The Health Care Swamp

View 707 Thursday, December 29, 2011

Mark Steyn, substituting for Rush Limbaugh this morning, says that Newt Gingrich is wrong on first principles: it is simply wrong in a free society for the government to require you to have health insurance, and anyone who believes that is beyond the pale, a liberal or socialist, not a conservative.

In fact Gingrich hasn’t been quite so clear in his “endorsement”, but leave that. Is it true that any consideration of mandated insurance is simply anathema?

Well, we can postulate that a free country ought not dictate what its citizens should buy, and that is perhaps a fundamental principle. Yet while there is certainly a sense in which that is true, it neglects other principles and facts, none of them particularly obscure.

To begin with, it is certainly no less conservative to insist that someone pay for his own health insurance than it is to insist that someone else pay for it. If you aren’t obliged to provide your own insurance, should someone else be so obliged?

And that is the essence of the health care debate.

One answer is that no one is obligated to pay for anyone’s health care insurance. It’s a free country and you’re free to have insurance or not, as you determine by your needs and income. That was the case for most of the history of this Republic: you’re on your own. If you get sick, pay your own bills. If you must, seek charity, or else be sick, languish, suffer, and if your illness is sufficiently severe, die. This is a free country. You are free to pay your own way, but you are not free to demand that others pay your medical bills.

Of course if you have had the forethought to buy health insurance, you are in good shape. If you have not, then pay your bills. Whatever you do, this is no business of the government.

The problem is that this doesn’t really seem acceptable. People are born with defects that prevent them from getting medical insurance. Others develop problems. These people encounter the problem of “pre existing condition.” They plead they would have bought health care insurance but the pre existing conditions make the premiums too high. Others say they once were insured, but when their conditions developed, the insurance company dropped them. It is barbaric simply to ignore all these people. In order for a man to love his country, his country ought to be lovely. Look at these innocent victims. Surely we must do something?

And over time, particularly in boom times when the nation was getting richer, in many parts of the country and perhaps nationally, a new consensus was developed: first, that there ought to be a safety net, then that people have a right to health care insurance, and their birth defects, or health problems developed over time, should not prevent them from obtaining it. Nor is it fair for the insurance companies to charge premiums consistent with the risks the company is assuming.

Thus came the demand for health care insurance available to all at the same price. Of course that’s not insurance at all except in the sense that we are all insuring each other: we all pay and we all benefit. But that requires that we all pay, without exception, and that requires mandated insurance, and we’re back to where we started, except that now we find it is the will of the people that there be this universal insurance policy. Can’t we just accept that and get on with it? And thus Obama Care, modeled in some ways on the Massachusetts system implemented by the Democratic legislature of Massachusetts and the Republican Governor, then Mitt Romney.

And there we are. Meanwhile, the costs skyrocket, in large part because those who receive the benefits are not those who pay for them, and those who pay for them have no control over what benefits are paid. Everyone wants the system to deliver more but cost less. This squeezes some health care providers while opening up the gates to fraud for others. If a system were designed to insure runaway costs while infuriating dedicated health professionals it could not work better to accomplish those nefarious purposes than the system we have now. It doesn’t work, we can’t afford it, and it tramples what we once thought were liberties; yet how is it conservative to overlook people dying in waiting rooms? Or –

That discussion can go on for a long time, and involve any number of well meaning people.

It hardly matters whom we shall elect as President so long as these fundamental questions continue unresolved, and castigating one or another of the candidates as not sufficiently conservative does nothing until we establish just what is a conservative position. No one wants things to go on as they do. No one wants to bite the bullet and come out for “Death Panels” — health care committees that allocate the available health care resources. There doesn’t seem to be much desire for simply nationalizing the health care system and having done with it. And every year, we spend more money and get less for it.

There aren’t many ways out of this swamp, and none that will not infuriate some people. And it’s never going to be addressed if it becomes a third rail, a subject discussable only at peril.

It does seem to me that there is a constitutional solution: make it clear that the federal government has neither the obligation nor the power to solve it. National health care perhaps ought to be a national concern, but it is not mentioned in the constitution, and thus is not a power granted to the Federal government. If this be any government’s concern it is the business of the states. One may argue that all government ought to get out of the health care business, but that, surely, is a matter of politics; but I argue vigorously that as concerns the Federal Government, it is not politics but law. The Constitution didn’t give the Federal Government that power, just as it did not give the Federal Government the power to provide, interfere with, or regulate education.

