Category Archives: Healthcare

Community Conservatism: Healthcare Under Fire

The "A"CA - Good for Elites, Bad for the Middle Class

The “A”CA – Good for Elites, Bad for the Middle Class

Contain the Cost of Healthcare and Preserve Options for the Middle Class

This is an issue that requires a bit of an introduction. We believe it is very important to recognize that our healthcare system is both incredible in its productivity and humanity…and very much broken. The middle and lower class see healthcare is a pressing concern because the cost to maintain insurance is getting high enough that it is forcing some serious and uncomfortable decisions onto struggling families who have to balance their budgets. The CBO estimates that, by the year 2045, the average American family will spend nearly 20% of its take-home pay on health insurance (about what they currently spend on their mortgage!). At the same time, unfunded liabilities to cover the cost of government-backed health programs like Medicare and Medicaid will soon account for 100% of all estimated tax revenue taken by the government. This is obviously an enormous problem. One that threatens to destroy our economy, cripple our access to quality care, and generally make us miserable in the not so distant future.

There are many theories for how we might go about solving this problem, but few of them have been fleshed out enough to back with the force of legislation. Prior to the bastardized half-breed of state-driven insurance mandates and taxes that is now commonly known as the Affordable Care Act, there were two competing visions for the future of healthcare in American. On the left, you had advocates for a single-payer state-run healthcare system as is common throughout the European Union and in Canada, among other places. On the right, you had advocates for transparency in healthcare service charges, tort reform, and interstate insurance commerce. The left’s concept would immediately be recognized by the American public as a massive tax hike. The right’s concept is a series of piecemeal, small-scale ideas that don’t sound like they can really fix the problem of out-of-control healthcare costs on their own.
The healthcare system has costs far beyond the basic ones associated with providing care directly. There are costs associated with:

• Medical Research and Development (and government regulation thereof)
o The research has basic costs
o The government heavily regulates how this research must proceed to get drugs and equipment to market
o The government research institutions try to assist in a wide variety of areas and this unfocused mandate yields inefficiencies
• Malpractice Insurance
o Private practice doctors report that something like half of their profits go straight to malpractice coverage because malpractice lawsuits now routinely go for huge payouts and the insurer must cover the cost
• Hospital Administration
o Here again, there are basic administration costs for running any healthcare business
o And then there are bloated government regulations that require record-keeping that rarely makes sense and is exceedingly expensive, while forcing administrators to retain fleets of expensive lawyers
• The Actual Medical Care
o Even here, there are basic costs…and then there are costs associated with doctors padding their bills to bilk the insurance companies (or at least to force them to pay out as much as they possibly can)
o And further, there is the cost of unpaid medical care given to people who are not insured and cannot pay
o And, ironically, there is the added cost of the government’s drive to get us to see our doctors more regularly (preventive care), which has yet to show any evidence of reducing expensive and undesirable health outcomes
• Insurance Company Administration
o And then we have the insurers – who are, themselves, heavily regulated by the government, and are also guilty of padding their bottom lines, and perhaps of paying out more than they should when doctors are overbilling
• American Status as Cost Sponge
o What I mean here – the US is doing most of the work to lead the way on new medical breakthroughs because countries running on single-payer systems or depending on US financial assistance to function cannot afford to do high end medical research – the result is that all of the world comes here to advance medical science (at great cost to our government research institutions), but we in the U.S. pay higher prices for all of the beneficial new drugs and technology they produce, because other places around the world can’t pay enough for big pharma and big med-tech to break even without us being charged far more

The ACA does, to its credit, recognize many of the places where profiteering, waste and excessive spending are occurring, but the liberal answer to each spending sore spot is the heavy hand of more regulation. Rather than just propose a series of bills the way we’ve done elsewhere in this series, we will explain what the ACA does about each sore spot and the risks that method poses vs. what the conservative counter should be. We’ll use the same bullets from above to organize our plan.

A) Medical R&D Costs

The ACA doesn’t specifically address medical research in a major way, other than to levy a medical device tax and make matters worse for research, but the common answer on the left is to move the cost out of the private sector and into increased government spending on the issue. This way, private sector companies can charge less for the drugs and technology they produce and the actual cost of the work can be spread among the taxpayers less obviously. The conservative approach would include carefully relaxing certain regulations on big pharma and big med-tech regarding the cumbersome and lengthy process to get from experimental drug to approved market-ready drug or experimental medical device to sales and reduce the scope and cost of the FDA. It would also include a restructuring of the NIH, CDC and other government health researchers to significantly narrow their focuses and cut the sugar out of their research diets. And finally, the GOP approach should include a repeal of the medical device tax in the ACA.

B) Medical Malpractice

The ACA doesn’t even tackle the cost of malpractice insurance for private practitioners or legal counsel for hospitals – one of its most disappointing failures, but one that is understandable, considering that the Federal Legislature can’t really regulate state civil courts). The left has, traditionally, completely ignored the increasing need for tort reform. Unfortunately, so has the right. Every once in a while, you’ll hear a Republican talk about the need for it, but they tend to be economists, rather than politicians with any clout. The GOP must act now to enact stiff limits on settlement amounts in medical malpractice cases in the states. We recognize that medical mistakes are always extremely damaging and life-altering (or ending) for their victims. We also recognize that the legal system shouldn’t be a lotto-draw for someone looking to get even with a doctor or make a quick killing after a mistake. The GOP should also enact “loser pays” laws for all civil matters, including medical malpractice. Unfortunately, these are generally matters reserved for the states, and the GOP must spearhead the effort at the state level to address them.

C) Hospital Administration and Record-Keeping

The ACA likely made these costs much worse, I’m afraid, by changing medical billing codes to a ludicrous, byzantine array of unrecognizable codes and further regulating how this information is to be collected. The GOP should move to vastly simplify medical insurance/incident/billing codes, and take a more holistic approach to auditing hospital financial and medical records.

D) Medical Fees and Insurance Models

As we know, the ACA attempts to decrease the number of people who are uninsured and thus to lower the liabilities for hospitals who must treat all patients, whether or not they are insured, by requiring that everyone get health insurance and taxing you if you do not. On top of this, the ACA requires all businesses of a certain size (more than 50 full time employees) to offer health insurance or pay massive fees. The ACA requires that children under the age of 26 be allowed to remain covered by their parents. And it requires that insurance companies never reject someone who has a pre-existing condition. And finally, the ACA requires that those plans cover a huge range of medical services in an attempt to capture all of the potential costs. The theory was that young, healthy people were going uninsured to avoid paying for it when they felt invincible at rates high enough to balance out all of the people who’d been rejected for preexisting conditions. The mandate-driven approach has proved to be a spectacular failure. Many are choosing to pay the tax – especially the healthy – many more are finding that their plans are far too expensive and have huge deductibles as insurance companies look for ways to shield themselves from the increased cost of covering high risk people. And, of course, if the government is forcing the insurers to cover everyone, many insurers will drop out of the marketplace, and that is exactly what is happening.

Having said all of that, we do not think that every idea in the ACA is bad and we do not think it is necessarily the best approach to wholesale repeal it at this point. We believe that there should be a national program to provide everyone with catastrophic insurance (to protect hospitals for huge unpaid bills, and patients from bills that ruin them financially). We also believe “guaranteed issue” and the clause extending coverage to children under the age of 26 are popular because they are necessary. We even believe the idea of a national health insurance marketplace is a very good one (we wouldn’t have the government running it, we’d set up a cooperation between the various health insurance providers and let a private company maintain the marketplace). Here is what a conservative plan would look like:

• Repeal the individual and employer mandates
• Require all Americans to buy catastrophic coverage plans the same way we require them to buy at least minimal collision insurance if they drive
• Nationalize the healthcare market (no more state insurance networks; this is not simply “selling across state lines”, this is true nationalization) and allow insurers to offer a la carte supplemental coverage – if you need coverage for prenatal care, you buy it; if you need coverage for prescription drugs, you buy it, etc.
• Require healthcare providers (private doctors and hospitals and clinics) to publicly announce their price points on a government-managed website for all of their procedures to allow consumers to price compare instead of being blind to the cost – market awareness frequently leads to market efficiency
• Require insurers to similarly announce what they’ll pay out for given procedures (in an attempt to prevent the sort of “doctor charges way too much to max out what the insurer will pay out” games we previously mentioned)
• Give tax credits to people who buy preventive care packages and repeal the Cadillac tax
• Enact the Ryan/Wyden plan for Medicare

E) Insurance Company Administration

The ACA includes a bunch of downright frightening top-down controls in an attempt to reign in insurance payouts for Medicare (because retired people are expensive, health wise, and paid for on the government dime), including but not limited to yet another in a long line of ill-advised price-fixing schemes promulgated by the left. They keep trying to fix the market to their liking and it keeps going spectacularly wrong and cause misery every time. This time, I’m referring to the Independent Payment Advisory Board. While I would stop short of calling it a ‘death panel’, there is excellent reason to fear this entity and its impact on the end of life process. IPAB will basically regulate insurance company payouts to Medicare by fiat, which will cause doctors and hospitals to begin to refuse to perform certain procedures, leading to a downward spiral in the quality of care for the elderly. We saw a glimpse of this with the VA – where aging WWII and Korean War veterans were being denied access to treatments and redirected to hospice care in some cases. The left sees the IPAB as a way to end insurance company inefficiency and doesn’t understand why this process should lead inexorably to premature death in some cases, but we have many examples – starting with the British National Health Service. The conservative answer to insurance company bloat and overpayment is, as noted above, to improve price transparency and let the customers straighten out the market. We would also add that government could play a role here with some far less heavy-handed regulations on payouts based on the going market rate for the service, once the service itself is priced publicly. Data is power – market data leads to a powerful market. Either way, the IPAB must be dismantled as soon as possible.

We’ve laid out many proposals here that attempt to make healthcare decisions less costly and stressful for the middle class, but rest assured, we’ve barely scratched the surface. We are hoping that this will start a dialogue among conservatives as to what sort of healthcare platform GOP Congressmen should build heading into 2016.

Watching the Watchers: Resistance to Transparency a Problem at Every Level of Government

We do not have leaders in the United States of America. We have representatives. They are chosen by us to do a job for us. They are our employees. We do not owe them any respect or subservience beyond the same basic respect we choose to show fellow human beings, and in particular those who are our employees.

And we have a right to watch them.

Yet at all levels of government, we face rebellion against our right to watch.

STATE LEGISLATURE IN THE NEWS FOR VIOLATING OPEN MEETING LAWS

Open MeetingsOne of the Republican candidates for my state’s legislature actually came to my door twice this election cycle in an effort to earn my vote. Even had I been otherwise inclined to vote for him, his refusal to answer voter guide questionnaires would have been a deal-breaker.

