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The Poster Hairdresser for How Government Interferes with Civil Society

Rhode Islanders may have noticed that Providence Democrat Representative Anastasia Williams has submitted legislation to allow people to braid hair for pay without requiring a license.  This is actually a subject that the RI Center for Freedom & Prosperity has raised in the past (although I can’t find a link, just now) and is consistent with both our long-running insistence that the state government is strangling our economy with regulations and our more-recent emphasis on shifting policy in favor of helping Rhode Island families and facilitating non-government civil society.

Via Instapundit, however, comes an entry by Eric Boehm of Reason, who may very well have spotted the poster child for the government’s overreach in directing our lives and preventing us from serving one another as human beings:

The Arizona State Board of Cosmetology is investigating Juan Carlos Montesdeoca after receiving complaints that he was cutting hair without a license, Tucson News Now reported Monday. According to the complaint, which Montesdeoca shared with the TV station, the board received an anonymous complaint alleging that Montesdeoca was “requesting local businesses and local stylists to help out with free haircuts (unlicensed individuals) to the homeless.”

This morning, the Tiverton Budget Committee (of which I’m a member) toured the town’s Senior Center, and the new director related some of the anecdotes that she’s heard about the 100-year-old building.  Back when it was a school, apparently doctors would open weekend clinics for various procedures, including the removal of tonsils.

Now, given advancements in knowledge, we can surely agree on a role for government in requiring sanitary conditions and licensed professionals to perform such surgeries.  At the same time, we should be able to agree that rules against hair braiding and charity trims don’t really protect anybody but established practitioners who are able to charge more money the less competition they have.

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Anybody Buying the UHIP Spin?

Come on, now. This is like lie-detector 101:

“There was pressure [to launch UHIP despite its not being ready], no doubt about it,” Raimondo told reporters. “High ranking members of the General Assembly said, ‘Deliver this now.'” …

[Department of Human Services Director Eric] Beane, called to testify about his month-long probe of UHIP, tempered his answer, saying employees he spoke with at DHS and the Executive Office of Health and Human Services talked about pressure from former House Finance Committee Chairman Raymond Gallison and former Rep. Eileen Naughton, who chaired the finance subcommittee on health and human services.

So, the governor tried to deflect some blame, and the administration realized it was starting a political fight, so a flunky ostensibly testifying with a neutral assessment of what went wrong implied (indirectly, notice) that the blame should fall on two legislators whom a governor would hardly take seriously as directing the administration’s actions and who, conveniently, are no longer in office (one because he was jammed up with criminal investigations).

This is cover-up land. The governor can’t be trusted.  As I suggested in my “Last Impressions” podcast this week, it appears that Raimondo has invested in the tagline that she’s the “governor who gets things done,” and sliding down the UHIP wormhole had to be a major concern.

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A New Winner for Most Pro-Government-Spin Headline in the Providence Journal?

I’ve been meaning to nominate the headline that the Providence Journal used in its print edition for this article (from the Associated Press):

‘Obamacare’ sees high enrollment

To be fair, the Projo headline writer was taking his or her cue from and amplifying the spin of AP writers, Ricardo Alonso-zaldivar and Kevin S. Vineys who try to slip in the real story in the third paragraph:

Although initial enrollment is about 4 percent lower than last year, the sizable number of sign-ups illustrates the risk Republicans face as they begin moving to dismantle the Affordable Care Act and put in its place a yet-to-be-defined conservative approach.

You can’t get from a 4% drop in enrollment to a headline proclaiming “high enrollment” without being something more like propagandists than journalists.  If I were an objective journalist working for one of these organizations, I’d be furious with my coworkers for undermining our publication’s credibility.

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The Creeping Grim Reaper of Euthanasia

Just in case you’re thinking the grim reaper of euthanasia won’t be a creeping killer, here’s a Catholic News Agency article to consider:

An Oregon bill on advanced medical directive rules could allow patients who suffer from dementia or mental illness to be starved or dehydrated, opponents warned.

These are patients who are awake, can chew and swallow and want to eat, even though in some cases they may need help in delivering food to their mouths,” Gayle Atteberry of Oregon Right to Life said Jan. 31. “Current safeguards in Oregon’s law protect these patients from this type of cruelty. This bill take away these safeguards.”

Whether proponents see euthanasia as compassion or as a scheme to slough off some excess population, it has no boundaries once one cedes the argument over the sacred value of human life.

