There has been more and more press with health experts claiming that healthcare costs will become completely unmanageable, with our without reform, unless we, as a society take action to improve our collective diets. They go so far as to suggest banning sweet snacks, and high fat foods. They could be right.

I don't care if they are right, and this is where some opinions of healthcare reform proponents start to collide with my opinions on personal liberty. Jacob Sullum takes this on at Reason http://www.reason.com/news/show/28840.html. Showing how really, depending on what your interests are, you can make a case for virtually any and every ingestable substance to be eligible for inclusion in dangerous foods that cost our healthcare system money.

The relative costs of food to our heathcare system is a separate debate, and reform supporters should take great care to keep these arguments separate and fight the food police just as hard as they fight the misguided souls who protect the status quo of a government bought and paid for by the health insurance industry. I see healthcare reform, especially the public options, as a balance to the regulatory capture of our government with respect to history of the industry using its resources to influence the government into protecting and enriching their industry, to the detriment of the citizens that government is supposed to represent, all far outside of the parameters of free-market economics.

This is where I start to wonder if the slippery slope argument of reform opponents may hold some water. Except that we are already moving down this slippery slope, and they remain completely separate arguments.
Given a choice between having the government tell me what I may and may not ingest, and having unaffordable health insurance, I'll choose unaffordable health insurance costs, but that is NOT the choice being made. Reform proponents often cite mandatory car insurance as a model for mandatory health insurance, but the big difference in how they want health insurance to look is in underwriting. Car insurance is underwritten on a driver by driver basis. People with a history of bad driving, or members of groups that are deemed to be higher risk drivers, pay higher premiums. In healthcare, the goal seems to be to have the same premium, regardless of risk. I am fine with that, if we have a large enough group that can absorb high risk and low risk individuals resulting in a reasonably affordable individual cost. What I absolutely oppose is using the fact that all risk is equally shared as the foundation of an argument that since we all pay in equally, it's not fair for some to have unhealthy lifestyles, and then legislate prohibitions on lifestyle choices.

In my view, personal freedom demands that we accept the risks of individuals who make bad choices, or we let insurers (public or private) underwrite individuals and charge them a premium for their lifestyles. What we absolutely cannot allow is for one good argument (sharing risk) to be used as the foundation for one very bad argument, that since we are sharing the risk, people can prohibited from exercising personal freedom that harms no one but them, using the argument that since we are sharing the risk, they are now harming the collective, therefore it is within the rights of the collective to apply these prohibitions. This argument is being used now to pass legislation, and will continue, with or without health insurance reform.

I live a pretty healthy lifestyle, though I have my vices, and already pay sin taxes on those vices. I can live with sin taxes on alcohol and tobacco, they are demonstrably a revenue drain on every system, and in moderation, the sin taxes are moderate. But I would sooner argue that even these sin taxes should be abolished as anathema to liberty than allow that since we accept that these products are a drain on the collective and are taxed as such, that any and every product that could fit this description could, or should be taxed.

There are degrees here, but freedom loving Democrats should be very vocal in disputing any notion that any form of collective healthcare automatically allows limitations on individual rights. None of this means that government policy cannot be mindful of its impact on dietary choices. While I disagree with policies designed for the sole purpose of discouraging a behavior, I also oppose the existing policies which encourage, and subsidize bad dietary offerings and choices. I find it ironic that while some want to place a sin tax on sugar, we already subsidize sugar production, making the product artificially cheaper than it should be. Removing the subsidies does not deny freedom, and really, to have a subsidy on one side of the equation, and a sin tax on the other, seems to be something of a conflict, most likely resulting in the same outcome as simply removing the subsidies. The same with corn, no better than other veggies(nutritionwise), and after massive processing, it does more to add bulk than nutrition to our diets. Don't punish corn eaters, but by the same token, don't encourage corn consumption by subsidizing it's production.

