Monday, March 29, 2010

Rebuttal Rage

Why I generally don't read or listen to political viewpoints opposing mine :

I formerly held the same views arrived at by the same manner of thinking so I'm already familiar with the faulty logic.
Everyone with whom I'm on speaking terms, is liberal. Therefore in any political discussion I get involved, which is admittedly rare since I do try to avoid them, all I hear are leftist arguments.
There are only so many hours in a day and there's much intelligent commentary to digest, so there's little time left for extraneous inanities.
I'm irritated seeing deeply flawed liberal viewpoints appearing in mass media - a forum they don't deserve.
Conservative observers keep current with liberal commentary and often refer to it in theirs. They read it so I don't have to.
The MSM is so ubiquitous, there's no escaping leftist viewpoints anyway. CNN in airports is one example. Another is Weather Channel blather about "climate change". Yet another is Yahoo News which appears on my home page.

A digression - Since Obamacare passed, Yahoo, initiating its electoral campaign for Democratic members of Congress who voted for the bill, has been headlining its benefits. Conspicuously absent have been any headlines trumpeting the recent revelation of one of the bill's hidden unpleasantries - the rescission of the tax break for corporate retiree prescription plans. (Remember Ms. Pelosi saying we have to pass the bill to find out what's in it? We're finding out.) The potential results of this provision? Lower corporate earnings, writeoffs, lost jobs, increased premiums and retirees' loss of their prescription benefits (or if over 65, being shoved into Medicare. Not exactly a cost effective development). It took exactly one day for bad stuff to start happening. The MSM hasn't noticed.
(For a lucid and entertaining explanation of that one noxious Obamacare provision, as well as a typically scathing assessment of the bill's total noxiousness, see the Mark Steyn (NRO) column linked below).

Anyway back to the topic - why I avoid leftist commentary.
A final reason - Reading (or listening) to these compels me to respond, which I do occasionally in this blog. And the time and labor involved can be quite substantial. (I obssessed over a lengthy response to an op-ed written by George McGovern appearing in the WSJ last year. The effort was necessary in order to thoroughly counter all of his distortions, misconceptions and bad advice).

I should have heeded my self-imposed censorship. In the letters section of the WSJ Friday (3/26), mixed in with sensible critiques of the Obamacare bill were three voicing support. And, I read them. Now I'm driven to respond. First, I'll reproduce two of the letters which are similarly themed.

In response to your March 22 editorial "The Doctors of the House":

Americans will soon realize the important benefits of the health-care reform package. Insurance companies will no longer be able to deny coverage for pre-existing conditions. They won't be able to cancel anyone's health insurance when the policy holder gets sick. They won't be able to impose lifetime and annual caps on benefits.

Democrats made these things happen, without a single Republican vote, and they are bringing health insurance to tens of millions more Americans. Republicans fought these basic, common-sense goals every step of the way and now vow to repeal the whole thing if they regain power. Go on, Republicans, explain to the voters this fall why you want to take away their health care. I dare you to do it without lying.

Todd Belknap

The passage of health-care reform is a great day for America. We are blessed to have a leader like President Obama, who can turn on the charisma when he needs to, but whose greatest strength is intelligence, patience and self-confidence.

Democrats are able to claim full credit for passing a bill that has many popular provisions. Soon it will become illegal to deny children coverage for pre-existing conditions. Adults will have to wait until 2014 for that protection but will at least get access to new high-risk insurance pools until then. Children will be able to stay on their parent's insurance plans through age 26. Lifetime limits will disappear, and so will an insurer's ability to cancel your policy when you get sick. Starting Jan. 1, Medicare patients will qualify for free annual wellness visits. And insurers will be required to pay out at least 80% to 85% of premiums in actual health-care reimbursements. Customers of insurers who pay out less will get rebates.

Glen Gillette

William Buckley once said that conservatism is the politics of reality. A corollary is that liberalism is the politics of fantasy. To liberals all government giveaway programs are beneficial. There are no tradeoffs involved. We are "getting" "popular provisions" - gifts from caring Democrats - and evil, heartless Republicans are trying to deny them. "Republicans want to take away our health care", as Belknap puts it.

First, and it's ridiculous to have to make this point, but U.S. "health care" is already in abundant supply and it is readily available. Surprising as it may be to the two letter writers, the vast majority of Americans already have health insurance and polls consistently show that well over 80% are happy with the quality of their health care. (A June 2008 ABC News/USA Today/Kaiser Family Foundation survey put the number at 89%).

Those policy features mentioned in the two letters - children's coverage to age 26, no lifetime limits, no annual caps on benefits, free annual wellness visits - are all common in employer provided policies and are all available to those purchasers of insurance policies who want them. That these policies may be prohibitively expensive to some is in large part caused by, again, government created restrictions and distortions in the health care market. (The mention of a cancellation due to illness provision is laughable. That's like a life insurance policy that expires a moment before a policyholder's death. No insurance company would long survive engaging in such scandalously illegal practices. If a policy contained such a provision, then its terms would have to be clearly stated. And anyone who would buy such a policy or was given one by an employer and wasn't aware of those terms, has only himself to blame).

The goal of health care reform should be to make quality health care affordable and accessible to as many people as possible. The goal is not to mandate universal health insurance coverage. Or - as will be the eventual result of Obamacare - universal coverage by a single payer, the government. (Monopolies are bad. Those operated by the ruling entity are especially so). These mandates do not "give people health care". They do not increase the supply of health care. They do increase the demand for it. Increased demand + static supply = increased cost.

Belknap and Gillette recite a fantasy. A childish one at that. Profligacy without repercussions; indulgence without consequences. And Belknap expresses indignation that, to this, there is resistance. The reality is that resources "given" to some must be taken from others. And, contrary to liberal mythology, Washington is not nearly smart enough to manage such a transaction in something as complex and immense as U.S. health care. Conservatives understand this and can anticipate the collateral damage such an undertaking would produce. I expanded below Mark Steyn's original list* of potential Obamacare ramifications, most of which are quite likely. (The final two, especially the last one, being more speculative, may take some time).

Longer wait times*, fewer doctors*, bankrupt hospitals, stifled innovation, fewer medical breakthroughs, more bureaucracy*, loss of privacy, higher taxation, massive IRS expansion*, bankrupt states burdened by Medicaid, explosive debt*, persistent unemployment, the end of the Pax Americana*, and global Armageddon*.

Republicans don't want to "take away our health care", Mr. Belknap. They want to make health care as affordable to as many as possible. Democrats want to compel citizens to adhere to arbitrary mandates put in place by politicians and unelected bureaucrats. Republicans favor allowing citizens free rein to exploit an open market unencumbered by government restrictions. Instead of shifting resources around, Republicans seek to grow resources. They want to take advantage of the great wealth creation machine that is capitalism. Republicans are not averse to income based government subsidies. But fostering economic growth is essential. Obamacare's failure is ensured more than anything by its hinderance of economic growth.

In today's NRO, Jay Nordlinger makes a salient point about the very term, "health care system".

I think this is one difference between liberal Democrats and conservative Republicans: They want a “system”; we don’t want any system at all. We just want . . . life. Healthy, democratic, free-market life.
To my knowledge, we don’t have a housing system, or a food system, or a clothing system, or a car system (although we have some government ownership of auto manufacturing). We just have — what? An economy. An open, American economy, in which people meet other people’s needs as they arise.

Nordlinger goes on to say that "system" is a word that central planners use. Like the ones who ran the former Soviet Union.

One other point. Gillette's letter credits Obama's persuasive powers for turning the tide. For allegedly convincing the American people to support the bill which in turn convinced reluctant legislators to vote for passage. In reality it was a only series of blatantly corrupt deals that bought just enough votes to allow passage by a slim margin. This was necessary, and the process took over a year, despite huge Democratic majorities in the House and Senate and a compliant press. Obama's "charisma" was not a factor. Since the health care debate began, he's given roughly 60 speeches on health care and support for the plan consistently declined.

Now to the third letter which works a different angle - the miserable state of American health care.

Your editorial concludes that "we fought this bill so vigorously because we have studied governmental health care in other countries, and the results include much higher taxes, slower economic growth and worse medical care." I, too, have studied health care in other countries. The dominant feature in which the U.S. is clearly superior is the cost of care, which runs about twice the cost of care in countries such as France, Germany, Canada and the U.K., which have varying systems of universal medical coverage. For this extra care the U.S. ranks 38th in the world in life expectancy, behind Cuba as well as the above four countries; we rank 29th in infant mortality, and well behind most European countries in survival of dialysis patients. It is challenging to find a desirable health-care statistic besides cost in which our care significantly exceeds that of our peers.