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Freestanding ER Bill Shows How Price Has Been Disconnected from Service

The lesson of Susan Campbell’s WPRI story about one woman’s surprise bill from a “freestanding ER” business from which she received service may not be quite what’s intended:

“They gave me oxygen, they did chest X-rays, an EKG, and blood work,” [Elizabeth] Darling said.When she got to the ER, however, Darling overlooked a sign at the front desk, warning patients that Medicare and Medicaid are not accepted at the facility. She was billed more than $1,600.“I never would have stayed there,” Darling said. “I would have walked out that door, had I known.”

This may look bad — and we’ve been trained to see the word “gouging” between the lines of such stories — but it goes with my broader analysis: We’ve completely disconnected price from service.

Given her insistence that she would have gone elsewhere if she’d known her price of service, this woman could obviously have made it to another service provider that would have saved the system money.  Instead, within a system that ensures that the decision-making consumers don’t usually care about the price of services, she chose a high-cost option.

A great many people would do the same thing, because the way the government has manipulated our health care system, people not only don’t associate direct payments with services, we don’t even have a concept of what those services actually cost to provide.  It’s a system designed for waste.

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Transfer to Medicaid “Main Driver” of HealthSource Decline

Rhode Island’s Affordable Care Act (“ObamaCare”) health benefits exchange lost 5,027 members (18.6%) as of the December 31 deadline for open enrollment.  Officials largely blame the withdrawal of UnitedHealthcare’s plans:

HealthSource RI said in a statement that the “main driver” of the enrollment decline was the departure from the market of UnitedHealthcare, which HealthSource RI estimated insured roughly 1,400 exchange customers in 2016.

One source of lost customers was more significant, however: Medicaid.  A HealthSource spokesperson tells the Current that “about 1500 individuals who had [qualified health plan] coverage at the start of Open Enrollment have since been determined eligible and enrolled in Medicaid.”  A request for the number of Medicaid recipients who went the other way — losing the taxpayer-funded welfare benefit and signing up for a paid (if taxpayer subsidized) plan — had received no reply as of this writing.

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Since the beginning of HealthSource RI and the related Unified Health Infrastructure Project (UHIP), the RI Center for Freedom & Prosperity has warned that the system was designed to draw Rhode Islanders toward welfare benefits and dependence on government.  From the beginning, new Medicaid enrollment has far exceeded the numbers of Rhode Islanders who have used the exchange to purchase insurance.

These decisions and results have been a significant part of Rhode Island’s drop to 48th in the country on the Center’s Jobs & Opportunity Index (JOI) and to 39th on the index’s Freedom Factor, which is the ratio of jobs and employment to reliance on welfare programs.

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Never Any Way to Fix Costly Government Programs, Medicaid Edition

Reporting on a study by a couple of health care experts, Ted Nesi writes on WPRI:

Using 2015 data, their projections showed Rhode Island would lose $514 million in annual federal Medicaid funding under such a formula – a huge amount of money, equal to 22% of the state’s $2.3 billion in total Medicaid spending during the 2014-15 budget year. Massachusetts would lose $3.4 billion under the scenario.

First, let’s have a little perspective, here.  The revised spending on “Medical assistance (including Medicaid)” for fiscal 2015 was $2,382,919,281.  The year before — in fiscal 2014 — it was $1,819,597,682.  If you don’t have a calculator handy, that’s a difference of $563,321,599, or about $50,000,000 more than the “huge amount of money” in the possible reduction.

According to the mainstream calculus, government spending can never go down, even just to the prior year’s level.  On the one hand, we’re told it would be a terrible thing if Congress were to block grant Medicaid based on state income because states that rely on the program as a large part of their budgets would face massive reductions.  As the study says, it “would result in a seismic redistribution of federal spending.”

On the other hand, the authors go on to say, we can’t possibly calculate block grants based on current spending, because that “would lock in large and arguably unfair variation in funding across states.”  The only solution, clearly, is to just keep giving states as much money as they need for however many Medicaid recipients they’re able to sign up.

Folks, this is the government plantation, or company state.  As I wrote when I first began tracing that economic model in Rhode Island, when the state’s major industry (government) relies on its ability to sign up people for services in order to charge other people for them, the people forced to pay the bill will eventually flee the system, if they’re local, or push their own representatives to stop the bleeding, if they’re in other states being soaked by the feds.

Rhode Island should take the opportunity of the Trump Administration to get off this track.  The chasm toward which it leads has no bridge.

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If It’s “Unpaid Care,” It Cuts into the Government Plantation’s Market

It seems a point of personal pique for him, but Wesley Smith makes a great point when he objects to the characterization of families’ taking care of their own special needs children as “unpaid care”:

Really? What about mothers providing “unpaid care” for their babies? Or spouses for each other? Should such care also be measured in terms of the cost of having services provided by professional caregivers?