He explained at my door that politicians who answer voter guide questions are sometimes “discriminated against for their religion.” Only by questioning him on my porch was I able to elicit his position on issues from gay marriage to the War on Drugs—which he supports because “we need to be moral.”

He won handily without my vote and is now a state senator. His counterparts in the state House have just made news by, once again, being accused of violating Montana’s open meeting laws. Earlier this month, the House Republican Caucus met in the basement of a hotel without providing the requisite notice. During the 2013 session, the Caucus similarly met in the basement of the state Capitol without posting notice.

The state media have been quick to point out that both parties and both houses of the state legislature routinely violate the state’s open meeting laws. The interviews with the politicians engaged in such violations are candid and telling. One Democrat senator, for example, detailed how rather than simply post the notice and allow reporters to cover the event, his party would instead make just enough people leave to be under the limit of the notice requirements:

“We were always mindful of the numbers,” added Sen. Mike Phillips, D-Bozeman. “And when we realized we were over the limit, someone would leave.”

One of his Republican counterparts lamented that the open meeting requirements make it “impossible” for elected politicians to talk to each other:

Where do you draw the line?” he asked. “How does a group function if they can’t get together and talk to each other? This is supposed to be a country of freedom of association and freedom of speech. If you’re going to take that away at a caucus, how is the caucus going to function?”

He does not seem to understand that the caucuses can still talk, even if the people they work for are listening. If they do not want the voters to know about it, perhaps they ought not be doing it.

POLICE DEPARTMENTS RESIST BEING RECORDED

olson_scottOn Saturday night, Ferguson police arrested a member of the press, apparently for standing on a sidewalk. This comes in the wake of federal court orders directing that Ferguson police not engage in any practice of interfering with citizens’ right to record police. These orders were obtained based on events following the death of Michael Brown, in which police detained journalists, wrongfully interfered with people recording the protests and police response, and instituted a no-fly zone to prevent the media from flying over.

Both cops and citizens behave better when they know they are being recorded. Recordings exonerate innocent people who have been wrongfully accused and help ensure that the right people are punished. As Reason’s Ronald Bailey has reported:

Earlier this year, a 12-month study by Cambridge University researchers revealed that when the city of Rialto, California, required its cops to wear cameras, the number of complaints filed against officers fell by 88 percent and the use of force by officers dropped by almost 60 percent. Watched cops are polite cops.

Yet all over the country, police continue to harass citizens who lawfully record the police, a fairly well recognized right in these United States.

Police officers are not our overlords. They are public employees hired by the people to enforce the laws passed by the people. Like any other employer, We, The People, get to watch the work done by our employee police officers.

MOST TRANSPARENT ADMINISTRATION IN HISTORY

Obama secretOpen enrollment for Affordable Care Act health plans began in mid November. States have been releasing their enrollment numbers. But trying to get enrollment numbers from the federal government continues to be like pulling teeth.

In the wake of an embarrassing revelation about an “unacceptable” mistake inflating the total enrollment numbers, Health and Human Services Secretary Sylvia Mathews Burwell has ordered her agency to come up with ways to increase transparency. I hope she follows through.

But the “most transparent administration in history” has a mixed record on living up to its own hype. Lingering questions remain about the transparency of the drone program. Just this week, the administration continued its established practice of dumping thousands of new regulations on the eve of a major holiday.

Let us not forget that last month, USA Today Washington Bureau Chief Susan Page called this administration “the most restrictive” and “most dangerous” to the press than any other in history. She echoes sentiments expressed earlier this year by New York Times editor Jill Abramson, who said the Obama administration is setting new standards for secrecy:

“The Obama years are a benchmark for a new level of secrecy and control,” says Abramson. “It’s created quite a challenging atmosphere for The New York Times, and for some of the best reporters in my newsroom who cover national security issues in Washington.”

*     *     *

Those that are covering national security, according to Abramson, say that is has never been more difficult to get information.

*     *     *

Abramson says that the Obama Administration uses legal loopholes to make things difficult for journalists and media organizations. She says, for example, that the Obama Justice Department pursues cases against reporters under an obscure provision of the 1917 Espionage Act.

“I think, in a back door way using an obscure provision of an old law, they are tip-toeing close to things that, here in the United States, we’ve never had,” says Abramson.

*     *     *

While Abramson says that the White House hasn’t completely shut out the U.S. press corps, even routine media coverage has become difficult to obtain.

“The amount of friction and confrontation involved in just going about what I see as perfectly normal coverage, that in the past wouldn’t have even provoked a discussion, becomes a protracted and somewhat exhausting process,” she says.

As technology and government overreach continue to threaten the walls of privacy that traditionally protected Americans, we must be vigilant in making sure the watchers are themselves watched. They are not leaders, but employees. We should demand that they conduct themselves as such. That entails consistently subjecting their official conduct to scrutiny.

_____________________________________________________

Open Meetings image via In El Dorado County News. Ferguson image via The Center for Media and Democracy’s PR Watch. Obama image via Poor Richard’s News.

Sarah Baker is a libertarian, attorney and writer. She lives in Montana with her daughter and a house full of pets.

Long Slow Burn – GruberGate as a Microcosm

GRRRRRR

We, here, at The Liberty Papers do not generally share our correspondence, but the big issues of the day are, in fact, talked about at length in our site’s Google Group as we coordinate what we’ll be talking about at this lovely blog. Without being specific or quoting anyone directly, I would like to put forward what the group reaction was to the so-called ‘GruberGate’ scandal. In a word:

‘Meh’

If you’ve been living under a rock or watching nothing but MSNBC (same difference, really), I’ll give you a quick summary of what GruberGate entails. For six years, conservatives have blasted away at the Affordable Care Act (hereafter, the ACA). For six years, we’ve been talking about how the promises made by people trying to get it passed were impossible to keep, how the bill would raise the deficit, make healthcare more expensive and less stable, drive away doctors, narrow your networks of providers – basically the exact opposite of every claim put forward by Democrats between 2008 and 2012. The media uncritically reported White House talking points for most of that time, doing absolutely zero digging and finding no evidence of problems with the law as a result.

Then some guy who’d lost his insurance after being promised that that wouldn’t happen and decided to do some actually investigating. Within a day of beginning his search, he found video footage of one of the ACA’s chief architects, Jonathan Gruber, candidly discussing the ACA with his peers in Academia in which he said THIS (follow the links to see the videos), THIS, and THIS.

Many things have been said about GruberGate, and I won’t rehash them here. The response to this story by many libertarians (not just those of us writing here) has been a collective “well duh!” We have, after all, been talking about everything that Gruber willingly admits in his various talks on the ACA – that it’s a pack of lies intended to fool the American taxpayer by fooling the Congressional Budget Office, that it amounts to a giant national experiment and the architects have no clue what it’ll do, that expanded coverage can’t happen without raising revenue to pay for it, and that the archetype (RomneyCare) was already a failure, being propped up by federal dollars all along. We knew all of that. The insults he lobs at the American voters aren’t entirely unfounded either. Many Americans, like it or not, vote without any idea of what they’re supporting. So why should we get up in arms over it.

After arguing rather cantankerously with my fellow bloggers here, trying to explain why this story enraged me so, it dawned on me what was really going on in my head. I may come to self-awareness later than I should on occasion, but I generally get there if I think on it long enough. This whole story – the story of the Affordable Care Act from conception, to birth, to signing, to repeal efforts to angry Americans who feel lied to and voting R to prove something to the left to the GruberGate controversy…it is a microcosm of everything I’ve been battling for years.

When the ACA was first being discussed, the conservative reaction was a combination of people like those in my family, who were horrified by the likely outcome of such a bill and who relied heavily on health insurance to make their various medical problems affordable to treat, but who reacted by studying the proposal and attempting to logically argue as to why it was a very bad bill indeed…and people screaming at town hall meetings because they just instinctively feared such a big, sweeping change. It’s human to fear change, and in this case their fears were justified, but instead of focusing on doing the work of exposing the lies in the ACA, most of conservatism was consumed with death panels and doomsday imagery of Uncle Sam examining a woman’s lady parts (yes, that was a real conservative ad).

Now I’m not saying I think the IPAB is good for “end of life” care…it’s not. But ‘death panel’ rhetoric sounds literally insane to your typical low-information swing voter who might be swayed by bringing a convincing argument to the debate. And, of all of the conservative reactions to the ACA, which ones do you suppose were primarily covered by the media, by ACA advocates and in the political discussion on Capital Hill – the reasoned arguments as to why the ACA would fail and make things worse, or the fear-mongering?

But guess what – that made someone like me who worked hard to understand the problems with the ACA into a looney tune screaming about death panels when I voiced my opposition to the law before any leftist. They accused me of being a liar. They accused me fearing change. They accused me of not caring about the poor and the uninsured. And they had the support of, once again, an uncritical, unserious mainstream media telling them any concerns about the ACA raising costs, impairing the system, causing doctor shortages or narrow networks, etc. were just crazy conservative fear mongering. Our detached, empirical expert, Jon Gruber, says so – read the study.

When the truth came out – when it turned out that Jon Gruber believed everything I did about the ACA except the part about those results being bad for healthcare…when he gleefully admitted that RomneyCare was a failure economically, that the ACA had nothing to do with making healthcare affordable, and that he and his colleagues had no clue how to bend the cost curve down – and then had the audacity to call us stupid for believing him, I would have been satisfied. I wouldn’t have been angry for long – it would have brought some semblance of peace to be vindicated in the fight. Except that the reaction of the left was to lie even more, minimize Gruber’s roll in crafting the bill, and then…call conservatives fear mongers again for reacting to this story with anger and for losing trust in government to solve problems like these.

This is inherently the entire problem I have with the left – every time their bad ideas don’t work and people realize it, they find the loonies in the conservative ranks and make those guys their opposition, and when you try to bring reason to the party, they accuse you of just being one of the loonies. And when you turn out to be RIGHT…oh well whatever nevermind. That fight never mattered anyway – on to the next fight.

Until conservatives are willing to call liberals (and other conservatives) out for not fighting fairly, for distorting the history of the argument, for scanning through the crowd for the easiest person to attack, for straw men and lies, for parliamentary tricks and poor research, and for their ugly assumptions about the American people, we will always lose the argument. Always. And that…is what is truly terrifying me into anger. We were right. All along, conservatives were right about the ACA and the insincere, cynical motives of its creators. We were right, they were wrong, and somehow, we still lost the argument. And it’ll happen again and again until we get angry enough to turn the tables on them – to call them out on their unfair tactics and their bad science and their twisted, utilitarian assumptions.

We’re about to have the same fight on immigration. Learn to recognize their tactics and fight back, or there will come a day when you remember how right you were about the negative consequences of an open border, and how little it mattered that you were right.

