determines what car I end up with?   Why, I do.  And who pays for the car and shops around for a price that makes sense in the context of the perceived value of the car?  Why, I do again.  The person who uses the car, the person who chooses the type and quality of the car, and the person who pays for the car are all the same person.

This clever procurement model of integrating the payer, the shopper, and the user all into a single individual is one we use for, well, just about every product and service we buy.  Milk, Internet service, DVD's, house painting, airline tickets -- all the same model.

OK, lets consider a model that does not work this way.  Let's say someone just rear-ended your car and, miracle of miracles, they actually have a good, solid insurance policy that owes you for your car repairs.  In this case, you will be consuming the repair services, and have the incentive to find the absolute best, cost-no-object body shop you can find to do the best, most fabulous job fixing your car, because someone else (ie the insurance company) is paying.  The insurance company has a different incentive.  They want to get off with as small a loss as possible, to protect their profitability as well as keeping prices low for future policy-holders.  They are going to want you car fixed cheap, particularly since you are probably not even their customer.  They are going to try to deliver the minimum.

No surprisingly, people tend to get ticked off in these situations, as they grind against the opposing incentives of the insurance company.  It's one reason that the insurance field is highly regulated (because nowadays people complain to their Congressman whenever they get irritated).  It's also a measure of how ineffective regulation is in really managing this friction, since despite zillions of government rules people still get pissed off.  The reason is that there is simply no good solution.   Both parties want a solution at the extreme end of a cost-value scale, neither have much of an incentive to compromise, and neither will be happy with a solution in the middle of these extreme incentives, and no amount of government fiddling with the tradeoff point is going to change this.

OK, but in this example, at the end of the day, it is just a car, and probably this is a once-in-a-lifetime event.  What if we replace "car" with "baby daughter" or "grandmother" or "your life?"  Now, as Bill Murray says, the kidding around is pretty much over.  It is a recipe for an incendiary disaster.  Which is exactly what we have in health care.

If we take these three roles - user, service quality specifyer, and payer/price shopper - there are very few places in medicine today where these three roles are united.  Further, despite the fact that the vast majority of the problems in US health care are demonstrably from this role separation, none of the plans currently being considered by Obama or Congress unify these three parties.

With my high deductible medical policy, I am actually one of the few middle/upper class folks who actually shops for health care.  And I can tell I am in the minority by the reaction I get from doctors and medical services companies, that look at me like I am from Mars when I ask for detailed pricing, or when I order less than the full and complete battery of potential tests and services based on my own judgment and price/value trade offs.  Folks in the medical profession are used to people saying "whatever, the insurance company is paying for it."

We all know the straights that the auto industry is in, but can you imagine how bad their price and product would be if everyone had some sort of policy that purchased just about any car they wanted for them whenever they wanted it?  What do you think would happen to the prices at your grocery store or at BestBuy if the proprietors of those stores knew, absolutely knew, that you were not even going to look at a price tag before you bought what you wanted?  So why do we expect anything but inflated pricing in the health care field?

Devon Harrick via Carpe Diem writes

The market for medical care does not work like other markets. Providers typically do not disclose prices prior to treatment because they do not compete for patients based on price. Payments are usually not made by patients themselves but by third parties "” employers, insurance companies or government (only 12% of medical costs are paid directly by patients, see chart [below]). And the amounts paid are not really market-clearing prices; they are "reimbursement" rates negotiated with bureaucratic institutions and networks. Furthermore, when providers do not compete on price, they usually do not compete on quality either. In fact, in a very real sense, doctors and hospitals are not competing for patients at all "” at least not in the way normal businesses compete in markets.

The author above has an interesting analysis.  The one exception to the separation of roles in medicine is cosmetic surgery.  Not covered except in special circumstances by most insurance, cosmetic surgery is something the individual must pay for and thus has a tendency to shop for.  The results in prices are clear.

This pricing differential is all the more compelling because itis probably opposite what most people would initially assume.  As cosmetic surgery tends to be a luxury good, one might expect it to have the higher-than-average inflation rate that many luxury goods have had over the past 10 years.

The flip side of the pricing situation is the incredible dissatisfaction that seems to permeate health care customers.  Because the users aren't paying the bills, health care providers have little incentive to provide good service, as even with bad service the value they provide will be able to exceed the user's price of zero, or close to zero.

