Post-ObamacareApocalypse: The Way Forward (UPDATED & Edited Wednesday)

Lot's of angry emails from people from whom I haven't heard in awhile. And with good reason. Never, in the history of this country, has legislation so transforming been passed with out a bi-partisan majority and against the will of the people.

Could the American people--through numerous opinion polls, the election of Scott Brown, the Tea Party movement, hundreds of thousands of emails, calls, and letters to member of Congress--have been any more clear about their opposition to, and in some instances, intense hate of, ObamaCare?

Though I plan on responding to everyone individually, I figured I'd give my opinion, in the form of what I'm reading/thinking/etc., to the question on everybody's minds: What next?

Before I even get to the practical stuff, let me remind us all (myself included) of what we are--we are Happy Warriors. Whatever else happens, it is always Morning in America. We must be positive, optimistic and upbeat as we respond to the haters on the extreme left. If there were no battles left to fight, life would be pretty boring.

First of all, here's the BookFace page of Dan Benishek, the guy who's challenging the pro-life Benedict Arnold, Bart Stupak. Join his group, donate to his campaign and do whatever else you can to help get him elected.

Also, you absolutely must get on that Twitter. Every last bit of news is broken first on Twitter. I'm not saying you have to follow me, but looking through the list of people I follow, would be a good place to start.

Yesterday, for instance, I was doing a running commentary while watching CSPAN on the interwebs. And so were lots and lots of other people.

Second, here's a few articles to educate you about our Nanny State future:

Tuesday 23 March

12:22pm BST: Jonah Goldberg on the ongoing culture war the left has wrought and will continue to bring as a result of the passage of Obamacare:

this legislation is a superconducting super collider of culture-war conflagrations. It will throw off new and unforeseen cultural spectacles for years to come (if it is not repealed). The grinding debate over the Stupak amendment was just a foretaste. The government has surged over the breakwater and is now going to flood the nooks and crannies of American life. Americans will now fight over what tax dollars should cover and not cover. Debates over "subsidizing" this "lifestyle" or that "personal choice" will erupt. And when conservatives complain, liberals will blame them for perpetuating the culture war.

Silver lining? Ross Douthat writes that now we get to see if all those crazy liberal predictions about Obamacare saving the planet, etc., will actually come true.

Amity Shlaes (one of the old man's fav columnists, BTW) writes that Democrats' math is more than just fuzzy, it's a straight up lie--or, as Douglas Holtz-Eakin put it, "fantasy in, fantasy out." (regarding those ridiculous CBO numbers)

Monday 22 March

Milton Friedman on "A Way Out of Soviet-Style Healthcare." I wish he were still around.

WSJ Op-Ed on the real question underlying the bill: 'who commands the country's medical resources--the people or the government?'

Megan McArdle on the Democrat Party's parliamentary hijinks, deception of the people, and contempt for the majority will.

Christopher DeMuth of AEI on the 'historical inevitability' of progressivism. What he doesn't point out is just how much theory today's progressives borrow from Karl Marx. Yes, that Karl Marx.

UPDATE 1:12pm BST: The NRO Symposium on What Now?

AND

'Paul Ryan is not ready to give up on the fight on health care.' Good thing.

UPDATE 2:16pm: There are a lot of things I really dislike and disagree with in this piece by David Frum, but he does make one very important point: Major legislative victory trumps legislative majority. I hope future Republican majorities take this to heart and pass conservative-transformative legislation.

In the future, we must have gamechangers. Getting the White House or a majority in Congress is worth very little if all we do is slow the increase of government and spending. Then Republicans are just Democrats-lite. Republican representatives must pass market-based reforms of all areas of government. They must do away entirely with departments like Education and above all, they must repeal Obamacare.

The guys at Power Line with their Silver Linings.

In yesterdays Washington Post, Randy Barnett, a constitutional lawyer at Georgetown, asked, "Is health care reform Constitutional?" Requiring people to purchase heath care? I don't think so.

UPDATE 2:37p: Watch Paul Ryan and Mike Pence (two potential contenders for the 2012 GOP Presidential nomination) speechify about health care and rights and freedom.

Romney's condemnation of Obamacare--"unconscionable abuse of power"

Also, there's this: Blame Bush.

