The Beginning Of America's Decline?

Depressing that this post comes after the one about America's comeback. But as Mark Steyn put it, it's tough to be optimistic:

Well, it seems to be in the bag now. I try to be a sunny the-glass-is-one-sixteenth-full kinda guy, but it's hard to overestimate the magnitude of what the Democrats have accomplished. Whatever is in the bill is an intermediate stage: As the graph posted earlier shows, the governmentalization of health care will accelerate, private insurers will no longer be free to be "insurers" in any meaningful sense of that term (ie, evaluators of risk), and once that's clear we'll be on the fast track to Obama's desired destination of single payer as a fait accomplis.

If Barack Obama does nothing else in his term in office, this will make him one of the most consequential presidents in history. It's a huge transformative event in Americans' view of themselves and of the role of government. You can say, oh, well, the polls show most people opposed to it, but, if that mattered, the Dems wouldn't be doing what they're doing. Their bet is that it can't be undone, and that over time, as I've been saying for years now, governmentalized health care not only changes the relationship of the citizen to the state but the very character of the people. As I wrote in NR recently, there's plenty of evidence to support that from Britain, Canada, and elsewhere.

More prosaically, it's also unaffordable. That's why one of the first things that middle-rank powers abandon once they go down this road is a global military capability. If you take the view that the U.S. is an imperialist aggressor, congratulations: You can cease worrying. But, if you think that America has been the ultimate guarantor of the post-war global order, it's less cheery. Five years from now, just as in Canada and Europe two generations ago, we'll be getting used to announcements of defense cuts to prop up the unsustainable costs of big government at home. And, as the superpower retrenches, America's enemies will be quick to scent opportunity.

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 . . .

Congratulations, progressives. You've just made the citizens of the country started with a Declaration of Independence permanent wards of the state. This is what you wanted--to begin to manage and organize and run people's lives--and you got it.

The post-WWII decline of Great Britain wasn't inevitable. It was hurried along its way by their "governmentalized" health care. And all of the things that everyone now predicts for the US are already reality in the UK: long wait times, fewer doctors, ever-expanding debt & cost, drop in quality, bureaucracy between the patient and the doctor, and on and on.

As my econ-minded friends like to point out, there are always trade-offs. Don't assume that this, the most massive entitlement in American history, will come without cost. By the time the full reality of this thing hits, it's going to hurt everybody.

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Leftists Say We're Crazy Lunatics For Thinking The Country Is Headed In A Socialist, Freedom Reducing Direction (UPDATED)

But then they write health care "reform" legislation that will throw people in jail for not purchasing insurance. Something that wasn't "illegal" behavior has suddenly become something punishable with prison time.

Stone: Do you think it’s fair to send people to jail who don’t buy health insurance?

Pelosi: … The legislation is very fair in this respect.

Look, folks, there are different paths to collectivist, socialist, repressive, Orwellian states, just because the United States isn't on the exact same one as, say, the former Soviet Union, doesn't mean that what the current group of leftists (including our President) is doing isn't of a piece with what was done elsewhere to limit the freedom of individual Americans.

This is how it's done in Nanny States. 20 years ago, the social democracies of Western Europe (including the UK) didn't look like they do now. Now, per the Telegraph, new environmental regulation could result in carbon rationing cards for subjects of the crown (remember, they're not citizens).

An Environment Agency spokesman said only those with "extravagant lifestyles" would be affected by the carbon allowances.

He said: "A lot of people who cycle will get money back. It will probably only be bankers and those with extravagant lifestyles who would lose out."

However, some have criticised the move as "Orwellian" and say it will have a detrimental impact on business.

Ruth Lea, an economist from Arbuthnot Banking Group, told the Daily Mail: "This is all about control of the individual and you begin to wonder whether this is what the green agenda has always been about. It's Orwellian. This will be an enormous tax on business."

Under the Climate Change Act, Britain is obliged to cut its emissions by 80 per cent on 1990 levels by 2050. This means annual CO2 emissions per person will have to fall from about 9 tonnes to only 2 tonnes.

