Archive for the ‘Cato Publications’ Category
Innovation: the Most Important Kind of Health Care Reform
In the Orange County Register, I explain how ObamaCare would stifle innovations in health insurance and medical delivery:
Economist Glen Whitman and physician Raymond Raad found that, when it comes to basic medical sciences, diagnostics (e.g., MRIs and CT scanners), and therapeutics (e.g., ACE inhibitors and statins), the United States often produces more medical innovations than all other nations.
America’s health insurance markets are not following suit, despite the ready availability of innovations that can improve the delivery of care, insure the “young invincibles,” and provide secure coverage for the sick. Bringing those innovations to consumers requires tearing down regulatory barriers to competition — the very barriers that the Obama plan would stack higher.
Such innovations include comparative-effectiveness research, coordinated care, insurance policies that persuade the “young invincibles” to purchase coverage, and health insurance that comes with a total-satisfaction guarantee.
Filed under: Cato Publications; Health, Welfare & Entitlements
WWJC?
Or, whom would Jesus coerce? That’s the question that comes to mind when I read the Center for American Progress’ latest attempt to argue that, if Jesus were a member of Congress, He would vote for President Obama’s individual mandate.
I was raised Catholic, and I don’t remember Jesus teaching that we should put people in jail for not buying health insurance. As I recall, He let the priest and the Levite go their merry ways.
OK, technically all the CAP report claims is that the Obama plan is consistent with Catholic social teaching.
The authors invoke all the right Catholic doctrines: “human dignity, solidarity, special status of the poor … concern for the common good … stewardship.” Except they omit the Catholic doctrine of subsidiarity, which teaches that problems should be addressed at the most local level possible.
They left out what Pope John Paul II wrote about the welfare state in a 1991 encyclical:
By intervening directly and depriving society of its responsibility, the Social Assistance State leads to a loss of human energies and an inordinate increase of public agencies which are dominated more by bureaucratic ways of thinking than by concern for serving their clients and which are accompanied by an enormous increase in spending.
They sidestep the small matter of whether the legislation would actually force taxpayers to finance abortions, which Catholic doctrine teaches is the taking of innocent human life.
They note that “the Catholic Health Association is the largest provider of nongovernmental health care in the United States,” and the CHA has essentially endorsed the Obama plan. They do not mention the material fact that the CHA therefore depends on the government for much of its revenue, and is susceptible to retribution if it doesn’t play ball.
But I keep coming back to the absurdity of suggesting that using government coercion to achieve social change is the Christian thing to do. The authors do not channel Christ so much as Richard III:
And thus I clothe my naked villany
With old odd ends stolen forth of holy writ,
And seem a saint when most I play the devil.
Or to put it differently, they cast their lots with Caesar, not Christ.
Filed under: Cato Publications; Government and Politics; Health, Welfare & Entitlements; Political Philosophy
Weekend Links
- Michael Cannon exposes and corrects seven myths about the health care overhaul.
- The real problem with the American health care system: Nearly nine of ten medical dollars is paid in the first instance by someone else. When you don’t have skin in the game, there’s little incentive to keep costs down.
- GOP Reps say that most Republicans in Congress now think the Iraq War was a mistake.
- “In sheep’s clothing”…how to spot a politician who calls himself a libertarian, but is really just another conservative.
- Podcast: “Transparency Suffers in Health Care Fight” featuring Jim Harper.
Lawrence Lessig’s Constitutional Amendment
Lawrence Lessig has proposed a constitutional amendment in response to the U.S. Supreme Court’s decision in Citizens United. It reads:
“Nothing in this Constitution shall be construed to restrict the power to limit, though not to ban, campaign expenditures of non-citizens of the United States during the last 60 days before an election.”
In Citizens United, the Court said that the First Amendment concerns speech rather than speakers. Congress has no power to discriminate against speakers; hence, a source of speech – people organized as a corporation – could not be prohibited from speaking (or funding speech).
Professor Lessig hopes to introduce a discrimination among speakers into the First Amendment. His proposed discrimination will not lose a popularity contest. He wishes to allow Congress to control the speech of non-citizens. He follows two lines of argument in support of his amendment, one less rational than the other.
