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<title>A Stitch in Haste</title>
<link>http://kipesquire.powerblogs.com/</link>
<description>A collection of real-world libertarian, individualist and laissez-faire rants on policy, culture and other current events by an average, everyday lawyer &amp; investment banker and part-time pop scholar.</description>
<dc:language>en-us</dc:language>
<dc:date>2008-06-28T11:06+00:00</dc:date>
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<item rdf:about="http://kipesquire.powerblogs.com/posts/1213823295.shtml">
<title>Another "Just Testing" Emotional Distress Incident</title>
<link>http://kipesquire.powerblogs.com/posts/1213823295.shtml</link>
<description>For those who were righteously indignant after reading my recent post about an incident involving some California educrats and law enforcement officials maliciously tormenting students by falsely informing them that...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2008-06-18T21:06+00:00</dc:date>
<content:encoded><![CDATA[For those who were righteously indignant after reading <a href="http://www.kipesquire.net/2008/06/a-new-kind-of-schoolhouse-gate-infringement/">my recent post</a> about an incident involving some California educrats and law enforcement officials maliciously tormenting students by falsely informing them that their classmates had been killed in DUI accidents (<i>"we want them to be traumatized"</i>), may I offer you <a href="http://www.telegraph.co.uk/news/uknews/2125525/Mother-was-accused-of-kidnapping-baby-as-part-of-hospital-exercise.html">a denouement</a>?<blockquote>An unsuspecting mother was accused by hospital staff taking part in a security exercise of stealing a baby from a ward as she left the building with her new daughter.<br />
<br />
Clare Bowker, 37, was confronted by staff as she got into her car outside Good Hope Hospital in Sutton Coldfield, West Midlands [U.K.]. She was asked to accompany them to the maternity unit with Hannah, her seven-week-old baby, and her other daughter Holly, then four, where she was told a baby had been snatched. Mrs Bowker was questioned by police and her bag searched to verify her identity. <br />
...<br />
A distressed Mrs Bowker was allowed to leave the hospital after 40 minutes, still believing the situation was real. <br />
...<br />
The Good Hope Hospital Trust has agreed to pay her undisclosed compensation, believed to be a five-figure sum, to cover her suffering and loss of earnings.</blockquote>It would tempting to simply observe, without elaboration, that this was a British socialized medicine facility and be done with it. But correlation does not imply causation. It's also not clear why the December 2005 incident is only being reported now. One should also note that the hospital in question is now managed by a different NHS trust that insists it was simply a case of mistaken identity (i.e., they thought the mother was a willing participant in the exercise). As if the difference between "intentional" and "negligent" were equivalent to the difference between "reasonable" and "outrageous."<br />
<br />
Meanwhile, and more akin to the DUI hoax: Is it fair to the staff (the target of the ruse) to stage such exercises, even when executed as planned (i.e., without cases of mistaken identity)? When my employer runs a fire drill, we're told it's a fire drill, not a fire. Why traumatize the staff by lying about a baby-snatching -- is the added panic-induced adrenaline (not to mention tears) somehow helpful?<br />
<br />
(And does the expression "boy who cried wolf" mean anything to these bureaucrats?)<br />
<br />
One tangential observation that I also take away from these incidents is the fallacy that local decision-making tends to be better. Utter nonsense. Local authorities are far more likely to make decisions in a vacuum and to be staffed with incompetents (because the less-incompetent have moved on to higher positions).<br />
<br />
Moreover, the smaller the group, the easier it becomes for a potentially tyrannical majority to arise within the group (e.g., it is far easier for a theocrat to insist that "<a href="http://www.kipesquire.net/2008/05/one-negative-person/">this is a Christian town</a>" than "this is a Christian nation"). Better for the sheep to be a minority in the zoo generally than in the wolf den specifically.<br />
<br />
In any case, let's hope that such incidents of idiocy remain isolated and newsworthy rather than business as usual.<br />
<br />
(Via <a href="http://socglory.blogspot.com/2008/06/disgraceful-act-by-british-hospital.html">Socialized Medicine</a>.)]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1213040279.shtml">
<title>Doctors, Lawyers and the Ownership Society</title>
<link>http://kipesquire.powerblogs.com/posts/1213040279.shtml</link>
<description>Fascinating comparison-and-contrast:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2008-06-10T00:06+00:00</dc:date>
<content:encoded><![CDATA[Fascinating <a href="http://ohiosurgery.blogspot.com/2008/06/physician-owned-and-operated.html">comparison-and-contrast</a>:<blockquote>Apparently, there has been a steady, driving force from Democratic circles (Hi <a href="http://www.mondaq.com/article.asp?articleid=51418">Pete Stark</a>!) over the years to restrict the existence of physician owned facilities. The assumption is that when doctors own a hospital, they will order more unnecessary tests and procedures because there exists a financial incentive to do so.<br />
...<br />
I'm not naive enough to think this doesn't happen. Doing the right thing for the patient always takes precedence over any financial gain. But at the same time, isn't this a market driven, capitalistic country?<br />
...<br />
I just think the Pete Starks of Washington have it in for us. Once again, it's an attempt to demonize physicians as profiteers looking to wring everything they can out of the system.</blockquote>As I noted in a comment:<blockquote>Contrast that with law firms, which are forbidden by law and ethics codes from allowing anyone but a lawyer from having an equity stake in a law practice [purportedly to avoid any conflict between "serving the interest of the client" and "serving the interest of the owners"].</blockquote>I'm not sure what the takeaway is from this divergence. But I'm sure that there is indeed a takeaway of some kind.<br />
<br />
Thoughts?<br />
<br />
(Via <a href="http://www.kevinmd.com/blog/2008/06/physician-owned-hospitals.html">Kevin, MD</a>.)<br />
<br />
---<br />
<br />
<a href="http://www.concurringopinions.com/archives/2008/06/the_specialty_h.html">Meanwhile</a>:<blockquote>Over the last few decades, one of the biggest trends in health care has been entrepreneurial doctors' efforts to strip out the most profitable business from general hospitals.<br />
...<br />
When cardiac or orthopedics departments migrate away from the general hospital, it is not easy to find alternative funding for vital public services. <br />
...<br />
This "cream-skimming" recalls the classic debate about whether insurers should be allowed to "cherrypick" the healthiest consumers as a business model. This worry is at the heart of various Congressional, administrative, and state moratoria on Medicare reimbursements for the procedures done at specialty hospitals.</blockquote>Keep this little dose of socialized medicine in mind then next time you go to any non-hospital for any non-emergency medical procedure: You are, somehow, "robbing" the government of your "cream." By not allowing the government to "spread its costs" (i.e., overcharge) you, you are &mdash; somehow &mdash; being fundamentally unethical.<br />
<br />
Somehow.<br />
<br />
The pesky fact that you are either paying for your procedure or for your own insurance (not to mention a lifetime of Medicare taxes that you may or may not be allowed to recoup later in life) apparently doesn't matter: You are, by not going to a hospital, "exploiting" it. You are, in essence, exploiting people by not letting them exploit you first.<br />