Do you have an "extravagant lifestyle" as defined by the Holy Church of the Environment & Mother Gaia?

Prepare to have your unrighteous behavior curbed.

My friends here in the UK don't even know to be upset about most of these things. Like a frog in a pot of water, with the temperature slowly increasing, they're lives are managed and regulated to the Nth degree and they don't even know it.

President Obama, Nancy Pelosi, and Harry Reid 2009 alone have shown their government control-loving, liberty-reducing in just the last 10 months. Card check to take away the secret ballot and sneak unionize wherever they can. Cap & trade to regulate 1/6th of the economy. Health "reform" to control another 1/5th or so. Takeover of domestic automakers. Takeover and regulation of the financial sector. Am I missing anything? I feel like I'm missing something.

The shocking thing about this is that I had no idea how wide reaching their grasp for power was until I started typing it all into this blog post.

My liberal-leftist friends are always convinced of the power of ever-greater reform and policy tweaking and technology and other knowledge advancement to bring efficiency to the inherently inefficient government bureaucracy.

But here's the thing, you cannot efficient-ize the government enough to make up for the concurrent loss of liberty.

UPDATE 14 November 6:17p BST: Ryan Decker's comment from the Facebook thread:

You could have ended the sentence thus: "you cannot efficient-ize the government." Even if the liberty/efficiency tradeoff did exist the point would be moot because government is not capable of increasing efficiency. Policymakers simply face the wrong incentives, lack the competence, and cannot process the information required to increase the efficiency of anything.

So there's no trade-off in which government policy could somehow increase efficiency at the cost of liberty. If they're taking your liberty, they're doing it inefficiently.

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There Is An Alternative To Obamacare

Several, actually.

Republicans have done more this summer than just take pot shots at the economy-reorganizing plans coming out of Democrat controlled committees.

From the Chicago Tribune (h/t Scott L.), hardly a bastion of conservative, Republican-friendly commentary:

Over the summer and fall, Republicans in the House and Senate have introduced six -- yes, six -- health care reform proposals. You didn't hear? Well, those plans didn't produce much of a ripple because Democrats dominate the Congress.

We don't agree with everything in these bills. But the GOP proposals contain smart ideas to increase choice and competition in the health insurance market -- a powerful Republican counterpoint to the Democrats' expensive plans. The ideas include:

--Let insurers sell policies across state lines. That would loosen the strangling state-by-state regulations and unleash competition to drive premium prices down.

--Give people who buy insurance in the private market the same tax breaks as those who get it through employers. Now, employers that offer coverage get a tax break on the premiums they pay for employees. And employees don't pay taxes on the value of the coverage they receive. People who want to buy insurance in the individual market should get the same tax breaks. That would help millions of people acquire coverage.

--Expand the ability of small businesses, trade associations and other groups to set up insurance pools to offer coverage at more attractive rates.

--Control health costs in part by reining in the medical malpractice system that raises insurance premiums and forces doctors to order tests to protect themselves from lawsuits. Limiting certain kinds of damage awards would reduce spending on health care by about $11 billion in 2009, or about one-half of 1 percent, the Congressional Budget Office estimates. Think about that in human terms: Reform would save millions of patients the expense and trauma of unnecessary tests and procedures.

These excellent ideas could expand coverage for the uninsured without cratering the federal budget or curbing the competition and innovation that drive the U.S. health care system. Republicans should keep pushing them -- and ruling Democrats need to give them a full and fair hearing.

Look, if leftist Democrats' real goal were to insure health care for the 5% of the US population that remains uninsured and to lower the costs for the remaining 95%, they would at least consider the Republican plans.

But it's patently not their goal.

Some of them, maybe, are open to conservative, non-socialist solutions.

A few more don't care about the relative efficiency of the system or the inherence loss of liberty in a government-run plan.

The ones who really bother me are those who want more power and more control over their fellow Americans. These are the ones to whom I frequently refer whose condescending attitude knows no bounds.

They think they know better. Yet, they willfully ignore the lessons of the failure of the command & control economies of the 20th century (USSR, &c.). For these leftists, the plan always failed because the right people weren't in control or because the plan just needed to be tweaked or given more money.

