Monday, August 13, 2012

Medicaid as blueprint for universal healthcare

It has been proposed by some that had Obamacare been ruled as unconstitutional, that Obama could use that ruling to justify universal healthcare based off the Medicaid model. It is obvious that Obamacare is unconstitutional since the federal government does not have the authority to mandate commerce in order to regulate it and the fine for not purchasing insurance does not fall into any of the categories of taxation authorized by the constitution.

It is clear that Obamacare will severely damage the health insurance market by increasing free-ridership in the same way Romneycare did in Massachusetts and by increasing demand and decreasing supply so as to increase healthcare costs among other problems. However, since much of the problems in healthcare are caused by government programs, I would like to examine why universal healthcare based on Medicaid would be a certain disaster.

Medicaid has a terrible record of patient outcomes. A study published in the Annals of Internal Medicine found that the most significant factor in determining the survivability of heart attack was whether or not a patient was on Medicaid. Another paper published in the journal Psychiatric Services found that Medicaid was associated with worse outcomes among mentally ill patients. If you believe that universal healthcare means more people living and better health outcomes, you are dead wrong.

The system is so poorly designed that only about two-thirds of doctors will even see new patients on Medicaid while those with private insurance and even the uninsured can see almost any doctor.One of the big reasons that doctors are dropping covering Medicaid patients is because it often fails to cover costs and to get paid doctors have to spend countless hours filling out forms. In order to make up for fewer doctors, people on Medicaid are 1.5 times as likely to go to the emergency room as someone on private insurance. This is an unmitigated disaster for the hospital since they cannot deny Medicaid patients and according to the American Hospital Association, 56% of hospitals receive payment from Medicaid that do not cover the costs of service.

If Medicaid won't cover the full cost, guess who makes up the difference. By cheating doctors and hospitals, Medicaid forces up healthcare costs on private insurance companies and uninsured patients. These increased cost force insurance companies to increase their premiums. But who will cover the loss if their were no private insurers? Hospitals and doctors would be forced out of the market. To make up for this, the only possible solution short of going back to a freer market would be to completely nationalize the healthcare industry.

Nationalized healthcare does not avoid the costs of providing service, however. The costs will still be there now they will be ignored in determining how to allocate resources. Taxes will have to be raised to make up for the losses. Productivity will suffer and we will move to a European style slow-growth economy with a lower standard of living. But we will have "free" healthcare.

Saturday, August 4, 2012

Return to Reason

I recently read Return to Reason by Kelly James Clark. This book examines the arguments both for and against the existence of God. In the end, Clark concludes that argument and evidence are not sufficient. If he had simply left the argument at that point, I could have agreed with him.

While the first half of the book looks at the evidences on both sides of the argument for God, the second half tries to argue that belief in God does not require evidence. Rather than being a fideist, though, the argument is that belief in God is properly basic. A properly basic belief is a rational belief we hold that is not supported by other beliefs.

While there are multiple arguments he makes for the case that belief in God is basic, I will focus on two of them. The first deals with the idea of belief in persons. A belief that a fellow human being is a person is not deemed irrational even though we have no basis for believing anyone else is actually a person. For all we know, other humans could be automatons. Belief in God is simply the belief in a person.

There are two problems with this argument. First, some people actually believe that animals and even robots are persons. I recently saw an episode of Nova Science Now that included a segment on how robots could play a large part in the daily lives of people in need. One of the concerns is that people may start to treat these very life like robots as persons because of the way they are able to mimic us.

Another problem with the God as person belief is that unlike actual people, we do not see or interact with God. I can understand someone jumping to the conclusion that an animal or a robot is a person, because there is something there to see and interact with but God is conspicuously absent.

The second argument I would like to deal with is the idea that what we experience with our senses is properly basic. He uses an analogy of a person seeing a timber in the mountains. When he goes back to tell his friends, his friends argue that timber wolves are extinct. However, since he in fact saw the timber wolf, regardless of what his friends say he is rational in his belief.

