At a recent talk at Liberty On the Rocks in Denver, Amanda Muell argued that the birth control insurance mandate violates individual rights. She compared it to a law forcing restaurants to offer more extravagant and more expensive meals that customers wish to buy. The mandate does not merely violate religious liberty, she said, but individual rights.
I caught up with Constitutional scholar Dave Kopel at the Independence Institute’s annual banquet February 16. In these two short videos, he explains why the Medicaid mandate as the individual mandate (to purchase health insurance) under ObamaCare are unconstitutional.
First Kopel argues that the Medicaid mandate violates the principles of federalism:
Next he argues that the Constitution never granted Congress the power to compel people to purchase products.
Pajamas Media has published my latest article, “Health Insurance and Personal Responsibility,” a reply to Wolf Blitzer’s remark about letting people without health insurance die.
While my piece was in processing, several others wrote about the issue as well, including Mike Rosen and John Goodman (who in turn links to several other articles on the matter). See also my previous post, “Tea Party Crowd Cheers Voluntary Health Charity.”
Following are some of my favorite quotes from the PJ article:
… Blitzer’s question presumes that the only three alternatives are overpriced insurance, letting him die, or forcing others to pay for his care. Thankfully, the real world offers us far better options. …
“Society” has no right to violate the rights of minorities or of individuals. Doctors, hospitals, and individuals who wish to help pay for others’ care remain free to do so, but they should not be forced by federal politicians to do so.
The deeper problem, the real reason a healthy 30 year old grows tempted to forgo health insurance, is that politicians have made the costs of health care and insurance ludicrously expensive. …
Free-market reforms make it easier for people to live and pursue a healthy and autonomous life. In moving toward that goal, all that needs to die are the misguided political controls on health care and insurance that have so thoroughly debilitated those fields.
According to a YouTube video by Talking Points Memo about the GOP debate of September 12, the “Tea Party Crowd Cheers Letting Uninsured Die.”
Here’s how Curtis Hubbard, the editorial page editor of the Denver Post, describes the scene: “Cheering for people without insurance to die? Unbelievable.” [Note: Please see the update below.]
Mike Littwin, a member of the Denver Post‘s editorial board, writes:
I don’t want to say the crowd was rough, but when Wolf Blitzer asked Ron Paul whether a doctor should refuse to treat a 30-year-old man in a coma who had failed to buy his own health insurance, some in the crowd shouted, “Yes, yes.”
I’m serious. I’m a little shocked, but I’m deadly serious.
If “half the truth is a great lie,” then Talking Points Memo, Hubbard, and Littwin are great liars. [December 1 Update: See my post, Belated Apology to Littwin regarding this line.]
So let’s back up and look at the entire sequence.
Wolf Blitzer asked Ron Paul (whose candidacy I do NOT support):
Let me ask you this hypothetical question.
A healthy 30-year-old young man has a good job, makes a good living, but decides, you know what? I’m not going to spend $200 or $300 a month for health insurance because I’m healthy, I don’t need it. But something terrible happens, all of a sudden he needs it.
Who’s going to pay if he goes into a coma, for example? Who pays for that? … He doesn’t have [health insurance], and he needs intensive care for six months. Who pays?
Paul answers, “That’s what freedom is all about, taking your own risks. This whole idea that you have to prepare and take care of everybody…”
At this point, as the video makes clear, the audience interrupts with applause.
Blitzer cuts in, “But Congressman, are you saying that society should just let him die?”
At that point, at least three idiots in the audience scream, “Yea!” Is this the “Tea Party Crowd?” No. Littwin at least gets that point right. The few chanting “Yea” are not representative of the crowd or of the Tea Party movement. (They are not even known to be self-identified Tea Partiers, though I suspect they are.)
Obviously every large crowd has its idiots. This is true of Tea Party crowds, leftist crowds, union crowds, etc. Notice that those leftists who wish to demonize the entire Tea Party movement based on the idiocy of a tiny minority at the fringe of that movement do not similarly wish to condemn the entire left when a few leftists call for (or enact) violence, racism, or other variants of destructive stupidity (even though such things are much more prevalent on the left). So how about some intellectual honesty here?
