Monday, October 26, 2009

The Health Care Debate is Part of a Moral Struggle

Arthur Brooks, president of the American Enterprise Institute, writing in today's WSJ, suggests that the health-care debate is part of a larger moral struggle over the free-enterprise system, here's an excerpt:

We will continue to hear both sides of the health-care debate argue about particulars of insurance markets, the deficit impacts of reform, and the minutiae of budgetary assumptions. These arguments, while important, do not address the deeper issues involved.

The health-care debate is part of a moral struggle currently being played out over the free enterprise system. It will be replayed in every major policy debate in the coming months, from financial regulatory reform to a cap-and-trade system for limiting carbon emissions. The choices will ultimately always come down to competing visions of America's future. Will we strengthen freedom, individual opportunity and enterprise? Or will we expand the role of the state and its power?


28 Comments:

At 10/26/2009 1:05 PM, Anonymous morganovich said...

the current federal government is already so far past any rational reading of the 10th amendment as to be ludicrous.

the whole point of having such rights enumerated in our constitution was to prevent just the sort of massive usurpation of power that has been accelerating since the 30's.

recall that under coolidge, the US federal budget was 2% of GDP.

2 presidents later (hoover, fdr) is was 30% (even without WW 2) and has never gone back down.

for those who have forgotten the text:

"The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

it's difficult to see how current federal healthcare legislation is constitutional, though i could say the same of a great many other federal programs that have been imposed, so it's illegality may be less of an issue than one might hope...

 
At 10/26/2009 1:29 PM, Blogger Steve said...

Is every aspect of modern society necessarily a 'market' that is best served by profit-seeking enterprises?

Prohibitions against selling votes prevents the setting of market-clearing prices and allows for mis-allocation of those resources.

Outlawing slavery was an abrogation of private-property rights and government interference in the existing free-markets. (well, 'free' for some people).

Forcing emergency rooms to treat uninsured patients is a slap in the face of the idea that private entities can do business, or not, with those they wish.

Allowing citizens to voluntarily participate in a government-organized health care co-op is obviously contrary to free-markets, and is thus anti-freedom.

 
At 10/26/2009 1:42 PM, Blogger ExtremeHobo said...

"Prohibitions against selling votes prevents the setting of market-clearing prices and allows for mis-allocation of those resources."

Aren't politicians "selling votes" with healthcare? Vote for healthcare and you will get your medical bills paid for by others!

Voting is creating a scary market of its own where both sides are not willing partners. The masses can 'vote' that a small minority HAS to give them something. This is why we founded our country with a constitution. Sadly, as morganovich pointed out, no one cares anymore.

 
At 10/26/2009 2:15 PM, Anonymous morganovich said...

steeve-

"allowing"? the current plans are "compelling", not allowing. employers MUST provide insurance or be fined. the same is true of private citizens. you need to have health coverage, or you'll be fined. the freedom not to have it is gone.

further, the kinds of coverage that an insurer can sell you are going to be heavily limited. again, limiting the kinds of contracts willing adults may enter into is compulsion. telling me i can't buy a health plan with high deductibles or without aromatherapy or whatever limits my freedom and that of businesses.

this is very, very different from allowing.

compelling hospitals to treat those who cannot pay (and not to be compensated) is a total abrogation of the rights of private citizens and businesses. it's completely constitutionally indefensible.

if you argue that healthcare is a right or an entitlement, then what else is? food and shelter seem more fundamental requirements than healthcare. shall all restaurants be required to provide meals to people who can't pay? how about if all apartment building must give space to the homeless whenever they ask?

will you feed and house such people at your place? you probably have extra food. if not, why should i have to do so at my business.

where does such an idea end?

the issue is not "might abrogating freedom this one time lead to a result i like" but rather, "what will happen if we abrogate this freedom altogether".

it becomes a very slippery slope.

the whole point of rights is that they can't be taken away. it's what keeps a democracy from devolving into a tyranny of the majority.

 
At 10/26/2009 3:02 PM, Anonymous Anonymous said...

To phrase the question posed a bit differently do we want to be a liberal society(19th century definition not todays) or a social democracy. Recall that WW1 and WW2 lead Europe and Japan to move to Social Democracy as a result of the trauma to society caused by the two wars.
In the US the fundamental argument boils down to was Andrew Jackson right in saying that what the people want the people get?

 
At 10/26/2009 3:46 PM, Blogger juandos said...

"Forcing emergency rooms to treat uninsured patients is a slap in the face of the idea that private entities can do business, or not, with those they wish"...

Hmmm, absolutely...

Funny how the people who think hospitals and paying patients should also be forced to carry the costs of the other societal parasites that wash up into the ER...

How come these same people don't volunteer their OWN money to care for these parasites?

So Steve just how many 'impoverished people' have you bought medical services for with your OWN money?

