Category Archives: Healthcare

Should We Force Women To Bear Disabled Children?

Rick Santorum believes that the Obama administration is in favor of some Gattaca-like dystopia, I suppose:

“One of the things that you don’t know about ObamaCare in one of the mandates is they require free prenatal testing,” Santorum began telling about 400 people here. “Why? Because free prenatal testing ends up in more abortions and, therefore, less care that has to be done, because we cull the ranks of the disabled in our society. That too is part of ObamaCare — another hidden message as to what president Obama thinks of those who are less able than the elites who want to govern our country.”

Now, I’m in a weird position to discuss this, because I’m a bit of a pro-life libertarian, but at the same time I’m very libertarian about being pro-life. I think when it comes to my wife and I, I’m very strongly pro-life. But that said, I’m not sure I’m strong enough in the belief in being pro-life that I’d throw a woman or a doctor in a cage for aborting a pregnancy.

My wife and I have two kids, are expecting a third. For the first two, we deliberately declined the amniocentesis because we were willing to bear the child regardless of the results. It seemed that sticking a needle into my wife’s uterus is probably a silly risk to take [despite being a low-risk procedure] when we had no intention of letting the results change our behavior. With the third, it appears that medical technology has advanced to the point now where a blood test & ultrasound can now determine if there’s any major risk-factors, and luckily the results to date are that rather than being a 1 in 200 chance of having a baby with Down’s Syndrome, we’re happy to say that the odds are 1 in 11,000. It is nice to know that.

But do I want to force a woman to bear a child with Down’s? Do I think we should somehow cheer those women as being heroes, as folks like Santorum, who has a disabled child, and Palin, who has a disabled child, are cheered by the right? The responsibility of raising a child is huge, and it’s hard enough to do with a non-disabled child. Do we want to force that on people who are unwilling — or unable — to bear it?

This hits home for my wife and I. In October, we found out that our younger son was diagnosed with autism. We had some idea prior to this that something was amiss, as he wasn’t talking (nor showing much interest in starting, i.e. making the normal child “babble”). Autism is a scary diagnosis, especially with a 2 1/2 year old. With now 4 months of intensive speech therapy, at best we can say that we’re seeing improvement, but it’s slow going. Not a week goes by that my wife doesn’t ask me, “He’s going to talk eventually, right??” Well, I think he is, but we’re not seeing it happen so much yet. He has many of the characteristic behaviors — he’s very picky about environment and routine, not at all interested in interacting with other children [and will throw a fit when they encroach on his space]. Trying to get a haircut requires my wife and I to work together to hold him down in a seat as he screams and struggles while the lady at “Cool Cuts 4 Kids” tries not to cut his head, rather than his hair. At 2 1/2 years old, the first time he ever let me clip his fingernails was last Friday. And the worst thing of all is that he has no concept of language, so while you can sometimes soothe or explain what’s wrong to a 2 1/2 year old, nothing gets through. I believe it will be easier someday, due to all the work that we’re putting in now to intervene, but severe cases of autism sometimes never result in an adult who can function for themselves in society.

As I said, had my wife and I known this prior to his birth, we still would have had him. But had my wife and I known before she’d conceived that this was going to happen, I’m not ashamed to say we might have waited a month to avoid this outcome. I dearly love my son, and I can honestly say that he regularly brings great joy to my life. But it’s hard. It’s really hard. And I know that it’s going to be hard — that he’s going to face difficulties doing “normal” things — all his life. I wouldn’t tell prospective parents that I wish they have an autistic child. Every parent wants to have a child that they can mold into a success, emotionally and intellectually. This diagnosis is a disability that means that we’ll have to work that much harder to overcome. We want him to have all the success that my wife and I have had in life, and that his older brother [and his upcoming younger sibling] have in life. We know, as parents, that we and that he are going to have to work much harder than “typical” for him to achieve that success. We’re willing to take that on; but I can’t say it’s what we would have chosen, all things being equal.

Nor is it only an emotional and parental burden — it is financial. We’re lucky, as parents go. I have an excellent job with pretty good insurance, and a lot of what we’re doing is covered by my insurance or through non-profits funded by the State of CA. That said, I’m on an HSA-driven health care plan, so we’ve got a pretty sizable deductible, and we blew through it in 3 months of his therapy. All told, we’re talking about costs related to the diagnosis and associated other testing that would have cost close to $10K at “book” prices (obviously the insurance-negotiated rates are lower), and ongoing therapy that would cost at least $2K/month at “book” prices, and still at least $1K/month at insurance-negotiated prices. To give our son the level of care that we feel he needs without all the insurance might be possible, but would be extremely painful (likely requiring us to move out of our house to a cheaper rental, or for my wife to get a job outside the house, which we’d especially want to avoid as she needs to keep up with his care & therapy). And it would only be possible for us to do because I’m the exception, rather than the rule, when it comes to economics.

Rick Santorum suggests that Obama wants to “cull the disabled” as a cost-saving measure — it’s easy to say that when you have the level of wealth that Rick Santorum (and to a lesser extent, upper-middle-class folks like myself) have access to. When you don’t have access to the level of care that we can provide, you’re consigning your disabled children to a second-class life. I don’t think that’s a Republican value, nor do I think it’s a Christian value*, to bring people into this world and not be ready and able to give them the tools to succeed in life. Rick Santorum might say “well then you should be chaste and not produce a child” — but being ready and able to provide those tools for a normal child, and being ready and able to provide those tools to a disabled child, are two very different things. (*Full disclosure — I’m neither a Republican nor a Christian, so perhaps I can’t necessarily hold court on those two declarations)

When it comes to autism, unlike something like Down’s, though, the “typical” case can be “recovered”. It’s tough to describe, but I often say that autism is something that makes “normal” things a lot more difficult than they would be for non-disabled people. Most of these difficult things can be language-oriented, and we know that language development occurs in fury in the 0-3 year range. During this time, a child is developing mental pathways in the brain, and it’s much easier at these early years than later in life. One of the critical problems dealing with autism is that we don’t typically know a child is autistic until after he starts displaying speech delays, i.e. after the age of two. This means that the intervention after the age of two to get an autistic child to “catch up” to their more typical peers must be very intense — right now my son is in 8 hours of speech, OT, and ABA therapies every week, and we’re looking to get some of the hours increased. The goal is to slam those neural pathways into place through repetition, because they don’t come naturally.