The fact that that America does not have armed guards or electrified fences across every linear foot of our borders makes us more vulnerable to terrorism. So what? This is the cost of liberty. The fact that we do not allow police to enter any premise at any time makes us more vulnerable to drugs and crime. So what? This is the cost of liberty. The fact that people who arouse suspicion cannot be tortured until someone decides whether or not the suspicion was warranted makes us more vulnerable to violence. So what? This is the cost of liberty. The fact that illegal immigrants cannot be stopped by government officials or citizens and asked for their papers makes us more vulnerable to immigration problems as well as terrorist attacks. So what? This is the cost of liberty. The fact that the government cannot eavesdrop on every phone call, email message, or web session makes us more vulnerable to all manner of crime and violence. So what? This is the cost of liberty.

Liberty has a cost, and I will gladly pay that cost. Liberty has risks, and I will gladly take those risks. When we rely on the state to protect us from everything, including ourselves, there will be no protection from the source of our greatest risk, the state itself.

I would go so far as to suggest that it be included into any legislation that no future legislation may seek to contain healthcare costs by taxes or prohibitions on any common dietary elements, including sugar, fat, caloric density, or any other characteristic.

The experts may be right about the cost of our collective diet, or even individual diets, but it's either a cost we need bear, or an individual responsibility, we can never allow our diets to be a collective decision.

All this said, it is important to point out that even without heath insurance reform, these arguments exist, and these laws are being passed. Since 60% of healthcare dollars pass through government at some level or another, the collective argument is out there and being made and being won in some cases. So while I make the argument against these collective dietery prohibitions, health insurance reform is needed, and the arguments that passing reform is a slippery slope to authoritarian diet mandates fails in one major respect, we are already on that slope, and these encroachments on our liberty need to be argued for what they are, separate and distinct arguments. Support health insurance reform, oppose authoritarian dictates on individual choices, but don't conflate the two.

I keep getting email messages, and Facebook comments about healthcare reform, and what’s wrong with the current bills in Congress. I happen to think there are a number of things wrong with the bills, but oddly, the specific points of my apprehension are rarely mirrored in the opposition emails I receive. Instead, I get a lot of wholly fabricated assertions, and what I can only assume are either intentionally incorrect interpretations of the bill, or interpretations made by people to whom a sack of what hammers would be their intellectual superior.

I decided to have a little fun with intentional misrepresentations and tried to imagine what these same people might have done with the Bill of Rights, if they were around to mangle it.

If Republican healthcare reform opponents interpreted the Bill of Rights in the US Constitution…

Amendment I

Congress will not respect religion, freedom of speech, or freedom of the press.

Amendment II

in order to own a gun, you must be a part of a militia regulated by the federal government.

Amendment III

Soldiers are going to be forced to sleep outside.

Amendment IV

Government can seize your property.

Amendment V

Soldiers will be denied due process and can be held or executed by the government without trial.

Amendment VI

The government will hurry convictions of people accused of crimes without regard for guilt or innocence.

Amendment VII

Poor victims will not have access to jury trials.

Amendment VIII

Torturing and agonizing capital punishment will be regulated for uniformity.

Amendment IX

Denial of rights not specified in the Bill of Rights will be accomplished through legislation when and how the government decides.

Amendment X

People’s right are the last priority, after the federal government and the state governments.

The recent controversy about the scheduled Presidential address to our nation's elementary school children prompted me to look into just what we are teaching our children about politics. My K12 experience in school from the late 60's to the late 70's was that of hero-making of all former Presidents as well as the President who currently held the office, but we were also taught ideology, through a historical lens in elementary school, and through current events in high school. The differences between party ideologies was taught, discussed, and debated, from both sides, even in elementary school. I think this gave me a good grounding to develop my own personal philosophy, but also gave me respect for opinions that I did not agree, and more importantly, that good people can disagree, and both can have valid points. The political environment today is polarized almost to the point of violence, and I believe this is caused by ignorance of opposing arguments, where opposing arguments are replaced with caricatured strawmen of the persons who hold opposing opinions. This caricaturization has the same effect that the American view of the Japanese people (and vice versa) which served to demonize the enemy, and more significantly, dehumanize the enemy, making their lives, or taking their lives, and insignificant act. This became brutally apparent when a women confined to a wheelchair was heckled because of her point of view at a healthcare reform townhall meeting. When this woman described her situation of being unable to walk as a result of two incurable diseases, she was greeted with sarcastic "Awww's" from opposing members, clearly, her existence as a human being was undermined in the minds of these people simply because of her opinions.