The moral struggle I see here is how to keep the federal government from stealing more personal wealth of one group of citizens in order to pander to another group of citizens...

 
At 10/26/2009 4:12 PM, Anonymous WestWright said...

Bravo Morganovich and Juanos for your sterling arguments in rebuttal to the oderous thief, steve!
This Universal HC if passed must be challenged as unconstitutional and must be taken to the Supreme Court!

 
At 10/26/2009 4:19 PM, Anonymous Benny The Real Free Marketeer said...

I love free markets.
But., free markets do not always work. Smog comes to mind. No way for free market to solve that one.
National defense is another.
Health care seems to fall into a netherworld, with o good solutions. As a human being, and one who wishes that his society prospers and perpetuates itself, I see a need for health care, regardless of a person's ability to pay.
When push comes to shove, I don't want to tell someone, "Sorry, we could operate and save your life, but you have no money. So, go die now."
So, we good people end up paying for others who have emergencies or bad luck, or even if they don't take care of themslves, as we regard life as sacred. Even a lazy drunk--you want to be the one who pulls the plug on a 31-year-old drunk?
There is also the strange problem that I can't buy health insurance out-of-state.
So, we need a public option.
I agree with the sentiments of many here that government is too big, and I think we should eliminate whole departments, such as HUD, the Ag. Department, DOL, and cut the Pentagon in half. For starters.

 
At 10/26/2009 4:27 PM, Anonymous Benny The Real Free Marketeer said...

And I gotta add this: How come Arthur Brooks never waas-waas about the huge moral issues at stake when every year we send about $60 billion in subsidies (cash, baby) to U.S. farmers, and another $8 billion in cross-subsidies to rural telephone users?
The Republican party loves rural subsidies, and cross-subsidies of rural infrastructure, but that is never a topic, despite adding up to $200 billion a year.
How comes Brooks and AEI never produce a compehensive compiliation of rural subsidies in America, and then call for elimination of such subsidies?
Could it be that the AEI is just a catamount for the R-Party?
Don't get me wrong. The D-Party loves urban subsidies--but they are less skilled than the R-party at playing the pork and subsidy game.

 
At 10/26/2009 5:00 PM, Blogger steve said...

Republicans aren't more skilled. It's just that Democrats never have to be bought. I.E. Lets make the the Government bigger and more powerful. Name your price. Democrate: 0, Republican: something to get my constituents off my back.

 
At 10/26/2009 5:02 PM, Blogger juandos said...

"Even a lazy drunk--you want to be the one who pulls the plug on a 31-year-old drunk?"...

If keeping this clown afloat means money out of my pocket well just show me the socket where the plug is at...

Sally Pipes at Investors Business Daily has the following: The Middle-Class Health Tax Heist Of 2009

'But by the time one gets to the end of the bill, estimated to cost $829 billion over 10 years, clarity emerges — the Democrats plan to finance their expanded government care on the backs of America's middle-class taxpayers.

Baucus and company have decided to tax what the press calls "Cadillac" health plans. Prior to hitting the fine print, this indicates that only excessive, gold-plated plans found in the executive suites would be hit
'...

 
At 10/26/2009 5:36 PM, Anonymous morganovich said...

benny-

i would argue precisely the opposite: what we don't need is a public option, especially one that will have the playing field so slanted towards it.

the problem with healthcare is not that too few people are insured, it's that too many are. all you can eat healthcare is insane. the whole third party payer system is insane. it results in either massive inflation and subsidization (our model) or in severe rationing (europe, canada).

the issue is that it breaks the fundamental market for healthcare. if you pay your insurance and hit your deductible, you no longer care what you spend. people don't even ask what healthcare costs. do you ask you doctor what blood test costs? why would you? it doesn't matter to you. worse, as you don't care what you pay, the doctor is likely to over test and treat you because he's either interested in getting paid more or because he wants to avoid being sued.

is their any other service that we consume where we never ask the price? can you imagine shopping for a car or cell phone service this way?

this is why the costs of medical care in the US are going up at over 2.5X CPI. there is an astoundingly strong correlation between the drop in healthcare deductibles and healthcare inflation. amazingly, cash pay procedures like lasic and cosmetic surgery have had NEGATIVE inflation over the same period. why? because people shop around and providers compete on price, use technology, and become more efficient.

this is driven by market forces of supply and demand. break that relationship (as we have) and everything runs out of balance. no one goes to the ritz carleton buffet and has muffins instead of lobster to save the ritz money.

the solution is obvious: HSA's. let people spend their own money. let it build up if they don't. save into the acount when you are young to spend when you're old. then YOU make all the choices about what you spend it on. YOU decide which doctor to see and what procedures are worth it.

