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Archive for the ‘Obamacare’ Category

I originally wrote this in 2009.  Seems timely again.

One worrisome aspect of greater government involvement in health care is the politicization of health care, which would allow the government indirectly to punish critics, oddballs, and any others that are deemed undesirable.  Obamacare is nothing short of giving the government the power to destroy the lives of individuals without any due process whatsoever through the hazy and easily manipulated realm of “psychological institutionalization.”

This might appear, at first, kind of paranoid.  This is America, after all.  But it’s not unprecedented.  The Soviet Union declared political dissidents as mentally ill rather than having formal charges pressed through the criminal justice system.  Even in that sorry regime, it was easy for state evil to fly more easily under the radar in the medical field rather than in traditional law enforcement. The Soviet Union’s doctors locked decent men up for many years in mental wards. The state-paid psychologists did the bidding of the Communist Party in the end.

In the Soviet Union, where the government was the sole employer, the notion of professional independence had disappeared.  The state swallowed up every group or institution that might provide some locus of resistance–the wealthy, private property, private industry, free speech, education, labor unions, professional guilds, and the Orthodox Church.  In these circumstances, lone individuals had very little power to stop the state’s destruction of private life and were often themselves deemed “difficult” individuals suffering from mental illness.  All in the name of creating a socialist utopia.  The same trend of increasing government power over our lives is underway in the United States today.

It may be objected that there is a strong culture of professional independence and concern for patient welfare in the American regime.  How viable is this alleged protection?  For starters, whatever ethic prevails today depends on the about-to-be-destroyed system of fee-for-service, which will be eroded to nothingness under the influence of Obama’s “government option.”  Obamacare will require government approval for payments to doctors for the majority of patients and further encourage conformity to government-dictated “best practices.” It may go something like this:  “Well, you doctors can do whatever you like doctor, but we’ll only pay for X, Y, and Z. Govern yourself accordingly.”

Even today, it’s not so clear that the purported ethic of physician responsibility provides effective protection for patients.  Drug companies, for instance, have created a serious financial incentive for doctors to prescribe particular drugs to patients, regardless of their effectiveness, their own lack of expertise in psychological illnesses, or the desirability of therapies that do not involve mind-altering drugs.  Nowhere is this more evident than in the field of mental health. Hitherto unknown diseases like “shyness” now are declared sicknesses that require expensive drug treatments.  Primary care physicians with no time for time-consuming counseling instead hand out Prozac and Paxil like candy canes.  According to Forbes, “We now spend more on mood-altering drugs for our children, including antidepressants, than we spend on antibiotics.” This is a scandal.

We have also witnessed psychiatrists in particular gladly assist the military, the police, and industrial organizations with an eye towards institutional goals like effective interrogation, screening of employees, and the creation of systems that promote worker productivity. Institutionalization of people was once the norm, as too is a habit of experimentation, including in the abuses of lobotomies in the middle 20th Century right here here in the United States.  Patient welfare is secondary in all of these well established practices, and the proximity of the abuses should give pause to those that call critics “paranoid.”

What historical or ethical limit would prevent careerist doctors from also engaging in punitive diagnoses of “authoritative personalities” and labeling conservative “sickos” under Obamacare?  What would prevent the creation of new diagnoses such as “homophobia” or pathological conservatism?  After all, such politicized definitions of mental health and long-term involuntary incarceration of political dissidents happened under the long-standing socialist medical regime in history, that of the former Soviet Union.

The world is more politically correct than ever.  To a great extent, we’ve become desensitized to the brainwashing and indoctrination of liberal group-think in corporate and academic settings.  Why wouldn’t medicine also be abused?  From diversity seminars to the scandalous sub rosa euthanasia that takes place in hospices to the anti-life practice of abortion, the potential oppressiveness of liberals knows no boundaries, because it’s not limited by the conscience:  it imagines itself to be good and promoting the good of all; therefore, dissent can be dismissed and classified as an expression of hate, racism, and, most sinisterly, “sickness.”

We must consider all the possibilities of evil under the Obamacare regime.  The potential abuses of Obamacare will not be spelled out in the plan.  Instead, the plan must be reviewed critically in light of the times, the dilapidated state of medical ethics, and the sorry history “repressive psychology” in the world’s longest-running experiment of government-run healthcare.

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I am more than a little chagrined about the passage of Obamacare. 

