Coyote Blog

Via the Dallas Morning News:

A last-minute change in the federal health care bill ditched a proposed 5 percent tax on cosmetic medical procedures and replaced it with a 10 percent tax on indoor tanning services.

Goodbye Botox tax. Hello tan tax.

This seems really random.  Why should either of these businesses foot a special, disproportionate share of my health care bill?  Well, things that seem random to most of us make perfect sense in Congress.

The tan tax popped up in the health care bill last weekend after powerful medical lobbies – including the American Academy of Dermatology Association, American Medical Association, American Society of Plastic Surgeons and Botox-maker Allergan – persuaded Congress to remove a tax on cosmetic medical procedures and replace it with a 10 percent surcharge on indoor tanning services.

Lobbyists are very good at punching political hot-buttons.  Since they couldn’t argue that botox is “for the children,” and since it is generally used by rich white people they could not place the race or class card, they played the only card they had:

“Since 90 percent of cosmetic surgery patients are women, this would have been a very discriminatory tax,” said White, who opposed the cosmetic surgery tax.

Technocrats want to believe, and perhaps honestly believe themselves, that care guidelines in the new Federal health care system will be science-based.  What possible basis do they have for thinking that?  We have 50 state laboratories, where states specify must-carry rules on procedures, and not a single one of these lists are science based – they are loaded with special interest handouts.   I even show in this post how special interests give money to academia to produce studies whose entire conclusion is that certain procedures (performed by the special interest group funding the study) need to be in the minimum coverage laws.   The very first time out, when confronted with a science-based care recommendation (that women not receive breast cancer screening until after 50), the Congress specifically overrode it in the bill under a firestorm of public outcry.

But maybe the dermatologist guys are really looking after us?  After all:

The American Academy of Dermatology warns of significant health risks caused by indoor tanning.

But, as it turns out, it only sees health risks in the use of ultra-violet light by practitioners who are not members of their trade group.  I have bolded the key passage that gives away the game.

Indoor tanning industry groups note that dermatologists use tanning equipment in their offices for cosmetic skin conditions, such as eczema and psoriasis, in phototherapy treatments that cost up to $100 per visit billed to health insurance companies. In contrast, indoor tanning salons cost as little as $6 to $20 per session.

The tan tax would exempt phototherapy services performed by a licensed medical professional.

“This is like Coke being allowed to lobby the government to tax Pepsi, but that Coke be allowed to sell the same product and not be taxed for it,” International Smart Tan Network Vice President Joseph Levy said in a statement. “It’s unbelievable.”

Kevin Drum is reporting, as I predicted, that the Democrats have bought off the remaining votes they needed (with our tax money) and that there will be a successful cloture vote this evening on the health care bill.  Bad news, though I have been prepared for it for a while.  I honestly believe that 90% of this country is going to end up worse off to help out the remaining 10%.  The analogy I often use is that this is just like the crappy public housing we built in the 1960′s, except everyone, not just the poor, are going to have to move into it.    The only remaining questions that remain are 1) how long after passage of this bill do Democrats admit they grossly fibbed on the price and start jacking up taxes; and 2) how hard a hit (and how fast) will drug and medical innovation take.  Enjoy.  The only silver lining is that many of the folks who passed this mess are not going to have their jobs a year from now.

Update: Overlawyered has more bad news about the bill’s provisions.   A lot more of this will come out as the people are actually allowed to read it.

It has bothered me in an earlier post that I missed several critical tricks the Democrats in Congress are using to understate the cost of their health care bills.  These are important enough that I am re-writing the original post:

Good editorial today in the WSJ on the myth of government health care cost control:

A field as dynamic and innovative as U.S. medicine, in which costs are largely driven by new technologies and better ways of caring for patients, is rife with complexities and uncertainties. But no one bothered to strike that note of caution when Washington was hopped up on a cost-control gambit that was too painless to be true. The new cost-control apologists concede that there isn’t any actual plan for controlling costs: Throw enough speculative policies against the wall, they say, and some breakthrough will stick. Yet Mr. Orszag’s no-less-confident predecessors spent decades trying to pull down Medicare spending with little to no success. Technocracy rarely if ever works as intended. Mr. Gawande points to the case study of U.S. farm policy, and if politically sacrosanct agriculture subsidies and rural price-supports are the best to hope for, then what’s the worst?