if people are too poor or lack employers to fill up their accounts, then the government can, if deemed necessary, give them grants as a substitute for medicaid. this has the massive advantage of actually letting us see what the system costs as opposed to these massive off balance sheet unfunded liabilities we are building up.

using your own money first will allow health insurance to really act like insurance. drop $2500 a year into the account and in a few years, it's no problem to carry a policy with a $5000 deductible to cover catastrophes. the rates for such will be very low.

this HSA system wins on every level compared to the existing system. it will drive healthcare costs down (unlike the current system which is causing an upspiral), give more consumer choice, cost less overall, and be incredibly simple to administer.

this is the only system that will allow us to maintain our best in the world medical system and our unparalleled access to care.

if we cap pricing, we'll get rationing. if we give all you can eat to more people, costs will run even wilder.

the problem with healthcare is not that it needs to be more socialized, it's that it needs to exposed to market forces.

 
At 10/26/2009 6:04 PM, Anonymous Benny The Real Free Marketeer said...

morganovich-
I like your approach.
But, the private sector could do it w/o an HSA. (I do not believe in nanny-state tax subsidies).
Any insurer (in a free market) could just ask for a $5k deposit, and that's your balance against deductibles.
Probably, we need to outlaw state restrictions on interstate health care insurance, and legalize binding arbitration for all disputes. No more medical lawsuits.

The public option should be a bare bones offering, that participants use only if they give up legal right to sue, and in which they understand some services and procedures, past a certain age, will be denied as too expensive. Euthanasia in other words.

I still wonder if any system can work. The baby boom is aging--no way they can save or pay enough for medical care. The rest of society either pays for it, or we go to euthanasia, or let them die without euthanasia.

Juandos says he will pull the plug. Maybe he would. But what of social fabric in such cases? And will the public embrace capitalism if it results in mass euthanasia?

And who, do you suppose, pays for Dr. Perry's health insurance?

 
At 10/26/2009 6:23 PM, Anonymous morganovich said...

benny-

sure, we don't NEED HSA's, but i think they are a good idea, just like an IRA. it gives you a way to more easily save money when you are young, to use when you are old. also, unlike a $5000 deposit, HSA's build up over time. this is a key aspect, as it lets you go to a higher and higher deductible as you age and keep your insurance costs down.

i agree that too many things get "tax advantaged" especially mortgage interest. (why on earth would we encourage using the single most leveraged purchase most people make as their primary savings vehicle?)

but things like IRA's and HSA's make sense as tax advantaged programs if they are used to replace government programs like medicare and social security.

those programs are already doomed. barring hyperinflation, it is mathematically impossible to meet the commitment. between healthcare and retirement, the federal government has $75 trillion in unfunded liabilities.

that's $250k per american, or $1 million per family of 4. debt service alone will work out to $50k/year/family if we actually pay it.

we need a system in place where the costs are up front - money goes into accounts, and we know how much it is. our government has demonstrated, time and time again, that it cannot be trusted to manage current inflows for future liabilities. if you use GAAP accounting and include these liabilities, the US has not has a balanced budget since Eisenhower.

only by taking the control out of their hands do we have any hope of fiscal sustainability.

these monkeys have had the keys to the banana plantation for far too long.

 
At 10/26/2009 6:41 PM, Anonymous Dr. T said...

I don't see this as a moral issue. This is an economic ideology issue. Do we strive for a capitalist and free market economy, or do we move to a socialist and paternalistic economy? Unfortunately, for the past eighty years, we continually pick socialism and paternalism over capitalism and free markets. Obama is just accelerating the process.

Health care can function in a capitalist/free market economy. There is nothing special about it that requires government ownership or control. We need food, clothing, and shelter more than health care, but few people claim that grocery stores, textile plants, and building contractors must be government owned or run. But, logic matters little in the situation we now face. Congress will pass and the President will sign the disastrous health care "reform" bill based on the benefits to them, not to us.

 
At 10/26/2009 6:56 PM, Blogger sbw said...

It's not a question of whether Obamacare is moral, but if its premises are benign.

 
At 10/26/2009 10:41 PM, Blogger QT said...

Dr. T,

Agree with you. A debate between 2 different socio-economic views of America is not a moral issue.

 
At 10/26/2009 10:49 PM, Anonymous Anonymous said...

On the 10th amendment issue: The meaning of the 10th amendment was changed by the Civil War. Since the Constitution does not say anything about secession, then the 10th amendment could be read to say that it is a reserved power. (The south held this perhaps not using the 10th amendment but ...) They lost the war, so that reading was changed.
Recall that the Civil War changed the United States from plural to singular, i.e. these US to the US.
So it also changed how the amendments are read by the courts.

 
At 10/27/2009 12:10 AM, Blogger W.E. Heasley, CLU, LUTCF said...