Curtis J. Krock, M.D.
Clinical Associate Professor of Medicine
University of Illinois College of Medicine at Urbana-Champaign

Before I get into the particulars of Dr. Krock's letter, and there aren't many, I want to reiterate a couple of points I keep making. First, Krock is enamored of countries that provide universal health care. Every American ally that does this, does it without the concurrent burden of providing for the bulk of its defense. We provide that service free of charge. There is no present model to predict the effect on those nations' economies, not to mention on their survivability, should the U.S. adopt an extravagant nationalized health care system, significantly decrease our military spending, and withdraw our defense umbrella. Those nations would then be forced to spend from their own budgets for protection from bad players like Russia, China, North Korea and Iran, for keeping sea lanes open for commerce, to support the international community's rare combat ventures to prevent mass slaughter, for transport and logistical capabilities for humanitarian relief efforts, etc, etc, etc. National Review had good reason to suggest that the U.S. military should be awarded the Nobel Peace Prize every year by default.

Second, I agree that our health care isn't as good as it can be. Its shortcomings are caused by government restrictions on the free market. Strengthening those restrictions will make it worse. The WSJ likened the progressive approach to the old Marx Brothers' joke - "The soup is terrible - And such small portions".

Krock correctly identifies the problem in the U.S. being the overall cost of health care. A problem that Obamacare will only intensify. What he doesn't mention is the cost to patients. This is from an article by Fred Barnes that I referenced last year.

A little-known fact: Out-of-pocket expenses by American patients amounted to 12.6 percent of total national health spending ($2.24 trillion) in 2007.
That's one of the lowest percentages of private out-of-pocket spending among the world's advanced countries--lower than Germany, Japan, Canada, and most countries in Europe, including those with government-run health care systems. Why do Americans get more and pay less? Because their insurance policies provide broader coverage than most government plans, says Tom Miller of the American Enterprise Institute.
(My emphasis).

This advantage to American consumers is the primary driver of high health care cost since people are unaware of just how much they're spending and don't take steps to control it. But it is an advantage. Our health care costs more because we get more.

Krock is very discriminating in his choice of supporting data, selecting only those that he thinks help his case. (And he doesn't provide much). He introduces a redundancy right at the start, by including both life expectancy and infant mortality, the latter being a major factor in the former. Krock, (as do all those trying to make the case for socialized medicine) overemphasizes the importance of life expectancy statistics. Those numbers are influenced by several variables other than health care including lifestyle, diet, culture, climate, genetic makeup, diversity of population and size of population. (Of the countries ranked above the U.S. in LE, none is even remotely as large. Japan with 127 million is second to the U.S with 309 million. Japan has a nearly homogeneous population and a better diet which helps explain its number 1 ranking with an LE of 82.6). And ranking the countries doesn't say much about their absolute values. For instance, the U.S. ranks 38th with an LE of 78.2. France with an LE of 80.7 ranks 10th. 2.5 years is worth 28 places. The fact is, most countries that are not desperately poor have closely bunched life expectancies. To get below a 70 year LE you need to go down to 116th place. (Trinidad and Tobago - A strange name for a country I've always thought. How about a country named "East Anglia and Vanatu with a little Morocco thrown in").

The culture factor includes the subfactor of teenage birth rates. With a rate of 41.9 per 1000 births, the U.S. is by far the leader in this category. For comparison, the U.K is at 26.1, Canada at 13.7, France at 11.7, and Germany at 10.0. The high U.S. teenage birthrate undoubtedly contributes to its infant mortality figures. As does its method of counting births. The following is from the Wikipedia entry on infant mortality.

The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR (Infant Mortality Rate) numbers somewhat lower and raises their rates of perinatal mortality. 2009, the US CDC issued a report which stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries and which outlines the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.

So if life expectancy isn't a good indicator of the quality of a country's health care, what is?

Survival rates for serious illness.

Dr. Krock cites just one example of this - survival of dialysis patients. Well, actually he cites no examples. Dialysis is a treatment, not a disease. Its success rate says nothing without information about who is getting treatment and why they're getting it.

The following is from a report on the website.

The U.S. has the highest rate of new (hemodialysis) treatment for ESRD (End Stage Renal Disease) among reporting registries worldwide. The U.S. accepts double the number (per million population) than does Europe, 40% more than Canada and 20 % more than does Japan.

Giving a specific treatment to substantially more high risk patients will necessarily increase its failure rate.

Anecdotal evidence is unscientific, but I'll include the following because it helps to illustrate the point. A few years ago, my father-in-law was hospitalized with (among other things) ESRD. He waited too long to be treated, for reasons other than economics or lack of due diligence on the part of his doctors. Though doctors believed it would be futile, he was put on dialysis anyway. He died shortly after and became another contribution to the low dialysis patient survival rate in the U.S. Chances are, in Europe or Canada or Japan, the treatment would not have been initiated. Tort lawyers have less influence on those countries' doctors' medical decisions.

Dr. Krock attempts to indict the entire U.S. health care establishment by citing only one disease criterion and it's a fallacious one at that. This is misleading and dishonest.

Then he adds, "It is challenging to find a desirable health-care statistic besides cost in which our care significantly exceeds that of our peers".

I'll ignore the hedging terms, "challenging" and "significantly exceeds", and just remark, Oh, really? (This is a family friendly site, otherwise I might have responded with something along the lines of, hogwash).

Here's some more of Barnes' article where he makes the case that the U.S. is unequalled, much less unsurpassed in the treatment of our most deadly afflictions, cancer and heart disease.

Private insurance, Medicare, and Medicaid cover most of the high cost of treating critical illnesses such as cancer and heart disease. And those are the ones in which the survival rates in the United States are significantly higher than in Europe or other countries. There are clinical data substantiating this. Two major studies (EUROCARE-4 and a study by the National Center for Epidemiology, Health Surveillance, and Promotion, in Rome, both published in the September 2007 issue of Lancet Oncology) were used to compare five-year survival rates for Americans and Europeans diagnosed with cancer.
For all cancers, 66.3 percent of American men and 63.9 percent of women survived. In Europe, 47.3 percent of men and 55.8 percent of women survived five years. Those are statistically important gaps.
And the survival rates were higher in the United States for the most common cancers as well. More than 99 percent of men with prostate cancer had survived in the United States after five years, 77.5 percent in Europe. Those with colon or rectal cancer survived at a 65.5 percent rate here and 56.2 percent in Europe. The rates for breast cancer showed a similar difference, 90.1 percent for Americans, 79 percent for Europeans.
Dr. Atlas cites a different set of results that underscore the same point: Your chances of living longer are better with treatment here. "Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom," he reports (see "Here's a Second Opinion," Hoover Digest online). "Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher."
Canada, whose single-payer health system is admired by many liberals, fared better but still trailed the United States. "Breast cancer mortality in Canada is 9 percent higher than in the United States, prostate cancer is 184 percent higher, and colon cancer among men is about 10 percent higher," according to Dr. Atlas.

In treating heart disease, Americans have far more access to statin drugs that reduce cholesterol. "Some 56 percent of Americans who could benefit from statin drugs .  .  . are taking them," Dr. Atlas wrote. "By comparison .  .  . only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them."

"Wildly successful" is the way David Brown of the Washington Post has characterized the transformation of heart treatment. "Today, someone having a heart attack who gets to a hospital in time is likely to get cardiac catheterization, angioplasty, the placement of a medicated stent, therapy with four anticoagulant drugs and, on discharge, a handful of lifetime prescriptions," he wrote. These are innovations over the past half-century.
The results are in.
"In the 1960s, the chance of dying in the days immediately after a heart attack was 30 to 40 percent," Brown wrote. "In 1975, it was 27 percent. In 1984, it was 19 percent. In 1994, it was about 10 percent. Today, it's about 6 percent."
These results are matched by the success in dealing with all heart disease. "In 1970, the death rate from coronary heart disease was 448 per 100,000 people," according to Brown. "In 1980, it was 345. In 1990, it was 250. In 2000, it was 187. In 2006, it was 135."

Cold numbers don't capture the breathtaking drama of what's happened. The transformation of heart care "has saved the lives of millions of Americans," Brown wrote. ".  .  . It is safe to say that almost everybody who has a heart attack wants the best treatment available. Nobody wants to turn back the clock." Nor should they, despite higher costs.
(My emphasis).

Dr. Krock claims to "have studied health care in other countries". Study it some more doc. You'll see that it falls short of ours.

All this just to respond to three measly letters. And measly is "le mot juste" as Mark Steyn would say.

And, bear with me. Just one more thing, speaking of Mark Steyn. I had to include this gem from his column linked below. (There are others included therein).

Incidentally, has the CBO ever run the numbers for projected savings if the entire CBO were laid off and replaced by a children’s magician with an assistant in spangled tights from whose cleavage he plucked entirely random numbers? Just a thought.

Barnes article


Friday, March 26, 2010

Canada, Coulter, Cuba; Patriots, Privacy, Pelosicare

Sorry for renaming that monstrosity. I needed it for the alliteration.

Cuban emigre (actually escapee) Humberto Fontova has written an article touching on a couple of themes that I've been preoccupied with over the past few days - nationalized health care and Ann Coulter's Canadian adventure. Noting Coulter's mistreatment by the University of Ottawa this week, Fontova contrasts it with the school's embrace of Fidel Castro. It turns out that the U of O (an apt title) is co-owner with the Cuban government of a patent for a purported vaccine against Meningitis B. The university also co-sponsored research efforts to promote the treatment. This same vaccine was hailed as a medical breakthrough in Michael Moore's quack of a film, "Sicko". Back in 1999, news agencies criticized the U.S. for not making available this life-saving treatment. They weren't being honest, as Fontova writes.