There are three problems with this argument. First, as Clark has defined is, beliefs based on sense experiences are not properly basic. They are actually founded on the belief that our senses are accurate. Since we have no way to test the accuracy of our senses beyond the experience of our sense, the belief that our senses are generally accurate would be properly basic.

The second problem is that while our senses may in general be accurate, our interpretation may not be. One only need to see an optical illusion or a mirage to know this. The idea that our belief about what we see is properly basic means that nuts who believe in alien visitations because they saw a UFO are not irrational for their belief. Is a person who hears the sound of hoofs clip-clopping along rational for believing it is zebras and not horses?

The third and perhaps worst of the problems with this argument is which sense exactly are people supposedly using to discover God? While one can argue that the person who thought he saw an extinct wolf actually saw something, what can we say about sensing God? There are mental institutions filled with people who think they heard God. We certainly do not think they are rational for that belief.

When we have a sensory experience, we should not jump to conclusions about what it is we are experiencing. If what we are experiencing is within the realm of our normal experiences, it seems reasonable to think that what we are experiencing is true. If we have an experience with multiple other witnesses of something odd, we should try to reconstruct what happened. We should not jump to the extraordinary without first eliminating the ordinary.

Wednesday, July 11, 2012

Why my vote does not matter (and neither does yours)

Supposedly we live in a democracy where our vote matters. Get Out the Vote campaigns tell us how important it is to let our voice be heard. But when we have the choice between Tweedledee and Tweedledum, or is it dumb and dumber, who sound very much alike, it is hard to say we really have a choice.

But even if there was a significant difference between Romney and Obama, it would not make my vote matter one bit. The only way my vote could matter is if it were the deciding vote in a tie or the tieing vote. If neither of these extremely rare cases occurs, my vote does not matter.

There is good evidence that the odds of getting in a car crash increase on election day. I have better odds of dieing going to the polls than of my vote mattering.

Friday, July 6, 2012

Fixing health care

Now that the legal issues surrounding the constitutionality of the Affordable Care Act, also known as Obamacare, have been resolved by the creation of a constitutional extra-constitution ability to tax nothing, we can now move on to fixing our countries health care issues.

As I have mentioned previously, the first step in resolving an issue is to determine what the true problem is. If we try to solve a problem with a band-aid, we will likely just make the problem worse. What is the true problem with our healthcare system? Obamacare was designed to force people to purchase insurance and prohibit denying coverage on the basis of preexisting conditions.

Is the problem in healthcare that everyone does not have insurance? Why do people need insurance? People need insurance because the costs of getting healthcare are rising. The reasons for rising costs are hotly debated.

One reason costs are rising is our dependence on third party payments. Since the government or insurance covers the majority of healthcare costs, there is no incentive for consumer to show around. Demand becomes incredibly price inelastic.

A recent letter to the editor in the Reno Gazette-Journal made this point very clear. The gentleman who wrote in informed us that his wife had a CAT scan that was billed to her insurance for $4500. Since he did not have insurance, he shopped around and was able to get a CAT scan for $500. This kind of price disparity could not exist if the consumers where responsible for the full cost.

Eliminating our dependance on third party payments will for the market to behave in a more efficient manner. Health insurance should continue to exist for the purpose of cover insurable events, but should be eliminated for non-insurable evens. An insurable even is one that the insured cannot control. This pretty much leaves us with health insurance that covers only catastrophic events like cancer, heart attacks, accidents not covered by other insurance, etc.

One could argue that chronic conditions are insurable against beforehand. However, I do not think that insurance as currently constructed is the best way to pay for these. There exists discount plans under our current system that help patients get prescription drug and other medical devices at discounted rates. These could be utilized for those who have chronic conditions.

Another option is Health Saving Accounts (HSAs). As currently envisioned, HSAs as intended to be used with high deductible health insurance to help cover the costs of the deductible. They are tax deferred and unlike Flexible Spending Accounts, money rolls over at the end of the year and continues to accumulate.