More relevant examples include Medicare’s “relative value” payment scale, which was designed in 1985 by the Harvard economist William Hsiao to encourage more primary care. That’s this year’s rallying cry too. “Diagnosis-related groups” were introduced into Medicare in 1983 to alleviate hospital cost growth, and what a monumental success that turned out to be. With only brief periods of relatively slower growth, nominal Medicare spending has risen on average at an annual rate of 9.6% since 1980. Over the same period total Medicare spending has grown 13-fold, climbing from 1.2% of the economy to 3.2% today.

Congress lacks the stomach for serious cost control in any case. One policy Mr. Orszag favors—Medicare penalties for hospitals that re-admit certain patients—is limited to only three conditions in the Senate bill, and the penalties are trivial.

Another—a putatively independent commission that is supposed to enforce cost cutting—is barred from going after costs incurred by doctors and hospitals, which leaves out more than half of Medicare spending. Earlier this year Mr. Orszag got into a heated debate with Henry Waxman over such a commission at a dinner party hosted by Connecticut Rep. Rosa DeLauro, precisely because the House baron enjoys the political power that flows from controlling health spending.

Paging Friedrich von Hayek.  The administration constantly whines that none of his critics ever offer an alternative (a patently false statement that seems to play well in the sympathetic press, very parallel to the global warming alarmist charge that skeptics haven’t offered an alternative explanation of past warming).

Hmmm. One liberal sage noted in a 2007 paper that “four decades of empirical research” have shown that insulating people through third-party insurance coverage “from the full cost of health care has been responsible for anywhere from 10% to 50% of the large increase in health expenditures.” Ultimately, he concluded, increasing cost-sharing would give individuals a direct stake in more prudent purchasing, as opposed to today’s invisible health dollars that vanish as more expensive premiums, foregone wages and higher taxes.

Those are the words of Jason Furman, now the White House deputy economic director who seems to have been put into witness protection. Every serious health economist in the country recommends reforming the tax exclusion for employer-sponsored insurance, perhaps by converting it to a deduction or credit. Cost control will never stick unless it is extricated from politics and transferred to individuals to make their own trade-offs.

Such reforms were ruled out by union opposition, so the Senate gestures at them with a 40% excise tax on high-cost insurance plans, on the theory that two wrongs will make a right. But this untargeted tax will simply raise the cost of coverage for all workers in a given pool—it’s too clever by 40%—while doing nothing to stem the distortions from first-dollar, third-party insurance.

This was simply amazing to me.  For years, I and others have said that putting more health care spending under insurance plans was going exactly the wrong direction, both from an individual choice as well as a system cost perspective.  By eliminating the need or incentive to shop by the consumer of services, prices almost inevitably rise.

Here is a fabulous smoking gun example from my windshield repair today.  I happen to have free windshield replacement in my insurance policy.   I called the insurance company and said I had an auto glass claim.  I was transferred to Safelite Auto Glass, who apparently (very intelligently) have a contract to process claims for my insurance company.  They said I could use any provider, but would I like them to call out someone for me — if I used their choice, the insurance company would guarantee the work.

Well, what did I care — I wasn’t paying for it — so I had them make an appointment for me.  Unsurprisingly, it was with Safelite Auto Glass.

I must add here that Safelite did an exceptional job, the guy who showed up at my workplace was friendly and competent.  No complaints at all about the service or workmanship.

Anyway, I got a bill for which I owed zero dollars, which I suppose is heading right this minute for the insurance company.  Before I show it to you, I was curious what I would have paid for this service if it hadn’t been insured and I shopped around.  I got just one quote – from the Safelite Auto Glass web site.   This is a bit unrealistic because for a purchase this large, I would have gotten several quotes.  But this was the only quote I needed.  The charge to me if I bought the new glass service with my own money without insurance was$321.05  (click to enlarge).

And this was the bill I signed for the insurance company:

For a total of $710.40.  Same service.  Same car.  Same customer.  Same part.  Probably the same repair guy.  2.2x higher price.

Now, I suppose I might be willing to believe there is some invoice pricing game here and the insurance company may get a discount over invoice, similar to car sales, though I am not sure what their incentive would be for this game — it should be the opposite.  In fact, we can be nearly positive they are marking up the price to insurance companies given a) the web quote says right up front it is not good for insurance work and b) I have already shown how glass companies give enormous consumer kickbacks for insurance work.

