Healthcare RSS feed for this section
justin-katz-avatar-smiling

Acceptance of Life’s Disappointments, U.S. and U.K. Attitudes

Here’s some interesting philosophizing on a rainy summer day.  Building on the observation that folks in England are too content to accept drying machines that don’t dry, Corinne Purtill draws broad conclusions about the difference between Brits and their American peers.

Purtill herself is an American just returning to her native country after five years across the Pond, and although she flirts with complimenting her fellow Americans, she can’t quite bring herself to side with us.  Indeed, in backing away from that conclusion, she may capture modern progressives’ true sense of trade offs:

This American bias toward change—newer, better, different—has fueled countless innovations. It has also fueled a culture of thoughtless consumerism.

Like progressives, one gets the sense that Purtill’s final analysis is that “thoughtless consumerism” outweighs “countless innovations” on the scale of human values:

Under the proper circumstances, [the British have] is a mature and useful perspective. Suffering—large and small—is an unavoidable feature of human existence. In the face of illness, loss, or heartbreak, the American insistence on looking on the bright side and fixing the problem can feel heartlessly clueless. Some things cannot be fixed.

Here’s what Purtill misses: Seeing a “bright side” shows that there is acceptance of suffering.  We accept what is and seek to improve what can be changed.  Why compound the loss of a loved one with the frustrations of a dryer that doesn’t work?

For that matter, why not work to reduce the amount of human suffering?  Let’s turn our lens in the other direction and witness Charlie Gard, whose parents the British government told they could not try to save his life, even though they had the money and a doctor willing to attempt new methods for helping him.  Where did the parents want to take the child for help? The United States.

Maybe it’s because I’m so thoroughly American that I can’t achieve an adequately “mature and useful” perspective, but I can’t quite see how innovating to fix problems while maintaining a fundamentally positive outlook on life is the “heartlessly clueless” attitude, here.

justin-katz-avatar-smiling

“Converting” Our Form of Government

If we want to live under a government with the power to forbid children and their parents from seeing what therapeutic options might be available for unwanted feelings, I guess that’s a conversation that we can have, although I find myself on the side of the ACLU in worrying about giving legislators “wide latitude to ban unpopular medical treatments.”  But if we’re going to have this conversation, we should do so with accurate information about what the bans cover, and Linda Borg’s Providence Journal article on Rhode Island’s new ban of “conversion therapy” fails on that count:

The bill makes it illegal in Rhode Island for licensed health care professionals to advertise or engage in conversion therapy for anyone under 18. It does not affect religious counselors or leaders — or adults who choose such a program.

That “does not affect” sentence is just not correct.  Read this section of the law:

23-94-4. Prohibition on state funding for conversion therapy. No state funds, nor any funds belonging to a municipality, agency, or political subdivision of this state, shall be expended for the purpose of conducting conversion therapy, referring a person for conversion therapy, health benefits coverage for conversation therapy, or a grant or contract with any entity that conducts conversion therapy or refers individuals for conversion therapy.

This is separate from the section that bans “licensed professionals” from offering such therapy to minors, and it goes much farther.  It covers “any entity that conducts… or refers individuals for conversion therapy.”  So, while a licensed professional would only lose his or her Rhode Island license if he or she provides the therapy to minors, that professional would lose access to any state or local funds that somebody might complain subsides the therapy for for adults, as well as any “grant or contract” whatsoever, whether related to conversion therapy or not.

This would apply, as well, to any person, group, or organization that refers an adult to such a therapist.  An aggressive judiciary could find within this language justification for removing tax exemption from any church that even suggests trying therapy to any church member.

This bill is your supposed representatives using your government to tell you what you must believe about the universe and your very self.

justin-katz-avatar-smiling

UPDATED: Raimondo’s Got Nothing to Say About Mercy

Ethan Shorey of The Valley Breeze is having a hard time getting an answer from Democrat Governor Gina Raimondo about a charitable dental effort that the Community College of Rhode Island (CCRI) shut down this year:

On June 28, Gov. Gina Raimondo sent out a mass email denouncing Trumpcare, calling it “immoral” and saying it would bring “disastrous ramifications” for “Rhode Island residents at risk of losing health care coverage.” The use of the word immoral got me to wondering about Raimondo’s thoughts on the Community College of Rhode Island’s decision to end the Mission of Mercy, an annual volunteer event giving some of Rhode Island’s poorest residents access to free dental care. …

It’s now July 12 and I still haven’t heard back from [spokeswoman Catherine] Rolfe. Perhaps my email was lost again?

