Archive for September, 2009
A Consumer’s Look at Health Care
Michael Tanner and Michael Cannon have been doing an excellent job exposing the fallacies and misconceptions of Obama’s proposal to further expand government intervention in the health-care sector. One of their challenges is explaining to people that many of the problems that currently exist are the fault of government.
For instance, I went for my annual checkup today (though “annual” is a slight exaggeration since I went 35 years without a checkup and this is just my second visit in the past 3.5 years). As I dealt with a blizzard of paperwork at the doctor’s office, I realized that this was just the beginning of a tedious process. At some point in the next few weeks, I’ll receive incomprehensible statements from my insurance company, followed by similarly indecipherable bills from the doctor. And since I also went down the hall to a different office for my blood test, I suspect I’ll have two statements and two bills — neither of which I’ll have the energy to figure out (though I shouldn’t complain too much since I once went to a local clinic after spraining my ankle playing basketball and somehow had to deal with three separate bills).
I’m guessing that this type of experience is one of the reasons why Americans express some degree of unhappiness with our current system — especially when they wind up having to write a check and suspect that their insurance company is squeezing them in some unknown way.
But how many people realize that this bureaucratic process is the result of government interference? For all intents and purposes, social engineering in the tax code created this mess. Specifically, most of us get some of our compensation in the form of health insurance policies from our employers. And because that type of income is exempt from taxation, this encourages so-called Cadillac health plans. This seems great, at least on the surface, but now let’s consider the unintended consequences.
We have replaced (or at least augmented) insurance with pre-paid health care. Insurance is supposed to be for unforeseen major expenses, such as a heart attack. But our gold-plated health plans now mean we use insurance for routine medical costs. This means, of course, we have the paperwork issues discussed above, but that’s just a small part of the problem.
Politicians Standing in the Way of Data Destruction
There is no better security for data than not collecting it in the first place. And when data is no longer needed, the best security for it is to destroy it.
That’s why I was surprised to see a request from the chairman and ranking member of the House Homeland Security Committee asking the Transportation Security Administration to preserve data that is scheduled for destruction.
Chairman Bennie Thompson (D-MS) attended and spoke at the first meeting of the DHS Privacy Committee four years ago. I have regarded him as a champion of privacy since then. But he and Rep. Peter King (R-NY) want biometric data collected for the defunct Registered Traveler program preserved on the chance that Registered Traveler is revived. This is an inappropriate request.
Anyone who submits data to the government should recognize the risk that it will be preserved longer than promised and put to new uses. There were merits to the Clear system within Registered Traveler. I wrote about them in my book and testified about them in 2005. One of the serious demerits is that Registered Traveler created stores of biometric data that politicians are now trying to control.
The Coast Guard Kerfuffle: Normalcy Breeds Overreaction
Terrorists are weak actors who use violence to induce overreaction on the part of their stronger victims. That lesson was on display today when someone overhearing radio traffic from a routine Potomac River Coast Guard exercise misinterpreted it and alerted the media. Among the results was a 20-minute grounding of planes at Reagan Airport.
The good news is that the country is relatively safe. Americans and the national security establishment are tuned to the threat of terrorism. No attack to rival 9/11 ever occurred, and it’s unlikely that one ever will.
But the 9/11 attacks had a dastardly effect. To match the results of those attacks, we imagined that terrorists had outsized technical skills, support networks, and insights. Vigilance and continued antiterror efforts will ensure that they never do.
The bad news is that the government has never issued any reassuring signals. American society remains on edge and predisposed to overreact when something happens and — in this case — when nothing happened. The “scare” produced by the Coast Guard exercise illustrates how sensitive the country remains to terror fears.
Despite improved rhetoric and the promise of sensible, strategic counterterrorism, the Obama administration has yet to give the country confidence in its security. It has not articulated its counterterrorism plan and it has not created or implemented a terrorism communications plan. Unlike health care and education, these are responsibilities of the federal chief executive.
Without a strategy and communications plan in place, the administration will be at a loss to keep the nation on an even keel if and when any real terror incident occurs. The Obama administration must plan, and must be seen as having planned, if it is to prevent any future terrorism event from needlessly harming the country with panicky overreaction.
Based on what I’ve read, I see no fault in what the Coast Guard did, and I hope their review of the incident produces no changes in their procedures other than perhaps better preparation to quell overreaction.
Weekend Links
- Jack of all trades and master of none: What happens when the government gets so big that it fails to fulfill its most important role.
- The hard truth about end-of-life care in America.