My youngest child has just completed his elementary education this past June, and not did the class every teach or discuss ideology or differing political opinions, and the teachers have made it clear that these topics are taboo in school, best left to parents to teach for fear of offending parents by introducing viewpoints different than there own. This is in my opinion a very easy decision, and also a cowardly, academically dishonest decision.

Parents are ultimately in the best position best position to shape their child's ideology, but since most people barely understand their own arguments, and have no clue about the genuine points of opposing arguments, they are in a terrible position to teach what a political discussion should really be, rational discussion about the relative merits of opposing arguments.

I suggest that every elementary school student be exposed to proponets of various realistic ideologies, and the class, led by the teacher, discussed the relative merits and learns to debate political thought in a thoughful manner, and identify and discourage logical fallacies in arguments.

If we continue down the road we are traveling, a civil war, complete with shooting and atrocities, may not be as far away as we once believed. So as to avoid being too hyperbolic, I do still believe that such a conflict is still a long way off.

With all this misinformation propagated by health insurance reform opponents, especially the evocative “death panels”, I decided to review how life and death decisions are made now for people who are excluded from the system today. Rather than try to gather information on every manner of illness and disease, and the impact of being uninsured, it seemed more practical to choose a single common, but deadly, disease, and understand the data in this more narrow view. Cancer seems the most logical disease to review. First, it’s important to understand actual life threatening emergencies, the COBRA of 1985 made it illegal for any medical provider who accepts Medicare or Medicaid dollars to deny emergency treatment to anyone on the basis of their ability to pay. This covers about 99% of doctors and hospitals. That’s the good news.

The bad news, especially with regards to cancer, is that by the time an individual is in such dire condition that they need emergency care, their chances of survival are far less than those whose cancer was discovered earlier.

Before considering a comparison between the insured and uninsured, it’s important to understand why people are uninsured. Clearly, some individuals are uninsured by economic choice (they could afford it, but choose not to for economic reasons), and others by empirical economic realities (they simply cannot afford health insurance), and others are uninsured because they simply cannot qualify for health insurance coverage. There are also a small percentage of people who are uninsured for non-economic reasons, religious, moral, ideological, and the like. In all of the current health insurance reform proposals, a level of mandatory insurance is proposed for all American, and denial of coverage or price discrimination of individuals with pre-existing conditions is prohibited. So let’s look at the difference this might make in the mortality rates of cancer victims who are currently uninsured.

An American Cancer Society study shows that about 20,000 uninsured individuals die of cancer each year. The study further finds that uninsured individuals are 50% more likely to die in the first five years than insured individuals. This means that of approximately 57,000 uninsured diagnosed with cancer, 35% die within five years, while of their insured counterparts, 23% percent die within the first five years. In raw numbers, that equates to about 7000 people each year, whose death is clearly correlated, and arguably caused, by a lack of insurance.

I submit that the current health insurance system, which is being aggressively protected by the GOP, effectively lines these 7000 people up in front of metaphorical death panels and deems them too insignificant to live. And remember, this is ONE disease, one potential cause of death.

Looking at the broader picture, a study by Brigham and Women’s Hospital found that the uninsured between the ages of 50 and 64 are 43% more likely to die than their insured counterparts. This adds up to 105,000 people each year whose death is directly correlated to their lack of insurance. The authors noted that if being uninsured were a disease, it would qualify as the third leading cause of death in America for that group.