It will cost a lot, it will reduce quality of care, and eventually it will create a debt crisis when combined with the impact of other entitlements. This debt crisis will end in American default on its debt (and insanely high interest rates and mass confusion) or  slow motion inflation (and insanely high interest rates), and, in either case, a general destruction of wealth for many years not so different from the recession we’re now enduring. 

This is all very bad, of course, but the worst impact of Obamacare will be spiritual:  Obama has made us all welfare cases.  And every election from now until the end of time will be one where the majority of voters (i.e., net recipients) clamor for more from the government, which will squeeze every harder on the shrinking  plurality of the prouctive class (i.e., net taxpayers).

In addition, I am greatly afraid this victory will embolden Obama, who is verye sensible of the backlash that will hit vulnerable Democrats this fall, and thus he will be filled with a great sense of urgency and ability to continue to change America and the relationship of Americans to their government as long as his party has the majority.  

Perhaps, Cap and Trade or Immigration Amnesty is next. 

The man is, if nothing else, driven by an agenda.  He is an ideologue.  His goal is to put wins on the scoreboard of history, and he sincerely believes in much of what he’s doing.  This makes him all the more dangerous, as evidenced by his maniacal energy and focus on healthcare even as the economy continued to stay in the tank  and even as his numbers fell.  He will push on the gas harder, even if it weakens his party and his own chance of reelection.  He knows, as we all should have known, once this passed it will be hard to repeal, and he knows, as we all should have known, that this type of entitlement will change the dynamics of American politics for generations if it becomes part of the landscape.

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I’m in a bit of a blog rut. The same news basically keeps repeating itself: Obama’s abominable healthcare bill, our massive debt, our ailing economy, our lack-of-strategy or will or purpose in Afghanistan, and the general and increasing weakness of the country under Obama. What else is there to say about the latest behemoth healthcare bill. It’s an atrocity, and let’s hope it fails, but I have no particular ability to handicap its likelihood of passage or not.

As for the economy, the situation is bad and Obama is making it worse by running up huge deficits. Friends from extremely normal backgrounds–i.e., they weren’t reading Paladin Press books in college like I was–are talking about stockpiling guns, survival retreats, and general doom and gloom. These are guys that walk lon Wall Street and the Chicago commodities exchange, not habitual survivalist oriented nut jobs like yours truly.

Times have been worse of course. And God has his own mysterious unfolding plan in store for us individually and collectively. But I hate to write about the same things in the same way over and over again. I’m not quitting the blog. It’s still fun and helps me collect and clarify my thoughts. Something interesting and new should be on the horizon before long. But for now I feel great weariness.

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Obama is surprisingly naive for a guy who spent so much time in Chicago; there will be a million ways to bankrupt his healthcare system and exploit its vulnerabilities, and the end result will be an unpopular, unworkable, and very expensive system that will alienate his marginal supporters among white yuppies and independents.

Consider the scenario envisioned by Dick Morris:

Will a young, healthy, childless individual or couple buy health insurance costing 7.5 percent of their income, as required by Obama’s health legislation? Not until they get sick. Then they can always buy the insurance, and the Obama bill requires the insurance companies to give it to them. And if the premiums come to more than 7.5 percent of their income because they are now sick, no problem. Obama will subsidize it.

Instead, young, healthy, childless people will likely opt to pay the $1,000 fine (aka slap on the wrist) mandated in the bill. After all, even if they make as little as $50,000 a year, the fine is a lot cheaper than 7.5 percent of their income (or $3,500 a year)!

So … these young households will not contribute to the coffers of any health insurance company until they are sick and need the coverage. By then, their costs will come to vastly more than their premiums.

Who will subsidize the difference? We will.

“We,” by the way, are the “money people,” the 30-40% net contributors of the federal government’s revenues. These people of the upper middle and upper class, typically professionals or small business owners who have decent incomes–a far cry from the idle rich–will be ground into dust under Obama, and perhaps this is the real goal even beyond universal health care.

I’m not sure, though. Naivite, wishful thinking, and outright stupidity often explain things more fiathfully than grand and malevolent conspiracy theories. If there is one thing Obama has demonstrated in spades since his election, is that he’s not as sharp or even as street smart as his credentials would suggest. He’s a man of idealism and attainment more than actual achievement.

Naivite is exactly what we would expect from a guy with the “golden resume” rather than actual life experience. Rahm Emmanuel on the other hand . . .

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I thought Obama’s big speech was more of the same. It seemed more of a pep rally than an attempt at persuasion. I doubt it moved the ball much.