"Cuba has developed the world's first Meningitis B vaccine which is available in Third World countries but not in Europe or in the United States due to U.S. sanctions," dutifully reported Anthony Boadle from Reuters' Havana bureau right after Sicko’s first screening (oddly good timing for such a “scoop” by a Castro-sanctioned “news” agency, I’d certainly say!)

Of this 27 word sentence, by a news agency regarded as authoritative worldwide, exactly 14 words are true. Yes, this Castroite/Ottawa Univ. vaccine is not available in the U.S. and Europe -- but hardly because of ”sanctions.” In fact, in 1999, Bill Clinton's Treasury Department granted the pharmaceutical giant SmithKline Beecham a license to market the vaccine in a joint venture with Castro’s medical ministry -- pending FDA approval.

That approval never came, as the "vaccine" was shown to be totally ineffective.

Fontova also writes about Castro's vaunted "Doctor Diplomacy" program wherein Cuban doctors were sent to Caribbean and Latin American countries to provide treatment to the poor free of charge. In 2005, 96 of these "doctors" were kicked out of Brazil. Fontova quotes the judge who issued the order.

Based on the results they’d achieved with Tocantins' residents, the judge referred to the Cuban doctors as “Witch Doctors and Shamans...We cannot accept doctors who have not proven that they are doctors.”

The University of Ottawa, it appears, has no such qualms.,_embraces_fidel_castro?page=1

Also related to the health care issue is Jonah Goldberg's latest article on NRO. He recall's the left's hysterical reaction to the Patriot Act as a government (read Republican) effort to invade the privacy of all Americans. This despite the law's rather mild provisions.

The Patriot Act, considerably weaker than similar laws in Europe, allowed the FBI to ask a judge for a warrant to seek third-party business records and search suspected terrorists’ homes without notifying them right away. (The alternative is to tip off the next Mohamed Atta prematurely.)

For some reason, librarians were particularly incensed.

My favorite response came from Jan O’Rourke, a Pennsylvania librarian who destroyed the records of all library visitors so she could prevent the G-men from finding out who borrowed Catcher in the Rye or surfed the Web for adoptable kittens.

President Obama and the Democratic Congress have quietly renewed the Act's provisions for another year, confirming its necessity and effectiveness. Note the absence of public outcry.

Patriot Act hysteria consumed American politics for years, even though the bill was reasonable and the number of those affected by it comparatively miniscule. No libraries were searched. Terrorists were caught. Inconveniences and mistakes surely transpired, but not on some grand scale. American privacy endured.

Goldberg's main point is that the new health care bill provides far more reason to fear its ramifications than those of the Patriot Act, including an invasion of privacy on an infinitely larger scale. Yet liberals are wondering what all the fuss is about.

Now consider what the left-wing magazine Salon calls the conservative “freakout” over the health-care legislation passed by Congress and signed into law by Obama. Unlike the Patriot Act, which passed with overwhelming, almost unanimous, bipartisan support, the Patient Protection and Affordable Care Act of 2010 was passed narrowly, against the public’s wishes and in the face of bipartisan opposition. It will cost trillions of dollars we do not have. It gives the government greater say in the most intimate areas of your life, far more private than your library record. It is based on dubious constitutional assumptions.

Lots of liberals opposed the Patriot Act on slippery-slope grounds, but it’s worth noting that very few conservatives said the Patriot Act was just a “first step” or a “down payment” toward an even more aggressive police state, while many hoped it would be a temporary measure. Lots of liberals insist health-care reform merely begins the process of pushing for full governmentalization of health care.

Thursday, March 25, 2010

"...a wretched embarrassment to a once free society"

As would be expected, Mark Steyn had a sharp reaction to Ann Coulter's treatment in his native country (see my post yesterday). Here is his commentary on NRO in its entirety.

A couple of days ago, I mentioned Fran├žois Houle, the leftist apparatchik and provost of the University of Ottawa who threatened Ann Coulter with criminal prosecution before she'd even set foot on Canadian soil.

M. Houle warned Miss Coulter not to “promote hatred.” As this young lady points out in her report from the university, the only hate-promoter here is the buffoon Houle, whose barely veiled threats led to a gang of menacing Houligans (le mot juste) getting the event closed down. Alliances between the state’s ideological commissars and street mobs are a familiar feature of certain kinds of societies, and I suppose Canada will soon get used to its membership of this unlovely club. Ann Coulter says of her experience in the Great White North:

This has never, ever, ever happened before — even at the stupidest American university. . . . Since I’ve arrived in Canada, I’ve been denounced on the floor of Parliament — which, by the way, is on my bucket list — my posters have been banned, I’ve been accused of committing a crime in a speech that I have not yet given, I was banned by the student council. So welcome to Canada!

In one of the oldest settled democracies on the planet, freedom of speech flickers very dimly. To recap:

Fran├žois Houle in his letter to Ann Coulter:

I would, however, like to inform you, or perhaps remind you, that our domestic laws, both provincial and federal, delineate freedom of expression (or “free speech”) in a manner that is somewhat different than the approach taken in the United States. I therefore encourage you to educate yourself, if need be, as to what is acceptable in Canada.

Dean Steacy, lead investigator of the Canadian “Human Rights” Commission:

Freedom of speech is an American concept, so I don’t give it any value.

Susan Cole, Canadian “feminist,” defending the mob on Fox News:

We don’t have that same political culture here in (Canada). . . . We don’t have a 1st Amendment, we don’t have a religion of free speech. . . . Students sign off on all kinds of agreements as to how they’ll behave on campus, in order to respect diversity, equity, all of the values that Canadians really care about. Those are the things that drive our political culture. Not freedoms, not rugged individualism, not free speech. It’s different, and for us, it works.

Translated from the original Canadian, “diversity” means “state-mandated mob-enforced conformity.” As for whether “it works” for Canadians, ask Guy Earle. On Monday Mr. Earle, a stand-up comedian of conventionally Trudeaupian views, goes on trial at the British Columbia “Human Rights” Tribunal for putting down two hecklers at his nightclub act. They were, alas for him, of the lesbian persuasion, and so he is now charged with “homophobia.” What a wretched embarrassment to a once free society.

A couple of comments -
Imagine being proud of restrictions on free speech. As always, I feel fortunate to be living in the U.S. and not some regressive Euro-Canadian society.
Houligans - gotta love it.

Resisting Coercion

Maybe I'm missing something, but it seems to me that the health care bill signed into law Tuesday by President Obama contains the seeds of its own destruction.

First there's the delay for the payout of "benefits" to begin. This was made a feature of the bill to allow the Democrats to perpetrate their Enronesque accounting scam - collecting ten years of revenue for six years of payouts and claiming no increase to the deficit. The delay gives opponents time to mount their campaign for repeal.

Then there are the actuarial assumptions. As I understand it, the bill mandates that all citizens be covered by a federally approved medical insurance policy or pay a fine. Additionally, a person cannot be denied coverage even if he/she waits to be sick before signing up. Since the fines will be much less costly than the insurance premiums, it makes perfect sense not to buy the insurance until treatment is needed. (And then drop the insurance once the treatment is completed). If enough people do this, and I don't see why they wouldn't, the entire system would collapse.

In a commentary (3/24), Shikha Dalmia raises that prospect. Though she comes at it from a different standpoint - that of civil disobedience rather than that of practical choice - the effect would be the same.

The Wall Street Journal ran this excerpt of Dalmia's article today.

Resisting ObamaCare, Gandhi Style

By foisting ObamaCare on a deeply unwilling country he might have set the stage for the largest civil disobedience movement since the civil rights era, which, if it plays its cards right, could undo his legislation and his legacy. . . .

By some estimates, Uncle Sam will need to hire an additional 17,000 IRS agents or so just to enforce the coverage mandate. But even if a few million Americans simultaneously refuse to abide by it [or pay the fine], they could easily overwhelm the system. Self-rule or swaraj, Gandhi said, requires a collective understanding of the immense capacity of citizens to “regulate and control” the coercive apparatus of the state through mass nonviolent resistance.
President Obama and his fellow Democrats are counting on this resistance petering out. That could happen. But it will be a lot easier for opponents to maintain this zeal in the age of social networking. . . . After all, this issue is not just about the fate of an industry. It is about maintaining control over basic decisions about one’s own life and health.

In the original Forbes article, Dalmia also stresses the other avenues available to fight Obamacare - electoral; procedural; juridictional; and legal.

...the perpetrators of ObamaCare must be defeated in November and 2012. But right now it is entirely appropriate for Senate Republicans to stall the reconciliation process as much as possible. They are right in calling every point of order that they can--if only to call attention to the bill's manifest corruption. Likewise, the 30-plus states that are issuing sovereignty resolutions and exploring ballot initiatives that would protect their residents from Uncle Sam's coverage diktat are on the right track. Even if these efforts are ultimately thrown out in court because federal law trumps state law, they will make a powerful statement against the coercive nature of ObamaCare.