If I had cared, I would have eschewed the offer on the call to have them set up the appointment and shopped around for the best kickback.  All a cross subsidy from those who don’t use the insurance to those who do use the insurance.  Talk about a terrible incentive.

I think the conclusion is pretty strong.  Anything we shift to insurance from having individuals pay out of pocket gets substantially more expensive.  And this doesn’t even address my changing willingness to live with a small windshield crack and avoid this purchase altogether when I am paying the bills vs. when I am not.

Megan McArdle has a great post on the CMS post. Bascially, there is no magic bullet to cut medical costs.  Benefits are going to get cut and costs are going to go up.

I really don’t need the report to tell me this.   Here is the common sense answer — before this administration embarked on the health care fiasco, we all pretty mich knew that Medicaire and Medicaid bankrupt and was going to blow a huge hole (McArdle’s term) in the budget.  So, since this bill at its heart is really just an expansion of Medicaire/Medicaid to cover more people, how can we expect it to do anything but blow an even bigger hole in the budget.

By the way, years ago I wrote:

…health care is not like failed Great Society housing programs.  In those housing programs, only the poor got crappy government housing — the rest of us kept what we had.  Universal health care is different, because it will effectively be like forcing everyone to move into the housing projects.

Now that we know what is in the actual bills, I stand by this prediction.  Here is the poll question I would still like to see:

Would you support a system of government-run universal health care that guaranteed health care access for all Americans, but would result in you personally getting inferior care than you get today in terms of longer wait times, more limited doctor choices, and with a higher probabilities of the government denying you certain procedures or medicines you have access to today.

118, and counting…

I am not sure anyone has actually said this, but that has certainly been the implication, right?  Obama & Pelosi spends a lot of time accusing insurance companies of having profits that are too high, so I have to believe his intention is to reap cost savings by cutting into them.

I have blogged about this before, but Carpe Diem also picks up this thread, observing that health insurance companies are #86 on the list of US industries in terms of profit margins, with a ROS of  3.3%.  As Mark Perry points out, this gives them a profit of about $100 per individual policy.  Not really a very promising source of savings, is it?  But it is very scary for any industry that makes more than 3.3% profits, knowing that the Administration thinks they are making too much money and has shown a willingness to slice into profits it thinks to be excessive.

1502 pages.  Enjoy.

Bruce McQuain points out something I think has not gotten enough attention in the health care bill.  The new taxes being proposed start in 2010, but the benefits don’t begin until 2013 and are phased in through something like 2018.  That means for any 10-year budget look, there are 10 years of taxes but only 6-7 years of benefits.  And even with this trick, the plan STILL adds a trillion dollars to the deficit, even before the certainly more pessimistic CBO numbers come in.

Tonight, Obama reduced the number of “uninsured” Americans he is trying to help from 47 to 30 million.   Megan McArdle hypothesizes that he has dropped immigrants and illegal aliens from the number to avoid the political fallout from paying for these groups.

But we can also further drop the number from 30 million to 18 million, because 12 million people are in a category “reform” supporters say could afford insurance today but choose not to buy it.  Rather than being helped by the plan, these 12 million will be expected to either buy insurance they don’t want or need or else face severe penalties from the feds:

Under the plan, people who earn between 100% and 300% of the poverty level (or between about $22,000 a year and $66,000 a year for a family of four) would face fees ranging from $750 to $1,500 a year.

For taxpayers with incomes above 300% of poverty, the penalty starts at $950 a year and reaches as high as $3,800 for families. Nearly 12 million people fit in this category, according to the National Institute for Health Care Management.

The idea behind the penalty is that those who can afford insurance but don’t buy it are imposing costs on the entire health system. Under the proposal, nearly 12 million people who currently have no insurance could be subject to such fines, according to figures compiled by the National Institute for Health Care Management.

It is hard to argue these 12 million are being helped.  In fact, they are the milch cows helping to pay for the program, giving the lie to Obama’s promise not to raise taxes on the middle class.

But of these remaining 18 million, as many as 10-14 million are eligible for Medicare, Medicaid, or SCHIP and are simply waiting until they need medical care before signing up.

Every time anyone counts it, there are about 8-10 million truly hard core poor and uninsured.  So we are going to screw up the medical care for the other 290 million of us to help these guys?   As I said before, this country is generous and if one were to point out a segment in true need, the money would likely be made available.  What concerns most people is not the libertarian fears I have of more spending and government, but the fear that helping a few folks will mean worse care for everyone else.  The analogy I have used many times is that people don’t have a problem contributing to public housing for the poor (even if it turns out to suck), but they do have a problem if they are forced to leave their own home and enter the crappy public housing as well, in the name of some misplaced notion of egalitarian “fairness.”