But, like with the body shop in the collision, someone is indeed paying the bills.  And that someone faces a choice -- either let customers run amuck and buy absolutely as much health care as they want, or try to ration or restrain the care users receive in some way.  So, when Joe and Mary want the 9th sonogram performed just to make sure their fetus is still doing great, the insurance balks at the cost as unnecessary.  The insurance company is upset, because they feel like Joe, Mary, and their doctor are milking the insurance for unnecessary procedures.  Joe and Mary get upset, because they feel like the heartless insurance company doesn't care about their little darling baby.  Everyone calls their Congressman to tell him or her that they are unhappy and could the government please intervene to make them happier.

And so we get to current health care proposals.  Folks have, rightly, come to the conclusion that a system where the user benefits from the service and decides how much and of what quality should be consumed, while someone else pays, is not sustainable.  However, in response, no one in power is suggesting we end the split.  Instead, they are suggesting that the role of service determination and payment/price-shopping be performed by the government.  We as a consumer will just have to trust that the government will make this price-value tradeoff somehow close to how we would make it for ourselves.

But of course, this is absolutely freaking impossible.  First and foremost is the problem that the government can only choose one policy for everyone embodying a single point on the trade off curve.  But we have 300 million people with 300 million different preference functions.  No one is going to be happy.  Second, the government is a terrible shopper.  We all know this to be true.  So why do we think they are going to suddenly become wizards when it comes to health care?  Third, the government is a terrible administrator.  As a monopoly provider, they simply don't have the inventive to be either responsive of cost-effective.  Again, we all know this to be true, so why are we so willing to hope that things will suddenly change for health care?

The only thing that makes any sense at all to me is to try to give the user of health care some financial incentive to participate in the price value tradeoff and shopping process.  I know that I have simultaneously saved a ton of money as well as substantially increased my health care shopping IQ since our family adopted a high-deductible health insurance policy.  Incredibly, however, this is one solution that absolutely is off the table -- for example, the first step Massachusetts took in their single payer system was making it illegal for consumers to buy the kind of high-deductible insurance I have.  Illegal!

I suspect many of my readers also read Megan McArdle, but in case you missed her story, its pretty funny (as long as you are not the person experiencing it):

While consuming my one (1) beer, I was apprehended by agents of the
Pennsylvania Liquor Control Board.  They called my parents, fined me,
and made me attend a class on the horrors of underaged drinking (did
you realize that drinking can lead to uncontrollable vomiting?)  It was
during that class, with the errors of my ways now readily apparent,
that I made a pledge to myself to quit underaged drinking with all due
speed.  And on January 29th, 1994, I honored that pledge....

The
problem, you see, is that at the time of my conviction, I did not have
a Commonwealth of Pennsylvania Driver's License.  Indeed, I had no
driver's license at all, being one of those benighted city people who
get their first driver's license at the age of 23.  The laws of the
State of Pennsylvania, however, say that the Department of
Transportation is entitled to suspend the driver's license of anyone
arrested for underaged drinking.  And the Commonwealth of Pennsylvania
Department of Transportation is, apparently, determined to exercise
this privilege.  Thus, the spectacle of a 35 year old woman being
informed that she is about to have her driver's license suspended for
underaged drinking.

To add insult to injury, I am expected to
fill out a form and, at my own expense, mail it to the DOT in order to
commence this suspension.

This would be funny and mildly
annoying if it were not for the fact that until they clear the
suspension, I cannot get a DC driver's license, because states are
required to scan for violations from other states before they issue a
new license.  (No word on how I got one out of the State of New York).
And until I get a DC driver's license, I cannot register the car I just
bought.  The DMV here, after much wrangling, gave me temporary tags,
but it looks like I'm going to have to garage the thing for three
months unless the Commonwealth of Pennsylvania relents.  Which, at this
time, they show no evidence of doing.

The stories keep coming about using health concerns as the thin edge of the fascism wedge.  This time via Hit and Run:

Sheridan Communications and Technology Middle School
eighth-grader Michael Sheridan was suspended from school for three
days, barred from attending an honors student dinner and stripped of
his title of class vice president.

     His offense?

     He bought a bag of Skittles.

The punishment was meted out because the New Haven school
system banned candy sales and fundraisers in 2003 as part of the
districtwide school wellness policy.

In fact, this school has outlawed an financial transactions whatsoever between students:

Turner had repeatedly warned students that she would
not allow any candy to be sold in schools, nor did she want money
changing hands in school, said Sullivan-DeCarlo.

This one comes via a reader, and is from Belgium:

Two sets
of parents in Belgium were recently handed five month prison terms for failing
to vaccinate their children against polio. Each parent was also fined 4,100
euros ($8,000)....

"Nobody
has the right to unfettered liberty, and people do not have a right to endanger
their kids," said John Harris, a professor of bioethics at the
University
of Manchester.