- If current trends continue, the U.S. government will soon spend a greater portion of GDP on Medicare and Medicaid than Canada now spends on its entire single-payer government-run system. Here’s a way to fix that.
- How about a little honesty from time to time in the tobacco policy debate?
- More drug-related chaos along the Mexican border.
- Go North Young Man! Will Wilkinson becomes “forever Canadian.”
Afghanistan Debate Starting
Gen. Charles C. Krulak
George Will’s excellent op-ed piece on Afghanistan may be forcing a debate over the role of counterinsurgency/armed nation-building as a component of American grand strategy.
Yesterday afternoon, the Small Wars Journal, a counterinsurgency blog, posted an email sent to Will by Gen. Charles Krulak, the 31st Commandant of the Marine Corps (.pdf). Krulak wrote that he was “in total agreement” with Will’s views, and wrote that “no desired end-state has ever been clearly articulated and no strategy formulated that would lead us to achieve even an ill defined end state.” Krulak concluded by urging that Will not to “be dismayed by the people who disagree with you. There are many retired and active-duty military who feel you hit the bull’s eye.”
Well.
Now LTC Paul Yingling has responded to Krulak, accusing him of advancing “incomprehensible” views and claiming that Krulak’s proposed “light footprint tactic has failed for the last eight years.” To which I would respond: “failed to do what?” Failed to create a functioning modern state in Afghanistan? Well, fair enough. But it’s by no means clear that our foreign policy must be targeted at creating such a state. In fact, if the ends of our foreign policy are to ensure the safety and security of the American people and the defense of the Constitution of the United States, it’s far from clear that we have “failed” in Afghanistan.
There is now a reasonably heated debate raging in the comments section to Yingling’s response, with Col. Gian Gentile and others advancing the argument that Yingling and others are mired in “the tactics, methods, principles, and catechisms of population centric counterinsurgency” while ignoring the much-more-important subject of strategy.
To the extent that Krulak’s email can bring into the debate those retired (or even active-duty) military officers who believe we’ve run off the rails, it may be a very important contribution. At this point, those who support the current approach have felt it right to participate in this debate, adding their voices to those of the civilians who are promoting the strategy. (Occasionally these people claim they are merely promoting the “doctrine,” and that their views do not bear on the debate over strategy. This is not persuasive.)
If Krulak is right in claiming that “there are many retired and active-duty military” who agree with George Will, it would be good to start hearing more from them.
Even Arianna Huffington Supports Private School Choice
Arianna Huffington — yes that Arianna Huffington — wrote an interesting article this week reiterating her support for private school choice.
I’d just like to say thanks for opening fire from the left on this issue. Unfortunately, Arianna supports a federal, single-payer voucher system, and there are a few problems with that approach.
Let’s start with feasibility. Vouchers are controversial at the state level, and they would be even more so at the federal level. Current funding is mostly through state and local taxes, so — as Huffington notes — a new federal tax would be required. A federal voucher program is, thankfully, extremely improbable.
In fact, even state-level vouchers are less preferable than education tax credits.
Education tax credits are less controversial and more popular than vouchers. A recent poll from Education Next found an astonishing 57 percent of public school teachers support tax credits. Only 26 percent support vouchers.
Wichita Witch Hunt
That’s the only appropriate term for the investigation of pain relief advocate Siobhan Reynolds. She is the widow of Sean Greenwood, a victim of a debilitating connective tissue disorder.
Greenwood’s doctor, William Hurwitz, prescribed the medicine that allowed him to function in spite of the condition until Hurwitz was indicted in 2003 for “illegal drug trafficking.” Greenwood could not find another doctor to prescribe his medication; doctors had been bullied into submission by vague federal statutes and aggressive prosecutors. Greenwood died three years later of a brain hemorrhage, likely brought on by the blood pressure build-up from years of untreated pain.
Siobhan Reynolds founded the Pain Relief Network, highlighting the plight of those afflicted with debilitating conditions who are unable to get the appropriate pain medication because of federal anti-drug efforts that make targets of doctors and patients alike.
The U.S. Attorney’s Office in Wichita, Kansas, indicted physician Stephen Schneider and his wife, Linda, a nurse, for illegal drug trafficking in December 2007. Reynolds found an eerie parallel between Schneider’s case and the prosecution that denied her husband pain medication, so she took action. Her public relations campaign on behalf of Dr. Schneider so annoyed Assistant U.S. Attorney Tanya Treadway that Treadway sought a gag order to bar Reynold’s advocacy. The presiding judge denied the gag order.
