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Regunberg’s Drug Innovation Disincentive Act

Barely out of the gate in the new legislative session, progressive Democrat Representative Aaron Regunberg of Providence is proving exactly how dangerous he is to the health and well-being of Rhode Islanders:

The bill (2018-H 7042), which Representative Regunberg introduced Jan. 3, would establish a board of pharmacy to examine how prescription drug manufactures set the price for certain prescriptions, and give it the authority to set a maximum allowable price to protect the Rhode Island consumers.

The price-fixing scheme would give nine unelected board members, most of them pharmacists with a financial interest in the industry, deep access to the private information of drug companies and the power to set prices for drugs — particularly those that are among the most innovative and life changing — below the level that companies believe necessary to make it worthwhile to develop more.

There is no reason to expect pharmacists to understand every aspect of drugs’ production and sale generally, let alone the internal operations of a particular company.  If companies are forced to justify pricing decisions to Rhode Island’s socialist-nine board members and beg their indulgence, the potential for corruption is immense.  If the members are cycled out every three-year term, then they’ll lack a long-term perspective, but if they’re kept on the board for much longer, they’ll become less accountable.

The minimum price for a drug in the state will always be zero… in the sense of being unavailable.

Given the critical nature of its products, our health care market does need controls against price gouging, but we should go the route of reform and competition, not the philosophy that has brought Venezuelans into the gutter.  Reform patent laws, giving generic drug manufacturers more opportunity.  Take the thumb off of insurance companies so they’ll have more leverage against drug companies.  Take the restrictions off of health care providers and consumers so they’ll have leverage to shop around for drugs, insurers, and types of treatments.

Above all, Regunberg’s bill illustrates how close we are to the end game of government control, and that’s an extremely unhealthy place to be.

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The Necessary Schemes of the Government Plantation

Red Jahncke describes one part of the government plantation funding strategy:

… 42 states tax hospitals. Why? One answer is the perverse incentives built into the Medicaid law. When a state returns tax money to hospitals through Medicaid “supplemental payments,” it qualifies for matching funds from Washington. Connecticut hospitals will pay $900 million in taxes, but the state will offset that with $600 million in supplemental Medicaid payments—matched with $450 million of federal funds, meaning Hartford comes out ahead in the whole scheme by $750 million. Nice work if you can get it.

As Jahncke closes his essay by suggesting, if government wants to do this, it should be straightforward about it. The problem is that, increasingly, the business model of government is to seek people to whom to provide benefits or services and then find ways to make taxpayers at all levels of government pay for it.  If the wealth transfer were more obvious, then the people paying the bill would more quickly decline to do so, especially for those portions funded across state lines by the federal government.

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Pawtucket Senators’ Wrong Focus

Yesterday, the Rhode Island state senators who cover Pawtucket put out a press release (which does not appear to be online):

The Pawtucket delegation to the Rhode Island Senate today expressed their profound disappointment at the closure of Memorial Hospital, effective January 1, 2018. They had taken many steps to avoid the closure. Earlier this year, they won enactment of legislation they sponsored to facilitate the hospital’s sale. When negotiations for the sale of the hospital broke down, they implored the Department of Health to reject the closure plan and laid out potential steps forward that could keep medical services in the community. …

Senator Nesselbush (D – Dist. 15, Pawtucket, North Providence) said, “For more than a century, Memorial has been relied upon by the people in our community for affordable, quality health care. The detrimental impact of Memorial’s closure is substantial to us in the community. We are grateful for the attempts being made by the Department of Health to address some of the unique challenges associated with the closure, but remain concerned that nothing can replace the accessible care we have come to know and expect at Memorial.”

Rhode Island needs its legislators to stop trying to maintain the status quo in the face of the state’s deterioration.  Want to maintain a vibrant medical offering in your community?  Then stop trying to find ways to restrict people and business and start trying to free them.  Take restrictions off of medical providers and insurers specifically and businesses in general.

Not only will providers be able to make a profit, but the economy will revive and the tide will start coming into the Ocean State, rather than inexorably sliding away. A state that sees itself as mainly serving the people who need services will find fewer and fewer people willing to constrain their ambitions — their lives — in order to pay the bills but be unserved.

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Life Expectancy and Drug Overdose Deaths Don’t Fit the Identity Politics Narrative

The headline that the Providence Journal gave to a Washington Post story, “Fueled by drug crisis, US life expectancy declines for a second straight year,” hides the key point:

Overall, life expectancy dropped by a tenth of a year, from 78.7 to 78.6. It fell two-tenths of a year for men, who have much higher overdose death rates, from 76.3 to 76.1 years. Women’s life expectancy held steady at 81.1 years.

American women now have five full years of additional life, on average, than American men.  You better believe that if the sexes were reversed that would be not only the headline, but a theme for national coverage everywhere for a week.

Looking at a leading cause of the change only amplifies the point:

Men of all ages (26 deaths per 100,000) are twice as likely to die of a drug overdose as women (13 per 100,000).