What does this mean? It means that knowledge that a child is autistic prior to that child’s birth can be a signal to provide therapy for the autism at a much younger age. It means that instead of waiting for a delay to be prevalent, you’re working hard from day 1 to ensure a delay never develops. It still means there’s a lot more work than a typical child, as the neural pathways that the child would normally develop don’t happen on their own. But it means that you can be building those pathways earlier in life, and get better outcomes for those children — something that Rick Santorum and Barack Obama can agree is the goal.

Rick Santorum claims that Obama wants to provide this testing so those children will not be born. As much as I’m against Obamacare, I think Rick Santorum’s positions on abortion suggests that he cares a lot more about making sure those children are born than he cares about what life they’re born into. Those of us in the real world are trying to make good lives for our children — whether we choose to have them or choose not to because we cannot provide an adequate life — and prenatal testing gives valuable information whatever that choice might be.

Katy Bar the Door: Social Conservatives Want in Your Bedroom Too

Last week, I wrote a post about how the Left wants in the bedrooms of the people by mandating health insurance coverage for contraceptives. On the other extreme, we have Rick “every sperm is sacred” Santorum talking about the “dangers of contraceptives” and how non-procreative sex is somehow bad for society (as if concerns about “society” should trump the rights of the individual). I intended to write a full post devoted to making the opposite point (Does anyone really think that millions more unplanned births would actually be good for society?) and referencing a very interesting conclusion Steven Levitt made in a chapter his book Freakonomics called “It’s not Always a Wonderful Life.”

But I’m not going to do that. Santorum and his supporters’ antipathy for individuals making their own value judgments about sex has been documented on other blogs and I don’t know that I can really add much that hasn’t already been written. Having said that, I think Rick Moran at PJ Media nearly perfectly captures my concerns about Santorum and Social Conservatives more generally in his post: “The GOP’s Problem with Sex Could Cost Them in November.”

[Social Conservatives’] outdated, even primitive, critique of human sexuality that denies both the science and the cultural importance of sex and the sex act. Their main target appears to be women, and women’s sex lives, although the act of love itself is also to be placed in a strait jacket. No doubt the right will argue that their criticisms are only meant to help women, and nurture “healthy” attitudes toward sex. Nonsense. First of all, women don’t need that kind of help. They are capable of making their own choices without a bunch of ignorant busybodies telling them how to govern the most intimate and personal aspects of their lives.

Secondly, there is inherent in this critique a 19th century — or earlier — view of sex that seeks to keep the act of love within the confines of the marriage bed, and believes that physical intimacy should be primarily for one reason, and one reason only: procreation. At the very least, sex outside of marriage should be severely proscribed and limited to those who plan a long term relationship or eventual matrimony. Having sex because it’s fun, or because you’re bored, or because you crave physical intimacy, or for any other reason beyond traditional notions of “love” is grounds for disapprobation.

Certainly religion has much to do with this assault on sex. And if the extent of their critique stayed in the pews and pulpits of conservative churches, there would be no problem whatsoever. Christian denominations can tell their adherents how to live their lives, citing chapter and verse from the Bible, and nobody would care.

But when Republican politicians, and others associated with conservatism or the Republican Party, start echoing the various criticisms of contraception, of casual sex, of sex outside of marriage, the perception cannot be dismissed that the imprimatur of the entire party — and consequently, the government if they ever came to power — has been granted and that somebody, somewhere, might want to do something about it. As a voter making a political calculus on how to mark one’s ballot, the GOP is kidding itself if they don’t think this affects the decisions of millions of citizens.

Where do these people get off? Apparently they don’t…unless it’s for the purpose of procreation. No wonder they are so uptight!

Either You Want Government Out of Your Bedroom or You Don’t

One way we libertarians often describe ourselves are individuals who don’t want the government in our bedroom or our boardrooms. Those on the Left typically agree with the former while disagreeing with the latter while those on the Right typically believe the reverse. Yet when it comes to the federal government mandating that all health insurance policies provide “free” contraception via Obamacare, suddenly the Left wants the government in the bedroom while the Right correctly wants no part of it.

President Obama seems to believe (or more likely, wants us to believe) that by decreeing that contraception be free that it will be. No, birth control devices cost no money to develop, test, produce, or distribute; somehow these products are immune from the notion that there is no such thing as a free lunch*. This is the kind of policy that causes health insurance to go up in price because now everyone pays just a little more on their premiums whether everyone wants or needs contraception or not.

Much of the debate on this mandate has centered around the idea that Catholic and other religious organizations should be forced to either directly or indirectly provide contraception in their healthcare plans. Like Brian Lehman writes at United Liberty, this is missing the point. As a pro-choice libertarian atheist, I too am offended by the notion that I must pay for coverage I don’t want or need**. Why don’t I have a right to choose the level of coverage that suits my family’s healthcare needs?

Some healthcare providers may determine that offering the coverage is more cost effective than covering unplanned pregnancies and all that entails. Others may come to a different conclusion. In a more perfect world, individuals would be able to shop around for the right coverage independent of employers or the government. This would take the politics out of the issue except for those who insist that contraception is a right. (Here’s a hint: it isn’t.)

