“Free Market” Health Care

Posted on 2008-11-17 by David

The call for Lawyers to join health-reform efforts was a not so subtle reminder to me about how "free" our health care market is currently. We can’t really pretend that the cost of services or the services rendered are determined by patients and providers. In fact, they are not even determined by a combination of patients, providers, and insurance interests.

Malpractice lawsuits, whether as threat or reality, skew a provider’s treatment decisions to the legal safe side, members of the Legislature’s Health Care System Reform Task Force were told Tuesday. That approach, in turn, adds to the amount of redundant testing and is a significant but so far unaddressed factor in the reform process.

The cost of malpractice-insurance premiums for providers also is rising rapidly, Rep. Gregory Bell, R-Fruit Heights, and an attorney, told fellow task force members.

We have developed a pricing and practice environment based on a staggering concoction of laws, medical knowledge, middlemen, and advertising. Patients may demand unnecessary services or medications based on what they hear from advertisements. They may also have unreasonable expectations regarding how flawless our medical system is or should be – in other words, they may feel entitled to compensation for unavoidable tragedies. Governments step in to define what "unavoidable" means by specifying standards of practice which may bear little connection to medical necessity. Insurance companies can, by choice or accident, inflate the costs by demanding standards of practice and levels of compensation that can’t possibly take into account all the factors that should define the practice of health care and the commensurate compensation for care.

Care must cost more when malpractice insurance rates rise. Prices will increase when the salaries and profits of insurance companies must also be covered in the process of receiving health care. Checks against unnecessary care will disappear when those receiving care are not sensitive to the costs of individual procedures. Medical decisions will be skewed when manufacturers provide kickbacks to doctors and advertise their wares directly to customers who have no medical background.

While we use the Brass Serpent (the Nehushtan) as the symbol for the field of medicine we might find it convenient to use the Hydra as a symbol of the cost of health care.

The Hydra - photo by Craig Stephen
Hydra – photo by Craig Stephen

Somehow we need to slay this monster but while the sword of government may have a place in the battle it is not sufficient to complete the task – by itself the sword of government makes the monster more dangerous.

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Blogging Full Time

Posted on 2008-11-14 by David

No, this is not an announcement that I will be blogging for a living.

I have been doing a lot of reading lately. Besides any moral/religious reading (C. S. Lewis etc.) in the last month I have read:

As I read all these things I have lots of thoughts worth blogging about and I have come to the conclusion that I am missing some good opportunities because of the "Book Report" mindset. I have avoided blogging about things I am reading when I am still in the middle of a book. By the time I get to the end I am starting a new book and there is too much in any of those books to remember and synthesize it all (at least in the time I have to write a post). I decided this morning that I will try to avoid that mindset and just blog about thoughts and ideas that I have from my reading without trying to digest the whole book first. If I write about Atlas Shrugged it will be far from a book report because I have returned that book and don’t intend to re-read the 1200 pages in order to cover the many ideas more fully. On the other hand, I have not yet returned Why We Whisper and so I will probably go back through those 100 pages to gather the ideas that stoked my thoughts the first time around (the same applies to Lies – except that I own that one).

Also, I have started contributing as an author at the KVNU – For The People blog. I won’t cross post everything I write there, but I now have a section in the sidebar showing things I have written recently on other sites.

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Support But Don’t Trust

Posted on 2008-11-13 by David

I am a strong supporter of our government. I obey the laws (even little ones like speed limits and seat belt laws) and pay my taxes without complaint and without seeking any tricks to minimize those taxes. Supporting the government, however, does not mean that I trust the government when they ask for expanded powers. I oppose the efforts of courts, congress, or the President to increase their powers in any area of society. In the financial sector that lack of trust has proven to be a sound policy recently. As September turned to October I wrote six different times opposing the bailout. All over the news and in many blogs people were saying that we should hold our noses and accept that plan because it was necessary. Now I am finding it ironic that some those same people who support the government managing more of our lives are unhappy as they see the mismanagement of the "necessary" bailout funds.