As Smith goes on to insist (emphasis in original), “the societal expectation should also be that families are the first line of care-giving.”  The first line of care-giving.  The first line of financial assistance.  The first line of loan guarantees.  The first line for education.  The first line, period.

The problem is that such activities cut in on the government plantation’s market.  Governments can’t tax other people to provide the services.  Labor unions can’t take a cut (although they do try).  And politicians can’t count on votes from people who aren’t dependent on government.

The deeper affront of the “unpaid care” attitude is how it teaches us to see caring for those we love.  The insinuation can be that families would (and maybe should) offload care if they can afford to do so, just as a homeowner may patch a wall to save the cost of a tradesman.  As a new state senator from Lincoln touchingly exemplifies, caring for loved ones can be a joyful fulfillment, and society should encourage us to see it as such.

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The Political Realities of “Fixing” ObamaCare

Megan McArdle is well worth a read on why Congressional Democrats designed ObamaCare in the flawed way they did and what the consequent political reality means for Republicans’ likely steps for repeal-and-replace.  Both those who would prefer to save the law and those who would prefer to trample it to dust should consider the political reality.

Option One:

For Republicans to fix the system as it stands, they would have to jack up the parts people hate — not to deliver new benefits, but mostly just to keep the existing system from flaming into a tailspin. Only the price tag would now be much higher, for boring technical reasons I’ll leave in a footnote.

Option Two:

Yet repeal and replace now seems almost as unlikely, because it means taking something away from voters — stuff that polls really well, such as, er, prohibiting insurers from looking at pre-existing conditions.

Option Three:

Of course, the last option — doing nothing while the individual market flames into a tailspin — doesn’t look all that hot, either.

McArdle states that she’d probably go with a variation of the third:

I’d announce a blue-ribbon commission designed to study the matter and propose a comprehensive alternative. I’d give it plenty of time to study and make recommendations. Then I’d wait and see if 2017 brings more premium hikes and insurers pulling out of smaller counties — disasters that could then be blamed on Obama…

The key point, here, is that we’re in this situation — with our healthcare system, economically, and politically — because President Obama and his fellow partisans who controlled both chambers of Congress felt they had to, and had the power to, push through something big (as the vice president put in vulgar terms at the time).  But the American people didn’t want what the Democrats were pushing, so a party-line Congress created a system destined to fail and hoped its failure would teach Americans to want the socialized medicine that the party wanted to provide.

November made that possibility so unlikely that McArdle doesn’t even mention it.

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Government as Majority Customer, Making Healthcare Worse

So when do problems in healthcare stop being the fault of the proverbial greedy insurance companies and start being an indication that the system is too socialized already?  Maybe when it’s more than 50% reliant on government?  Consider this from a Ted Nesi report on WPRI.com:

Care New England also said more than half its gross revenue from patient services came from the two major government health programs in 2015-16, with Medicare accounting for 32% and Medicaid accounting for 28%. The share from Blue Cross was roughly steady at 20%.

At this point, Care New England is essentially what I’ve been calling a “government satellite.”  Given heavy regulations, it’s essentially a quasi-public agency that has some independent revenue.

Keep this in mind, too, the next time you hear about how government is going to hold reimbursement prices down for Medicare and Medicaid.  If you ran a business and your biggest — indeed, majority — customer (which also happened to have regulatory power over you) dictated prices for the services you provided to it, your only option would be to reduce services to other clients or find ways to soak those clients for more.

This is just one way in which government involvement in the healthcare industry is making things worse.

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Science and News and a Sexism Double Standard

I think we can safely say that if the findings of this study were reversed, it wouldn’t be making news, much less getting the very-top-of-the-front-page treatment from the Providence Journal:

A big study of older patients hospitalized for common illnesses raises that provocative possibility — and also lots of questions. Patients who got most of their care from women doctors were more likely to leave the hospital alive than those treated by men.

If reversed results were reported, the story would be the flaws in the methodology.  As it is, the results are printed to make them seem more significant.  Saying that 11.5% of elderly patients die when treated by men, versus 11.0% treated by women, seems like a bigger deal than saying that 88.5% survive with men and 89.0% with women.  In the first case, 4.5% more patients die with male doctors; in the second, merely 0.6% more survive with women.