UPDATE 3:22p: Greg Mankiw: "How long can the President wait before he comes clean with the American people and explains how high taxes need to rise to pay for his vision of government?"

UPDATE 4:36p: Today's WSJ Op-Ed on the passage of Obamacare:

We fought this bill so vigorously because we have studied government health care in other countries, and the results include much higher taxes, slower economic growth and worse medical care.

Some of my friends argued in favor of this bill because "finally their (fill in the blank) member of the family would be able to get care." Well, sure, if by "care" you mean that according to the bill, they can "technically" see a doctor. The reality will be much different. Just hope that your cancer ridden (fill in the blank) isn't getting on in age, because their care will be rationed.

The WSJ's Kimberley Strassel on all the threats, bribes, and kickbacks required to pass Obamacare. Are you okay with this sort of behavior?

(I'll update this post periodically throughout the day and week as I come across more stuff of note)

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

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.

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

The Power Of Markets In Healthcare: I Have Seen A Vision Of The Future And This Is It

This is my nomination for best article of the year.

Division of labor and specialization.

Geeta Anand of the WSJ pens an article about Devi Shetty, a heart surgeon who is single-handedly revolutionizing heart healthcare in India and, hopefully the world--Devi Shetty, the "Henry Ford of Heart Surgery."

The approach has transformed health care in India through a simple premise that works in other industries: economies of scale. By driving huge volumes, even of procedures as sophisticated, delicate and dangerous as heart surgery, Dr. Shetty has managed to drive down the cost of health care in his nation of one billion.

His model offers insights for countries worldwide that are struggling with soaring medical costs, including the U.S. as it debates major health-care overhaul.

"Japanese companies reinvented the process of making cars. That's what we're doing in health care," Dr. Shetty says. "What health care needs is process innovation, not product innovation."

At his flagship, 1,000-bed Narayana Hrudayalaya Hospital, surgeons operate at a capacity virtually unheard of in the U.S., where the average hospital has 160 beds, according to the American Hospital Association.

Narayana's 42 cardiac surgeons performed 3,174 cardiac bypass surgeries in 2008, more than double the 1,367 the Cleveland Clinic, a U.S. leader, did in the same year. His surgeons operated on 2,777 pediatric patients, more than double the 1,026 surgeries performed at Children's Hospital Boston.

[...]

But Jack Lewin, chief executive of the American College of Cardiology, who visited Dr. Shetty's hospital earlier this year as a guest lecturer, says Dr. Shetty has done just the opposite -- used high volumes to improve quality. For one thing, some studies show quality rises at hospitals that perform more surgeries for the simple reason that doctors are getting more experience. And at Narayana, says Dr. Lewin, the large number of patients allows individual doctors to focus on one or two specific types of cardiac surgeries.

In smaller U.S. and Indian hospitals, he says, there aren't enough patients for one surgeon to focus exclusively on one type of heart procedure.

Narayana surgeon Colin John, for example, has performed nearly 4,000 complex pediatric procedures known as Tetralogy of Fallot in his 30-year career. The procedure repairs four different heart abnormalities at once. Many surgeons in other countries would never reach that number of any type of cardiac surgery in their lifetimes.

Dr. Shetty's success rates appear to be as good as those of many hospitals abroad. Narayana Hrudayalaya reports a 1.4% mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9% in the U.S. in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons.

It isn't possible truly to compare the mortality rates, says Dr. Shetty, because he doesn't adjust his mortality rate to reflect patients' ages and other illnesses, in what is known as a risk-adjusted mortality rate. India's National Accreditation Board for Hospitals & Healthcare Providers asks hospitals to provide their mortality rates for surgery, without risk adjustment.

Dr. Lewin believes Dr. Shetty's success rates would look even better if he adjusted for risk, because his patients often lack access to even basic health care and suffer from more advanced cardiac disease when they finally come in for surgery.

In addition to keeping costs low so the people of his country can afford life-saving heart surgery, Dr. Shetty also turns a profit--about 7.7% after taxes and more than the 6.9% average in the United States.

This is the sort of thing I'm talking about when I refer to market reform of healthcare. Neither I, nor anyone else has to come up with all the answers, indeed, we couldn't possibly do so. That is for a market, full of enterprising, profit-seeking individuals to figure out.