"The
parents in this case do not have any rights they can appeal to. They have
obligations they are not fulfilling."

Next in my series about the health care Trojan Horse for fascism, comes this story via Q&O in Canada  (McQ gives as good a definition of any of the Trojan Horse: "once government has control over your health care, it will use all
sorts of justifications and excuses to exert more and more control over
your life as a result.")

For 60 years or more, libertarians and conservatives have been arguing
that government programs intended to promote the public welfare
inevitably end by restricting freedom more and more: as the state does
more for you, it finds itself doing ever more to you. Who
would dare challenge that premise now, in the face of Judge James
Blacklock's decision? The man made no secret of the chief pretext for
his ruling. Motorcycle riders who don't wear helmets are more costly to the medicare system; therefore, in the name of reducing those costs, the government is free to require the wearing of helmets,
even if that conflicts with a fundamental Charter right and interferes
with the most personal and intimate sort of decision-making conceivable.

I have chided women's groups for the inconsistency of supporting choice and freedom from government coercion when it comes to decisions about their bodies, but at the same time lobbying for universal government health care.  If after my previous posts you still fail to see the inherent contradiction, try this story:

A Winnipeg case currently winding its way to its grim conclusion pits
the children of Samuel Golubchuk against doctors at the Salvation Army
Grace General Hospital. According to the pleadings, Golubchuk's doctors
informed his children that their 84-year-old father is "in the process
of dying" and that they intended to hasten the process by removing his
ventilation, and if that proved insufficient to kill him quickly, to
also remove his feeding tube. In the event that the patient showed
discomfort during these procedures, the chief of the hospital's ICU
unit stated in his affidavit that he would administer morphine.

Golubchuk
is an Orthodox Jew, as are his children. The latter have adamantly
opposed his removal from the ventilator and feeding tube, on the
grounds that Jewish law expressly forbids any action designed to
shorten life, and that if their father could express his wishes, he
would oppose the doctors acting to deliberately terminate his life.

In
response, the director of the ICU informed Golubchuk's children that
neither their father's wishes nor their own are relevant, and he would
do whatever he decided was appropriate. Bill Olson, counsel for the ICU
director, told the Canadian Broadcasting Company that physicians have
the sole right to make decisions about treatment "” even if it goes
against a patient's religious beliefs "” and that "there is no right to
a continuation of treatment."...

The claim of absolute physician discretion to withdraw life-support
advanced by the Canadian doctors would spell the end of any patient
autonomy over end-of-life decisions. So-called living wills, which are
recognized in many American states, and which allow a person to specify
in advance who should make such decisions in the event of their
incapacity, would be rendered nugatory.

I find the discussion of the "duty to die" to save the state money especially chilling.  This story is also in the save vein.

The looming federal government takeover of health care as proposed by most of the major presidential candidates will be far worse than anything we have seen yet from government programs.  Take this example:  In the 1960's, the federal government embarked on massive housing projects for the poor.  In the end, most of these projects became squalid failures.

With the government housing fiasco, only the poor had to live in these awful facilities.  The rest of us had to pay for them, but could continue to live in our own private homes.

Government health care will be different.  Under most of the plans being proposed, we all are going to be forced to participate.  Using the previous analogy, we all are going to have to give up our current homes and go live in government housing, or least the health care equivalent of these projects.

Think I am exaggerating?

One such case was Debbie Hirst's. Her breast cancer had metastasized, and the health service would not provide her with Avastin,
a drug that is widely used in the United States and Europe to keep such
cancers at bay. So, with her oncologist's support, she decided last
year to try to pay the $120,000 cost herself, while continuing with the
rest of her publicly financed treatment.

By December, she had
raised $20,000 and was preparing to sell her house to raise more. But
then the government, which had tacitly allowed such arrangements
before, put its foot down. Mrs. Hirst heard the news from her doctor.
"He looked at me and said: "˜I'm so sorry, Debbie. I've had my wrists
slapped from the people upstairs, and I can no longer offer you that
service,' " Mrs. Hirst said in an interview...

Officials said that allowing Mrs. Hirst and others like her to pay
for extra drugs to supplement government care would violate the
philosophy of the health service by giving richer patients an unfair
advantage over poorer ones.

Patients "cannot, in one episode
of treatment, be treated on the N.H.S. and then allowed, as part of the
same episode and the same treatment, to pay money for more drugs," the
health secretary, Alan Johnson, told Parliament.

Here is the poll question I would still love to see asked:

Would you support a system of
government-run universal health care that guaranteed health care
access for all Americans, but would result in you personally getting
inferior care than you get today in terms of longer wait times, more
limited doctor choices, and with a higher probabilities of the
government denying you certain procedures or medicines you have
access to today.