Shorey’s background article gives the details.  CCRI didn’t technically kill the program.  The college just kicked the volunteers out of the campus’s dental facility and told them they’d have to set up in a field house, promising to kick in $10,000 toward the estimated $70,000 cost of setting up a mobile clinic each year.

CCRI may have a perfectly reasonable explanation for the decision, but it’s difficult to imagine one, and it’s impossible if government officials won’t even attempt to explain.  Shorey’s right, too, to wonder how rhetoric about reform of broad national health policy can be called “immoral” for removing mandates for insurance coverage and seeking to reform a welfare program when Raimondo’s extended administration directly removed access to actual health care.

ADDENDUM (4:01 p.m. 7/13/17):

I’m struggling to understand Ethan Shorey’s complaint about this post, but he seems to want some clarification to be made in this space.

His apparent insinuation in the text quoted above is that if one considers Trumpcare “immoral,” then the term could reasonably be seen as applying to CCRI’s treatment of Mission of Mercy.  This observation, of itself, does not tell the reader anything about Shorey’s own moral view, although one might infer from his attempts to get a comment from the governor that he finds the Mission of Mercy issue less ambiguous, if anything.

In paraphrasing Shorey’s sentiment at the end of my post, I kept the same structure, only adding more details about what partisans like Raimondo assert is “immoral” about Trumpcare.

Perhaps Shorey is worried that people might think he agrees with my broader views, which aren’t part of this post.  That would explain the “we both know” language in our tweeted exchange.  If that’s the case, I apologize for any detrimental effect that my approving citation of his work has on his social standing.

justin-katz-avatar-smiling

Redefining Humanity with No Allowance for Dissent

On National Review Online, Wesley Smith writes about a push in the United Kingdom to publicly fund womb transplants for men who want to become women:

This would be wrong on so many levels, ranging from safety concerns for both patient and potential future baby, the prospect of doctors and hospitals being forced to participate even if it violates their religious or moral beliefs–already beginning to happen–to the question of whether going to such extremes to satisfy individual yearnings constitutes wise and public policy.

But make no mistake: Powerful political and cultural forces will be–are–pushing us hard in this direction.

An advocate for the policy quoted in the Daily Mail “predicts” that this technology will eventually be in demand among not only homosexual men, but also heterosexual men who want to experience childbirth.

Smith focuses on the way in which this episode illustrates the impossibility of ever controlling health care costs, when the incentive for providers and government is constantly to broaden the services for which other people must pay.  I’m not sure, though, that Smith isn’t writing with his tongue in his cheek, because health care costs and the concerns he articulates in the above quotation are among the least of the concerns in the envisioned brave new world.

Go right to the profound:  If this sort of technology advances to perfection, people could install and remove organs as they desire them, which would make us more like organic machines than human beings.

We’re coming to a decision point at which individuals and society will have to decide in a very fundamental way what it means to be human, or even to exist.  It greatly aggravates the dangers of that decision point if we accept a pervasive attitude that everything’s a civil right at public expense and those who disagree must be forced to accept and financially participate radical changes almost from the beginning of their possibility.

justin-katz-avatar-smiling

Gee… Government Agencies Want to Expand Access to Government-Mandated Data?

Even good people with healthy political philosophies fall into the “we have to do something” trap.  So, when an opiate “epidemic” emerges, even people who would normally shy from creating government databases relent and allow the centralized, mandatory collection of prescription information because… “we have to do something.”

Well, this was inevitable:

The amended bill (S-656 Sub A) would remove the requirement that all law enforcement officials obtain a search warrant to access the database.The database contains information about highly addictive prescription opioids such as Vicodin and OxyContin, along with stimulants such as Adderall and sedatives, such as Xanax, and cough suppressants with codeine. The database allows health officials to track prescribing patterns as a way to identify possible over-prescribing and abuse.

