Health Insurance Isn’t Insurance

Steve Olsen started a discussion about healthcare at THE UTAH AMICUS (I’m looking forward to part II) by asking: Is “free market health insurance” a nonsense phrase? He then identifies two issues that we must face head-on if we are to have any hope of actually pursuing a solution to this problem.

We hear a little about “this is how I’m going to pay for it” in these proposals, but very little of “this is how I’m going to eliminate waste, fraud and excessive profits”. Most independent studies have estimated between 25 and 40 percent of America’s health care dollar is spent on things other than actually providing care. . .

Not only that, improving the cost efficiency of health care has become an economic necessity. Consider Chrysler Corporation. In 1998, Daimler Benz paid $38 billion to purchase Chrysler, and earlier this year, essentially paid Cerberus to take it off their hands. Why? To escape the billions of dollars in unfunded health care obligations to employees and retirees. Basically, a major American manufacturing company was driven to insolvency because America expects employers to foot the bill for health care, something no other major industrial country does.

It is interesting that everyone seems to know that inefficiency in the system needs to be removed and yet there are no concrete ideas being presented on how to do that by any of the candidates spouting their proposals. The last time I wrote about health care I said that we need consumers to become sensitive to the costs of health care services rather than being sensitive to the costs of insurance premiums. Steve’s post reminds me that most Americans has even been insulated from the costs of insurance premiums until the last decade or so. Free markets promote efficiency but we are not going to have a free market for health care until we address the second issue that Steve discusses. (This is true no matter what Health Insurance Connector Authority we may decided to create.)

I believe one thing that hamstrings our efforts to improve health care is our insistence on using the word “insurance”. Let’s look at the dictionary definition of insurance: “A means of indemnity (transferring the responsibility for loss) against occurrence of an uncertain event.” Using the conservative definition of socialism, insurance is essentially socialistic, since it transfers personal responsibility to a larger group in society. The characteristic that allows insurance (in the traditional sense) to work in a free market system, despite being socialistic, is the fact that the event insured against is both uncertain and undesirable. . . Except for isolated cases of fraud, the undesirability of the event being insured against means collection of the benefit will not be abused.

Is health care a proper fit for the insurance paradigm? There are instances of catastrophic illness or accidents that meet the definition. But, in general, most consumption of health care services is neither uncertain nor undesired. We want that daily dose of Lipitor to keep our cholesterol down. We purposely conceive children and consume the health care services necessary to bring a new baby into the world – and we also consume birth control medicine to avoid pregnancy. Whether the illness is diabetes or bi-polar disorder, health care is often a matter of planned consumption where strong and significant consumer demand exists for the product.

People should be allowed to choose the kinds of plans that currently pass as health “insurance” but we need to wake up to the rigged system that we are working with. Insurance companies make it more expensive for doctors to operate and consumers pay that price. Worse yet, patients who don’t have insurance are charged higher prices to compensate for those extra costs because the insurance companies set their own prices on what they will pay for various treatments and office visits. This may be financially beneficial in the short run, but the result is that patients want to get their money’s worth so they expect more services. More demand means higher prices. If consumers were sensitive to the prices of individual procedures the demand would level off as the procedures got too pricey. On the other hand, more demand can lead to efficiency, but the insurance companies keep paying the same price for a procedure (and never lower their premiums) whether the system is efficient or not so the costs remain high even when doctors find ways to improve the system.

One comment from Scott Thompson asks Steve to run for Congress against Rob Bishop again. I don’t know enough about Scott to vote for him (not that it matters since that’s not my district) but I am impressed that he would come out and directly identify the central fallacy that keeps us from actually fixing our health care system.

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The Real Voucher Question

In a very compelling argument against vouchers, Douglas Alder asks Are universal school vouchers consistent with Utah’s values? For the first time I had an argument that made me consider voting against vouchers. Simply put, if you believe the answer to that question is “no” then you should vote against Referendum 1. If you feel that the answer is “yes” then you should vote for it. Here is the portion of Doug’s argument that made me really consider my position:

Utah has a rather unique history regarding public schools and should be careful about it.

Between 1850 and 1880, most schools in Utah were run by the local villages. Between 1880 and 1890 the LDS leaders decided to turn their schools over to the state of Utah as part of the preparation for statehood. Later they decided to do the same thing with their high schools (academies).

The result is that today more than 90 percent of the elementary and secondary students in the state attend public schools. Thus students of all abilities and all incomes and all ethnic identities go to school together. There are a few private schools, so parents determined on the private option have that choice. Charter schools also provide choice.

Vouchers would encourage the dividing of students – particularly sending bright students to settings away from mainline youth and away from state standards. They would create “gated community” schools for the privileged. In a recent Deseret Morning News editorial, Don Gale argued that public schools are not set up to aid the elite. Vouchers are.

