Health Responsibility (In My PJs)

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.

Check out the complete article!

Law Should Protect Wanted Fetuses While Allowing Abortions

The following article originally was published March 1 by Denver Daily News.

A hit and run in Denver last December killed a woman’s fetus and led to calls for new legislation. If someone harms a woman’s fetus against her will, whether intentionally or through negligence, what is the proper legal penalty?

We recognize a woman’s right to bear a child, and we condemn as viciously evil the intentional killing of a woman’s wanted fetus. Likewise, when negligence or criminal violence causes the death of a fetus, we regard that as horribly tragic and look for legal recourse.

But the fact that the law should protect a woman’s wanted fetus does not imply that the law should also prohibit women from getting an abortion, though opponents of abortion often argue as much.

The mistake is to think that, because the law should protect a woman’s wanted fetus, therefore the fetus is a person with full legal rights, just like every born child and adult.

Legal protections for a woman’s fetus properly extend from the legal rights of the woman herself. Every woman has the right to life, liberty, and the security of her person. One of a woman’s most profound choices is whether to bear a child. A pregnant woman who wants to bear a child devotes great care and resources to having a healthy baby, and she contemplates her fetus in anticipation of the independent person it will become. Therefore, killing a woman’s wanted fetus, whether intentionally or as the consequence of violence or negligence, violates that woman’s rights.

Likewise, because the woman is an independent person with full rights, whereas her fetus is totally contained within her body and not a biologically separate and independent person, the woman has the right to get an abortion if she chooses.

Unfortunately, some on the religious right have attempted to hijack the issue of fetal protection for backdoor attempts to outlaw abortion. For example, in 2010 Senator Dave Schultheis’s bill attempted to define a fetus as a person in a fetal homicide bill.

Whereas sensible fetal protection laws protect a woman’s rights to her own body and choices, legally defining a fetus as a person strips a woman of her rights. If a fetus is legally declared a person with the right to life, then, logically, the pregnant woman must be legally forbidden from getting an abortion, even if that endangers her health, and even if she must be imprisoned and physically restrained to force her to give birth.

Thankfully, newly introduced House Bill 1256 explicitly avoids conferring personhood to fetuses. Existing laws already criminalize the “unlawful termination of pregnancy,” and last year a Mesa County court sentenced a man to five years in prison for giving his pregnant former girlfriend an abortifacient without her knowledge, the Daily Sentinel reported. [See also my previous post.] The new bill creates four ranges of offense, ranging from recklessness to the deliberate killing of a woman’s wanted fetus.

Bill 1256 has some problems. Rather than outline the general principles applicable to call cases, it contains unnecessary language about committing an offense while driving a vehicle. Moreover, the bill obscures the important distinction between a fetus and a born child by referring to an “unborn child.” Such vague, non-objective language should be removed.

Overall, though, the new bill seeks to more fully protect women against crime and reckless acts. While the law should not be contorted to serve an anti-abortion agenda, it should consistently protect the rights of every born person, including the rights of a pregnant woman either to get an abortion or protect her fetus, as she chooses.

Ari Armstrong blogs at and is the coauthor of the paper, “The ‘Personhood’ Movement Is Anti-Life.”


Scott Evans commented March 15, 2011 at 9:50 AM
If a woman can have her unwanted preborn child killed, why can’t she have her unwanted already born child killed?

Ari commented March 15, 2011 at 10:12 AM
Scott, There’s a reason why I linked to the paper. Please feel free to leave another comment only after you seriously consider those arguments and have something intelligent to say about them. Thanks, -Ari

Credit Controls Punish Responsible

The following article originally was published on May 24, 2009, by Colorado Daily.

Udall’s credit controls punish the responsible

by Ari Armstrong

Didn’t Sen. Mark Udall’s mama ever teach him to read contracts before signing them?

If he had learned that lesson, he wouldn’t impose new federal controls on credit cards — controls that would punish the responsible and the poor in order to reward irresponsible whiners.

Nobody is forcing you to get a credit card. If you don’t like the terms that a credit card offers, you are perfectly free to reject them.

Michael Riley writes in the Denver Post that Udall “hatched the idea in 2005 after watching a staff member’s experience with a credit-card company that boosted his interest rate to 21 percent even though he had never missed a payment.”