The bill has passed the Senate on its way into law.  If it comes up short this year, it’ll be back next year… and the next.  Eventually, the advocates will find some story, some crime that could have been prevented if only law enforcement had been able to dip into the data without a search warrant, and that will push it over the top.  “We have to do something.”  (Or maybe the Speaker of the House will need a vote to pass something else, and that’ll be the lever.)

This pattern is becoming clear enough that there’s no excuse not to predict it.  Let’s get back to a healthy skepticism that stops government from getting on these paths in the first place.

monique-chartier-avatar

One Hundred New State Jobs Would Only Perpetuate Failures & Failed Approach

Both the proven failure of a budget-centric approach and Governor Raimondo’s dismal public policy track record should give the General Assembly real pause when considering her reported request for one hundred new state hires – and other initiatives, past and prospective.

justin-katz-avatar-smiling

Journalists and RI Politicians to Blame for “Mounting Anxiety” over Medicaid Reform

Earlier today, I noted how willing Rhode Island politicians are to sacrifice the well-being of Rhode Islanders and then attempt to scare us into political activism against their opposition.  In wishing the news media would play a role in bringing them back toward more-reasonable rhetoric, I probably underplayed the degree to which journalists are complicit.  Consider Lynn Arditi’s Providence Journal article whipping up the panic about federal health care reform:

Now, Porreca and others like him could lose their coverage under a Republican plan to roll back that Medicaid expansion and limit future federal financing for the safety-net program. Able-bodied adults also could be required to work in order to qualify for Medicaid.

The first sentence is false, and the second is misleading.  The paragraph is partisan fear-mongering propaganda.  As I’ve already explained, the House Republicans’ AHCA legislation includes no cut to Medicaid.  Anybody claiming otherwise is wrong, and anybody claiming otherwise whose job it is to objectively inform people is either lying or committing professional malfeasance through his or her negligence.  Adding in the work requirement in that context makes frightening something that is arguably a reasonable policy and leaves out the reality that Rhode Island’s state government would have to go along.

If “anxiety” is “mounting,” as the Providence Journal headline suggests, the news media and Rhode Island politicians are to blame.  If only people would begin holding them accountable for the anxiety they cause out of their own selfish interests.

justin-katz-avatar-smiling

Know Their Love for Innovation by Their Actions

Rhode Island politicians like to give lip service to making the state a hub for technology companies, but they seem to think that means encouraging interactions between groups that can only survive with government subsidies, mainly because of (and by means of) government’s imposition of high barriers to entry and costs of doing business.  The secret to generating new industries in Rhode Island is to lower costs so all variety of businesses can afford experiment (without government approval, as expressed through the subsidies) and reduce restrictions on what they’re permitted to do.

RI Center for Freedom & Prosperity CEO Mike Stenhouse and Taxpayer Protection Alliance Senior Scholar Drew Johnson highlight a great example in today’s Providence Journal:

Fortunately, the free market recently developed a way to bypass the optometrists’ office. New technology — known as “ocular telemedicine” — allows consumers to accurately measure their prescription strength on a smartphone or computer screen from the comfort of their own homes. A board-certified ophthalmologist then emails a vision prescription based on the results.

Patients can then use that e-prescription to purchase lenses or glasses wherever they choose, typically at much lower prices. With this technology, healthy adults only need to visit a brick-and-mortar eye doctor once every two years for a full eye health exam (as recommended by the American Optometric Association) instead of every time a lens refill is needed.

Naturally, entrenched interests have pushed for legislation to halt (or at least slow down) such innovations, and of course, some Rhode Island legislators are answering the call… no doubt with entirely selfless reasons.  It’s funny how protecting people from themselves so often seems to profit somebody else, at least when it comes to regulations.

Can we stop that sort of behavior, please?  Why not just let people figure out how to provide other people what they want?

justin-katz-avatar-smiling

Demagoguing Pre-Existing Conditions

Rich Lowry gives an explanation, in the New York Post, of why the fear mongering about the American Health Care Act (AHCA)’s effects on those with pre-existing conditions is yet another manufactured outrage:

The perversity of it all is that the legislation is properly understood as doing more to preserve the ObamaCare regulation on pre-existing conditions than to undermine it. The legislation maintains a federal baseline of protection in such cases, and says only that states can apply for a waiver from it, provided that they abide by certain conditions meant to ensure that no one is left out in the cold.

