Coyote Blog

From my daily email from the Goldwater Institute:

In only five years, the Arizona Health Care Cost Containment System budget is slated to more than double.

When double-speak government agency names meet reality!

I remember in about 1978 going on a bus tour into East Berlin through checkpoint Charlie.  It is hard to describe to my kids what a creepy experience this was.  The state-run tour was clearly run by the propaganda ministry, and they really pulled out all the stops to convince you that life was great in the East.  The interesting part is that all this propaganda failed miserably.  No matter what streets they took you down, you couldn't help but notice the stark contrast in prosperity between East and West.  East Berlin was full of buildings in 1978 that still had not been rebuilt from WWII bomb damage  (this actually might have been a plus, since much of West Berlin was rebuilt in that hideous 50's European public architecture).

The most amazing statement was when the tour guide bragged, "And over 70% of everyone in the city has running water."  It was just so clueless and pathetic, to be so out of touch that what Westerners considered a statistic indicating poverty was hailed as one they thought indicated wealth.

I was reminded of this story when I read the British NHS response to an article that over 70,000 Britons a year travel abroad for health care.  Their response was:

A Department of Health official said the number of patients seeking
treatment abroad was a tiny fraction of the 13 million treated on the
NHS each year.

Waiting times had fallen. Almost half of patients
were treated within 18 weeks of seeing a GP. Most people who had
hospital care did not contract infections.

I had exactly the same response as I did to the East Berlin tour guide.  Half within 18 weeks?!  That's PATHETIC.  Again, what we Americans know to be awful service is being bragged about as a sign of excellence. 

The really creepy part, though, is that America is the last place on Earth that people understand that a medical system can do much better than 18 weeks.  But we are likely to elect a President in the next election whose goal is to bring our system down to the level of the rest of the world.  Unfortunately, someday our grandkids may not know any better.

I have argued on numerous occasions that government-funded health care is a Trojan Horse for detailed regulation of how we treat our bodies.  The Economist Blog has a great post on this topic:

Why exactly is obesity a public health issue? Well, when,
by force of law, you externalise responsibility for providing a good,
such as health care, then the effects of all individual choices that
affect the cost of providing that good for the individual are thereby
transformed from internal to external effects. If you, like
Mr Dubois, are in the grip of the blithe assumption that reducing
negative externalities by raising the cost of the behaviour that causes
them is simply what government does, then obviously my gluttony and sloth are public problems. Because public policy made them public problems! So, obviously,
it's up to the government to fiddle with prices to manipulate our
behavior in order to minimise its impact on the tax-financed national
budget.

This sort of thing drives me crazy because it's just so
thoughtlessly arbitrary -- intellectual empty calories. Why
specifically a tax on junk food? Yes, one
of the causes of obesity is "the consumption of too many calories."
Another is the failure to burn the calories one consumes. So why not
levy huge fines on people for not showing up at "voluntary"
government-funded yogalates classes? Or if people are consuming too
many calories, then just put a tax on calories. Why tax some calories
but not others? You can get fat eating steak, too. Maybe a national
"cap and trade" system of calorie credits would do the trick. Hey, do
you know who's healthy? Mormons are. Maybe the government should
provide giant tax credits for being Mormon. Or perhaps it would be
easier if the national health care system could just deny services for
ailments it judged to be obesity-related.  You could even decide not to
have a national health care system at all and allow insurance premiums to reflect the actuarial risk of individual behavior! But that would be crazy. 

Hat tip to TJIC, who has more.  I think this would be a great anti-universal-coverage T-shirt:

Ironically, this shirt is produced by the National Organization of Women, who are strong government health care supporters.  Go figure.

From the New York Post via Carpe Diem and TJIC:

For
seven hours a day, five days a week, hundreds of Department of
Education employees - who've been accused of wrongdoing ranging from
buying a plant for a school against the principal's wishes to
inappropriately touching a student - do absolutely no work.

The
Post has learned that the number of salaried teachers sitting idly
waiting for their cases to be heard has exploded to 757 this year -
more than twice the number just two years ago - at a cost of about $40
million a year, based on the median teacher salary.

The city pays millions more for substitute teachers and employees to replace them and to lease rubber-room space.

Meanwhile,
the 757 - paid from $42,500 to $93,400 a year - bring in lounge chairs
to recline, talk on their cellphones and watch movies on portable DVD
players, according to interviews with more than 50 employees.

For a while, I have been trying to highlight that the real problem with health care is that consumers who receive the service do not have any incentive to shop for the best price or to make trade offs on marginal procedures based on price.  The only people who have any incentive to shop are 1) people without insurance and 2) people with high deductibles (like me).  Politicians are trying to eliminate the former group, even if they don't want insurance, and programs like Romney's in Massachusetts actually ban high deductible insurance.

Now, Obama is worried about anti-trust:

The consequences of lax enforcement for consumers are clear. Take
health care, for example. There have been over 400 health care mergers
in the last 10 years. The American Medical Association reports that 95%
of insurance markets in the United States are now highly concentrated
and the number of insurers has fallen by just under 20% since 2000.
These changes were supposed to make the industry more efficient, but
instead premiums have skyrocketed, increasing over 87 percent over the
past six years. As president, I will direct my administration to
reinvigorate antitrust enforcement. It will step up review of merger
activity and take effective action to stop or restructure those mergers
that are likely to harm consumer welfare, while quickly clearing those
that do not.

How can these mergers harm consumers when consumers don't shop for the service and don't care about price in the first place?  Candidates like Obama and Clinton are threatening to create single payer systems that use monopsony power combined presumably with the coercive power of government to hammer suppliers.  Is it any wonder that they are joining together to try to gain some sort of bargaining position for themselves?  In the context of what Obama wants to do with health care buying, this can be thought of more as unionizing than merging.

By the way, does anyone else note the irony of Obama, who wants to create a single supplier for health care (the US Government) lamenting concentration in the health care field?

Reader Robert Hammond, who always sends me good stuff, pointed out this article from the Evening Standard about proposed new health care rules in England.  Frequent readers will know that I have long argued that nationalized or single-payer health care is a Trojan Horse for fascism (and much more here) in the form of micro-management of individual decisions.  If your personal choices that in the past only put yourself at risk now cost other taxpayers money, then those other taxpayers are going to try to redirect your choices.