But the lawsuits that have a shot at sticking in court are the ones that various attorney generals around the country are preparing under the Constitution's commerce clause. This clause gives the federal government expansive powers to regulate interstate commercial activity. But it has never before been invoked to force Americans to purchase a product as a condition of lawful residence in this country. This crosses a line that might well make five Supreme Court justices balk.

If these tools fail then Dalmia urges playing the civil disobedience card beginning December 31, 2013 - the date the individual mandate goes into effect. She quotes Gandhi,

"civil disobedience becomes a sacred duty when the state has become lawless and corrupt."

WSJ excerpt

Original article

Wednesday, March 24, 2010

Fun, Fun, Fun

Ann Coulter in Canada. Need I say more?

Well, just one thing. It was probably a mistake for someone with a name like Francois A. Houle to get on her bad side.,_canada!

(For some reason this link is leading to the columnists page but you can get to Coulter's column from there).

Tuesday, March 23, 2010

Breaking What Works

For those who are now celebrating the onset of the nationalization of our health care system, I'd like to present an academic exercise with practical applications. Read on.

Located in Massachusetts, Zoll Medical Corporation develops and manufactures medical devices. It's one of the many obscure, unsung American businesses that provide the world with cutting edge medical technologies. Zoll's website describes its mission as follows :

(Zoll) helps responders manage, treat, and save lives in emergency rescues and in hospitals; outside the hospital while at work or home; in doctors' and dentists' offices and schools; in public places and on the battlefield. ZOLL's products contribute to managing patient care and saving lives, as well as increasing the efficiency of emergency medical, fire and hospital operations around the globe.

To help pay for its onerous costs, Obamacare imposes burdensome taxes on firms such as Zoll. This reality is presenting a formidable predicament for the company's managers. The Washington Examiner explains.

The bill passed by the House Sunday night contains a particularly damaging version of the $20 billion hit for the medical device industry, meaning Zoll and other medical device makers could well be headed for hard times.

"We believe that the tax will cost us somewhere between $5 million and $10 million a year," says Richard Packer, Zoll's chairman and chief executive officer. "Our profit in 2009 was $9.5 million."

That would be a devastating blow. Zoll employs about 1,800 people. Roughly 1,600 of them are in the United States, and about 650 of those are in Massachusetts. Once the new tax kicks in, that could all change. "We can't run this company at a break-even or a negative rate," says Packer, "so we will be forced to look at alternatives."

The company's first option is to pass the increase on to customers like hospitals and ambulance companies. That might or might not work, given that they are coming under increasing pressure to cut their own costs.

The next option is to cut research and development -- a short-term, money-saving move that will surely cost Zoll down the road. And a third option, says Packer, is to "look at trying to shift jobs to lower-cost places around the world." That would be bad news for Massachusetts and the USA.

No matter what happens, the makers of the devices that save our lives are going to take a major hit.

"It's a real concern for some of these companies, in that they probably are operating on pretty thin margins," says Brian Johnson, publisher of MassDevice, an independent business journal devoted to the medical device industry. Johnson adds that even those companies that can pay the tax face perhaps even more serious problems because of recent government actions, apart from health care reform, making it harder and more costly to win Food and Drug Administration approval for new products. "As a whole, in terms of stricter regulation and the added tax, that's a pretty big bag they're carrying right now," says Johnson.

And then, of course, there is the continuing economic downturn. All in all, it's not a good time to levy a new and burdensome tax on a highly innovative American industry. And yet that is exactly what Obamacare does.

When I called Richard Packer at Zoll on the morning after the House passed the bill, I asked how he was doing. "A total state of depression," he answered, with the kind of short, dry laugh that says it's not really funny. A lot of Americans are feeling that way now.

OK, Obamacare fans. The challenge - Devise a solution to Zoll's problem - Our problem too, since the company (and others like it) occupies an essential role in the health care system that you profess a desire to improve. The ideal solution would allow Zoll to continue to produce its high quality products and services, maintain its current staffing levels, especially in the U.S. and retain its innovative energy all while allowing it to earn a healthy profit. And then when you think you've found a solution, I have countless more of the Democrats' health care plan's toxic side effects for you to fix.

Incidentally, your answer will receive zero credit if you suggest that a government run, non-profit operation take over the services provided by Zoll. Anyone submitting such an answer will be assigned to study the satellite photograph below until he/she understands the consequences of governments that encourage free enterprise and of those that don't.

"A Word Fitly Spoken... like apples of gold in pictures of silver".

This is a saying that I somehow remember from a style manual that somehow found its way into my possession when I was quite young, maybe 9 or 10. I didn't understand its meaning at the time, but I do now.

From a quality of writing standpoint, George Will is probably the best political commentator we have. He's consistently able to transmit thoughts to words (often long strings of words), clearly, intelligently and with a good deal of wit.
Writing on the subject of baseball, Will often emphasizes the professionalism and the "craft" of the players. It's clear he takes his own craft very seriously.

Some elegant phrasings from his latest column on Obamacare.

As America's teetering tower of unkeepable promises grows, so does the weight of government, in taxes and mandates that limit investments and discourage job creation. America's dynamism, and hence upward social mobility, will slow, as the economy becomes what the party of government wants it to be -- increasingly dependent on government-created demand.

I particularly like the following sentence.

Because logrolling is how legislative coalitions are cobbled together in a continental nation, the auction by which reluctant House Democrats were purchased has been disillusioning only to sentimentalists with illusions about society's stock of disinterestedness.

I'm one of those disillusioned sentimentalists, by the way.

Besides, some of the transactions were almost gorgeous: Government policy having helped make water scarce in California's Central Valley, the party of expanding government secured two votes by increasing rations of the scarcity. Thus did one dependency lubricate legislation that establishes others.

During the Democrats' health care monomania, the nation benefited from the benign neglect of the rest of their agenda. Now the nation may benefit from the exhaustion of their appetite for more political risk.

Monday, March 22, 2010


That should be the rallying cry for every Republican running for Congress this coming November.

On today's Fox News panel, Charles Krauthammer predicted that President Obama will push for the imposition of a European-Canadian style VAT (Value Added Tax) to help pay for his new health care entitlement. After November, of course.
It just gets better and better.

Yesterday, I became a Republican. For a little more than a decade, I've considered myself a conservative with no real party affiliation. I voted for Republicans mostly because they weren't Democrats. But with yesterday's House vote on the health care bill, Republicans earned my respect and loyalty. Unanimously rejecting that awful piece of legislation was a remarkable, admirable achievement. It renders the Democrats' "victory" hollow - illegitimizes it as a scandalous bribe-fest with Party leaders reduced to buying votes from their own reluctant members with taxpayer money.
The House vote follows the Senate vote last December which was similarly unanimous. That's 217 - 0 among all GOP legislators. One voice shouting a resounding, NO!

A recurring theme of Mark Steyn's is the langorous effect of a citizenry's overreliance on government. As dependency advances it saps the nation's economic vitality. National defense capabilities wither and national culture and identity dissipate. Birth rates plummet. The culmination is a demographic death spiral. Steyn cites government control of health care as the tipping point in this process. Once personal medical decisions are surrendered to a centralized bureaucracy, there's no turning back.
Is all of this ridiculously overstated? Is the passage of the health care bill really the beginning of the end of the American way of life? Of Western Civilization?
Well, in just one generation, Great Britain went from being a proud world superpower to a self-loathing welfare state. Its postwar Labor Party government led by Prime Minister Clement Atlee, the Barack Obama of his day, put the British National Health Service in place. (Labor was kicked out in 1951 and didn't return to power until 1964 but the damage was done). Except for a brief resurrection during the Thatcher years it's been all downhill from there. Britain's disgraceful health care system* is only one dysfunctional segment of a society in decline - its entitlement rich economy heavily dependent on assimilation-averse immigrants.
Steyn has written that Europe's decline has been relatively comfortable, cushioned as it is by American largesse in the form of our defense umbrella. There'll be no such cushion for us. Steyn lamented after the House vote,

Longer wait times, fewer doctors, more bureaucracy, massive IRS expansion, explosive debt, the end of the Pax Americana, and global Armageddon. Must try to look on the bright side . . .

Paul Ryan's impassioned speech on the House floor yesterday addressed the dependency syndrome that Steyn describes. He blasted the Democrats' paternalism, arrogance, condescension and their disregard of the national will. Ryan also gave a forceful affirmation of traditional American ideals and American exceptionalism. His performance should propel him to the top tier of GOP presidential prospects.
Here's hoping it does.

The passage of health care legislation by the House yesterday generated some Latin (and mock-Latin) responses among conservative commentators.