In Rhode Island, where female Democrat Governor Gina Raimondo hosts an annual student contest that discriminates against boys, the number of overdose deaths among men is almost three times that of women:

RI-overdosebysex-2009-2016

 

The most important antidote to drug use and overdose isn’t a government program, it’s hope.  Unfortunately, that’s only a word on our flag in Rhode Island.

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The Market Will Produce a “Comfortable Default”

Fred Schwarz makes a point that unfortunately appears to be accurate:

One reason that conservative health-care schemes are less popular than we’d like is this: They assume that what Americans want is choices, when in fact what most Americans want is a comfortable default. The same goes for school choice, even in otherwise conservative areas. New York City has a vast number of options for schooling your kids — large, small, public, private, parochial — and I have yet to meet parents who consider it anything but a burden. Customizing health insurance and education options is like customizing Microsoft Word — yes, that little elevated “th” every time you type an ordinal number is annoying, but hardly anyone bothers to fix it. That’s why people say they like their employer-provided health insurance: It’s not because of the benefit structure or the customer service, but because you don’t have to do anything to get it; it’s just there.

There are caveats.  As I’ve written before, the availability of school choice in Vermont is associated with higher property values, for example.  We shouldn’t be surprised if New York City is a somewhat unique circumstance; throughout most of the country, the options will be more manageable than in the most bustling metropolis on the planet.

Similarly, support for conservative health care policies might improve if they’re explained (accurately) as allowing for just the “comfortable default” that people tend to want.  That’s the beauty of conservative reliance on the market.  Policy wonks may make the public feel like they’d be facing an incomprehensible maze of options, because that’s what excites wonks, policy but in the absence of overwhelming government regulation, the market will provide simple options, too.

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General Assembly and Projo Editors Show Nurses Who Owns Them

Don’t miss Jennifer Bogdan’s article in the Providence Journal, about the hassles that the State of Rhode Island created for nurses in the state by failing to pass legislation to remain in the interstate Nurse Licensure Compact, which allowed nurses in any of the 25 participating states to carry use licenses across borders.

…  a bill was never even introduced in last year’s General Assembly thanks in part to strong resistance from nurses unions that argue the compact has deprived Rhode Island nurses from opportunities to work here.

The situation has left local nurses who pick up out-of-state work scrambling to quickly acquire other state’s licenses. Meanwhile, out-of-state nurses currently working in Rhode Island under the compact are flocking to the Department of Health with their $139 applications for Rhode Island licenses in tow.

Donna Policastro, executive director of the Rhode Island State Nurses Association, which supports the compact, said she’s been fielding calls from concerned nurses who’ve learned about the change. In one case, a nurse is working from home advising for a national company in 16 states. The woman now needs 16 additional licenses.

The Projo’s editors did Bogdan a huge disservice by recasting her article — completely inverting both the angle of the story and the significance of recent events — with the headline, “Unions: Compact deprives R.I. nurses of work.”  The bias of the headline writer is apparently so deep that he or she created the false impression that there is currently a compact in effect in the state.  The headline should have been something like, “Nurses scramble for licenses after state quits compact.”

More important, though, is the lesson on our relationship with our government.  Think of it:  These folks, mainly women, have to beg the General Assembly to keep their jobs possible every year, and this year, the unions managed to brush them aside to ensure more-total ownership of our lives in the Ocean State.

None of this should be acceptable, across the board.

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ObamaCare’s Injustice and Millennials’ Position

Tom Rogan makes a point I’ve articulated before on the injustice of ObamaCare to the young:

The key problem takes root in Obamacare’s creation of an artificial price-premium on younger, healthier Americans. Obamacare imposed a 3:1 price ratio, which meant older Americans could only be charged three times the insurance premium of younger Americans. The problem with this regulation is that it has forced younger Americans to pay absurd premiums to unjustly subsidize their elders. And be under no illusions, this state of affairs is morally unjust.

It’s not just that older Americans have higher earnings and the potential to have saved more for their health needs, it’s that older Americans are about to get a great health deal anyway. Consider, for example, that the average Medicare recipient now receives three times more in lifetime out-payments from the government than what they paid into the program. Why shouldn’t near-Medicare age Americans be forced to pay a more proportionate cost for their healthcare?

Keeping young adults on their parents’ insurance until they’re 26 distributes the burden onto middle-aged, mid-career parents (while also reducing their kids’ incentive to take those first wobbly steps into full adulthood and out from under the comfort of their parents’ household budgets).  Then young, early-career adults get hit with the cost.  The beneficiaries are generally wealthier folks at the ends of their careers or in early retirement who are about to gain access to a government Ponzi scheme that, as Rogan notes, GenXers and younger generations are unlikely to enjoy.

It’s a testament to the power of mainstream propaganda and government school brainwashing that Millennials are understood to be progressive followers of the Left-Democrat line.  But for four years or so, I could count myself a Millennial by some definitions, so I’m largely in the same boat as they are, and I’d insist to them that they’re being scammed.