But that's the problem with these grand social plans: The right people don't exist and eventually you run out of other people's money.

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On Egalité

Ruling regimes have always been this way about the privileges of power.

Like the revolutionaries in France, Russia, and elsewhere, they appeal to the masses' utopian desire for égalité--equity & fairness--all the while excepting & exempting themselves from the plans and rules they outline for everyone else.

In the extreme, they give the hoi polloi communism or in the intermediate, socialized medicine, etc., to sate the class warfare they (revolutionary leaders in the former, John Edwards with his "two Americas" or Barbara Boxer with her "well-dressed" critique of town hall participants, in the latter) themselves started.

This impulse, this pursuit of égalité has caused more death and destruction than any other single ideological movement in world history.

Between Stalin's Russia, Mao's China, the Khmer Rouge and many, many more, literally hundreds of millions of people have either been killed outright or starved and died as a result of the programs & policies emanating from égalité.

Mind you, I'm not opposed to the idea that all men (& women) ought to be viewed equally before the law. This, I believe, is the idea expressed in the Declaration of Independence.

What I have a problem with is the leveling philosophy that views equality as an end unto itself. Most often, this philosophy is expressed by people who do not subject themselves (see the Sidwell Liberals from last week, "limousine liberals," and anyone else in history or contemporary times who opts out of the programs they establish for everyone else) to the practical ramifications of their social reordering.

In the USSR, China, Cuba, etc., they had/have their private doctors, dachas, and other special privileges, while the people around them lead equally sucky lives.

This then is the end result when égalité is your highest order principle: No one is lifted up, because of the disincentive to improve one's lot in life. Rather, in order to achieve equality or equity, others are pulled down, their wealth redistributed, and their liberty, along with that of everyone else, limited.

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Your Colon & You: An Harbinger Of Things To Come (UPDATED)

For all of you universal healthcare enthusiasts, a cautionary tale:

At issue are "virtual colonoscopies," or CT scans of the abdomen. Colon cancer is the second leading cause of U.S. cancer death but one of the most preventable. Found early, the cure rate is 93%, but only 8% at later stages. Virtual colonoscopies are likely to boost screenings because they are quicker, more comfortable and significantly cheaper than the standard "optical" procedure, which involves anesthesia and threading an endoscope through the lower intestine.

Virtual colonoscopies are endorsed by the American Cancer Society and covered by a growing number of private insurers including Cigna and UnitedHealthcare. The problem for Medicare is that if cancerous lesions are found using a scan, then patients must follow up with a traditional colonoscopy anyway. Costs would be lower if everyone simply took the invasive route, where doctors can remove polyps on the spot. As Medicare noted in its ruling, "If there is a relatively high referral rate [for traditional colonoscopy], the utility of an intermediate test such as CT colonography is limited." In other words, duplication would be too pricey.

This is precisely the sort of complexity that the Democrats would prefer to ignore as they try to restructure health care. Led by budget chief Peter Orszag, the White House believes that comparative effectiveness research, which examines clinical evidence to determine what "works best," will let them cut wasteful or ineffective treatments and thus contain health spending.

The problem is that what "works best" isn't the same for everyone. While not painless or risk free, virtual colonoscopy might be better for some patients -- especially among seniors who are infirm or because the presence of other diseases puts them at risk for complications. Ideally doctors would decide with their patients. But Medicare instead made the hard-and-fast choice that it was cheaper to cut it off for all beneficiaries. If some patients are worse off, well, too bad.

[...] Washington's utilitarian judgments about costs would reshape the practice of medicine.

The debate about health care isn't simply one about costs. This is not about providing "health care" to all Americans the cheapest way possible. One could hand out vitamins to all Americans very cheaply and call this "universal coverage." Congratulations.

This is also a debate about liberty--having control over the type & quality of health care one receives.

All of the efficiency gains the social scientists say we'd get from universal health care rely on rationing. Thus, if costs spin out of control, the central planners (all more intelligent and enlightened than you and me) decide which procedures, medicines, and people to cut out. They may not limit your coverage to vitamins, but you better hope you are on the ObamaCare-most-favored list.

