Caffeinated Simpleton

In any political debate, there is rhetoric used by both sides to imply how obviously correct their position is. The current healthcare debate is no different, with “healthcare is a right” being a favorite phrase of those on the left. Those that use the phrase take it to mean that every person deserves some form of healthcare. However, this is not what a “right” is. Rights are those properties of a human being that are granted to us because, and only because, we are human. They are granted a priori, and cannot be denied us except through force and submission. Healthcare does not fall into this category. Healthcare is something that is consumed, and is therefore granted by those that have it to those that do not (usually in exchange for some other good, mostly cold, hard cash these days). Nothing that falls in this category can be a basic human right, as the providers themselves have the right to determine who they provide to.

Whether or not healthcare is a right, however, is not the debate. Rather, it’s a tactic used by one side to make an argument in a sentence instead of in a carefully constructed thesis. What those in favor of healthcare reform are trying to push for is the idea that we, as a society, have some moral imperative to force the provider’s hand and provide some level of healthcare to all, whether providing such care is beneficial to the provider or not. This is an argument for a restriction of rights, which, paradoxically, is something goverments have been granted the right to do by their citizens.

The question then is how much we are morally obligated to restrict the freedoms of healthcare providers in order bring the general health to some acceptable level. This is a very difficult question, made more difficult by the fact that the value of healthcare changes with time and economic prosperity. This is a terrific example of imperfect duty, a duty which is never complete but which we are morally bound to strive to make progress on. We have made great progress too. Healthcare as it exists today is better than at any previous point in history and available to more people. It does seem to be the case, however, that society feels that too many of its members are in a situation where they do not have access to the kinds of care that should be available to all. This probably doesn’t include very expensive experimental treatments, but does include expensive but common procedures and treatments like those used to fight cancer, heart disease, and other widespread diseases.

The current legislation is too large for me to really know what’s in it, but the goals are fairly clear. The bill is meant to require health insurance for almost all Americans, require coverage for those with preexisting conditions, make selecting insurance options more transparent, facilitate keeping your insurance between jobs, and providing some form of publicly funded insurance. These components really try to kill two (or perhaps 3 or 4) birds with one stone. In addition to the much touted coverage for those that are currently without, a large portion of the bill is designed to make health coverage more manageable by individuals. That sounds great to those of us that have healthcare that we really don’t even know how to use, but doesn’t really take steps towards fulfilling our society’s imperfect duty. Perhaps that’s why we don’t hear a whole lot about that part of the bill.

Whatever ends up in the final bill, it seems to me that it will not fulfill any of its goals. The less talked about goal, that of making health insurance more manageable by its own customers, is not something governments are particularly good at. It’s difficult to regulate complexity. The best way to achieve this goal is competition. This would require insurance companies to market straight to consumers instead of their employers. You can be sure that insurance companies will become more transparent in a hurry when they have to convince you that they are actually better than the next guy rather than your company’s HR department. Auto insurance, for instance, is substantially simpler than its healthcare counterparts.

Where government is probably not the best answer for reducing the complexity of the healthcare system, government has become the preferred vessel for carrying out society’s obligations to itself. In the current debate, this has translated to “we must provide insurance to the uninsured”. This seems noble enough, except that the insurance model itself is deeply flawed. Those of us that already have insurance can see this quite obviously. We do not know the cost of healthcare, nor do we care. Co-pays are minimal, so we take what healthcare we need and bill the insurance company. For those of us with insurance, healthcare is near free and limitless. It stands to reason, then, that by providing insurance to those without, they will also have unlimited, near free healthcare.

The question then becomes, is unlimited, free healthcare the fulfillment of our moral obligation? I believe that it is not. Society should not be asked to cover the costs of keeping the elderly around longer than is prudent, nor should we be asked to bear the burdens of an individual’s poor decisions. Society should provide the level of healthcare that most of us enjoy to as many as possible, but we should not give a blank check.

Many are disgusted by the idea of trying to figure out who should get what healthcare. It does not seem ethical to have “death panels” or enforce that your bypass will only be covered if you didn’t eat bacon for a year. Should we provide orthodontics, which seem like a luxury until you look at the importance of good teeth in the white collar world? Again, this is one of those things that government does a poor job of regulating, and again, these decisions should be left up to the individual. How we do this is something that the current legislation doesn’t touch, and I believe is absolutely necessary for true healthcare reform.

