Tag: Health Policy

Various agents of the government confront the problem of defining the line between parental rights and the protection of children from physical abuse. Agents in such cases might respond in one of four ways:

1. Not intervene when parents are within their rights.
2. Intervene to save a child from serious physical abuse and/or death.
3. Not intervene when the child suffers from serious physical abuse (that possibly results in death).
4. Intervene when parents are within their rights.

Even though the first two types are (I can only imagine) much more common, the second two types are the ones that end up in the newspapers, and that is worth bearing in mind. Nevertheless, such abuses result in serious violations of people’s rights, so they rightly draw the extra attention.

On January 9, the Rocky Mountain News ran an article that describes a case that seems likely to fall within the fourth type of case. The author of the aricle, John Ensslin, begins:

A Garfield County man [Tom Shiflett] contends sheriff’s deputies barged into his home and forcibly took his 11-year-old boy to a hospital after he refused to allow paramedics to examine a bump on the boy’s head.

Garfield County Sheriff Lou Vallario, however, said the deputies were acting on a warrant obtained out of concern about the boy’s injuries, which he said also included an ankle injury, a contusion and swelling over his eye. …

The incident started Thursday at the Apple Tree Mobile Home Park south of New Castle when the son, Jon Shiflett, hit his head “real hard” on the pavement after he grabbed the door handle of a moving car driven by his sister, the father said.

Someone called for an ambulance, but before paramedics arrived, Tom Shiflett said he picked his son up, brought him inside, put him on a couch and applied an ice pack to his head.

When paramedics arrived at the home, Shiflett said he let them look at his son, but refused to let them treat the youngster.

It is likely that, had a wealthy parent in a posh neighborhood, rather than somebody living a a trailer, told the paramedics to take a hike, they would have taken a hike, and the story would have ended there. But our story continues:

That led to a visit on Friday morning from two social workers. Shiflett said when he rebuffed them, they vowed to come back with a court order.

Deputies returned to serve the order later that evening. Shiflett contends he would have let them in if they said they had a warrant.

He claims they gave no such notice and barged in with a battering ram.

Shiflett said deputies temporarily handcuffed him and his wife and their oldest daughter and left with the boy.

Did this violent assault result in better care for the boy? No, it did not:

They returned the boy around 2:30 a.m. Saturday along with a doctor’s note advising them to make sure the youngster drank plenty of water, that he take some ibuprofen, that an antibiotic ointment be applied as needed and that a cold compress be put on his bruises.

“This is exactly what I was doing,” Shiflett said. He accused deputies of overreacting.

Did the sheriff, Lou Vallario, respond appropriately? The article reports: “Vallario also said two deputies gave the father, Tom Shiflett, 62, ample opportunity to resolve the situation peacefully before a team of officers used force to enter the home.”

The sheriff had a “court order,” but did he have a responsibility to force the child into treatment? A warrant grants permission to an officer; it does not compel an officer to act. The sheriff had no way of knowing the severity of the injuries. Then again, neither did he have any reason to doubt the claims of the father. Were the paramedics consulted regarding the court order? At least they saw the boy. Was the judge too hasty in issuing the order?

The article continues:

Vallario said his office has had previous confrontations with Shiflett.

In 2005, he said deputies arrested Shiflett on a charge of felony menacing after he allegedly threatened someone with an ax.

That charge was dismissed, the sheriff said, but the case was a factor in the deputies’ response. Shiflett said the charge was dropped because he was acting against a man who had threatened his family at his home.

If the charges were dismissed, then the case must be assumed to be lawful self-defense. Aren’t people who live in trailers also innocent until proven guilty?

Vallario also questioned why the father would not let paramedics examine the child’s injuries, especially after human-services officials assured the father he would not incur any medical bills.

“Why is this guy being so uncooperative?” Vallario asked. “Where’s the harm?”

However, parents — even those who live in trailers — have the right not be “cooperative” with paramedics regarding their children’s health care, so long as the parents do not place their children in real physical danger. Shiflett sensibly responded: “What’s the harm of letting a parent care for his own child?”

The claim that Shiflett should have released his son to “human-service officials” because Shiflett “would not incur any medical bills” is quite astounding. According to this reasoning, any time that the government creates an entitlement, that implies that government agents can force people to subject themselves to the related services. That road ends in a frightening place.