SCOTUS Has Accepted Appeal of Case That Could Topple Obamacare

SCOTUS

On Friday, United States Supreme Court agreed to hear the appeal in King v. Burwell. The plaintiffs in that case assert that the Patient Protection and Affordable Care Act only allows tax credits to people who buy insurance “from an exchange established by a state.” The Fourth Circuit Court of Appeal disagreed and ruled that the federal government may interpret that language as allowing tax credits to purchasers who bought insurance on one of the federal exchanges, operating in the more than 30 states that declined to create their own.

On the same day the Fourth Circuit delivered its decision in King, a panel in the D.C. Circuit found for the plaintiffs in a companion case captioned Halbig v. Burwell. This conflict would ordinarily invite SCOTUS to weigh in. However, the D.C. Circuit then accepted a rehearing en banc in Halbig. Thus, even though the King plaintiffs appealed, many observers speculated SCOTUS would wait to see if a conflict really developed, or if after rehearing in Halbig, the courts ended up aligned.

As a result, it is somewhat surprising that SCOTUS accepted the King appeal, and it may signal bad news for the Affordable Care Act. As Nicholas Bagley writing a SCOTUSblog explains:

[F]our justices apparently think—or at least are inclined to think—that King was wrongly decided. … [T]here’s no other reason to take King. The challengers urged the Court to intervene now in order to resolve “uncertainty” about the availability of federal tax credits. In the absence of a split, however, the only source of uncertainty is how the Supreme Court might eventually rule. After all, if it was clear that the Court would affirm in King, there would have been no need to intervene now. The Court could have stood pat, confident that it could correct any errant decisions that might someday arise.

There’s uncertainty only if you think the Supreme Court might invalidate the IRS rule. That’s why the justices’ votes on whether to grant the case are decent proxies for how they’ll decide the case. The justices who agree with King wouldn’t vote to grant. They would instead want to signal to their colleagues that, in their view, the IRS rule ought to be upheld. The justices who disagree with King would want to signal the opposite.

And there are at least four such justices. If those four adhere to their views—and their views are tentative at this stage, but by no means ill-informed—the challengers just need one more vote to win. In all likelihood, that means that either Chief Justice Roberts or Justice Kennedy will again hold the key vote.

If I read this correctly, the speculation is that four (or more) SCOTUS justices agreed to accept the case in order to send a signal to the lower courts still considering challenges to this provision of the ACA. The signal they wanted to send is that those other courts should not necessarily follow King, because SCOTUS might think it was wrongly decided.

A reversal of King (i.e., a finding in the plaintiff challengers’ favor) would seriously undermine—perhaps fatally—the structure of the Affordable Care Act. Fully 87% of the people who purchased policies through the federal exchanges during the first open enrollment period are receiving subsidies. If the government cannot give subsidies to low-income purchasers, it cannot tax them for failing to have the insurance, and the entire system collapses under its own weight. Fewer people can afford the insurance, the risk pool shrinks, costs rise, and more people are forced to opt out.

If on the other hand, SCOTUS upholds tax credits not authorized by Congress, it would be one more in a long line of revisions, waivers, exemptions, delays and modifications made to the law made by the very administration that purports to uphold it.

Sarah Baker is a libertarian, attorney and writer. She lives in Montana with her daughter and a house full of pets.

Can We End the Insulting “War on Women” Meme Now?

Lady Parts

Colorado Senator Mark Udall has a strong record of fighting back against surveillance state abuses. If I lived in Colorado, I would have considered voting for him, as the lesser of two evils, on that basis alone. Instead “Senator Uterus” squandered that advantage by running on the phony and demeaning “war on women.” Let us hope his defeat, along with that of Wendy Davis, sends this insulting meme to the quick death and deep burial it deserves.

Even the use of the word “war” is offensive.

War is the Rape of Nanking. It is the Sebrenica Massacre. War is the Rwandan Genocide. It is 45 million people dead in four years under Mao Ze-Dong and twenty million murdered or starved under Stalin.

War is the freakin’ Holocaust.

Acid attacks, honor killings, forced marriages, slavery, and stoning. Those things might rise to the level of a “war on women.”

Having to pay for your own birth control does not. Neither does a deadline of twenty weeks to terminate a pregnancy. If the wage gap was real (it is not), even that does not constitute “war.”

Using that word to describe anything experienced by women in the 21st century in the United States is an insult to my fortitude and intelligence, and to the victims of real wars all over the world.

But the meme does not stop there. It doubles down on this heaping pile of insult by treating certain issues as inherently interesting to women.

I am more than the sum of my “lady parts[1] and the issues inevitably lumped together under the rubric “women’s issues” hold little interest for me.

Abortion has been protected since 1973. Only 28% of women believe it should be legal in all circumstances. Like 72% of all women, I am not one of them. The wage gap has been massively and repeatedly debunked.[2] The right to purchase and use birth control has been protected since 1965, and I have been able to afford it since I took my first job as a teenager. To the extent I have political concerns about birth control, it is to support over-the-counter availability, as proposed by Udall’s Republican challenger, or to wonder: If birth control is so unaffordable, how are women to pay for the health insurance policies covering birth control as just one of many expensive mandates?

Here are my issues: I think the growth of the surveillance state is an unacceptable trade-off in the fight against terrorism. I worry that the U.S. is crossing moral lines in its reliance on drone warfare, and that we are getting bogged down in never-ending conflicts in the Middle East. I fear our overseas interventions constitute sprinkling water on little terrorist Mogwai. I want non-violent drug offenders released from prison and reunited with their families. I worry about inflation in consumer prices outpacing real increases to income. I believe free markets produce the most beneficial results and that minimum wage laws destroy jobs and harm low-income workers. I think government debt and deficits are immoral and untenable burdens to pass on to our children. I am opposed to restrictions on political speech.

I care passionately about each one of those things.

When politicians suggest I should instead be focused on free birth control or manufactured outrage over phantom discrimination, it is like they are saying, “Oh, don’t worry your little head about those other issues. Those are for the menfolk to work out.”

It is like I am being patted on the head and told, “You’re pretty smart…for a girl.”

To those on the left who want to keep this meme alive, please watch this video of a woman fall down, get back up and start running again. Then consider whether you really want to tell us you think buying our own birth control is too hard.

[1] Unlike man parts, lady parts are protected by U.S. law, both figuratively—as set forth in this post—and literally.

[2] When economists control for educations, occupations, positions, length of time in the workplace, hours worked per week, and other similar variables, the gap narrows to pennies on the dollar. It may not exist at all, since even the remaining gap may be explained by “legitimate wage differences masked by over-broad occupational categories,” lumping together such disparate professions as sociologists and economists or librarians, lawyers and professional athletes.

Sarah Baker is a libertarian, attorney and writer. She lives in Montana with her daughter and a house full of pets.

Tesla Whines About Protectionist Legislation for Auto Dealers While Using Government Largesse to Compete

Last week, I wrote about rent seeking auto dealers lobbying for protection from competition with manufacturers utilizing direct-to-consumer sales models. I mentioned direct-to-consumer manufacturer Tesla by name, and suggested such legislation would prevent consumers from enjoying the savings that might otherwise be realized from Tesla’s efforts to “eliminate the middle-man.”

I should have taken the opportunity to address Tesla’s own abundant receipt of government largesse.

And to be clear, “government” largesse is always paid for by the taxpayers.

In a piece entitled “If Tesla Would Stop Selling Cars, We’d All Save Some Money,” Forbes contributor Patrick Michaels details all the ways Tesla benefits from government handouts. Michaels concludes that taxpayers shell out $10,000 for every car Tesla sells.

Michaels starts with a claim that purchasers of Tesla vehicles receive a $7500 “taxback bonus that every buyer gets and every taxpayer pays.” Since the tax credit appears to be non-refundable, I would not count it as a cost to other taxpayers, as Michaels does.

But the federal tax credit is only the tip of the crony capitalist iceberg for Tesla.

There are also generous state subsidies paid by taxpayers to the wealthy people who buy Tesla’s expensive vehicles. Purchasers in Illinois, for example, can receive a $4,000 rebate from that state’s “Alternate Fuels Fund,” a $3,000 rebate to offset the cost of electric charging stations, and reduced registration fees. California likewise offers a long list of rebates and subsidies to buyers of electric vehicles.

One of the hidden costs to consumers comes in the form of the increased price tag on cars sold by manufacturers who do not qualify for California’s mandated emissions credits, which they instead have to buy from Tesla, allowing it to earn a profit despite selling cars at a massive loss. As Michaels explains:

Tesla didn’t generate a profit by selling sexy cars, but rather by selling sleazy emissions “credits,” mandated by the state of California’s electric vehicle requirements. The competition, like Honda, doesn’t have a mass market plug-in to meet the mandate and therefore must buy the credits from Tesla, the only company that does. The bill for last quarter was $68 million. Absent this shakedown of potential car buyers, Tesla would have lost $57 million, or $11,400 per car. As the company sold 5,000 cars in the quarter, though, $13,600 per car was paid by other manufacturers, who are going to pass at least some of that cost on to buyers of their products. Folks in the new car market are likely paying a bit more than simply the direct tax subsidy.

Slate’s Scott Woolley details another way in which Tesla has cost taxpayers money. In 2009, Tesla received a $465 million Department of Energy loan that allowed it to weather a financial maelstrom. Unlike Solyndra (and Abound Solar and Fisker Automotive and The Vehicle Production Group LLC), Tesla managed to repay the loan in 2013. According to Michaels, it did so by reporting its first ever quarterly profit (earned from the sale of the emissions credits), which sent its stock soaring and enabled it to borrow $150 million from Goldman Sachs, and then issuing a billion in new stock and long-term debt.

But Tesla paid the U.S. taxpayers back at a rate far below what venture capitalists would have earned on the same loan. As an example, Tesla’s CEO Elon Musk also made a loan to Tesla. Musk got a 10% interest rate and options to convert the debt to stock, which he did, resulting in a 3,500% rate of return on his investment.

In contrast, the U.S. taxpayer received a 2.6% rate of return.

In other words, in our crony capitalist system, taxpayers take the loss on bad loans like the one to Solyndra, but do not enjoy commensurate reward on good loans like the one to Tesla.

But there is still more. Tesla cannot keep earning emissions credits, which allow it to earn a profit despite selling its cars at a loss, unless it can keep selling those cars. Josh Harkinson, writing for Mother Jones, writes that:

Its first-quarter profit, a modest $11 million, hinged on the $68 million it earned selling clean-air credits under a California program that requires automakers to either produce a given number of zero-emission vehicles or satisfy the mandate in some other way. For the second quarter, Tesla announced a $26 million profit (based on one method of accounting), but again the profit hinged on $51 million in ZEV credits; by year’s end, these credit sales could net Tesla a whopping $250 million.