National Review advised conservatives,
Nil desperandum—never despair

Bill Kristol (Weekly Standard) added the mock-Latin motto of the Harvard band, Illegitimi non carborundum--don't let the bastards get you down

My own personal favorite is
Comunistus vacumum - Democrats suck

* Britain's notoriously decrepit hospitals are the stuff of legend. Here's a report of just a few examples. (link below)

In March 2008, Lord Mancroft, a Tory peer who has held responsible positions in the public health area, claimed it was a miracle he was still alive after a stay in a filthy British public hospital with uncollected infected waste in the wards and dirty, drunken and sluttish nurses.

The Daily Telegraph wrote in 2007 that in the hospitals run by the Maidstone and Tunbridge Wells National Health Service Trust staff told patients suffering from diarrhea to "go in their beds." Between 2004 and 2006, 90 patients there died from Clostridium difficile, and the disease was a factor in the death of a further 241: "Were it not for bad nursing, bad medical attention and bad administration, none of these patients need have died. Indeed, they would not have contracted C. diff. at all unless they had gone into hospital. So, after 150 years' advance of education, technology, prosperity and science, we have lost what Florence Nightingale taught [about cleanliness]."

Recently, at Eastbourne General hospital in East Sussex, another 13 patients died after an outbreak of Clostridium diff. Several wards have now been closed for cleaning. Others have died in the East Sussex Hospital. "Hospital care for the elderly has been given a very low priority," says Sarah Harman, a solicitor representing families of several victims.

A senior Conservative MP, Nigel Evans, demanded an inquiry into "shocking" failures of care after his elderly mother died of C. diff. He demanded to know why she had not been tested sooner and he criticized doctors for the off-hand way in which they told the family she had died.

Mr. Evans's sister said: "We were told to leave the room and a doctor came and asked us whether we'd discussed resuscitation. When we looked shocked, he said: 'I can tell you weren't expecting this.' It was only then that we realized she was dying." She said she had found patches of grime in the corners of bathrooms at the hospital as well as under beds. "The whole thing was like a horror film."

"First of all this infection can and should be prevented, and secondly it can be treated if it's diagnosed in time," he said. "Neither of these things happened. There are thousands of families up and down the country grieving for the same reason."

Deaths involving C. diff. in England and Wales doubled from 3,757 in 2005 to 8,324 in 2007, the vast majority of them elderly people, before a decline last year. It appears that while restaurants are prosecuted for unsanitary conditions, hospitals are not.

It has now come to light that up to 1,200 -- yes, that's right, one thousand two hundred -- patients may have died through bad nursing and filthy conditions at a single National Health Service hospital in Staffordshire.

Thanks Barack, Nancy and Harry. We now have something to look forward to. (Especially the sluttish nurses).

Saturday, March 20, 2010

"...quite mad"

Some recent health care debate comments.

In our world of infinite wants but finite resources, there are only two ways to allocate any good or service: either through prices and the choices of millions of individuals, or through central government planning and political discretion. This choice is inexorable. Stripped of its romantic illusions, ObamaCare is really about who commands the country's medical resources. It vastly accelerates the march toward a totally state-driven system, in contrast to reforms that would fix today's distorted status quo by putting consumers in control.

As in the Western European and Canadian welfare states, doctors, hospitals and insurance companies will over time become public utilities. Government will set the cost-minded priorities and determine what kinds of treatment options patients are allowed to receive. Medicare's price controls will be exported to the remnants of the private sector.

All bureaucratized systems also restrict access to specialists and surgeries, leading to shortages and delays of months or years. This will be especially the case for the elderly and grievously ill, and for innovation in procedures, technologies and pharmaceuticals.

Eventually, quality and choice—the best attributes of American medicine in spite of its dysfunctions—will severely decline.

Democrats deny this reality, but government rationing will become inevitable given that overall federal spending is already at 25% of GDP and heading north, and Medicare's unfunded liabilities are roughly two and a half times larger than the entire U.S. economy in 2008. The ObamaCare bill already contains one of the largest tax increases outside the Great Depression or the world wars, including a major new tax on investment income—and no one seriously believes it will be enough.

WSJ editorial, 3/20/2010

During the (recent health care) summit, Obama insisted that bare-bones insurance coverage — insurance that protected only against financial catastrophe — was not insurance at all.

The truth is closer to the reverse. As Nobel Prize–winning economist Kenneth Arrow pointed out nearly five decades ago, using insurance to pay for routine and predictable expenses makes no sense. The market can provide catastrophic insurance. It cannot provide comprehensive insurance. If the government insists on comprehensive insurance it will have to interfere in markets again and again. This is why liberals are dead-set against letting people buy insurance from out of state. If healthy people can evade their states’ mandates that insurance provide comprehensive coverage by buying insurance in less regulated states, they will raise the price of that comprehensive coverage and thus make it unsustainable.

Ultimately, to make this system work, people have to be forced not to buy catastrophic insurance or forgo insurance altogether: They must be forced to buy comprehensive policies. Those who can’t afford them must be subsidized. Such policies come with built-in incentives for overconsumption, so eventually government experts must swoop in to ration care.

National Review 3/22/2010 issue

Obamacare will result in the creation of at least 16,500 new jobs. Doctors? Nurses? Ha! Dream on, suckers. That’s 16,500 new IRS agents, who’ll be needed to check whether you — yes, you, Mr. and Mrs. Hopendope of 27 Hopeychangey Gardens — are in compliance with the 15 tax increases and dozens of new federal mandates the Deemocrats are about to “deem” into existence. This will be the biggest expansion of the IRS since World War II — and that’s change you can believe in. This is what “health” “care” “reform” boils down to: fewer doctors, longer wait times, but more bureaucrats.

Investor’s Business Daily argues that the “health” debate is really a proxy fight on the size and role of government. According to their poll, 64 percent of people think the federal government has “too much power.” Correct. But a big chunk of that 64 percent voted less than 18 months ago for a man and a party explicitly committed to more government with more power, and they’re now living with the consequences. Obama is government, and government is Obama. That’s all he knows and all he’s ever known. You elected to the highest office in the land a man who’s never run a business or created wealth or made a payroll, and for his entire adult life has hung out with guys who’ve demonized (deemonized?) such grubby activities.

Whatever is “deemed” to have passed in the next few days doesn’t end the debate but begins it. If you’re sick of talking about health care, move to Tahiti, because in the U.S. we’re going to be talking about it until the end of time, or at least until the Iranians nuke Cleveland.

Mark Steyn, NRO

The grip of progressivism is probably the best explanation for the Democratic Party's astonishing campaign to nationalize the U.S. healthcare sector by all means necessary. To attempt to enact a radical and unpopular program in a bill that includes many corrupt provisions, on a party-line vote and through a procedural trick (if the "Slaughter solution" is employed) that seems clearly unconstitutional, appears quite mad and self-defeating to the outsider. But it is not mad ... to those who think it is ... historically inevitable that the government must administer medical care.

Christopher DeMuth, on the AEI Enterprise Blog

It was dispiriting, to say the least, to watch George Mason University students cheering wildly while listening to the president's shameful lies about the fiscal effects of his health care bill. Obama clearly understood his credulous audience and played it like a Stradivarius. Ironically, those fawning, ignorant students will bear the brunt of the bill's exorbitant costs while their aging parents and grandparents struggle with an increasingly overburdened and overregulated health care system.

This blogger




Friday, March 19, 2010

Scaling Up Health Care Reform

I was employed as a research chemist at a large pharmaceutical company for 34 years, with the last 26 as a process chemist. Chemical compounds that have been previously synthesized on a small scale, anywhere from a few milligrams (thousandths of grams) to five grams or so, are prepared in larger, sometimes much larger, amounts - up to multi kilograms (thousands of grams) by process chemists. Very often, a process workable on a small scale is not feasible on a large scale. Modifications are always necessary and sometimes the entire process needs revamping. Never is an attempt made to synthesize a large quantity of a compound without first running trial reactions, making a few grams and then gradually scaling up. Not following an incremental approach is courting disaster. At best, a highly inefficient, wasteful and needlessly expensive process results. At worst, the entire project blows up. Literally.

Obamacare is the health care equivalent of synthesizing many kilograms of a compound without any prior process development. And it's being rushed into law while while its proponents are ignoring an ongoing experiment that is producing some useful, relevant data. The state of Massachusetts is presently trying out a mini-me version of Obamacare. After only three years of operation, that system, call it RomneyPatrickcare, is already facing serious problems. These were outlined in a WSJ op-ed (3/17) by Grace-Marie Turner.

While Massachusetts' uninsured rate has dropped to around 3%, 68% of the newly insured since 2006 receive coverage that is heavily or completely subsidized by taxpayers.

More than half of the 408,000 newly insured residents pay nothing.

Another 140,000 remained uninsured in 2008 and were either assessed a penalty or exempted from the individual mandate because the state deemed they couldn't afford the premiums.

A typical family of four today (in Massachusetts) faces total annual health costs of nearly $13,788, the highest in the country. Per capita spending is 27% higher than the national average.

Further, insurance companies are required to sell "just-in-time" policies even if people wait until they are sick to buy coverage. That's just like the Obama plan. There is growing evidence that many people are gaming the system by purchasing health insurance when they need surgery or other expensive medical care, then dropping it a few months later.