Ah, but Shiflett is an odd duck, and everybody knows that odd ducks don’t have the same rights as everybody else: “Shiflett has 10 children, ranging in age from 8 to 29 years old. All but one were born at home, he said. A remodeler, Shiflett said he has had trouble finding work since he rescinded his Social Security number.”

I am suggesting that the courts and the sheriff’s office forcibly intervened even though Shiflett was within his rights. However, consider a hypothetical case that begins the same way: a young boy falls, somebody calls an ambulance, the father lets the paramedics look at the boy but not treat him, and social services shows up. But then the judge tells social services to mind their own business, so the sheriff never breaks into the house. How would we evaluate the case if the boy died? Then the situation would seem to fall under type three as described above.

In this case, though, the father did seem to know that the boy’s injuries weren’t very serious, and he provided appropriate medical treatment. The sheriff’s deputies violently assaulted the family members, subjecting them to serious emotional trauma. Here in America, one’s home is one’s castle, and the legal authorities ought not force their way into somebody’s home without a very good reason supported by tangible evidence. In this case, it seems that the social workers, the judge, and the sheriff’s office got carried away without sufficient reason to act. But who cares, because Shiflett’s just some oddball living in a trailer, right?

Brian Schwartz wrote an article titled, “The Collective Punishment Model,” for today’s TCS Daily:

Politicians peddle compulsory insurance under the guise of “personal responsibility.” The story is that the uninsured receive medical care without paying for it. Their freeloading passes costs onto the insured, which increases premium costs. Compulsory insurance, say its supporters, can remedy this problem by forcing both the insured and uninsured to purchase medical insurance – as defined by politicians.

Schwartz offers three basic replies to this rationale for mandated insurance. “First, freeloading from the uninsured does not significantly increase insurance premiums.” However, the various proposals to impose more political controls on medicine would cost far more.

Second, holding people responsible would mean punishing freeloaders themselves and allowing providers to prevent customers from skipping out on the bill. This is the exact opposite of compulsory insurance, which forces the innocent to purchase insurance policies determined by political interests, rather than their own needs.

I would point out here that, in a voluntary system, such “freeloaders” often would receive charity, either from health-care providers or from independent donors.

“Third, government controls already punish the innocent – insured and uninsured alike – by making medical care and insurance prohibitively expensive.”

The biggest reason that some people lack health insurance is that political controls have dramatically increased the costs of health insurance. Now, because of the harm caused by those political controls, some “reformers” wish to impose still more political controls.

Why do we supposedly need to socialize medicine? Here’s the answer, according to one Colorado “reformer:”

Health care reform could span years
Lawmakers will begin to lay out a plan based on five proposals from a state panel, but a major package is unlikely this year.
By Jennifer Brown
The Denver Post
Article Last Updated: 01/08/2008 12:38:14 AM MST

…Convincing voters to foot the bill for massive health care reform is a huge challenge.

For starters, 92 percent of voters are insured, said Rep. Anne McGihon, a Denver Democrat who chairs the House health committee.

Why would they support a tax increase to give poorer Coloradans health coverage? Lawmakers point to this statistic: Coloradans who have insurance spend an extra $950 each year to cover the costs of those who show up at the hospital without insurance. …

The first reply to the reporter’s claim is that her figures seem to be way off. As Brian Schwartz comments beneath the article:

TAX US $400 TO SAVE $100?

…This figure [of $950] conflicts with the “Baseline Coverage and Spending” report* at the 208 Commission’s website, which shows this cost to be less than $100.

The Commission’s proposed $1.1 billion annual tax increase would force everyone to buy politically-defined insurance. Since 2.8 million Coloradans have private insurance, the tax would cost each privately-insured Coloradan about $400 — to save $100?

Out of the $1.4 billion annual medical spending for the uninsured, the uninsured themselves pay 45% out-of-pocket. Private philanthropy, workers compensation, and veterans benefits account for another 23%. Public programs, which taxpayers already are forced to fund, account for 15% of medical costs for the uninsured. Only the remaining 17% ($239 million) — categorized as “free from provider” — can directly contribute to higher premiums. That’s less than $100 per insured Coloradan. …

208 Commission report at: www.tinyurl.com/yuqkk8

Brian Schwartz, www.wakalix.com

Posted by Brian Schwartz (aka wakalix)
at 10:14 PM on Tuesday Jan 8

In other words, the socializers’ “solution” to “cost shifting” is to massively expand cost shifting.