I think Obama has read the anger of the last few weeks and his declining poll numbers not as a rejection of his extremism, but as a call to rally the faithful and the American people, who supposedly endorse this liberal craziness. He continues to misread moderates, old folks, and Reagan Democrats. The speech manifested an echo-chamber belief that the only problem is a lack of Democratic Party unity and passion, rather than principled disagreement and abject fear among critics.

I thought shouting “Liar” by Congressman Joe Wilson was a bit out of line, but, then again, there are times when a man’s passion for truth gets the best of him. . . . particularly if he’s of Scots-Irish descent.

This is fundamentally a health insurance debate, not a health care debate. People basically like their doctors, the high tech tests, the state of the art medicines, the rosacia drugs, and the idea that doctors will do anything and everything to save you. Because all of this high quality care is subsidized either through employers or group plans or Medicare and Medicaid, we don’t have a culture of economizing; people like the gold-plated care. But this is only because people don’t pay for it.

If people had to pay for it, though, they’d accept lesser quality of care, and this and this alone would drive down prices. It’s a chimera to say earlier interventions and less use of emergency rooms and records-keeping innovations alone would significantly reduce costs. The tests themselves are expensive, and they would reveal expensively treatable but otherwise serious or fatal conditions before they lead to death. This is probably a good thing from a social welfare standpoint, but it’s not cost-saving.

The Democrats’ beef with health care are contradictory, namely,

Democratic Diagnosis of Healthcare “Crisis”

1. There are too many uninsured.  Perhaps.

2. Costs are going up too much and too quickly.  But this is itself a phenomenon of third party payment, which will be made worse by expanding insurance coverage. See point 1.

3. They say there’s too much gold-plating and too much care at end of life.  But they do not state a willingness to embrace explicit rationing as a necessary feature of government-provided health plans. Further, these “problems” are quite popular with recipients, and channeling these people to government care worries them.

4. There are system-wide inefficiencies and inequities as a consequence of employer provided coverage, such as widely varying and confusing pricing, lack of portability, penalties for preexisting conditions.

My diagnosis of the problem is quite different, and it points to different solutions.

Conservative Diagnosis of Healthcare Problems

1. Too much goldplating and overconsumption due to third party payment.

2. Costs not transparent hindering competition in general and for copays due to widely varying private party negotiated prices and Medicare reimbursements.

3. Not enough penalties and incentives to self-insure leading to
abuse of emergency rooms .

4. Not enough demanded of recipients of public aid to reimburse and internalize costs of activities and poor choices .

Obama’s talk of paying for his plan by efficiencies in record-keeping, negotiated prices, limits on care, limits on “waste and inefficiency” is either disingenuous–the equivalent of proposing “flying cars”–or the inefficiency talk is a Trojan Horse for painful rationing that will be necessary to maintain Medicare and this new regime as solvent.

I have no problem in principle saying that we’re irrationally spending more on health care than we should. We are.  But we are because other people are paying for it. This is natural and predictable. But the market can and should decide the “right” amount through the kinds of insurance people choose ex ante and the kinds of care they choose ex post when they have to pay for it. I think most people will 80/20 everything and look for bargains when it’s up to them, just as they do on other necessities like housing, food, clothing, and cigarettes.  Those that want more will pay more.

Perhaps, people will think twice about destroying their kids’ inheritance for long shot care after a certain age, but, maybe not. Either way, that’s OK. It’s their choice, when it’s their money.  The problem with Obama’s plans is that this type of high quality care is not available, and the rationing is the choice of a government death panel. We make similar choices about homes to buy, cars to fix, and other necessities every day, and we do so privately with little government interference or subsidization.

I am above all a realist. There is a problem with people not doing what is in their own interest and abusing the welfare regime in place through emergency room visits. There is a problem when people are locked into jobs where there are ones at which they’d be more productive due to fears of lost coverage.  There are also problems with the lack of transparency in pricing, which hurts competition. With this view in mind, I would propose something like the following:

1. Limit Third Party Payment: End the preferential tax treatment of benefits. Mandate employers who drop insurance must pass some percentage of lost benefits to employees in terms of increased wages. (Admittedly, this is kind of crazy and interventionsist, but it’s necessary to sell the transition, and this is equitable to workers and should be revenue-neutral or revenue-positive to employers).

2. Mandate Rational Catastrophic Care: Require everyone individually to get absolute bare-minimum insurance or face extreme tax penalties and mandatory channeling to government poor-house care. This is paternalistic but necessary.