Few people think that Obamacare is the ideal solution to our health care crisis. I do not intend this list of ideas to be comprehensive no do I assume that any particular proposal is the ideal solution. However, critics of Obamacare rarely talk about alternatives. We need serious reform but few people are talking about it. The Libertarian candidate that I support, Gary Johnson, does not mention his plans for health care at all. Mitt Romney has a plan, though like most campaign promises it will likely never be implemented. And Obama is more interested in promoting the plan he implemented then working on a real solution.

There are more issues that need to be tackled and I hope to address some of those in the future.

Thursday, June 28, 2012

Supreme Court ruling

Today, June 28th, 2012 is a historic day. The Supreme Court has upheld the Affordable Care Act, affectionately known as Obamacare, as constitutional. The basis for constitutionality is not the commerce clause, as the Obama administration argued, but the taxing authority. Rather than extending the reach of congresses ability to regulate to allow compelling actions in the name of regulating commerce, the Supreme Court has stated that congress has the authority to compel action through taxation. This means inaction is now a taxable activity.

What does this mean for those of us advocating for limited government? This is a huge set back and a massive expansion of government power. This ruling officially marks the end of any constitutional limits on federal power. However the government wants to remake society, they are authorized to compel compliance through a fee and call it a tax.

A interview claimed there was a silver lining. However, everything that congress could have done to abuse the commerce clause if the mandate were upheld on that basis, they can still do through the new taxing power.

Given that Obamacare is widely unpopular, this is a huge victory for Mitt Romney. Though he would never denounce Obamacare by pointing to how Romneycare has decimated health insurance in Massachusetts, he can gain support by promising to repeal Obamacare. Since Republicans will need to hold the House and win the Senate in order to gain enough support for repeal, we may see a sweeping change in the balance of power.

Unfortunately, the failure of the Supreme Court to uphold the limited and enumerated powers nor the clear intent of the tax laws cannot simply be repealed by government action. And why would we expect congress to want to repeal their new powers? The only way we can ever expect to get back to limited constitutional government is if we make our voices heard.

Saturday, June 23, 2012

Corporate Personhood

Are corporations people?
The answer to this question depends on the meaning. I won't get bogged down in the metaphysical definition of person. There are 2 different possible meanings to this question and we need to address which meaning we intend to convey.
The first meaning is that a corporation is a person separate from all human people and created at the time of incorporation. When people on the left say that corporations are not people, they are I hope referring to this meaning. Legally, a corporation is a person in this sense.
There is a second sense in which a corporation is people. A corporation is a group of people coming together for a common goal. Some corporations produce goods, others services. The corporation is made of managers, workers and shareholders.
When I say corporations are people, I mean it in this second sense. The issue of corporate personhood comes up in several contexts. Corporate taxes are not paid by some soulless nonperson but by the individuals who make up the corporation or by the people who buy the goods and services made by the corporation.
In the same sense, when the corporation says something, it is not a personless entity making unprotected speech, it is a collaborative effort by the people within the corporation exercising their right to free speech in a collective manner.

Wednesday, June 20, 2012

Fixing problems

When ever a problem arises, the first step in solving the problem is to determine the cause of the problem. If the new problem is a symptom of some other underlying issue, attempting to address the problem directly is merely treating the symptom. There are many instances where politicians are proposing solutions to problems while ignoring the underlying causes.

While this same issue is relevant to other problems in our daily lives, since government policy effects every person in the country, I would like to focus on those issues. There are problems in health care, education, the economy, etc. and I hope to deal with each one in turn. For now, I would just like to emphasize the importance of not just trying to deal with the apparent issue but rather seek the underlying cause and address it.

Thursday, June 14, 2012

Laws as violence

Few people think about what it means to pass a law. All laws are threats of violence. If you do A or fail to do B, the government will enact violence upon you perhaps by forcibly detaining you or taking your property.
Violence is an appropriate response in defense against violent acts. That is why no one disputes laws against murder, rape, theft, etc. These laws threaten violence when violence is committed.
However, responding to non-violent acts with threats of violence is wrong. Something to consider when you voice support for a law against a non-violent act.