Opponents of reform might argue that the US has lower wait times than countries with universal healthcare, suggesting that lower wait times insure early treatment and save more lives. While it is true that the US has lower wait times, the conclusion that it equates to more lives saved is false. The actual results, as compared to universal health plans are better in countries with universal coverage, with higher life expectancies, overall performance, and lower cost. Lower US wait times are a statistical anomaly caused by the fact that people without coverage are statistically under-represented because they are far less likely to try and schedule treatment or care at all. Essentially, the wait times for some of the uninsured are infinite, but since no appointments are made, the wait times are skewed to show a misleading lower wait time average. Reform opponents actually acknowledge this fact in their arguments, but do not understand the implications. They say that if you add 50 million insured, there will be more people to make appointments, so wait times will have to go up, essentially arguing that they want their wait times lower at the cost of sacrificing care for other Americans. All this, ignoring that fact that broader coverage, not lower wait times are more significant elements to improved healthcare performance.

Additionally, while Republicans talk about the government sentencing people to death because they will cost to much, the private vs. public rality tells a far different story. The big public insurance plans available today, Medicare, Tricare, and the VA have NO maximum limit on lifetime benefits. Two Thirds of private health insurance plans DO have lifetime limits, creating an automatic "death panel" for those who cost the insurance company too much.

The “death panel” boogeyman propagated by the GOP is pure fiction, an invented scare tactic designed to provoke fear among older Americans who are already covered by Medicare, so have no vested interest in seeing health insurance reform, but are a very powerful and active constituency if they can be swayed to oppose health insurance reform. But our current system, in contrast with proposed mandatory insurance coverage, kills 105,000 individuals each year, essentially lining them up in front of an economic policy “death panel” and telling them the current system must be protected and their lives are a worthwhile sacrifice to this goal.

The “death panels” we have heard about are fictional, but the Republican policy “death panels”, though metaphorical, are real in their impact on the lives and deaths of real Americans today.

Republicans are opposing meaningful healtcare reform, although every Republican seems to be on record agreeing we NEED meaningful healthcare reform. Republicans also know they lost the election so they don't get to write the bills, but could help shape the bills, something they feigned participation in ahead of the recess. Republicans have made it clear that politically, they need for Obama to fail in order to have a chance to win in 2010 and/or 2012. None of the bills are perfect, and no bill will be, but I think it's time the Democrats forget about a bi-partisan bill. If there is going to be a meaningful bill, there won't be Republican votes.

Republicans have said that healthcare is going to be on the Democrats head, and they will take no responsibility for it. I say fine, let the Democrats future political rest on what they accomplish on healthcare reform. They really don't have much of choice, since their future will rest on failing to accomplish health care reform if they continue to allow their success to hinge on gaining Republican support.

More importantly, I think Republicans fear a successful healthcare reform more than anything. The American public's approval of New Deal programs kept the Democrats in power for decades, and I think Republicans would rather have death panels than a successful healthcare system created and implemented by Democrats.

As a side benefit, the Blue Dogs can even vote against the bill, mitigating the effectiveness of attacks in the upcoming campaign season in the Blue Dogs moderately conservative districts.

Potentially a win, win, win, lose scenario. The American people win by getting meaningful healthcare reform, the Democrats win, the Blue Dogs win, and Republicans lose. Maybe after an even more crushing defeat the Republicans can re-invent their party as something a little less crazy-centric.

I have been frustrated by the recent news that the public option could be out of the healthcare reform proposals, but on second thought, this may be some clever political jujitsu. The consumer protections and mandates served the purpose of putting private insurers on an even field with the public option. The public option plans oculd not compete if only they were accepting pre-existing conditions, and following other elements of the consumer protection elements of the reform proposals, and my frustration was that without the public option, the mandates and consumer protection aspects were just new guaranteed customer for private insurers without any counterbalance of the public option.

Then I was thining about it, and what the public option really is, and how easy it could be to pass later. The start up costs for the public option are about $2B, which in parlance of the federal government, is about a penny, and could probably be done without legislation at all, but I doubt it would go that way.

The public option could be tagged onto any old spending bill, and the initial costs wouldn't probably get the slightest notice.

It's the mandates and the consumer protections that made the public option viable, so I could not for the life of me understand why they let the public option slip away, but really, if they get the rest of it, creating an exchange or non-profit to offer huge group policies is probably a fairly simple thing once separated from the rest of the proposal.

Just a thought.

