Al's Opinions

I ran across a link to the Cato Institute on Daily Kos, in which Cato is marketing a book called David's Hammer, by Clint Bolick. Douglas Kmiec of Pepperdine University submitted a short review of the book that intrigued me. Here it is:

“Clint Bolick is one of America’s greatest champions of freedom. In this accessible and timely book, he challenges the political left and right to set aside time-worn and ill-defined complaints of “judicial activism.” His writing is a call to principled reciprocity: those who readily embrace speech and associational rights ought not begrudge like recognition of property rights or our innate desire to pursue a lawful occupation. At a time when Supreme Court Justices are mounting national platforms to defend judicial independence, Bolick reminds those privileged to serve in the third branch that judges are given independence for a reason—and it is neither unthinking deference to legislative majority nor the imposition of personal will.”

What intrigued me about the review was the request that those of us who value freedom of speech should "not begrudge like recognition of property rights...." I know that some of us who treasure the First Amendment right to freedom of speech tend to forget that there are limits on freedom of speech. The right is not absolute. The classic example is that one does not have the right to shout "fire" in a crowded theater. Professor Kmiec is a conservative but also a reasonable man. I am sure that he recognizes that a property right or a right of intellectual property is also not absolute. I own my house; my wife and I paid off the mortgage thirteen years ago. However, I do not have the right to set up a slaughter house in my back yard, nor do I have the right to operate a jet aircraft engine at full power which generates a sound level of 160 decibels. My neighbors have the right not to be annoyed or harmed by what I choose to do with my property.

I wonder whether our new conservative Supreme Court will recognize sensible and logical limits on the use of provate property.

Labels: Cato Institute, Clint Bolick, Daily Kos, Douglas Kmiec, Pepperdine University

In yesterday's post (see below) I commented on a recent Libertarian argument against a proposal to provide universal health insurance to all by means of a single-payer system. Canada has such a system, as do many other industrialized countries. I am not satisfied with my own critique of the Libertarian argument against such an approach. I know that there are others who are much more able than I am to mount a convincing defense of single-payer and a devastating attack of the Libertarian argument. However, I will attempt such an attack anyway.

The writers made the following four arguments against proceding now with setting up a single-payer plan:

1. A single-payer or universal plan doesn't provide timely access to certain expensive medical procedures, such as joint replacements or organ transplants.
2. Lack of personal health insurance or personal wealth does not preclude Americans from obtaining health care from hospital emergency rooms.
3. Statistically, one can not show that having health insurance correlates with having better health.
4. The additional cost of caring for the uninsured is no more than three percent of the total cost of the American health care system, the writers say.

Rather than proceed with a single-payer or universal plan, the writers recommend that we should try to do something about things that drive up the cost of health care to mericans. We should adopt such remedies as health savings accounts, a standard health insurance deduction in the personal income tax, and deregulating the insurance industry.

1. Access to such procedures as joint and organ replacements are delayed in some countries by a shortage of facilities to perform the procedures, not by the bureaucratic inefficiency of the government's health care plan. In addition, in our own country, these precedures are not available to persons who lack both insurance and the money to pay for them. We read in the papers of accounts of poor, uninsured persons who do receive such procedures, but they are the exceptional cases in which some generous person or organization pays the cost. Libertarian point #1 is not a valid argument against universal health care.
2. Emergency room care also does not provide expensive treatments like organ or joint replacements. It provides only the medical services needed to prolong a person's life or to treat an illness. If you have a weak heart and have a heart attack, the emergency room staff will resuscitate you but will not give you expensive treatment for your condition.
3. There are several possible explanations for the lack of correlation between having good health and having insurance. One is that a majority of Americans do have health insurance. The lack of correlation simply means that insured Americans, on the average, are as healthy as the average uninsured American. A good fraction of uninsured Americans are young people with good health who either can't afford the insurance or don't see any need for it. Another is private insurance is not structured to encourage one to stay healthy by having frequent check-ups. It is structured to enhance profit by discouraging visits to the doctor unless the patient has a case that is convincing to the insurance adjuster.
4. To argue that the cost of caring for the uninsured amounts to "only" three percent of the cost of the American medical care system and then to argue in favor of such controversial and untested remedies as deregulating the insurance industry, setting up personal health savings accounts, and an insurance deduction in the income tax seems rather hypocritical to me. I have no doubt that providing insurance to the uninsured would reduce that three percent cost to something less.

Anyway, for what it's worth, there is my answer to the Libertarian argument against universal health care or universal health insurance. I welcome your comments.

Labels: Cato Institute, delays in expensive medical treatments, Libertarian, single-payer, Universal health care

Writers Michael Tanner and Michael Cannon have an opinion article in the Los Angeles Times for Thursday, April 5 in which they present the Libertarian argument against universal health care or universal health insurance. Mr. Tanner and Mr. Cannon are scholars at the Cato Institute. In their argument they make the following points:

1. Providing universal insurance does not necessarily provide universal or equal access to medical care. Many countries that provide universal health insurance still require waiting periods for many more expensive procedures, such as joint replacements or organ transplants. The patient may die while waitint.
2. In our own country, lack of health insurance does not deny medical care. An uninsured person can always obtain medical treatment at a hospital emergency room. Hospitals are legally required to provide such care.
3. The writers cite studies that show that having health insurance does not correlate with having better health.
4. The writers cite a report that shows that the cost to society of providing health care to uninsured persons amounts to no more than three percent of the total cost of medical care in the United States.

The writers conclude that, rather than concentrate on providing affordable health insurance to everyone, politicians should work on fixing some of the other problems and applying other solutions,

such as enacting a standard health insurance deduction, expanding health savings accounts and deregulating insurance markets.

I think that these writers are living inside a bubble. Even they concede that it would be good to provide everyone with health insurance. They don't think it would solve anything to do so. They don't recognize that our national health care system is broken and is deteriorating. It may be statistically true (I can't dismiss their statistics out of hand) that a person who must rely on a hospital emergency room for medical care is otherwise just as healthy as a person with health insurance or with enough money to pay for visits to the doctor. I do know that more and more hospitals are closing their emergency rooms. Emergency treatment is still available, but waiting times are longer and longer. I have good health insurance and I have enough money to pay for medical costs out of pocket, but if I have a heart attack I may not be able to reach a hospital with a working emergency room in time to save my life.

It is very wrong to argue that we don't have a pressing need for universal health insurance, at least, simply because emergency rooms are legally required to care for the uninsured and indigent members of our society. We all need access to emergency treatment from time to time. Such treatment should not be delayed because ideologues have objections to society providing afforcable health care to all.

Labels: Cato Institute, hospital emergency rooms, Universal health care, Universal Health Insurance