Failing to follow a healthy lifestyle could lead to free NHS treatment being denied under the Tory plans. 

Patients would be handed "NHS Health Miles Cards" allowing them to earn
reward points for losing weight, giving up smoking, receiving
immunisations or attending regular health screenings.

Like a
supermarket loyalty card, the points could be redeemed as discounts on
gym membership and fresh fruit and vegetables, or even give priority
for other public services - such as jumping the queue for council
housing.

But heavy smokers, the obese and binge drinkers who
were a drain on the NHS could be denied some routine treatments such as
hip replacements until they cleaned up their act.

Those who
abused the system - by calling an ambulance when a trip to the GP would
be sufficient, or telephoning out of hours with needless queries -
could also be penalised.

The report calls for a greater
emphasis on the "citizen's responsibility" to be healthy and says no
one should expect taxpayers to fund their unhealthy lifestyles.

Here is the real problem:  This is absolutely logical.  There is nothing at all incorrect about the last statement for example.  This is not an abuse or an excess.  This is a completely predictable result of single-payer health care.  Any single-payer is going to have these incentives, but when the single-payer is the government, they not only have the incentives but the full coercive power to do something about it.  I am exhausted with the statist defense against such outcomes that "well, its just the particular individuals in charge -- if we could get the right guys in there, it would work great."  No.  The right guys are never in there, despite technocrats' big dreams, in part because the incentives in place turn even the right guys into the wrong guys. 

One of the reasons we spend so much on health care today is because most of us can do so without any personal financial cost.  Few of us (I am an exception, with a very high deductible policy) actually have to make cost-benefit trade offs in each of our health care purchases like we do in contrast for ... absolutely everything else we buy except health care.   The results are predictable.  We get pissed off when our insurance company denies coverage on some procedure or cost, we is part of the base-level of discontent that health care "reformers" draw on.  But it is stunning to me that people who have discontent with their current insurer feel like things will be better with the government!

Hey, this sounds like a women's issue!

What this article really shows is that by going with a single-payer government system, each of us would be ceding the decisions about our health care, our bodies, and even lifestyle to the government.  So surely women's groups, who were at the forefront of fighting against government intrusion into our decisions about our bodies, is out there leading the fight against government health care.  WRONG!  Their privacy arguments stand out today as sham libertarian arguments that applied only narrowly to abortion.  It's clear that as long as they can get full access to abortion, women's groups are A-OK with government intrusion into people's decisions about their bodies.

So please, dedicated feminists are urged to comment.  How do I relate this T-shirt from the NOW web store:

With this button from the NOW home page:

And a bit of text from their site:

People need and deserve universal, continuous,
and accessible health coverage that is provided by a single payer and
does not require full-time employment and a beneficent employer.
Learn more with our action toolkit....

With the recent release of Michael Moore's new movie, "SiCKO", and the
introduction in Congress of a bill to provide health insurance to all
U.S. residents, the movement for universal single-payer health
insurance is gaining momentum. This toolkit is provided to help you
take action on this important issue....

Health care is a right, not a privilege.

I am always absolutely amazed when advocates of some form of national or single-payer health care argue that such a system would be more efficient.  For example, Kevin Drum argued:

A few days ago, during an email exchange with a
friend, I mentioned that I don't usually tout cost savings as a big
argument in favor of universal healthcare. It's true that a national
healthcare plan would almost certainly save money compared to our
current Rube Goldberg system, but I suspect the savings would be
modest. Rather, the real advantages of national healthcare are related
to things like access (getting everyone covered), efficiency (cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies), choice
(allowing people to choose and keep a family doctor instead of being
jerked around everytime their employer decides to switch health
providers), and social justice (providing decent, hassle-free healthcare for the poor).

I don't think any of these are true.  For example, let's take access.  Yes, everyone in a universal health care system would have a piece of paper that says they have health care, and the left seems really focused on that piece of paper.  But that paper has about as much value as my piece of paper that says I own a hundred shares of Enron.  Because someone has to redeem that piece of paper and actually provide the care, and there is the rub, is it not?  Canadian David Gratzer writes (vis Q&O):

My book's thesis was simple: to contain rising
costs, government-run health-care systems invariably restrict the
health-care supply. Thus, at a time when Canada's population was aging
and needed more care, not less, cost-crunching bureaucrats had reduced
the size of medical school classes, shuttered hospitals, and capped
physician fees, resulting in hundreds of thousands of patients waiting
for needed treatment"”patients who suffered and, in some cases, died
from the delays....

Nor were the problems I identified unique to
Canada"”they characterized all government-run health-care systems.
Consider the recent British controversy over a cancer patient who tried
to get an appointment with a specialist, only to have it canceled"”48
times. More than 1 million Britons must wait for some type of care,
with 200,000 in line for longer than six months. A while back, I toured
a public hospital in Washington, D.C., with Tim Evans, a senior fellow
at the Centre for the New Europe. The hospital was dark and dingy, but
Evans observed that it was cleaner than anything in his native England.
In France, the supply of doctors is so limited that during an August
2003 heat wave"”when many doctors were on vacation and hospitals were
stretched beyond capacity"”15,000 elderly citizens died. Across Europe,
state-of-the-art drugs aren't available. And so on.

I had forgotten about the heat wave.  Could you imagine backwards old America having 15,000 people die when the temperature got into the 90's?

As to efficiency, which Drum defines as "cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies," does anyone really ascribe these characteristics to the government?  Really?  Even European health care bureaucrats would not agree with this statement:

This privatizing trend is reaching Europe, too.
Britain's government-run health care dates back to the 1940s. Yet the
Labour Party"”which originally created the National Health Service and
used to bristle at the suggestion of private medicine, dismissing it as
"Americanization""”now openly favors privatization. Sir William Wells, a
senior British health official, recently said: "The big trouble with a
state monopoly is that it builds in massive inefficiencies and
inward-looking culture."