But the fundamental question is, why are hospitals forced to give people “free” care? After all, people who need food or clothes can’t show up at the grocery store or the mall and demand free stuff. Lin Zinser and Paul Hsieh, MD, explain the history in their article, “Moral Health Care vs. ‘Universal Health Care’:”

One reason for the overcrowding and overuse of ERs is the Emergency Medical Treatment and Labor Act of 1985 (EMTALA). This law requires that hospitals that accept Medicare patients diagnose and treat anyone who comes within two hundred feet of an emergency room, regardless of whether the person can pay for the treatment. The effect of this law is that anyone can walk into an emergency room at any time and receive treatment — without concern for payment.

That law should be repealed. Those who need medical care and cannot afford it should rely on payment plans or voluntary charity, whether provided by treatment centers or individual donors.

However, the “cost shifting” resulting from forced care is only a minor part of the problem; socializers use it as a pretext to deflect the debate away from the broader issues. A larger problem is the “cost shifting” that results from underpayments by Medicare and Medicaid. But the biggest problem is not “cost shifting” at all — it is the transformation of insurance to pre-paid, tax-favored medical care, which results in more use without regard for cost and thus ever-higher costs. And that is precisely the problem that any of the schemes to expand political power over medicine would exacerbate — to then be “solved” through political price-fixing and rationing.

Yaron Brook of the Ayn Rand Institute wrote an outstanding article for yesterday’s Forbes.com on health policy. One of the points he makes is that Republicans too have promoted political control of medicine:

…Republicans have been responsible for major expansions of government health care programs: As governor of Massachusetts, Mitt Romney oversaw the enactment of the nation’s first “universal coverage” plan, initially estimated at $1.5 billion per year but already overrunning cost projections. Arnold Schwarzenegger, who pledged not to raise any new taxes, has just pushed through his own “universal coverage” measure, projected to cost Californians more than $14 billion. And President Bush’s colossal prescription drug entitlement–expected to cost taxpayers more than $1.2 trillion over the next decade–was the largest expansion of government control over health care in 40 years.

Brook briefly reviews the rise of political controls of medicine that have created today’s problems, then he outlines the proper approach rooted in individual rights.

Wayne Laugesen, long a columnist for Boulder Weekly, now works for Colorado Springs’s Gazette as “Editorial page editor.” Congratulations, Wayne! Though Wayne comes at some issues (such as abortion) from a religious perspective, usually he’s a dedicated “classical liberal” who cares first about individual rights. I’ll be interested to track his work at The Gazette.

Not coincidentally, yesterday The Gazette ran a substantive editorial endorsing liberty in medicine:

…The Blue-Ribbon Commission on Health Care Reform, appointed by legislative leaders and the governor, will present its recommendations to the Legislature on Jan. 31. …

“The majority of the commission favors a government-heavy proposal,” says Dr. Paul Hsieh, a Denver physician who has studied the new Massachusetts system. “They’re crafting it similar to the Massachusetts model.”

A year old, the Massachusetts system is resulting in rationing and shortages of care, and higher costs to taxpayers than originally expected. …

Government intervention, in fact, explains the failures of our current system. The IRS code drives most Americans to buy health insurance through employers. That means insurers don’t have to compete for consumers, because for most Americans, shopping around for a better deal involves a career change. And because health insurance has been packaged as a “free” benefit from employers, patients have spent the past half-century consuming health care without challenging the price. …

State legislators can’t change the morass of federal regulation that has led to a health care system unrestrained by the conventional market forces that control other services and goods. But legislators can improve access to health care by eliminating most of the state controls that prohibit affordable coverage. …

Brian Schwartz… proposed to the Blue Ribbon Commission a market-based health care reform package that mostly involved deregulation. …

Hsieh and Schwartz have become leaders in Colorado for liberty in medicine. Hsieh wrote an article with Lin Zinser, “Moral Health Care vs. ‘Universal Health Care’,” that explains the problems with health policy and how to fix them.

And yesterday Schwartz also had a letter published in Boulder’s Daily Camera:

…[W]e don’t have a free market in medical care or insurance. …Tax-exempt employer-provided insurance coddles insurers by tying us to our employer’s plans. Insurers are committed to satisfying customers, which are employers, not you. Hence, they can afford to be stingy and deceptive: they know that losing your premium dollars requires that you change jobs.