Since these provisions only involve the individual insurance market, a small slice of the overall insurance picture (about 18 million are on the individual market), and merely make possible state waivers, they are inherently limited.

You’re not affected if you get insurance through your employer (155 million people), or through Medicaid or Medicare. You’re not affected if you live in a state that doesn’t request the waiver, a category that will certainly include every blue state and most red states, too. Even if you buy insurance on the individual market and live in a state that gets a waiver, you’re not affected if you’ve maintained insurance coverage continuously and not had a gap in coverage longer than 63 days.

By this point, we’re talking about a fraction of a fraction of a fraction of the population. If you do have a pre-existing condition in a waiver state and haven’t had continuous coverage, you can be charged more by your insurer only the first year. The state will have access to $8 billion in federal funds explicitly to ease the cost of your insurance, and the state must further have a high-risk pool or similar program to mitigate insurance costs for the sick.

People who oppose these sorts of measures — especially with as much heat and smoke as we’ve been seeing related to the AHCA — give the appearance of elevating their own access to power above any real policy consideration.

justin-katz-avatar-smiling

Why Real Insurance Is Preferable to Centrally Managed Health Care

In The Washington Times, Cheryl Chumley tells the 2008 story of her husband’s sudden illness and brush with death.  Her insurer at the time, Blue Cross Blue Shield, didn’t deny any bills, even though the doctors keeping her husband alive told the family to prepare for his imminent death.

It was a few months after my husband left the hospital from his heart attack that we ran into one of the nurses who cared for him — at a presidential campaign event, no less. One chat led to another and the subject of socialized health care was raised. And this is what the nurse said: Had my husband been on Medicare or Medicaid at the time of his heart attack, the doctors would have quit their life-saving efforts long before his 10 comatose days had ended. Why? Because the government health care plan wouldn’t have paid for the around-the-clock intensive care. The situation would’ve quickly evolved into a pull the plug, wait and see what happens type of deal.

It occurs to me that, in a competitive market, of course this would be true.  The insurance companies are selling insurance, which means everybody who buys insurance is thinking of these sorts of horrible circumstances.  If it gets out that a particular insurance company doesn’t cover them, then the value of insurance for that company and generally goes down.

So, it’s in their interest to accurately price risk so as to charge a rate at which they can maintain their value proposition.  They do this with a mix of pricing features, including premiums, deductibles, and maximum out-of-pocket limits.  A consumer with a low tolerance for risk may choose to pay a high premium, while one who wants to save money understands that risk is part of the equation.

Central planning is a completely different thing.  In that scenario, supposed experts are figuring out how best to distribute resources.  They don’t have to have attractive products, because nobody has a choice.  ObamaCare’s hybrid system of planning and choice transforms the insurance incentives into hiding costs, not accurately assigning them.

mike-stenhouse-avatar

Important Questions for Rhode Island In A Reshaped Healthcare Landscape

If the final federal healthcare law that eventually emerges from Washington, D.C. is similar to the version that passed the House of Representatives in early May of 2017, Rhode Island lawmakers will find themselves in the middle of largely reshaped federal and state healthcare landscape. Soon they may be faced with multiple important questions; and they will also realize that they will be newly empowered to make state-specific decisions for the people of Rhode Island.

justin-katz-avatar-smiling

No Health Policy Is Perfect, but Remember Both Sides

Mary Katharine Ham makes a critical point as we all debate (make that, “debate”) health care policy:

Arguing about this as if beneficiaries of ACA don’t exist isn’t right. Arguing about it as if people like me don’t is also not right. ACA was never the panacea it was sold as and it remains distinctly un-utopian in its results. Lazy characterizations of things you like as perfect—and of people you oppose as big fans of people dying—are not particularly helpful to actual people.

So if you’re weaving a utopian or dystopian scenario for Facebook, remember reality is almost always less extreme and more nuanced than you’re asserting, and you probably know a real human on both sides of every imperfect adjustment to our Frankenstein system.