<br />
All because you dare, via your own resources, to exercise your own freedom of choice in how best to keep yourself alive.<br />
<br />
<i><b>This</b></i> is what they consider evil.<br />
<br />
As I have said before: The health care socialists will, in the end, attempt to enslave physicians (and nurses and dentists and ...). This insane indignation over the "scandal" of private doctors providing private services to private patients is just a small baby step in that direction.]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1210037125.shtml">
<title>Tort Reform and the Broken Window Fallacy</title>
<link>http://kipesquire.powerblogs.com/posts/1210037125.shtml</link>
<description>Some defenders of a tort reform program implemented in Texas since 1995 try to pull a fast one:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2008-05-06T01:05+00:00</dc:date>
<content:encoded><![CDATA[Some defenders of a tort reform program implemented in Texas since 1995 try to <a href="http://www.themonitor.com/news/reform_11619___article.html/lawsuit_www.html">pull a fast one</a>:<blockquote>Savings from reduced damages awarded by juries and fewer lawsuits filed against large businesses since the mid-'90s has created a climate in which medical and insurance companies can expand, the study states. Across Texas, the reforms have resulted in nearly $113 billion in additional annual spending, almost 500,000 new jobs and $2.6 billion a year in increased state budget resources.</blockquote>As I commented over at <a href="http://www.kevinmd.com/blog/2008/05/how-tort-reform-can-stimulate-economy.html">Kevin, M.D.</a>, where I saw this sleight-of-hand:<blockquote>Um, no.<br />
<br />
This is what economists call the <a href="http://bastiat.org/en/twisatwins.html#broken_window">Broken Window Fallacy</a>.<br />
<br />
You are only seeing the macroeconomic benefits achieved (for insurance companies and defendants). You are not seeing the macroeconomic benefits foregone (for affected plaintiffs).<br />
<br />
The additional money meritorious plaintiffs would have received but for tort reform would also have "stimulated the economy" in one form or another.<br />
<br />
The net effects may tilt one way or the other -- there's little way to know for sure. But evaluating a policy -- any policy -- based only on the gross effects ("what is seen") while ignoring the offsets ("what is not seen") is an fundamental logical error.<br />
<br />
Unfortunately, it is a fundamental logical error that permeates almost every aspect of American factional politics -- including health care policy generally and tort reform specifically.</blockquote>I am fully aware that Texas was a unique situation in which fundamental legal injustices were reportedly occurring against malpractice and product liability defendants in civil lawsuits. Point conceded. But tort reform for the sake of better legal outcomes (i.e., more "fair and just" outcomes) is altogether different from tort reform for the sake of economic growth. That way <a href="http://kipesquire.powerblogs.com/posts/1119537223.shtml">madness</a> lies.<br />
<br />
Access to the Bastiat-betraying report <a href="http://www.tlrfoundation.com/perryman-group-report">here</a>. My old chain on asbestos liability <a href="http://kipesquire.powerblogs.com/posts/chain_1109692500.shtml">here</a>; on Vioxx liability <a href="http://kipesquire.powerblogs.com/posts/1100542372.shtml">here</a>.]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1209957096.shtml">
<title>"Comment Left Elsewhere" of the Day</title>
<link>http://kipesquire.powerblogs.com/posts/1209957096.shtml</link>
<description>Obsidian Wings, critiquing John McCain's health care not-quite-reform not-quite-proposal, relays an anecdote:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2008-05-05T10:05+00:00</dc:date>
<content:encoded><![CDATA[Obsidian Wings, <a href="http://obsidianwings.blogs.com/obsidian_wings/2008/05/john-mccain-wor.html">critiquing</a> John McCain's health care not-quite-reform not-quite-proposal, relays <a href="http://www.nytimes.com/2008/05/04/business/04insure.html?ex=1367640000&en=b6f2b765ea15bb3f&ei=5124&partner=permalink&exprod=permalink">an anecdote</a>:<blockquote>Shirley Giarde of Walla Walla, Wash., was not prepared when her husband, Raymond, suddenly developed congestive heart failure last year and needed a pacemaker and defibrillator. Because his job did not provide health benefits, she has covered them both through a policy for the self-employed, which she obtained as the proprietor of a bridal and formal-wear store, the Purple Parasol. <br />
<br />
But when Raymond had his medical problems, Ms. Giarde discovered that her insurance would cover only $22,000, leaving them with about $100,000 in unpaid hospital bills. <br />
<br />
Even though the hospital agreed to reduce that debt to about $50,000, Ms. Giarde is still struggling to pay it — in part because the poor economy has meant slumping sales at the Purple Parasol. Her husband, now disabled and unable to work, will not qualify for Medicare for another year, and she cannot afford the $758 a month it would cost to enroll him in a state-run insurance plan for individuals who cannot find private insurance.</blockquote>To which I relayed a comment:<blockquote>Perhaps the problem isn't so much with health insurance as with Ms. Giarde's "Purple Parasol" business model. If her business can't produce enough income for her to pay her bills, then she's in the wrong business.<br />
<br />
Debate a "right to health care" all you like, but don't claim that there is a right to run an unprofitable, sub-mediocre business and then get taxpayer-extracted health insurance on top of that.<br />
<br />
P.S. What exactly was the back story of Mr. Giarde taking a job with no health benefits in the first place? Because I have no doubt that there was in fact a back story.</blockquote>It's bad enough seeing starving (i.e., crappy) artists demand &mdash; <i><b>and receive</b></i> &mdash; forced taxpayer purchase of their "art" through <a href="http://kipesquire.powerblogs.com/posts/1185240521.shtml">public funding</a>. Are we now to see the equivalent of forced consumption of bridal gowns (among countless other services) from inadequately profitable (i.e., badly run) bridal shops (among countless other services), through the money laundering socialist concept known as "universal health insurance"?]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1209640016.shtml">
<title>On McCain's Health Care Proposal</title>
<link>http://kipesquire.powerblogs.com/posts/1209640016.shtml</link>
<description>To review: The problem with the way the Internal Revenue Code treats employer-provided health care benefits to employees is not that employers can deduct such benefits (most notably insurance premiums), thereby...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2008-05-01T11:05+00:00</dc:date>
<content:encoded><![CDATA[To review: The problem with the way the Internal Revenue Code treats employer-provided health care benefits to employees is not that employers can deduct such benefits (most notably insurance premiums), thereby providing them tax-free (or at least tax-advantaged) to employees. The problem is that <b><i>only</i></b> employers can deduct the cost of such benefits (i.e., if the employer were to substitute more wage for less benefit, then the employee would be worse off net of taxes). The problem is not one of magnitude, but one of neutrality. An expense -- such as health insurance premiums -- either should or should not be tax advantaged. Who nominally pays the premium should be utterly irrelevant.<br />
<br />