Contraception is a good thing and we are very fortunate to live in a time when we can better plan if or when we want to have children but those who choose to be sexually active should take responsibility for providing it. Is it really too much to ask to buy your own condoms, pills, shots, or whatever? If for some reason you cannot afford contraception, there are organizations that offer these products and services at little or no cost. When did your orgasm become my responsibility?

I think it’s time for my friends particularly on the Left to make a decision: do you really want the government in your bedroom? I sure as hell don’t!

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Institute for Justice’s Bone Marrow Donor Compensation Legal Challenge Prevails

Here’s a follow up to a story I linked back in 2009 concerning the Institute for Justice’s legal challenge to the National Organ Transplant Act of 1984 and the act’s applicability to bone marrow transplants. This is very good news for the roughly 3,000 Americans who die every year while waiting to find a bone marrow match:

Arlington, Va.—The Ninth U.S. Circuit Court of Appeals today issued a unanimous opinion granting victory to cancer patients and their supporters from across the nation in a landmark constitutional challenge brought against the U.S. Attorney General. The lawsuit, filed by the Institute for Justice on behalf of cancer patients, their families, an internationally renowned marrow-transplant surgeon, and a California nonprofit group, seeks to allow individuals to create a pilot program that would encourage more bone-marrow donations by offering modest compensation—such as a scholarship or housing allowance—to donors. The program had been blocked by a federal law, the National Organ Transplant Act (NOTA), which makes compensating donors of these renewable cells a major felony punishable by up to five years in prison.

Under today’s decision, this pilot program will be perfectly legal, provided the donated cells are taken from a donor’s bloodstream rather than the hip. (Approximately 70 percent of all bone marrow donations are offered through the arm in a manner similar to donating whole blood.) Now, as a result of this legal victory, not only will the pilot programs the plaintiffs looked to create be considered legal, but any form of compensation for marrow donors would be legal within the boundaries of the Ninth Circuit, which includes California, Alaska, Arizona, Hawaii, Idaho, Montana, Nevada, Oregon, Washington and various other U.S. territories.

[…]

Rowes concluded, “This case isn’t about medicine; everyone agrees that bone marrow transplants save lives. This case is about whether individuals can make choices about compensating someone or receiving compensation for making a bone marrow donation without the government stopping them.”

Quote Of The Day

From a commenter over at Kevin Drum’s place. The discussion was about problems with the American educational system:

Yep. And as the posts by Aaron Carroll and Austin Frakt have shown over the last year (link below) the same is true of our health care system. We’ve gone through a 30+ year binge of hypercapitalism, naively believing the free market is a magic bullet for all problems. Health care and education stand as clear counter-examples and unless we get our act together national decline is inevitable.

Yes, the intense reliance on the free market in our education and healthcare systems clearly proves that capitalism doesn’t work. And here I thought that those areas of our economy were dominated by government, not the free market. Silly me!

Guest Post: A Five-Part Plan For Fixing America’s Health Care System

Today’s post was written by regular commenter Dr. Gregory Tetrault (aka “Dr. T”). Dr. Tetrault is a clinical pathologist who has directed four different medical laboratories since 1989. He was an Associate Professor of Pathology and Laboratory Medicine at the University of Tennessee Medical Center until 2009. His plan below is, IMHO, a realistic way to introduce crucial market-based reforms into our medical system while still maintaining a social safety net. Enjoy!

Health care costs have increased far faster than the general rate of inflation for decades. The most important cause was the transition from out-of-pocket payments for routine medical care (common in the early 1960s) to employer-based or government-based insurance or health maintenance organization (HMO) coverage. This produced price insensitivity among consumers, who believed that their insurance premiums paid for all the medical care as they wanted, and allowed medical costs to rise rapidly. We cannot rein-in health care costs without making drastic changes to our health care payment systems. My five-part proposal, if implemented, could reduce health care costs.

  1. Dissociate health insurance from employment.

    Employers don’t provide home insurance or vehicle insurance. They should not provide health insurance, either. A disadvantage of the current situation is that workers with chronic health problems become tied to their employer—if they switch employers their new health care plan typically will not cover their existing medical problems. Another disadvantage of the current situation is that most employers offer only a few health insurance options. Workers who opt out rarely get fully reimbursed for what the employer would contribute, cannot deduct health insurance premiums from their income taxes, and usually pay more for health insurance because they aren’t in a group plan.

  2. Require all adults to either purchase catastrophic health insurance for themselves and their dependents or provide proof that they can afford a moderately expensive hospital stay.

    This proposal is similar to the requirements in most states that all vehicle owners buy insurance or provide proof that they can pay for damages. The requirement violates libertarian principles, but it is necessary because clinicians and hospitals must provide medical care even if the ill or injured patient cannot pay. A fully libertarian approach would mean refusing to care for patients who cannot recompense providers at a mutually acceptable price. We aren’t ready for that much libertarianism.

  3. Require health insurance companies to accept all customers (no cherry picking) with only moderate stratification of premiums based on age and controllable risk factors (such as smoking).

    Insurers and others apparently forget that the purpose of insurance is to spread the costs of catastrophic events across the pool of insured persons. Insurers should not be classifying, sub-classifying, and sub-sub-classifying individual risks before calculating premiums. They should lump similar persons into large groups and charge everyone in each group the same premium. Example groups: 40- to 49-year-old male non-smokers, 20- to 29-year-old female smokers, 0- to 5-year-old children, etc. As an incentive for healthy behavior, insurers could offer discounts to those who can prove they are fit and in above-average health.

  4. Give a tax credit for health insurance premiums based on the cost of a minimal coverage policy to lessen the financial impact on the lower middle-class.

    This credit would replace the tax-deduction given to employers who provide health insurance to employees. The credit is capped at the cost of the minimum required health insurance plan to prevent large tax credits for those who buy expensive, low-deductible or full-coverage insurance.