That small difference could be sheer coincidence or methodological flaws, and no news reporter is going to dig through the research to double-check whether every relevant factor (e.g., the average ages or specialties of the doctors) is adequately adjusted.  Similarly, what does it mean to get “most” of your care from women?

One might even file this story as “fake news,” and going forward, we shouldn’t expect that if the results from a future iteration of this report are different the public record will be corrected with the same visibly.  Actually, one might predict that the stories printed at that time will insinuate sexist recidivism, as if it’s a “setback for women.”

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ObamaCare Repeal Plan Exposes Government Plantation

Even if he fails in office, President-elect Donald Trump — merely by promising to behave as if it’s possible for the people to push back against the government-expansionist march — will do much to expose the workings of the government plantation.  Consider comments from Democrat Governor Gina Raimondo in an article by Lynn Arditi of the Providence Journal:

Gov. Gina Raimondo said Tuesday during a meeting at The Providence Journal that she “loses sleep” over the prospect of a hasty unrolling of the Affordable Care Act and its Medicaid payment system. “It could be devastating for us,” she said.

Such a change would mostly be “devastating” if it portends a new pattern in which the federal government stops paying state governments to provide services. That is increasingly the business model of Rhode Island’s true major industry, government.

The Beast needs customers for its services, and it needs a mechanism to make other people pay the bill.  The federal government is critical in that transaction because it’s able to take money in so many ways and without people’s having a clear view of what it’s paying for or a straightforward way to decline the bill year after year.

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Monthly Tracking Will Be Welfare Boom

Pay attention to this tidbit from a Providence Journal article by Alisha Pina:

The majority, said Cindy Machado, chief human service policy and system specialist, were here because they want to know why their benefits were cut. Of the 97,000 receiving food assistance, 3,000 have been deemed ineligible or didn’t give the required paperwork in time to keep getting help.

Another 500 people on Thursday had their state health insurance cut for similar reasons. UHIP has a program that allows the state to check monthly if residents are still eligible for the insurance. Notices were sent to those in question, and time was given before benefits were ended. Officials had hoped that the program would save about $16 million this fiscal year, but delaying the launch by two months decreased the projected savings by $2.4 million.

Right now, it sounds like a money saver that 3,500 welfare beneficiaries were found to be ineligible, but we’re on an economic upswing, and all of the state’s welfare programs aren’t fully integrated, yet.  When the upswing stops and, more importantly, when all government programs are linked for this month-to-month assessment, UHIP will become a way to maximize payments, not minimize them.

Through a creepily invasive “program” that keeps a monthly profile of all Rhode Island residents — at least those below some income threshold that we might call the “dependence line” — the plan is for the government to actively sign up new “clients” as they become eligible, sucking a maximum number of people into the system.  Again, we’re all either potential produce or tax-money laborers for the government plantation.

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What a Democrat Governor Can Do to Medicaid

Ted Nesi has changed his Saturday quick-hit column back to “Nesi’s Notes.” I wonder if one of the items on his list in today’s edition was the inspiration.  Writing of Democrat Governor Gina Raimondo’s proclaimed savings from Medicaid initiatives:

The governor’s office frequently touts roughly $70 million in state-level savings from her Medicaid initiatives in 2015-16. But most of that money didn’t come from changing how care is provided; $19 million was from lower payment rates to hospitals and nursing homes, $13 million was from higher taxes on hospitals, $9 million was from cuts to managed care, $7 million was from maximizing federal funding, and so on. There were plenty of other 2015-16 initiatives, some of which achieved their promised savings and some of which didn’t, but that’s where the big money was saved.

As I noted last February, Raimondo’s “Reinventing Medicaid” seems to have a clear news-coverage advantage over the reforms championed by Republican Governor Don Carcieri (with help from the Bush administration), to which it bears a marked similarity.  The main difference was on emphasis, with the Republican looking for accountability from consumers while the Democrat has turned more to increasing revenue and shifting costs to private insurance, where the government is less likely to take any heat.

Or maybe the difference in how the program is treated isn’t so much a partisan thing as simply a better name…

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Raimondo Admin’s Dodgy Non-Response to ProJo’s APRA Request

So as you probably know, Rhode Island’s new computer system (UHIP) for qualifying applicants and disbursing social program benefits is a mess. The problems have been well publicized to the point of infamy: a backlog of applications; benefit payments delayed; nursing homes (who have no easy way to stop their expenses) wracking up serious amounts of uncompensated care; even a security “glitch” that could have exposed the personal information of 200-1,000 customers.

It has gotten to the point that the feds were compelled to step in again – this time, breathing fire.