Some Massachusetts safety-net hospitals that treat a disproportionate number of lower-income and uninsured patients are threatening bankruptcy. They still are treating a large number of people without health insurance, but the payments they receive for uncompensated care have been cut under the reform deal.

The Bay State is also suffering from what the Massachusetts Medical Society calls a "critical shortage" of primary-care physicians. As one would expect, expanded insurance has caused an increase in demand for medical services. But there hasn't been a corresponding increase in the number of doctors. As a result, many patients are insured in name only: They have health coverage but can't find a doctor.

Fifty-six percent of Massachusetts internal medicine physicians no longer are accepting new patients, according to a 2009 physician work-force study conducted by the Massachusetts Medical Society. For new patients who do get an appointment with a primary-care doctor, the average waiting time is 44 days, the Medical Society found.

As Dr. Sandra Schneider, the vice president of the American College of Emergency Physicians, told the Boston Globe last April, "Just because you have insurance doesn't mean there's a [primary care] physician who can see you."

The difficulties in getting primary care have led to an increasing number of patients who rely on emergency rooms for basic medical services. Emergency room visits jumped 7% between 2005 and 2007. Officials have determined that half of those added ER visits didn't actually require immediate treatment and could have been dealt with at a doctor's office—if patients could have found one.

Faced with soaring medical expenses, Gov. Deval Patrick, Mr. Romney's successor, wants to cap insurance rate increases at 4.8%, not the 8% to 32% increases the companies have requested for April 1. Three of the four major health insurers in Massachusetts showed operating losses for 2009. If their rates are capped, they say they'll be forced to cut payments to health providers, putting further pressure on doctors and fragile hospitals.

Someone who should know, Massachusetts State Treasurer Tim Cahill, had this to say about his state's system and the Democrats' proposed plan.

If President Obama and the Democrats repeat the mistakes of the health insurance mandate in Massachusetts on a national level, they will bankrupt this country within four years. It is time for the President and the Democratic Leadership to go back to the drawing board and come up with a new plan that does not threaten to wipe out the American economy.

Make no mistake – I firmly believe in the right of every American to access good quality health care. But as Congress and President Obama prepare to ram through a government run health care plan, they should heed the warnings about the way in which Gov. Patrick has managed the same model in Massachusetts.

No process chemist would ever consider proceeding with a super sized reaction before obtaining definitive results from smaller trial runs, especially when one of the trials is showing ominous signs of going awry. Yet this is what the Democrats are doing as they force their massive social experiment on an unwilling American public. An item the other day on Yahoo News (big Obama fans) claimed that whatever one thinks of the proposal, there's no doubt that it's "bold". No. The word is reckless. Irresponsibly. Dangerously. Reckless.

Warning! - Everyone stand back!

Thursday, March 18, 2010

Mideast Double Standards

Here are excerpts from a couple of recent articles about the Israeli-Arab conflict.

Jay Nordlinger (NRO)

We all know that the Palestinian territories — or whatever expression you prefer — are divided in two: The extremists, Hamas, control the Gaza Strip; the moderates, Fatah, control the West Bank. But what do you say to moderates’ naming a square in a town outside Ramallah after a terrorist? A mass-murdering terrorist?

They have just named the square for Dalal Mughrabi, a woman who led a team committing atrocities in 1978. Their atrocities are summed up in the name “Coastal Road Massacre.” I will quote from a column about this matter:

"On a Saturday in March 1978, the squad of Palestinian terrorists led by Mughrabi entered Israel by boat from Lebanon and made their way to the main road between Haifa and Tel Aviv. . . . By day’s end, they had murdered 38 innocent men, women and children.

The first person Mughrabi and her gang of terrorists encountered was Gale Rubin, an American photojournalist taking photos of birds near the beach. They killed her and continued on their deadly path.

They then hijacked a bus full of happy families returning from a Saturday excursion. On their way to Tel Aviv, the terrorists shot at passing cars and killed more innocent people.

The terrorists tied all the men’s hands to the bus seats. When Israeli security forces stopped the bus, the terrorists ran out while throwing hand grenades into the bus, setting it on fire. The men inside were burned alive."

I think of the Sbarro attack in 2001. Do you remember that one? A terrorist blew up a Sbarro’s restaurant in Jerusalem, killing 15. Okay, you say: Every society has its extremists, its murderers. But what do you do with this? At An-Najah University in Nablus, they created an exhibition celebrating this massacre. It was a diorama of sorts — a mock-up — showing the restaurant. The walls were drenched in blood, and body parts were strewn all over, along with pizza slices. Palestinian students — the best and brightest in that society — filed by reverently. It was like a religious rite.

How do you make peace with such people? Maybe you do. But can you grant it is hard?

When Israelis commit atrocities, Israeli authorities imprison them, and the society at large reviles them. When a Palestinian commits atrocities — the authorities may well name a square after her. And those authorities are not only Hamas: They are the “moderates” of Fatah, the moderates of the West Bank — the people you can do business with.

Ruth R. Wisse (WSJ) asks, How about an Arab "settlement freeze"?

Of the children of Abraham, the descendants of Ishmael currently occupy at least 800 times more land than descendants of Isaac. The 21 states of the Arab League routinely announce plans of building expansion. Saudi Arabia estimates that 555,000 housing units were built over the past several years. Iraqi Prime Minister Nouri al-Maliki announced during a meeting in Baghdad last year that "Some 10,000 units will be built in each province [of Iraq] with 100 square meters per unit" to accommodate citizens whose housing needs have not been met for a long time. Egypt has established 10 new cities since 1996. They are Tenth of Ramadan, Sixth of October, Al Sadat, Al Shurouq, Al Obour, New Damietta, New Beni Sueif, New Assiut, New Luxor, and New Cairo.

In 2006 the Syrian Prime Minister, Mohammad Naji Atri, announced a new five-year development plan that aims to supply 687,000 housing units. Kuwait expects to have a demand for approximately 100,000 private housing units by 2010. Last year Jordan's King Abdullah launched a National Housing Initiative, which aims to build 120,000 properties for low-income Jordanians.

Arab populations grow. And neighborhoods expand to house them. What's more, Arab countries benefited disproportionately from the exchange of populations between Jews and Arabs that resulted from the Arab wars against Israel. Since 1948 upward of 800,000 Jews abandoned their homes and forfeited their goods in Egypt, Iraq, Morocco and Yemen. In addition to assets valued at hundreds of billions of dollars, the property deeds of Jews from Arab lands is estimated at a total area of 100,000 square miles, which is five times the size of the state of Israel, and more than Israel would include even if it were to stretch over all the disputed territories of the West Bank.
(My emphasis)

These preposterous disparities are a result of contrasting political cultures. The Arab League was founded at the same time as Israel with the express aim of undoing the Jewish state's existence. Although much has changed over the ensuing decades, opposition to the Jewish state remains the strongest unifying tool of inter-Arab and Arab-Muslim politics. Trying to eliminate the Jews rather than compete with them has never benefited nations.

It is unfortunate that Arabs obsess about building in Israel rather than aiming for the development of their own superabundant lands. But why should America encourage their hegemonic ambitions? In December the White House issued a statement opposing "new construction in East Jerusalem" without delineating where or what East Jerusalem is.

Ramat Shlomo, the neighborhood at the center of the present altercation, is actually in northern Jerusalem, west of the Jewish neighborhoods of Ramot, home to 40,000 Jewish residents. Why does the White House take issue with the construction of housing for Jewish citizens within the boundaries of their own country? The same White House raised no objection when Jordan recently began systematically stripping citizenship from thousands of its Palestinian citizens rather than providing new housing units for them in a land much larger than Israel.

Monday, March 15, 2010

First, Do No Harm

The Correct Approach

Nothing poisons the health care reform debate more than the idea of the "right" to health care. No such right exists. Personal rights extend only as far as they don't impinge another person's rights. Coercing another to provide or pay for a product or service is tyranny - a kinder, gentler form of slavery. It's generally not looked upon as such because the providers and recipients are mutually anonymous. Natural rights, like those delineated in the Bill of Rights are protections from the encroachments of others, not claims upon others' time, talents, efforts or property.

Note that this doesn't even touch on the complex question of what constitutes health care. Words like "adequate" or "necessary" might be used but these have wildly different meanings to different people. Why deny a person who believes that it's necessary to have weekly physical exams? Or a month long hospital stay following a normal childbirth? Or an MRI for every headache? Who's to say no? It's a right.

Conversely, the government may (and probably will) decide to take a minimalist approach in defining what is "adequate" health care. One potential feature of Obamacare is the utilization of Comparative Effectiveness Research (CER) to determine the appropriate type of care a patient should receive. Oncologist and molecular pharmacologist Dr. Leonard A. Zwelling makes the point in a WSJ op-ed that CER can't keep up with the rapid pace of medical advancement. New, improved therapies don't have enough data points to merit consideration. And CER certainly doesn't make allowances for ideosyncratic differences between patients. No matter. From the government's vantage point, the "right" to health care can become the right to a one-size-fits-all standard of treatment. Take it or leave it.