This is why I'm having so much trouble processing <a href="http://www.washingtonpost.com/wp-dyn/content/article/2008/04/29/AR2008042902706.html">John McCain's proposal</a>:<blockquote>McCain's prescription would seek to lure workers away from their company health plans with a $5,000 family tax credit and a promise that, left to their own devices, they would be able to find cheaper insurance that is more tailored to their health-care needs and not tied to a particular job.<br />
<br />
Under McCain's plan, $3.6 trillion worth of tax breaks over a decade that would have gone to businesses for coverage of their employees would be redirected to individuals, regardless of whether they are covered by a company plan.<br />
...<br />
McCain's plan is aimed primarily at giving individuals the power to make health-care decisions by granting the same tax breaks for insurance whether workers get a policy from an employer or on their own. Aides call it a "radical" rethinking of health care that would drive costs down and give people more choice.</blockquote>I'm not sure <a href="http://www.johnmccain.com/Informing/News/Speeches/2c3cfa3a-748e-4121-84db-28995cf367da.htm">that's correct</a>:<blockquote>Under current law, the federal government gives a tax benefit when employers provide health-insurance coverage to American workers and their families. ... Many workers are perfectly content with this arrangement, and under my reform plan they would be able to keep that coverage. Their employer-provided health plans would be largely untouched and unchanged. <br />
<br />
But for every American who wanted it, another option would be available: Every year, they would receive a tax credit directly, with the same cash value of the credits for employees in big companies, in a small business, or self-employed. You simply choose the insurance provider that suits you best.</blockquote>So which is it -- true tax neutrality or the abolition of employer-based health insurance? They're not the same thing.<br />
<br />
And is a $2,500 tax credit a <a href="http://obsidianwings.blogs.com/obsidian_wings/2008/04/mccain-on-healt.html">true and fair</a> equivalent of a year's worth of employer-provided health insurance? Why should there be any limit, if the policy goal is "more health insurance"? And would the credit be insulated from progressivity in the income tax?<br />
<br />
If McCain's answers to those questions are the correct ones, then his proposal has merit. Stated differently, when McCain says employer-based benefits would be "largely untouched and unchanged," what precisely does he mean by "largely"?<br />
<br />
(Of course, a hypothetical "President McCain" would face a not-at-all hypothetical "Democratic Congress," so this is all academic anyway.)<br />
<br />
More thoughts from Cato's <a href="http://www.cato.org/pressroom.php?display=ncomments&id=14">Michael Tanner</a>, Reason's <a href="http://www.reason.com/blog/show/126267.html">Jacob Sullum</a>, <a href="http://www.rollingdoughnut.com/2008/04/tax_incentives_are_the_problem.html">Rolling Doughnut</a>.<br />
<br />
---<br />
<br />
Meanwhile, still no one discusses the modest first step of scrapping the absurd "<a href="http://kipesquire.powerblogs.com/posts/1104933101.shtml">use it or lose it rule</a>" for flexible spending accounts. Oh well...<br />
<br />
---<br />
<br />
Also meanwhile:<blockquote>We need to adopt new treatment programs and financial incentives to adopt "health habits" for those with the most common conditions such as diabetes and obesity that will improve their quality of life and reduce the costs of their treatment. <br />
<br />
Watch your diet, walk thirty or so minutes a day, and take a few other simple precautions, and you won't have to worry about these afflictions.</blockquote>Dr. McCain's Miracle Elixir: Just walk thirty minutes a day and you'll live happily forever after!<br />
<br />
What is it about politicians that makes it impossible for them to give a speech without making at least one asinine remark? In any case, it's rather sad to see a supposed "conservative" capitulate so abjectly on the question of anti-liberty nanny statism meant to "<a href="http://kipesquire.powerblogs.com/posts/1208986046.shtml">nudge</a>" people into the "correct" decisions. File that under "M for Maverick" I suppose.]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1208517618.shtml">
<title>Are We Heading Toward Socialized Medicine? (Part Two)</title>
<link>http://kipesquire.powerblogs.com/posts/1208517618.shtml</link>
<description>Homeowners insurance is a truly private market. Anyone screeching about a "homeowners insurance crisis"?...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2008-04-18T11:04+00:00</dc:date>
<content:encoded><![CDATA[Homeowners insurance is a truly private market. Anyone screeching about a "homeowners insurance crisis"? <br />
<br />
Auto insurance is not quite a truly private market, but it's light-years beyond health insurance. People may grumble about their car insurance, but at least it's a competitive industry (just ask Dennis Haysbert, or the gecko) where people can switch carriers with relative ease and choose from a variety of options that best suits their individual needs.*<br />
<br />
The only people who have anything remotely similar to "private health insurance," meanwhile, are the self-employed. They too are affected by the tax code (which is why they are not part of the "5%" the Urban Institute mentions), but at least they enjoy the flexibility to make their own insurance decisions and comparison shop for coverage that they most prefer. <br />
<br />
Medicare, on the other hand, is <a href="http://www.ssa.gov/OACT/TRSUM/index.html">a financial disaster</a> in which the working poor pay the health care costs of the retired rich &mdash; this incidentally somehow constitutes being "progressive." The truly enlightened approach &mdash; taxpayers providing basic health care to the incompetent and indigent as part of a humane social safety net &mdash; is already in place via Medicaid (assisted by not-for-profit institutions and private charity). To the extent that Medicaid is not covering everyone and everything it should, then let's expand it (unlike the Democrats' recent despicable <a href="http://kipesquire.powerblogs.com/posts/chain_1190752356.shtml">SCHIP fraud</a>, expanding Medicaid would not send most libertarians to the barricades). If most libertarians, provided with persuasive evidence of its propriety, would be okay with simply expanding Medicaid, then why is it such an abominable concept for the "socially concerned" radical left (whom, recall, universally insist that "compassionate libertarianism" is an oxymoron)?<br />
<br />
One way or the other, let's not pretend that there is a universal "right to suck at the taxpayer teat" cloaked as a "right to health care." And let's certainly not pretend that the current system is a "private market" or that its shortcomings are a "market failure."<br />
<br />
---<br />
<br />
*Note, however, the <a href="http://kipesquire.powerblogs.com/posts/chain_1144285635.shtml">insolent lie</a> that health care socialists use about how "we mandate that people have auto insurance." What "we" mandate in most states is that people have <b><i>liability</i></b> coverage, to prevent innocent third parties from incurring the costs of a motorist's negligence. But private health insurance is not analogous to liability coverage &mdash; it's analogous to <b><i>collision</i></b> coverage: insulating you from your own costs, not someone else's. I am not aware of any jurisdiction that requires motorists to carry collision coverage. In that sense &mdash; the only sense that matters &mdash; auto insurance is indeed a "truly private market." (As for the follow-up lie that health insurance is indeed analogous to liability coverage, because "we all pay for the uninsured" &mdash; see <a href="http://kipesquire.powerblogs.com/posts/1120844441.shtml">this post</a>.)<br />
<br />