That’s the level at which policy debates ought to be conducted, and it would be true to say that both sides have people who reach that level and people who decidedly do not.  It’s vertigo-inducing to watch the speed at which we go from a mainstream with no major concerns about the wholly partisan, parliamentarily manipulated, nature of ObamaCare to, for example, a Democrat Congressman’s proclaiming that overhauling health care shouldn’t be done in a partisan way.  (It’s like that childhood friend who would keep breaking the rules of a game and then saying that they would apply from that point forward.)

To get to that point, one must ignore the past, and in the case of ObamaCare, it means ignoring people who have been harmed, not to mention the long-term harm to our health care system and economy.  Somehow, we have to see the self-interested partisan talking points and get to the question of which direction policy should actually go.

justin-katz-avatar-smiling

Disconnect Between Health Care Rhetoric and Reality

So it seems that Rhode Island and national Democrats have decided that the outrage machine must remain dialed up to 11.  Rhode Island Congressman David Cicilline has proclaimed that Congress would kill “tens of thousands of Americans” if it passed the Republican health care bill.  (Put aside evidence that ObamaCare’s already tallying the deaths.)  Democrat governor of Rhode Island Gina (everybody calls me “gov”) Raimondo insists that the bill would strip families of health care coverage.

Meanwhile, as WPRI’s Ted Nesi reports, Care New England hospitals are losing money and struggling under ObamaCare:

The $26-million operating loss for the winter quarter, Beardsworth said, “further tells the story we have been very candid about – decreases in patient volume, a worsening payer mix, changing health care needs of the population, and extremely restrictive reimbursement caps in place through the state health insurance commissioner’s office.”

The payer mix refers to what share of hospital bills are paid for by different commercial and government insurers. In Care New England’s case, more of its revenue is coming from Medicaid, the state-federal insurance program for low-income people, and Neighborhood Health Plan; it says both pay less than Blue Cross & Blue Shield. The hospital group’s management attribute the shift to the Obama health law, which President Trump is now seeking to overhaul.

And not to be outdone, insurers around the country are beginning to be more vehement in warning that ObamaCare may have entered the much-warned-about “death spiral.”

Of course, many have suspected that a death spiral leading to full government control of health care was the underlying plan of ObamaCare all along.  So those now squawking are trying to score political points (and out-of-state donations, no doubt) while preventing Republicans from doing just e-pitiful-nough to keep American health care from fainting fully into the arms of the government vampire.

In a state with no political pull within the national Republican Party (i.e., the party in power), it seems politicians’ time would be better spent trying to figure out how to handle any changes that come along than jumping on this week’s excuse for stoking a “resistance.”

justin-katz-avatar-smiling

Congressional Health Care Bill and the Purpose of Government

Look, I get it.  It doesn’t do anybody any good (except maybe politicians) to caricature the opposition, and I understand that Big Government types believe, at some level, in the mission of government, and on that level, an equivalence between funding and policy goals is justified.  But reading news from up north, I can’t help but think a critical line of perspective has been crossed:

The health care bill that Congressional Republicans plan to bring to the House floor for a vote Thursday afternoon would result in “a massive loss of critical funds” for Massachusetts, Gov. Charlie Baker said. …

The potential loss of federal revenues, a major source of funds for the state budget, could compound budget problems associated with tax collections that for many months now have come in well short of the projections that Baker and legislative leaders have used to plan state spending.

Somewhere in this process of elected officials’ making statements and journalists’ reporting them, shouldn’t somebody have the role of putting front and center the key question, here, which is whether a particular policy is better for the people of the United States of America?  If ObamaCare crashes of its own weight, wouldn’t that be bad, too?  If so, wouldn’t that be worse than a state-level budget crunch?

(Yes, look, I get it… a health-industry collapse would just mean more money and power for the federal and state governments.  I’m being rhetorical, here.)

justin-katz-avatar-smiling

Why Knowledge Is Important (Pre-Existing Conditions)

Josh Blackman highlights one of those political truisms that still surprises when one sees evidence.