  5. Create a taxpayer-funded (or, better yet, a charity-funded) health insurance voucher program for low income persons.

    This would replace Medicaid. Eligible persons would choose a health insurance provider and a coverage plan and use vouchers to pay all or part of the premiums. The eligible persons would be responsible for their out-of-pocket health care expenses, but health care providers could offer discounts, delayed payment plans, or free care (something that is not allowed under current Medicaid and Medicare rules).

This five-part proposal will give workers bigger paychecks (no employer health insurance deductions) and return most routine care to an out-of-pocket payment system. The mandatory catastrophic health care insurance will prevent bankruptcies after serious illnesses or injuries. The proposal allows people to purchase however much health insurance they desire from HMOs, preferred provider organizations (PPOs), or other types of plans. Implementing this proposal would make people aware of the full costs of health care services. Some people will refuse expensive care or negotiate lower charges. Such actions will reduce overall health care costs.

Businesses will be pleased because this proposal reduces operating costs: no administrative personnel will be needed for handling employer-based health insurance. Productivity would rise slightly because employees would not spend working hours choosing employer-provided health insurance plans or solving problems related to health insurance claims.

Health care providers will experience reduced billing costs because most people will pay directly for routine medical care, dentistry, prescriptions, laboratory tests, and imaging studies such as x-rays and simple ultrasound exams. Elimination of Medicaid with its poor reimbursement and excessive documentation requirements will greatly benefit many providers.

The losers if this proposal is implemented are: employees who work in health insurance benefits subdivisions of businesses, government bureaucrats who hoped to control the health care economy, and advocates of ‘nannystate’ government who believe that Joe and Jane Average are incapable of making health care financial decisions lose. The winners outnumber the losers by at least 1,000 to 1.

Quote of the Day: Wet Blanket Edition

President Obama and his sycophant Keynesian friends in the MSM can’t quite figure out why his policies haven’t improved the economy. Maybe President Obama should listen to an actual job creator, Steve Wynn to get some clue about why businesses aren’t expanding.

Here is an excerpt from Wynn from a recent conference call where he describes Obama’s policies as “the greatest wet blanket to business, and progress and job creation in my lifetime.”

[Partial transcript, Wynn responding to a question during the Q&A portion of the conference call]

“Well, here’s our problem. There are a host of opportunities for expansion in Las Vegas, a host of opportunities to create tens of thousands of jobs in Las Vegas. I know that I could do 10,000 more myself and according to the Chamber of Commerce and the Visitors Convention Bureau, if we hired 10,000 employees, it would create another 20,000 additional jobs for a grand total of 30,000 […] And I’m saying it bluntly, that this administration is the greatest wet blanket to business, and progress and job creation in my lifetime. And I can prove it and I could spend the next 3 hours giving you examples of all of us in this market place that are frightened to death about all the new regulations, our healthcare costs escalate, regulations coming from left and right. A President that seems — that keeps using that word redistribution. Well, my customers and the companies that provide the vitality for the hospitality and restaurant industry, in the United States of America, they are frightened of this administration. And it makes you slow down and not invest your money. Everybody complains about how much money is on the side in America. You bet. And until we change the tempo and the conversation from Washington, it’s not going to change. And those of us who have business opportunities and the capital to do it are going to sit in fear of the President. And a lot of people don’t want to say that. They’ll say, “Oh God, don’t be attacking Obama.” Well, this is Obama’s deal, and it’s Obama that’s responsible for this fear in America. The guy keeps making speeches about redistribution, and maybe we ought to do something to businesses that don’t invest or holding too much money. We haven’t heard that kind of talk except from pure socialists. Everybody’s afraid of the government, and there’s no need to soft peddling it, it’s the truth. It is the truth. And that’s true of Democratic businessman and Republican businessman, and I am a Democratic businessman and I support Harry Reid. I support Democrats and Republicans. And I’m telling you that the business community in this company is frightened to death of the weird political philosophy of the President of the United States. And until he’s gone, everybody’s going to be sitting on their thumbs.

Will Individualized Medicine Increase Health Inequality?

Ezra Klein has a rather thought-provoking post today about human genome sequencing and its ability to allow doctors to better-tailor treatment to the specific needs of an individual patient. It presents a phenomenal opportunity to both make medicine more effective, and IMHO to make it cheaper by spending less time and energy on substandard treatments. Ezra raised a different point, though, and I think makes a logical error that warrants further discussion:

If that’s the path that medical advances ultimately take, one byproduct will be an immense explosion in health inequality. Right now, health inequality, though significant, is moderated by the fact that the marginal treatments that someone with unlimited resources can access simply don’t work that much better than the treatments someone with more modest means can access. In some cases, they’re significantly worse. In most cases, they’re pretty similar, and often literally the same.

But as those treatments begin to work better, and as we develop the ability to tailor treatments to individuals, we should expect that someone who can pay for the best treatments for their particular DNA sequences to achieve far better health-care outcomes than someone who can’t afford the best treatments and has to settle for general therapies rather than individualized medicine.

I believe Ezra makes assumes the premise that the “best” treatments are also the most expensive treatments. I believe this to be unsupported by evidence.

Suppose 10 different people all happen to have the same malady. To use a common one, let’s say that the malady is hypertension. Multiple drugs today exist for the treatment of hypertension. Some of them may be specific variants (branded or generic) of medications all within a specific class, but often multiple classes of drugs may be used to treat hypertension. Those multiple classes will affect different people in different ways, but my guess is that a typical doctor will offer a “standard” treatment regimen for hypertension and only deviate from that standard if something doesn’t appear to be effective. What’s further important to note is that different doctors may have different “standard” regimen, based on their own experience rather than exact current medical literature.