Doesn’t the situation boil down to: The Political Class agues that a moral obligation is required of the Producer Class to transfer income/wealth to the Recipient Class.

Unfortunately, the Political Class “moral obligation” equates to Tax. The current Tax Level applied to the Producer Class is out of equilibrium and has become a disincentive. Meanwhile, the Recipient Class has become an Entitlement Based Class.

 
At 10/27/2009 6:11 AM, Blogger QT said...

W.E.,

Whenever words like "moral obligation" are invoked, my spider sense tingles.

Isn't this a way of influencing behavior? Most people think of themselves as caring, good-hearted individuals and act in accordance with this view of ourselves. Presented with a choice between being a "nice" person or an uncaring one, which will we choose?

Often when someone wants you to do something, they will reframe the proposition presenting the action in terms of your interests rather than theirs or relying on your desire "to do the right thing".

Incentives are not the only thing that influences behavior.

 
At 10/27/2009 8:53 AM, Blogger ExtremeHobo said...

QT,
This is a moral issue to objectivists. It is the same way that I dont find alcohol use to be a moral issue but a lot of baptists and almost all Muslims do.

 
At 10/27/2009 9:02 AM, Blogger juandos said...

"But what of social fabric in such cases?"...

More leftist nonsense...

'Moral fabric'?!?!

Just code words to induce panicked reactions into people who haven't been paying attention...

If people think it through the idea that the federal government could handle the nation's health care is just ludicrous...

"Incentives are not the only thing that influences behavior"...

Hmmm, incentives is a polite way of saying 'more extortions' from the federal government for those who don't want to play...

Anyone want to take a guess at what the following really means?

Liberals offer guarded praise for Reid's opt-out compromise

 
At 10/27/2009 9:48 AM, Blogger QT said...

Extremehobo,

Don't tend to think of religious prohibitions against certain foods like pork or alcohol as moral issues...but then, I'm an aetheist. Tend to think of these as cultural norms.

Morality concerns right and wrong; good & evil. I believe when you try to take a complex problem and simplify the issues into moral lessons, the effect is very short-sighted, self-serving public policy.

If anything, there needs to be far more consultation with the medical profession rather than the usual Washington closed door process. Any organizations that have commented are expected to give rubber stamp approval without even knowing the contents of the bill or face the wrath of the White House. The legislation is not even being made available online so that the public or professionals can read it.

If this process results in high quality care of more people at less cost, then I will convert to whatever religion you wish to name and forego my evening martine. PTL

 
At 10/27/2009 9:52 AM, Blogger QT said...

Juandos,

The Reid's opt-out clause reminds me of the Anglican Church's introduction of The Book of Alternative Services. Please note that this book was used to mandatorily replace the Book of Common Prayer.

Nancy Pelosi proposes name change for the public option. My, there is a powerful smell of mendacity coming from the direction of Washington these days.

 
At 10/27/2009 10:36 AM, Blogger W.E. Heasley, CLU, LUTCF said...

QT:

Agree. Political Class uses “moral obligation” to mask an issue and/or influence an issue.

You likely can go one step further and state that “moral obligation” is one of the items used to keep the Political Class in power.

“Moral obligation” is also an item that indicates “elitists”. That is, how can the Political Class believe they have the authority to dictate what is a “moral obligation”.? They could only believe they have the authority if they are somehow/someway “above-it-all“. Endowed with the perceived power that allows them to dictate moral obligations.

 
At 10/27/2009 11:23 AM, Blogger ExtremeHobo said...

The morality that objectivists argue is that free-trade is always the morally right position because anything else is an unwilling transaction and thus theft.

Thus for subscribers of this, (aka Ayn Rand types) all of these issues are battles of morality at their core.

You seem to be stating that your view of ethics is Utilitarian (the most good for the most people) which is not the only view of morality. There is also the camp of Deontology in which morality is judged by what actions you take and not by their consequences (e.g. killing a man is always wrong no matter the benefits).

 
At 10/27/2009 1:42 PM, Blogger juandos said...

"My, there is a powerful smell of mendacity coming from the direction of Washington these days"...

Heh! Very well put QT!

From the Heritage Foundation's blog site: The Senate’s Public Plan “Opt Out” – More Optics than Option for the States

 
At 10/27/2009 5:09 PM, Blogger QT said...

ExtremeHobo,

Don't even consider myself a utilitarian. I do not presume to know what is right for others. Morality seems to be somewhat subjective unless the matter is fairly extreme (ie. murder).

On an issue such as health care, I see it as a highly complex problem which benefits from as many ideas as possible on the table regardless of the political stripe particularly experts working in the field. It is incredibly difficult to anticipate the consequences of public policy.

W.E.,

Agree that it is very elitist to dictate morality. Such powers bespeak the divine hardly the turf of politicians.

 

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