Partisans flatter them with proclamations about the power of their voice and all that, but those same partisans understand that Millennials’ voice is even stronger in the market.  That’s why progressives have invested so many resources attempting to convince them that morality and fairness require them to rely on Big Brother government.

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The Mystery of the UK Health System’s Urge to Kill Children

Once we hand the power over life and death to bureaucrats, their standards will evolve, especially when that power is paired with inherently limited budgets.  On National Review Online, Wesley Smith observes the socialized health system of the United Kingdom progressing its logic after the Charlie Gard case, in which the government forbade parents from giving an American specialist a shot at saving their terminally ill infant’s life (emphasis in original):

Well, it is happening again–except in this case the baby isn’t terminally ill but has been unconscious for a year. Moreover, as  I wrote here previously, there isn’t even a diagnosis as to the cause.

An Italian children’ hospital has offered to take the child as a patient for further inquiries and treatment. But the UK hospital administration and doctors are not only saying NO, but as in the Charlie Gard case, also seeking a court order allowing them to withdraw life-sustaining treatment.

As horrific as such stories may be, one could sort of understand the logic of declining treatment, beginning with different principles and assumptions.  The component that’s inexplicable is the refusal to allow transfers.

Smith thinks these are examples of the exercise of raw power, and perhaps there’s some of that.  I wonder, though, if the more human answer isn’t something more like insecurity.  After all, if a child dies, then the experts can insist that they were right and that nothing could have been done, except to cost the government money and perhaps the child discomfort.  If, however, any of these parents succeed in transferring their children out from under the government’s thumb and the child thrives, the doctors will have the discomfort of having been proven wrong on a matter of life and death and trust in the entire system could collapse.

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Government Good Intentions Edge in on the Family

Breakfast in school for lower-income children is not a public policy that many people are inclined to spend time arguing against, this author included.  That said, something in Bob Plain’s RI Future article promoting the program is worth highlighting:

Too many schools in Rhode Island are leaving federal money on the table when it comes to providing free breakfast to their students,” said Governor Gina Raimondo, who recently visited Veazie Street Elementary to draw attention to its breakfast program. “We know students can’t do their best work if they’re hungry.”

We should be careful not to lose the distinction between two things in the governor’s statement:

  1. Students who are well fed do better in school.
  2. Schools are missing out on money.

While I’ve forgotten the details, I recall from local discussions some years ago that districts can make their food programs into a bit of a profit center.  On the money front, the range goes from a well-intentioned effort to secure funding in order to feed children who otherwise wouldn’t be fed to a more-cynical plan to maximize money for the district for whatever purposes districts use money (mainly personnel).

Wherever a particular advocate or school district falls in that range, however, we ought to spare some sensibility to be shocked at something that is never mentioned in this context.  Nobody appears even to think of the possibility that some of the students for whom districts could collect money are adequately fed at home and that, by pushing the program, the government is pulling children away from a potentially family-boosting interaction.  At the very least, they’re transferring some of the child’s sense of who provides for him or her from the parents or guardians to the government.

We see this with government-subsidized child care.  On average, studies suggest that students receiving such care perform worse, particularly in behavior, and one explanation is that they draw children into a classroom setting instead of leaving them with parents, grandparents, or other individuals with direct relationships with the children.

We’re far too cavalier about the potential side effects of using government as a cure.

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From Mercy Killings in Hard Cases to Death on Demand

Fortunately, this hasn’t been much of a topic of conversation in Rhode Island (yet):  Wesley Smith describes how…

Once a society generally accepts killing as an appropriate response to suffering, there are few limits to the kind of “suffering” that will qualify for extermination.

The Netherlands shows the danger.  Permitted in a decriminalized form since 1972–and formally legalized in 2002–euthanasia deaths are skyrocketing.

Because it hasn’t been of immediate relevance at the level of news to which I devote most of my attention, I haven’t completely worked through my thoughts on assisted suicide.  As tends to happen with emotional matters that are closely tied to ideological or religious beliefs, people typically focus on the extreme cases that align with their first reactions.  On one end is the person facing an imminent and horrible death who wants to take his own life.  On the other end is a doctor having family members hold down a woman who wakes up and resists being killed.

So, one axis in a multidimensional spectrum could address such circumstances of each case, including degree of suffering, permanence of the condition, and imminence of natural death.  Another axis would be the degree of assistance, ranging from none at all through offering advice through the provision of supplies all the way to execution with dubious consent.  There may be other axes to consider.

According to my beliefs, nothing on this field is moral, but that does not necessarily mean everything must be criminalized and vigorously enforced.  In that regard, I find yet more reason to regret how integral we’ve allowed government to become.  To the extent that libertarians can cite an expansion of individual liberty, it seems always to be in these areas of personal destruction, which is to say when libertarians find common cause with progressives.

If government weren’t involving itself in the question of children’s lemonade stands, we mightn’t feel as compelled to write a policy on the tougher moral disagreements.  Similarly, if the fine details of employers’ insurance benefits weren’t up for national policymakers, so too might states and localities be able to draw different lines on other issues.

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