Saying that there's a right to health care isn't just morally wrong. The concept is a leading cause of the current problems in our health care system, notably high cost and lack of universal access.

But just because there's no "right" to health care doesn't mean there should be no interest in ensuring that access to care is provided as extensively as possible. Such a goal is desirable aside from its appeal to conscience. As a practical matter, improved access to health care strengthens the economic foundation of society. A citizenry is more productive, more prosperous, the healthier it is. Thus, if done correctly, everyone will benefit from health care reform. Any government involvement should be undertaken with this symbiotic outcome in mind.

Conservative dogma, properly understood, includes a commitment to improving the lives of all citizens - promoting the general welfare - as the Constitution put it. (Which was written by classical liberals like James Madison. Classical liberalism is today's conservatism). Rejected is the modern liberal's view that life is a zero sum game with one group gaining at the expense of another. Conservatives are also acutely aware of the Law of Unintended Consequences, especially when undertaking "comprehensive" reform. Things can always become worse - much worse - than they are.

Conservatives view private enterprise as the true engine of progress, not merely a source of funding for wasteful projects. That view holds that successful, profitable concerns - which in the area of health care includes doctors, hospitals, medical device makers, pharmaceutical companies and even insurance companies - are responsible for the remarkable advances in medicine achieved over the past century. Penalizing these concerns is grossly counterproductive.

More often than not, the liberal, Robin Hood approach hurts all parties - even - especially - those targeted for benefits. Much harm was, and continues to be, inflicted on poor minorities by LBJ's "Great Society" programs.

Or consider "Cap and Trade", the quintessential example of a liberal policy resonse to a perceived problem.
It's a program viewed as a moral imperative - an obligation of society to its citizens and the world. Proponents are doing "good". Opponents are opposing "good".
It calls for a vast intrusion of government over large swathes of the economy. (The program's true purpose).
It mandates ruinous expenditures.
Successful, profitable, vital enterprises are demonized and targeted as funding sources.
It does nothing to fix a problem for which there is scant evidence in the first place.
The legislation is purposely made complex so that a variety of unrelated measures, items on liberals' wish lists, can be and are, buried in it.
When the program inevitably proves ineffective, its insufficient scale is blamed.

The Democrats' approaches to health care reform and "global warming" are identical in most respects. (At least there are real problems to address in health care). If implemented, the shortcomings of our present system - excessive government control, restricted choice, rationed care, unequal levels of care, high cost - would worsen. Democrats who challenge the Party line (and resist considerable pressure from Party leadership and special interest groups) are candid about this. Rep. Glenn Nye (D- Va.) explains his opposition.

[I]f the bill that is put forth does not contain significant changes and does not actually reduce health care costs for Americans and small businesses, it will not have my support.

I believe it is absolutely imperative that any health care reform bill reduces costs for families and small businesses, allows Americans to keep their existing plan and choose their doctor, is bipartisan, is deficit neutral, does not force Americans to use a certain type of health insurance, maintains Medicare benefits for seniors, and lowers the overall costs of health care. H.R. 3962 does not meet these criteria, which is why I do not support it.

The Senate bill, which the House is now considering, is similar to H.R. 3962. Its principal difference, aside from its lack of abortion funding language, is its inclusion of corrupt side deals - The Cornhusker Kickback, The Louisiana Purchase, Gator Aid, The Union Exclusion and many others.

Implementation of the plan wouldn't even attain its stated, central goal. Millions of Americans would remain uninsured. Non-partisan, CBO estimates put the total, with the Democrats' plan in place, at 23 million by 2019.

And the cost would be exorbitant. The proposals come with an estimated price tag of $200 billion per year. Mona Charen points out the following.

In 1966, Medicare cost taxpayers $3 billion. The House Ways and Means Committee estimated that by 1990, we might be spending as much as $12 billion. The actual 1990 figure? $107 billion. In 1987, Congress estimated that the Medicaid DSH (disproportionate share hospital) costs would be less than $1 billion in 1992. The actual cost? $17 billion.

An ultimate cost of more than a trillion dollars a year would not be unlikely. That, or severe rationing will be needed.

Identifying The Real Problem

True health care reform would attack the problem at its source - its high and continually increasing cost. Out of control cost is the inevitable outcome of the absence of free market competition. Why is there minimal competition in the area of health care? A book review by Joseph Rago (WSJ - 3/12) of Roger Battistella's, "Health Care Turning Point" quotes the author,

"Because most consumers of health care are largely insulated from directly paying for the services they use, health care is generally perceived as an unlimited free good. . . . Wants and needs become insatiable when care is believed to be free."

Battistella cites the origin of this entitlement mentality with the advent of employer provided insurance 65 years ago. This benefit was offered tax free as a way to circumvent FDR's wartime wage controls. Aside from originating the expectation of "free" health care, it forever linked people's access to health insurance with their employment status.

Mr. Battistella begins with the original sin of modern American health care: the government's World War II-era decision that gave businesses tax incentives to sponsor insurance for their workers but that did not extend the same dispensation to individuals. Since third parties were paying most of the bills—employers at first and eventually, with the creation of Medicare in 1965, the government as well— no one had any reason to be assiduous about controlling the cost of care. Patients always seemed to be spending someone else's money.
(My emphasis)

George Will, in a recent column, put it this way.

Employer-paid insurance is central to what David Gratzer of the Manhattan Institute calls "the 12 cent problem." That is how much of every health care dollar is spent by the person receiving the care. Hence Americans' buffet mentality -- we paid at the door to the health care feast, so let's consume all we can.

The Democrats make a pretense of addressing the problem of cost. The following is from an essay written for the Washington Times by Milton Wolf, a doctor who just happens to be Barack Obama's 2nd cousin once removed.

The justification for Obamacare has been to control costs, but the problem is there is little in Obamacare that will do that. Instead, there are provisions that will ration care and artificially set price. This is a confusion of costs and price.
As one example, consider the implications of Obamacare’s financial penalty aimed at your doctor if he seeks the expert care he has determined you need. If your doctor is in the top 10 percent of primary care physicians who refer patients to specialists most frequently – no matter how valid the reasons – he will face a 5 percent penalty on all their Medicare reimbursements for the entire year. This scheme is specifically designed to deny you the chance to see a specialist. Each year, the insidious nature of that arbitrary 10 percent rule will make things even worse as 100 percent of doctors try to stay off that list. Many doctors will try to avoid the sickest patients, and others will simply refuse to accept Medicare. Already, 42 percent of doctors have chosen that route, and it will get worse. Your mother’s shiny government-issued Medicare health card is meaningless without doctors who will accept it.

(My emphasis)

The Solution

Any serious reform package would begin by addressing the government created market distortion. The solution - Employer provided health insurance should be taxed as ordinary income. This is one of Paul Ryan's proposals in his "Road Map for America's Future". It was part of John McCain's presidential campaign platform. And its advocates include thoughtful commentators like Charles Krauthammer.

The potential revenue produced by this tax is estimated to be $250 billion per year, or more than what the Democrats' plan is claimed to cost. It would be returned to all people, employed or not, in the form of refundable vouchers to purchase health insurance. (Refundable meaning that even those whose tax liability was less than the value of the voucher, would still receive the entire voucher). Though Ryan's plan doesn't specify it, the dollar amount of the vouchers could be linked to the income level of the recipients. That way, government subsidies would be provided based upon income level, not employment status. Such a "progressive" approach should be embraced by liberals. It isn't, because labor unions are bitterly opposed. Democrats caved when Big Labor protested the proposal to tax its "Cadillac" health care insurance plans. Union members are not scheduled to pay until 2018. Naturally, non-union employees would begin paying immediately.

Another government impediment to free market competition in health care is the prohibition of purchasing insurance policies from other states. There's no other item of commerce that's restricted in this way. (At least none I can think of). Krauthammer gives an analogous hypothetical example of residents of a state, say Wisconsin, being restricted to buying oranges produced only in that state. The cost of oranges to that state's residents would be prohibitive without access to Texas or Florida markets. And wealth producing economic activity would be stifled.

With these two steps - redirected government subsidies and the elimination of the out of state ban on insurance purchases - a consumer, with tax voucher in hand, could then compare a wide variety of policies offered by a dozen or more insurance companies with respect to types of coverage, cost of coverage, co-pays, deductible levels, out of pocket limits, lifetime maximums, lists of doctors and hospitals networking with the insurance companies, premiums, reputation of insurers, etc, etc. This is how people shop for just about anything today - cell phones, cameras, TVs, cars, financial advisors, even life and auto insurance. Insurance companies would be forced to compete with each other. So would health care providers vying for patients' business. Costs would come down as efficiencies were implemented. Importantly, people would become aware of the true cost of their health care and take steps to purchase it wisely.

An absolutely essential step to further reduce health care costs is tort reform. At least $50 billion worth of precious medical resources is wasted yearly trying to protect doctors and hospitals from lawyers. The solution - Cap monetary awards and throw out junk lawsuits. Doctors' liability premiums and the ordering of unnecessary defensive measures would both plummet. Of course, this is another area the Democrats won't go near since lawyers own the Party, paid for with box car loads of campaign cash.

