Establish Criteria, Not Quotas

Posted on 2008-05-09 by David

My wife was politically low-key when I first met her. I have enjoyed the fact that she has started to become more interested in political issues and principles of good government. This morning at breakfast, without any warning, she asked me about my thoughts on the issue of immigration. The conversation that followed led to some interesting insights (and must have been incomprehensible to our children).

First, as I have stated before, we need to make an informed decision on where we stand on the issue of immigration. Knee-jerk reactions (whether it’s “close the border” or “grant some legal status”) don’t fix the fundamental problem that we have created immigration laws that we are unwilling or unable to enforce.

One of the things that came out of the conversation was the idea that quotas are an arbitrary, and hence therefore poor, method for determining who can legally enter the country. In fact, quotas are a bad way to make any public policy. No matter where you set the numbers they are essentially arbitrary. There is no reason why person X+1 has greater potential to burden the nation than person X.

If we think that we should not have completely open borders then we should set criteria for who is allowed to come and then allow all people who meet the criteria to enter. Prior to 1924 when we started using quotas the criteria were essentially that we allowed anyone without major criminal backgrounds or communicable diseases to enter the country. I think those are good criteria to keep and there is no reason that we cannot develop other criteria to keep immigration at sustainable levels and make sure that we are getting the people that we want. For example, if we are looking for people to do menial jobs for us then we should allow people in who have arranged to take those jobs. If we only want people who will work to become citizens then we set criteria that they must achieve citizenship within a set amount of time or be deported.

I’m not saying what criteria we should use – I think that’s a national debate that we need to undertake – but I am saying that the land of the free should not be free only to the first 10000 people in line each year.

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Delving Into “Six Steps”

Posted on 2008-05-07 by David

Joe Jarvis is a doctor and a candidate for the Utah legislature. I was very interested in exploring the six steps to bring about true health-care reform in Utah that he outlined in the Salt Lake Tribune. He has been kind enough to answer some of my questions and I want to share what I have learned from him and from digging into his sources.

Health underwriting

Every critically ill or injured person will be treated in our health system whether they have health insurance or not.

The realization that doctors and hospitals are obligated under the law to treat people in need should really change the way we look at the issue of universal coverage and the underwriting process. It deserves to be one of the areas we look at to make fundamental change to improve our health care system.

Unsafe hospital practices

Another cause of inefficiency in the system. Dr. Jarvis pointed me to studies by the Institute of Medicine demonstrating the statistical results of accidents and poor industry practices. (I say statistical to make it clear that the above link does not lead to grotesque images of hospital injuries.)

Inappropriate care

Inappropriate care seems to be the symbol of all that is wrong with our system. It appears to be a direct result of a medical industry that is being controlled by the insurance industry which is more interested in avoiding legal repercussions than in keeping people healthy

Perverse incentives

Dr. Jarvis quoted an article from the Wall Street Journal on April 5. I was unable to find that article to confirm the numbers he quoted (“if everyone in America went to the Mayo Clinic, our annual health-care bill would be 25 percent lower (more than $500 billion) and the average quality of care would improve.”) I did find an article from April 7th in the Wall Street Journal, More Choices Drive Cost of Health Care, that appeared to be the same except that it had different numbers ($50 billion saved over 5 years). (Follow the link here to see more than the free preview.) While I could not verify the numbers he quoted, the concept that we must eliminate the perverse incentives that drive the health care system is sound.

Market-based health policy

Dr. Jarvis argues that “health care is not subject to market forces, such as a lowered price increasing demand. No one ever had an appendectomy because the price was right. The occurrence of illness and injury primarily determine demand for health services.” While I would agree with him in the case of an appendectomy there are services (lasik, orthodontics, or well child checkups for example) where demand will rise as prices fall. Besides that, the WSJ article cited above indicates that many people, fueled by a “more is better” attitude, will indulge in available health services that are unnecessary. This would probably not be the case if they had to pay more than a token amount for those extra procedures. Also, at times when the patient is not the driving force behind extra procedures the findings are that

More office visits, hospital stays and diagnostic procedures likely indicate poor coordination among doctors and facilities that can lead to worse care and outcomes.