Note also that "auto insurance" does not cover routine maintenance, and certainly not gas & tolls. Yet what we call "health care insurance" &mdash; which as <a href="http://www.cato-unbound.org/2007/01/08/arnold-kling/insulation-vs-insurance/">Arnold Kling</a> has noted is really "health cost insulation" &mdash; does include routine (and perhaps not so routine) "maintenance" expenses such as annual physicals, flu shots and disease tests. This removal of direct payment for direct service is yet another reason why health care expenses are rising disproportionately and why the current system is hardly a "truly private market."]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1208487560.shtml">
<title>Are We Heading Toward Socialized Medicine? (Part One)</title>
<link>http://kipesquire.powerblogs.com/posts/1208487560.shtml</link>
<description>The Urban Institute asks:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2008-04-18T11:04+00:00</dc:date>
<content:encoded><![CDATA[The Urban Institute <a href="http://www.urban.org/publications/411648.html">asks</a>:<blockquote>With health reform at the forefront of the national campaign, some charge that proposals to restructure our health care system represent dangerous steps moving the country towards government-run health care and socialized medicine. Similar rhetoric was heard last fall when President Bush vetoed legislation reauthorizing the State Children's Health Insurance Program (SCHIP).</blockquote>The answer, of course, is: <i>No, because we're already there:</i><blockquote>In terms of direct spending, federal subsidies for health care and coverage, provided through Medicare, Medicaid, and other programs, are projected to equal $829 billion in FY 2008. Medicaid and Medicare cover 42.7 million and 42.4 million people, respectively, with some poor seniors and people with disabilities receiving coverage from both programs. The government also provides publicly funded health care to almost 9 million current and former federal employees and dependents through the Federal Employees Health Benefits Program; 3.7 million veterans who receive health care through the VA; and the country's active-duty soldiers and their dependents. Only 5 percent of the insured population in the United States does not receive some kind of government subsidy, either directly or through a tax benefit. These government expenditures involve sizeable transfers of income, generally from higher-income to lower-income individuals, particularly in the case of the general revenues used to finance Medicare and Medicaid.</blockquote>Keep those numbers in mind the next time some health care socialist bemoans the (supposed) failings of our (supposed) "private" system. (Also keep in mind that those are just the federal numbers &mdash; state and local governments add a whole additional layer of government insurance and taxpayer expenditure.)<br />
<br />
---<br />
<br />
The "only 5%" figure is a curious number &mdash; I presume it refers to the independently (i.e., non-working) wealthy who simply pay all their health care costs and health insurance premiums out of pocket. But the number does indeed reflect a pesky fact that health care socialists rarely if ever acknowledge: Our bizarre, asymmetrical tax code that makes health benefits deductible to the employer but not the employee. (A system which, <a href="http://www.ama-assn.org/ama/pub/category/18102.html">recall</a>, was implemented by FDR as a "temporary" measure as part of comprehensive wage and price controls during World War II.)<br />
<br />
It's rather silly to suggest that a system where the consumers of a service cannot simply go out and buy it, and where providers of that service do not compete against each other to win customers &mdash; <b><i>all because the federal government makes it impossible thanks to a schizophrenic tax code from a war that ended over sixty years ago</b></i> &mdash; the "private sector," or its shortcomings a "market failure" (cf., <a href="http://kipesquire.powerblogs.com/posts/1143722633.shtml">the New York housing market</a>).<br />
<br />
And yet that's precisely what the health care socialists &mdash; from <a href="http://www.washingtonmonthly.com/features/2006/0610.eklein.html">Ezra Klein</a> to <a href="http://krugman.blogs.nytimes.com/2007/01/22/additional-notes-on-122-column-gold-plated-indifference/">Paul Krugman</a> to <a href="http://www.hillaryclinton.com/issues/healthcare/">Hillary Clinton</a> &mdash; do call it. Go figure.<br />
<br />
A truly "private market" for health insurance would be just that: neutral tax policies that would treat all health insurance premiums and benefits equally whether purchased by the employer or the employee (i.e., moving to higher after-tax wages with no health benefits), with the health insurance industry competing directly for end-customer business, not competing indirectly for the customer's <b><i>employer's</i></b> business.<br />
<br />
Unless and until we implement such a system, no health care socialist has earned the privilege of declaring health care a "market failure." You can't fail at something that you've never attempted.<br />
<br />
---<br />
<br />
<a href="http://news.yahoo.com/s/ap/20080414/ap_on_re_us/elder_care">Meanwhile</a>:<blockquote>Millions of baby boomers are about to enter a health care system for seniors that not only isn't ready for them, but may even discourage them from getting quality care.<br />
...<br />
Medicare may even hinder seniors from getting the best care because of its low reimbursement rates, a focus on treating short-term health problems rather than managing chronic conditions and lack of coverage for preventive services or for health care providers' time spent collaborating with a patient's other providers.<br />
<br />
The American Medical Association responded that seniors' access to Medicare in coming years "is threatened by looming Medicare physician payment cuts."</blockquote>Geriatrics is, thanks to Medicare, the subset of "health care" that comes closest to pure socialized medicine in America.<br />
<br />
Geriatrics is, thanks to Medicare, the subset of "health care" that is not only in the worst condition but is also deteriorating the fastest.<br />
<br />
It's not exactly brain surgery to figure out that problem is hardly "market failure."]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1202832396.shtml">
<title>Socialized Medicine: Don't Kill Off the Elderly...</title>
<link>http://kipesquire.powerblogs.com/posts/1202832396.shtml</link>
<description>...just kick them out:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2008-02-12T16:02+00:00</dc:date>
<content:encoded><![CDATA[...just <a href="http://www.telegraph.co.uk/global/main.jhtml?xml=/global/2008/02/11/noindex/wzealand110.xml&CMP=EMC-expat2008">kick them out</a>:<blockquote>A 101-year-old Briton may be kicked out of New Zealand after immigration bosses rejected his plea to spend his final years living with his son, his only living relative.<br />
 <br />
Despite savings of £145,000 and a £33,000 a year pension, the widower may have to pack his bags after being told his circumstances "do not make him special." A retired research chemist whose son is a university professor, the man, who has not been named, had pleaded to stay in New Zealand after arriving in 2006.<br />
...<br />
But although the unnamed man told the country's Residence Review Board that he ... is hale and hearty, officials have been unmoved by his plight fearing he may be a drain on health resources.</blockquote>Remind me again how "universal health care" (i.e., switching from having patients, physicians and insurers ration health care to having politicians and bureaucrats do it) represents a new, "enlightened" social awareness?<br />
<br />