Structuring the system to provide individual responsibility while still providing healthcare to those that cannot afford it seems fairly straightforward to me. Offering insurance policies with very high deductibles and supplementing them with health savings accounts ensures that an individual can determine their own regular healthcare needs while still being protected from unexpected disasters. Both the policies and the savings accounts can be subsidized or provided by the government, with the expectation that the individual contributes what they can. This simple combination seems to be the best bet for minimizing government’s interference in an individuals healthcare while still providing them with the level of care the rest of society enjoys.

There is a serious caveat to this seemingly simple solution. That caveat is that all health services, not just disasters, are obscenely expensive and getting pricier. I believe this is a direct result of the structure of the current private insurance industry. Since nobody except for the insurance companies care what the cost of health services is, and the insurance companies are buying in bulk, there is a strong incentive for the hospitals to reduce the costs of those services that the insurance companies will object to while increasing the costs of those services that are cheap by comparison. Added to the burden is the cost of patients that are unable to pay. The effect of the hospitals “making up” money by increasing costs of routine services is that all healthcare services are more expensive, without any incentive for them being made cheaper.

The current proposal for dealing with the cost problem is for the government to provide a public option to “compete” with the private insurers. I don’t understand this reasoning in the least, but it hasn’t been well explained by its proponents, so I could be missing something. Regardless of its ability to provide competition in an already highly competitive market place, the public option is fundamentally flawed since its structured like a traditional insurance company. It will have similar incentives, none of which will encourage lowering the costs of routine healthcare.

A better method for controlling costs is to make sure individuals are aware of them. If people are asked to pay for routine health services, they will pay much closer attention to the costs of these services. The best way to get individuals to pay for routine services is the same method by which we should cover those without insurance: through health savings accounts combined with high deductible insurance policies.

If those that can afford insurance are on a plan similarly structured to those that can’t, then we have a system in which the market can drive down the costs of things that should be cheap while insuring that those things that are not affordable are available to those that really need them. This seems to be the easiest and least error prone method of reforming healthcare.

There are a number of ways to fulfill the nebulous goal of providing healthcare to everybody in America. One way is to buy into the current system and ask society to pay for it. Another is to restructure the system in a way that benefits everyone and only then ask society to provide those minimal services it has deemed morally necessary to provide to its citizens. The latter seems like the more prudent, more moral, and simpler way to make this generation’s contribution to that imperfect duty that is healthcare.

Speculating about the future of the Republican party has become a popular conversation amongst the political pundits. The most popular discussions revolve around who will be the face of the rebranded GOP that will inevitably come about. That isn’t a very interesting topic. In all probability, the big names now will fade and a fresh, charismatic politician will emerge onto the scene and carry the new platform forward.  The more important issue is deciding what that platform will look like. There are a few things that must be in that platform to be successful.

Renounce the Religious Right

The religious right is the worst thing to happen to the GOP. There is nothing wrong with their beliefs, I am a Christian myself, but their desire to impose those beliefs on the rest of the country gets them nothing but resentment and a reputation for narrow-minded ignorance. It is vitally important that the influence of this group is greatly reduced or removed entirely. Their needs can be met by the party without their face being on it.

Make Peace with the Gay Community

While it’s true that gay rights don’t have popular support, the active opposition of them by the Republican party makes them look, for lack of a better word, mean. To undo this damage, Republicans should start vehemently defending personal rights from intrusion by the government. This goes along with the principles of small government that Republicans are supposedly for. Government intrusion into peoples lives should be kept to a minimum, and when it is unclear whether a person has a right to do something, err in favor of the right. A Republican that can defend the rights of every citizen, gay or not, will come across as much more principled than somebody writing anti-gay marriage bills just because they know it will pass.

Take Back National Security

The Republican dominance of national security issues took a big hit during the Bush administration. Whether or not Bush’s strategies are vindicated, the Republican party still needs to repair the immediate damage to their reputation. One way to draw a clear line between the two parties is free trade. The democratic caucus is too diversified to take a strong position on free trade, and Republicans would be well advised to exploit the clear links between trade and security.

Get a Pragmatic Energy Policy

Republicans don’t have anything to say about energy. They need to find something. Whether they align themselves with the Democrats or strike out and find something new, the “drill at home” argument isn’t going to cut it. An underrepresented energy policy that the Republicans could take up is one oriented around nuclear power. By simultaneously pushing for nuclear power plants and for more electic motors, their policy would be easy to understand and very green.