It seems that Congress is the special group in the world that can convince us to let them have more of our money based on how poorly they use it. Perot Charts reports that Theresa Ghilarducci, professor of economic-policy analysis at the New School for Social Research in New York testified testified in support of a plan that would "modify" 401K’s. Components of the plan include the following:

    • All workers would receive a $600 annual inflation-adjusted subsidy from the U.S, government but would be required to invest 5 percent of their pay into a guaranteed retirement account which would be invested in government bonds that would accrue 3 percent per year.
    • The current system of providing tax breaks on 401(k) contributions and earnings would be eliminated.

This is extremely frightening considering that the 5% that you would be required to "invest" (at only 3% return) on a $25,000 salary is $1250 For that you would receive a $600 subsidy. This might appear helpful to those who make very little money, but the benefits of their savings are insignificant compared to their needs at retirement and come at a very high price for everyone who just lost their tax savings that encourage them to save in a 401K, not to mention the disincentive that this would be to business who have provided tax free matching for 401K accounts which do much better than 3% returns 90% of the time. Overall savings in the country would decline under this plan.

Is it any wonder that my support of our government does not include my trust. We should all support our government no matter who is in power, but support means that we watch them instead of trusting them. It means that we hold our leaders accountable for what they do. For me, it means that every chance I get I will encourage them to give power back to the people and the states. I like that 10th amendment – too bad it gets worse treatment than the other 26.

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Speaking My Native Language

Posted on 2008-11-12 by David

I have always tried to maintain a very civilized and respectful tone here when discussing issues that are sometimes charged with emotion in the public arena. I have been reading the book Why We Whisper and I began to recognize that my efforts to be civil had resulted in my speaking a dialect that is not native to me – secularism. I recognize that my effort not to shout had resulted in a timid whispering of my opinions for which I would not like to be known. The result is that my declared stances are weakened by an often apologetic tone when I take a position on some issues. I have determined that I can no longer do that. From now on I will be more willing to state my positions without apology and without an effort to articulate my position using secular terminology.

I still intend to be civil in manner, but by abandoning the secular terminology I will not avoid taking positions that are considered politically incorrect. As I have in the past, I will still be open to changing my positions in the future when I have been convinced of an error but I will try to avoid situations where people might mistake my true position based on my whispered stances and open declarations of uncertainty.

I appologize in advance to any of my readers who might perceive my writing as becoming more partisan than it has been in the past. I don’t know where this will take me, but I know that I cannot bear to think of myself as one who whispers the truth as if I am afraid to offend anyone or afraid that my positions may come back to haunt me in the future.

In addition to this change to a less wavering voice, I have also determined that it is time for me to find a party to affilite with in order to become more engaged in the political process as a participant rather than just as a pundit. I am still in the process of deciding what party would most closely align with my goals because I intend to make a difference in shaping the way we actually conduct the business of government. I do not intend to participate only in order to say that "I’m a delegate" (or whatever level of participation I actually  achieve). In other words, if I were a delegate, I would be active in shaping the party platform and holding elected officials accountable to that platform not simply attending and casting a vote at the convention.

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Post-Election Subjects

Posted on 2008-11-11 by David

There must be something about the conclusion of an election that brings up the subject of term limits. I wrote about it a couple of times a year ago and have said nothing about it since then. Now the Standard Examiner has an article saying that It’s time to reignite the debate over term limits. The article talks about previous efforts to enact term limits in the late 90’s. In the comments section for the article Tired Old Argument says:

Term limits basically says, we don’t trust the voters to make a good, informed decision.

What Tired Old Argument forgets is that in a republic, such as the one we live in, the very structure of government says that we should not trust the voters to be able to be adequately informed for most major decisions – that’s why they are supposed to delegate the task to their best and brightest (which is who they would elect in theory). It turns out that our history suggests that knowing when to replace their elected representatives is among the things that voters are not very adept at doing.

This years numbers are instructive on this point. Congress has been mired with approval ratings hovering near 10% for most of the last year. Logically this would suggest that we would have a high rate of turnover when elections come amidst such an approval rating. In fact, approximately 90% of our elected officials are returning to Washington (this is not counting those who are returning as lobbyists or in appointed positions). What is even more telling is that of the 6 of the 10% who are not returning to elected office retired voluntarily. When 90% disapproval results in 95% retention that suggests that the voters are not very adept at replacing their elected officials.

As Reach Upward so astutely articulated in last year’s discussion:

. . . it may be good to toss even great statesmen because the office is more important than any person that may hold it.