Another step to increase flexibility for health care consumers - The continuation of health care savings accounts - tax free repositories of funds to be used for medical care. Make the HSAs unlimited in terms of their duration and the amount of money that they can hold. The only requirement is that the money can only be used to pay for specified medical expenses.

High risk patients would be covered by state run pools funded with a combination of insurance company contributions and government subsidies. Something along the lines of the system that exists for unemployment insurance.

There. The problems of health care are solved. I leave the details to be worked out by the likes of Paul Ryan and Eric Cantor. Ryan's website lists some other suggestions such as state run automatic enrollment programs and small business pools to lessen the strain of offering coverage to their employees. I'm sure it can all be explained in something smaller than a Form 1040 instruction booklet. Certainly less than 2000 pages. (27oo pages for President Obama's latest proposal). One thing I don't have a fix for is the unintentional health care subsidy that the U.S. provides to the world. Just as our military spending provides a defensive umbrella, free of charge, under which our democratic allies can survive and operate their welfare state economies, so does our relatively unencumbered entrepreneurial economy provide the innovations and improvements that allow the world's socialized medical systems whatever functionality they're able to manage. It's just our destiny, I suppose, to act as the free world's guarantor of safety and principal generator of medical miracles. Unappreciated, of course.

An Unintended Consequence - Job Destruction

Finally, here's an excerpt of a recent article in The Weekly Standard written by James Capretta and Yuval Levin.

Beyond taxes and spending, Obama-care would also wreak havoc on the labor market. Because employers would get penalized if any of their low- and moderate-wage workers ended up in the new subsidized insurance pool, they would avoid hiring such workers. Democrats claim they want to jam through health care reform so they can turn their attention to jobs, but the bill provides a strong disincentive for businesses to hire those who need jobs the most.

The plan would, moreover, trigger an inefficient and costly re-sorting of American labor. Under the bill, despite the enormous cost of subsidizing coverage in the new government-run “exchanges,” only 18 million people would be getting such subsidized coverage in 2016—even though there are 127 million Americans today with incomes in the targeted range of between one and four times the poverty rate. The vast majority of workers would still be in job-based plans and get no additional help. Gene Steuerle of the Urban Institute estimates that a worker making about $60,000 per year in 2016 would get $4,500 more in federal aid if he were able to get his insurance through an exchange rather than through his employer. That’s a powerful incentive for workers and firms to rearrange their operations to take advantage of the federal money. In time, the American economy would be divided into companies with low-wage workers getting government-subsidized health care and others with higher-wage workers who continue to get employer-based plans. This would make the labor market far less efficient (harming productivity), and it would mean that the subsidies themselves would cost far more than the CBO now estimates.

And for those workers who do end up getting federal subsidies for their insurance, the program is a trap. If they get a pay raise, they will lose some of their insurance subsidy. Indeed, the schedule of subsidy withdrawal is so severe that it will push many low-wage families into effective tax brackets of 60 percent to 80 percent, according to a CATO Institute analysis. Obama-care would thus provide a strong disincentive to work and so undermine the most successful policy initiative in generations: welfare reform.

The health care debate is not just about health care. The Democrats’ bill is so massive, so far-reaching, and so poorly designed that its implications for the larger economy (and especially for employment, which should now be Washington’s top priority) could be immense—and disastrous. For the sake of the economy, no less than for that of American health care, Congress should pause, think, and start over.

Amen to that.






Capretta and Levin

Ryan's health care website

Wednesday, March 10, 2010

She's So Excited

You’ve heard about the controversies within the bill, the process about the bill, one or the other. But I don’t know if you have heard that it is legislation for the future, not just about health care for America, but about a healthier America, where preventive care is not something that you have to pay a deductible for or out of pocket. Prevention, prevention, prevention—it’s about diet, not diabetes. It’s going to be very, very exciting.

But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.

House Speaker Nancy Pelosi

That last line of Pelosi's has come in for some well deserved ridicule. But what she said that was even sillier, I thought, was the business about the "very, very exciting" prospect of preventive care being covered in full. Maybe my experience is unusual but I've never had an insurance plan that didn't fully cover (except for a nominal co-pay) routine physicals, mammograms, colonoscopies and the like. Insurance companies are well aware that such coverage is an effective way to reduce medical costs. Compared to the big ticket items of surgeries, hospital stays and emergency treatment, preventive care is cheap. This is not a new or revolutionary concept. Imagine Pelosi hawking a new government program to provide big screen TVs to every family in America - "It comes with a special device which allows you to change the volume...even the channel! without getting up from your chair. Very, very exciting!"

And just what is meant by "diet, not diabetes"? (aside from allowing Pelosi to display her alliterative skills). Yet another federally funded education program? Or something more insidious - Government control of grocery shopping? Prohibition of fast food? No excuse for getting diabetes once you're diet is arranged? (And therefore no treatment)? Don't worry, it's all explained, in code, in the health care bill to be deciphered after enactment. As in the Twilight Zone episode, "To Serve Man".

Pelosi's latest asininities bring to mind her remarks made shortly after the Scott Brown victory. Attempting to explain that it wasn't a referendum on the Democrats' health care proposals she said,
"Massachusetts has health care. ... The rest of the country would like to have that too. So we don't say a state that already has health care should determine whether the rest of the country should."

Massachusetts has health care. The rest of the country doesn't. Anyone who talks like this should not be in a position to help redirect one-sixth of the U.S. economy.

Tuesday, March 9, 2010

Democracy In Iraq

Bret Stephens celebrates Iraq's transformation from dictatorship to democracy in an excellent op-ed in the WSJ today. He points to the contrast from eight years ago when,

...a presidential election was held in Iraq. Saddam Hussein won it by a margin of 11,445,638 to zero. "Whether that's because they love their leader—as many people said they do—or for other reasons, was hard to tell," reported CBS News's Tom Fenton from Baghdad.

You can't say they aren't fair and balanced over at CBS.

Several millions of voters participated in Iraq's recent election with the results "too close to call". Stephens stresses that this remarkable achievement, in the heart of the notoriously despotic Arab and Muslim world, cannot be overstated.

Paleontologists have described similar moments in evolution, when some natural cataclysm permits a nimbler class of animals to take the place of the planet's former masters.

Just so in Iraq: the Cretaceous period of the T Rex and the pterosaur is at last drawing to a close. George W. Bush, in all his subtlety, was their mass-extinction event.

Stephens notes that right from the beginning, even before the insurgency, Western liberals dismissed the importance of Iraq's liberation. Then as the violence increased, their disdain became a palpable joy.

...the insurgents murdered coalition soldiers and Iraqi civilians with equal abandon, right up to the morning of the election. Yet somehow the killing sprees (grotesquely replete with the cutting off of children's fingers) were treated by the world's great opiners not as the acts of evil men to be confronted and stopped, but purely as a function of the American presence in Iraq.

In this strange moral calculus, all the blood that was shed—including American blood—was on America's hands. It was also, by implication, a stain on America's "experiment" of "imposing" democracy on so obviously unwilling a people.

(My emphasis).

Here Stephens makes an important point. Leftists directed their outrage not at the insurgents but at those fighting them. Blaming the actual perpetrators of the violence did not advance their political agenda. It did not make Bush (and Cheney and Rumsfeld) look bad.

The correct moral response to the blowing up of markets, playgrounds, and mosques should be, "Let's put an end to this depravity. Let's destroy this ideology and its advocates and operatives." Instead, the left declared the U.S., (or more specifically, the Bush administration), culpable for the death and destruction. This deceit helped to fuel the insurgency. The insurgents - both the former Baathist Sunnis and the Iranian backed Shiites - were playing to a receptive audience. It was much easier to murder civilians than coalition troops. Perversely, the more civilians they murdered, the more political pressure was brought to bear on the forces arrayed against them. Still, a majority of Americans never bought into the 'blame the coalition' narrative. The war became unpopular not because it was seen as immoral but because it wasn't going well.

Stephens chastises those in the West who disparage democracy in general. Those that favor instead, a system led by a small group of self-described enlightened elitists. Previously tyrannized people, like the Iraqis, know better. That's why they braved the threat of violence to cast ballots in large numbers. Stephens quotes the late journalist Michael Kelly who wrote for the left-leaning publications The Washington Post and The New Republic and was killed during the U.S. invasion in 2003.

"Tyranny truly is a horror: an immense, endlessly bloody, endlessly painful, endlessly varied, endless crime against not humanity in the abstract but a lot of humans in the flesh. It is, as Orwell wrote, a jackboot forever stomping on a human face.

"I understand why some dislike the idea, and fear the ramifications of, America as a liberator. But I do not understand why they do not see that anything is better than life with your face under the boot. And that any rescue of a people under the boot (be they Afghan, Kuwaiti or Iraqi) is something to be desired. Even if the rescue is less than perfectly realized. Even if the rescuer is a great, overmuscled, bossy, selfish oaf. Or would you, for yourself, choose the boot?"