I won't get much into the last two, except to say that we actually have a ton of health care choice in the US today, far more than any other country.  And even if we did not, what does doctor choice mean if the best people are driven away from being doctors, as they are in socialized medicine.  And social justice?  Well, the poor get care in the US, the key is the "hassle-free" in his statement.  Would you immediately assume that a government-run service is going to involve less hassle than a private service?  Have you renewed your drivers license lately?  It may well be that the poorest 10% have such an awful health care experience that they will see things better.  But almost assuredly the other 90% are going to be worse off.

Remember this -- Universal health care is NOT a system in which the majority of us who are satisfied with our care can keep our current system, while the poor get a better one.  It is a system where all of us are thrown out of our current system and given the same care the poor get.  It is roughly equivalent to a Great Society housing program in which not just the homeless get housing, but everyone in the country are forced to give up their current house and live in public housing.

Postscript:  There is great improvement to be had in the health care system.  It revolves, though, around making the payer for health care the same person who receives the service, as it is for every other product and service we buy in this country.  We already have too much single-payer.  We need multi-payer.  I won't go there today, but I explained here.

Another Thought: A huge pillar of the women's movement was that the government should not make decisions for a woman and her body (e.g. by banning abortion).   All well and good.  But I have never understood how this was consistent with support, say, for the FDA, which tells women exactly what they can and can't put in their body.  And now women's groups are all for universal health care, where government will make all the medical decisions about what procedures one can and can't have, and when.  Consistency please?

As I wrote in a previous post, state-run health care tends to act as a Trojan Horse for increased government micro-management of our lives by giving the government a financial interest in our health and risk-related decision-making.  A reader sends along this article demonstrating this effect yet again:

An attempt to revive famous TV adverts
from the 1950s that encouraged people to "Go To Work On An Egg"
have been blocked by regulators on health grounds.

The British Egg Information Service (BEIS) had wanted to
bring back the adverts featuring comedian Tony Hancock to mark
the 50th anniversary of the British Lion mark.

But the Broadcasting Advertising Clearance Centre (BACC)
said the famous commercials could not be repeated because
eating eggs every day went against the policy of encouraging
people to eat a varied diet.

"The concept of eating eggs every day for breakfast goes
against what is now the generally accepted advice of a varied
diet and we therefore could not approve the ads for broadcast,"
a BACC spokesman told the BBC.

PS-  Readers who send me stuff - let me know if I can use your name when you email me the post.  When I sit down to blog in short bursts, I am happy to give specific credit but I am always unsure whether to use your real names or not.

For quite a while, I have been arguing that universal health care is a Trojan horse for freedom-robbing government interventions into our personal habits (and micro-habits).  Suddenly activities that used to be personal choices that affected only ourselves (e.g. unhealthy diet) become public interest questions affecting government-funded health care costs.

Jonah Goldberg, via Ronald Bailey, seems to agree:

The British government recently unveiled
plans for a massive crackdown on "excessive drinking," particularly
among the middle class. It will include all of the familiar tactics of
public health officials: dire new warnings on wine bottles,
public-awareness campaigns, scolding from men and women in lab coats...

Britain
still subscribes to a system where health care is for the most part
socialized. When the bureaucrat-priesthood of the National Health
Service decides that a certain behavior is unacceptable, the
consequences potentially involve more than scolding. For example, in
2005, Britain's health service started refusing certain surgeries for
fat people. An official behind the decision conceded that one of the
considerations was cost. Fat people would benefit from the surgery
less, and so they deserved it less. As Tony Harrison, a British
health-care expert, explained to the Toronto Sun at the time, "Rationing is a reality when funding is limited."

But
it's impossible to distinguish such cost-cutting judgments from moral
ones. The reasoning is obvious: Fat people, smokers and "” soon "”
drinkers deserve less health care because they bring their problems on
themselves. In short, they deserve it. This is a perfectly logical
perspective, and if I were in charge of everybody's health care, I
would probably resort to similar logic.

But I'm not in charge
of everybody's health care. Nor should anyone else be. In a free-market
system, bad behavior will still have high costs personally and
financially, but those costs are more likely to borne by you and you
alone. The more you socialize the costs of personal liberty, the more
license you give others to regulate it.

Universal health care,
once again all the rage in the United States, is an invitation for
scolds to become nannies. I think many Brits understand this all too
well, which is one reason why they want to fight the scolds here and
now.

I like his term "socializing the costs of personal liberty."  Its a good description of much of what is wrong with government today.

While it may have been unintentional, a quote in New York magazine helps make the point I have been trying to make about universal health care (HT: John Scalzi)

"With universal [health care], you'd get the same kind of
mediocre shittiness that you'd get in all other kinds of standardized
approaches. But for millions of people, that would be a big upgrade."

Americans are unbelievably charitable people, to the extent that they will put up with a lot of taxation and even losses of freedoms through government coercion to help people out.

However, in nearly every other case of government-coerced charity, the main effect is "just" an increase in taxes.  Lyndon Johnson wants to embark on a futile attempt to try to provide public housing to the poor?  Our taxes go up, a lot of really bad housing is built, but at least my housing did not get any worse.  Ditto food programs -- the poor might get some moldy cheese from a warehouse, but my food did not get worse.  Ditto welfare.  Ditto social security, unemployment insurance,and work programs. 

But health care is different.  The author above is probably correct that some crappy level of terribly run state health care will probably be an improvement for some of the poor.  But what is different about many of the health care proposals on the table is that everyone, not just the poor will get this same crappy level of treatment.  It would be like a public housing program where everyone's house is torn down and every single person must move into public housing.  That is universal state-run health care.  Ten percent of America gets pulled up, 90% of America gets pulled down, possibly way down. 

I don't think most Americans really know what they are signing up for.  Which is why it is so important for health care socialists to have people like Michael Moore running around trying to convince the middle class they will be getting better health care.  Because there is almost no possibility of this being true, and health care proposals will never pass if people realize it.

More here.

I missed this article the first time around, but Arnold Kling makes a point that I have been trying to make coherently for a long time:  The biggest problem in health care is not under-insurance or efficiency or drug company profits.  The biggest problem is the insulation of the consumer from health care prices.

