Tag: Health Policy

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.

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.

(APPLAUSE)

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.

(APPLAUSE)

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.

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.

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Comment

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.”