(And don't forget that this pensioner, a Briton who as a research chemist no doubt paid quite his fair share of taxes over his lifetime), is from another socialized medicine regime that is in fact <a href="http://news.bbc.co.uk/1/hi/health/6357627.stm">quietly</a>, and perhaps soon to be <a href="http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/01/27/nhs127.xml">not so quietly</a>, killing off the elderly.<br />
<br />
Health care, like all scarce goods, must somehow be rationed. Choices have to be made. But they don't have to be made this way. In our quest to feign a new "enlightenment," we are in fact reverting back to a barbarism reminiscent of the <a href="http://www.straightdope.com/mailbag/meskimoicefloe.html">ancient Eskimos</a>.<br />
<br />
And in the meantime, New Zealand's "enlightened" bureaucrats insist that it's no big deal to require this 101-year old man and his son to live on opposite sides of the world:<blockquote>"Presumably his son has visited him in that time and there is no evidence as to why his son could not continue to do this in the future."</blockquote>As if a flight from Auckland to London (26 hours, $2,500) were like a weekend drive across the suburbs.<br />
<br />
Madness. Sheer madness.<br />
<br />
(Via <a href="http://socglory.blogspot.com/2008/02/nastiness-engendered-by-socialized.html">Socialized Medicine</a>.)]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1201840257.shtml">
<title>Is There Really a "Too Fat to Eat Out" Bill in Mississippi?</title>
<link>http://kipesquire.powerblogs.com/posts/1201840257.shtml</link>
<description>Sometimes politicians introduce sarcastic bills in their legislatures to make a "slippery slope" or "jump the shark" sort of point -- a publicity stunt....</description>
<dc:creator>Kip</dc:creator>
<dc:date>2008-02-01T04:02+00:00</dc:date>
<content:encoded><![CDATA[Sometimes politicians introduce sarcastic bills in their legislatures to make a "slippery slope" or "jump the shark" sort of point -- a publicity stunt.<br />
<br />
Please let <a href="http://billstatus.ls.state.ms.us/documents/2008/pdf/HB/0200-0299/HB0282IN.pdf">this</a> be that:<blockquote>Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Obesity Prevention and Management established under Section 41-101-1 or its successor. The State Department of Health shall prepare written materials that describe and explain the criteria for determining whether a person is obese, and shall provide those materials to all food establishments to which this section applies. A food establishment shall be entitled to rely on the criteria for obesity in those written materials when determining whether or not it is allowed to serve food to any person.</blockquote>The location is Mississippi, the nanny state activist legislator is state representative W.T. Mayhall, Jr., and he <a href="http://junkfoodscience.blogspot.com/2008/01/no-fat-people-allowed-only-slim-will-be.html">insists</a> it's no joke:<blockquote>He said that while, regrettably, he doesn't believe his bill will pass, this is serious. He wrote it, he said, because of the "urgency of the obesity crisis and need for government action." He hopes it will "call attention to the serious problem of obesity and what it is costing the Medicare system."</blockquote>As I <a href="http://kipesquire.powerblogs.com/posts/1120844441.shtml">blogged previously</a>:<blockquote>The notion that "other people pay for obesity" is totally circular and obnoxious. Keep the true nature of this argument in perspective: The nanny-state central planners decide to provide public health care benefits, of whatever flavor, which are by definition paid for with public money (i.e., taxpayer money). They then turn around and tell those very same taxpayers that, since it's "the public's" money and not theirs, the government can therefore impose controls on the public's behavior to compensate for the resulting mismatch -- <i><b>that the government itself created!</b></i> -- between the "public" that pays for the benefits and the "public" that receives them.<br />
<br />
The government creates the moral hazard in the first place, then turns around and decries it -- all the while escalating the tax-and-regulate, tax-and-subsidize, tax-and-ban, tax-and-control spiral and all the while defending the practice with Orwellian economic double-talk.</blockquote>From the Northest liberal ivory tower of Paul Krugman to the brain-dead bumpkin bayous of Mississippi, we are as a people going totally insane.]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1201055556.shtml">
<title>It's Not Called "Universal Pay for What Works"</title>
<link>http://kipesquire.powerblogs.com/posts/1201055556.shtml</link>
<description>Scientific American, in an editorial titled, "Pay For What Works," calls for reality-based health care reform:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2008-01-23T02:01+00:00</dc:date>
<content:encoded><![CDATA[<i>Scientific American</i>, in an editorial titled, "Pay For What Works," calls for reality-based <a href="http://www.sciam.com/article.cfm?id=pay-for-what-works">health care reform</a>:<blockquote>The spending binge is rooted in the nation's technophilia: medical technology accounts for as much as half the growth in health care spending. Although this trend has benefited everyone &mdash; witness the near halving of cardiac arrest deaths from 1980 to 2000 &mdash; not all those added dollars have been as well spent as drug and device manufacturers would have us believe. Our love affair with next-generation imaging machines, implantable devices and the like has blinded us to the reality that scant evidence often exists for whether something novel works any better than existing equipment, procedures or chemicals.</blockquote>Unlike John Edwards' asinine "<a href="http://blogs.wsj.com/health/2008/01/07/edwards-invokes-teenagers-death-in-campaign/">livers for everyone</a>" histrionics, <i>Scientific American</i> acknowledges that socialized medicine, regardless of how it is packaged or labeled, will not change the laws of economics: like any scarce good, "health care" must be rationed. The only question becomes whether the rationing will be done by: (a) patients, together with providers and &mdash; yes &mdash; insurance companies (who, directly or indirectly, would have at least some accountability); or (b) politicians and bureaucrats (who are accountable to no one). All else is either political pussyfooting (Clinton, Obama) or flat-out lies (Edwards).<br />
<br />
Unfortunately, that choice is precisely where <i>SA</i> leaves the reservation:<blockquote>For [evidence-based medicine] to work as it should will require that a new president follow through with adequate funding, an assurance that Medicare (and, as a consequence, other insurers) will consider seriously its findings and, perhaps most important, a Federal Reserve-like independence from the momentary whims of the political establishment.</blockquote>Exactly what "independence from the momentary whims of the political establishment" might that be? I am not familiar with it, especially in the context of <a href="http://biz.yahoo.com/ap/080122/fed_interest_rates.html">the Federal Reserve</a>.<br />
<br />
In any case, who seriously believes that questions of funding for AIDS, cancer, Alzheimer's, ADHD, race-based medicine, reproductive health, <a href="http://kipesquire.powerblogs.com/posts/1170457565.shtml">vaccinations</a>, <a href="http://kipesquire.powerblogs.com/posts/1153334557.shtml">stem-cell research</a>, etc., can ever be truly insulated from political influences? It's facially absurd.<br />
<br />
A basic health care safety net (i.e., Medicaid) for the truly incompetent or hopelessly indigent need not be offensive to libertarian principles. Acknowledging the realities of health care economics need not be offensive to liberal principles. Delusional faith in the wisdom and disinterest of government is another matter altogether.]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1196908589.shtml">