For health care providers, insulation is a bonanza. Because
consumers are not spending their own money, they accept doctors'
recommendations for services without questioning them and without
concern for cost. Faced with an insured patient, a health care provider
is like a restaurant catering to convention-goers with unlimited
expense accounts. The customer will gladly take the most high-end
recommendation and not worry about the price.

Consumers are
happy as well. Insulation relieves the patient of the stress of making
decisions about treatment. The patient also does not have to worry
about shopping around for the best price.

The problem with
insulation is that it is not a sustainable form of health care finance.
Individuals, employers, and government are all under stress.

Health care plans on the table basically put decision making for a) making price comparisons and b) deciding if a given procedure is worth the price -- in one of two people's hands:

• The individual being cared for or
• The government

That's it.  Its one or the other.  The current system of "nobody" is not sustainable.  To the extent that people have grief about their employer or their insurer, it is usually because the insurer is trying to make these decisions (someone has to) and the individual is resentful that the insurer is not making decisions the way the individual might like.  In this context, it is nuts that many people see the solution not as "let individuals take over this decision" but as "let the government do it."  I'm sure that will turn out well.

By the way, I have been with a high deductible policy for a while now, and the medical care shopping process is a real eye-opener.  I really highly recommend it -- not only am I managing the costs but I am learning more about the care itself.  For those of you who don't want to price compare,  Michael Cannon of Cato makes the very good point that everyone does not have to price shop - only a few people need to for all of us to get the benefit.  I never even look at the price of toilet paper, but I know it is probably a good price because there are folks out there who DO compare.

From Kevin Drum, who I consider one of the smarter folks on the left (but not this time):

A few days ago, during an email exchange with a
friend, I mentioned that I don't usually tout cost savings as a big
argument in favor of universal healthcare. It's true that a national
healthcare plan would almost certainly save money compared to our
current Rube Goldberg system, but I suspect the savings would be
modest. Rather, the real advantages of national healthcare are related
to things like access (getting everyone covered), efficiency (cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies), choice
(allowing people to choose and keep a family doctor instead of being
jerked around everytime their employer decides to switch health
providers), and social justice (providing decent, hassle-free healthcare for the poor).

Name one industry the government has taken over in a monopolistic fashion and subsequently increased efficiency or individual choice?  Anyone?  Buehler?  In fact, I am not sure I can name one government program that even provides the poor with decent, hassle-free services. 

Lets take the most ubiquitous government monopoly, that on K-12 education. 

• Efficiency?  My kid's for-profit secular private school has a administrator to student ratio of at least 1:15.  How many assistant principals does your public school have?  Many public schools are approaching 1 administrator for every 1 teacher.
• Choice?  That's a laugh.  The government and its unions fight choice in education tooth and nail.  In fact, in the context of education, Drum and others have effectively argued that choice is the enemy of his last point, social justice, so it is absurd to argue that government monopolistic health care will optimize both.  Yes, people may be frustrated their insurance company does not cover X procedure, but this will only get worse when the government is making the choices for us.  Oh, and by the way, about the evils of those employers running our health plans?  They do so only because of WWII wage controls and decades of federal tax policy that have provided them strong incentive to do so. 
• Decent, hassle-free service?  Ask a concerned black family in an inner-city school how good their kid's government-provided education is.  In fact, I will bet that most inner city parents get healthcare of better quality today despite the admittedly Rube Goldberg system we have (courtesy of years of silly government interventions) than the quality of education they receive from the government education monopoly.  After all, most of them walk out of the hospital today with their life, while many of their kids are walking out of worthless government schools with no life.

As to the claim that national health care would "almost certainly save money," that is hard to argue with for this reason:  The government, once in charge of health care choices, can simply start denying procedures and care ("rationing").  This is in fact how costs are managed in most socialist medical systems.  So while this statement is technically true, it would be very hard for anyone to really believe that for the same quality and quantity of care, the government could do it cheaper.

The best answer, of course, as to why single-payer is bad is that the single-payer will not be me, and therefore will not make trade offs about my health, money, time, etc. in the same way I would.  One of the many problems with polling on issues like this is that someone asks a question like "Are you satisfied with your health care" and when XX% of people say "no", the person using the poll goes on to postulate that the people are dissatisfied for Y reason.  But people may be dissatisfied for many reasons.  For example, I know that many people's main source of dissatisfaction is that their current insurance company was callous in rejecting them for so-and-so procedure.  But do they really think the government is going to be less callous?

Unfortunately, this best answer does not seem to be getting anywhere, so I will offer another answer.  Single payer health care will almost certainly lead over time to single provider health care.  What is my evidence?  Well, that is what happened in K-12 education.  And note the very very strong opposition to migrating education from single-provider to single-payer by the exact same people who are the intellectual driving force for some kind of massive new federal intervention in health care.  Kevin Drum and Matthew Yglesias both argue that single payer is inherently unfair.  So get ready, Walter Reed and the Post Office may soon be teaming up to provide your medical care. 

I was sitting here today, and was trying to discern why the government-run health care issue made me more nervous than other government welfare programs.  I get ticked off, for example, about the horrendous rates of return (think negative interest rates) paid out by Social Security on what are nominally our retirement account premiums.  But I don't get nervous.  Why?

I think because unlike other welfare proposals that [just] cost us a ridiculous amount of money, the current plans for providing universal health care imply that my personal health care and health care options will get much worse.  When government provided housing, my housing did not get worse.  When government provided a ripoff retirement plan, my personal non-government retirement savings did not take a hit.  In all these cases, we paid out tons of money to provide some terrible base-level services for the poor and the true-government-believers in the middle class, but my options did not get worse.

However, in the case of health care, most proposals on the table will very likely result not only in much higher taxes, but also in my personal health care options getting worse.  The government will not want to provide multiple levels of service, and can't afford anything beyond "crappy", so as a result we will all end up with crappy service (Insert Rush song "trees" here).  A lot of crap is written about how great all these other socialized medicine services are, but thousands of people travel from other countries to have medical procedures in the states, and about zero travel the other way.  More on the topic of closing coverage gaps at the price of making your own personal care worse here.  More on why these gaps are not as large as advertised here.