What the idea of genome sequencing may bring to the table is that medical research can form stronger predictions of a particular person’s response to certain medicines based upon their specific genes, and it is easier to tailor the treatment to the patient. This doesn’t mean that the rich person’s treatment will be more expensive than a poor person’s, but it does mean that someone who has genome sequencing will likely have more effective treatment than someone who does not. What it also means is that someone who has genome sequencing may actually have less expensive medical treatment than someone without, as less effort and dollars can be used adding treatments that are statistically likely to be ineffective.

And herein lies the rub. Will a rich person have better access to genome sequencing than a poor person? Not if we have Ezra’s wet dream: government socialized health care. Once effectiveness at reducing costs is shown, government in its awesome authoritarian-ness will undoubtedly use the desire for cost-cutting in medical treatment to demand genome sequencing of anyone participating in Obamacare. Sure, we civil libertarians will soundly object to government getting access to everyone’s DNA, but I’m sure they’ll tell us, much like they do with the TSA pornoscanners and told us with our social security numbers, that there’s NO CHANCE the genome information will ever be used for anything other than our medical care, and will be completely confidential. And since nobody listens to us civil libertarians today, they’ll get it done.

If Ezra looks at the potential from this angle, I think he’d change his tune. If he sees genome sequencing as a potential cost-cutting measure, rather than an inequality-increasing measure, I’m sure he’d actually push for wider adoption of it. And like any government authoritarian impulse, if something is good [and if we’re paying for it with tax dollars], we might as well make it mandatory, right?

Wrangling Long-Term Costs

Ezra Klein, on education & health care costs:

I’m not going to end this post with some wan paragraph explaining how to transform these two industries into something closer to their potential. My ideas on health-care reform are available elsewhere on the blog and I don’t know enough about education to say anything worthwhile. But if you asked me to paint an optimistic picture of the American economy over the next three or four decades, the story I’d tell you would mainly be about how we finally figured out how to drag health care and education into the 21st century. And if you asked me to paint you a pessimistic story of the next three or four decades, it’d be about how we failed to do that, and the two sectors continued eating up more and more of our money while delivering less and less value.

Well, good news, Ezra! Those two sectors are increasingly coming under bureaucratic government control, so I’m just sure we’ll figure out the answers to these hard problems! It’s not like Washington has any history of eating up more and more of our money while delivering less and less value

Gov. Johnson Takes on Hannity

Former New Mexico Gov. Gary “Veto” Johnson made a recent appearance on Hannity last week (see video below). I have to say I was pleasantly surprised both with how Sean Hannity conducted the interview and how Gov. Johnson responded. I haven’t really watched Hannity since before the “& Colmes” was dropped a few years ago; from what I remembered he didn’t normally allow guests he disagreed with explain their position (especially on topics like drug legalization). I was also happy that he gave Gov. Johnson 20 plus minutes of some very valuable air time on a program widely watched by Republican primary voters. There’s just no way Gov. Johnson will ever be given that much time in a primary debate.

For Gov. Johnson’s part, I thought he communicated his message very skillfully. His cost/benefit approach that he is campaigning on, especially on issues that the G.O.P base generally disagree (ex: non-intervention and drug legalization/harm reduction) will be helpful in advancing libertarian positions in the long run (much as Ron Paul did in 2008 and since). When Hannity finally broached the war on (some) drugs, Johnson was able to get Hannity to concede that marijuana ought to be considered in a different category from harder drugs (i.e. heroin, crack, etc.). This in of itself is very encouraging.

Quote of the Day – Eyes wide shut?

In making the case for open and obvious centralized rationing, advocates claim that “we” must ration with “our” eyes open. From Beth Haynes at PJM:

That’s why Medicare needs the Independent Payment Advisory Board. Setting a cap on spending is the first step of rationing. The next is deciding who gets what medical care.

“Limited resources require decisions about who will have access to care and the extent of their coverage.” (Berwick, 1999)

As physician-blogger Dr. Richard Fogoros puts it: we can either ration overtly or covertly (“with our eyes open” or closed) — but ration we must.

The only problem with this is that a national central planner (or committee) can have their eyes wide open, yet will still be totally blind. No matter how hard you look, you can’t see a building that’s 3,000 miles away with the naked eye, can you? Centralized planners face the inevitable limitation of vision imposed by distance and the human being’s limited ability to comprehend information.

Technology increases the distance the planners can see, and allows them to comprehend more of what they see. But, contrary to the belief of the planners themselves, they’re still essentially blind. What the planners call careful, scientific decision-making I call groping blindly for solutions based on assumptions and personal preferences.

The fundamental truth forseeing the failure of Obamacare is that only individuals can ration well for themselves. Whatever centralized planners do, it’s with eyes wide shut.

Quote of the Day: Mandating Change Edition

In 2008, a U.S. senator made a very good point in arguing against government mandates for individuals to purchase health insurance:

“[I]f a mandate was the solution, we can try that to solve homelessness by mandating everybody to buy a house.”

Who was the senator who said this? Answer below the fold.

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Open Thread: Successes and Setbacks for Liberty in 2010/Hopes for 2011

Was 2010 a good year or bad year for liberty and why? Like most of you will likely respond, 2010 was very much a mixed bag IMHO.

On the positive side, the mandate section of ObamaCare was found unconstitutional, the military’s “Don’t Ask, Don’t Tell” policy was repealed, Wikileaks exposed the federal government for the corrupt organization it is, the Democrats took a beating on election day, and the Bush era tax cuts were extended (though with the return of the death tax, extension of unemployment benefits, and other compromises in the bill, I’m not yet sure if this was a good or bad thing).