The agency continued to warn that the DHS could soon lose federal funding for administrative costs because of the system’s “failure to meet FNS statutory and regulatory requirements.”

And a Rhode Island House committee held its second hearing into the matter on Monday.

The question is, who is responsible for all of this? Was this a failure by the vendor setting up the new system, Deloitte Consulting? Or did the Raimondo administration force a transition to the new system from the old too quickly? (This, in fact, was a blunt warning by the feds to the Raimondo administration in early September.) If so, why?

In order to shed some light on the matter, the Providence Journal’s ace reporter Kathy Gregg sent the Raimondo administration an APRA request on September 7 for

all correspondence between the state and the company that designed it: Deloitte Consulting.

We pause here to go back, review and note that the subject of Gregg’s request was “correspondence”.

Gregg reports in yesterday’s Providence Journal that six weeks later – on the night before Thanksgiving, to be precise – the Raimondo administration gave her a thumb drive that purported to respond to the request. It contained only reports from Deloitte – and those only through September 6. Critically, the thumb drive contained no correspondence whatsoever between the Raimondo administration and Deloitte.

To reiterate: Gregg asked for correspondence. What she got was reports. (In the same way, Gregg might ask a Raimondo-operated fruit stand for a bag of oranges and receive, instead, a small bag of turnips.)

This non-responsive response by the Raimondo administration would appear to conform to neither the letter nor the spirit of Rhode Island’s APRA law. Nor is it the action of a Governor who, in an interview with Rhode Island Public Radio thirteen months ago, claimed to be “deeply committed to transparency”.

I asked the CEO of the Rhode Island Center for Freedom and Prosperity (full disclosure: I work with the Center), Mike Stenhouse, if he had a reaction to this. He responded,

A curious, honest, and relentless free-press is vital to preserving democracy in our free society and in holding elected officials accountable to the people. In this case, the administration’s pitiful non-response certainly makes it appear as if they have something to hide.

When a reporter like Kathy Gregg asks questions, she isn’t just asking for herself and her newspaper, she makes the request on behalf of all Rhode Islanders. Something went wrong with the launch of a major new state computer system – a system, remember, that has come in at over triple the originally budgeted cost. We are all minimally owed answers about the why and how of all of this. It is time to move from the dodgy non-responses to the straight answers and transparency to which the Governor herself has indicated that she is “deeply committed”.

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HealthSource and Defrauding of Taxpayers

Ted Nesi reports that HealthSource RI — the state’s ObamaCare health benefits exchange — wouldn’t accept two lower-cost plans from Neighborhood Health.  Even on its surface the decision is an outrageous scam:

A Kaiser Family Foundation analysis, which originally included the two Neighborhood plans rejected by HealthSource, suggested they would have lowered the average premium for HealthSource’s second-cheapest mid-tier plan by 14% in 2017. Instead that number will only decrease by 0.5%, according to HealthSource.

But HealthSource officials said their decision was driven by the federal formula for premium subsidies, which are provided to about 90% of the Rhode Islanders who buy insurance through the marketplace.

In other words, Rhode Island officials didn’t want prices to go down too much because they want to force federal taxpayers (ultimately through debt) to pay $17 million more for Rhode Islanders’ health care than they ought to.  The openness with which “HealthSource officials” admit this shows they believe Rhode Islanders are happy to have their government stealing on their behalf, but some of us aren’t so immoral.  As a side benefit to local government agents, the after-tax cost of the exchange’s average health plan would have gone up 42% if they didn’t rig the market, making the exchange look even worse in the public eye.

And that’s not all.  Earlier this month, we learned that Neighborhood initially set its prices too high because its inexperience in the market left the organization no good basis by which to set prices.  So, they ended up refunding $2 million to members, probably with much of it simply a transfer of money taken from taxpayers as subsidies.

In summary, Neighborhood Health, which was arguably more like a quasi-public welfare agency before ObamaCare, overcharged its customers from the start, which forced us all to pay more in subsidies in our capacity as United States citizens.  It then refunded a chunk of the excess to its members, none to taxpayers.

Now, state government officials have refused to allow Neighborhood to charge less for plans in order to steal more money from taxpayers.  This action may very well result in another big transfer of wealth to Neighborhood members through another refund next year.

And on it will go.  If a private organization behaved like this, politicians and pundits would be declaring it scandalous.

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You Mean People Make Money by Selling Drugs?

Sometimes following the news makes one feel as if everybody else is willfully living in some sort of fantasy.  Today’s Providence Journal article on the profits of medical marijuana in the state, by Jennifer Bogdan and Tom Mooney, gives me that sensation:

Medical marijuana is big business in Rhode Island. It wasn’t intended to be.