Tesla’s ability to continue selling the cars that earn the credits is in question. The market for $80,000 cars has a limited number of buyers. Tesla must expand its customer base with a more affordable product.

One way to achieve that would be to cut the vehicle’s range. But subsidies, credits and fuel savings notwithstanding, consumers have little taste for lower ranges—even at a much lower price. Another way for Tesla to lower the cost of its vehicles is to cut the cost of its batteries without sacrificing the range. As Harkinson observes:

That, however, may again depend on massive subsidies—in this case funding to battery researchers and manufacturers by the governments of Japan and China. Over the past five years, Japan’s New Energy and Industrial Technology Development Organization, a public-private partnership founded in 1980, has pumped roughly $400 million into developing advanced battery technologies. Tesla’s Panasonic cells also might be pricier if not for subsidies the company received to expand its battery plants in Kasai and Osaka.

When Republican Gov. Rick Snyder signed the bill reaffirming Michigan’s protectionist legislation for traditional automobile franchise dealers, auto blog Jalopnik reported GM’s position as follows:

“Competition is always healthy,” GM spokeswoman Heather Rosenker tells Jalopnik. “But it needs to be on a level playing field.”

In the context of the substantial aid Tesla receives from federal, state and foreign governments, it is easier to have some sympathy for the plight of traditional manufacturers—and their dealers.

Ultimately, that sympathy shines a spotlight on the problems created when government starts “tinkering” in the market. Inevitably, that initial, well-intentioned tinkering necessitates ever more intrusive secondary tinkering aimed at remediating the unintended side effects of its initial foray into the market.

Consider health care. Inflation in the cost of U.S. health care began to outpace the general rate of inflation when the government began subsidizing health care costs. Nobel laureate economist Milton Friedman has estimated that real per capita health spending is twice what it would be in the absence of third party payments, and that Medicare and Medicaid are responsible for 43% of that increase. The remaining portion can be blamed in large part on the third party payments from mandated employer health care coverage, further separating patients from the cost of their care and eliminating the market forces that would otherwise keep costs down. Add to the foregoing the government-enforced monopolies on health care education, leading to 22% fewer medical schools in the United States now than one hundred years ago, despite a 300% increase in population, and attendant provider shortage. All that well-intentioned tinkering created a whole host of ugly, unintended side effects, necessitating more tinkering. The federal government responded with the Affordable Care Act and its accompanying thousands of pages of new regulations.

Everywhere the pattern repeats. The cost of higher education outpaces general inflation precisely because the government wants to help people pay for it. The unintended side effect is increasing numbers of graduates with useless degrees and few job prospects, necessitating further tinkering in the form of loan relief, jobs programs and minimum wage hikes. The Federal Reserve suppresses interest rates to artificial lows in the well-intended effort to speed recovery from the bust of the dot-com bubble. The unintended (in this case, it may actually have been intended, at least by Paul Krugman) side effect is a new bubble in housing. When that bubble bursts, the government must step in to bail people and banks out of their bad investments, create new bureaucracies and new regulations making it harder for people to qualify for loans (in contrast to previous tinkering designed to make it easier).

Lather, rinse, repeat.

I am not a radical free-marketer because I dislike poor people or have a special love for corporations. I am a radical free marketer because I know no amount of tinkering ever produces results as beneficial as what the market produces, naturally and efficiently, all on its own.

Sarah Baker is a libertarian, attorney and writer. She lives in Montana with her daughter and a house full of pets.

John McCain vs John McCain: Ebola Czar Edition

In 2008, even though the presidency of Barack Obama has been a disaster, the American people picked the lesser of the two evils. It is truly terrifying that John McCain won the presidential nomination of a major political party.

At first, Senator McCain was opposed to using “czars” in government as this tweet obtained by the Huffington Post shows:

Fast forward to now and the Ebola epidemic. What does Senator McCain urge President Obama to do? Appoint an Ebola czar.

Sen. John McCain (R-Ariz.) believes President Barack Obama should appoint a “czar” to lead America’s response to Ebola.

“From spending time here in Arizona, my constituents are not comforted. There has to be more reassurance given to them. I would say that we don’t know exactly who’s in charge. There has to be some kind of czar,” McCain said Sunday on CNN’s “State of the Union.”

“I don’t think we’re comforted by the fact that we were told there would never be a case of Ebola in the United States,” McCain continued. “Obviously that’s not correct.”

Today, President Obama did just that. He appointed Ron Klain, a longtime advisor to Vice President Joe Biden, to the post. Klain has no apparent healthcare background.
So where does Senator McCain stand on the appointment? Senator McCain blasted the appointment of Klain.

Sen. John McCain (R-Ariz.), who led the charge calling on President Obama to appoint a health czar to oversee the response to Ebola, says the president’s pick of Democratic operative Ron Klain is inadequate.

“Frankly, I don’t think Mr. Klain fits the bill, as a partisan Democrat, certainly not in any effort to address this issue in a bipartisan fashion,” McCain said Friday evening on Fox News.

“He has no experience or knowledge or background in medicine,” he added.

McCain is correct about the fact that Klain’s sole qualification to be Ebola Czar is that he’s a partisan Democrat hack and as such, he has no business coordinating anything. So what does McCain propose instead?

McCain said on Fox that Health and Human Services Secretary Sylvia Burwell was the logical choice to fill the role of an Ebola czar, adding that she is a “very capable individual.”

Do Senator McCain and President Obama know we already have an Assistant Secretary for Preparedness and Response within the Department of Health and Human Services whose job is to….coordinate the government’s response to pandemics like Ebola?

Why do we need yet another “czar”?

I’m one of the original co-founders of The Liberty Papers all the way back in 2005. Since then, I wound up doing this blogging thing professionally. Now I’m running the site now. You can find my other work at IJ Review.com and Rare. You can also find me over at the R Street Institute.

Performance Enhancing? Nope… normalizing… But don’t try to tell the DEA that

There’s a funny thing about my life… I’m not sure if this is comic, tragic, ironic or what…

I spent more than 10 years as a serious competitive powerlifter, football player, wrestler, and martial artist, and another few years as a just a hobbyist.

In that entire time, I never did a single “performance enhancing drug”… Never even tempted to do so.

Now I’m a broken down, fat, middle aged cripple… who the DEA looks at like I’m a drug dealer or abuser of “performance enhancing substances”… just to keep from getting fatter, more broken down, and more crippled.

I’m 8 years into the frank symptoms of chronic illness (which turned out to be a weird and rare kind of endocrine cancer, that almost killed me, and basically destroyed my endocrine system. I have been cancer free for almost 2 years now), and  I am now on damn near the exact combination of drugs that “juicers” would traditionally use for such things.

I take more testosterone every week than most steroid abusers would even think of… and I don’t cycle it, I take it constantly, deep muscle injection every week.

I take an aromatase inhibitor to keep all that testosterone from converting to estrogens and testosterone antagonists (and giving me all the nasty side effects that not cycling off testosterone injections give you). We’re experimenting with that one right now, but we may end up adding an estrogen/estradiol antagonist to the mix on top of the aromatase inhibitor.

By the by… those drugs are normally what they give to breast cancer and ovarian cancer patients. They actually say in the interaction warnings “do not take if you are a man”… unless of course you’re a man whose body is producing too much estrogen, or converting too much testosterone into estrogens and testosterone antagonists, and blocking his ability to produce and use testosterone properly. If you’re not one of those men, it dramatically increases the effect of testosterone (and other steroid hormones) on your body.

I’m on enough primary thyroid hormone to quite literally kill a normal person… in fact, not just “enough”, the amount I take is several times the lethal dosage. It’s still may not be enough for me. The doc just increased it today, and will probably increase it again in 6-12 weeks when we sort out the effects of the new meds. Sometimes athletes abuse thyroid hormones for weight loss, increased energy, and to boost other performance enhancing hormones naturally.

For allergies, and for inflammation pursuant to the endocrine issues, I take two different other steroidal medications (a glucocorticoid and a mineralcorticoid), which act as bronchodilators and anti-inflammatories.

To deal with some of the unfun and nasty side effects and after effects of the cancer (to improve metabolic function, energy, mental acuity etc…) I’m also taking enough creatine to put a normal person into kidney failure… For me, it actually makes my kidneys work better.

Because of the aftereffects of the cancer, the endocrine issues, and the side effects of the medications, I’m on megadoses of vitamins and minerals. I mean MEGADOSES.

Between all of those, my growth hormone production and DHEA production should be elevated through the roof… as if I was taking illegal supplementation of HGH. It’s not… because my endocrine system is so screwed up.

For my edema (another lovely endocrine side effect, which can be made worse by my meds), I take more diuretics than the most abusive wrestler, gymnast, or bodybuilder. I’ve lost 24lbs in 24 hours, and 48lbs in 7 days just from the pills.

For musculoskeletal pain and systemic inflammation, I’m on more and stronger anti-inflammatories than any athlete rehabbing after a major injury (I take 1000mg of etodolac twice a day). I also get periodic shots of antiinflammatory medications directly into my knees.

Those let me get out of bed and walk. Without them… I just don’t.

Between my normal blood chemistry, the damage the cancer did, and the side effects of medications, I’ve got polycythemia, and I’m a hyperclotter. I’m basically naturally blood doping.

To counter the aftereffects of the cancer and make the other meds work better (adrenal and pituitary support), I’m on enough stimulant medication (which is also a bronchodilator) to make the DEA look funny at my doctor… until he explains all of the above.

In fact, the DEA looks funny at several of the drugs I’m taking above. My doctors have had to explain to my pharmacists, and both have had to explain to the DEA… no, I’m not a drug dealer or abuser, I’m not a steroid abusing weight lifter… I’m just a guy who needs this stuff to live.

I should be taking actual pain killers too… I’ve got enough musculoskeletal  damage, neurological damage, and inflammation, that my baseline background pain is pretty substantial.

For those familiar with pain management, I live at about a 3-4 most days, with breakthrough to a 7 on good days, and 6 or 7 with breakthrough to 9 or 10 bad days.

That’s with the meds. Without… there are no good days. There’s just days I can get out of bed, and days I can’t.

I simply refuse to take painkillers. They don’t do a damn thing for me unless I take horse tranquilizer doses, and then they knock me out cold… or worse, leave me sami conscious and barely awake, but unable to think, or concentrate, or really actually sleep. Beside, I don’t like the other side effects.

I’ve learned just to live with the pain, and take what pain reduction I can get with my other medications.

And by the way… this is a MASSIVE REDUCTION of the stuff I used to be taking, during the cancer. My primary care physician and my endocrinologist are both alternative and integrative medicine believers who hate drugs, and only prescribe the absolute minimum necessary.