Notably, the Talking Points Memo video dishonestly cuts off at this point. But the transcript proceeds:
PAUL: No. I practiced medicine before we had Medicaid, in the early 1960s, when I got out of medical school. I practiced at Santa Rosa Hospital in San Antonio, and the churches took care of them. We never turned anybody away from the hospitals.
PAUL: And we’ve given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves. Our neighbors, our friends, our churches would do it. This whole idea, that’s the reason the cost is so high.
The cost is so high because they dump it on the government, it becomes a bureaucracy. It becomes special interests. It kowtows to the insurance companies and the drug companies, and then on top of that, you have the inflation. The inflation devalues the dollar, we have lack of competition.
There’s no competition in medicine. Everybody is protected by licensing. And we should actually legalize alternative health care, allow people to practice what they want.
This combination of free-market policy reforms in conjunction with voluntary charity is more typical of Tea Party beliefs, and it is what I advocate. (I would also favor the hospital sending this man “who makes a good living” the bill once he recovers.) For Talking Points Memo, Hubbard, and Littwin to mention the moronic tiny few chanting “Yea” to the “let him die” line, then to ignore Paul’s substantive answer and the general audience approval of that, is, as I suggested, less than fully honest.
But, hey, they’re talking about the Tea Party, so any smear goes, right?
September 14 Update: After I posted this material, Hubbard added on Twitter, “You infer my comment was directed at entire audience instead of at those who cheered. But you have your defending to do…” Apparently, then, he is claiming that his original comment was not“directed at the entire audience,” but only “at those who cheered.” Fine. Fair enough.
But, as should be obvious, I am not “defending” those who cheered the “let him die” line; I thought calling them “idiots” and “morons” adequately conveyed my attitude. As for Paul’s actual remarks on this issue, and the actual crowd’s response to them (as opposed to the earlier response by the few idiots), those do not need defending, which was the point of the post.
I did hesitate to include Hubbard’s remark with the other two. Talking Points Memo clearly smears Tea Partiers; Littwin ties the few idiots to the Tea Party, leaving to implication that they are representative. Hubbard, on the other hand, merely says that it is “unbelievable” that there was “cheering for people without insurance to die.” He was right to make the criticism.
The problem, and it is a minor one, is that Hubbard neglected the broader context, which is that the overwhelming majority of the audience supported Paul in taking the opposite stand of the few idiots. I read Hubbard’s subsequent Tweets, and he uttered not a word about that key fact, though he did manage to post numerous updates about a football game. I think if the first part of the story merits attention, then so does the second part, particularly as the second part reveals attitudes much more representative of the crowd.
Most of the attack ads I’ve seen this political season take something out of context. These ads, while technically correct, omit relevant context and thus lie by omission. However, a recent attack ad against Congressman Ed Perlmutter is technically incorrect, because it uses the word “can” rather than “might.”
A group called American Action Network ran the ad, which stated: “Apparently, convicted rapists can get Viagra paid for by the new health care bill… with my tax dollars… and Congressman Perlmutter voted for it.”
Adam Schrager of 9News explains:
The new health law treats sex offenders who are not incarcerated the same way the old law did. They can buy any health plan they choose. Some might cover drugs like Viagra, some might not. The new law doesn’t say anything about these types of drugs. As for the new health care law, the exchanges the government will be setting up as a low-cost alternative have not yet been set up, so no one knows what medications they will cover.
Schrager cites a document from FactCheck.org, an outfit run by the Annenberg Public Policy Center — a group that clearly favors the Democratic health bill despite the group’s self-proclaimed “nonpartisan” status.
The FactCheck.org document specifically attacks Nevada Republican Sharron Angle, who ran an ad against her opponent similar to the ad against Perlmutter. Yet FactCheck.org frankly admits:
There’s nothing in the legislation that supports, requires or even mentions such prescriptions. It also is true that the Congressional Research Service said that nothing in the health care law would mandate that health plans “limit the type of benefits that can be offered based on the plan beneficiary’s prior criminal convictions.” The new law will be just like the old: Convicts who are not in prison, including those convicted of sex offenses, will be able to buy any health plan they choose, some of which may cover drugs that treat erectile dysfunction. And former prisoners will be able to buy plans from the state-administered health exchanges with tax subsidies, if they qualify. The health exchanges aren’t set up yet, so it’s not clear whether Viagra (and similar drugs) will be one of the medications exchange plans cover.