The role of government is not to provide healthcare for everyone through some sort of trojan horse-like public option that morphs into British- or Canadian-style socialized medicine. It is to get the hell out of the way of a free market that would lower costs and improve quality.

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

Ghost Of Socialized Medicine (Read: Obamacare) Yet To Come

Via Mark Steyn and Newsrealblog:

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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.

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

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.

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

My Friend Branden B. On President Obama's New York Times Op-Ed

The main contributors to this blog are yours truly (lybberty) and my brother, matt. From time to time, I post submissions from guest contributors whose principles align with the principles of OL&L.

This is one of those times.

Longtime friend & friend of the blog, Branden B., weighs in with some insightful analysis of President Obama's health care op-ed which ran in Sunday's New York Times. I recommend it for your review.

I read Obama's editorial this morning on health care in the NY Times. A few things jumped out at me because they seemed incredible. I don't completely understand the issue nor do I pretend to; however, I did learn a thing or two in school along with everyone else who took Econ 110 and they could shoot holes through his argument as easily as I could.

First, it's obvious that the President is putting the majority of his effort into demonizing insurance companies. For those who have read Atlas Shrugged, it is phenomenal how similar his language is to the looters in Rand's book. I am not saying that insurance companies are perfect entities or that Rand's philosophy is even mostly correct. It just blew me away that he was lifting their language so exactly:

...in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits.

...we’ll be able to ensure that more tax dollars go directly to caring for seniors instead of enriching insurance companies.

...reform will provide every American with some basic consumer protections that will finally hold insurance companies accountable.

...A 2007 national survey actually shows that insurance companies discriminated against more than 12 million Americans

Secondly, take a few moments and read the following paragraph, think for a bit, and then tell me why this will not work.

We will put an end to these practices. Our reform will prohibit insurance companies from denying coverage because of your medical history. Nor will they be allowed to drop your coverage if you get sick. They will not be able to water down your coverage when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses.

Again, I understand that there are real people affected by the problems he outlined above. That said, what does he think is going to happen to the insurance premiums for everyone (including those that are sick) if companies are required to turn a blind eye to just about everything they use now in determine (insurance) premiums? He doesn't even acknowledge that your premiums are going to at least double and possibly triple or quadruple. At that point, the government will then step in and say that insurance companies can't raise premiums (as it was in Atlas). Insurance companies will then go bankrupt and the government will conveniently step in with their fixed plan, paid for with your tax dollars.

Finally, what does this last sentence mean?

If you have health insurance, we will make sure that no insurance company or government bureaucrat gets between you and the care you need.

The first "we" is Obama, a government bureaucrat. We could rewrite that to say:

If you have health insurance, we [government bureaucrats] will make sure that no insurance company or government bureaucrat gets between you and the care you need.

I don't normally do these sorts of rants but I could not believe that the President peddled these fallacies so blatantly in the morning newspaper.

[ed. note: Branden, this is what you get for reading the NYT Op-Ed page.]

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

The Latest In My Ongoing Critique Of Progressivism

Yesterday I wrote about how progressives' knee-jerk response to world problems--real or perceived--is yet another government plan that will re-order society, reduce individual liberty and centralize power & control with the enlightened ones.

It's not that I think progressives are bad people. God love 'em, they've got great intentions, it's the unintended consequences of their utopian reordering that I'm worried about.

Consider healthcare. Does the United States have problems? I've admitted countless times that it does and in numerous posts, suggested a few things we could do to reduce costs & improve quality. I always remind people that ~90% of Americans have insurance, another 5% choose not to because they are healthy or wealthy, 2.5% are illegal immigrants, & the remaining 2.5% are the 2.5% I think we can help by introducing market reforms--essentially eliminating state & federal distortions of the market.

I think these things would do much of what progressives want to accomplish, only without a hasty, ad hoc reordering of 1/6th of the American economy.

Progressives are prepared to throw out the baby with the bath water, because for them, health care is a moral issue. Cost/benefit doesn't play a role at all. Despite what they may say (and here I remind readers that I'm not lumping all Democrats together, just the far progressive left), the cost or the quality of the care is not the issue.

The only thing they care about is the fairness of it all. Ah, égalité.