<title>If God is So Great, Then Why are You Sick?</title>
<link>http://kipesquire.powerblogs.com/posts/1196908589.shtml</link>
<description>Socialized medicine is an inevitable disaster everywhere it's tried not just because it politicizes health care rationing, but also because it ends up politicizing everything else....</description>
<dc:creator>Kip</dc:creator>
<dc:date>2007-12-06T02:12+00:00</dc:date>
<content:encoded><![CDATA[Socialized medicine is an inevitable disaster everywhere it's tried not just because it politicizes health care rationing, but also because it ends up politicizing everything else.<br />
<br />
For <a href="http://www.dailystar.co.uk/news/view/22961/IT-S-NHS-BEDLAM/">example</a>:<blockquote>Overworked nurses have been ordered to stop their work five times a day &mdash; and move Muslim patients' beds to face towards Mecca.<br />
<br />
The procedure is creating turmoil among staff on NHS wards already struggling through a lack of beds.<br />
...<br />
One nurse at Dewsbury said: "It would be easier to create Muslim-only wards with every bed facing Mecca. Some people might think it is not that big a deal but we have a huge Muslim population in Dewsbury. If we are having to turn dozens of beds to face Mecca five times a day, plus provide running water for them to wash before and after prayers, it is bound to impact on the essential medical service we are supposed to be providing."</blockquote>But socialized medicine is never really about "essential medical service we are supposed to be providing." It's about politicians and bureaucrats playing God &mdash; or Allah, as the case may be &mdash; not only with people's wallets but with their health and indeed their lives.<br />
<br />
Another thought: If Muslims (the ones who don't go around blowing each other up in Iraq, that is) are so dedicated to their Religion of Peace, then couldn't they round up some faith-based candy-striper volunteers to accommodate their fellow Muslims' bizarre need to engage in primitive rituals? Compare:<blockquote>But we also are keen to accommodate all faiths, for example if a patient is Roman Catholic then we would try and ensure they can receive Holy Communion.</blockquote>Perhaps. (And eating a transubstantiated cracker is certainly no less bizarre a ritual than eating faith-based dirt from a certain direction five times daily.) But that of course doesn't mean turning nurses into priests &mdash; it only means allowing and perhaps facilitating access to priests. The difference is not a difficult concept, except to those who deliberately seek to make it difficult &mdash; such as Muslim intolerance-mongers and their health care socialist collaborators.<br />
<br />
Nurses should be allowed to stick to nursing, or else what lingering claim can socialized medicine have to being a "better system for the allocation of scarce resources"? At some point that claim must cross from "unlikely" to "utter nonsense."<br />
<br />
<b>UPDATE:</b> The NHS bureaucrats <a href="http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=499547&in_page_id=1770">capitulated</a> and scrapped the policy.]]></content:encoded>
</item>

<item rdf:about="http://kipesquire.powerblogs.com/posts/1195273717.shtml">
<title>Socialized Medicine: First They Came for the Lawyers...</title>
<link>http://kipesquire.powerblogs.com/posts/1195273717.shtml</link>
<description>One of the points I try to emphasize from time to time is that a purported "right to health care" requires, as a matter of basic metaphysics, a "right to enslave...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2007-11-17T11:11+00:00</dc:date>
<content:encoded><![CDATA[One of the points I try to emphasize from time to time is that a purported "right to health care" requires, as a matter of basic metaphysics, a "right to enslave health care providers." This is not histrionics: How, exactly, are you to enjoy your "right to an emergency appendectomy" without a surgeon to perform it? If your "right" truly is a right, and if no willing surgeon is available, then an unwilling one will have to be conscripted.<br />
<br />
Health care socialists would respond that, no no no, they do not mean to enslave physicians (not to mention nurses, dentists, lab technicians, physical therapists, pharmacists, optometrists, etc.). They merely intend to enslave <b><i>taxpayers</i></b> &mdash; because if the government throws enough money at enough people, surely health care providers will come forward (i.e., for the right price) to provide the "health care" to which there is a purported "right."<br />
<br />
Put aside the Kafkaesque implications of that reasoning: "private parties paying private money for private services" (i.e., throwing money around) is "compassionless" (and therefore immoral) but "government extracting taxpayer money for private services" (i.e., throwing money around) is "enlightened" (and therefore moral). Somehow.<br />
<br />
My point instead is that, should push come to shove (and why wouldn't it?), even that perverse economic model might, indeed eventually almost certainly would, give way to something worse: Compulsory service &mdash; enslaved physicians.<br />
<br />
Think it <a href="http://blogs.enotes.com/decision-blog/2007-11/ninth-circuit-upholds-forced-labor-for-lawyers/">can't happen</a>?<blockquote>Under Arizona law, all superior court cases with less than $65,000 at stake go to arbitration. In Maricopa County, the arbitrators are drawn from a pool of local lawyers who get paid $75 a day. That's chump change for lawyers, many of whom would scoff at $75 an hour.<br />
<br />
But the arbitration program is mandatory. All County attorneys with at least five years of experience must serve at least two days per year, if asked. [Mark] Scheehle was asked three times in two years. The third time, he refused, and the County fined him $900. So Scheehle sued, challenging the arbitration service as an unconstitutional taking and a violation of the Equal Protection Clause. ... But ultimately, the Ninth Circuit concludes that the Maricopa County program survives Scheehle's constitutional claims.</blockquote>You can balk at the term "enslaved" all you want, but the premise is sound: Anyone who wants the privilege of being an attorney in Arizona must provide their services, on behalf of the government, for almost no compensation whenever instructed to. If that's not "slavery," it's close enough.<br />
<br />
Now, how preposterous a leap would it be to replace "attorney" with "physician" in this fact pattern? To require &mdash; not just as a condition of eligibility for socialized medicine reimbursement, but as a condition of keeping your medical license &mdash; that you provide your services for free or essentially free on a regular basis and at the whim of the state, based solely on its "need" for your services?<br />
<br />
And you thought compulsory jury duty was irksome.<br />
<br />
This is the unacknowledged asymptote of socialized medicine: a surgeon, hovering over you with a scalpel, who is not only paid by the government, not only employed by the government, but actually a feudal serf of the government and in the operating room against his will. This, to health care socialists, is utopia.<br />
<br />
Madness. Sheer madness.<br />
<br />
The case is <i>Scheehle v. Justices of the Supreme Court of Arizona</i>, No. 05-17063 (9th Cir., Nov. 15, 2007) (<a href="http://www.ca9.uscourts.gov/ca9/newopinions.nsf/7C79FA8E16F6D02E88257393007B6B81/$file/0517063.pdf?openelement">PDF</a> - 17 pages).<br />
<br />
<i>For Discussion:</i> Of course, the state cannot enslave a physician who does not exist. So how, exactly, would there be a "right to health care" if people stop becoming physicians (not to mention nurses, dentists, lab technicians, physical therapists, pharmacists, optometrists, etc.)? Think it <a href="http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20050128/doctor_shortage_050127?s_name=&no_ads=">can't happen</a>?]]></content:encoded>