It never would have occurred to me that any libertarian could ever support a public healthcare option under any circumstances. But I started thinking about libertarians who supported the Iraq War, and wondered, if a person could consider themselves libertarian, and could rationalize supporting an offensive pre-emptive war, how much of a stretch could it to be support public healthcare?

Personally, I believe that some large public healthcare option is a fait accompli because of one simple fact about our society; we will not refuse necessary care to someone who needs it, regardless of their ability to pay. There are certainly libertarians who adamantly oppose this position, and on fundamental principal would argue that people have a right to life, not a right to have their life extended at someone else's expense. I would suggest that this would be the purest libertarian position. But libertarians with that kind of ideological purity would oppose having a standing military, much less using a standing military for pre-emptive wars of aggression. So considering the less "pure" libertarians, I would wonder what their position is on denying care to the indigent.

I went to the LP website, and it’s all platitudes, deregulate, tax cuts, and deregulate some more, and of course they blame federal policies for doctors not making house calls anymore. No comment on whether they would support denying care for people with immediate necessity. Regardless, as a society, denial of care is non-starter, so if politics is the art of the possible, considering that we now guarantee a level of care to every American, and there is no chance of this reversing, wouldn’t the responsible libertarian (as opposed to the purist) desire to make this situation as efficient as possible?

From a libertarian perspective, recognizing the unchangeable elements, I would think making the best policy within the constraints of the certain would be appealing. Protect rights, both civil and economic, to the greatest extent possible, as opposed to the current system, which fails in both the public elements and the private aspects. Even libertarians agree that there are some things handled better by government than private enterprise, police services, firefighting, and the like. We’re not sure whether government could really do health insurance better than private industry, so wouldn’t the libertarian thing to do be to set up the competition and let the most effective policy win?

My proposal for a healthcare policy that a libertarian could support (albeit grudgingly, because of the immovable object of guaranteed care) is a public healthcare insurance option in the form of a non-profit corporation that could not be bought by private industry (as so many of the effective not-for-profit insurers have been). This corporation would have the full faith and credit of the US Government, and would be empowered to negotiate on behalf of their insured. Interestingly, this non-profit might well be designed similar to the Federal Employees Health Benefit Plan, which essentially negotiates with private insurers, but gets far better rates, and far better coverage than individuals, smaller groups, or even large groups can negotiate by virtue of number of insured’s they represent. The FEHBP represents 15 million members, making it the largest health insurance plan in the world, outside of national healthcare across most industrialized nations. This non-profit could also have the option of self-administering, eliminating the private insurance companies if they find that would be more efficient. The effect on private insurers would be simple, they would be both competitor and partners with this new public option, and their need to control costs both in their private offerings (to compete) and their negotiated government rates (to win contracts), would serve the interests of the public, putting their corporate interests in profitability in line with the public interests of better value in healthcare.

If the private offerings are better, then they will win, and the public option will languish and people won’t choose it, but hopefully, the competition will create better value. If the public offerings win, the private insurers can still prosper, but only if they control costs and win contracts with the federal plan. Most of this plan would have zero cost to the taxpayer, only more options and greater competition. The costs to the taxpayer would come from the existing healthcare subsidies and government plans, policies like Medicaid, SCHIP, state programs, and possibly even Medicare itself could be eliminated and rolled into this non-profit entity. All the billions that go into those programs could be streamlined into this program. The savings should be significant over the current policy that pays a premium for emergency care under the guaranteed treatment policy. Corporations could maintain the current beneficial tax status of health insurance premiums they pay, and, for employees who opt out of their plans, they could have tax beneficial treatment on insurance stipends for their employees, maintaining the benefit of continuing to offer health benefit monies for their employees.

The plan would have to evolve over time, but the key is that private insurance would not have to be eliminated, and in fact could emerge as the more effective option. But most importantly, actual care would retain it’s private industry status, as it should.

There are certainly pieces missing here, and room for adjustment, but as a general foundation for a plan, I think this should be more desirable for a libertarian than the status quo, and more likely doable than the impossibility of repealing all existing government involvement in healthcare, as well as reversing our society’s stand on guaranteeing care for those in need regardless of their ability to pay.