In many states a considerable percentage of students attend private schools. Often the result is a distinct separation from their mainline contemporaries. Thus, schools become a tool of social segregation.

I think that the history of Utah Public School as outlined above and the culture that had resulted from that history is an asset to our state. After considering my stated position on vouchers I have concluded that I already agreed that we should be supporting the public schools. However, my reason for supporting vouchers included concerns about a monopolistic attitude among public school administrators (at the higher levels – I’m not talking about the principals of individual schools) and the intrusive hand of the federal government in our local school system. Those concerns still stand.

Interestingly there was another anti-voucher article by Kory Holdaway, a state legislator and public school teacher, who states that even the members of the NEA have concerns about the top-down heavy-handedness of NCLB. Once the voucher issue is settled I would love to see the NEA take a stand against Congress passing bills like NCLB. I’m looking for more than the perpetual complaint that it’s under-funded. It’s time for the education lobby to state unequivocally that NCLB goes too far even if it were fully funded.

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GOP Meltdown

I have written previously about my views on social conservatives abandoning the party in 2008 if the Republican nominee is Rudy Giuliani. I have been interested in the various articles about why they would, or wouldn’t go through with that threat. Some of the people suggesting that this is a bluff, or a poor choice, show that they do not really understand the people who are set against Giuliani. I have read some columnists who think that this is just a childish stunt. Others believe that the social conservatives have been given short-shrift in the GOP coalition and are not surprised by their desire to flex their muscles.

I argued that the social conservatives needed to support a single candidate rather than just opposing a single candidate. It has been nice to see others who feel the same way. Another convincing suggestion for social conservatives is that they need to work harder at winning the hearts and minds of other factions of the GOP coalition.

Based on what I am hearing I would bet on one of four candidates getting the Republican nomination: Rudy Giuliani – if the social conservatives don’t coalesce around another candidate, Mitt Romney – if they are really afraid of Rudy, Mike Huckabee – if they just can’t bring themselves to back a Latter Day Saint, or Ron Paul – if his extremely committed and growing core of followers can break through to mainstream voters (meaning those who are more laid back about their politics and thus are less likely to go seeking a candidate who is not at the top of the MSM listing of candidates).

Because I don’t believe that social conservative leaders are bluffing about Giuliani, I predict that all of the other Republicans have a better shot in the general election that Rudy does.

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Facts in Debate

I was excited to see the Daily Herald use the text of HB 174 to support their position. That is the way that debates over vouchers should be. Instead of getting teachers who are concerned about their students to speak in ads saying that the voucher bills are vague and full of loopholes, the voucher opponents should demonstrate one loophole that concerns them in the text of the voucher bills. Voucher supporters should be making arguments in favor of the voucher bills rather than guilt-by-association tactics against voucher opponents.

I have determined that I will not post anything more on vouchers without supporting my arguments with the relevant text of the voucher bills. Anyone who wants to add to the debate would do well to read the text of HB 148 and HB 174 rather than sticking to the vague sound bites we’ve been treated to so far.

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Candidate Compatibility

Overall Candidate ResultsI found the results of this candidate compatibility calculator interesting. The calculator consists of 23 issues that you rate your support as Yes/No/unsure and the importance of the issue as High/Medium/Low. I visited to find out what candidate my views supposedly corresponded with. I have been surprised by some calculators before. Aside from the top candidate I thought that the calculator did pretty well with me (My Candidate Matchup). I may agree generally with John Cox on the issues, but I don’t know that he is much more prepared than I am to be President (except that he’s over 35). I was disappointed to see that until I expanded the list of top candidates and found that Mike Huckabee has the same percentage of compatibility with my views followed by Ron Paul. Mitt Romney, John McCain and (surprisingly) Tom Tancredo were tied below that followed by Fred Thompson. I knew that the calculator was right to put Rudy Giuliani at the bottom among the Republicans on my list (below a Democrat no less).

When I saw the results I was surprised to see the aggregate results which show that 55% of respondents lined up with Republicans when the prevailing wisdom is that Democrats have the edge in the 2008 election. Complicating this surprise is the fact that the number one individual candidate with the for respondents overall was Mike Gravel – a Democrat. Perhaps one of the reasons for this interesting combination of results is that the scoring does not penalize candidates who oppose your position on issues of high importance to you – they are scored the same as candidates who take no position on the issues of high importance to you. Perhaps the high success for Mike Gravel is that he is undeclared on most issues where there is not much consensus on the issue. This would allow him to get points with every respondent who did not list the issue as being of high importance.

UPDATE: I used the calculator again and took a stance on some of the issues I had marked as unsure before. This time Ron Paul topped my list. More interestingly Rudy Giuliani was now significantly below two Democrats and tied with a third. (Is it any wonder that I won’t vote for him?)