Advocates wanted dispensaries to provide a safe, ample supply of medicine for those who needed it. But the program has proliferated virtually unchecked, offering yes, relief for the ill, but also opportunity for investors who can operate behind the opaque screen surrounding Rhode Island’s three dispensaries. …

There were so many questions that they couldn’t answer at the time [legislation was crafted]. “I mean who knew?” How should the dispensaries operate? How much marijuana should they be allowed to grow? Would the legislature be more receptive if dispensaries weren’t influenced by shareholders?

“We said they were supposed to be nonprofits. Why? Well, first of all, we didn’t want them to be in it for the money.”

Oh, come on.  Are people really that unable to break down issues to their core components and categorize them properly in order to predict outcomes?  With medical marijuana, our (famously corrupt) state gave oligopoly authorization to three entities to sell an otherwise illegal product.  As I put it in 2011, the state was estimating that each dispensary would be “an instant $20 million business facilitated by the Department of Health.”  According to today’s article, the profits appear to be smaller and not quite so instant, and yet, the article presents 78% growth over a year, to $17 million for all three dispensaries, as if it’s unexpected and suspicious.

To the extent that the organizations aren’t making big returns on their investments, the article expresses suspicion about other ways in which participants are trying to make money.  It never fails to surprise that people really believe that those who work for non-profits can’t be “in it for the money” and that government power tends to breed corruption.

Look, there’s nothing wrong with making a profit.  Money is just an indication of value, and our economic system is supposed to determine what people value and provide it — whether that means innovating to create new products or building new capacity to produce and supply existing products.  People value drugs, but it takes an investment to get the industry over a start-up hump, and then it takes the flow of money to prove the consumer interest.  (As a society, we love to harvest the fruits of investment, but we never want to pay the reward.)

The way in which Rhode Island legalized marijuana was almost expressly designed to ensure that the government maintained pent-up demand in order to drive up prices and increase the tax take.  That’s been obvious along; people who are surprised really need to go back and review the assumptions that they have about the way things work and reevaluate how they believe government should behave.

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The Problem When Government’s an Economic Player

This should be an uncontroversial story offering the latest in medical thinking on a vaccine:

Since the HPV vaccine went on sale a decade ago, three doses have been needed. The panel decided Wednesday that two doses are enough.  

“It will be simpler now for parents to get their kids the HPV vaccine series, and protect their kids from HPV cancers,” said Dr. Nancy Messonnier of the Centers for Disease Control and Prevention.

As readers of the Current know, Rhode Island responded (arguably) more strongly than any state in the country to the nationwide push to mandate that all students receive this vaccine — which is produced by a single company — as a condition of attending school.  That nationwide push makes one think it awfully convenient that the government would recommend 50% more shots than it now says is necessary.

On the other hand, with ObamaCare, government is increasingly (and disastrously) involved in handling payments for health care, and excess vaccines may not make the cut as it balances its desire to make people pay for other people’s services with the voting-and-campaign-donating payers’ willingness to sit idly by as their wallets are raided.  With premiums continuing to rise, and the government positioned to take the blame, spending isn’t all fun and games.

Obviously, these two dynamics are not mutually exclusive.  The government may have loved the idea of prodding consumers toward excessive utilization of a monopoly drug while it wasn’t so directly visible in the funding stream, but is now reevaluating the corporate cronyism in light of its own accountability.

So if we take away the government’s incentive to meddle, what would be the recommended dosage of this vaccine?  Unfortunately, the question points to the most profound reason to resist society-by-government.  Who knows?  The same entity we’re supposed to trust to give us an analysis of the data is in bed with those who profit from higher recommendations and on the hook if the prices get too high.

Somewhere in this great muddle of health care policy, there’s the intention that government agencies could be objective voices coming to conclusions on the basis of medical science and leaving the market to work out the consequences and individuals to make decisions about resulting priorities.  Trust in that intention has now reached the point of naiveté, and we’ll all be poorer and less healthy for it as long as we allow it to continue.

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Sticking with Principles Isn’t Retreat

With an eye on the moral-legal weather vane, Wesley Smith notes the move afoot in Canada to force Catholic hospitals to kill people who want to be killed.  Quoting the Canada’s Charter of Rights and Freedoms provision on “conscience and religion,” he writes (emphasis his):

That’s an explicit and enumerated right.

If that right is to retain any heft, Catholic and other religiously-affiliated institutions should promise to close their doors before buckling under to the boot of the state.

