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Posts Tagged ‘healthcare’

For those not following the Whole Foods controversy, this is roughly what happened: John Mackey, CEO and co-founder of Whole Foods, and a fairly committed libertarian who once debated Milton Friedman on corporate responsiblity to stakeholders, decided to pen an article against Obama-care at the WSJ. Here’s an excerpt.

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That’s because there isn’t any. This “right” has never existed in America.

He also suggested some sensible ideas for reform. Of course, in politics, sensible is a relative term.

• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor’s visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

• Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.

Now, if you have ever shopped at Whole Foods (I have) it is fairly obvious what the reaction to Mackey’s oped would be. It was swift and expected.

To quote Epic Etheridge writing in the NY Times.

Reaction from pro-reform Whole Foods shoppers was swift and vociferous. As Brian Beutler noted the next day at TPM DC, Whole Food’s “Web site has been fielding angry comments all afternoon, and has had to set up an online forum where customers can vent their frustrations, and, oh, call for a boycott!”

Here’s a thought,” added Beutler. “If you own a major supermarket chain that caters to a great deal of liberal-minded people with money, don’t rail against the evils of health care reform in The Wall Street Journal.”

At Daily Kos, blogger DarkSyde wondered if Mackey had lost sight of his demographic — “Mr. Mackey, I’m not sure if you understand who it is that shops at your organic grocery chain” — and, in case that had happened, reminded him:

A lot of progressives, vegetarians, professional and amateur athletes, and others who care so much about the environment and what they eat that they’re still willing to shell out three bucks for an organic orange, even in the midst of the worst recession in sixty years. I was proud [Whole Foods] was based in my hometown of Austin, and defended it against most of the conservatives I knew growing up there, many of whom still hold your entire business in utter contempt. Some of them ridiculed me for shopping at Whole Foods, with all the “tree huggers and granola eaters and hippies” who, incidentally, made you a millionaire.

At the Huffington Post, Ben Wyskida said “the bottom line for me, reading Mackey’s op-ed, is that by shopping at Whole Foods I’m giving money to a Republican and I am supporting by proxy a donation to the RNC and to health scare front groups like Patients First. I don’t give money to Republicans, so I will have to cross Whole Foods off my list.”

I have three thoughts on this.

– Mr. Mackey will probably lose a few customers who do not want to shop at a chain because its CEO has views which differs from theirs. After all, the Boycott Whole Foods group in Facebook already has more than 13,000 members. But he will also gain customers of other ideological dispositions. Bloggers such as Radley Balko have been writing about this episode too. His readers will certainly be spending a few extra dollars there in the coming months. As for me, I will sacrifice my love for Trader Joe’s and instead make sure to spend money at Whole Foods whenever I come to the US.

– This episode again demonstrates the astonishing insularity of the Obama loving, NY Times reading urban, liberal, yuppie crowd (actually this would include a majority of my friends). They do not seem to realise that everyone who is not a Democrat does not become automatically a Republican. And Mr. Mackey has never been a Republican. He is a libertarian. More importantly, there is nothing contradictory or hypocritical about adhering to libertarian views while selling good organic food and paying ones employees well and doing all the things the Obama loving, NY Times reading, urban, liberal, yuppies claim to cherish. And responding to a polite expression of another point of view on the healthcare debate by boycotting the company the writer is emplyed at is as lame as lame gets, particularly when the actions of the company actually further your political goals overall. Really.

– Thirdly, I find substantial parallels between the Mackey saga and the Wynand saga. Gail Wynand, that is, the tragic character from The Fountainhead. When Wynand went against his own brand’s clientele to push something he believed in (Roark) it ended badly for him. I hope it does not for Mackey.

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Ashutosh points me to this fine article by Atul Gawande on healthcare reform in the US. While the overall viewpoint of the author is pragmatic liberal, the emphasis is definitely on the pragmatic — indeed, his insistence on the value of building upon existing institutions rather than attempting a drastic overhaul gives the piece a slightly Burkean conservative flavor. In any case, it is an article worth checking out, even if you, like me, don’t agree with much of what he says.

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I missed this post by Andrew Sullivan from a while back.