In other words, the Democratic health bill may very well use tax funds to pay for Viagra for sex offenders — we simply don’t know yet. (For more on the report from the Congressional Research Service, see this news article from Fox.)
As Lynn Bartels reports, 9News yanked the ad against Perlmutter — apparently preferring to make money only off of more subtle forms of deceit.
But most people are missing the important issues here. Allow me to review them.
1. The fact that we don’t even know whether ObamaCare will fund Viagra for sex offenders points to a major, catastrophic problem with the bill: it is an open-ended, bureaucrat-empowering, arbitrary, and capricious political takeover of health care. We already see the capricious nature of the bill with the recent waivers granted to various politically-connected companies.
2. Politicized health care turns many issues into political footballs. What benefits will the government fund, and what benefits won’t it fund? Viagra for sex offenders? Viagra for anybody? Drug and alcohol recovery? Psychotherapy? Chiropractic care? Massage? Aroma therapy? Long before the passage of the Democratic health bill, special interests lined the halls of Congress and state capitols, lobbying to mandate their own favored benefits by force of law. ObamaCare will only make this problem much, much worse.
3. Over time, ObamaCare will increasingly drive (nominally) “private” health insurance off the market, so more and more people will be forced to buy their insurance through the political “exchange.”
4. The mere fact that any health insurance funds Viagra (for anybody) points to the political manipulation of health care over the past few decades. Because of the the distortions arising from the tax code, most Americans treat health insurance predominantly as pre-paid health care, not as real insurance. Thus, much of the optional, low-cost, routine, and expected care that would otherwise be paid out of pocket is instead paid through higher insurance premiums, which dramatically reduces the incentive to economize on such care.
So, while Colorado’s major media outlets obsess over a trivial detail — whether ObamaCare “can” or merely “might” subsidize Viagra for sex offenders — they are missing the bigger picture and the real problems with Perlmutter’s vote for the health bill.
Tony October 29, 2010 at 2:28 PM
Thanks for the common sense talk. The problem with Hyperbole is that it discredits the entire movement. Common-sense talk, getting back to the basics and what is rather than what might be is the way to address these problems.
It’s like I always say:
“If you liked the way they handled the Iraq war and the TARP and Stimulus funds… If you like the VA and want some more of that, and think that the response to Katrina was spot on… then I think it’s time to give them control of your health care as well.”
Rob Natelson discusses the constitutionality of ObamaCare, the 17th Amendment, and amending the Constitution. Natelson is a former law professor at the University of Montana and a Senior Fellow with the Independence Institute.
As I wrote yesterday, Jennifer and I are planning to have a kid. One of the major outstanding issues was how insurance would handle this. I was relieved to confirm that our health insurance would cover emergency contingencies related to delivery (after the deductible). Moreover, we have 30 days to add a newborn to our plan, and the child is covered from birth.
We have a high-deductible plan with Assurant that costs us $148.16 per month (for both of us). We don’t expect our insurance to cover any of our routine or moderate-cost care; that’s why the premium is relatively low. Instead, we save the maximum allowable in our Health Savings Account, which is pre-tax money. We already have ample funds in our HSA to cover a routine delivery at Mountain Midwifery.
But, as Tracy Ryan, the owner of the facility, warned us yesterday, in a minority of cases a woman may need an expensive C-section, and the infant may need expensive intensive care. The worst-case scenario could easily cost tens of thousands of dollars.
Our family deductible is $10,000 per year. So, given our insurance covers delivery emergencies, that’s the maximum bill we’re looking at, and by then we’ll have more than that in our HSA.
Assurant also gave me an estimated premium to add a newborn: a family total of $202.69 per month. While decades of political controls have mostly destroyed the market in health insurance, that’s a premium I can live with. The big question for us is whether and how long ObamaCare will allow my high-deductible insurance to exist.
Blog housekeeping: I’m adding a “family” label for posts related to pregnancy and children. I use “PPC” — for People’s Press Collective — for posts on politics. I’ll use a “home” label for everything pertaining to food and the household. I’ll also use a “religion” label.
Despite enactment of the Democratic health law, one reform Republicans and market advocates should fight to keep alive is the Health Savings Account (HSA), which allows people to put pre-tax money into an account dedicated to health-related expenses.