I posted the other day that one explanation of rising health care expenditures in the US is rising wealth.  As we are wealthier than other Western nations, doesn’t it make sense we would spend more on our health than other nations.

James DeLong adds:

Robert Fogel, in his NBER paper, which has more detail than his American article (and will cost you $5), looks at changes in U.S. consumption patterns from 1875 to the present. A striking number is the reduction in the costs of the basics — food, shelter, clothing took 74% of income in 1875; 13% in 1995. This has freed up a lot of income, and one of the great gainers has been health. In 1875, it took only 1% of consumption, largely because there was little to be bought, except for patent medicines loaded with alcohol and opiates, or a saw to lop off an injured limb. By 1995, it was 9%.Leisure was another big gainer — 17% in 1875; 68% in 1995.

So if improvements in medical technology lead people to reallocate money toward health, fine.

From Joe Biden, in the debates:

“No one making less than $250,000 under Barack Obama’s plan will see one single penny of their tax raised, whether it’s their capital gains tax, their income tax, investment tax, any tax.”

Oops:

Under the plan, people who earn between 100% and 300% of the poverty level (or between about $22,000 a year and $66,000 a year for a family of four) would face fees ranging from $750 to $1,500 a year.

For taxpayers with incomes above 300% of poverty, the penalty starts at $950 a year and reaches as high as $3,800 for families. Nearly 12 million people fit in this category, according to the National Institute for Health Care Management.

The idea behind the penalty is that those who can afford insurance but don’t buy it are imposing costs on the entire health system. Under the proposal, nearly 12 million people who currently have no insurance could be subject to such fines, according to figures compiled by the National Institute for Health Care Management.

People focus too much on the penalty itself being a new tax.  But the new tax is actually the requirement that individuals buy a product (in this case a health insurance policy) that they feel has no value (or else they would purchase it of their own free will today).  The government stopped pretending long ago that these younger middle class families will get much value from such a policy.  In fact, if they did get value commensurate with the premiums they will be paying, the mandate would not be achieving its purpose.  The whole point is that healthy people pay more into the insurnace system than they get back to support sick people.  If that payment is mandatory, then it is a tax, even if it is called an “insurance mandate” instead.

In fact, this is made all the more clear when politicians also suggest that cheaper high deductible health insurance plans be banned, as they were in Massachusetts.  Again, the whole point is to get young healthy people to overpay for insurance, and allowing them to buy sensible, cheaper, high deductible insurance defeats the whole purpose.

This is a tax on middle America, and Obama knew he was going to propose it way back in the campaign.  This is not something he just thought up or was a victim of changing circumstance.  This is an out and out lie on his part.

This is awesome, from Carpe Diem:

On a purchasing power parity basis, France, Japan, and Germany would all be the poorest states in the United States, based on per capita GDP.  People on the coasts don’t benchmark their education or health care spending against Mississippi, except perhaps to make the case that Mississippi is spending too little.  So why do they benchmark their spending against Germany or France.  Of course we spend more on health care per capita – we spend more than these countries per capita on everything from TV’s to cars to movie tickets.

Via Steve Chapman at Reason:

[President Obama] says though the United States spends more per person on medical care than any other nation, “the quality of our care is often lower, and we aren’t any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do.”

That’s one of the favorite rationales for a government-led overhaul. But it gives about as realistic a picture of American medicine as an episode of Scrubs.

It’s true that the United States spends more on health care than anyone else, and it’s true that we rank below a lot of other advanced countries in life expectancy. The juxtaposition of the two facts, however, doesn’t prove we are wasting our money or doing the wrong things.

It only proves that lots of things affect mortality besides medical treatment. Heath Ledger didn’t die at age 28 because the American health care system failed him.

One big reason our life expectancy lags is that Americans have an unusual tendency to perish in homicides or accidents. We are 12 times more likely than the Japanese to be murdered and nearly twice as likely to be killed in auto wrecks.

In their 2006 book, The Business of Health, economists Robert L. Ohsfeldt and John E. Schneider set out to determine where the U.S. would rank in life span among developed nations if homicides and accidents are factored out. Their answer? First place.