(I will be quick to point out that Reach had no committed position on the issue of term limits at that time.) I would love to hear from anyone on where they stand on the issue after our elections this year.

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Laboratories of Democracy

Posted on 2008-11-10 by David

I have been thinking about the full faith and credit clause of the Constitution (FF&C) and how that has played out in some areas of public policy. Specifically I have been thinking about how some areas of policy allow for states to pick and choose what faith and credit they apply to the policies of other states and how that contributes to the laboratories of democracy that out states were expected to become within our nation.

Specifically I woke up thinking about gun rights. This is not because I carry a gun for my own protection, although I fully support a broad interpretation to the 2nd Amendment, it is simply because it provided a convenient illustration of the issue.

Full faith and credit might be used to argue that every state should be required to accept a concealed carry permit issued by any other state. In fact they do not. Each state is able to set their own requirements to carry such a permit and also to permit reciprocity of permit recognition with other states on a state-by-state basis. The thing that got me thinking of that is that Utah’s permit is one of the most widely recognized permits in the nation.

This lack of uniformity among the various states allows people to experiment with different approaches to problems and different variations on legislation. Each state is then able to recognize and/or duplicate what they see as successful in other states. This is true of individuals as well as states. For example, gays who wish to marry are free to move to Massachusetts while residents of Massachusetts may choose to leave the state if they find themselves in the minority and do not like the side effects of legalized homosexual marriage.

This kind of legislative experimentation was short circuited in the abortion debate when the Supreme Court stepped in and eliminated a wide range of available positions that had been adopted by many of the states. The Defense of Marriage Act was passed specifically in an effort to ensure that the debate about what constituted legal marriage would be allowed to follow its natural course between states rather than ahving that debate hijacked by the courts or by the argument of FF&C combined with a Massachusetts choosing to be the first to recognize a form of marriage that was prohibited elsewhere.

I don’t think we will be able to solve our national issues in any reasonable time frame unless we quit thinking that we have to solve everything from the top down with one unified solution for each issue. We should allow each state to decided which problems they feel are the most pressing and to push for solutions on those issues. That allows all the issues to be addressed simultaneously and for different approaches to be tested on each issue. If we had ten major issues that were widely considered to be our most pressing we might find that there are four to six states choosing to tackle each issue allowing us to test four to six approaches to each problem simultaneously. The other 44 to 46 states can adopt their favorite approach, or mix and match for a second round of experimentation.

It seems to me that there is only one truly federal problem that we face – that is our overspending habit by the federal government. The solution to that one problem is simple – start spending less by getting out of the business of trying to solve all the problems of the country. Start acting like a coach managing the strategy direction and development of the team (which includes states on defense and private enterprise on offense) rather than trying to be the star player trying to single-handedly carry the team to a championship.

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Legislated Equality

Posted on 2008-11-10 by David

I have been thinking about the “equality” that we equate with the American dream – the one that we want our government to guarantee for us. This has lead me to consider the difference between equality of opportunity and equality of outcomes. I don’t think that many people would openly argue for equality of outcomes if people see that argument as depicting that everybody should be earning $50,000 a year with no opportunity to earn more. As much as we may like equality we always want the chance to get ahead of the Joneses.  This tells me that what we really want as a nation is equality of opportunity which leaves us with the issue of defining what that means.

We can easily see that an equality of outcomes would encompass legislation that the demographics of any profession must match the demographics of the population at large. Unfortunately, what gets argued by the discrimination chasers is that equality of opportunity requires enforced demographics in hiring or admissions processes. They ignore the fact that demography based approaches to equality lead exactly to the best possible outcomes that governments can guarantee. If we would like to see where that leads we need look no further than our public education system. For decades the system has become centrally controlled to greater and greater degrees and during that same time period we have fallen further in our educational outcomes whether compared to other nations or compared to objective standards such as literacy levels or percentage of graduates who have basic mathematical competency. Our public education system has shown unequivocally that legislating an equality of outcomes is tantamount to legislating a low quality outcome.