Experiences my wife and I have had this week illustrate the power of paying for one’s own health care, which an HSA encourages. Rather than pay a hundred plus dollars each to a doctor and an out-of-state testing facility, we each paid King Soopers $20 to test our blood cholesterol. I’m not saying this is a good substitute for seeing a doctor, but we wanted to get a test between regular doctor visits. Our actions illustrate the fallacy of claims that self-payers don’t get preventive treatment. We are highly committed to doing what we can to prevent long-term health problems by taking care of ourselves and paying for preventive care.
Yesterday we checked out Good Samaritan Exempla in Broomfield (more on this later). When we asked for referrals for local doctors, the hospital’s representative told us, “You’ll probably want to pick a doctor based on what your insurance allows.” I proudly replied, “No, we will pick a doctor based on who we judge is the best doctor.”
Paying for one’s own health care encourages the health consumer to be active-minded and pro-active. It encourages the consumer to seek good value for the money. In short, it promotes better long-term results for lower costs.
By contrast, ObamaCare in its core elements will promote wasteful and frivolous health spending and irresponsible behaviors, and it will contain costs only through bureaucratic rationing.
On the health bill, the Democrats won. But, even as free-market advocates fight for the full restoration of freedom and individual rights in medicine, they should push to keep the HSA alive.
It is unclear to me when and if ObamaCare will forbid or make impossible my high-deductible insurance. (It would indeed be unfortunate if one result of ObamaCare were to push me from having insurance to not having it.) Currently, an HSA is tied to such insurance (as I understand it), so if high-deductible insurance goes away, that would quickly phase out HSAs. An easy fix to this would be to sever HSAs from insurance, or allow an HSA to be linked to any sort of health insurance. To appease the “soak the rich” crowd, limits on annual contributions could remain (so that people couldn’t get too good of a tax shelter).
A key reform to HSAs would be to allow the funds to purchase health insurance policies too, as well as health care.
I suspect, as I have heard others claim, that ObamaCare will encourage some people — those who want to remain in control of their own health decisions — to utilize “medical tourism” and cash-only clinics. HSAs would help enable the latter. (Indeed, a selling point to Democrats could be that HSAs would encourage people to seek medical treatment in the U.S. rather than in Costa Rica or India, if HSAs were valid only within the U.S. Of course, I would rather see HSAs valid for any health-related expense anywhere, but that’s probably wishful thinking at this point.)
The Democrats may have changed the law, but they have not altered the basic fact that people take charge of their own health care by directly paying for routine or moderate-cost care, drawing on insurance only for high-cost emergencies. ObamaCare will continue to disempower patients and empower bureaucrats (including employees of nominally “private” insurance companies), but HSAs could help keep some remnant of consumer choice alive.
John Ansted April 18, 2010 at 2:36 PM
Agree, Ari! We also have, use, and like our HSA-compliant high deductible health insurance and savings account. Such has made us much better health-care consumers. Something I think we all need to become: people just as good at shopping for a blood test vendor as for groceries, cars, or other goods and services we purchase.
The sheer insanity of politically-controlled dieting is illustrated in the hope of one Health Nanny that the new labeling mandates will result in “reducing the fat in pastries,” as the New York Times reports. Because, you know, sugary, empty-carb pastries are so good for you when they have slightly less junk fat in them.
To the Health Nannies, good health is about tweaking the right variables, offering people the right carrots, and smacking them with the right sticks (but of course only when they really need it). Who needs persuasion and voluntary association when we have politicians and their pet bureaucrats to tell us what to do?
I remember a professor long ago who insisted that weight loss is a simple matter of burning more calories than one consumes. By this rationale, it hardly matters what form the calories take: so much flour equals so much canola oil equals so much steak. In the real world the sort of food one eats makes a great deal of difference in one’s health, one’s metabolism, and one’s appetites. But, as the simple-minded believe that merely cutting calories is the key to a good diet, so they believe that merely increasing “preventive medicine” is the key to good overall health.
Reality is more complicated. In the real world, not all calories are equal, and neither are all forms of “preventive medicine.” For many, subsidized “preventive medicine” will largely become another way to figure out which ailments the individual need not make any effort to prevent, as the treatment of those ailments also will be funded by others.