That discovery indicates our health care system is doing a poor job of preventing shootouts and drunk driving but a good job of healing the sick. All those universal-care systems in Canada and Europe may sound like Health Heaven, but they fall short of our model when it comes to combating life-threatening diseases.

I have seen several folks of late testing out a meme that opposition to health care reform is mostly about churlish unwillingness to help people.  My sense is that this is dead wrong.

As a strong libertarian, that may well be my motivation.  But the vast majority of Americans accept and support the government safety net and generally will support reasonable expansions of it to address true need.   I think most Americans would be willing to help people who honestly need financial aid to pay the health care bills.  This is particularly true for children — you don’t remember people going ballistic over SCHIP, do you?

I am not representative.  The vast center of this country is willing to accept, even embrace, increased government interventions in the right cause.  I forgot to blog on it, but remember that poll a few weeks ago that a majority of Americans think the government should required that women take their husbands last name after marriage?  I think the notion that there is any kind of sizable block of small government libertarian type folks out there is simply a myth.

So health care intervention and spending can be sold – again remember SCHIP but also the prescription drug bill.  I think the Administration is having trouble selling it in this case for two reasons:

• They are having difficulty showing people who truly are not getting care.  Sure there are a lot of people who are uninsured, but I think that meme has been around enough for people to deconstruct.  Who isn’t getting care?   Sure, for some folks getting care is a real hassle, but there are arguments to be made that accepting charity should not be that easy (remember the old Welfare?)  And sure, some folks have financial straights and can even face bankruptcy over health care bills, but our bankruptcy laws are incredibly generous and when tens of thousands are facing bankruptcy because they bought too many TV’s on their credit cards, it almost seems honorable to face bankruptcy over your wife’s cancer treatment.
• The second problem is what I call the public housing problem.  In the late 1960s, Americans were concerned about the poor and homeless and spent billions to build housing projects for them.  It turns out that this doesn’t work out so well, but that is not my point.  My point is that Americans could be convinced to spend money to build poor people government homes.  BUT their position would have been very different if investments in public housing required the rich and middle class who were paying for the program to move out of their homes and into public housing as well.That is the fear that I think much of America has today.  If asked, they would likely pay to provide government health care in an instance where it was demonstrated that health care was entirely lacking.  They would likely suspect that such care, like much of public housing, would suck, but as it was being offered to someone who supposedly had nothing, it would represent a net improvement.  But they don’t want to move into the projects themselves, and frankly don’t understand why agreeing to help poor people afford more health care also means they have to move into the government system themselves.

The whole “health care rationing” debate is reaching new levels of absurdity.  In part, this is because the very term “rationing” is a confusing misnomer.

So here is what it boils down to:  For every product or service purchase, someone makes a price-value trade-off to determine if that product or service should be purchased for a given price in that particular instance.

One option for making this decision is to have the person who actually will consume the product or service — and whose money will also be used to complete the transaction — make this price-value tradeoff.  This is how we make these decisions for just about, um, absolutely everything that gets purchased.  Since it is your money and you are the one who will enjoy whatever is being purchased, it makes sense that you make the decision – is the price worth it?  Do you buy a cheaper substitute?  Do you do without?

A second way to do this would be to have someone who has you specifically in mind make the price value tradeoffs for you.  This might be like your wife volunteering to go out to buy you some new underwear.  While results may be superior for this approach in a few cases (e.g. my wife buying me clothes), in most cases this approach is fraught with information asymmetries that will likely lead to a suboptimal purchase.  Consider, for example, my wife buying me the cheap 28″ TV when I had wanted to drop the big bucks on a 60″ beauty.

If one were sloppy, he might say that this second approach is the role that exists with insurance companies or is being proposed for the government.  But this isn’t the case.  Because these third parties are NOT making the decision with me and/or my personal preferences in mind.  They can’t.  While my wife may have an imperfect understanding of my preferences, a government health board has none.

So a third model, and almost certainly the worst in terms of individual satisfaction, is to have a third party make price-value tradeoffs for me only with some notion of average preferences for average people, or worse, with an incentive system that has absolutely nothing to do with my satisfaction at all.  This is clearly the case for the government, and is probably the case for many private insurers today — though at least in the latter case one could imagine a regulatory regime that allowed for much more competition and a range of offerings with different service levels and pricing, such that I was more likely to find a pairing close to my preferences than I would in a one-size-fits-no-one government regime.