So long as everyone has access to care--even if it's just a few vitamins & a glass of water--it doesn't matter that some people die in the queue for a heart transplant or that others don't get hip replacement surgery or needed meds to improve their quality of life--the only thing that matters is that it is equal for everyone.

Of course, it won't be equal for everyone. And this is what history teaches. The rich opt out because they can afford it. The well connected in government opt out because they're owed favors. Everyone else suffers. So it went in the former USSR. And China. Continues for the Castros & their revolutionary cronies in Cuba. Ditto North Korea. Even in the social democracies of Europe--the elites (including socialist & other miscellaneous left-leaning members of parliament) always opt out.

Even in the European countries where you think socialized medicine in all its incarnations is a such a screaming success, it's not. They are dealing with mounting costs which result in higher taxes, more rationing, & poorer overall care.

Additionally, the only reason they are as good as they are is because as in so many other things, they are able to free ride on American drug development and other medical technology improvements. Because of the high prices Americans elect to pay, pharmaceutical & other medical technology companies respond with new and better drugs and medical devices.

Everyone else, everywhere else in the world benefits as a result.

As I said at the outset, social justice (whatever that means) is the morality of this century's progressives. Those who question their crusade for justice & equality--deniers!--will be subject to ad hominem attacks for not submitting to the latest dogmatic demand. Obviously, the degree to which one embraces the social justice cause du jour is a sign of how good of a person she or he happens to be (thus, the unfunny Goode Family).

How socially unrighteous of us deniers. As penance for our skeptical reception of the latest progressive nostrum, I suggest buying a few carbon offsets & repeating aloud Obama's 2004 Democratic convention speech 10 times.

But, of course, progressivism as religion is another post for another day.

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

Democrats Don't Want Health Care Reform, They Want Socialized Medicine

And nothing else will do.

According to health care economists (h/t Matt L.), 90% of Americans are insured. Of the remaining 10%, better than 25% are young & healthy and feel no need to subsidize the health care costs of the old & sick and thus, go uninsured. Shall we force them?

About another 25% of the remaining 10% are of sufficient means that they feel they are able to burden the risk of going uninsured and pay for their own care. Shall we take away their liberty?

Roughly 25% more are illegal aliens. Um, yeah.

The remaining 25% of the 10% of Americans who are uninsured are financially or medically (pre-existing conditions, etc.) or some combination thereof, unable to get insurance.

Democrats want to scrap the whole system--the best system in the world--to cover about 2.5% of the population.

There are better, cheaper ways to enable these people to get access to health care. And contrary to Obama, Reid, Pelosi & co., Republicans have made a number of proposals which would make health care cheaper & better for everyone.

To wit, Jim DeMint on ABC's "This Week" with George Stephanopolous:

Republicans, including me, have introduced lots of health care reform proposals. I introduced a tax equity, which would allow people to deduct the cost of their health insurance. The president and Senator Conrad voted against it. I had a proposal that would allow people to buy health insurance in any state, not just a single state monopoly. The president and the Democrats voted it down. I had a proposal that would allow individuals to use their health savings account to pay for a premium. They voted it down. They even voted against allowing small businesses to come together and buy their health insurance . . . . So, George, what we've seen is that Republicans do want reform that will make health insurance more affordable and available. But the only proposals we're getting from Democrats is more government control of health care.

[emphasis added]

The point, for Democrats, is not about finding a way to make health care cheaper & better for Americans, it is about putting everyone into a scheme over which they, in their infinite wisdom, have complete control.

(see also Cap & Trade)

via Political Diary

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

American Healthcare Has It's Problems, But It's Still The Best In The World

Seriously. There are some things that could done to resolve these problems (see here & here), but American healthcare is still the best in the world, warts and all. Free market reform of American healthcare would only widen the gap between us and everyone else.

From doubleplusundead via Russ from Winterset at Ace of Spades (standard language warnings about AofS apply), a cautionary & enlightening tale.