3. Accept Variable Quality of Care: Have low requirements for minimum policies that contain all kinds of limits on care in order to cut price and costs. This way people, not the government, are choosing to get state-of-the-art circa 20 or 30 years ago complete with generics, leeches, mercurochrome, whatever.

4. Make Welfare Painful: For those who are totally broke or improvident, channel funds and provision of care to government-run and charitable clinics, but make these sources suitably unpleasant with long waits, mandatory community service in case of nonpayment, and the like in order to encourage people to buy their own insurance. End mandatory emergency room care and transport the uninsured to this regime.  As a civilized society, we should not let people die of easily treated illnesses, but we should make public care costly in other ways so that recipients know they’re on welfare and will want to get off of it quickly.  This regime should completely replace Medicaid.

6. Transition From Medicare and Limit Costs: On Medicare, there’s a bit of an equity question. People have planned their affairs on the basis of expected benefits. But the system is going broke. I’d raise eligibility requirements, push out the retirement age, and phase-in means testing. I would also create financial incentives for the transition of younger individuals to lifetime, portable insurance contracts along the lines of life insurance policies. Those 45 and younger should have to do this.  This way people can pay a little more when they’re young than their immediate risk profile would suggest, but the risk is spread lifetime, and they’re choosing the level of care they want and can afford. Perhaps some tax benefits for choosing lifetime, over immediate care, policies would make sense.

7. Transparency: On prices, mandate something like the Truth in Lending Act.  Only allow one price for everything. Insurers can pick it up to whatever amount their agreement with their customer says. The rest can either be paid by the patient or written off by doctor.  Ban price discrimination between insurers, uninsured, different classes of plans, or the like. Mandate publishing online so people can check out-of-pocket expense based on their insurance plan.  It doesn’t matter what’s done with that price once it’s in place, so long as it’s out in the open.  The present-day regime of hidden, negotiated, and opaque pricing now hinders competition massively.

Clearly I don’t like the government involved in any of this, but other than facilitating the transition, an approach like this would radically reduce (a) government involvement in health care and (b) unrealistic expectations of highly subsidized government welfare. Instead, the government would only be doing things to avoid fraud and facilitate markets–such as measures to permit price transparency–and making people do what they would do if they were rational and responsible to avoid being wards of the state.

While not a perfect approach, this is a hell of a lot more freedom-oriented and reasonable than Obama’s. It would preserve the high quality and freedom associated with the American system, while addressing the genuine problem of skyrocketing costs, middle class anxiety over losing coverage, and the burden on the system and the public from the spread-out costs of the uninsured.

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I attempted to go to a Health Care Town Hall today with my radical local congressman, Alan Grayson.  What a joke.  It was held in a tiny union hall that held about 120 people.  The event was announced only a day before.  Still, around 1,000 people showed up.  Prior to the public meeting, a local Democratic Committee meeting was held.  About 70 of the seats were already filled when it was opened to the public.  Some of the “no” questioners asked things like, “You changed my mind.  Why can’t everyone realize how great this is?”  It was a farce.

The crowd waiting hopelessly to get in was large and varied and mostly against the bill.  It was fairly diverse and a bit younger on average than I expected.  A few supporters were there, apparently members of college Democrats, union folks,  ACORN members, and a few random supporters.  A large cohort of opponents were there, though, perhaps three fourths of the attendees.

The few I spoke to showed up after hearing it on the news.   Many had home-made signs, including a pretty funny one that said, “Don’t Kill Granny.”  Many opponents’ signs said, “Read the Bill.”  People were generally well behaved, but there was a little bit of shouting, particularly when we all realized how full the hall was and how impossible it would be to get in.  People spoke to their neighbors in line, mostly in fear of the bill, expressing concern for declining quality, euthanasia, abortion, and their elderly relatives being deprived of care.  A great many people were worried about government spending and our loss of freedom.  His strategic choice of a friendly and tiny venue was almost universally reviled as a cowardly gesture.

Grayson is a radical who snuck into Congress on the reverse coat-tails of local mediocrity, Ric Keller.  He is a trial lawyer in the back pockets of ATLA and has proposed “free vacation” and other feel-good giveaways.  I hope his embrace of Obamacare is his Waterloo.  It was encouraging to see so many opponents asking generally intelligent questions and showing fear and outrage at the prospect of a significant growth in government and government’s role in our lives.

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