Leave these matters to the states. Meanwhile, if the Congress wants to show how well it can provide health care and education, it has the undoubted right to take over the health care and education systems in the District of Columbia. Let it show how well it can do there. If what it does works well, it may be tried by the states. If it turns into a bureaucratic mess, the states can avoid the Federal methods.

Leave these matters to the States. Get the Federal government out of the health care and education business.

December 29, 2011 1100 AM

I’m writing this at the kitchen table on Khaos, my Mac Book Air. One set of workmen have left. They finally found the cracked and leaking six inch of gas pipe. This was the third attempt. Each previous time ended with supposed success, but turned out to be This Time For Sure. All would be well for a couple of hours and then we would smell gas. The first time was at ten PM. The Gas Company technician, a very pleasant man who turned out to have kids who read science fiction so I gave him a copy of Starswarm, was able to show us how to turn off the section where the leak was while leaving the water heaters, but because it was after ten PM he was alone and they don’t crawl under the house unless they have a partner. Yesterday the contractors came out twice, and each time thought they had found it, but last night there was once again the smell of gas. This time they actually found a pipe with an actual crack in it, and replaced it. They’ve been gone for an hour, all the relevant valves are open, there’s heat in Roberta’s bathroom which was the whole point of the operation, and there is no smell of gas in the hallway. I believe we can at last rejoice.

The moral of the story is that Roberta’s persistence in finding a reliable firm to do the work fixing her bathroom heater has paid off in spades and big casino.

Now she’s out taking Sable for a walk, and I’m sitting at the kitchen table while the plasterer fixes our ornate dining room cornice which was damaged by leaks from my upstairs bathroom, which had to be repaired and – but you get the idea. Chaos Manor has been sufficiently chaotic for the month. With luck it will all be over by Saturday. Meanwhile one of us has to be downstairs while there are workmen in the house, which is why I am working with my wonderful Mac Book Air at the kitchen table.

I’d forgotten how nice the Air is for working. My normal work position involves a Henry Miller chair and a keyboard at precisely the height I want, and big monitor screens. I don’t have any of that at the kitchen table. It takes a bit of getting used to. First I set the Air far enough back on the table so that I can rest my arms on the table and my fingers properly on the keyboard. Strange at first, but after a few minutes it turns out to be very natural.

Of course the Air saved my sanity back when I was getting my brain burned out – 50,000 rads of high energy X-rays to eliminate the inoperable lump in my head – and I was daily in the Kaiser Sunset radiology facility waiting room. I was able to work there, and that’s about the only thing that kept me sane. Clearly the treatment worked since I am still here and they can’t find any traces of cancer left.

Of course the Air saved my sanity back when I was getting my brain burned out – 50,000 rads of high energy X-rays to eliminate the inoperable lump in my head – and I was daily in the Kaiser Sunset radiology facility waiting room. I was able to work there, and that’s about the only thing that kept me sane. Clearly the treatment worked since I am still here and they can’t find any traces of cancer left.

The Mac Book Air – mine is named Kaos for the Goddess of Air – is a remarkably useful device. I don’t think it’s quite enough computer to be one’s only system, and my main machine remains Bette, a quad core Windows 7 machine and a 23” screen. If I am going somewhere for days and I need a system to set up in the hotel room and leave it in place, I tend to carry a ThinkPad; but for just knocking about writing wherever I happen to be, cruising the Internet at need, and just generally having a computer to use, the Air is wonderful. Lightweight, good battery life, gorgeous to look at, and easily carried in a small brief case or messenger bag. She’s not fast but she’s fast enough, and she’s easy to use in awkward places.

And, suddenly, all is well. The gas lines are fixed, the plasterer is done, Roberta is back from her walk, and I can go back up to the office. I can say I enjoyed resuming my affair with Khaos. She really is gorgeous.

For some of my early impressions of the Mac Book Air, see http://www.jerrypournelle.com/view/2008/Q2/view512.html

At work at the breakfast table with Khaos, the Mac Book Air.

Khaos at work. The Mac Book Air (mine is an old one, of course) is my favorite carryable if I need to get some real work done.

Did the real Cheetah die in 1938? A chimp named Cheetah died at 80 this week, but the conspiracy theorists claim that the real Cheetah died, and this one is a fake.

There was apparently a major problem with the site today. It has been hacked up and fixed, although there’s now contemplation of some internal structure changes (which you won’t see).  I believe all is well there now. Thanks.