Skeptics worry that such a range of choices would not exist under private competition, but in fact it does in every single market where the government allows it.  Take grocery stores, since the President of Whole Foods has come into so much criticism from government health care promoters.  The choices in grocery shopping are simply staggering — just think what different price/value points Wal-Mart, Whole Foods, Safeway, AJ’s, and the farmers market offer.

I am constantly amazed when people say that government health care is no different than private competitive models because there will always be rationing.  If you cannot see the difference between “rationing” for yourself based on your own budget and preferences and “rationing” by government committee, well I suppose you deserve what you get.  Except for the problem that unfortunately, I will be forced to take it too.

Here are some notes on the health care bill from one person who plowed all the way through it.  Some of the interpretations are a bit over the top, but I find it a useful index to help me find relevent sections I want to read in more detail.

Previously, I thought I was on the hook to pay 8% of wages only if I did not offer a health care option.  But it turns out that even if our company offers a health care option, we STILL owe the 8% if the employee chooses not to avail him or herself of the company plan.  From the legislation, page 145:

Beginning with Y2, if an employee declines such  offer but otherwise obtains coverage in an Exchange participating health benefits plan (other than by reason of being covered by family coverage as a spouse or dependent of the primary insured), the employer shall make a timely contribution to the Health Insurance Exchange with respect to each such employee in accordance with section 313.

Beyond the costs, the record-keeping requirements are staggering.  I have to keep track of how every employee chooses to get their health care, and have to pay different private and public agencies based on these individual decisions.  Beyond this, for my part time employees (which is everyone), the maximum amount I have to pay varies by the hours worked, meaning the legal requirement for employer health care contribution will vary from employee to employee, and may be different, and change year to year, for all 500 of my employees.

Most of my employees are either on Medicare (which presumably has been paid for with their lifetime Medicare taxes) or on a private retirement health plan.  I have been reading the plan for hours and have not figured out if I will owe money for employees on either of these programs.  Anyone with an insight into this is welcome to email me.

I have been trying to find a word to describe the legislative style we have seen prominently over the last 9 months (though it was used long before this administration — the Patriot Act comes to mind).   Unable to think of any other name, an in homage to “murder-death-kill” in “Demolition Man,”  I am going to call it Crisis-Emergency-Rush.

TARP was a Crisis-Emergency-Rush.  As was the Stimulus bill, Waxman-Markey, and now Health Care.  (The last two are particularly hilarious when one needs to evaluate the need to rush.   Waxman-Markey is implemented over decades, and the health care bills as currently written don’t really begin to take effect until 2013).

So here is my prediction for the next Crisis-Emergency-Rush:  Raising taxes.  Obama already has his boys out sending trial balloons about new taxes, even beyond those required in Waxman-Markey and to fund the health care bill.  Having spent over a trillion dollars on useless spending to support favored political constituencies, Obama will now declare a fiscal crisis that can only be solved by increased taxes on his non-favored constituencies.

One of the burning reasons we apparently need a government takeover of health care is that it is “expensive,” or more precisely, we spend a lot of money on it.

So what?  In everything else I can think of, rising per capita spending and higher spending in the US than elsewhere is a sign of wealth and prosperity, not a “problem.”  We spend a lot of money on a lot of sometimes trivial sh*t, and no one blinks.  We spend more money because we have more beyond what we need to keep ourselves alive.  Or we spend more money because technology provides us new options and frontiers.  But when we spend a lot of money on our health and well-being and longevity, its a problem requiring massive government intervention?

There are a lot of problems with the health care bills in Congress.  At the end of the day, I will endure most of them, as I have every other indignity thrown at me by the Feds.  If they charge me 8% of my company’s payroll as a health care tax, well, we can probably raise prices, particularly in the inflationary spiral the Fed has set us up for.  I will be sad to see the most successful in this country punished with high new taxes, but these taxes mostly won’t apply to our family.  And I will find some way to get my family the health care it needs, even if we have to fly to India to do it.

But my biggest fear is for individual liberties, with the effect I have called “the health care Trojan Horse for fascism.”  We all know that the government has developed a taste for meddling in the smallest details of our lives.  But as more of the nation’s health care spending flows though government hands, nearly every decision you make will suddenly affect the government’s budget.  What you eat, how heavy you are, whether you smoke, whether you play an athletic sport where you can get hurt, whether you pursue dangerous hobbies like rock climbing or skiing, whether you wear a bike or motorcycle helmet, whether you have a seat belt on, whether you drink alcohol, whether you like to use dangerous power tools — all these become direct inputs into government spending via medical bills the government is paying.  And if you think that Congress will avoid legislating on these activities once it inevitably gets in financial trouble with health care, you have not studied much history.