If you sign up for a credit card that tells you it will raise your rate whenever it wants, then why are you complaining when the company does exactly what it said it was going to do to you?

If you don’t like the deal, then pay off the card and cancel it.

What if you’re not able to pay off your card or transfer your balance elsewhere? If you can’t handle your balance, then don’t charge it in the first place.

The new controls will have two main effects. They will ensure that the young and the poor have less access to credit. And they will make it harder for responsible cardholders to negotiate good terms.

An Associated Press article summarizes the key provisions of the Senate bill. It would force credit card companies to lower rates even for people who miss payments, increasing rates for the rest of us.

It would require a “45 days notice before rates are increased,” making it harder for credit cards to lower rates for others. It “requires anyone under 21 to prove that they can repay the money before being given a card,” making it harder for young adults to build their credit.

Additional Federal Reserve controls would limit “excessive fees” charged to “people with bad credit,” limiting their ability to rebuild credit.

For a few years, my wife and I got in over our heads and faced high balances and interest charges. We made a budget, controlled our spending and steadily paid off our debts. The more debt we paid off, the better the credit terms we could negotiate.

Today credit card companies pay us to use their cards. Our American Express card charges an insanely high interest rate on balances — which is why we never carry a balance on that card. The card also pays cash back for purchases and offers free monthly interest when we pay in full.

We carry about $6,000 on a Chase MasterCard at guaranteed 0 percent interest forever (provided we make all our payments). Counting inflation, the credit card company effectively pays us to keep the balance.

Of course, if you bury high-interest charges beneath a no-interest balance, it’s not such a good deal — which is why we don’t do that.

We worked hard to earn good credit terms, and now Udall wants to punish us to buy the votes of the whiner demographic.

Udall’s scheme flows from one fundamental premise: You’re just too stupid to live your own life without the “help” of federal politicians.

Unfortunately, those who push for political control over their lives would drag the rest of us down with them.

Ari Armstrong, a guest writer for the Independence Institute, is the author of “Values of Harry Potter” and the publisher of

A Very Costly Health-Care Solution

The following article originally was published by the Rocky Mountain News:

SPEAKOUT: A very costly health-care solution

By Linda Gorman and Ari Armstrong
Wednesday, January 30, 2008

As the health-care debate unfolds, we hear a lot about cost-shifting, the idea that some people are charged more for health care to make up for the fact that others do not pay. Various legislators, journalists and activists tell us that the state should adopt the Blue Ribbon Commission on Health Care Reform’s recommendation to impose an individual mandate and force everyone to buy health insurance in order to end the unfairness of cost-shifting.

In fact, the commission’s recommendations likely will shift more costs onto those who already have insurance. Along with the individual mandate, the commission recommends large subsidies for those whom the commission considers too poor to purchase the insurance it says they should have.

Under the commission’s plan, people with health insurance would be taxed to subsidize health insurance for single people making as much as $40,000 a year, and families of four making as much as $82,600 a year. Many of these people pay for their own health care now, or have the assets to do so in an emergency.

The commission would also increase cost-shifting by forcing many more people into Medicaid.

Because Medicaid pays so little to providers, Medicaid as a whole generates far more uncompensated care and cost- shifting than the uninsured.

Those who advocate an individual mandate throw up all kinds of numbers to support the wild claims that the proposal would save everyone money. A Jan. 8 article from The Denver Post claims that “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 article attributes the number to state Rep. Anne McGihon, who said that the figure comes from Partnership for a Healthy Colorado. Partnership for a Healthy Colorado, in turn, says it got the figure from Families USA, which published a paper in 2005. That paper’s estimates were unable to accurately predict the percentage of uninsured residents in Colorado. The paper also grossly overestimated at least some costs of uncompensated care.

The Lewin Group, the modeling firm hired by the commission to collect information about Colorado, reported total Colorado expenses for the uninsured of about $1.4 billion. Of that amount, around 45 percent, or $627 million, was paid out-of-pocket by the uninsured themselves.

Private philanthropy covered $197 million. Another $341 million was paid by the Veterans Administration, workers compensation and various public programs.

The leftover uncompensated costs, the ones that are not paid by any identifiable source, total $239 million. Divide $239 million by Colorado’s 2.8 million insured residents, and the result is a maximum likely cost-shift of about $85 per insured individual per year.