Update:  Quick proof -- My chosen health plan is now illegal in Massachussetts

Can you imagine any other product or service you buy for which you would have to sign this release, which was part of my health insurance application (emphasis added):

You understand and agree that you are applying for individual health
insurance for you (and your family).  You further understand that this
application for health insurance will be fully medically underwritten
and that coverage is not guaranteed. You are personally paying the
entire premium for this health insurance coverage.  Your employer is
not contributing in any way to the payment of premium, either directly
or indirectly.

Do you agree with these statements?

You mean my company is not paying for my new Taurus?

Every time I write that government funded health care and health nannyism are becoming a Trojan horse for fascism, I get several emails telling me I am being a paranoid flake.  So I will have to just keep posting this kind of thing (from England), via Overlawyered:

SOCIAL workers are placing obese children on the child protection
register alongside victims thought to be at risk of sexual or physical
abuse.

In extreme cases children have been placed in foster care because
their parents have contributed to the health problems of their
offspring by failing to respond to medical advice.

The
intervention of social services in what was previously regarded as a
private matter is likely to raise concerns about the emergence of the
"fat police".

Some doctors even advocate taking legal action against parents for
illtreating their children by feeding them so much that they develop
health problems.

Dr Russell Viner, a consultant paediatrician at Great Ormond Street
and University College London hospitals, said: "In my practice, I can
think of about 10 or 15 cases in which child protection action has been
taken because of obesity. We now constantly get letters from social
workers about child protection due to childhood obesity."

Frequent readers will now that I have long warned of government-funded health care acting as a Trojan horse for micro-management of our personal lives, the logic being that if our lifestyles or behaviors make us less healthy, then the government that funds medical care may claim an interest in regulating those behaviors.  I often post examples of this phenomena, the most recent of which is here.

This installment comes via Reason, and looks at the NYC Health Commissioner Thomas Friedan's new fascism to prevent diabetes program.  I am not sure I even need to comment on the following for you to get the picture:

New York City is at the forefront of this new public health movement. In
January, city health officials began
requiring
that medical testing labs report the results of blood sugar tests for all
the city's diabetics directly to the health department. This is first time
that any government has begun tracking people who have a chronic disease.
The New York City Department of Health will analyze the data to identify
those patients who are not adequately controlling their diabetes. They will
then receive letters or phone calls urging them to be more vigilant about
their medications, have more frequent checkups, or change their diet....

So what could be wrong with merely monitoring and reminding people to take
better care of themselves?  New York City Health Commissioner Thomas Friedan
has made it clear that it won't necessarily end there. If nagging is not
sufficient to reduce the health consequences of the disease, other steps
will be taken. Friedan
argues
that "modifications of the physical environment to promote physical
activity, or of the food environment to address obesity, are essential for
chronic disease prevention and control." Friedan envisions regulations for
chronic disease control including "local requirements on food pricing,
advertising, content, and labeling; regulations to facilitate physical
activity, including point-of-service reminders at elevators and safe,
accessible stairwells; tobacco and alcohol taxation and advertising and
sales restrictions; and regulations to ensure a minimal level of clinical
preventive services."

The NYC health department starred in a previous post for their brave attack on restaurants that give patrons too much for their money.

For about a year now, I have been arguing that public funding of health care will be used as a Trojan Horse to introduce a near fascist micro-regulation of our lives.  I argue that if the government is funding health care, then they will claim a financial stake in your health, and begin regulating everything from your food intake to your exercise habits, even your risk choices (e.g. snowboarding).  I made this argument here and here, among other places.  The general reaction has been, "gee Coyote, nice theoretical argument but you can put your tinfoil hat away now.  You are being paranoid."

Well, check this out:    (via Reason)

Another doctor who examined the journal report was Dr. Brian
McCrindle, a childhood obesity expert and professor of pediatrics with
a pediatric hospital in Toronto.

He warned that the looming problem must be addressed.

"The wave of heart disease and stroke could totally swamp the public health care system," he said.

He warned that lawmakers had to take a broader view of the looming
problem "” and consider doing things such as banning trans fats and
legislating against direct advertising of junk food toward children.

"It's not going to be enough any more just to say to the consumer 'You have to change your behavior,'" he said.

Notice that he left the second half of his last sentence unsaid.  That second half is "the government is going to have to force them."  Of course, none of this is an issue if we all have personal responsibility for our own health care costs and therefore for the consequences of our own decisions.

Postscript:  By the way, for anyone older than 30 who grew up in the sixties and seventies when all the intelligentsia were painting pictures of Malthusian starvation nightmares, this is GOOD news:

The percentages of overweight children also are expected to increase
significantly in the Middle East and Southeast Asia. Mexico, Chile,
Brazil and Egypt have rates comparable to fully industrialized nations,
James said.

He estimated that, for example, one in five children in China will be overweight by 2010.

The reason for this is not because of some evil corporate conspiracy (though that's what the article attributes it to) but due to the fact that these kids are simply not starving to death any more.  I am absolutely sure that the public health "crisis" from these overweight kids is less of a problem than the public health crisis of 30 years ago, when they were all malnourished and dying of being, well, severely underweight.  I mean, are there any of you out there in the over 40 crowd who didn't get the "there are starving kids in China" guilt trip growing up when you didn't eat your dinner?

As a follow-up to this post, I wanted to take on the argument that people use against the US's health care system, arguing that it must be worse than other countries socialized approach because it costs so much more.  Well, I am the first to agree that reduced regulation and a better matching of who is paying the cash to who is receiving the services would result in huge cost savings.  However, it may also be true that you get what you pay for, as discussed in Cafe Hayek.  The key chart is shown below:

One thing I forgot to mention in the previous post was a bit of background of exactly why we have a model where health care is payed for by the employer.  This structure of company-paid health care was not a natural market evolution, but was in fact a direct result of several very distorting government regulations.