That would leave Canadians with a choice: Do they want more good hospitals available, some of which won’t allow euthanasia, or would they prefer fewer facilities all of which willingly allow homicide.

Progressives’ political calculation on such matters puts morally traditional institutions in a difficult position.  The progressives rightly understand that Catholics (for instance) engage in these activities because we feel called to do so in order to help others and because we understand that only a visible light can attract wanderers (i.e., only public behavior can attract converts).

As a strategy, therefore, the Left seeks to corrupt those activities or to drive Catholics out.  We can keep doing them, but only if we continue to shrink the observable difference between our practices and those of the secular world.  As Smith’s example illustrates, the preferred method is to further make Catholics do things that seem to prove some teaching or other of the Church’s negotiable.

The other option is for traditionalists to do as Smith suggests and close up shop.  Such an action, while powerful as a threat, also opens us to the accusation that we care about some controversial social policy more than helping people, including clients, employees, and communities.

Unfortunately, we’re getting to the point that this is the better option.  The tests will become harder and the demands for compromise more thorough and more forceful.  If we’re to salvage the principles that define us, moving sooner is better than waiting for resistance to become even more difficult.

That doesn’t mean going about our lives, though.  It means moving back a step and making the charitable activities more fundamental.  Take the lesson of Saint Teresa of Calcutta.  If Catholics can’t operate a hospital, per se, then we should find some way to help those whom hospitals won’t take or for whom they can’t do anything.  We should go out in the community and help people to do such things as keep them out of hospitals, and so on.

That is, if we don’t replace charitable occupations with some other activity of life, but with more charity, it will be clear that we didn’t choose our pro-life, pro-marriage, or pro-whatever stance over helping people, but were pushed away from doing more good because progressives have made society into a moral trap.

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Health Care Farther Along Our Path

This every-parent’s-nightmare story out of Venezuela brings to mind my fears when the forces of big government make a gain in the United States, as they did with ObamaCare:

Two surgical residents sterilized a used needle and injected Ashley with anesthetic. It took them half an hour to clean and drain her knee. They had become experts in the procedure over the summer, as more children come in with complications from simple injuries. The only thing unique about Ashley was how well-fed she seemed; healthy enough to fight to save.

The family celebrated a week later as Ashley was able to breathe without her oxygen mask. Her fever was running below 100 degrees (37.8 degrees Celsius). With any luck, she would soon be back to dancing on her bed to music videos.

But the next day, the fever was inexplicably worse again, 102 degrees. By the end of the week, she was quaking under her Dora the Explorer sheets, drenched in sweat, with a fever of 106 (41 Celsius).

Ashley is three years old, and her months’ long ordeal resulted from the infection of a scraped knee and would have ended very differently without the effort of parents and an extended family scouring the region for hospitals and clinics with the ability and the remaining resources to help.  A basic medical machine that costs $100 in the United States meant hours of calls and searching.  Inadequate supplies of drugs turn into new complications, like the rare heart infection with the symptoms in the above quotation.

The United States is a long way from Venezuela, in its condition… or at least we can still reasonably believe that it is… but as we make decisions, we have to look farther down the slippery hill.  The shortages threatening children like Ashley are not the result of some natural disaster or disappearance of natural resources; they result from a lack of freedom and rule of law, preventing people from figuring out ways to produce or import products and services.  They are unnatural, and for the most part they result from a too-heavy reliance on government.

Add in the damage that Americans have done to family and community structures, and we may not have to fall as far as Venezuela before we find ourselves in our own nightmare stories.

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Refund or Redistribution from Neighborhood Health?

Something about news that Neighborhood Health Plan of Rhode Island’s $2 million in rebates to overcharged customers is nagging at me, but since it’s become so difficult to find contacts for data inquiries in this area, I’ll just describe the question.  Here’s the basic story:

Refunds are mandated by the Affordable Care Act for policyholders whose health plans did not spend at least 80 percent of their premiums in a given calendar year on doctors, hospitals and other health care services or activities to improve healthcare quality. That leaves 20 percent for salaries, bonuses and other administrative expenses.

Because Neighborhood was essentially a Medicaid processor prior to the government’s need for easily controlled insurance providers who would make it look like customers actually had a choice through HealthSource RI, the state’s ObamaCare health benefits exchange, the organization didn’t have much experience from which to determine what to charge its new government-mandated customers.  So, it overcharged for its plans, which is also why the insurer requested a premium decrease in the upcoming year.