So far I am not convinced that real market forces do not have a significant role to play in radically improving our health care system.

Benefit denial

I had never previously considered the cost associated with claim denials, but Dr. Jarvis provided some eye opening data. In his article he stated that “Claims costs are at least 10 percent higher in Utah than would be optimally efficient.” He was gracious enough to allow me to look through the data he used to arrive at that figure and answer my questions to help me understand what I was seeing.

Here’s what I learned; the claims cost is the percentage of the insurance company’s revenue that is spent in evaluating and denying claims – it does not count the cost of claims paid, just the cost of processing the claims. The 10% figure is a bit misleading. Let me try to clarify the numbers. The most efficient insurance provider in Utah is apparently the Public Employees Health Plan (PEHP) which spends nearly 4% of revenue in processing claims. The data from the other major health insurance providers (IHC, Blue Cross, Altius, and UHC) shows that they spend between 12% and 19% of revenue on the processing of claims. To put that in perspective, PEHP spends 1 of every 25 dollars in claims processing while the other providers spend between 1 in 8 and 1 in 5 dollars. That is 3 to 5 times higher than optimal. It is a difference of 10% of their revenue but it is not evidence that they spend 1.1 times the optimal amount on claims processing.

Conclusion

Even where I do not fully agree with the details of Dr. Jarvis’ claims about these six steps I do agree that all six of these steps are important issues to address if we are to come up with a decent approach to improving health care in our state. I also agree wholeheartedly with Dr. Jarvis that the system requires a major overhaul, not just some tinkering if we are to avoid the looming crisis in the health care system.

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A Good Summary of the FLDS Situation in Texas

Posted on 2008-05-06 by David

I really liked the content of the well titled San Angelo Witch Hunts. The author does a good job of outlining the case and demonstrating that so far we have ample evidence that the authorities are and were violating the Constitutional rights of the FLDS people (even if they were breaking the law) and that we have zero solid evidence that the FLDS people were actually violating the laws. Either there is a lot of evidence that is not being made public (which would still not excuse the illegal actions of the authorities) or else this is an example of authorities who have zero respect for the most fundamental laws of the nation.

I don’t think anyone could read that post and still excuse the actions of the Texas authorities.

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Hillary Clinton: Babysitter in Chief

Posted on 2008-05-05 by David

Here is another gem from Laura. She came in to my office this afternoon and told me that she had just seen a bit of a speech by Senator Clinton. She thought it very important that I be aware that Hillary Clinton had just told her audience that they wanted a President who would solve their problems, take care of their families and watch out for their children. (I don’t claim that to be verbatim.)

Of course my first thought is that I would prefer a president who would enforce the laws of the land, defend the Constitution, and tell the truth to the American people. I don’t need someone to keep pushing the lies that there are painless, if complex, solutions to the problems we have been busy creating for ourselves.

Upon reflection I realized that maybe Senator Clinton is really making a good offer – free babysitting of my kids. I’ll bet she’s a lot more dependable than many a teenage babysitter. Of course by the time I finished writing this I realized that she never said she would babysit for free – or even for cheap.

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Willing Suspension of Disbelief

Posted on 2008-05-03 by David

Reports from the CBO that a Universal Health Coverage Bill would be budget neutral are obviously based on the third kind of lie (namely statistics). Commonhealth sums up the effects of the bill like so:

The legislation:

  1. gets rid of employer based insurance (employers that contribute to coverage would give employees that money at first, and eventually shift to a federal health coverage tax)
  2. requires all Americans to have health insurance
  3. offers subsidized coverage up to 400% FPL (Mass is up to 300%)
  4. sets up purchasing pools (like the Connector)

Could someone please point out to me where this plan gives health care providers an incentive to provide efficient, high-quality care? It seems to me that insuring all our uninsured citizens will never pay for itself in a system that thrives on inefficiency – as the current system does. Adding inefficiency couldn’t possibly pay for itself.