First, he cites a 2009 Kaiser Family survey finding that support flips for an ObamaCare provision that makes it difficult “for insurance companies to drop your coverage when you get sick or water it down when you need it the most” when people are informed that it would increase their own premiums.  Next, he cites the same phenomenon in a more recent Cato/YouGov survey, concerning the “community rating” provision that forbids adjusting premiums based on medical history.

This is why it makes a difference how surveys are worded and, even more, what points news stories present.  It makes progressive policies look much, much more attractive if there’s never any cost associated with the feel-good legislation.  Every story should contain a micro-lesson on basic economics.

Making this tendency more tragic, in this case, is that these small populations of exceptions could be addressed in ways that are much more fair and much better economically and with regard to outcomes.

Knowledge, as they say, is power, which is why the Left spent decades corrupting institutions like the media and higher education by which Western Civilization transmits its information.

(Via Instapundit.)

justin-katz-avatar-smiling

Government Is Allowed to Change Bad Decisions (As on Medicaid)

Virgil Dickson, of Modern Healthcare, reminds us that government is allowed to rethink bad decisions, even when they relate to welfare entitlements:

Democratic lawmakers in Oregon are considering ending the state’s Medicaid expansion in an effort to address a $1.6 billion budget shortfall.

The state’s Ways and Means committee, which includes both senators and representatives, suggested cutting Medicaid expansion in an effort to curb Oregon’s $1.6 billion budget deficit.

As Kevin Mooney pointed out in this space in 2012, the Medicaid expansion was implemented in Rhode Island through administrative action and with little debate.  It was just assumed that we would and should do it.

It’s been a disaster.  In a policy brief from the RI Center for Freedom & Prosperity, we expected one in four Rhode Islanders to be on Medicaid by 2020.  Instead, we’re already nearing one in three and increasing every month.  Medicaid enrollment exploded as soon as the expansion and the health benefits exchange (HealthSource RI) came online, and it’s reaching the point that the exchange is shuffling its own paying customers onto Medicaid, undermining its own business model.

Legislators should admit that the expansion was a mistake and repeal it.

justin-katz-avatar-smiling

Does ObamaCare Kill?

Here’s an interesting finding to ponder as we wrap up the work week, from Brian Frankie in The Federalist:

We know that the same year Obamacare’s insurance expansion provisions took effect, there was a pronounced, and statistically significant, surge in U.S. adult mortality. We know the surge in mortality remains after removing drug-related deaths, and other external morbidity causes, from the statistics. That is all we know. The rest is speculation. But it is fascinating speculation.

Has Obamacare, or some of the secondary effects of Obamacare, actually caused the negative impact in U.S. adult mortality so evident in the statistics? Is the improvement in public health that was assured turned out simply to be another false Obamacare promise, like being able to keep our doctors and health plans, or reducing our health costs?

As with the infamous ObamaStimulus metric of jobs “saved or created,” supporters of the O will insist that we cannot possibly know what mortality rates would have been like had ObamaCare never passed.  That’s a nifty trick to never have to truly subject one’s policies to real-world assessment, but serious discussion would require finding some evidence that an even bigger surge came in low.

I’m not saying I’ve got any answers on a Friday afternoon, but I certainly find it plausible that ObamaCare actually killed thousands of people (to put it in not-at-all-inflammatory terms).  Medicaid has worse health outcomes than private health insurance, even than no coverage at all, so people ushered onto Medicaid would be expected to increase mortality rates, especially if they’d planned to buy private health insurance through an exchange and discovered their eligibility for the free version.

Whatever the cause, we should certainly get past the simplistic public debate that saving ObamaCare saves lives and trying to eliminate (or even substantially reform) it is an inhumane goal.

justin-katz-avatar-smiling

The Many Methods of Expanding Government’s Role

Although fully aware that I’m (let’s say) unique, I still think bottle deposit charges ought to outrage people.  The idea of the charges was to give consumers some incentive to recycle bottles and cans, but Susan Haigh reports for the Associated Press on how that rationale continues to transform into something else:

In Connecticut, distributors were allowed to keep the unclaimed bottle deposits to help offset the costs of running the program, but state officials decided in 2009 to use that money — about $34 million each year — to help balance the government’s budget.