The less rational line of appeal to the reader is both implicit and predictable. The Chinese are invoked along with the Chamber of Commerce. A denial of xenophobic intent follows immediately, and “We the People” appear near the end. Carl Schmitt would recognize the rhetorical construction of “friend and enemy.” Rather cleverly, Lessig manages to equate the foreign devils with the internal demons of the liberal mind. Corporations (including the Sierra Club?) and the Chinese (or other foreigner) are on one side of political struggles while “We the People” are on the other.
Filed under: Cato Publications; General; Government and Politics; Law and Civil Liberties; Political Philosophy
An Important Defense of Citizens United
M. Todd Henderson of the University of Chicago Law School has a brief but important essay making the case for Citizens United. As they say, read the whole thing.
Filed under: Cato Publications; General; Government and Politics; Law and Civil Liberties; Political Philosophy
Yet. Another. Fraudulent. Cost Estimate.
House Democrats claim that a not-yet-released Congressional Budget Office report puts the cost of their revised health care overhaul at $940 billion over the next 10 years.
Though I have yet to see the CBO score, I’ll bet anyone a fancy lunch that it does not claim the legislation would cost the federal government just $940 billion from 2010 through 2019.
As former Congressional Budget Office director Donald Marron has explained over and over, the figure that Democrats consistently cite for the cost of their bills is only the CBO’s estimate of the cost of federal spending related to the expansion of health insurance coverage. It is not the full cost to the federal government, because each bill also spends taxpayer dollars on other items.
Marron examined the CBO’s March 11 score of the bill that passed the Senate on Christmas Eve, and found an additional $96 billion of spending over 10 years. If the most recent iteration of ObamaCare is similar, then new federal spending in that bill would be approximately $1.036 trillion — pushing the total over the president’s spending target.
Anyone care to take me up on that fancy-lunch wager?
Moreover, the on-budget costs of the legislation probably account for only 40 percent of the total costs. The other 60 percent come from the private-sector mandates. But Democrats have systematically suppressed any estimates of those hidden taxes, probably because such an estimate would reveal the full cost of the legislation to be closer to $2.5 trillion over the next 10 years.
It has been 272 days since Democrats introduced the first complete version of the president’s health plan. We still haven’t seen an honest cost estimate.
Filed under: Cato Publications; General; Health, Welfare & Entitlements
Would ObamaCare Improve Public Health? Probably Not.
George Avery is an assistant professor of public health at Purdue University. In today’s Daily Caller, Avery rebuts claims that the Obama health plan would improve public health:
The idea that health care contributes significantly to population health is both intuitively appealing and untrue….
In fact, federal “reform” often hurts the public health system. Both public health and health care experts have criticized Medicare and Medicaid, enacted by Congress in 1965, for changing the focus of health care practitioners from prevention to treatment….
Requiring all Americans purchase health insurance, which the current bills hope to do, would not address the underlying socio-economic issues at the root of most public health problems….
Indeed, access to health care can help individual patients, but can also aggravate some public health problems…. High rates of surgical intervention increase the risk and spread of drug resistant infections like MRSA.
Avery is the author of the Cato Institute briefing paper, “Scientific Misconduct: The Manipulation of Evidence for Political Advocacy in Health Care and Climate Policy.”
Filed under: Cato Publications; General; Health, Welfare & Entitlements
AP: Obama Misleads Voters about ObamaCare’s Effects on Premiums
Buyers, beware: President Barack Obama says his health care overhaul will lower premiums by double digits, but check the fine print…
The [Congressional Budget Office] concluded that premiums for people buying their own coverage would go up by an average of 10 percent to 13 percent, compared with the levels they’d reach without the legislation…
“People are likely to not buy the same low-value policies they are buying now,” said health economist Len Nichols of George Mason University. “If they did buy the same value plans … the premium would be lower than it is now. This makes the White House statement true. But is it possibly misleading for some people? Sure.”