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Who Do You Believe?

I had two interesting (and unconnected) thoughts about the arguments being made in the voucher debate. The first thought came as I was hearing the argument again that vouchers take money away from our schools. Of course the voucher supporters argue that vouchers will pump new money into education as parents who use vouchers will have to put some of their own money in to finish paying for private schools. The difference between the price of a voucher and the per-pupil money being spent on public education also means that there more money left in public schools on a per-pupil basis (this is the foundation of the infamous Oreo example). In a moment of clarity, some voucher opponent argued that this equation did not take into account the overhead costs of running a school. It’s certainly true that the cost of lighting an elementary school is the same whether the classes are full of students or only half full. The thought that captured my attention was – if an average voucher leaves $5000 per student extra and that $5000 is not enough to cover the overhead that remains when a student leaves then I see a huge problem with public schools. We should not have 2/3 of our public education money ($5000 out of $7500 per pupil) being dedicated to overhead costs.

The other thought that has percolated in my brain recently is that voucher supporters have focused their defense on the financial aspects of vouchers. This is probably a wise move considering that every time I try to dig into the numbers of the voucher opponents I come away feeling that their arguments don’t wash. Voucher opponents spend an equal amount of time talking about social consequences (or potential consequences) such as desegregation. Voucher opponents – when they are not talking about the financial impact of vouchers put forth pathetic arguments such as “Hillary Clinton, MoveOn.org and Ted Kennedy oppose vouchers.” Sorry, but Ted Kennedy is a huge fan of breathing air and despite how much I disagree with him I don’t plan to give up that practice just to oppose him.

It is up to the voters to decide rationally what they believe about the financial impact of vouchers (where the opponents can’t seem to make a solid argument) and what they believe about the social consequences of vouchers (where the supporters don’t seem to want to bather with an argument). If voters make their decision based on an emotional response to the pro or con arguments then the state will lose on this issue whether vouchers pass or fail.

Personally I think that vouchers make financial sense and I have more faith in the choices that parents will make than the opponents of vouchers do who seem to suggest that parents will pander to their baser instincts until we create an economic apartheid.

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Arguments Against Vouchers

I enjoyed reading Dixie Huefner’s opinion in the Salt Lake tribune recently. It was one of the more well-considered arguments against vouchers. Despite avoiding the emotionally charged shouting-match feeling that seem to dominate divisive issues like this, she still managed to skew the data to fit her position rather than presenting more accurate facts along with her legitimate personal opinion. (Yes, my support for vouchers does not cause me to think that everyone who opposes vouchers is a mindless zombie big-government liberal.) So here are some thoughts to temper her arguments.

Siphoning off tax dollars to support private school enrollment . . . also siphons off support for the public schools by parents who obviously care deeply about their children’s education.

This is perhaps one of the strongest legitimate arguments against vouchers. What is not mentioned is that the availability of vouchers gives parents who care deeply about their children’s education a lever to demand more accountability from public schools when the schools are not serving their children well.

The subsidy, from $ 500 to $ 3,000, mostly helps families who can afford to pay a significant portion of the private school tuition. Many of the best private schools cost between $ 10,000-15,000 a year. If vouchers are meant to help those who cannot afford private schools, they significantly limit the private school choices available to low- and many middle-income families.

Many of the best private schools – this ignores the fact that the $ 10,000 to $ 15,000 private schools make up a tiny fraction of the private schools in the state. There are many others which cost significantly less (some even less than $ 3000) and still offer a greater range of choices to parents than public schools do. The vouchers are not limited to being spent at the “best” (read “most expensive”) private schools. I would bet that 50% of private schools charge less than $5000 and if vouchers are implemented new charter schools are likely to spring up catering to this within-reach-of-the-vouchers price range. For those who argue that $ 5000 is still a lot of money I argue that:

    • A $2000 voucher brings the cost to $ 250 a month which is a good chunk, but if you are serious about your child’s education you’re likely to find a way (start by ditching your $ 60 cable bill).
    • Voucher opponents do not suggest raising the level of vouchers – they prefer to limit parental choice to the rich.

The provision allocating money to public schools to partially offset the loss of tax dollars for children receiving education vouchers expires after five years.

Why should public schools be perpetually paid for students that they never educate? This argument directly conflicts with the argument that vouchers cost too much. If the public schools were paid for more than five years the vouchers would cost more. Besides, the provision itself does not expire after five years, the offset money expires for individual students who remain outside the public school system for more than 5 years. In other words, the schools quit receiving money after parents have determined that their student really is doing better outside the public school system.

Other parents may determine that their child’s instructional needs have not been met by the school. They may have a child who is harassed or bullied by other children, or they may prefer smaller class sizes.