I’m not overmedicated… if I go off of any of them, or all of them, nothing gets better and it all gets worse. We’ve done differential testing, going off one at a time and seeing the impact then going back on, then varying dosages… I’m definitely not overmedicated.

If anything, there are some other medications that might help me more. We’re very slowly adding things in one at a time, so we can test and measure and adjust.

This isn’t overmedication…

This is what happens, when your endocrine system completely loses the ability to regulate itself. It’s trying to regulate through medication, what the body normally regulates naturally.

It’s what I need to live, and be functional.

The worst thing is though… because of DEA actions, regulations, guidelines, and investigations… Several of my medications, that I need to live, and be productive, and actually be ME?

They’re constantly short of them, or out of them entirely. Sometimes it’s every pharmacy within 30 miles.

They don’t stock them, they don’t stock the dosages I need, or they don’t stock enough to fill my scrips for a month.

I have to get hand written, signed scrips every month, I can’t get refills, and I can’t get more than a 30 days supply at once. If I’m caught with more than a 30 days supply, I can be charged with unlawful possession, and possession with intent to distribute.

I have to hand carry those scrips to the pharmacies, only for them to tell me that it might be a week, maybe two weeks, before they can fill the scrip; because the DEA production quota for that quarter had been exceeded, or the distributors orders were above the DEAs suspect threshold, or because they had sold out of all they could order for that month without the DEA investigating them, or because one scrip of mine was more than the DEA told that pharmacy they could keep in storage.

We won’t even get into what the drugs themselves cost, or what they would cost without the regulatory and compliance burden to deal with these issues.

…And god help me if I actually took the painkillers I should be taking.

All this… because the medications that I need to live and function… are sometimes abused by other people to “enhance their performance”.

… and somehow, some people still seem to think that the “drug war” is helping?

I am a cynically romantic optimistic pessimist. I am neither liberal, nor conservative. I am a (somewhat disgruntled) muscular minarchist… something like a constructive anarchist.

Basically what that means, is that I believe, all things being equal, responsible adults should be able to do whatever the hell they want to do, so long as nobody’s getting hurt, who isn’t paying extra

Re-post: The Right to Life Also Implies a Right to Die

Brittany Maynard says ‘I don’t want to die.’ The 29 year-old is is not unique in her desire for self-preservation as most of us do not want to die. What does make her somewhat more unique is she has tragically been diagnosed with a stage 4 glioblastoma. To put this in laymen’s terms, she has terminal brain cancer which will end her life if nature is allowed to take its course.

Brittany, however; has other plans. She has moved from California to Oregon to take advantage of Oregon’s ‘right to die’ law. Her goal is to live until her husband’s birthday on November 1st. If she lives until November 2nd, Brittany says she wishes to die on her own terms on that day. “I may be alive on Nov. 2 or I may not, and that’s my choice,” Brittany explained.

Back in June of 2007, I wrote a post entitled: The Right to Live Also Implies a Right to Die. I wrote the post in response to Dr. Jack Kevorkian’s release from prison. While I appreciated the gravity of physician assisted suicide then, it was still a bit abstract. Since that time I have seen friends and family members waste away to terminal conditions and it is truly horrifying to witness. I cannot say for sure that any of these friends or family members would have opted to make the same choice as Brittany and others have made but they should have had the choice. The state should not stand in the way of end of life decisions by the person who owns his or her life.

The following is a re-post of the original article I wrote in 2007.

Dr. Jack Kevorkian has finally completed an eight year prison term. For what exactly? For helping a terminally ill and suffering man exercise his right to a have a dignified and peaceful death. I find it very irritating that the media has given Dr. Kevorkian the nickname ‘Dr. Death’ as if he were some kind of serial killer.

Dr. Kevorkian has done our society a great service by bringing this issue into the national debate. On what basis can society deny a person his or her right to die? If we truly believe that every individual has the inalienable rights of life, liberty, and property, then the individual cannot be denied this right on any of these measures.

The individual has the right to life but this does not mean that government can force an individual to live. The individual has the right not to exercise his or her rights. The individual has the right to keep and bear arms but the government cannot force an individual to own a gun. The individual has the right to his or her liberty (provided he or she does not infringe on the liberty of others) but he or she can willfully surrender his or her liberty to be subjugated to a cult or religion. The individual has a right to his or her property (which would include his or her body by the way) which means he or she can do with it whatever he or she wishes (again, provided he or she does not infringe on the life, liberty, or property of others).

Thomas A. Bowden has an excellent piece on this issue at Capitalism Magazine.

The Declaration of Independence proclaimed, for the first time in the history of nations, that each person exists as an end in himself. This basic truth–which finds political expression in the right to life, liberty, and the pursuit of happiness–means, in practical terms, that you need no one’s permission to live, and that no one may forcibly obstruct your efforts to achieve your own personal happiness.

[…]

For these reasons, each individual has the right to decide the hour of his death and to implement that solemn decision as best he can. The choice is his because the life is his. And if a doctor is willing (not forced) to assist in the suicide, based on an objective assessment of his patient’s mental and physical state, the law should not stand in his way.

The fear by those who oppose the inherent right to die is that the government would eventually start killing those who are suffering regardless of the wishes of the individual. But upon closer inspection, recognizing an individual’s right to choose his or her manner of death is protecting the individual’s right to life. The individual does not live for the purpose of pleasing society or the religious sensibilities of others.

Watch A Couple Of Millennials Talk About Barack Obama’s Policies Have Harmed Their Generation

A couple of young Millennial women, Alyssa Lafage and Elly Mae, appeared on “The Rick Amato Show” on the One America News Network (don’t worry, you probably don’t even get the channel). Amato had both young ladies on to talk about how the policies of President Obama and progressives have harmed the Millennial generation.

Some reports show that Millennial unemployment remains high at 15% in September. This summer, it was estimated that Millennials are 40% of the overall unemployed in this country. Millennials still cannot afford health insurance, despite Obamacare’s promises.  Finally, Millennials are trapped by high amounts of student loan debt, which cannot be discharged in bankruptcy, in order to obtain near worthless degrees.

Watch these two Millennial women describe how the polices of President Obama and progressives have harmed their generation and made their generation worse off than ever. Also, check out our own Quincy’s takedown of Obama drone Paul Krugman’s proclamation of Obama as one of the greatest presidents ever which touches on some of these same issues.

h/t: Wayne Dupree

I’m one of the original co-founders of The Liberty Papers all the way back in 2005. Since then, I wound up doing this blogging thing professionally. Now I’m running the site now. You can find my other work at IJ Review.com and Rare. You can also find me over at the R Street Institute.

The view from the bubble

They say we’re entitled to our own opinions, but not our own facts. Except, of course, if we’re Paul Krugman:

When it comes to Barack Obama, I’ve always been out of sync. Back in 2008, when many liberals were wildly enthusiastic about his candidacy and his press was strongly favorable, I was skeptical. I worried that he was naive, that his talk about transcending the political divide was a dangerous illusion given the unyielding extremism of the modern American right. Furthermore, it seemed clear to me that, far from being the transformational figure his supporters imagined, he was rather conventional-minded: Even before taking office, he showed signs of paying far too much attention to what some of us would later take to calling Very Serious People, people who regarded cutting budget deficits and a willingness to slash Social Security as the very essence of political virtue.

And I wasn’t wrong. Obama was indeed naive: He faced scorched-earth Republican opposition from Day One, and it took him years to start dealing with that opposition realistically. Furthermore, he came perilously close to doing terrible things to the U.S. safety net in pursuit of a budget Grand Bargain; we were saved from significant cuts to Social Security and a rise in the Medicare age only by Republican greed, the GOP’s unwillingness to make even token concessions.

But now the shoe is on the other foot: Obama faces trash talk left, right and center – literally – and doesn’t deserve it. Despite bitter opposition, despite having come close to self-inflicted disaster, Obama has emerged as one of the most consequential and, yes, successful presidents in American history. His health reform is imperfect but still a huge step forward – and it’s working better than anyone expected. Financial reform fell far short of what should have happened, but it’s much more effective than you’d think. Economic management has been half-crippled by Republican obstruction, but has nonetheless been much better than in other advanced countries. And environmental policy is starting to look like it could be a major legacy.

As usual, his screed is filled with cherry picked statistics, unsupported claims, and plenty of vitriol for those who don’t agree with him. He uses these weapons, such as they are, to paint a picture of Barack Obama as a consequential and successful president. While I certainly won’t argue with consequential (there have certainly been consequences for electing Obama), the bar Krugman sets for success is convenient for his case but meaningless to Americans outside the elite bubble.

How does Krugman address this?

Yes, Obama has a low approval rating compared with earlier presidents. But there are a number of reasons to believe that presidential approval doesn’t mean the same thing that it used to: There is much more party-sorting (in which Republicans never, ever have a good word for a Democratic president, and vice versa), the public is negative on politicians in general, and so on. Obviously the midterm election hasn’t happened yet, but in a year when Republicans have a huge structural advantage – Democrats are defending a disproportionate number of Senate seats in deep-red states – most analyses suggest that control of the Senate is in doubt, with Democrats doing considerably better than they were supposed to. This isn’t what you’d expect to see if a failing president were dragging his party down.

More important, however, polls – or even elections – are not the measure of a president. High office shouldn’t be about putting points on the electoral scoreboard, it should be about changing the country for the better. Has Obama done that? Do his achievements look likely to endure? The answer to both questions is yes.

Krugman’s point about changing the country for the better is an interesting one. It inevitably leads to the question of better for whom. We the people, pesky knaves who base our opinions on the reality we face every day, have been rejecting the claim that Obama has been successful in poll after poll for years.

That rejection is not hard to understand. Jobs are still hard to come by. Our hours have been cut. Our benefits have been slashed. Our savings haven’t earned interest in half a decade. We see more and more people on the streets, not just in big cities but in suburban towns. We know we might be one job loss away from joining them. We see a generation graduating from college into a hopeless economic situation. We know our children might be next. Worst of all, we’ve had to listen to the media trumpet recovery and economic good news while our situations are still terrible.

Instead of acknowledging the reality faced by the people, Krugman moves to silence and marginalize us. Our opinions are due to partisanship and being down on politicians in general. With a wave of a hand, he rewrites our stories to fit his narrative. This leaves room to for Krugman to explain Obama’s successes using only his preferences and priorities for reference. Inside the bubble, he matters and we don’t.

Ebola: A Consequence Of Austerity?

Kevin Drum, today, on how “slashing” funding for the NIH has resulted in us not having an Ebola vaccine:

What’s more, even without a vaccine we’d probably be better prepared to react to the Ebola outbreak if we hadn’t spent the past decade steadily slashing funding for public health emergencies. The chart on the right, from Scientific American, tells the story.