Nichols’ comments are also misleading — which makes the president’s statement not just misleading but untrue.
Under ObamaCare, people would not have the option to buy the same low-cost plans they do today. That’s the whole problem: under an individual mandate, everybody must purchase the minimum level of coverage specified by the government. That minimum benefits package would be more expensive than the coverage chosen by most people in the individual market. Their premiums would rise because ObamaCare would take away their right to choose a more economical policy.
Note also that the CBO predicts premiums would rise by an average of 10-13 percent in the individual market. Consumers who currently purchase the most economic policies would see larger premium increases.
Finally, the Obama plan would also force millions of uninsured Americans to purchase health insurance at premiums higher than current-law premium levels, which they have already rejected as being too high. Their premium expenditures would rise from $0 to thousands of dollars. Yet the CBO counts that implicit tax as reducing average premiums, because those consumers are generally healthier-than-average. Only in Washington is a tax counted as a savings.
Filed under: Cato Publications; General; Health, Welfare & Entitlements
Massachusetts Treasurer Blasts RomneyCare and, Equivalently, ObamaCare
Massachusetts state treasurer and recent Democrat Timothy Cahill has harsh words for the health plan foisted on his state and the identical plan that President Obama is trying to foist on the nation. From The Boston Globe:
“If President Obama and the Democrats repeat the mistake of the health insurance reform here in Massachusetts on a national level, they will threaten to wipe out the American economy within four years,” Cahill said in a press conference in his office.
Echoing criticism leveled by congressional Republicans in recent weeks, Cahill said, “It is time for the president, the Democratic leadership, to go back to the drawing board and come up with a new plan that does not threaten to bankrupt this country.”
[T]he state’s health insurance law…Cahill said, “has nearly bankrupted the state.”
Cahill said the law is being sustained only with the help of federal aid, which he suggested that the Obama administration is funneling to Massachusetts to help the president make the case for a similar plan in Congress.
“The real problem is the sucking sound of money that has been going in to pay for this health care reform,” Cahill said. “And I would argue that we’re being propped up so that the federal government and the Obama administration can drive it through” Congress.
Commonwealth Connector, the independent state agency established to help residents find the health insurance, has “totally failed,” to create competition and connect people with affordable insurance, Cahill said, pointing out that 68 percent of the residents it serves receive subsidized care.
“We haven’t done anything about driving down costs,” Cahill said. “We haven’t helped small business. We haven’t changed the way we pay for health care and the way we deliver it.”…
Asked for solutions today, Cahill said he would seek to “level the playing field” between hospitals that charge different rates for similar procedures, seek to increase competition by allowing health insurance companies plans to sell plans across state lines, and would slash benefits mandated under state law.
For more on the Massachusetts health plan, see “The Massachusetts Health Plan: Much Pain, Little Gain.”
Filed under: Cato Publications; Health, Welfare & Entitlements
Tuesday Links
- Gene Healy on the “Al-Qaeda Seven”: Republicans who assail President Obama for his allegedly “soft-on-terror policies” are running a campaign that is based on phony charges, and is a dangerous distraction from the fight for limited government.
- Doug Bandow on the costs of war.
- This week, Sen. Chris Dodd (D-Conn) discussed imposing massive new regulations on the financial sector. Mark Calabria explains the potential impact.
- If the House enacts the Senate health care bill without voting on it, are we under obligation to obey it? The answer may be no.
- Podcast: “Reagan and the Tyranny of the Status Quo” featuring John Samples, author of the forthcoming book, The Struggle to Limit Government.
If the House Enacts the Senate Health Care Bill without Voting on It…
…are we under any obligation to obey it? The answer may be no.
Democrats are considering a scheme that would “deem” the Senate health care bill to have passed the House if a separate event occurs (specifically: House passage of a budget reconciliation bill). That strategy has been named after its contriver, House Rules Committee chair Louise Slaughter (D-NY). House Speaker Nancy Pelosi (D-CA) says of this scheme: “I like it because people don’t have to vote on the Senate bill” (emphasis added).