But here’s the thing:  Neighborhood is the lower-end provider covering 49% of all “paid” customer plans for an exchange on which 88% of plans are subsidized.  The question is, therefore, how much of this $2 million in rebates is going to Neighborhood clients because taxpayers gave the insurer too much?

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Two Steps Down Our Health Care Road

It sure was good of the British to embark on socialized medicine some decades ago.  If Americans were inclined to learn lessons from failed left-wing experiments, then this would be a great one:

Hospital leaders in North Yorkshire said that patients with a body mass index (BMI) of 30 or above – as well as smokers – will be barred from most surgery for up to a year amid increasingly desperate measures to plug a funding black hole. The restrictions will apply to standard hip and knee operations. …

Under the latest restrictions, patients in the catchment area who have a BMI of 30 or more will be barred from routine surgery for non-life-threatening conditions for a year, although they may secure a referral sooner if they shed 10 per cent of their weight. …

Smokers who refuse to quit will have planned operations postponed for six months, but may be included on surgeons’ waiting lists earlier by proving they have given up for at least eight weeks.

From this point, the argument could go in multiple ways.  “Why should we all finance the bad behavior of some people?” To which others might respond, “Who gets to pick these particular bad behaviors rather than, say, promiscuous sex?”  Alternately, “Are you saying that wealthy obese people should be able to buy knee operations while poorer people can’t get life-saving treatments at the same cost?”  To which the response might be, “Doesn’t this zero-sum game only arise because government has taken over the industry?”

The more immediate observation, though, is that progressives never seem to want us to get to these central questions until they’ve changed the system in their favor.  Prior to passage of ObamaCare, they proclaimed it a lie that the law might lead to panels that choose who gets operations and who doesn’t.  It will only be after the system is such that almost everybody is dependent on government for health care (or at least believes as much) that we’ll be permitted to have the discussion of whether government control is worthwhile with this as one of its consequences.

But that’s what puts the “progress” in “progressive”: One suspects they know what the end game looks like, but they want to ensure that the rest of us “progress” along convenient stages of finding out.

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Reed, Whitehouse Hope Rhode Islanders Don’t Pay Attention

Leave it to our own Democrat Senator Sheldon Whitehouse to weigh in on the recent price increase of the EpiPen in a way that is both blindingly insidious and enlightening:

The sky-rocketing cost increase of the EpiPen is just the latest evidence that our regulation of prescription drug pricing is broken. (The) system is rigged by the pharmaceutical industry to allow this price-gouging, and that is what needs to be corrected.

Drug pricing doesn’t have to be regulated; it’s regulation of drug production that’s the problem.  Everybody from The Guardian to the Wall Street Journal knows that the pricing of the EpiPen is made possible by the government’s enabling of Mylan’s “near monopoly” (as Whitehouse and other senators characterize the company). A Wall Street Journal editorial explains:

… the steady Mylan rise is hard to read as anything other than inevitable when a billion-dollar market is cornered by one supplier. Epinephrine is a basic and super-cheap medicine, and the EpiPen auto-injector device has been around since the 1970s.

Thus EpiPen should be open to generic competition, which cuts prices dramatically for most other old medicines. Competitors have been trying for years to challenge Mylan’s EpiPen franchise with low-cost alternatives—only to become entangled in the Food and Drug Administration’s regulatory afflatus.

Of course, when I write “everybody,” I’m limiting my set to those who are modestly well informed.  A little economic understanding helps, too.  Let me repeat something I write regularly: Prices are measurements of value.  If a price goes up a great deal, especially if it does so quickly, that means people want more of the product than they’re able to get, and it’s a signal to other producers that they should enter the market, even at great expense.

Immediately after a devastating hurricane, it may seem predatory for people with chainsaws and water bottles to charge super-high prices, but their doing so not only forces affected families to weigh the value of the assistance, but also sends a signal far and wide that it’s worth people’s time to invest in tools, supplies, and gasoline and travel to the affected spot.  Of course, as a moral matter, we should all approach such situations in a spirit of charity, but by the same principle, we shouldn’t stroke our own moral vanity by insisting that only those with the right intentions can help.

In the case of pharmaceutical gouging, the focus of Congress should really be on creating laws that require smarter, lighter handed, less capricious regulation and therefore allow more companies to offer comparable products at competitive prices.  Unfortunately, it’s so much more profitable for progressive politicians to empower unaccountable bureaucracies to manipulate the market and create “near monopolies” that make the politicians’ corporate friends and donors rich and allow the politicians to posture in meaningless poses while grabbing more power to repeat the process.

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