Ending employer based insurance is potentially a good thing. Requiring everyone to buy insurance looks like an incentive for more inefficiency and even price gouging. And one of my senators is sponsoring this. I think he should have his head examined.

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A Thin Red Line

Posted on 2008-05-03 by David

I stumbled upon a great statement on the line that separates civilization from anarchy. Timothy Gatto writes this in response the the FLDS situation:

While you might not agree with what the FLDS is doing, it doesn’t warrant any civil authorities to act outside of Constitutional law. When civil authorities bypass or ignore the Constitution, we are all put in jeopardy, and we are that much closer to living under a totalitarian government that makes up its own laws as it goes along. Sometimes the issues are larger than the crimes. I think I can safely say that most Americans abhor the practice of using young girls as ‘breeders” and in the process satisfy the lust of old men, but that issue isn’t as important as civil authorities acting outside the law. We are supposed to be a nation that believes in the rule of law. That premise is behind the definition of a civilized state. The law is for everyone to obey, the governors as well as the governed. Once the line that separates civilization from lawlessness is crossed, the result is anarchy, no matter who crosses that line first. There were other ways of stopping what was happening to these young girls. The authorities didn’t have to violate anyone’s constitutional rights.

While he is speaking specifically to that one case, the line he draws – the respect for law by those who govern and those who are governed – is a universal line. It’s a line we really can’t afford to cross.

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Wired for Authoritarianism

Posted on 2008-05-01 by David

Starting by referring to two posts I wrote back in January, Obi wan Liberali posts More Thoughts on Authoritarian Thinking. I have to say that, like Obi wan, I am deeply concerned about our shift towards a more authoritarian society. I also agree that the positions publicly identified as conservative are tending towards greater social authoritarianism although I’m not sure they are becoming more authoritarian economically. On the other hand, the positions publicly identified as liberal have always been likely to take an authoritarian stance economically while remaining libertarian in the social arena.

I believe that Obi wan is correct in identifying two classifications of authoritarians – most being authoritarian followers, and the minority being authoritarian leaders (he calls them dominators). Obi identifies religion as being naturally authoritarian in structure. While I agree that religion is generally authoritarian I don’t believe that this is peculiar to religion – I believe that authoritarianism is human nature.

People who strive for power are naturally going to be authoritarian leaders. Leadership based solely on logic and persuasion is not a dependable way to maintain authority. Those who rely on persuasion are not concerned about their personal authority. The reason that so many people qualify as authoritarian followers is a combination of short-sightedness and laziness. Some people are unwilling to do the work necessary to form their own opinions so they follow whatever authoritarian leader they are inclined to follow. Others are willing to do the work to form their own opinions, but they fail to foresee the dangers of supporting the authoritarian pursuits of those who are ideologically in line with the positions they have chosen.

The reason that authoritarian systems are so worrisome to me is that I view personal responsibility to be the foundation and the working definition of liberty. Authoritarianism is antithetical to personal liberty and personal responsibility. People who are unwilling to take the time to gather the information to form their own opinions will always be seeking for someone to follow politically, religiously, or in any other arena. People who will put forth that effort will enjoy the fruits of their personal liberty only to the extent that they are allowed to – meaning that they cannot enjoy the fruits of liberty in a situation where their opportunity to make choices is cut short by the system. This applies to equally economic, political, and religious systems.

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Federalist No. 9

Posted on 2008-04-30 by David

Federalist No. 9 can be almost completely reduced to this extended quote by Montesquieu:

a CONFEDERATE REPUBLIC. . . is a convention by which several smaller STATES agree to become members of a larger ONE, which they intend to form. It is a kind of assemblage of societies that constitute a new one, capable of increasing, by means of new associations, till they arrive to such a degree of power as to be able to provide for the security of the united body. . .

The form of this society prevents all manner of inconveniences.