And all this avoids discussion of other powerful individual liberty-related topics, such as the ability to get the end of life care you want or whether the government will even allow you to go “off plan” with your own money if you disagree with its Commissar’s rulings on what care you should and should not receive.

It’s fascinating for me to watch all these children of the sixties in the Democratic Party, most of whom screamed (rightly) at George Bush continuing to implement new plans where we give up individual liberties for security.  But here come those exact same people, with the exact same message – because this is what health care reform is about, at its core – giving up individual liberties in exchange for a (perceived) increase in security.

The NY Post has a very good editorial on the health care bills (HT:  Q&O).  Too much good stuff to excerpt, it includes even more crazy provisions in the House and Senate bills I had not seen yet (its like a scavenger hunt as people go through the 1000 pages, or maybe more like searching for landmines).

But since the bill doesn’t even start taking effect until 2013 (except for the higher taxes, which come earlier, of course), we have to really really rush and make sure its approved before the August recess (and before critics are able to actually read the thing – no chance those in Congress will read it, ever).  Also, its such a burning problem, it just must be solved now, as evidenced by…

The most recent ABC News/Washington Post poll (June 21) finds that 83 percent of Americans are very satisfied or somewhat satisfied with the quality of their health care, and 81 percent are similarly satisfied with their health insurance.

They have good reason to be. If you’re diagnosed with cancer, you have a better chance of surviving it in the United States than anywhere else, according to the Concord Five Continent Study. And the World Health Organization ranked the United States No. 1 out of 191 countries for being responsive to patients’ needs, including providing timely treatments and a choice of doctors.

I have written a number of times, the fact that we spend more on health care is not a bug, its a feature.  We are the wealthiest nation on earth, and there is only so much we can spend on food, clothing, shelter, plasma TV’s and other necessities.  We choose to spend a lot of that extra money on our health and longevity.  Why is that a bad decision?

Not much I even need to add to this, via Riehl World View:

On Tuesday, the Senate health committee voted 12-11 in favor of a two-page amendment courtesy of Republican Tom Coburn that would require all Members and their staffs to enroll in any new government-run health plan. Yet all Democrats — with the exceptions of acting chairman Chris Dodd, Barbara Mikulski and Ted Kennedy via proxy — voted nay.

In other words, Sherrod Brown and Sheldon Whitehouse won’t themselves join a plan that “will offer benefits that are as good as those available through private insurance plans — or better,” as the Ohio and Rhode Island liberals put it in a recent op-ed. And even a self-described socialist like Vermont’s Bernie Sanders, who supports a government-only system, wouldn’t sign himself up.

Does anyone else find this reminiscent of Obama’s decision to send accept a scholarship for his own education, send his kids to private school in DC, and then, nearly as his first action as President, kill the voucher program that let other African American kids in DC go to private school.

It is often said that one of the “problems” with American health care is that we spend far more on health care as a percent of GDP than other nations.  But why is this necessarily a problem?

The US is the wealthiest nation on Earth, top to bottom.  At every level of society, except perhaps for a few recent immigrants, people in this country are wealthier than their peers in a similar income quintile in another country, even Europe.  So it is not surprising that basic needs, like food and housing, might represent a smaller percentage of GDP here than in other nations.  Despite all the efforts of McDonalds and the Country Buffet to change things, there is only so much food we can consume, only so much living space we need, only so many cars we can drive at one time.

As these basics fall as a percentage of our income, something must gain.  It could be savings, but it could also be other spending where incremental outlays return percieved incremental benefits.  And so, why not health care?  What could possibly be more important than extension of our lives and/or the improvement of the quality of our living?  If we as a nation choose to spend our extra wealth on such things, is this really a bug, or a feature?

Update: Yes, I know, the problem is that we aren’t really always able to make this decision as individuals optimizing our own tradeoffs.  We are too often forced to accept someone else’s tradeoff.  Unfortunately, this problem is only going to get worse under any plan Congress is currently considering.  Someone else who is not you and doesn’t even know you will decide how much a procedure is worth for you.