There are consequences for budget cuts. Right now we’re living through one of them.

Hey, my fellow Libertarians… We won! We trimmed government to the point where it could be strangled in a bathtub. Taxes are low. Regulation is minimal. Government spending is back at pre-WWI levels. We did it, and now we’re going to have to live without the nanny that we slaughtered. [sadface]

Oh, wait. No, that didn’t happen.

Government has grown by 59% in inflation-adjusted dollars since 1999. It’s grown from 17.6% of GDP to over 21% in the same time.

Clearly, we’re not at a loss for a vaccine because government wasn’t spending money. And whether you’re on the Left, the Right, or even a Libertarian, one can make quite a strong argument that research into cures or treatments for epidemic-level diseases may be a “public good”. It is quite true that shareholders for pharmaceutical companies find a lot more value in helping middle-aged men get erections than staving off the next extinction-level-event*. This sort of pure healthcare research is exactly the sort of thing that the market doesn’t do well, and has such widespread benefit to society overall to be worth it.

So. If we can agree that government’s spending a lot more money in inflation-adjusted dollars, and we can agree that both sides of the aisle view this sort of research as a true public good, worthy of public investment, why is its budget getting slashed?

Simple: science spending doesn’t buy votes.

The truth is that the government has plenty of money. They spend plenty of money. Even beyond this, a lack of money has never been a barrier to them spending money, whether they have to borrow it, or print it, or have the fed print it so they can borrow it from themselves. If something is important to politicians, they’ll find a way to funnel money to it.

In fact, the problem is similar to that of many government programs. They’ll find money for sexy new things like rail line extensions, but suddenly are broke when it comes to maintaining the lines they already have. Oh, and the lack of maintenance mentioned in that story cost more lives than Ebola has in the US.

Apparently the war in Iraq was worth $1T. The stimulus was worth $787B. Obamacare (Apr ’14 CBO estimates) will cost $1.383T over the 2015-2024 period.

Compare that to the NIH, which costs ~$30B/year.

It’s not a question of spending. It’s a question of priorities. Incremental scientific advancements to third-world diseases are important, and worthy of funding. But very few politicians will get credit for voting for that funding, so they let the NIH wither on the vine while they spend money on “important” things. That is the libertarian critique: the NIH could have been fully funded if the government wasn’t distracted–as they always are–by anything shiny.

» Read more

Facts Are Stubborn Things, Mr. Reid

Every individual who has told the press that they have had a bad experience with ObamaCare is either lying or are too stupid to know how to use the Internet. This is the latest line by Senate Majority Leader Harry Reid (D-NV), anyway. Perhaps it’s these kinds of accusations that gave one Colorado woman the presence of mind to record her phone call with the “Connect for Health Colorado” navigator due to her own problems with the website.

Rebecca Ryan of Fort Collins has a preexisting condition but until recently, she was covered by a different government healthcare plan called “Cover Colorado.” The reason for changing her plan? As it turns Cover Colorado did not meet the requirements of ObamaCare and some 14,000 plans were canceled as a result. Rebecca liked her healthcare plan but wasn’t able to keep it. Sen. Reid wants Americans to believe Rebecca is lying about this “horror story” but this is only the beginning of Rebecca’s experience so far with ObamaCare.

As it turned out, Rebecca could save $15 a month with the new plan with one little caveat: she would lose her doctor whom she has received care from for the last 9 years. If, however; Rebecca wants to keep seeing this doctor she can do so if she is willing to pay an additional $140 a month:

Rebecca: So, the lowest monthly premium is, um, way higher than I was paying before and I thought this was supposed to be lower.

Rep: Now this could be way higher if it’s a doctor, if you have a doctor that’s (??) in there. So, often, if you have a doctor that you work with, you can be picking plans that are higher, if that doctor is a more specialized doctor.

Rebecca: She’s just a general family doctor. She’s not specialized.

A few minutes later, Rebecca was looking for dental coverage but was having some trouble with the website. The navigator explained that she needed to remove the filters Rebecca had in place for her doctor (stupid citizen!):

Rebecca: Do I have to go through the whole filter thing again?

Rep: Is your doctor listed when you hit ‘Find a Dental Plan’?

Rebecca: I don’t know why she would be. She’s not a dentist.

Rep: But she was put in as a provider? (pause)

Rebecca: Ok, my hospital was listed too, so I removed them both [as search filters]. However, what if I want to keep her? I’ve been with her a long time, and I don’t want a different doctor.

Rep: If you want to keep her then you’re looking to pay the 515 dollars a month.

Rebecca: So they’re going to penalize me because I want to keep my doctor?

Rep: Yes.

There you have it Mr. Reid. One individual whose experience is that 1. she lost the healthcare plan she liked, 2. can keep her doctor if she wants to pay a higher price, and 3. had some difficulty with the website (I’ll leave it to the readers and you to decide if its the fault of Rebecca or the website).

And lest you believe, Mr. Reid; that Rebecca, the original reporter on this story, or I have taken this call out of context, please feel free to listen to the entire 24 minute conversation in the player below.

You see Mr. Reid, no amount of smearing of the groups which oppose ObamaCare, no amount of calling people liars, and no amount of repeating “billionaire Koch brothers” can change the objective fact that some people are now worse off than before ObamaCare. Perhaps many others will also record these phone calls to expose your lies. I’m quite confident that Rebecca Ryan of Fort Collins, Colorado is but one person being hurt by this boondoggle.

I Want My — I Want My — I Want My DNA

Today the FDA dropped a big m-fing hammer on 23andme, a service that will allow you some insight into your own genome. They offer, along with the ability to get a raw report about the specific genes they track, some level of analysis of your genome. They can use your data to look for specific known genetic markers of inherited conditions, and giving you advance warning that you may be at elevated risk of certain problems. In addition, by trying to build a large database of genetic data, they are vastly accelerating the degree to which future genetic markers can be understood for analysis.

This, according to the FDA, is data used for diagnostic and prevention purposes, and therefore makes 23andme a “Medical Device”. Suffice to say that medical devices must to be FDA approved, according to the law, and 23andme hasn’t completed all the hoops necessary to allow me to spit in a cup and send it to a lab. So they can’t sell their kits any longer.

This puts some people, like my wife and myself, in a bit of a strange position.

As many of you know, our 4yo son is autistic. We’ve been through quite a bit to potentially understand the causes of his autism. Without getting too deep into the matter (there are many possible causes, each with its own camp of die-hard adherent believers, all of whom hate each other*), one of the avenues we’ve been traveling down is testing for various types of biomedical dysregulation. As a result, we’ve found that he has a genetic mutation common in a lot of autistic individuals related to what is called the “methylation pathway”. This is a biologic process related to brain activity and development, so the fact that it’s short-circuited gives some indication of where things can be helped**.

So my wife and I are taking this as a chance to better understand more about our own genetic profiles, and with the added benefit of determining more clearly where my son’s genetic mutations have come from***. So we both did the “spit in a tube” thing last week, and our samples are happily on their way to 23andme.

Now, I’m smart enough to know that genetics is NOT an exact science. That getting a report that there might be elevated risk for X doesn’t mean I have X****. I’m not going to use the information to make rash decisions about my medical care.

But it’s a start. It’s information that I don’t have today. It’s information that may be of immeasurable benefit to me in the near term and down the road, if it reveals something real. And it’s information that the FDA doesn’t trust me to have.

“Trust” is the term there. The FDA doesn’t trust us mere citizens. It doesn’t believe we’re capable of making decisions that affect our very lives. The 23andme genetic information isn’t perfect, but they believe that if we can’t get perfect information, we’re better off with no information. This information, of course, is getting better. One of the possible advantages of a widening circle of people partaking in 23andme research is that they can improve their ability to analyze a sample, looking for correlations years from now based on the sample I just gave. Part of the reason I wanted to do this was based upon expected future benefit in addition to learning about the aspects of my genetic that already relate to known markers.

So, our saliva is on the way. With the FDA’s recent proclamation, does that mean that 23andme will complete the testing on our samples? Or will the brakes be put on before they’re allowed to run the test? Will this action end up killing the company, so that even if I *do* get my results today there will never be any future research to make the findings more valuable to me?

So thanks a lot, FDA. You’re making me wonder if I’ll ever get the information I absolutely want and paid for. You’re making the future value of that investment lower, by putting into question the future of 23andme and the amount of data they have access to to analyze. And by doing so, you’re probably putting the brakes on the speed at which future genetic breakthroughs will manifest by artificially culling the data set. Nobody will know how many people will die in the future as a result of slower progress in the growing field of genetic research, but they won’t thank you, nor will I, for protecting me from this information today.

» Read more

Bye Bye 4th and 5th amendment: Obamacare info may be used for Law Enforcement and Audit activities

Well… we knew that the 4th and 5th amendment meant nothing to them… never mind HIPAA… but really?

 

Obamacare Marketplace: Personal Data Can Be Used For ‘Law Enforcement and Audit Activities’

Maryland’s Health Connection, the state’s Obamacare marketplace, has been plagued by delays in the first days of open enrollment. If users are able to endure long page-loading delays, they are presented with the website’s privacy policy, a ubiquitous fine-print feature on websites that often go unread. Nevertheless, users are asked to check off a box that they agree to the terms.

The policy contains many standard statements about information automatically collected regarding Internet browsers and IP addresses, temporary “cookies” used by the site, and website accessibility. However, at least two conditions may give some users pause before proceeding.

The first is regarding personal information submitted with an application for those users who follow through on the sign up process all the way to the end. The policy states that all information to help in applying for coverage and even for making a payment will be kept strictly confidential and only be used to carry out the function of the marketplace. There is, however, an exception: “[W]e may share information provided in your application with the appropriate authorities for law enforcement and audit activities.” Here is the entire paragraph from the policy the includes the exception [emphasis added]:

Should you decide to apply for health coverage through Maryland Health Connection, the information you supply in your application will be used to determine whether you are eligible for health and dental coverage offered through Maryland Health Connection and for insurance affordability programs. It also may be used to assist you in making a payment for the insurance plan you select, and for related automated reminders or other activities permitted by law. We will preserve the privacy of personal records and protect confidential or privileged information in full accordance with federal and State law. We will not sell your information to others. Any information that you provide to us in your application will be used only to carry out the functions of Maryland Health Connection. The only exception to this policy is that we may share information provided in your application with the appropriate authorities for law enforcement and audit activities.

The site does not specify if “appropriate authorities” refers only to state authorities or if it could include the federal government, as well. Neither is there any detail on what type of law enforcement and/or audit activities would justify the release of the personal information, or who exactly is authorized to make such a determination. An email to the Maryland Health Connection’s media contact seeking clarification has not yet been answered

The second privacy term that may prompt caution by users relates to email communications. The policy reads:

If you send us an e-mail, we use the information you send us to respond to your inquiry. E-mail correspondence may become a public record. As a public record, your correspondence could be disclosed to other parties upon their request in accordance with Maryland’s Public Information Act.

