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.