[One group guaranteed to be on the official, funded-procedure list (though if they could speak, they'd probably opt out): The unborn.]

But even their decisions won't be pure and untainted by the touch of the lobbyist. Just like the bank and auto bailouts, those who are close to the Obama administration will be favored. In this decision making process, the most important factors will be, "how much can you donate to the campaign? How many people (unions) can you turn out to vote?"

This is what happens when government takes control of your life.

(thanks to Scott L. for the tip)

UPDATE 3:18pm BST: An alternative & the essential decision facing Americans:

Who will control the system? Doctors and patients, or politicians and regulators? That's the crux of this year's health-care debate.

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Universal Health Care Sucks

I've often said that the egalitarian impulse towards universal health care--broadly, socialized medicine--is pleasant sounding rhetoric that really means everyone's health care will suck equally.

Thomas Sowell, as he is wont to do, makes a better point about the difference between health care and medical care. At first brush, it seems like a splitting of hairs, but it is not.

To wit:

Insurance is not medical care. Indeed, health care is not the same as medical care. Countries with universal health care do not have more or better medical care.

We often hear the number--40 million--of uninsured people in the United States as though this were itself a problem begging for a solution. It almost never occurs to anyone that many of these people choose to go without health care--for whatever reason.

The bottom line is medical care. But the rhetoric and the talking points are about insurance. Many people who could afford health insurance do not choose to have it because they know that medical care will be available at the nearest emergency room, whether they have insurance or not.

This is especially true for young people, who do not anticipate long-term medical problems and who can always get a broken leg or an allergy attack taken care of at an emergency room — and spend their money on a more upscale lifestyle.

This may not be a wise decision but it is their decision, and there is no reason why other people should lose the right to make decisions for themselves because some people make questionable decisions.

Enough Sowell-quoting. Read the column for yourself. Universal Health Care isn't about bringing down the costs of health care. I don't care at all that the UK or Sweden or wherever spend less on health care than the United States. We spend more because (and I know this is going to shock some of you) we want to spend more on health care.

Sure, if you want the country to spend less on health care, give over control of it to government bureaucrats who will ration whatever limited medical options they make available--fewer MRIs, surgery only for the young, 1 drug option instead of unlimited, money for research for drugs which most successfully lobbied members of Congress.

And this is just a short list of things that occurred to me at 1:43am.

I'm not going to argue that US health care is the best it could be. I would argue that though flawed, it is the best in the world and further, that deregulation and simplification of insurance markets and de-coupling health care from employment, etc., etc., would make it even better. Socialization/universalization of health care would make it worse.


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Howard Dean, Un-Apologetic Socialist

From Kyle Wingfield in today's Political Diary:

BRUSSELS -- Conservative bloggers went bonkers back in 2006 when then-Democratic National Chairman Howard Dean traveled to Portugal to keynote a meeting of the Party of European Socialists. At last, they clucked, Democrats were showing their true colors, though in truth Dr. Dean never hid his sympathies.

Just calling a spade a spade.

He was back again last week to rub shoulders with his ideological soul mates, albeit without his former title as DNC chief or a job in the new Obama administration. Still, in an interview here amid the latest meeting of the Eurosocialists, he was especially enthusiastic when talking about the Obama health care plan.

A former physician, Dr. Dean is a fan of the cost-cutting merits of President Obama's "comparative effectiveness review," to be funded by $1.1 billion quietly inserted in the recent stimulus bill. Critics say CER would provide a formula, in a future government-run health care system, for denying treatment options to save money -- much as happens today in other countries, where rationing-by-waiting list or outright refusal to provide care are the norm. "That's never going to happen in the U.S.," responds Dr. Dean. American patients wouldn't put up with it. Instead, he says, under Obamacare, doctors will be free to prescribe any procedure or remedy they deem appropriate as long as they're willing to "go through some hoops." Dr. Dean seems to assume physicians will be willing to wade through red tape and risk the ire of government overseers by insisting on prescribing expensive treatments. Others might have their doubts.