It seems that a Canadian couple gave birth to a premature baby this weekend in Hamilton, Ontario. Since Canada is just another Third World Hellhole where brain surgery is done with a 16" Poulan and a 6-pack of Moosehead, its not exactly a shock that NOT. ONE. SINGLE. Neonatal Intensive Care Unit (NICU for short) bed could be found for the child. I know what you're thinking: Russ, they couldn't find one single NICU bed available in the City of Hamilton for this baby? NO. They couldn't find one single NICU bed available for this baby in the entire PROVINCE of Ontario. You know, a PROVINCE? Sort of like a STATE, only 196% more [dumb]?

Luckily, Canada just happens to be the mildly retarded cousin of the United States of America; and like most families, we look after each other - even if the slow relatives are complete window-lickers who eat their own boogers in public. The baby was brought to Buffalo, NY, where she is enjoying the fruits of America's evil profit-driven health care system. If this was the end of the story, I'd be willing to smile and wish the happy hosers well with the addition to their family; however, as Paul Harvey used to say, there is ..... the rest of the story.

This kind of stuff--Canadians coming to American for medical care, surgery, &c.--happens all the time.

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

Taxing Your Good Health

That is what will happen if Democrats get their way with single-payer health care--socialized medicine--in this country. And the President admitted as much in his infomercial last night:

As a candidate, then-Sen. Obama bashed his rival for the Democratic nomination, Hillary Clinton, for proposing that Americans be mandated to have health insurance.

"She'd have the government force you to buy health insurance," he said Feb. 23, 2008. "I disagree with that approach. I believe that the reason Americans don't have health care isn't because no one's forced them to buy it, it's because no one's made it affordable."

But now the president is acknowledging that his thinking on the issue has "evolved" and he could support a law mandating that individuals purchase health care coverage, with fines for those who do not.

Obama stressed that there must be some kind of waiver for those who are simply unable to afford it.

"People have made some pretty compelling arguments to me that if we want to have a system that drives down costs for everybody, then we've got to have healthier people not opt out of the system," the president told ABC News.

As he notes, in order for this system to work--to actually drive down costs--you have to include healthy people as well as the sick--everyone is forced into the plan. Many of these healthy people do not have health insurance or carry insurance with really high deductibles because they are healthy and do not need it.

In a single-payer system, the healthy would be forced into the same health plan as the sick--effectively taxing their good health and eliminating all other choices open to them. This is utilitarian leveling at its, well, level-best. In order to reach a more equal outcome for everyone, Obama and co. will tax your health and infringe on your liberty.

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

Milton Friedman Fridays - On 3rd Party Payment In Healthcare

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What Market Reform To Health Care Could Look Like Vs. Obama's DMVification Of Healthcare

Two of my three favorite columnists at the WSJ Op-Ed page--Holman Jenkins & Daniel Henninger with Bret Stephens writing about Iran--wrote about healthcare this week and their columns were fantastic.

In his column, Jenkins "reflects," in 2070, about the effects of market reform on healthcare in the United States. This is what we could get, if only Eric Paul, Ryan Cantor, and Kemp Newtley were in charge rather than the Democrats.

And, lo, it proved true, as 100 million intelligent, well-educated employees of Corporate America were allowed to see for the first time what "tax free" health insurance was really costing them. They saw how it distorted their behavior and caused them to allocate far more of their incomes to the medical-industrial complex than they would have chosen for themselves.

Eyes newly opened, they demanded cheaper insurance options, covering fewer services (cancer wigs, family counseling, in-vitro fertilization), and opted for plans with higher deductibles and co-pays in return for much lower monthly rates.

Because consumers were now spending their "own" money on health care, doctors and hospitals found it necessary to publish and even advertise their prices. A hospital that specialized in heart surgery, performing thousands of procedures a year, found it had both the highest quality and lowest cost -- and now marketed itself as such. Ditto specialists in cancer, diabetes and other conditions.

For the first time, Americans spent less and got more. Spending fell overnight by 13%, which happened to be exactly what economists had predicted if the price tags were restored to health care and consumers were allowed to see clearly what they were getting (or not getting) for their money. As predicted, too, spending thereafter rose only in line with incomes.

What's more, many fewer people remained voluntarily uninsured now that health insurance was no longer a gold-plated extravagance affordable only by those in the top brackets who could slough off 40% of the cost on other taxpayers. Existing programs for the needy, in turn, could be downsized and revamped into voucher programs. The federal budget benefited twice over -- from fewer claimants and from medical care that was less costly. Fiscal wreck was avoided.