Not so fast, says former federal circuit court judge Michael McConnell in The Wall Street Journal:
Under Article I, Section 7, passage of one bill cannot be deemed to be enactment of another.
The Slaughter solution attempts to allow the House to pass the Senate bill, plus a bill amending it, with a single vote. The senators would then vote only on the amendatory bill. But this means that no single bill will have passed both houses in the same form. As the Supreme Court wrote in Clinton v. City of New York (1998), a bill containing the “exact text” must be approved by one house; the other house must approve “precisely the same text.”
Democrats have already hidden 60 percent of the cost of the Senate bill, effected an obscenely partisan change in Massachusetts law to keep the bill moving, pledged more than a billion taxpayer dollars to buy votes for the bill, and packed the bill with an unconstitutional individual mandate and provisions that violate the First Amendment. It’s almost as if, to paraphrase comedian Lewis Black, Democrats spent a whole year, umm, desecrating the Constitution and at the last minute went, “Oh! Missed a spot!”
And these people want us to put our trust in government.
Filed under: Cato Publications; General; Government and Politics; Health, Welfare & Entitlements
Weekend Links
- Andrew Coulson on national education standards: “The whole idea of imposing a single set of age-based standards on all students rests on a false premise: that children are identical widgets capable of being dragged along an instructional conveyor belt at the same pace, benefiting equally from the experience.”
- Question of the day: Would Obamacare end corruption—or expand it?
- Making things worse: How increasing the minimum wage will kill even more jobs for black teens, a group already facing 45 percent unemployment.
- The unintended consequences of a National ID card. (Now with support from both sides of the aisle.)
- Podcast: “Bad Statutes, New Crimes” featuring Marie Gryphon.
Another State and Local Bailout?
Rep. George Miller (D-CA) has introduced a bill that would give state and local governments another $100 billion to prevent public sector job cuts. The bill was written at the behest of the U.S. Conference of Mayors and other local special interest groups addicted to federal largesse.
These days it’s hard to open a newspaper without reading a tug-at-the-heart-strings story about state and local officials having to make the “painful” decision to cut supposedly crucial government spending. Very rarely do journalists dig in deeply and examine in detail where state and local governments are actually spending their giant budgets.
Sometimes stories highlight some superficial waste, such as this Los Angeles Times story reporting that “As Los Angeles County supervisors prepare to carve deeply into everything from public safety to social services, they also are spending millions in taxpayer dollars to burnish their public images, pay for chauffeurs, hold parties for friends and lobbyists and support pet projects.”
The story assumes that every penny L.A. County spends on public safety and social services is a penny well spent. Like their federal counterparts, state and local programs are rife with waste, fraud, and excess. Unfortunately, for every 100 stories you read about teachers being furloughed, you might read one that questions the basic efficiency of the services being provided or possible private-sector alternatives.
In a new Cato Policy Analysis on the cost of public education, Adam Schaeffer found that the Los Angeles school district’s real per-pupil cost is $25,000 – not the $10,000 it reports. This compares to average Los Angeles private school per-pupil spending of $8,400.
Filed under: Cato Publications; Government and Politics; Tax and Budget Policy
ObamaCare Will Include Taxpayer-Funded Abortions
According to MSNBC, Democratic leaders have given up on trying to appease pro-life House Democrats:
House leaders have concluded they cannot change a divisive abortion provision in President Barack Obama’s health care bill and will try to pass the sweeping legislation without the support of ardent anti-abortion Democrats.A break on abortion would remove a major obstacle for Democratic leaders in the final throes of a yearlong effort to change health care in America. But it sets up a risky strategy of trying to round up enough Democrats to overcome, not appease, a small but possibly decisive group of Democratic lawmakers in the House…
Democratic Rep. Henry Waxman of California, chairman of the Energy and Commerce Committee…predicted some of the anti-abortion lawmakers in the party will end up voting for the overhaul anyway.
Pro-life Democrats will vote for taxpayer-funded abortions? Without even a fig leaf of a compromise?