To “fix” the problem of $239 million in cost-shifting, the commission proposes to increase health spending in Colorado by more than $3 billion, funded with an income tax increase of $800 million to $1.8 billion, new taxes on various politically incorrect types of food and drink, and an increase in the cigarette tax.

The sensible way to solve cost-shifting is to reduce health-care costs so that people fund their own health care, not to force people to buy insurance created by special-interest groups or to expand Medicaid. Professor Christopher Conover of Duke University estimates that 10 percent of annual health costs are caused by inefficient regulation. Results from experiments in consumer-directed health-care plans suggest that freeing consumers, providers and insurers can reduce costs by up to 30 percent.

The hostility of the commission to any plans like this was summed up in two votes that took place one after another on the same day. First the commission voted to recommend that the state legislature study single-payer health reform plans. Then it voted not to recommend that the legislature study consumer-directed reforms. While single-payer plans have failed around the world, consumer-directed reforms are succeeding wherever they’re given the chance.

Linda Gorman, a senior fellow with the Independence Institute, serves on the Blue Ribbon Commission for Health Care Reform. Ari Armstrong writes for

March 8, 2008, Update: After reading Dave Kopel’s article about citations, it occurred to me that I had not provided the citations for the article above, so here they are, as provided by Linda. The first eight references refer to the “experiments in consumer-directed health-care plans.”

1. Willard G. Manning et al. June 1987. “Health Insurance and the Demand for medical Care: Evidence from a Randomized Experiment.” American Economic Review, 77,3, p. 251-275.
* The abstract says “A catastrophic insurance plan reduces expenditures 31 percent relative to zero out-of-pocket price.”
* In the body of the paper they predict expenditures and find that “Mean predicted expenditure in the free care plan is 46 percent higher than in the 95 percent plan…” (p. 260)
2. Agenda, FY 05-06 Joint Budget Committee Hearing, Department of Health Care Policy and Financing, State of Colorado, January 4 and 5 2005. In response to question 32 the Department wrote: Average monthly allocation per client, $3,925. Average monthly expenditure per clint:$3,131 per client. This works out to a monthly saving of 20%.
3. “Full placement feat: HSA helps Wendy’s grill health costs,” Employee Benefit News, June 1, 2006. Gale Infotrak version, record A146476601. Reports that the return on investment for HSA program is 221% due to the fact that health claims costs fell by 14% from 2004 to 2005 and are on track to be 4% less than last year.
4. Silicon Designs experiment in 2005/2006. Lower out-of-pocket costs from employees (4.9 %) Lower company cost, from about 17% of salaries paid to about 15 percent of salaries paid. John Cole. “Report on One Year of Experience with HSAs/HDHPs,” Accessed March 8, 2008.
5. Humana, Inc. June 2005. “Health Care Consumers: Passive or Active? A Three-year Report on Humana’s Consumer Solution.” accessed March 8, 2008. A report on a three year internal experiment with a consumer directed plan for Humana employees. Cost increases were lower than trend by roughly 15 percent over the two years.
6. Wharam et al. 2007. “Emergency Department Use and Subsequent Hospitalizations Among Members of a High-Deductible Health Plan,” JAMA, 297, 1093-1102. This article looks at ED visits and subsequent rehospitalizations among members of a health plan that switched a fraction of insureds from a traditional HMO to a high deductible plan in 2001-2005. It concludes that ED visits decreased in those switched to high deductible plan with reductions primarily in repeat visits for conditions that were not high severity and in the rate of hospitalizations. It does not conclude anything about spending clinical outcomes.
7. J. Hsu et al. 2006. “Cost-sharing for emergency care and unfavorable clinical events: findings from the safety and financial ramifications of ED copayments study,” Health Services Research, 41, 5, 1801-20. Another study of the effects of copayments on ED use that does not directly address expenditures but does find that ED visits decrease with no apparent health effects when payments range from $20 to $100.
8. John Mackey. October 2004. Whole Foods Market’s Consumer-Driven Health Plan. A speech delivered at the State Policy Network Annual Meeting. Transcript available at

Christopher J. Conover. October 4, 2004. Health Care Regulation a $169 Billion Hidden Tax, Policy Analysis No. 527, Cato Institute, Washington DC.