Certainly, private schools have a role in educating children who are not well-served by their public school. But the selection of another public school is also an option for parents who are seeking a more effective school environment for a particular child.

Students are allowed to move between schools within their districts. Their choice of schools are limited to other schools that are directed by the same people who are directing the schools they are trying to get away from. That sounds like Henry Ford telling people that they could have their car in any color they chose – so long as it was black.

Another concern about the voucher legislation is that it will encourage private schools that lack a track record and will not be as instructionally effective as the public schools. Public schools are accountable to the public and must report such matters as drop-out and attendance rates and achievement scores.

The voucher legislation will not provide vouchers for schools that do not have a track record. The track record in private schools is that if they do not meet the demands of parents they lose their students and have to close. Public schools are insulated from that kind of accountability – they just have to report their numbers but there is no risk to their bottom line.

[Public schools] must comply with due process protections and equal protection mandates of the U.S. and state constitutions.

This is a nice scare tactic, but what “due process protections and equal protection mandates” are private schools going to violate?

If all the energy in time and money spent on supporting private school vouchers went to promoting ongoing professional development of educators; [etc.] . . . we might have an education system that better meets the needs of all our children.

If all the energy in time and money spent on oppopsing private school vouchers (that’s much more than has been spent supporting them) we might have an education system that was better, but one size still does not meet the needs of all our children.

As I have said before, there are valid arguments against vouchers. Most of them are based on personal beliefs about the way our children should be educated and what is in the best interest of society. Let’s quit pretending that this is a fight between good an evil. It’s largely a matter of personal preference and social vision. “What do you think is best?” That’s the real question behind this legislative fight.

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Put Ethics Before Politics

As a voucher supporter I have to agree with Jesse:

As a voucher supporter, I have gone from embarrassed with to disgusted by PCE. This event, going from unethical and sleazy to potentially illegal, is absolutely inexcusable and I would encourage every Utahn to immediately stop donating to them and every candidate to refuse their filthy money and return whatever campaign contributions they’ve been given. Utah businesses should refuse to do business with them and Utahns should refuse to work for them. Astroturfing, phishing, push polling… these are not acceptable. PERIOD.

If you truly support vouchers like I do, you will run as far away from PCE as possible and give them the stern and harsh punishment they now deserve. Starve them for dollars and make them wither and die in this state. They have done more to damage the concept of vouchers than any anti-voucher group could ever dream of. Their loud and visible bad example makes everyone else look bad by association. Thanks to PCE, anyone who supports vouchers, no matter how honest, sincere and open they are, will be tainted with the labels of dishonesty, trickery and ulterior motives.

Besides starving PCE of cash, voucher supporters should refrain from any further reference to PCE – they don’t deserve any further publicity for any of their arguments. Perhaps if the reaction against this is strong enough people will recognize that PCE is not representative of the entire voucher support base. As Jesse said, some of us are honest and sincere and staunchly opposed to gutter politics.

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Four Good Criteria

I’m always looking to quantify what makes a candidate acceptable or not. Thus I was drawn to four criteria that Scott suggested we should seek in candidates we would support. They should be Honest, Good, Wise, and Constitutional. Scott does a good job of expanding on each of the criteria, but this qualifier should guide all our political decisions:

All of the criteria we are called upon to apply to candidates is highly subjective and/or runs on a sliding scale. It requires a fair amount of personal effort to find out about each candidate and determine how well each measures up to the criteria. We should avoid a knee-jerk reaction to any candidate.

As I have been thinking about these criteria the idea came to me that we might be well served to apply the same criteria to the laws we sometimes vote on. Doubtless there is plenty of disagreement on whether vouchers are honest, good, wise, or constitutional. Different people will come down to different conclusions on each criteria, but it might elevate the debate if we would focus on those fundamental qualities rather than stooping to political maneuvering and scare tactics.

As citizens we do not directly vote on most of the laws that are made, but if we are able to choose representatives with these four characteristics, and then those public servants were to evaluate the laws they are called to vote on by applying those criteria we would be more likely to get laws that are in the best interests of the people and not merely the best interests of a special interest group, or a lobbyist, or the candidates hopes for reelection.

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Despicable

I’ve come out in support of vouchers, but not very supportive of the often weak efforts of the pro-voucher groups. Not supportive and downright disgusted are two different things. This makes me downright disgusted. So far the misleading email has not been conclusively tied to any official pro-voucher group but I don’t trust them enough to abandon that possibility. I would like to think that this is the work of a weasel who thought he’d do his part to help the cause – if so then someone needs to track him down and shout “Hey, you’re not helping!!”

At the risk of having someone throw eggs at my house I just have to consider the slim chance of reverse-psychology logic leading voucher supporters to pull this trick to manufacture yet another black eye for their inept opponents.

Isn’t politics lovely?

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