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<item rdf:about="http://kipesquire.powerblogs.com/posts/1192591831.shtml">
<title>Should We Worry About SCHIP Mission Creep?</title>
<link>http://kipesquire.powerblogs.com/posts/1192591831.shtml</link>
<description>A New York Times editorial assures us that fears of "mission creep" within an expanded SCHIP program are unfounded:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2007-10-17T12:10+00:00</dc:date>
<content:encoded><![CDATA[A <i>New York Times</i> editorial <a href="http://www.nytimes.com/2007/10/16/opinion/16tue2.html?ex=1350273600&en=846b705ec9f8c585&ei=5124&partner=permalink&exprod=permalink">assures us</a> that fears of "mission creep" within an expanded SCHIP program are unfounded:<blockquote>To hear the Bush administration tell it, expanding the State Children's Health Insurance Program would entice hordes of families to drop their private coverage and put their children on the public dole. As the Health and Human Services secretary, Michael Leavitt, argued in a recent television appearance, states that cover middle-income children as well as the poor are essentially telling people to "cancel your private insurance and we'll have the government pay for it."</blockquote>The <i>Times</i> then points to a Congressional Budget Office study that concludes that "only" two million children (!) currently covered by or eligible for private insurance would be lured into this new middle class entitlement.<br />
<br />
Of course, history shows &mdash; over and over and over &mdash; that, when evaluating federal programs, mission creep should always be the default assumption. For example:<br />
<br />
--The first income tax (after the Sixteenth Amendment took effect) "<a href="http://www.treas.gov/education/fact-sheets/taxes/ustax.shtml">only</a>" applied to incomes over $500,000 and was capped at a 7% rate. Fewer than 1% of Americans had to pay any federal income tax at first. Now the income tax is paid by <a href="http://kipesquire.powerblogs.com/posts/1191764019.shtml">roughly half the population</a> and reaches as much as 35% of marginal income.<br />
<br />
--The first Alternative Minimum Tax applied "<a href="http://www.taxpolicycenter.org/publications/url.cfm?ID=901051">only</a>" to 155 hyper-rich families who would otherwise have paid no federal income tax whatsoever. It will soon apply, if left unchecked, to <a href="http://kipesquire.powerblogs.com/posts/1122139319.shtml">the entire American middle class</a>.<br />
<br />
--Social Security (insanely <a href="http://www.google.com/search?sourceid=navclient&ie=UTF-8&rlz=1T4DMUS_enUS202US202&q=social+security+most+successful+program">described</a> by liberals as "the most successful government economic program in history") initially "<a href="http://kipesquire.powerblogs.com/posts/1124046844.shtml">only</a>" taxed 2% of income and was capped at "only" $3,000. It now confiscates one-eighth of most workers' entire paychecks.<br />
<br />
--A "temporary" 3% tax was imposed on long-distance telephone service "only" to fund the Spanish-American War. It was not repealed until <a href="http://www.usatoday.com/money/industries/telecom/2006-05-25-phone-tax_x.htm">last year</a> &mdash; 108 years after the five-month war ended.<br />
<br />
--Similarly, three generations after the Great Depression, the federal government still sees a need for taxpayer-funded <a href="http://www.usda.gov/rus/electric/">rural electrification programs</a>, <a href="http://kipesquire.powerblogs.com/posts/chain_1113438570.shtml">farm subsidies</a>, the <a href="http://www.tva.gov/abouttva/history.htm">Tennessee Valley Authority</a>, and countless other leftover New Deal zombie-ocracies. No mission creep in any of that, apparently.<br />
<br />
--PBS was established when there were exactly three homogeneous broadcast networks. Now that 300 astoundingly diverse television channels (or more) is the norm, politicians and bureaucrats consider PBS to be &mdash; still <a href="http://kipesquire.powerblogs.com/posts/1185240521.shtml">absolutely vital</a>. <a href="http://www.pittsburghlive.com/x/pittsburghtrib/s_309204.html">Somehow</a>.<br />
<br />
--One word: <a href="http://kipesquire.powerblogs.com/posts/chain_1111013340.shtml">Amtrak</a>.<br />
<br />
Add you own examples in the comments.<br />
<br />
So to think that SCHIP will somehow be different, that it will forever avoid mission creep and could never expand even further into a "teaser rate" for socialized medicine, is either unforgivably naive or unforgivably disingenuous.<br />
<br />
Not that it makes much difference which.<br />
<br />
We already have a health care safety net for the poor in this country &mdash; Medicaid. To the extent that Medicaid is failing in its mission to cover poor children, it should be fixed. That would be an acceptable form of "mission creep." But Medicaid should not be supplemented by a duplicative, politically loaded, warm-fuzzy-feeling middle-class entitlement that would, intentionally or otherwise, almost certainly lure self-sufficient households to suckle at the teat of socialized medicine.<br />
<br />
More thoughts at <a href="http://blogfromonhigh.blogspot.com/2007/10/march-toward-mediocrity.html">From On High</a>.]]></content:encoded>
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<item rdf:about="http://kipesquire.powerblogs.com/posts/1192238907.shtml">
<title>Render Unto SCHIP That Which is SCHIP's?</title>
<link>http://kipesquire.powerblogs.com/posts/1192238907.shtml</link>
<description>A self-standing comment I left at another blog:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2007-10-13T01:10+00:00</dc:date>
<content:encoded><![CDATA[A self-standing comment I left at <a href="http://www.concurringopinions.com/archives/2007/10/jeffries_on_sch.html">another blog</a>:<blockquote><i>"So I ask: Would Jesus have vetoed the SCHIP bill?"</i><br />
<br />
Is he suggesting that Jesus was a tax collector? Because I can think of a Bible passage or two that would suggest otherwise.<br />
<br />
There is no rational basis to invoke any government entitlement program, or any compulsory tax that finances one, as "proper Christian policy."<br />
<br />
"Doing good works" is not the moral equivalent of "forcing your neighbor to pay for them." No true Christian has difficulty with this basic concept. <br />
<br />
It is mind-boggling to me to think that there are self-professed "Christians" who consider it a "Christian" virtue to force other people to be "Christian." It's offensive when the conservative theocrats do it, and it's no less offensive when liberal theocrats do it.<br />
<br />
The conservative theocrats put "God" on the money in our wallets. The liberal theocrats now want to put "God" on the tax bill that pulls the money out of our wallets. While both insolently claim the moral high ground.<br />
<br />
Bottom Line: There is no cognizable difference between <a href="http://www.blackprof.com/archives/2007/10/bush_faith_and_schip.html">Shavar Jeffries</a> and James Dobson.<br />
<br />
A pox on both their churches.</blockquote><s>Blaspheme</s> Discuss.]]></content:encoded>
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<item rdf:about="http://kipesquire.powerblogs.com/posts/1191892377.shtml">
<title>Socialized Medicine: What's In a Name? Or a Dichotomy?</title>
<link>http://kipesquire.powerblogs.com/posts/1191892377.shtml</link>
<description>An op-ed contributor* at the Washington Post tries to go from "oncologist" to "economist" &amp;mdash;...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2007-10-09T01:10+00:00</dc:date>