Since emails to the marketplace could conceivably involve private matters regarding finances, health history, and other sensitive issues, the fact that such information could be made part of the “public record” could prevent users from being as free with their information than they might otherwise be. However, as noted, any requests for such emails would still be subject to Maryland’s Public Information Act which contains certain exceptions to the disclosure rules.

Read the fine print eh?

 These are such clear 4th and 5th amendment violations I can’t believe anyone didn’t immediately say “uh guys… we cant actually do this”…

… but as I said, we know that our elected and selected “lords and masters” don’t give a damn about the 4th or 5th amendments (or really any of the others ones any time they become inconvenient).

So while I’m sure they were told they couldn’t do it, I’m sure they said “ahh well the disclaimer and release is enough, we’ll be fine”.

 Yeah no.

 And as far as HIPAA goes… In reality these terms of use are not anywhere near an adequate HIPAA disclosure release, so using any of this data in any manner other than for healthcare purposes would be a federal offense.

I am a cynically romantic optimistic pessimist. I am neither liberal, nor conservative. I am a (somewhat disgruntled) muscular minarchist… something like a constructive anarchist.

Basically what that means, is that I believe, all things being equal, responsible adults should be able to do whatever the hell they want to do, so long as nobody’s getting hurt, who isn’t paying extra

Defunding and Debt Limits and Shutdowns Oh My!

Welcome to the sideshow folks…

Step right up and enjoy the posturing, rhetoric, and antics of our congressional clown crew…

Over to your right you’ll see the amazing vocal endurance of Republican Senator from Texas Ted Cruz as he tosses red meat to the base…

… To be serious, there are a large group of people, who don’t understand why the rest of us consider what Ted Cruz did (a 21 hour “filibuster” of a motion in relation to items within a continuing resolution for funding the federal government for the next six months), both harmful to the country, and nothing more than grandstanding.

For them, it looks like Cruz was (in the composite words of many Americans on the right):

“Taking a brave and principled stand against the funding of a bad law that will harm our country.”

In reality, he was doing no such thing.

Cruz is being maligned by his own party because he was being a clown. This “filibuster” was nothing but a clown show.

It may be viscerally satisfying, but it’s idiotic. It will do absolutely NOTHING for the Republicans, of for those against Obamacare, except throw red meat to the stupider side of the base.

This is underpants gnomes strategy.

Step one: “Non-filibuster a piece of already passed legislation that I can’t stop by doing this… but that’s OK I wasn’t really trying to, really I was just trying to get media attention and attract donations from the less intelligent and aware side of my political base”.

Step two: … uh….

Step three: Electoral Victory?

“But, one brave man, standing up for what he believes in, can do amazing things. A small group of patriots can change the world, just look at the American revolution.”

No, they can’t. No guns involved in this one. No big foreign war distracting the occupying power. No actual fight going on among the actual fighters… just a series of bargaining and trading; while the rhetorical fight goes on among the spectators.

It may be emotionally satisfying rhetoric, but that’s all it is, rhetoric.

You are not a member of the patriotic few, bravely standing up against the despotic elite, risking all for freedom.

In fact, unless you support drug legalization, getting the state out of marriage…and almost everything else… giving up legislating morality and goodness entirely… You AREN’T EVEN ON THE GOOD GUYS SIDE.

You’re just another guy on the badguys side, who wants the badguys to tax the tea a little differently.

Oh and as “just another guy”, you actually aren’t on their side at all…

You’re a spectator rooting for your team from… not even the stands… from the comfort of your own home; with the game streamed lived via satellite into your living room.

“But what would you have us do? Just give up, let the Democrats run the country into the ground”

Nope… Not at all…

I’d have you stop assuming the rhetorical mantle of revolutionary patriot because it makes you feel good; and stop supporting things which reinforce that feeling, without actually DOING anything.

If you buy Ted Cruz’s stunt, you are perpetuating this crap.

If you want to actually do something… ACTUALLY DO SOMETHING. Get involved with your political party on a local level. Get onto policy committees. Become a subject matter expert for the party on something you know, and use that position to help steer the party, and the politicians in the party, in the right direction.

That’s actually doing something. This thing with Cruz? It’s just something you can say you supported so you can feel morally vindicated while not actually doing anything.

“You’ll see… Cruz was right, this is bad law and we must stop it. Cruz will be vindicated, time will tell”

Well of COURSE he’s RIGHT, we all know that… it’s AWFUL law… even Jon Stewart thinks it’s bad law… but that doesn’t mean he was doing any good… or even try to for that matter.

Vindicated how?

Sure he’s increasing his own fundraising, and certainly he’s right about Obama care… but to be vindicated you have to have done or said something substantive, and then been proven right later.

How has he done that?

He’s hurt the Republican party badly with the center, and provided yet another target for mockery and ridicule… and to scare those who think this sort of thing is either stupid or crazy…

Yes, he’s increased his own fundraising… and tripled that of everyone on the left.

This is not some brave heroic last stand. This was a foregone conclusion. Obamacare would never, under any circumstances, be defunded. This wasn’t a filibuster. This wasn’t moral courage.

If it was a serious attempt to stop Obamacare, fine, that would be great. Even if it were a futile attempt, if it were even structurally capable of stopping it, sure… it wasn’t and isn’t.

It wasn’t really even a symbolic gesture.

It was pandering, to the lowest common denominator. It was Ted Cruz setting himself up to be the poster boy for the low information voters of the right.

And he knew EXACTLY what he was doing… By all accounts Cruz is a brilliant man.

“It doesn’t matter if he was doomed to fail, it was the right thing to do anyway. Standing up for what’s right is never wrong”

If that’s what he was actually doing, I wouldn’t be so irritated by this.

I’m irritated because this is what they do instead of something useful. “I supported Ted Cruz’s filibuster but those nasty democrats and RINOs passed it anyway”

The people who believe this, don’t seem to understand that what Cruz did actually hurt us. Us being those of us who really fight against government overreach, and bad law.

It gave cover to the people who wanted to do nothing anyway, it encouraged a few whackjobs to make spectacles of themselves, and it INCREASED the morale and assumed moral authority of the other side.

Do you not realize how stupid and ridiculous this makes anti-obamacare people to the middle? How hysterical it makes them appear to the other sides donors? How this is a permanent harmful soundbite/video clip?

It’s idiots like this that made them able to paint Mitt Romney as an ultraconservative ultra right damn near American Taliban…

When in fact, he wasn’t conservative enough for a lot of people to bother even coming out, and they just stayed home rather than vote.

This is NOT a dedicated small group of principled people fighting against government overreach… That would be excellent.

This is the Republican equivalent of a college student “sticking it to the man” by wearing Che Guevara t-shirt an shouting about oppression and justice, out in front of the admin building.

“You don’t understand… Cruz is different… he’s the only one of the Republicans with the guts and the principle to stand up and do something”.

If he had actually done that, I would more than agree… I’d be cheering him on too.

But he didn’t.

If he were actually different… I’d be 100% behind him… Hell, I think he’s a good man, and in general he will probably be a good senator, though it’s a bit early to tell. If nothing else, he’s a LOT smarter than most Senators.

But really… other than that… he’s not much different than any other professional politician.

I’ve read the mans bio, read some of his speeches, hell I was even on a conference call with him and Marco Rubio at some party event during the campaign last year.

Yeah, he’s accomplished, and he’s got a hell of a back story (great family tale), but… what is it you think makes him so special?

He’s a smart guy, apparently a great legal mind, clerked for Rehnquist, editor of the Harvard law review… which are great things sure… but but I don’t see what you seem to see that makes him particularly exceptional among senators. He’s been a politician basically since law school; either full or part time.

He spent less than a year in private practice before going into an administration job, then less than 4 years out of the fedgov, where he ran for office twice, before going back to the fedgov.

He’s a professional politician.

I think he’s probably going to be a good senator (kinda hard to tell 9 months in), but I don’t see anything there that says anything other than professional politician… He’s a smart man and seemingly a good man… and those are great things… but he’s still a professional politician, and has never been anything but a professional politician.

I mean… he actually voted… in fact the senate voted unanimously 100-0… for the motion he was supposedly filibustering…

How can you even call it a filibuster if you’re going to vote for it?

So… In the next show, we have the “Government Shutdown”.

As of right now, the Republicans in congress have refused to sign any continuing appropriations bills that require the raising of the U.S. federal debt ceiling, and which fund Obamacare.

Therefore, the Republicans are trying to pull a repeat of 1996 and “shut down the government”; again to foster the illusion that they are taking a principled stand against excess spending and government waste etc… etc…

They aren’t.

“Why can’t they just balance the budget, instead of raising the debt ceiling again… That’s not a solution, that’s just making the problem worse?”

That’s the question of a well meaning, intelligent person, looking at this problem from a rational perspective…

So it’s completely irrelevant to anything they do in Washington of course.

First thing, the whole “Defund Obamacare” spiel is, and always has been, a sham. It’s more redmeat for the base. It’s not going to stop Obamacare, never was going to, never could; and even if it could, the republicans couldn’t get it past the senate, or a presidential veto, or an override etc… etc…

It’s just PR.

The Republicans saw what happened to Mitt Romney. They know that a large portion of the electorate doesn’t think they’re conservative enough and so won’t bother to vote for them… This is how they’re trying to address that issue. Nothing more substantive than that.

This still leaves the debt ceiling issue… and of course, incurring yet more federal debt is a bad thing. We are already at more than 105% of GDP (of course, that’s far lower than most other nations, but it’s still quite bad).

However, since it is quite literally impossible for any continuing appropriation to be passed that doesn’t require increasing the debt ceiling… In fact, even without a continuing appropriation the debt ceiling will need to be increased (because of credit payments, entitlements, and other already legislated spending); the debt ceiling is GOING to be raised.

Either that, or an accounting trick will be used to do the same thing.

It’s not a solution. It’s a requirement of the circumstances.

Balancing the budget… that’s a joke; given that we haven’t actually PASSED a budget or OPERATED under a budget , since 1997. From 1998, the government hasn’t been funded with a passed budget, it’s been funded with omnibus spending and special appropropriation bills, and continuing resolutions.

In fact, since Obama was elected, we haven’t even managed to pass an omnibus spending bill, and have exclusively funded the government with special appropriations and continuing resolutions.

The reality of the “debt ceiling” is, the U.S. is NOT going to default on its credit payments, under any circumstances.

In the first place, a U.S. credit default would trigger a world wide economic collapse and long term depression the likes of which have not been dreamed of outside of dystopian fiction.