Filed under: Cato Publications; General; Health, Welfare & Entitlements
The Senate Bill Would Increase Health Spending
Ezra Klein quotes the Congressional Budget Office’s latest cost estimate of the Senate health care bill when he writes:
“CBO expects that the legislation would generate a reduction in the federal budgetary commitment to health care during the decade following 2019,” which is to say that this bill will cover 30 million people but the cost controls will, within a decade or so, leave us spending less on health care than if we’d done nothing. That’s a pretty good deal. But it’s not a very well-understood deal.
Indeed, because that’s not what the CBO said.
First, the CBO said the “federal budgetary commitment to health care” would rise by $210 billion between 2010 and 2019 under the Senate bill. Then, after 2019, it would fall from that higher level. And it could fall quite a bit before returning to its current level.
Second, the “federal budgetary commitment to health care” is a concept that includes federal spending on health care and the tax revenue that the federal government forgoes due to health-care-related tax breaks, the largest being the exclusion for employer-sponsored insurance premiums. If Congress creates a new $1 trillion health care entitlement and finances it with deficit spending or an income-tax hike, the “federal budgetary commitment to health care” rises by $1 trillion. But if Congress funds it by eliminating $1 trillion of health-care-related tax breaks, the “federal budgetary commitment to health care” would be unchanged, even though Congress just increased government spending by $1 trillion. That’s what the Senate bill’s tax on high-cost health plans does: by revoking part of the tax break for employer-sponsored insurance, it makes the projected growth in the “federal budgetary commitment to health care” appear smaller than the actual growth of government.
Third, the usual caveats about the Senate bill’s Medicare cuts, which the CBO says are questionable and Medicare’s chief actuary calls “doubtful” and “unrealistic,” apply. If those spending cuts don’t materialize, the “federal budgetary commitment to health care” will be higher than the CBO projects.
Fourth, Medicare’s chief actuary also contradicts Klein’s claim that the Senate bill would “leave us spending less on health care than if we’d done nothing.” The actuary estimated that national health expenditures would rise by $234 billion under the Senate bill.
And really, Klein’s claim is a little silly. Even President Obama admits, “You can’t structure a bill where suddenly 30 million people have coverage and it costs nothing.”
Filed under: Cato Publications; General; Health, Welfare & Entitlements
Senator Graham’s Inexplicable National ID Support
Compromise is catnip in Washington, D.C. That’s my best guess at why Senator Lindsey Graham (R-SC) would endorse New York Senator Chuck Schumer’s (D) widely reviled plan to create a mandatory biometric national ID system.
Schumer’s national ID plans have no more definition today than when he wrote about them in his 2007 campaign manifesto Postitively American. Among the thin gruel of that book is a two-page lump displaying more ignorance than understanding of how identity systems work and fail. Schumer doesn’t know the difference between an identifier—a characteristic used to distinguish or group people—and an identification card or system, which does the entire task of proving a person’s previously fixed identity. (My thin gruel on the topic is the book Identity Crisis: How Identification is Overused and Misunderstood.)
“All the national employment ID card will do is make forgery harder,” says Schumer.
No, that’s not all it would do: It would also subject every employment decision to the federal government’s approval. It would make surveillance of law-abiding citizens easier. It would allow the government to control access to health care. It would facilitate gun control. It would cost $100 billion dollars or more. It would draw bribery and corruption into the Social Security Administration. It would promote the development of sophisticated biometric identity fraud. How long should I go on?
Senator Graham’s take is equally simple: “We’ve all got Social Security cards,” he said to the Wall Street Journal. “They’re just easily tampered with. Make them tamper-proof. That’s all I’m saying.”
No, Senator, that’s not all you’re saying. You’re saying that native-born American citizens should be herded into Social Security Administration offices by the millions so they can have their biometrics collected in federal government databases. You’re saying that you’d like a system where working, traveling, going to the doctor, and using a credit card all depend on whether you can show your national ID. You’re saying that bigger government is the solution, not smaller government.
The point for these senators, of course, is not the substance. It’s the thrill they experience as nominal ideological opponents finding that they can agree on something, securing a potential breakthrough on the difficult immigration issue.