Did I ever tell you, dear readers, about the morning I walked past my local Brent Council health clinic? The waiting room was full and there was a huge line out the door and down the sidewalk. At first I thought, "hmm, they must have legalized crack." But then I realized, "nope, they're just waiting for health care, the way the Russians used to wait for half a loaf of moldy black bread."

Ah yes, the glories of universal health care.

But wait, there's more.

On the flip side, even Dr. Dean worries about the fate of pharmaceutical research under a system of government-dictated prices. Americans already pay for most the world's drug research because only in the U.S. are drug companies allowed to charge a price that covers their huge sunk research costs. His solution: Sue the European and other countries that put price controls on medicines at the WTO. "The rest of the world must pay their fair share of R&D," he said.

Good luck getting anyone else in the world to fund something they've been getting for free for the last, what, 50 some odd years?

If you have a disease or malady for which your government masters don't deign to provide R&D funding, too bad.

If you're on the list of people deemed unworthy of life saving surgery or limited supplies of meds or a frickin MRI, too bad. Wait in line and hope you don't die before your number gets called.

Look, the status quo sucks, but it's better than socialized medicine and worse by far than the type of health care reform suggested by conservatives.


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Cramer, Obama, Liberals, &c.

Ever since I first noticed the phenomenon, I've looked for the right opportunity to put it into practice. What might it be, you ask? Why, quoting myself, of course.

It was prompted by an email I received from Matt P. Given that I hadn't heard from him in awhile, I jumped at the chance.

Matt wrote:

So low taxes are good in bad economic times so people can get rich, but when the economy is good we can soak the rich and damn the poor? I can't understand how he can't see the fault in his logic. Even when he's right, he's still wrong.

From his post yesterday:

"To be totally out of the closet, I actually embrace every part of Obama's agenda, right down to the increase on personal taxes and the mortgage deduction. I am a fierce environmentalist who has donated multiple acres to the state of New Jersey to keep forever wild. I believe in cap and trade. I favor playing hardball with drug companies that hold up the U.S. government with me-too products.

"... I believe his agenda is crushing nest eggs around the nation in loud ways, like the decline in the averages, and in soft but dangerous ways, like in the annuities that can't be paid and the insurance benefits that will be challenging to deliver on.

"So I will fight the fight against that agenda. I will stand up for what I believe and for what I have always believed: Every person has a right to be rich in this country and I want to help them get there. And when they get there, if times are good, we can have them give back or pay higher taxes. Until they get there, I don't want them shackled or scared or paralyzed. That's what I see now."

I'm all for "giving back," but shouldn't that be my choice?

To which I responded as follows:

Cramer is a liberal Democrat & an idiot [ed. note: but I repeated myself]. I guess, from him, we should be glad when he criticizes Obama at all, as he has done recently.

Obviously, I am in wholehearted agreement with what you say.

To liberals, your money is not really your money. It's the money you got by exploiting people, probably, and you don't deserve it. Plus, they know how to use it better than you do. It's all about power & control--that's the conservative vs. liberal argument at it's core:

Conservatives want everyone to have as much control over their lives as possible. They understand that some people are going to screw up, and that sucks, but that most people will do best whatever makes them happy.

Liberals want to control everyone's lives in every possible way because they think they know how to make everyone equally happy, or, as happens to be the case back in a little place I like to call reality, they know how to make everyone's life suck equally (except, of course, for the American version of the Politburo and their friends who get the green dacha's* in the countryside.)

This is the new reality: In a country where market forces aren't left to themselves to pick winners and losers; in a country where trillion dollar budgets and spenduli are used to shower billions of dollars on campaign supporters (read: ACORN, Unions, etc.); in a country where government picks the winners and the losers, you better hope that, at the very least, you aren't on Obama's naughty list.


*In Soviet Russia, supposedly everyone had access to homes in the countryside surrounding Moscow & other Russian cities. In reality, the only ones who stayed there, ate black market food, owned cars that ran, took hot showers, etc., etc. were the leading Communist party members & their friends.


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Li'l Obama OR Treacher Is Awesome

Link.


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