Now Treadway is investigating Reynolds for obstruction of justice. She has subpoenaed Reynolds and the Pain Relief Network for communications pertaining to the Schneider prosecution, and Reynolds is now being fined $200 a day for not complying with the subpoenas.
Ohhhhhh! That ‘NEA’
Imagine my confusion when I saw this article summary in my inbox this morning: “Official Leaves NEA After Suggestions That He Used Agency To Further Obama Agenda.”
Uhhh, I thought to myself, the NEA has given 93% of its $30 million in federal political contributions since 1990 to Democrats, so wouldn’t somebody there get fired for NOT furthering the president’s agenda?
It turns out, there’s some other NEA that does something else. Phew! Apocalypse not on horzion after all.
Dalmia on Obamacare Speech
Reason Foundation’s Shikha Dalmia offers a colorful visual in her take on President Obama’s health care speech:
For several months now, the American people … have been standing athwart the Democratic agenda of socialized medicine, yelling, “Stop!” But President Barack Obama showed them the policy equivalent of the middle finger Wednesday night.
If there was anything bipartisan about the speech it was that he embraced every bad big-government idea from both sides…
Perhaps the most striking — and disturbing — thing about the speech was the unblinking confidence Obama exuded while breaking key campaign promises he made to voters. He had raked poor Hillary Clinton over the coals for admitting that her road to universal coverage was paved with an individual mandate. “Everyone would be forced to buy coverage, even if you can’t afford it,” warned Obama in an ad. “You pay a penalty if you don’t.”
Yet, there he was last night scolding “individuals who can afford coverage but game the system by avoiding responsibility”…
The one Republican idea that Obama did endorse — caps on medical malpractice awards or tort reform — will actually hurt rather than help patient choice. Big medicine has long blamed the unnecessary tests and procedures these awards encourage for rising health care costs. But several studies have shown that this so-called practice of defensive medicine is a smaller driver of costs than excess physician salaries. By capping these awards, Obama will leave patients even less recourse against physician negligence — hardly the American way.
Obama lambasted the critics who claim his reform plan amounts to a government takeover of the health care system. But the plan he laid out Wednesday night will control every aspect of the medical transaction. It will tell patients when, what and how much coverage they must buy; it will tell sellers when, what and how much coverage they must sell. This is not a government takeover of health care? Then Tony Soprano is just a decent, hard-working businessman.
You had me at “middle finger.”
Preventive Detention: What Would Thomas Jefferson Do?
By all accounts, the White House is going to unveil its proposal for indefinite detention within the next four to eight weeks, and it has begun dispatching proponents of that scheme to lay the rhetorical groundwork. In The Washington Post today, one of the proposal’s architects — Law Professor Robert Chesney, a member of Obama’s Detention Policy Task Force — showcased the trite and manipulative tactics that will be used by advocates of indefinite detention to win support for their radical program [anyone doubting that detention without trials is radical should recall that Obama's own White House counsel Greg Craig told Jane Mayer back in February that it's "hard to imagine Barack Obama as the first President of the United States to introduce a preventive-detention law"; New York Times reporter William Glaberson wrote that "Obama's detention policy "would be a departure from the way this country sees itself"; Sen. Russ Feingold warned that it "violates basic American values," "is likely unconstitutional," and "is a hallmark of abusive systems that we have historically criticized around the world"; The New York Times' Bob Herbert said that "Americans should recoil as one against the idea of preventive detention"; and the Obama policy's most vigorous Congressional proponents are Tom Coburn and Lindsey Graham].
According to Chesney, though, the real extremists are those “on the left” who oppose preventive detention; those who believe that radical liberties such as criminal charges, trials and due process are necessary before the state can put someone in a cage for life; those who agree with Thomas Jefferson that trial by jury is “the only anchor ever yet imagined by man, by which a government can be held to the principles of its constitution.” Chesney insists that such people (these “leftists”) are (as always) the mirror images of the extremists on the Right, who “carelessly depict civil-liberties advocates as weak-kneed fools who are putting American lives at risk.” These two equally partisan, radical, extremist sides (i.e., those who believe in due process and trials and those who oppose them) are — sadly — “shrink[ing] the political space within which reasonable, sustainable policies [i.e., Chesney's preventive detention scheme] might be crafted with bipartisan support.”
…This is how political debates are typically carried out in Washington by the Serious Centrists and Responsible Adults. Chesney writes an entire Op-Ed defending the soon-to-be-unveiled preventive detention policy without describing a single aspect of it. To Serious people, the substance of the policy is irrelevant. What matters is that anyone who opposes it is a radical, partisan, shrill extremist. Conversely, as long as the Obama administration stays somewhere in the middle of the two sides — between Tom Coburn and Russ Feingold — then it proves they are being sensible, moderate and responsible, regardless of how extreme and dangerous their proposal actually is, and regardless of how close to Coburn and as far from Feingold as they end up.