Company funded health care plans began in the 1930's and 1940's as a way for companies to try to get around government controls and freezes on wage rates, first instituted with the NRA and later during WWII.  In particular, during the incredibly tight domestic labor markets in WWII, employers struggled with government-mandated wage controls, and used the promise of employer-paid health care as a way to provide higher effective compensation to attract employees, since these non-cash benefits were not counted in the wage freeze calculation.  After the war, the government locked in this practice when the IRS and Congress agreed that company-paid health care was not taxable as regular income, meaning that such health plans were given a strong tax-preference over cash wages.

Finally, if you are not familiar with the appalling experiment in fascism that was the NRA, I wrote about it here.

Daniel Weintraub has a nice take on our health care system in a post recently in the Sacramento Bee.

Imagine for a moment that your employer was required by law to buy a
plan to manage your nutrition needs - rather than simply paying you a
wage, out of which you buy the food you want to eat.

Or suppose the government required your employer to pay for a housing
plan, rather than paying you and letting you decide where and how to
live.

Finally, consider what it would be like if the company you work for was
mandated to design and finance a transportation plan for you, with a
list of options for how you could get to work and back home each day.

Each of these scenarios brings a few things to mind.

First, you'd probably get paid a lot less than you do today, because
your employer would be diverting much of your current wages to pay for
these plans instead.

Second, you would have less choice than you do now, because your
employer would have to standardize these food, housing and
transportation plans to fit the needs of many workers.

Third, the service you would get from your local grocery store,
landlord or automobile dealer would probably be worse, since your
relationship with each of them would now be muddled through the entry
of a third party, your employer. Your local grocer would have a greater
incentive to try to satisfy his real customer - your boss, or worse,
the food management company your boss chose - than to serve your needs.

Fourth, the costs of each of these goods would tend to rise over time -
especially if you and your fellow employees were able to eat as much as
you liked, or live in any size house or drive as far as you wanted
within the choices provided. While large employers might be able to use
their superior bargaining power to drive down costs a bit, their power
in the marketplace would be outweighed by the increased cost of
providing food, housing and transportation in quantities unlimited by
the discipline that comes when a consumer pays for something
out-of-pocket.

Finally, as the costs did start to rise, you would feel less secure
about where your next meal was coming from, or whether you'd have a
place to live tomorrow or a car to drive to work. With the management
of these essential items in the hands of a third party, you'd feel
vulnerable, worried about whether they might cut back on your choices
or on the quality of the offerings in order to save money.

Beyond these arguments, there is the threat of using publicly funded health care as a Trojan Horse for complete government micromanagement of our lives.

Welcome to the Carnival of the Capitalists and my second time hosting the COTC.  Note that several people tried to submit multiple posts - when that happened, I picked just one to include this week.

Many thanks to Silflay Hraka for starting the Carnival of the Vanities, of which this is a spin-off, to showcase smaller blogs to a wider readership.  Look for future Carnivals of the Capitalists at these sites (you can submit articles here):

December 26, 2005      Multiple Mentality   

January 2, 2006      Chocolate and Gold Coins   

January 9, 2006      The Social Customer Manifesto   

January 16, 2006      Wordlab   

January 23, 2006      Patent Baristas   

January 30, 2006      PHOSITA   

While you're here, feel free to look around -- this post will tell you more about what I do at Coyote Blog.

In what has now become a tradition of my hosting the COTC, and, in true capitalist fashion, I have taken on a sponsor for this week's Carnival:

This Carnival of the Capitalists is Proudly Sponsored by"¦ ACME Maker of fine anvils for over 50 years

Government Spending and Regulation

Here at Coyote Blog, I have been warning for years that government-funded health care is a Trojan horse for more regulation of your personal life.  I hate it when I am right.

Porkopolis,
a blog highlighting the insanities of pork barrel spending, offers an
out-of-the-box alternative to rebuilding New Orleans at government
expense.

BardsEyeView takes a look at the Federal Budget through the lens of Shakespeare.  Really.

Joshua Sharf at A View from a Height looks at government price and supply regulation of taxis, and wonders what's the point.

Taxes

Jeff Cornwall at the Entrepreneurial Mind gives us the happy news that 2006 will bring us more IRS audits and more people paying the AMT.

Property Rights

Multiple Mentality asks why a man in Atlanta was handcuffed and arrested for selling his own property.

This Carnival of the Capitalists is Proudly Sponsored by"¦ ACME Escalating crises since 1952

Blogging and the Internet

Kicking over My Traces observes that robot blogs are clogging up Technorati, and that Google blog search does a better job of weeding these out

Wayne Hurlbert of Blog Business World is, not surprisingly given his blog's name, bullish on professional blogging and business blogs.

Similarly, ProHipHop is bullish on the business of podcasting.

Barry Welford
brings us a fable to illustrate that InternetLand or cyberspace can be
as complex and confusing to executives as Wonderland was to Alice

The China Stock Blog has the 12 hottest search term keywords in China.   Not sure the Coyote is doing well on any of these...

Gaurav Agarwal's Blog
observes that while computers have penetrated the developed world,
mobile phones have been much more popular in the develop ping world.

Marketing and Growth

Elisa Camahort in Worker Bees Blog reinforces the idea, via two customer service tales, that a bad customer experience can last a lifetime.

Fire Someone Today goes after the difference between "small business owner" and "entrepreneur", and posits that every self-described small business owner who is not focused on growth is probably a hobbyist, a slave, or an impending failure

Jim Logan advises aiming customer communications at the customers, not at grammatical nitpickers.

This Carnival of the Capitalists is Proudly Sponsored by"¦ ACME The secret to Glenn Reynolds success

Business Opportunities

Jane's Fit by Five enjoys getting her first "press" credential and reviews the Fortune Innovation Forum

Anita Campbell at Small Business Trends is doing her annual trends series, and spoke by phone with noted futurist Watts Wacker who gave his forecast
of trends we can expect to see in 2006, along with a bit of advice
about how to interpret and use trends.

Starling David Hunter investigates the success of the $15 apple in Japan, and draws some broader conclusions about the nature of business opportunity.

Barry Ritholtz observes in the Big Picture that the film industry has been much savvier in responding to market and technology changes than has the music industry.