Bookending this imagined optimism, Henninger reminds us that government always over-promises and under-delivers. He uses the "fearmongering scare tactics" of reviewing the history of Medicaid. The faint of heart would do well to ignore historic reality and read the fawning reviews of the President's healthcare plan written by his fellow travelers in the MSM. Henninger just might persuade them that Obama isn't right all the time.

Whatever Medicaid's merits, this federal health-care program more than any other factor has put California and New York on the brink of fiscal catastrophe. I'd even call it scary.

Spending on health and welfare, largely under Medicaid, makes up one-third of California's budget of some $100 billion. In New York Gov. David Paterson's budget message, he notes that "New York spends more per capital ($2,283) on Medicaid than any other state in the country."

After 45 years, the health-care reform called Medicaid has crushed state budgets. A study by the National Governors Association said a decade ago that because of "new requirements" imposed by federal law -- meaning Congress -- "Medicaid has evolved into a program whose size, cost and significance are far beyond the original vision of its creators."

In his speeches, Mr. Obama makes the original vision of his "public option" insurance plan sound about as simple as driving through toll booths with an electronic pass on your windshield. It's going to be all about "best practices" with patients "reimbursed in a thoughtful way," as if the federal government is about to become just another big Google.

Medicaid is a morass. Since the program's inception, Congress has loaded it up every few years with more notions of what to cover, shifting about 43% of the ever-upward cost onto someone else's tab, mainly the states. A 1988 congressional mandate requires local schools to pay for schooling and related services for disabled children, but because Congress underfunds its mandates, the states pay the rest through Medicaid.

The list of add-ons is endless, and there's little about it that is thoughtful. Why shouldn't one think that, as with Medicare and Medicaid, the Obama Public Option in time will become an impossible fog for patients to navigate? But unto eternity the program's administrative complexity will provide work for bureaucrats, Members of Congress, their staffs, lobbyist spouses and the "health-care" establishment of foundations and economists.

The President's "public option" will cost more in taxes, provide poorer overall medical care and will infringe on individual liberty. These are the facts.

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

Mark Steyn Holds Forth On Socialized Universal Healthcare & The Spread Of Apathy

This is why someone hopefully pays Mark Steyn the Big Bucks.

Look, by historical standards, we’re loaded: We have TVs and iPods and machines to wash our clothes and our dishes. We’re the first society in which a symptom of poverty is obesity: Every man his own William Howard Taft. Of course we’re “vulnerable”: By definition, we always are. But to demand a government organized on the principle of preemptively “taking care” of potential “vulnerabilities” is to make all of us, in the long run, far more vulnerable. A society of children cannot survive, no matter how all-embracing the government nanny.

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.

Government In Your Refrigerator: Health Care & Liberty

Safeway CEO Steven Burd has got a great piece in today's WSJ describing his company's market-based reform of their healthcare plan. Effectively, they have incentivized good behavior--not smoking and reducing your weight, for instance--while penalizing the flip side of that coin.

Their costs have remained flat since instituting this plan and now Burd wants to be able to increase the cost penalty of bad behavior/incentive for good behavior to more accurately reflect the real costs.

All of this is fine and innovative for a private company; I do not like the liberty-infringing possibilities of this type of reform coupled with universal health care.

As with anything else, it is one thing for a private entity, which gives employees the choice to work there or somewhere else, to adopt these types of reforms. I don't even really have a problem with Medicare/Medicaid adopting these types of market incentives/penalties.

But this type of response from the Federal Government in a universal healthcare environment is just one example of the loss of individual liberty. Of course the government is going to take an interest in what you eat and smoke when they are the ones footing the bill for your healthcare.

When I pick up the London tabloids to see what's what (not often, obviously) I often read about how some arm of NHS (their universal healthcare agency) is going door to door to take a look-see in people's refrigerators.

At this stage, it's just "taking a look." But the next, logical step is to prohibit consumption of whatever the government deems unhealthful or whatever. It doesn't take a predictive genius to see where this is going: complete government prohibition on whatever is considered "bad" and forced adoption of whatever the latest science considers "good."

And they said you couldn't legislate morality.

If you have tips, questions, comments or suggestions, email me at lybberty@gmail.com.