When we talk about guaranteeing an equality of opportunity we can look to the 14th amendment as an example of what such legislation would look like and how it would operate (specifically the first two sections). This amendment did not guarantee that every male would vote, nor did it specify that the number of white men voting would only be proportional to the number of white men in the voting population as a whole. Instead it specified that the right for men to vote should not be abridged and specified the penalty incurred by the state for violating that right. The key here is that the punishment – although aimed at ending racial discrimination at the voting booth – was completely colorblind. If a state were to become dominated by Latinos due to immigration – let’s say New Mexico for example – and the majority of citizens chose to implement a policy stating that voters must have ancestors from Central or South America in order to vote New Mexico would be subject to the punishment of only having representation in Congress proportional to the population which had Central or South American ancestry. In fact the state would be allowed to do that.

Equality of opportunity  leaves the door wide open for unequal outcomes. An open door for unequal outcomes is an open door for incentive to promote outcomes that are above average – in other words, the opportunity to fail is the best motivation to succeed. Now we need to ensure that our government does not try to legislate the equality of outcomes, only of opportunity.

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A Step Backwards in Utah

Posted on 2008-11-07 by David

Some people might think that Tuesday was a step backwards because Obama won. Others might consider it a step backwards because Chris Buttars won again. The real step backwards was that 59,000 fewer people voted in Utah this year than in 2004. That is not just lower percentage turnout, that’s lower numbers.

Mark Thomas with the Lieutenant Governor’s Office says . . . the ballot generally lacked hotly contested local races.

“There are people who feel that this is a Republican state and my vote won’t make a difference,” Thomas says. “But I think that’s not a very good attitude in the sense that there are a lot of other races that do affect you, and perhaps even more so in your day to day life, on a local level.”

We need hotly contested local races on a consistent basis to bring people out to the polls. Too many of our elected officials are chosen at the state and county Republican Party conventions where only the elected delegates get to vote. It cannot be considered anything like a democracy when our officials are chosen by the votes of less than 1% of the population (the delegates) who were given the chance to vote based on the support of the 2% of our population who attended their neighborhood caucus meetings.

I’m almost tempted to suggest that the Republicans be allowed (required?) to place two candidates for every office in Davis and Utah counties just so that the general election will have some real meaning. Perhaps better would be a general rule that in a county where more than 70% of the elected officials come from a single party that party be required to field two candidates in the general election. After all, the first Tuesday in November was supposed to be a choice, not a ratification.

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Huntsman for Senate (2012)

Posted on 2008-11-06 by David

After receiving more than 75% of the vote on Tuesday Huntsman has to be considered the person most able to oust Orrin Hatch when he comes up for re-election.

Huntsman said he hopes he can build "coalitions" with willing legislators from both political parties to achieve what he believes must be done. "Not running again (for governor) means no political game-playing — but doing what is right for all Utahns," he said.

The fact that he has promised not to seek a third term (and reiterated that promise) combined with the fact that McCain is not going to the White House means that he will be looking for something to do when this term expires. I’d love to see another popular Republican who would take on Hatch to refresh our senate representation with a Utahn (Hatch can barely find Utah on a map – his politics are all Washington).

Now we just need someone to run against Sen. Bennett in 2010. Perhaps Steve Urquart could do that now that he won’t have to worry about his own re-election in 2010.

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An Illegal Constitutional Revision?

Posted on 2008-11-05 by David

Gay-rights advocates in California think that everyone else is an imbecile. They have decided to file a lawsuit claiming that Proposition 8 is "an illegal constitutional revision — not a more limited amendment." They expect that nobody will recognize that the California Constitution makes no distinction between an amendment and a revision. They also expect that they can bully people into forgetting that the nature of an amendment is that it cannot be illegal so long as it is enacted according to the established procedures.

Of course it is possible to make an amendment that goes against common sense, such as an amendment to designate that "in government math 2+3=7." As stupid as that sounds, if such an amendment were passed into law by following the established procedures it would be the law of the state and government calculations would have to be revised accordingly until an amendment were passed to repeal it. (Think back on the 18th and 21st amendments to the federal Constitution.)

There is no such thing as an illegal constitutional revision so long as the revision is made according to the legal procedures. They just hope they can bully the people of California through the courts on this like they did with Proposition 22 from 2000. The difference is that Proposition 8 is now the law of California and the California courts may not invalidate their own constitution – only a new amendment can do that.

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