If a single member should attempt to usurp the supreme authority, he could not be supposed to have an equal authority and credit in all the confederate states. Were he to have too great influence over one, this would alarm the rest. Were he to subdue a part, that which would still remain free might oppose him with forces independent of those which he had usurped and overpower him before he could be settled in his usurpation.

Should a popular insurrection happen in one of the confederate states the others are able to quell it. Should abuses creep into one part, they are reformed by those that remain sound. The state may be destroyed on one side, and not on the other; the confederacy may be dissolved, and the confederates preserve their sovereignty. (“Spirit of Lawa,” vol. i., book ix., chap. i.)

Ever since the United States made the transition from being a plural noun (ex. “the United States are . . .”) to being a singular noun (ex. “the United States is . . .”) it seems that the individual sovereignty and identity of the states is becoming more of a formality than a reality. Contrary to the argument made in Federalist 9, I am not convinced that “So long as the separate organization of the members be not abolished; so long as it exists, by a constitutional necessity, for local purposes; though it should be in perfect subordination to the general authority of the union, it would still be, in fact and in theory, an association of states, or a confederacy.”

It seems that the last half century or more have shown that when the states become fully subordinate to the federal government the balancing of interests that are present in a confederacy are minimized and the Federal authority begins to act more like a monarchy with an ever-changing head.

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Government is a Tool

Posted on 2008-04-30 by David

LaVarr Webb asks Utah Policy readers if they think government is always a necessary evil or if it can be a force for good. Since my answer to that question goes directly to the heart of what my blog is about I thought I’d share my answer here.

Government is not always necessary (an isolated group of people who were respectful of each other would not need any government – if it were possible to be really isolated anymore), and it is certainly not always evil. Can it be a force for good? The answer depends on what you mean by “force.” It is not possible to force people to be good so when government is being used to force people to act a certain way then you can be sure that it is not good.

Government, like any tool, is good so long as it is being used for its proper purpose. The purpose of government is to protect individual rights. Once people start using government as a force to mandate the will of the majority on the minority, or even the will of the minority on the majority, then government is not good. Unfortunately that is how too many people view government today, as a force to promote their own view on society as a whole.

No matter how well intentioned (and most of them are well intentioned) an activist is in their efforts to make the world better through some government action, they are using the tool of government incorrectly and there will be undesirable consequences.

Take the example of racism. Government cannot be used as a force to make people be not racist. It can be used to force students of different skin colors to attend the same school building, but that is not the underlying problem. The underlying problem can only be solved by using a different tool.

Racism is not right or good, but it is the right of each individual to be racially fair-minded or racially biased. Where racism is concerned, the proper place of government is to ensure that appropriate action is taken when one person tramples the rights of another. In fact, the government need not even consider whether racism was the cause of that infringement of rights, only that the rights were infringed and what the appropriate response is towards the person or persons who did the infringing.

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Embracing Broad Perspectives

Posted on 2008-04-28 by David

I was listening to a story on NPR about young Indians abroad returning to help their country. One statement that caught my attention was the assertion that Indians who have lived in Western cultures have experienced the problems and some of the attempts to fix problems that the West has been dealing with for decades and which the Indian culture and economy are just beginning to experience as the economy there expands. Because of their perspectives from other nations they have a unique ability to help India avoid some pitfalls that the West has seen – if enough people will listen to them.

Later I was having a conversation about transportation issues in Utah and it occurred to me that the same phenomenon applies here. People in Utah who have spent appreciable time back East in areas of higher population density are much more likely to be supportive of mass transit options, tolling, and other transportation options that are often distasteful to those who have lived in the sprawling west all their lives. If those with the perspective of having lived back East are heard we might be able, as Utah continues in its rapid population growth, to avoid some pitfalls such as becoming another concrete urban jungle like Los Angeles. Only if we start making better use of transportation infrastructure options besides increasing amounts of asphalt.

Trax is good, FrontRunner is good, but lets try to make sure that such transportation options are part of the fabric of the area, not just an anomaly that feeds people into the downtown Salt lake City area.

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