I was going back through my archives and I found a health care poll question I suggested about a year ago that I would still love to see asked.  I believe it accurately reflects the reality that most middle class Americans face with various universal health care plans:

Would you support a system of
government-run universal health care that guaranteed health care
access for all Americans, but would result in you personally getting
inferior care than you get today in terms of longer wait times, more
limited doctor choices, and with a higher probabilities of the
government denying you certain procedures or medicines you have
access to today.

I have said a number of times that health care is not like failed Great Society housing programs.  In those housing programs, only the poor got crappy government housing -- the rest of us kept what we had.  Universal health care is different, because it will effectively be like forcing everyone to move into the housing projects.

Well, I can't blame this bit of command and control on Mitt Romney, but it is still a great example of politicians doing exactly the opposite of what is needed to making US health care even more convenient and affordable.

In-store health care services offer cheap primary care, ease the
burden on emergency rooms, and help people who can't afford health
insurance"“or who have insurance but can't find a decent primary care
physician. They also boast stratospheric customer satisfaction ratings. 

So why is idiot Boston Mayor Thoma Menino against them?  Because they're driven by profit!

The decision by the state Public Health Council,
"jeopardizes patient safety," Menino said in a written statement.
"Limited service medical clinics run by merchants in for-profit
corporations will seriously compromise quality of care and hygiene.
Allowing retailers to make money off of sick people is wrong."

This is as opposed to doctors in hospitals, who everyone one knows don't make any money off of sick people.  Seriously, who in their right mind could possibly oppose a free market solution to cleaning out these non-life-threatening type cases from hospital emergency rooms?

More on state-run health care as a Trojan horse for fascism, this time from France:

Writing in the left-wing Liberation newspaper, sociologist Henri Pierre
Jeudy suggested the ban marked "the end of an era" for France -- and a
danger for personal freedoms.

"Public health costs are being used to justify an ever more
coercive control over our private lives," he said, with France's yen
for smoky cafes now cast as "an unhealthy mistake".

My other posts on the same topic here.

In about the hundredth post in this series, yet another example of government health care costs being used to micro-regulate even the smallest personal lifestyle decisions:

The city that banned plastic grocery bags and styrofoam take-out
containers has found a new cause: your favorite soft drink. San
Francisco may impose a new fee on those big retail stores that sell
them. The purpose is to curb the obesity problem among kids and adults.
Such fee or tax would be the first in the nation.

 

San Francisco says the obesity problem is costing the city too
much money in health care costs. Studies have linked obesity to
diabetes and heart disease.

"One third of all of our new
on-set diabetics are type 2 because of obesity and this is in children
now," says Robert Lustig, M.D., Endocrinologist, UCSF.

It is perhaps appropriate, given the polls in Iowa, that Mike Huckabee precipitated one of the earliest posts in this series:

Mike Huckabee, the Governor of Arkansas, now
requires annual fat reports. These are sent to the parents of every
single child aged between 5 and 17; a response, he says, to "an
absolutely epidemic issue that we could not ignore" in the 1,139
schools for which he is responsible.

I
just cannot craft any reasonable theory of government where this is the
state's job.   The "obesity" crisis in this country just amazes me.
"Experts" every few years broaden the definition of who is overweight
or obese, and suddenly (surprise!) there are more people defined as
overweight.  Even presuming it is the state's job to optimize our body
weights, is it really the right approach to tell everyone they are too
fat?  Having known several people who were anorexic, including at least
one young woman who died of its complications, is it really a net
benefit to get young people more obsessed with looks and body style?
And what about the kids that are genetically programmed to be
overweight?  Does this mean that years of taunting and bullying by
their peers is not enough, that the state's governor wants to pile on
now?

It is interesting to note that governor Huckabee apparently started
this initiative after his own personal battle with weight loss:

[Huckabee] lost 110lb after being warned that his
weight, more than 280lb after a life of southern fried food, was a
death sentence. A chair even collapsed under him as he was about to
preside over a meeting of state officials in Little Rock.

We
all have friends who have lost weight or gotten into homeopathy or
became a vegan and simply cannot stop trying to convert their friends
now that they see the light.  Now we have the spectacle of elected
officials doing the same thing, but on a broader scale and with the
force of law, rather than  just mere irritation, on their side.  One
can only imagine what report cards kids would be carrying home if
Huckabee had instead had a successful experience with penis
enlargement.  What's next, negative reports for kids with bad acne?
For women whose breasts are too small?  For kids who are unattractive?

Update: I see Q&O posts on the same issue