No system of justice is perfect. But it’s no improvement to decide that in certain cases we can just do better without one.
All that such a policy does is to move the act of judging back one level — and to locate it at the point where someone, somewhere decides that this particular case doesn’t get judged in the usual way. And so the accused gets “detention” rather than “trial, followed possibly by prison.” But we are still putting a person, and perhaps a dangerous person, in a cage, are we not? The acts of judging and of punishing are still there, and we have hidden them only from ourselves.
It is no improvement to shift the fundamental problem of justice to a different location — out of open courtrooms, out of review, out of established legal tradition — and into a shadowy realm where potentially anything goes. We’re deluding ourselves if we think that it is a step forward or a refinement in the criminal law to have its work done somewhere else, by someone else. The work goes on, and with it all of the associated dangers. Western legal philosophy has spent centuries forcing these dangers out into the open, so that we may confront them directly.
But oddly, Professor Chesney is actually right in one respect:
The problem is twofold. First, the national dialogue has been dominated by a pair of dueling narratives that together reduce the space available for nuanced, practical solutions that may require compromise from both camps. On the one hand, critics of the government’s policies promiscuously invoke the post-Sept. 11 version of the Imperial Presidency narrative, reflexively depicting security-oriented policies in terms of executive branch power aggrandizement (with de rigueur references to former vice president Dick Cheney; his chief of staff, David Addington; or Justice Department attorney John Yoo, if not all three). On the other hand, supporters of the government’s policies just as carelessly depict civil-liberties advocates as weak-kneed fools who are putting American lives at risk.
Second, individual issues in the debate over detention policy are often framed in stark and incompatible terms. Take, for example, the Guantanamo detainees, who are portrayed in some quarters as innocent bystanders to the last man and in other quarters as the “worst of the worst.” While both extremes are misleading, their influence is pervasive.
True enough. A reasonable middle position? Give the detainees trials in which they can individually prove their guilt or innocence. Surely they aren’t all guilty, and I don’t believe I’ve ever seen anyone claim that they are all innocent, either. The truth really is somewhere in between, and it just so happens that we already have a mechanism for sorting out muddled cases like these.
Congressional Conflict of Interest
It looks like farm subsidy reform is unlikely for another few years. Senator Blanche Lincoln has been selected the new head of the Senate Agriculture Committee. Dow Jones notes: “Lincoln is a two-term moderate Democrat who described herself Wednesday as a ‘farmer’s daughter.’”
Lincoln has been “a tireless advocate for the Arkansas rice industry” and a “champion for agriculture.” You can see what 20 or so other agriculture lobby groups say about Lincoln here. These are very laudatory remarks, but what about the taxpayers? What do taxpayers think about her support for the $20 billion or so in annual giveaways to farmers?
I’m guessing that Lincoln will put the interests of subsidy-receiving farmers in her state ahead of the interests of the nation’s taxpayers, given that Arkansas ranks seventh out of the 50 states in terms of farm subsidies received yet has a small population.
This sort of pro-spending bias on committees is common across Congress of course. I’ve argued that one step toward getting the House and Senate to make to more rational and frugal trade-offs on spending would be mandatory random committee assignments every two years. It’s absurd that generally the only people overseeing farm programs are people who are in the bag for farmers. It’s an obvious conflict of interest.
It would be much better if we had one of the senators from, say, Rhode Island chairing the Agriculture Committee, because that state receives less farm subsidies than any other. A Rhode Island senator would be more likely to dispassionately balance the trade-offs of the $20 billion or so of pain imposed by taxes to support farm subsidies with the benefits of farm subsidies (if any).
Nobel Laureate James Heckman Responds to Cato Stimulus Analysis
I received a letter this morning from Prof. James Heckman, in response to my post on the impact of the education stimulus. Prof. Heckman does not take issue with my thesis, which is that the $100 billion in new k-12 spending will likely slow U.S. economic growth. This doesn’t mean that he necessarily agrees, but no doubt he is well aware of the relevant evidence and econometric analysis showing that higher public school spending does not raise student achievement, and hence burdens the economy with higher taxes while failing to boost human capital.
Instead, Prof. Heckman argues that “[t]he question is not whether we should invest in human capital, it is when and where we get the most value for our investment—and whether the facts will guide our decisions.” He adds that “we should not let partisan or ideological biases cloud the facts or obscure the obvious opportunities.”
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