On the other hand, Republicans gained ground on election day (I’m not optimistic that they have changed much since the last time they ran things), the vast majority of incumbents in both parties were easily reelected, government spending is way out of control, the Fed wants to pump some $600 billion into the economy by printing more counterfeit money, unconstitutional invasive searches continue to take place at airports in the name of safety, both Democrat and Republican politicians consider Wikileaks to be a “terrorist” organization, and President Obama believes he can assassinate American citizens where they stand with no due process whatsoever.

On the criminal justice front, The Innocence Network (part of The Innocence Project) exonerated 29 individuals in 2010 for crimes they did not commit. Back in March, Hank Skinner came within an hour of being executed when SCOTUS halted the process. Skinner’s case continues to wind its way through the courts. In other death penalty news of 2010, Kevin Keith’s death sentence was commuted to life by Gov. Strickland, Anthony Graves became the 12th death row inmate to be exonerated in Texas, a key DNA sample was determined to not be a match for another Texas man, Claude Jones who was executed in 2000, and Texas continues to stonewall inquiries into the likely wrongful 2004 execution of Cameron Todd Willingham. As these questionable death penalty cases pile up, hopefully this will be the beginning of the end of the death penalty in Texas and elsewhere.

In a couple of other cases we never quite got around to at The Liberty Papers but deserve to be mentioned: Cory Maye was granted a new trial by the Mississippi Supreme Court because the trial judge failed to give jury instructions to consider a “defense of others” defense and in Arkansas, the Arkansas Supreme Court ordered a new hearing for the so-called “West Memphis 3” to consider newly discovered DNA evidence and juror misconduct from the original trial (if you are not familiar with this case, I urge you to follow this link as a starting point. The more I have looked into this case the more disturbing I find it to be…a perfect example of what is so terribly wrong with the system).

Hopes for 2011
Rather than offering predictions for 2011, here are some of my hopes:

– I hope that the justice will be served in the above cases.

-I hope I am wrong about the Tea Party Republicans and that they will actually be a force of positive change for more liberty and smaller government

-I hope that Ron Paul decides not to run for president for the 2012 campaign but instead puts his support behind former New Mexico Gov. Gary Johnson (I’ll get into my reasoning in a future post).

-I hope by this time next year, I’ll have far more successes than setbacks for liberty to report.

Now it’s your turn. How do you feel about the state of liberty in 2010 and how do you feel about the year ahead?

Cuba banned Michael Moore’s “Sicko” for fear of public backlash

The latest revelation from Wikileaks shows that Michael Moore may have been a bit too good at making agitprop even for Cuban authorities to handle:

US diplomatic cables released by Wikileaks show that the government of Cuba banned Michael Moore’s 2007 documentary, Sicko, “because it painted such a ‘mythically’ favourable picture of Cuba’s healthcare system that the authorities feared it could lead to a ‘popular backlash’, according to US diplomats in Havana.”

It continues:

The revelation, contained in a confidential US embassy cable released by WikiLeaks , is surprising, given that the film attempted to discredit the US healthcare system by highlighting what it claimed was the excellence of the Cuban system.

But the memo reveals that when the film was shown to a group of Cuban doctors, some became so “disturbed at the blatant misrepresentation of healthcare in Cuba that they left the room.” Castro’s government apparently went on to ban the film because, the leaked cable claims, it “knows the film is a myth and does not want to risk a popular backlash by showing to Cubans facilities that are clearly not available to the vast majority of them.”

Government-Run Amputation Panels

For some time, we’ve been using words and sometimes charts or graphs to describe the multitude of problems with government-run health care systems. The Greeks have finally allowed us to put a face to the issue. Well, perhaps a few extremities lower. From the Daily Caller:

This Saturday, one of Greece’s most respected newspapers, To Vima, reported that the nation’s largest government health insurance provider would no longer pay for special footwear for diabetes patients. Amputation is cheaper, says the Benefits Division of the state insurance provider.

In a true free market, health insurance providers couldn’t allow this sort of imagery, as it would hurt obviously their sales. Who’d want to purchase insurance from a company with a reputation of cutting granny’s feet off instead of covering the cost for therapeutic shoes?

The photograph above is from some Civil War amputation footage. I’d like to thank Congress and the president for bringing the United States one step closer to 1865.

Aren’t You Glad To Be A Gamma?

I had a really interesting philosophical discussion with Brad Warbiany, our curator at The Liberty Papers, over a Facebook status I wrote. I had just re-listened to the CBS Radio Workshop rendition of Brave New World and had commented that it seemed like a far more livable situation than 1984.

Warbiany added that California, if Prop. 19 passes and allows the modern equivalent of soma to be freely ingested, the state really will look like Brave New World. With the state already self-organized into a caste system (Listen to someone from Northern California talk about Southern California or someone from Berkeley talk about Sacramento some time), abortion and every sort of contraceptive widely available and the domination of a vapid mass culture (seen at San Diego Comic Con or Wonder Con in San Francisco) taking precedence over civic involvement for Californians, the Golden State really resembles Huxley’s “negative utopia.”

Warbiany also handed me this great cartoon:
Orwell v. Huxley

On Twitter, alot of progressive and libertarian leaning activists tend to advocate alot for issues of freedom and emancipation in countries like Iran or China. In a way, situations in so obviously repressive countries like those are much easier for the activist. They fit into the Orwell dynamic and the villains and heroes are very clear. In his opposition to the death penalty, our own Stephen Littau does take on the American equivalent to state repression. Along with questionable foreign policy and drug policy, however, those are really the only avenues for passionate American political activism.

Beyond such clear issues of state force, however, one runs into a brick wall when faced with the mass culture, dullness and vapidity of consumer society. It seems that in this society, the majority of more normal people (myself and most people reading this strongly excepted) do not become Jeffersonians but instead “turn on, tune in and cop out,” as Gil Scott Heron once said. How does one become an activist in a society in which people freely subjugate, segregate and limit themselves?