One reason I’m a conservative is the British National Health Service. Until you have lived under socialism, it sounds like a great idea. It isn’t misery – although watching my parents go through the system lately has been nerve-wracking – but there is a basic assumption. The government collective decides everything. You, the individual patient, and you, the individual doctor, are the least of their concerns. I prefer freedom and the market to rationalism and the collective. That’s why I live here.

Andrew, of course, is a British citizen, who was born and raised there but has been living in the US for a long time now, so his perspective is certainly worthwhile.

Now I’ll be the first to admit that this is mere anecdotal evidence which does not prove anything. Andrew Sullivan’s healthcare experience has been better in the US; there are obviously British citizens who prefer their system. However as long as we keep the anecdotal nature of this statistic in mind, there is nothing to lose by considering it. Indeed, I get the idea that a lot of dyed-in-the-wool liberals who have lived in the US all their life automatically assume that everyone who has lived in single payer prefers it. Quotes like these may at least help them open their minds to the truth.

For the truth is much deeper than that little quote by a popular blogger. Yes, the US healthcare system sucks in many ways. However any system of government mandated healthcare has fundamental drawbacks. Excessive regulation adversely affects medical research and the quality of healthcare provided. It encourages the passage of nanny-state laws designed to compel people to stay healthy. Even the claimed reduction in costs does not necessarily happen in all cases; see this article on the Massachusetts mandate. Above all there is a moral issue — a government mandate involves coercive takings and elimination of choice.

My personal preference leans towards “freedom and the market”, as Sullivan puts it. If the government has to be involved it should do so in the following ways:

1) Change the nature of regulation to light, smart ones designed to reduce costs (those associated with litigation, inefficient record keeping, bureaucratization, compliance with unnecessary rules), increase transparency/information disclosure and foster competition.

2) Replace Medicare etc. with a system of vouchers that can be spent on any health provider.

3) Retain one catastrophic government run health insurance system with a high deductible that would cover everyone in case of emergencies and other catastrophes and deal with the free-rider problem in those situations; eliminate all other government insurance schemes.

These measures are influenced by Milton Friedman’s views, espoused among other places in this article.

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I don’t usually agree with the National Review, but this article is bang on the money.

During the presidential debate Tuesday night, Barack Obama was asked if he thought health care was a “right.”

He said he thought it was a right. Well, if you accept that premise, I think you can ask some logical follow-up questions: Food is more important than health care. You die pretty quickly without food. Do we have a “right” to food in America? What about shelter? Do we have a “right” to housing? And if we do have a right to housing, what standard of housing do we have a right to? And if it is a right, due to all Americans, wouldn’t that mean that no one should have to accept any housing, or health care, which is inferior to anyone else’s… since it’s a right?

Do we have a right to be safe? Do we have a right to be comfortable? Do we have a right to wide-screen televisions? Where does this end?

There are a lot of things that a person needs to live a decent life. However, the word “right” implies something much more fundamental — it means that the government is legally bound to provide you that. It is not a word to be used loosely. In the libertarian worldview, the only fundamental rights are those that protect you from the initiation of force. In other words, it means that you have a birthright to free speech, complete sovereignty on your private properties, the freedom to do whatever you want with your body, the right to associate freely with others and to engage in any consensual activity. The law is bound to treat you equally and to protect these freedoms from other citizens and the government irrespective of your wealth or your status.

In other words, you ought to be able to do anything you want provided you respect the equal liberty of others. The freedoms that stem from this basic principle are the only legitimate rights. It is not a big list. However governments already do a terrible job of safeguarding these. Obama ought to strengthen these constitutional rights before pandering to his audience.

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This guy needs to loosen up. Someone get him a stiff drink!

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There are many good arguments libertarians put forward against the idea of mandating universal health insurance (either through single payer or a Massachusetts style measure).

It is morally wrong to coerce some people to disproportionately pay for others’ costs or to tell someone who decides to take his chance that he cannot do it.

A mandate would almost surely be accompanied by excessive regulation which would adversely affect medical research and the quality of healthcare provided.

It will encourage the passage of nanny-state laws designed to compel people to stay healthy.

Despite these flaws, it was assumed that such a measure would at least reduce medical costs and thus make life better for a lot of people. However it now appears that even this economic rationale does not hold good.

Of course, the linked article of course only looks only at the Massachusetts model but it seems extremely likely that the same problems will arise in any similar scheme.

So what’s the best solution? I don’t have a completely satisfactory answer; check out, however, Milton Friedman’s short essay on the topic.