What “powerful and wealthy forces” oppose changing this? Labor unions. …[T]he AFL-CIO supports “single payer health care”: politically controlled medicine with government as a monopolistic insurer. This is even worse than buying it through your employer. If you don’t like what the government “health barons” offer, it’s not enough to change jobs, you must move out of state to change providers.

If you like “single payer,” don’t worry that the 208 Commission on Healthcare Reform has not recommended it. They recommend an “individual mandate,” which makes it a crime not to purchase politician-approved “insurance.” Such compulsory insurance is essentially single-payer in disguise. Strict regulations on legal insurance plans severely limit competition, so insurance companies are effectively government contractors for politically-defined insurance.

Colorado was supposed to be one of the national testing grounds for socialized medicine. Now, thanks to the work of people like Laugesen, Hsieh, Zinser, and Schwartz, the idea that we need more liberty in medicine, rather than more political controls, has become part of the public debate. While we still face a real and serious threat of more political interference in medicine, at least now liberty has a fighting chance.

Yesterday John Goodman, president of the National Center for Policy Analysis, sent out an email pointing out some of the absurdities coming out of today’s health-care “reform” movement:

Exhibit A: Critics who complain that the US health care system outspends every other country and gets nothing in return and then advocate…(can it be?)…more spending! For Sen. Obama, it’s $60 billion more every year. For Sens. Clinton and Edwards, it’s $120 billion – more than $1,000 per year for every household in America.

Exhibit B: Critics who complain that the error rate in US hospitals is way above anything that is tolerable in any other industry and then advocate more rules and regulations that would…(surprise!)…make it more difficult for hospitals to operate like other businesses.

Exhibit C: Critics who complain that poor people have inadequate access to health care and then advocate enrolling them in health plans where…(you guessed it)…they will have even less access than they have today.

Under ordinary circumstances this would all be laughable, but in health care – hey, they might get away with it.

Goodman points to his article, “Applying the ‘Do No Harm’ Principle to Health Policy,” as well as to a health plan from his organization. However, for a clear account of the problems with American health care and a principled solution rooted in liberty, I suggest the article by Lin Zinser and Paul Hsieh, MD, “Moral Health Care vs. ‘Universal Health Care’.”

Colorado’s own Lin Zinser and Paul Hsieh, MD, have written an article for The Objective Standard titled, “Moral Health Care vs. ‘Universal Health Care’.” The journal has made the article available at no cost to all comers.

Hsieh summarizes:

Lin Zinser and I have written an article on health care history and policy that will be appearing in the Winter 2007-2008 issue of The Objective Standard…

We argue that the current crisis in American health care is the result of decades of government interference and violations of individual rights in health insurance and medicine. Hence the solution to the problem is not more government controls but instead to gradually and systematically transition to a rights-respecting, fully free market in those industries.

Also, Yaron Brook and Keith Lockitch have written an article on the same theme for Modern Health Care. The article argues:

The notion that America has a private, free-market medical system is a widespread misconception. More than 45% of total spending on healthcare in 2004 was government spending. Our semisocialist blend of Medicare, Medicaid and government-controlled, employer-sponsored health plans-with its onerous system of regulations and controls on medical providers-is the opposite of a free market.

To date, I have not heard a single defender of politically-controlled medicine even attempt to counter the arguments of Zinser, Hsieh, Brook, Lockitch, and fellow travelers. Instead, those whining for more political interference in medicine simple ignore the fact that political interference is the cause of modern problems in American health care. Let us work to assure that the articles proving the point are widely read.

Here’s my take on the old song, “There Was an Old Woman Who Swallowed a Fly.”

There Were Politicians Who Made Prices Fly

There were politicians who made prices fly.
They feared wages too, would travel sky high.
Perhaps we’ll die.

There were politicians who set wages tighter.
Biz wiggled and jiggled and set health pay sweeter.
They set wages tighter for prices did fly.
They feared wages too, would travel sky high.
Perhaps we’ll die.

There were politicians who made tax exempt
employer-payed health, showed for markets contempt.
They made health exempt because wages were tighter.
Biz wiggled and jiggled and set health pay sweeter.
They set wages tighter for prices did fly.
They feared wages too, would travel sky high.
Perhaps we’ll die.