So yeah… that’s bad… let’s not do that.

Even if that weren’t true, the politicians in this country are not going to let people miss entitlement payments… which is the whole reason why we don’t have a budget in the first place…

Every politician in America knows that if they get blamed for their constituents missing a social security check, they are done… dead… never to be elected to anything, even dog catcher, again.

So, any threat not to raise the debt ceiling, or to have a true and complete government shutdown, really is just grandstanding.

Until we make serious cuts to entitlements, we are not going to have anything close to a balanced budget. No politician in this country who has actually managed to get elected and wants to be re-elected is going to EVER under any circumstances, vote to cut entitlements. Therefore we are never going to have a balanced budget again… or at least not until there is a real unavoidable crisis, where they can cover themselves by saying “we had to do it to save the country”, and their opponents can only look like irresponsible liars if they try to say otherwise…

Of course, if this country weren’t filled with economically and politically ignorant “citizens”, then perhaps the electorate as a whole would understand that we’ve long past the point at which such a crisis could be avoided, and that something really needs to be done right now…

Unfortunately, what looked like it was going to be the first major group of voters working for entitlement cuts in this country, the “tea party”; was quickly overrun by a huge number of these idiots who, completely un-self aware were saying, with complete sincerity “get the government out of healthcare and welfare… but don’t touch my social security and medicare”.

The politicians noticed this… Particularly the smart ones… Like, say, Ted Cruz.

I am a cynically romantic optimistic pessimist. I am neither liberal, nor conservative. I am a (somewhat disgruntled) muscular minarchist… something like a constructive anarchist.

Basically what that means, is that I believe, all things being equal, responsible adults should be able to do whatever the hell they want to do, so long as nobody’s getting hurt, who isn’t paying extra

Open Thread Question of the Day: Now that ObamaCare is Here, What Are You Going to Do About Your Own Healthcare?

Like it or not, ObamaCare is here. Much has been written about the overall chaos this law will have on employment, the cost of healthcare, and the economy overall. What I am interested in, however; is what are you as an individual going to do regarding your own healthcare choices? Are you going to stay on your employer’s plan, sign up for the exchanges, pay the fine or do something else? Also, I’m interested in finding out if any readers have already had experiences, good or bad regarding ObamaCare.

Don’t Bail the Democrats Out By ‘Defunding’ Obamacare

If something isn’t done to stop the train wreck known as Obamacare before next year, the healthcare system and the economy will suffer. Tea Party Republicans in the House and Senate have vowed to “defund” Obamacare even if it means shutting the government down. Obviously, opponents of this law should do everything possible to stop this from happening…right?

Maybe it’s not so obvious.

Obamacare cannot truly be defunded because the spending is built into the law itself but for the sake of argument, lets say there was some loophole that would make defunding possible. Why would Republicans want to bail the Democrats out? The Democrats own this legislation because not a single Republican voted in favor.

Let the Democrats suffer the consequences at the ballot box in 2014 and 2016. If the Republicans somehow managed to delay, add exemptions from some of the laws worst aspects, or alter Obamacare’s implementation, the Democrats would then have an out. President Obama could resort to his usual demagoguery in the campaign season the “Affordable Care Act would have worked if the Tea Party extremists hadn’t screwed it up!” The Obama media would be more than happy to echo this party line.

There is a better way. What if allowing Obamacare to be fully implemented as scheduled would lead to its ultimate demise? Far from trying to soften the blow or delay the law’s implementation, opponents of the bill, especially Republicans in positions of leadership should call the president’s bluff and let the train wreck occur. Over the many objections from many of us, Obamacare passed, failed numerous repeal efforts, and prevailed in the Supreme Court.

Also, consider that Obama was reelected. Its time for the American people to take their medicine and live with the consequences. We keep hearing about how the progressives have a better plan than those of us who believe in smaller government and free markets; let’s find out together just how wise they are!

No delays to save incumbents in the 2014 election. No waivers for employees, employers, the labor unions, for Congress, or for government workers. No waivers for anyone. How many times have we heard progressives say “we’re all in this together”? We should call their bluff on this as well.

To the extent that President Obama is trying to selectively enforce the law, Republicans should challenge his authority to do so in the courts and ask the president why he wants to delay his signature accomplishment as president.

Let the American people experience the broken promises of Obamacare for themselves. Let the Democrats defend the law in the 2014 campaign when voters see their work hours cut to less than 30 hours a week (if they are lucky to keep their jobs at all), their premiums rise, and/or lose the insurance plans they already have.

If after the American people (and I mean all of the American people) experience this pain sooner than later and still decide that Obamacare is the way to reform health care then I suppose we are getting exactly the system we deserve.

Free Market Organs: The Case for Capitalism in the Organ Transplant System

A 10-year old Pennsylvania girl by the name of Sarah Murnaghan could die within a few weeks if she doesn’t receive a lung transplant soon. There’s currently a petition on Change.org directed at HHS Secretary Kathleen Sebelius to alter the current policy so that Sarah is made a higher priority on the donor list because the clock is ticking at least somewhat faster than some who are ahead of her.

I’ll leave it to the readers to determine if this petition is the right way to go in the case of Sarah, but I think there is a much larger problem with the organ donation system that I believe could be addressed by the free market. Back in 2008, I wrote a post about why a regulated, above board organ market would be superior and much more moral than the current “altruistic” system. Some of my examples might be a little dated (Hanna Montana is all grown up now) but my overall point stands. Though this post is mostly about live donations, compensation going to an individual’s estate would give Sarah and countless others a much better shot at living.

Free Market Organs (Posted January 24, 2008)

Last week, Doug linked a post about British Prime Minister Gordon Brown’s support for a policy that would allow hospitals to harvest organs without prior consent of the decedent or his/ her family. In essence, the organs of all deceased British citizens would belong to the government’s healthcare system except for those individuals who “opted out” prior to death. The policy in the U.S. is an “opt in” approach rather than “opt out.”

Why is this distinction important? Answer: the presumption of ownership. If citizens have an option of opting in, this shows that individuals own their bodies; to suggest that an individual has to opt out shows that citizens’ bodies are property of the government (unless s/he makes an affirmative claim on his/her body).

The reason for Brown’s support for this policy is quite obvious: like just about everywhere else in the world, Britain is having an organ shortage. So if presumed consent is not the answer to solving the organ shortage, what is? Randolph Beard, John D. Jackson, and David L. Kaserman of Auburn University published a study in the Winter 2008 issue of Cato’s Regulation Magazine. The team studied the effectiveness of current policies aimed at maximizing donor participation and organ matching. Among the policies they analyzed were: increased government funding for organ donor education, organ donor cards (such as having the words “organ donor” on driver’s licenses), required request, kidney exchange programs, and donor reimbursement. None of the policies have come close to solving the shortage. The researchers estimate that roughly half of the potentially viable cadaver organs are ever harvested. With the exception of the inefficient kidney exchange program, one feature that all of these programs have in common is that they each rely on altruism on the part of individuals to donate organs without any sort of compensation.

The one solution which the researchers believe would be effective, monetary compensation to organ donors or their families, is illegal almost everywhere. In 1984, the National Organ Transplant Act was passed making it a crime in the U.S. for a surviving family to receive payment for their loved one’s organs. The law was passed mostly on ethical grounds without any consideration for what would happen to the supply of available organs. The researchers estimate that some 80,000 lives from 1984 to present have been lost because of the bill’s passage and other subsequent policies in the current “altruistic” system. The researchers further project that another 196,310 lives will be lost between 2005- 2015 (and this is what they consider a “conservative” estimate!).

As controversial as compensating families organs of deceased family members is, the thought of an individual driving to a hospital, removing an organ (such as a kidney), and selling that organ to someone in need of the organ for a profit is a complete non-starter. This shouldn’t come as a shock given that in today’s lexicon; the word “profit” is a dirty word. The people who scream bloody murder whenever people decide to “scalp” tickets to sporting events or tickets for Hanna Montana concerts (what’s the big deal with Hanna Montana anyway?) will not likely be in favor of selling vital organs. Anti-capitalist objections aside, free market buying and selling of organs appears to be the most practical solution.

Cato Institute’s Director of Bioethics Studies Sigrid Fry-Revere found that Iran is the only country that does not have an organ shortage and has not had a shortage in ten years. Why? Because Iran (of all places!) is one of the only countries where it is legal for individuals to buy and sell organs from live, voluntary, donations. Revere’s findings also revealed that even if all the viable organs were taken by force by the government from cadavers, there would still not be enough organs to provide an organ to everyone who needs one (Cato Daily Podcast dated January 15, 2008). Maybe the Iranians are on to something here? David Holcberg, writing for Capitalism Magazine agrees arguing in favor of a free market system for organs on both practical and moral grounds:

If you were sick and needed a kidney transplant, you would soon find out that there is a waiting line–and that there are 70,000 people ahead of you, 4,000 of whom will die within a year. If you couldn’t find a willing and compatible donor among your friends and family, you could try to find a stranger willing to give you his kidney–but you would not be allowed to pay him. In fact, the law would not permit you to give him any value in exchange for his kidney. As far as the law is concerned, no one can profit from donating an organ–even if that policy costs you your life. Patients’ attempt to circumvent this deplorable state of affairs has led to the emergence of “paired” kidney donations, an arrangement whereby two individuals–who can’t donate their organs to their loves ones because of medical incompatibility–agree that each will donate a kidney to a friend or family member of the other. But this exchange of value for value is precisely what today’s law forbids. Thus, under pressure to allow this type of exchange, in December the U.S. House and Senate passed The Living Kidney Organ Donation Clarification Act, which amends the National Organ Transplant Act to exempt “paired” donations of kidneys from prosecution.

The congress says that kidneys can be exchanged without sending anyone to jail; how thoughtful. While this is an encouraging step in the right direction, why won’t our elected officials go the rest of the way? Is it the potential risks for the donors? Holcberg points out that the risk for a healthy person dying from donating a kidney is about .03% and usually live normal lives without reducing his or her life expectancy.

No, I suspect the objection to selling organs is more rooted in the overall distain far too many people have towards capitalism. It’s simply unethical to make a profit off of something that someone else “needs” whether its gasoline, Hanna Montana tickets, or a kidney. Only the “privileged” will be able to buy organs if such a system were adopted, they would argue.

Even if this were true, denying a person the right to purchase an organ to save his or her own life should not be subject to a vote or someone else’s ethical hang-ups. If I want to remove a kidney and sell it to a willing buyer for $30,000 (or whatever the going market rate is) I ought to have that right. Why must we assume the government has the right to tell us what we can do with our bodies whether it’s selling our organs by our own choices or government taking them from us after we die without prior consent? Our individual rights of life, liberty, and property demand that we have the ability to make these choices for ourselves.

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