Or, I could be completely wrong and the libertarians who strayed so far from libertarian ideology were just Republicans who like to call themselves libertarians and they will fight for the status quo just because it's what the Republicans want.

As one looks at the political landscape of America, it would be hard to miss the simple fact that whether Republicans win or Democrats win, the American people lose. We have seen an attempt at Social Security reform that looked more like a trillion dollar stock broker commission, or health care reform that looks more like a trillion dollar premium check to the insurance industry. Good ideas, or even bad ideas, are consistently turned into policies that hand out cash, directly or indirectly, to the biggest players in the game. This happens because with respect to the political system of electing politicians in America, this program has been brought to you by the largest big money interests and industry lobbies in the world.

Statism, libertarianism, liberalism, conservatism, and every other “ism”, are shams in this environment because they are all talk, and when it comes to action, they spin sponsored legislation as if they were honest policies matching the rhetoric these people used during their campaign. The reality is that the most significant legislation in America either pays or protects various election sponsoring industries, or retards their potential competition.

There’s a name for this phenomenon, but we never hear it. Instead, we hear about the evils of liberalism or conservatism, we hear about how Democrats or Republicans are so wrong, and why, using concepts like self-reliance, or lack thereof, social responsibility, or lack thereof. And the sad reality is that none of these “ism’s” are inherently bad, and there are policies where each of these ideological positions could result in successful policies. There are people and groups that really could not care less whether policies achieve the stated goals, only that they serve the interests of their sponsors, and these sponsors drive policy more than any ideology ever has.

It’s called Regulatory Capture, and it is as pervasive as it is invisible. It is the hand that feeds. And worse, it is not just the hand that feeds the political system, on both sides, but also the hand the feeds the news/talk industries, as well as the think tank business.

The policies of Regulatory Capture can appear statist or laissez faire, authoritarian or libertarian, and often can be spun as being all of the above. Maybe President’s can be immune, maybe not, but is doesn’t matter, since Presidents don’t make laws. Maybe GWB really wanted to improve the Social Security system, but what was bouncing around Congress was a plan to improve money management fees on Wall Street. Maybe Obama really does want to make healthcare work for everyone, but what’s bouncing around in Congress seems more like what the insurance industry would write if they were told that something that seems significant needs to be passed by Congress and they get to make sure it just seems significant, but allows them to maintain the essential status quo.

Regulatory Capture can be regulation, it can be deregulation, it can be restrictions on business that make it difficult for small players to enter markets, it can be the elimination of restrictions that hide the activities of industries from the public eye or official review. But the common element that policies structured by Regulatory capture is that there is absolutely zero interest in accomplishing any policy goals and a total focus on accomplishing the goals of the sponsor. It doesn’t guarantee the failure of any given policy, but sure it makes failure more likely.

The most frustrating aspect of Regulatory Capture is that is so very well protected. The ability of lobbies to sponsor your Congressman is protected under the First Amendment as validated by Buckley v Valeo, the SCOTUS case that determined that money IS speech, and therefore the ability of lobbyists to spend cannot be restricted. So every four years, these various groups spend about four billion dollars and are rewarded with hundreds of billions in revenues, either through protection of their revenues, direct government largess, or other policies that help these sponsors maintain their edge.

I can’t support policies that preclude Americans from using their dollars as a megaphone, but I can support policies that prevent those megaphones from being so loud. That’s why I support public financing of elections. Let we the taxpayer foot that four billion of direct campaign support for candidates rather than allowing interest groups to use that funding to purchase policy. They can go out and pay for candidates that refuse public financing or they can pay for their own issue campaigns, but we could take these groups out of the equation for a new generation of politicians who want the freedom to be responsive to their constituents, not their sponsors.

Our system is too complex and requires too much faith in our institutions to do away with regulation, and it is too easy to manipulate to allow lobbyists to write laws. We can’t eliminate influence, nor would we want to, but we can, and must, reduce how that influence is applied, and how effective it can be in the current environment.