There were politicians who raised a health tax.
So medical costs, they climbed to the max.
They raised a health tax and they made health exempt.
They made health exempt because wages were tighter.
Biz wiggled and jiggled and set health pay sweeter.
They set wages tighter for prices did fly.
They feared wages too, would travel sky high.
Perhaps we’ll die.

There were politicians who set more controls
on doctors and patients and insurance tolls.
They set more controls on top of the tax.
They raised a health tax and they made health exempt.
They made health exempt because wages were tighter.
Biz wiggled and jiggled and set health pay sweeter.
They set wages tighter for prices did fly.
They feared wages too, would travel sky high.
Perhaps we’ll die.

There were politicians who finally mandated
that people buy “coverage” at cost quite inflated.
They want a mandate because of controls.
They set more controls on top of the tax.
They raised a health tax and they made health exempt.
They made health exempt because wages were tighter.
Biz wiggled and jiggled and set health pay sweeter.
They set wages tighter for prices did fly.
They feared wages too, would travel sky high.
Perhaps we’ll die.

There are politicians who want to take over;
they think bureaucrats can on health care deliver.
They want to take over and have it mandated.
They want a mandate because of controls.
They set more controls on top of the tax.
They raised a health tax and they made health exempt.
They made health exempt because wages were tighter.
Biz wiggled and jiggled and set health pay sweeter.
They set wages tighter for prices did fly.
They feared wages too, would travel sky high.
Perhaps we’ll die.

Recently I’ve mocked The Denver Post for its stance on Halloween, and I’ve criticized Republicans over health policy, tax spending, and investment controls.

But on October 26, The Denver Post published an outstanding op-ed by Republican Mark Hillman that criticizes health-insurance mandates. The article is part of the “Colorado Voices” series, which often produces duds, but on this occasion the Post has found somebody who writes very well and who has something interesting to say. (Note: the publication dates noted on the Post’s web page sometimes precede the dates of print publication.)

Hillman writes, “Ironically, despite the abysmal record of lawmakers and bureaucrats to produce lower prices or create greater choice, the public still clamors for government to ‘do something.’ Perhaps the more logical outcry should be: ‘undo something’.”

Hillman offers the following main reasons to oppose health-insurance mandates:

* “[A]nother law won’t produce universal coverage,” because some people won’t obey the mandate or will be exempted.

* Mandated insurance would be a bad deal for many consumers, because “special interests perennially lobby the legislature to require you to buy things you don’t need, don’t want or can’t afford.”

* Politicians tend to require insurance to pay for care that “you could more easily and less expensively pay for… yourself…”

Hillman summarizes, “The end result is that you and I are no longer allowed to choose the insurance coverage that best fits our needs, and insurance companies can’t respond to what we want.”

Hillman perfectly captures the state of today’s health-care “reform” movement: “[L]awmakers and lobbyists control the health care market, as they have increasingly for the past 40 years; then they react in amazement when the product is something you and I either do not want or cannot afford.”

Hillman’s article demonstrates that both The Denver Post and Republicans can produce good work.

I do have one criticism of Hillman. I recognize that short newspaper articles cannot cover every aspect of the issue. Sometimes the moral argument is not the focus. But Republicans often seem to be allergic to pronouncements that hint of the morality of rights in property and income — probably because most Republicans are so busy violating those rights. To date, and as far as I can remember, I have not heard any Republican other than my dad (who I’m pretty sure is a Republican) endorse the argument: “Insurance mandates are morally wrong because they violate the rights of individuals to control their own lives and resources.”

The Rocky Mountain News is rightly skeptical about the “208” Healthcare Commission’s plan to “reform” health care by expanding government control of it. The News writes in an October 28 editorial:

Is the Colorado Blue Ribbon Commission on Health Care Reform going to lay an egg in January, when by law it must offer its recommendations to the legislature?

It’s too early to say, but prospects for the commission’s success dimmed somewhat the other day when the price tag was announced for the panel’s own proposal – we’ll call it Plan Five because the commission will submit four others, too, written by outside groups.

Plan Five’s cost: between $1.4 billion and $2.1 billion a year, according to the Virginia-based Lewin Group.

The News continues to explain why such a hefty tax hike is unlikely in Colorado.

I particularly like the title, “Plan Five.” For some reason, it reminded me of Plan 9 from Outer Space. The comparison is doubly fitting, because the movie is about the goofy plans of extraterrestrials, and the movie is one of the worst ones ever made. But at least it’s funny. Not so with “Plan Five” from the 208 Commission.