What the “preventive medicine” Nannies miss is the critical importance of human volition. Somebody who seeks out good medical advice — as I finance out of my Health Savings Account and in a truly free market would pay out of pocket — probably is genuinely seeking ways to stay healthy and avoid unnecessary long-term ailments and related monetary costs. Somebody who does not bother to stay healthy will not suddenly do so merely because “preventive medicine” is now “free.” Such a person may indeed spend a lot more money on doctors and treatments, but that probably won’t translate to better long-term health.
On the diet side, the reporter from the Times reveals his bias against “fatty, high-calorie foods.” Yet many have successfully lost unhealthy pounds and regained good health through eating precisely such foods as consistent with a “paleo” diet or (for instance) the findings of Gary Taubes. Most Americans would be far better off if they would abandon their grains, sugars, and vegetable fats in favor of “fatty, high-calorie” meat plus vegetables.
Now that the Health Nannies will be calling the shots, they will be lobbied relentlessly by those who want to manipulate the rules to their own advantage. Which “necessary” and “preventive” services must be provided for “free?” Which practices must be legally encouraged, and which legally discouraged? Wait and see. Those political battles will never end, so long as politicians remain in control of medicine.
The only thing we can be sure of is that politically-established “preventive medicine” will tend to produce the equivalent of “reducing the fat in pastries.”
One of the big fights leading up to the vote on the Democratic health bill (ObamaCare) was over abortion funding. The basic dilemma is whether tax-subsidized health care — and taxes already fund most U.S. health costs — will cover abortions.
What both sides seem to forget is that, when politicians control health care, it turns out that politicians control health care. So whether politicians will permit tax funds to subsidize abortions depends entirely on which politicians get into power.
Anti-abortion Christians who think that an executive order or even an explicit legislative declaration can permanently prevent the tax subsidization of abortions are simply delusional. Various Catholic groups endorse politically run medicine but insist that it not subsidize abortions. But when you render unto Caesar the control of medicine, Caesar will dip into tax funds to pay for whatever medical procedures he damn well pleases. That U.S. medicine is controlled by thousands of pigmy Caesars who vote, bicker, and draft reams of regulations first does not alter that basic fact.
Leftists who wish to protect a woman’s right to choose to get an abortion, but who deny to all women and men the right to associate freely to obtain medicine and insurance, should contemplate a possible future in which the religious right seizes control of the political machinery built by the left. Prohibitions on the tax funding of abortions will be the least of our worries.
I have some questions for the religious right. Do you really care, at all, about liberty in medicine? Does forcing somebody to finance a kidney transplant register a blip on your moral radar? Or are you perfectly fine with the forcible redistribution of wealth to fund health care, so long as it doesn’t include abortions? If the left offered to completely ban abortions, in exchange for the complete political control of medicine, is that a bargain you’d happily accept?
I have only a couple of questions for the left. What sort of world do you think we’ll be living in if the religious right takes over the Democratic health law? How is politically run health care remotely consistent with the exhortation to “keep your laws off of my body?”
I don’t really expect either the religious right or the left to attempt to answer these questions. Even the attempt to answer them would indicate some residual concern with liberty and individual rights, which I do not believe that many on either side any longer possess.
Sherrill March 25, 2010 at 11:22 AM
the only comment I have is that the solution is that our government stay out of our healthcare then both sides are in check, no?
JustinAC March 25, 2010 at 2:29 PM
If you ask someone on the right why they oppose tax funded abortions, they are likely to say, “I do not want my money funding something as offensive and immoral as the killing of fetus. I refuse to fund that.” Of course, the easy reply is, “Well, I do not want my money funding something as immoral and offensive as the killing of civilians in countries that never attacked us. Nor do I want my money going towards cages that lock nonviolent criminals up.” If folks could opt out of funding acts which they considered immoral, then our military industrial complex would crumble (along with many, many other atrocities). I just find it funny that the right is offended by abortion, yet they embrace the killing of innocents abroad.
Trevor March 26, 2010 at 4:14 PM
Facebooked. Your point about the religious right taking over the political machinery put in place by the left is truly chilling. I hadn’t even considered that consequence.
TJWelch March 30, 2010 at 6:38 PM
I remember thinking a similar thought during the debates over the Patriot Act and its extensions: would the right really want to be living in a world where the left took over the political machinery the right put in place?