Step 1: Use some public purpose as justification for the creation of a new funding stream, claiming (don’t worry) the government’s intentions are wholly dispassionate.  Step 2: Spot a big pot of money that government can contrive a justification for taking, and take it.

And now:

Connecticut, Massachusetts and Iowa are among the states where bills have been proposed to replace the bottle deposits with a tax. Supporters say the tax revenue could support recycling efforts that did not exist when the bottle redemption systems were introduced.

Thus does the government essentially open up a line of business in recycling.  What started as an incentive charge that government imposed, but from which government did not profit, is becoming an excuse for government to process money for a particular activity.

Liliana Rutler and Rosie Woods report on another line of work the government of Massachusetts is edging toward entering:

Sheriffs urged lawmakers Monday to use the legalization of marijuana as an opportunity to invest in substance abuse treatment. They are urging state lawmakers to increase the tax on pot from 10% to 15% to pay for those treatment programs.

Step 1: Legalize an illegal industry.  Step 2: Effectively turn it into a government-monopoly.  Step 3: Find new sideline businesses such as treatment for those who abuse the government-monopoly substance.

justin-katz-avatar-smiling

Consumers Can’t Handle Options They Don’t Have

Not to build a day of blog posts drawn from a source, the Wall Street Journal, to which not everybody has full access, but an essay by Amanda Frost, taking up the “no” side of the debate question, “Can consumers be smart health-care shoppers?,” gives an opening for a point that ought to be made more frequently:

When it comes to making decisions about our health care, being a “smart shopper” takes more effort than most of us are willing to put in.

Advocates for price transparency would have us believe that we, as “consumers,” should consider our health care a product to be shopped for, like a pair of shoes. But mainly we are “patients,” with varied, often time-sensitive health-care needs. There is an important distinction between presenting the information—and choices—to patients and asking consumers to make complicated decisions about their health care based on that information. …

Available evidence is not cause for optimism about how much money can be saved with more choices and publicly available prices. While large health-care payers may save some money from consumer shopping, the average person will likely see little, if any, savings.

Frost’s argument appears to be that consumers in a market with artificially constrained options — that is, in which choices are limited, obscure, and difficult to understand — don’t seem to want to clear that high hurdle, so lowering the bar is a bad idea.

Look, if shopping for health care “takes more effort than most of us are willing to put in,” then people will pay extra for options that free them from the burden.  Frost is essentially saying that those who are willing to put the effort in should not be allowed.

But I don’t believe she’s correct.  Once people get used to the idea that they aren’t under the watchful eye (or the thumb) of their insurance companies and the government, they’ll begin figuring out pricing and talking among themselves.  The possibility of choices will make new products and more competition possible, lowering prices and improving quality.

justin-katz-avatar-smiling

Rhode Island Does (or Did) Something Right

In its design (as opposed to its objective) Stephen Moore doesn’t much like Medicaid:

You’d be hard-pressed to find a more poorly designed program in the federal budget than Medicaid, the health insurance program for low-income Americans. The costs are shared between the states and the feds, which means that the more money a state wastes under Medicaid, the bigger the check Washington writes to the state. No wonder the program costs keep spiraling out of control.

Obamacare added nearly 20 million people to the Medicaid rolls, and the left considers that a policy victory. Federal and state budgets are swelling.

Oh, to return to the days when taking people off of welfare — not putting them on the dole — was the goal.

In an unusual experience, for a conservative, Moore cites Rhode Island as an example of a different way, referring back to a block-grant program implemented in the waning days of the President Bush and Governor Carcieri days.  Gary Alexander, who ran Health and Human Services in RI back then comments in Moore’s essay:

Alexander has become the Pied Piper for Medicaid waivers. “This is such a terrific solution because in Rhode Island we reduced costs and provided better care. When the state had an incentive to save money rather than spend it, this changed everything.” He added, “State waivers are the way out of the Medicaid crisis.”