They’re only ”nominal” ideological opponents, though. Chuck Schumer has always been a big government guy—and long a supporter of having a national ID, despite the lessons of history. Lindsey Graham is not really his ideological opponent. Typical of politicians with years in Washington D.C., Graham is steadily migrating toward the big-government ideology that unites federal politicians and bureaucrats against the people.
Filed under: Cato Publications; Telecom, Internet & Information Policy; Trade and Immigration
Tuesday Links
- Why the line-item veto is no quick fix for massive spending.
- Supreme Court Justice Scalia holds himself out as the patron saint of originalism, but is he abandoning the idea that judges should interpret the Constitution according to its original public meaning?
- Michael Tanner: “In case you lost count, President Obama’s remarks on Wednesday were his 35th major speech on health care reform. The news: this time he really, really, really means it when he says it’s time to act. As for the speech itself, it was virtually indistinguishable from any of the previous 34.”
- Podcast: “Chris Dodd’s Credit Price Controls” featuring Mark A. Calabria.
Sen. Schumer’s Immigration Reform Is a National ID
So reports the Wall Street Journal:
Lawmakers working to craft a new comprehensive immigration bill have settled on a way to prevent employers from hiring illegal immigrants: a national biometric identification card all American workers would eventually be required to obtain.
It’s the natural evolution of the policy called “internal enforcement” of immigration law, as I wrote in my paper, “Franz Kafka’s Solution to Illegal Immigration.”
Once in place, watch for this national ID to regulate access to financial services, housing, medical care and prescriptions—and, of course, serve as an internal passport.
Filed under: Cato Publications; Telecom, Internet & Information Policy; Trade and Immigration
Obama’s HSA Gambit a Net Minus?
President Obama evidently thinks that if he promises not to kill health savings accounts (HSAs), opponents will swoon for his government takeover of health care. If that doesn’t do the trick, he should make clear that his health plan would not eliminate other things too, like the Defense Department and puppies.
Of course, that hollow gesture didn’t win the president any Republican support. But it may have cost him some Democratic support — or at least frayed the nerves of a few House Democrats. According to CongressDaily:
Liberals, meanwhile, are fuming over an addition Obama made to his proposal to make the effort appear bipartisan and possibly switch the votes of moderate Democrats who opposed the House bill last year.
The Congressional Progressive Caucus co-chairman, Rep. Raul Grijalva, D-Ariz., said Wednesday he is disturbed and bitter about an addition he said goes against Democratic principles.
“I’ve been leaning ‘no’ for a long time. That hasn’t changed,” Grijalva said about voting for the healthcare overhaul the Senate passed in December and a package of changes that would move through a separate bill through reconciliation.
Obama indicated he might be open to a provision that would encourage the use of health savings accounts, a tax-exempt savings account that typically is used in conjunction with a high-deductible plan. The provision would allow the exchanges to offer high-deductible plans.
“For some of us, the bitterness about HSAs in and the public option completely out, I don’t know how long that’s going to linger,” Grijalva said.
Which tends to confirm what HSA supporters have long feared: killing HSAs is the Left’s game plan.
Filed under: Cato Publications; Health, Welfare & Entitlements
Before Administering the Lethal Injection, Dr. Obama Offers to Sterilize the Needle
In a letter to congressional leaders, President Obama wrote of his openness to including Republican proposals in his health care legislation.
Dropping a few Republican ideas into a government takeover of health care is like sterilizing the needle before a lethal injection: a nice thought, but the ultimate outcome is the same.
- Two of the four Republican ideas – federal grants to states that adopt medical malpractice liability reforms, and ratcheting upward Medicare’s physician-price controls – would increase government spending.
- The president’s health savings accounts (HSAs) proposal would merely loosen the noose around consumer-directed health plans.
- Undercover investigations in Medicare and Medicaid are likely to be as unsuccessful as past efforts to combat fraud.
This is not bipartisanship. President Obama is creating the illusion of bipartisanship while taking the most partisan route possible: forcing his legislation through Congress via reconciliation.
(Cross-posted at National Journal’s Health Care Arena.)
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