I have a funny story that relates to this, that I didn’t even remember until I read what Brad said. While living in Alameda, California, I lost my phone. A teenage girl, around college age most likely, found it and called my mom, who e-mailed me about it. When I got the phone back, I was really grateful but had no money on hand. The only possession I had literally was a copy of Aldous Huxley’s Brave New World. I offered it to her.

She literally responded, “No thanks. I don’t read.”

I know. Alameda is not a low income area where reading should be rare, either. There are several bookstores in the area, along with hip restaurants, record stores and everything else you expect in cosmopolitan society. It even has an incredible vintage movie theatre that I rank as the best in Northern California, next to Oakland’s Grand Lake Theatre. This girl was obviously more involved in other factors of modern life, all of which I can safely assume are of less consequence intellectually than the work of Huxley.

It’s especially ironic given that there is a passage in Brave New World in which infants are given books while bombarded with screeching, loud noises, in order to dissuade them from being too intellectual when they reach adulthood. With video games, television, the internet and iPhones, that seems unnecessary as modern people have been incentivized out of intellectualism.

That girl did go to extra trouble to give me my phone back, with no advantage to her, however. That means she had a decency and sense of altruism that her lack of reading hadn’t impeded. Having grown up around the hyper-educated and being on that road myself, I can also attest that we’re not the nicest group of people. Perhaps then we really are on the road to progress.

Medicare ‘Waste, Fraud, and Abuse’

Obama on Saturday:

“We’ve made Medicare more solvent by going after waste, fraud, and abuse – not by changing seniors’ guaranteed benefits”

Really? And how aggressively have you been “going after” them?

It took private sleuths hired by Medicare an average of six months last year to refer fraud cases to law enforcement.

According to congressional investigators, the exact average was 178 days. By that time, many cases go cold, making it difficult to catch perpetrators, much less recover money for taxpayers.

A recent inspector general report also raised questions about the contractors, who play an important role in Medicare’s overall effort to combat fraud.

Out of $835 million in questionable Medicare payments identified by private contractors in 2007, the government was only able to recover some $55 million, or about 7 percent, the report found.

Medicare overpayments – they can be anything from a billing error to a flagrant scam – totaled more than $36 billion in 2009, according to the Obama administration.

7%, huh? That’s about the percentage of people in the Obama administration who’ve actually held a real private-sector job!

PS – Numbers are tricky, but the article states that in 2007, $55M was recovered. The article also states that in 2005, the contractors were paid over $100M. Even when they’re looking for waste they appear to be creating more waste!

Oh Noz! Unintended Consequences!

A few months ago, when Pelosi crowed about the immediate effects of Obamacare, I pointed out a long list of them and my responses. My thoughts:

6. NO DISCRIMINATON AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS—Prohibits health plans from denying coverage to children with pre-existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to all persons.)

Again, an increase to private health insurance premiums. But hey, who’ll complain? After all, it’s for the children.

Today, it looks like one is becoming even worse than I’d thought:

In Florida, Blue Cross and Blue Shield, Aetna, and Golden Rule — a subsidiary of UnitedHealthcare — notified the insurance commissioner that they will stop issuing individual policies for children, said Jack McDermott, a spokesman for McCarty.

The major types of coverage for children — employer plans and government programs — are not be affected by the disruption. But a subset of policies — those that cover children as individuals — may run into problems. Even so, insurers are not canceling children’s coverage already issued, but refusing to write new policies.

The administration reacted sharply to the pullback. “We’re disappointed that a small number of insurance companies are taking this unwarranted and unnecessary step,” said Jessica Santillo, a spokeswoman for the Health and Human Services department.

Starting later this year, the health care overhaul law requires insurers to accept children regardless of medical problems — a major early benefit of the complex legislation. Insurers are worried that parents will wait until kids get sick to sign them up, saddling the companies with unpredictable costs.

Blue Cross and Blue Shield of Florida issues about 9,000 to 10,000 new policies a year that only cover children. Vice president Randy Kammer said the company’s experts calculated that guaranteeing coverage for children could raise premiums for other individual policy holders by as much as 20 percent.

“We believe that the majority of people who would buy this policy were going to use it immediately, probably for high cost claims,” said Kammer. “Guaranteed issue means you could technically buy it on the way to the hospital.”

Of course, I’m being generous here in my suggestion than muscling private insurers out of providing coverage is truly an “unintended” consequence.

H/T: Jason Pye @ UL

What The Appointee Says, And What It Means

While most of us were in the middle of a slow week following a holiday, Obama decided to issue a recess appointment for the job heading Medicare & Medicaid.

Could it be that he issued it as a recess appointment because he didn’t want us digging too deeply into what the good Dr said? Below is his quote, and Stephen Green’s (the Vodkapundit) opinion:

I just now got around to reading the actual article Nick quoted, and get this bit:

“In America, the best predictor of cost is supply; the more we make, the more we use—hospi tal beds, consultancy services, procedures, diagnostic tests,” Dr. Berwick wrote. “… Here, you choose a harder path. You plan the supply; you aim a bit low; you prefer slightly too lit tle of a technology or a service to too much; then you search for care bottlenecks and try to relieve them.”

That’s right — the way to reduce prices is to — wait for it, one more time– decrease supply!

It must take a major IQ and a Harvard degree to wrap your brain around that one.

With all respect to Stephen, I don’t think the Dr is making the point that he can repeal the laws of supply and demand. However, what he’s actually claiming is not, as Stephen is suggesting, stupid. Rather, it’s evil.

Allow me to demonstrate:

In America, the best predictor of cost is supply

He’s not making a point about cost of individual services. He’s making a point about consumption, and therefore spending.

the more we make, the more we use — hospital beds, consultancy services, procedures, diagnostic tests,

Okay, so he says that demand is larger than supply, because as supply increases, there is enough demand to fully utilize it. Essentially he’s saying that as medical care & technology becomes available, we want to utilize it, to do silly things like saving our own lives.