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From the SF gate report:

Mayor Gavin Newsom has proposed prohibiting tobacco sales in pharmacies, including Walgreens and Rite Aid. The city’s public health chief said the proposal is modeled after rules in eight provinces in Canada but has not been tried anywhere in the United States.

Supervisor Chris Daly has proposed legislation that would vastly limit areas where people can smoke.

Gone would be smoking in all businesses and bars, which now make an exception for owner-operated ones.

Gone too would be lighting up in taxicabs and rental cars, city-owned vehicles, farmers’ markets, common areas of apartment buildings, tourist hotels, tobacco shops, charity bingo games, unenclosed dining areas, waiting areas such as lines at an ATM or movie theater, and anywhere within 20 feet of entrances to private, nonresidential buildings.

Mitch Katz, director of the Department of Public Health, said he strongly supports both measures – even if they are angering business owners who say it’s one more example of San Francisco City Hall overstepping its bounds.

“Tobacco remains the No. 1 cause of preventable death in the U.S. – period,” he said. “It’s government’s responsibility to protect people from obvious risks.”

To paraphrase a comment at the Reason blog, whose responsibility is it then to protect people from tyranny?

Indeed, it’s scary listening to these public-health fanatics. By their logic, speed limits should be lowered to 10 mph, burgers and cokes banned and motorcycles outlawed. Gambling and extreme sports ought to be banished from the face of the earth. And did I forget to mention unprotected sex?

Its a simple enough principle but some don’t get it. Costs and benefits are different for different people. An act that one person views as self-destructive is completely worth the risk to another.

As Jacob Sullum eloquently put it:

Maximizing health is not the same as maximizing happiness. The public health mission to minimize morbidity and mortality leaves no room for the possibility that someone might accept a shorter life span, or an increased risk of disease or injury, in exchange for more pleasure or less discomfort. Motorcyclists, rock climbers, and sky divers make that sort of decision all the time, and not all of them are ignorant of the relevant injury and fatality statistics. With lifestyle choices that pose longer-term risks, such as smoking and overeating, the dangers may be easier to ignore, but it is still possible for someone with a certain set of tastes and preferences to say, “Let me enjoy myself now; I’ll take my chances.” The assumption that such tradeoffs are unacceptable is the unspoken moral premise of public health. When the surgeon general declares that “every American needs to eat healthy food in healthy portions and be physically active every day,” where does that leave a guy who prefers to be fat if it means he can eat what he likes and relax in his spare time instead of looking for ways to burn calories?

It’s true that, as the anti-smoking activist William Cahan pointed out on a CNN talk show several years ago, “People who are making decisions for themselves don’t always come up with the right answer.” They don’t necessarily make tradeoffs between health and other values in an informed or carefully considered manner. Sometimes they regret their decisions. But they know their own tastes and preferences, and they have access to myriad pieces of local information about the relevant costs and benefits that no government regulator can possibly know. They will not always make good decisions, but on balance they will make better decisions, as measured by their own subsequent evaluations, than any third party deciding for them. Leaving aside the question of who is better positioned to decide whether a given pleasure is worth the risk associated with it, there is an inherent value to freedom: When it comes to how people feel about their lives, they may well prefer to make their own bad choices rather than have better ones imposed on them.

Now the smoking ban of course goes beyond nanny-statism. It is also about protecting other people from the risks of second-hand smoke. That’s a laudable intention and as a libertarian I have no quarrels with the underlying principle. But my point is this — how does preventing the sale of cigarettes from certain shops or preventing their use in private bars designated for smoking serve this goal? People who enter such a bar or restaurant usually do with the intention to smoke — those who do not can always choose not to enter.

And whats this about banning smoking in rental cars? Second-hand scent? WTF?

Ultimately, we must recognise these type of bans for what they are – an act of those who are pompous enough to believe others’ well-being is their business and deluded enough to think they are in a better position to make these value judgements than the individual involved. The result is a further expansion of government power in an era when the threat to civil liberties and personal freedom from such intrusions gets bigger every day.

And just so that no one ascribes imaginary motives – I have never smoked, do not ever intend to and hate the smell of second-hand smoke as much as any regular guy. (I do however believe in respecting others’ choices.)

(Hat-tip: Reason Hit and Run)

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