Win Back the Latino Vote

The Republicans should have the Latino vote. Their small business support and smart economic policies should speak to Latinos. However, the immigration debate has aliented large numbers of them. The Republicans should come out with a sensible immigration bill that puts amnesty at the top. A party oriented around less goverment interference in people’s lives should apply those principles to any person who wants to be an American.

Find a Good Tone

One of the biggest differences between Democrats and Republicans is that Democrats tend to regulate and Repulicans tend to incentivize. This is a point that works well for Republicans. If they can show that they are trying to acheive the same goals as the rest of the country but want to leave choice in the equation, they can almost always win the debate against somebody trying to achieve those goals through force. People do not like to be forced into things, and the Republicans won’t do it. They’ll just charge you a bit.

Stop Being Corrupt

Every Republican that gets caught in some corruption scheme or affair reflects poorly on the entire party. Democrats have this problem too, but since they are in power, it will probably be happening more often to them for a while. If the Republicans can have a few scandal free years, they can emerge as the honest brokers for the people. Trust is probably the most important thing you can have in politics, and the Republicans have some time to earn theirs back.

If the Republicans can do these few things, as well as define clear and workable alternative plans for hot issues like education and health care reform, they will be able to compete again. Where the Republican party is currently associated with hate, foolish wars, closed borders, guns, and rednecks, a few smart changes could position them as the party defending the people from government encroachment, accepting of every person, and ready to do what it takes to keep Americans safe and prosperous. That’s a party people can vote for, and one that we haven’t had in a very long time. Perhaps losing power was the best thing to ever happen to the GOP.

There has been a lot of debate in the past few months about what the government should do about all these “toxic assets” that various financial institutions have on their books. My less than educated opinion is that it doesn’t matter, but the government has to make its intentions clear, and it has to make them clear fast.

These “toxic assets”, which are largely comprised of bad mortgages to people who will never be able to pay them back, have an undefined value. Nobody is really sure how much they are worth, if they’re worth anything at all. Once people realized that these assets were of questionable value, and certainly worth a lot less than previously thought, the total value of the financial institution plummets down. This is an overly simplified version of what makes these institutions “insolvent”.

The customary thing for a bank to do when a mortgage cannot be paid back is to foreclose on the home. This allows the bank to sell it for something close to its actual value and recoup the money they lost on the bad loan. This is what happened en mass at the beginning of the financial crisis. However, it’s my belief that this is only continuing because of governmental indecision.

Houses are as close to worthless now as they have been in anybody’s lifetime. We suddenly find ourselves in a situation where there are far more houses than there are people with the means to purchase them. This means that foreclosure no longer makes sense. If a bank cannot sell the property they foreclose on, then it is in their best interest, by far, to renegotiate the mortgage. In many cases, the people most willing to pay for a house are the people who don’t want to lose their home, and they’ll pay what they can.

The government sees this, of course, which is why they want to help. By purchasing all these bad assets, or so the argument goes, they can get what value is there without throwing people out on the streets. However, they have not made their intentions clear. The government’s failure to do something or say that they will not do anything is the single worst thing they could do. As it is now, financial institutions have no incentive to renegotiate mortgages because there is a sporting chance they will get a better deal from the government. If the bad mortgages look worthless, so much the better, the government has to act to save these institutions that appear insolvent and are “too big to fail”, and the government will look at those “worthless” assets, see that they are not worthless, and see a potential money making opportunity (especially after the savings and loan crisis). In essence, the financial institutions can’t lose, as long as they keep these toxic assets looking worthless.

I have my personal opinions about what the government should do, but anything is better than straddling the fence, debating whether or not to do something or not. These institutions will be forced to work out their problems, or they will have them taken off their hands. Either outcome is preferable to the current  predicament of millions of people in default. This isn’t the banks’ fault, it’s the government’s, and it’s crucial that they do something about it.

I just moved to California, and was very amused when I tried to use Obama’s voter registration application to update my voter registration.

At Real Clear Politics, you can play with electoral maps based on current poll numbers and what you think is going to happen. Try it now, it’s lots of fun!

So what do I think is going to happen? I think Obama is going to win. Naive, perhaps, but for the past four years, I’ve been surrounded by university liberals in Illinois, no less. How does he do it? Well, it’s ridiculously close. I think Indiana and Florida are going to go McCain. In that case, Obama needs to grab both New Mexico and Colorado. Assuming he can do that, Virginia, Pennsylvania, Ohio, and Michigan are going to be big battlegrounds. If Obama can win two of those, he’ll win the election. I think he’s going to do it.