Personal Finance

My Money Blog deconstructs Ameriprise Financial and finds their hiring criteria and training seem to support his concerns about the company (Lots of interesting comments to the post as well with further information)

All Things Financial has a positive review of Lee Eisenburg's book "The Number", which discusses the dollar figure you need to have set aside to retire the way you want to retire.

Free Money Finance lists 10 questions you should be asking about your retirement

Why Homeschool discusses the importance of early economics training for your kids, and some approaches for teaching them outside of the classroom.

Searchlight Crusade responds to privacy concerns over real estate and mortgage forms, and explains why you have few alternatives to providing your information if you want to close the deal.

Jim at Blueprint for Financial Prosperity describes how he saved $200 on a car repair by ordering parts himself, but still letting the mechanic do the work.

David Porter advises you to make sure you understand your ARM in the light of recent interest rate increases.

This Carnival of the Capitalists is Proudly Sponsored by"¦ ACME Leader in dehydration technologies

Wall Street & Investing

Retired at 30 announces the brand-new Carnival of Investing, which seems like a pretty good idea given how many investing and personal finance posts the CotC is attracting.

George at Fat Pitch Financials discusses the phases associated with
publicly traded corporations going private to avoid Sarbanes-Oxley
regulations.

The Internet Stock Blog analyzes what impact the new Google music search function may have on other search and music sales-related stocks.

Mike Price discusses his value-investing strategy

The Japan Stock Blog brings news that the XBOX 360 is not selling well in Japan, for reasons that may be bad news for Microsoft.

Triple Pundit reports that institutional investors are beginning to press insurance companies over their risks/exposure to global warming.

Michael Cale of Financial Methods argues that based on current inflation and interest rates, investors should
allocate more assets to bonds and gold and fewer assets to equities.

Triple Witching Friday has camera-phone pictures of the floor melee that ensued from MIzuho's $335 million trading error, potentially one of the most expensive typos in history.

Patri Friedman of Catallarchy argues that index funds using the S&P 500 are not true index funds as the composition of the index is actively managed by humans

Having just exercised some employee stock options, Early Riser explores potential investments for his money.

Economic Forecasts

Financial Options has a summary of economic indicators for release next week, with commentary.

This Carnival of the Capitalists is Proudly Sponsored by"¦ ACME Never be without a date on Friday night

Economic & Business Theory

James Hamilton in Econbrowser takes another stab at bringing sanity to the gas price "gouging" meme.

The Prudent Investor discusses a seismic shift in power in global financial markets from west to east.  "When a conflict-torn dwarf nation like Serbia can sell debt maturing in
20 years with a coupon of 3.75% while the USA has to pay 4.50% for the
same maturity it is high time to throw the old dogmas of investing
overboard."

Sophistpundit looks at the effect of tradition on journalism and the evolution of successful media companies.

The Common Room draws from a book written in the 1870s where 'Aunt Sophronia' advices her nieces on economic principles.

Thinking about Peter Drucker leads David Foster of Photon Courier to some conclusions about what is wrong with today's business schools.

Health Care and Malpractice

Good News!  InsureBlog reports that it may be getting easier for cancer survivors to get life and health insurance.

This Carnival of the Capitalists is Proudly Sponsored by"¦ ACME California Dreamin' with Earthquake Pills

Business Practices

David Daniels in Business and Technology Reinvention argues that companies' use of forced stack ranking of employees is out of date.

Ed at Daily Dose of Optimism observes that when a Japanese business struggles, its execs often get a pay cut.  He wonders why this logical practice is much rarer in the US.

Jack Yoest writes that corporations don't seem to be showing their traditional hesitation at firing employees before Christmas.

Joe Kristan tells us a tax fraud story and draws the moral:  Don't cheat on your taxes and then piss off the CFO who is helping you do it.

200Motels engages the Three Stooges to explain why Enron is pushing up daisies.

The Coyote Within (hmmm, coyotes and business blogs) provides us a business fable about finding out your true character.

Humor and Other

Wordlab looks at politically correct alternatives to "Christmas"

Noah Kagan advises the occasional reversal of holiday gift-giving.

Gill Blog has a picture of the portable inflatable meeting room

Closing Notes

Thanks to the Original Illustrated Catalog of Acme Products for the advertising copy.  You can find more ACME promotional material here.

Thanks, its been fun.  Gotta go...

This Carnival of the Capitalists is Proudly Sponsored by"¦ ACME Escape from it all with the Smoke Screen Bomb

On several occasions, I have warned that government funded health care is becoming a Trojan horse for increasing government micro-management of your life.  The logic is that by paying for your health care, the government can argue it has a financial interest in your not eating fatty foods, not smoking, wearing a bike helmet, exercising, etc, decisions that would otherwise only affect the individual themself.*

For those who often accuse me of exaggerated paranoia when it comes to government intervention, check out this from the UK:

People who are grossly overweight, who smoke heavily
or drink excessively could be denied surgery or drugs following a
decision by a Government agency yesterday.  The National Institute for Health and Clinical Excellence (Nice) which
advises on the clinical and cost effectiveness of treatments for the
NHS, said that in some cases the "self-inflicted" nature of an illness
should be taken into account.

Sorry, but I told you so.  What's next?  Is an unwanted pregnancy "self-inflicted"?  How about an STD from unprotected sex?  The rulers of this process in England might argue that "Oh, we would never include those things" but technocrats in the US have seen parallel things happen as they have lost political control of their similar institutions in the US.

It gets me to wondering whether the Solomon Amendment may be the new template for government control of individual lives.  In both Universities and state governments, the Feds use the threat of withdrawal of federal funds to coerce actions (think 55 mile speed limit, title IX, military recruiting on campus) that the Constitution nominally does not see to give them authority over.  Now, there is the distinct possibility that federal funds to individuals (Social Security, Medicare, unemployment) could be used to increase federal authority and coercive micro-management at the individual level.

*Update: Yes, I do know that "themself" is probably not correct grammar.  I sometimes use they, them, themself as a grammatically frowned-upon but I think less awkward substitute for he/she, his/her, and his-or-herself when trying to be gender-neutral.  Sometimes I just use the traditional male pronoun, sometimes I use the female pronoun generically since women will complain about "he" used generically but men will not complain about "she", and sometimes I mix them up.  There is still some consensus building to do in coming up with gender neutral pronouns, though this person defends the singular "they".