Of course, elected officials in Rhode Island moved quickly to give away the budget slack in the Medicaid expansion and other constituent buy-offs, so clearly we have to work on step 2 of the “saving money” process (i.e., not immediately spending it on something else).  But it’d be nice to be recognized more often for innovative, smart policies.

justin-katz-avatar-smiling

Lining Up to Be the Future of Vulnerability

Yes, the idea of receiving scannable implants in the body for the collection and transmission of information is terrifying of itself, but it’s the peer-pressuring described in this James Brooks AP article that’s truly unsettling:

The [Swedish startup company, Epicenter,] offers to implant its workers and startup members with microchips the size of grains of rice that function as swipe cards: to open doors, operate printers, or buy smoothies with a wave of the hand.

The injections have become so popular that workers at Epicenter hold parties for those willing to get implanted. …

The implants have become so popular that Epicenter workers stage monthly events where attendees have the option of being “chipped” for free.

Encouragement parties.  Coworkers prying into your business — almost literally under your skin — to ask “Are you chipped?”

Go ahead.  Everybody else is doing it.  Don’t worry that it can be read some distance from your body and that you’d need to cut open your skin to take it out and perhaps face the inverse peer pressure for being a troglodyte and apostate who has become “unchipped.”  You can trust that the company won’t collect any creepy information, or anything.

What else does “the future” that these chipped folks talk about hold in store?

justin-katz-avatar-smiling

The Dead End of Rhode Island’s Government Plantation Model

The entitlement mentality in this state will be palpable as the federal government rolls back the Obama Administration’s give-aways. Lynn Arditi writes about the potential cost to Rhode Island if it refuses to change its Medicaid program to reflect federal spending under the Republican health care plan:

Predicting how much it might cost the state to cover the roughly 70,000 adults in the Medicaid expansion population under the Republican plan is especially difficult, health experts say, because people move on and off the rolls. If, for example, the job market weakened and people who had left the Medicaid rolls return, the lower federal cost-sharing rate means they’d be much more expensive to re-enroll.

“While certainly we’d support the state continuing to fund the Medicaid expansion population,” [Linda] Katz [of the Economic Progress Institute (no relation)] said, “the reality is … it would be very difficult to replace with state dollars the federal dollars and keep people insured.”

Rhode Island never should have signed on to the Medicaid expansion if this was possible, and the likes of the RI Center for Freedom & Prosperity were ignored when we warned that it was most definitely possible.  What everybody can see clearly now is that insiders and bureaucrats padded their budgets at great cost and risk to others.

And it’s not just Medicaid.  Dan McGowan reports from Providence for WPRI:

President Donald Trump’s proposal to eliminate the $3-billion Community Development Block Grant (CDBG) program would be a “devastating” blow to Rhode Island’s capital city, Mayor Jorge Elorza said Friday.

Trump’s proposed budget would do away with the 42-year-old CDBG program, which provides local governments across the country with funding for community centers, housing programs and neighborhood improvements.

None of these programs should ever be built into state government budgets or the local economy.  They should be treated as gravy on a healthy, independent economy.  Instead, we’ve allowed our elected officials to suffocate real industry and substitute a government plantation model premised on being able to bill the federal government and local taxpayers for government services for others.

Eventually, when you turn toward an obvious dead end, you reach it.

justin-katz-avatar-smiling

CBO Points to the ObamaCare Abusive Spouse

This Wall Street Journal editorial offers some worthwhile perspective on the meaning of the Congressional Budget Office’s (CBO’s) estimates around Republicans’ initial ObamaCare repeal bill:

The CBO attributes “most” of this initial coverage plunge to “repealing the penalties associated with the individual mandate.” If people aren’t subject to government coercion to buy insurance or else pay a fine, some “would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

What this finding says about the value Americans attach to ObamaCare-compliant health insurance is damning. If CBO is right, some 14 million people would rather spend their money on something else, despite the subsidies.

In keeping with the general worldview of central planners, if you cease to get something through them, you’ve “lost” it.  This attitude permeates government, from charitable grants that local governments give to their preferred charities up to massive federal entitlements.  In this case, the government isn’t even just taking credit for something it’s using other people’s money to provide, but behaving as if forcing people to do something gives them that something.

As perverse as that is, it may be the perfect representation of progressive government.  It’s like an abusive spouse who rationalizes his or her pathology into the belief that commanding and berating his or her significant other is for the other person’s good.

As for the CBO, the Journal also reminds us that it’s a policy group working off a model, not a mystic order of prophets telling the future.

Quantcast