Here, you choose a harder path. You plan the supply; you aim a bit low; you prefer slightly too little of a technology or a service to too much;

You ration. You deliberately restrict supply, so that people cannot obtain the life-saving care and technology that they need. The British are well aware of this, although they use the term “queue” over there, while we prefer the less elegant “waiting in line”. Do some of them die? Sure, but hey, you spend a lot less money this way!

then you search for care bottlenecks and try to relieve them.

Translation: You make sure that the politically visible ailments — you know, the ones that have their own special colored bracelets — are well-cared for, so you seem like you’re actually helping people. At the same time, less common, less well-funded, or less dramatic diseases are starved for funding and new technology, because there’s just not a large political incentive to fix it.

Welcome to Obamacare!

Why I Don’t Listen To Jenny McCarthy — Or the CDC

The journalist responsible for the original uproar about the MMR vaccine and autism has been shown to have produced very shoddy research, and widely discredited. He was even recently banned from the practice of medicine in the UK. This has, of course, not quieted the debate. In fact, it’s gotten even worse, with his vaccine supporters claiming the science is settled, and vaccine opponents acting as if this is all a big cover-up.

The problem with this debate, for most people, is that they don’t have the training to actually view the real research and make an informed decision. They’re trying to decide whether to listen to their usual source of information, an emotionally-charged celebrity (Jenny McCarthy) or to trust the authorities, who just naturally have that stink of “they must be hiding something” about them. Add a dash of humanity’s propensity to swallow conspiracy theories, and nobody knows what to believe.

As a parent, I decided it was my job to educate myself and make the decision for my kids, regardless of what the CDC said. Nothing is riskless. It is my job to weigh the risk of vaccinating against the risk of not vaccinating, both for specific vaccines, for the age of administration of those vaccines, even to the level of possibly discriminating against brands of vaccine based upon ingredient levels (you may laugh, but I have asked my pediatrician which brand they use).

Some anti-vaccine folks in my extended family supplied me with the crackpot books they’ve read (i.e. books where the author was denouncing the entire germ theory of disease as bogus), and it was clear reading these that the authors had an axe to grind. A book written from an ideological perspective is not necessarily a disqualification, but books where the ideology trumps the science are out of the question.

I ended up on a book published by my kid’s pediatrician. I chose it because it seemed to honestly and neutrally discuss the relative diseases guarded against, the ingredients of the vaccines in question, and the safety record of the vaccine. The author supports vaccination, but it was clear that he did his level best to offer the evidence without bias, separate from his own recommendations pro/con on each vaccine.

I ended up choosing the vaccine schedule that I put my kids through based on that information — i.e. a cost/benefit analysis of the likelihood my child might contract the disease in question, the severity of the disease if he did catch it, and the relative risks of the vaccine in relation to the above.

As an example, I chose that my children get the polio vaccine. While it’s a rare disease, it’s a particularly nasty disease, and the vaccine is one of the safest available. I also chose to get vaccines such as HiB and Rotavirus, because they’re relatively harmful diseases, particularly in infancy, and also diseases that my kids aren’t that unlikely to contract.

On the other hand, I chose against MMR. While measles, mumps, and rubella are common, they’re also typically mild diseases. The vaccine has a higher prevalence of adverse reactions than most, and there is a worry that some of the vaccines for “mild” diseases can lead to complications later in life, with a more virulent and dangerous form of a disease affecting the individual in adulthood. Thus I didn’t believe taking risks to protect my kids from diseases that seemed relatively innocuous in most kids made a lot of sense, especially since the long-term effect is unknown. I had the same rationale for the chickenpox vaccine.

I also opted for a more spread-out vaccine regimen (i.e. not necessarily later in life, but more visits and less shots per visit), because I think the likelihood of an adverse reaction may be increased when you subject a body to the stress of several vaccines at once.

This, of course, is done with the unique attributes of my family taken into account. It’s a low-risk household, with the kids breast-fed until 12 months, no day care, and not a huge amount of interaction with hordes of other youth. Further, they’re well-nourished and healthy kids, so I feel they’d be far better than “average” at weathering the storm of a disease like measles or chickenpox. This, of course, also makes them less likely to have an severe adverse reaction to a vaccine, so it affects the risk/benefit of vaccinating just as much as not vaccinating.

I know that this decision is my responsibility as a parent. I know that I am weighing some risks against others, and that there’s a chance that things could go wrong. It is because of that responsibility that I read 3 books cover-to-cover on the subject, discarding two of them as trash and settling on one that I thought trustworthy before making my decisions. At the end of the day, I feel like I made the best decision I could, given the evidence I had, and I and my family are going to be the ones who have to live with the consequences, right or wrong. That’s a heady weight, and one that most parents probably don’t want to bear. But that’s the responsibility that comes with raising a child.

The problem will come when the kids need to go to school. The schools typically demand that you’re current with all or most of the vaccines on the CDC schedule. Most public schools will allow you to let your unvaccinated child attend if you claim a philosophical objection to vaccinations. It’s a major hassle, but they do allow it. The problem for me is that I don’t have a philosophical objection to vaccination (especially as an atheist — no religious reasons for me). One of the pieces of evidence against a philosophical objection is to give your child any vaccines — i.e. my piecemeal approach is not philosophical.

I do have a philosophical objection to bureaucratic one-size fits all government mandates, though, and thus I don’t accept that the government should be the one demanding that I follow their cost-benefit analysis for “most” kids when it doesn’t fit my family’s particular situation. My philosophical objection is being forced to take risks with my children that the CDC wants me to take, when I’ve evaluated the research myself and I disagree. That objection, though, is less well accepted in California than Scientology.
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