I get email and comments from time to time that my language deriding government's intervention into every aspect of our lives is overblown and exaggerated.  My answer:  Oh yeah, well how about this:

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?

As I have argued many times in the past, a large part of the blame for these initiatives is public funding of health care.  Beyond the efficiency and choice arguments, I have tried to point out that publicly funded health care is a Trojan horse for a number of truly intrusive nanny-state government controls of our lives.

It isn't such a stretch to imagine the effect
when people realise "” as residents of Arizona have been told already "”
that about 40 per cent of their healthcare charges are spent treating
the consequences of avoidable obesity.

When health care is paid for by public funds, politicians only need to argue that some behavior affects health, and therefore increases the state's health care costs, to justify regulating the crap out of that behavior.  Already, states have essentially nationalized the cigarette industry based on this argument.

By the way, I am willing to make a bet with anyone that no where near 40% of our healthcare charges in Arizona are due to obesity.  I am positive some advocate made up this number, or created it using some ridiculously broad assumptions, and it has now been swallowed by the credulous and scientifically-illiterate press.

Update: Wow, the solution to obesity!  Government funded shrubbery:

City dwellers living in areas with little greenery and high levels of
graffiti and litter are more likely to be obese than those living in
pleasant areas with lots of greenery, say researchers in a study
published on bmj.com today.

Reason number 6,345 not to ever take "facts" from a "study" reported in the media at face value.

Update #2: More about the health care as a trojan horse for statism  (emphasis added)

BangkokThe World Health
Organization (WHO) has always had a rather expansive notion of what it
means to be healthy. If one looks at the official definition it defines
health as a "state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity." According to that
understanding there isn't much that is not in some way connected with
health.  And for the health promoters at WHO's recently completed Bangkok conference that means that health is the supremely important value that trumps everything else.

After
all, the health promoters argue, it is surely obvious that health is a
necessary condition for any sort of life, so it must follow that for
any truly rational person health must outweigh any other value that
might conflict with it. But the "obvious" -- especially the obvious of
the health promoter -- is often likely to be untrue. While it may be
true that being alive is in some not very interesting sense necessary
for having a life, it is not at all true that being "healthy,"
especially as defined by WHO, is a necessary condition for having a
good life.

 

All
of us make trade-offs between optimal health and other values all of
the time. We travel by car for instance, for reasons of economy or
convenience, even though we might recognize that statistically planes
are safer. We smile at Alan Dershowitz's cardiac calculus where a
patient chooses between ten years of inactive life and the risk of
sudden death:

 

"My
doctor has made a prognosis/That intercourse fosters thrombosis/But I'd
rather expire/Fulfilling desire/Then abstain, and develop neurosis."

Welcome to the Carnival of the Capitalists.  Many thanks to Silflay Hraka for starting the Carnival of the Vanities, of which this is a spin-off, to showcase smaller blogs to a wider readership.  Look for future Carnivals of the Capitalists at these sites (you can submit articles here):

While you're here, feel free to look around -- this post will tell you more about what I do at Coyote Blog.

For this week's Carnival, I have decided to take a bit of a risk, and, in true capitalist fashion, I have taken on a sponsor for this week's Carnival:

This Carnival of the Capitalists is Proudly Sponsored by"¦ ACME Maker of fine anvils for over 50 years

Continue reading ‘Carnival of the Capitalists’ »

Jane Gault at Asymmetrical Information is on a roll with a series of posts about the problems with the Medicare system.  Check out her posts on the ,  the media bias when programs are cut, and the rising cost of Medicaid.

The problem in the world of health care costs is actually very simple:  patients have the incentive to over-consume services and providers have the incentive to over-provide services.  Patients consume as many services as possible because some other entity is generally footing the bills, such that the marginal cost to the patient of extra services is generally nil (if you don't believe this, imagine a world where a 3rd party paid for your car - would you choose the same care you drive today?)  Providers tend to over-provide in part for the same reason, and in part as a defensive response to the threat of torts.  As a result, costs go through the roof, and those who pay (government, insurance companies, employers) respond by rationing, which pisses everyone off.

This disconnect between the entity paying the bills and the entity selecting the care cannot endure.  The fix in the future is guaranteed to be one where the decision maker on the selection of care is the same person who is paying for the care.  The only choice we have in designing the system is whether that entity making the decisions is the government (as preferred by statists of all stripes) or the patient. 

We need a system where people pay their own everyday medical bills, with insurance in place for catastrophic needs (which is basically how we take care of our cars).  You could probably incentivize this tomorrow by making personal medical expenses tax deductible while at the same time making employer-provided medical insurance taxable just like every other kind of compensation.  Not only would this fix the incentives problem in the system, but would also eliminate the portability issue associated with employer-provided coverage.

Unfortunately, people have a huge mental block where paying for their own medical care is concerned.  My wife is a great example.  When I became self-employed, she was shocked that I did not get dental insurance.  I tried to explain that we would just use the insurance to pay for checkups and a filling here-or-there, and it would probably cost more than just paying the expenses ourselves.  But for her, medical bills are paid by insurance, not by individuals, and it actually felt wrong for her to pay her own doctor's bill (we have a big annual deductible on our medical insurance too so it acts mainly as catastrophic coverage).  This is not an isolated attitude - it is why many people equate "not insured" today with "not getting medical care".

Postscript:  There is nothing magical about the system of employer-paid medical insurance we have today.  Many large employers implemented paid health benefits as a way to evade government wage freezes during the NRA of the 30's and later in World War II.  In the tight labor market of WWII, government mandated maximum wages could not lure enough workers, so free health benefits were thrown into the compensation mix since only cash wages were frozen.  The system is perpetuated today by a tax code that does not tax health insurance as it does all other parts of the compensation package.

UPDATE:  Or, we could just try this

UPDATE#2:  A small example of the mindset:  Carly Fiorino get $42 million as a parting gift from HP, but still insists that HP privide her medical insurance.  With $42 million, she couldn't pay for it herself? (via gongol)