<content:encoded><![CDATA[An <a href="http://www.washingtonpost.com/wp-dyn/content/article/2007/10/07/AR2007100701033.html">op-ed contributor</a>* at the <i>Washington Post</i> tries to go from "oncologist" to "economist" &mdash; <blockquote>The U.S. health-care system has two distinct parts &mdash; financing and delivery. The financing system is how we pay for health-care services. It is composed of employer-based insurance, the individual insurance market, Medicare, Medicaid, SCHIP, the veterans health system and other programs. Today, the private part &mdash; employer-based coverage and individual insurance &mdash; accounts for just under 55 percent of all payments for health care, while government contributes about 45 percent. <br />
<br />
The delivery system consists of about 850,000 doctors, 5,000 acute-care hospitals, 39,000 pharmacies and 8,100 home health agencies, as well as hospices, surgical centers, radiological centers, laboratories and other outlets that provide the actual health-care services Americans need.</blockquote>Strange, nobody thinks of the local supermarket in terms of "two distinct parts &mdash; financing and delivery." Nor does anyone partition a restaurant, or an auto body shop, or an investment bank, or a barbershop, into "financing and delivery." Just health care. Why might that be?<br />
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And the answer is <b><i>not</i></b> "because of insurance." Automotive insurance is not thought of in terms of "two distinct parts &mdash; financing and delivery." Neither is homeowner insurance, life insurance, travel insurance or any other kind of insurance.<br />
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The answer is because we have a government-imposed disconnect, an obsolete relic of World War II command-and-control economic authoritarianism, in which employers receive an irrational tax advantage for providing health insurance directly rather than simply paying employees more and having them buy their own insurance. The "financing and delivery" dichotomy is in no way endemic to health care &mdash; it is entirely a creature of government. As are, by corollary, all the problems and shortcomings that have flowed from it over the past sixty years.<br />
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And still the apologists for socialized medicine refuse to even consider that maybe, just maybe, the solution is to revisit that archaic structure: to revisit those "two distinct parts &mdash; financing and delivery" rather than simply take them as a given.<br />
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Oops, did I say "socialized medicine"? Shame on me!<blockquote>Properly speaking, socialism is when the state owns or controls the means of production. Thus "socialized medicine" is when the doctors are state employees; when the hospitals, drugstores, home health agencies and other facilities are owned and controlled by the government.</blockquote>Assume as a thought experiment that tomorrow the federal government imposed a bubble gum tax, added on to existing payroll taxes. In exchange for these compulsory taxes, everyone would receive "free" bubble gum (because all enlightened, compassionate folk agree that there is a "right to universal bubble gum"). The bubble gum could come either directly from government-run bubble gum dispensaries, or via a bubble gum voucher or reimbursement program.<br />
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Would this be "socialized bubble gum"? I think so. I think you have to be a moron not to think so. Either way, does it really make a difference regarding the underlying impropriety of the program whether it's called "universal bubble gum coverage" or "socialized bubble gum" or "authoritarian bubble gum" or "command-and-control bubble gum" or "HillaryBubble 2.0" or "RomneyGum" or "zoop"?<br />
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Of course not, any more than it matters whether you call a cancerous growth a "tumor" or a "lump" or a "malignancy." Whatever you call it, it's simply not a good thing. And the appropriate treatment for it is certainly not be "more of it."<br />
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*The piece seems to have been pulled from the WaPo site. Go figure.]]></content:encoded>
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<item rdf:about="http://kipesquire.powerblogs.com/posts/1191764019.shtml">
<title>Tax Progressivity Update</title>
<link>http://kipesquire.powerblogs.com/posts/1191764019.shtml</link>
<description>I always try to pass along these data whenever I see them updated:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2007-10-08T11:10+00:00</dc:date>
<content:encoded><![CDATA[I always try to pass along <a href="http://www.taxfoundation.org/news/show/250.html">these data</a> whenever I see them updated:<blockquote>The top-earning 25 percent of taxpayers (AGI over $62,068) earned 67.5 percent of the nation's income, but they paid more than four out of every five dollars collected by the federal income tax (86 percent). The top 1 percent of taxpayers (AGI over $364,657) earned approximately 21.2 percent of the nation's income (as defined by AGI), yet paid 39.4 percent of all federal income taxes. That means the top 1 percent of tax returns paid about the same amount of federal individual income taxes as the bottom 95 percent of tax returns.</blockquote>Also:<blockquote>From other IRS data, we can see that 90.6 million of the tax returns came from people who paid taxes into the Treasury. That leaves 42 million tax returns filed by people with positive AGI who used exemptions, deductions and tax credits to completely wipe out their federal income tax liability.</blockquote>When you add in those so poor that they need not even file a tax return, and then adjust the returns for family size (the poor tend to have more children), it turns out, as I have noted ad nauseum, that roughly the poorer half of all Americans simply pay no income tax.<br />
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Two hasty stitches:<br />
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--Remind me again how "the rich don't pay their fair share"? (Or, stated differently, has John Edwards no shame whatsoever?)<br />
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--These data are for the federal income tax. The working poor of course do pay taxes: FICA taxes &mdash; Social Security and Medicare. So I repeat: Anyone who claims to care about the working poor must, by simple logic applied to irrefutable data, advocate Social Security reform ("soak the rich" is <i><b>not</b></i> "reform").<br />
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<center><a href="http://kipesquire.powerblogs.com/files/kipesquire-01taxes.jpg"><img src="http://kipesquire.powerblogs.com/files/kipesquire-01taxes-small.jpg" width="220" height="111"  alt=""></a><br />
<i>(Click to enlarge.)</i></center>]]></content:encoded>
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<item rdf:about="http://kipesquire.powerblogs.com/posts/1191460684.shtml">
<title>Is SCHIP Analogous to Public Schools?</title>
<link>http://kipesquire.powerblogs.com/posts/1191460684.shtml</link>
<description>Harold Meyerson sees &amp;mdash; well, "invents" would be a better word &amp;mdash; a contradiction in the president's veto of expanded SCHIP coverage:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2007-10-04T01:10+00:00</dc:date>
<content:encoded><![CDATA[Harold Meyerson sees &mdash; well, "<a href="http://www.washingtonpost.com/wp-dyn/content/article/2007/10/02/AR2007100201823.html">invents</a>" would be a better word &mdash; a contradiction in the president's <a href="http://today.reuters.com/news/articlenews.aspx?type=topNews&storyid=2007-10-03T141213Z_01_WAT008190_RTRUKOC_0_US-USA-HEALTH-KIDS-VETO.xml">veto</a> of expanded SCHIP coverage:<blockquote>Beyond question, there are parents in Fairfax and Montgomery who could easily afford to send their kids to private schools but who send them nonetheless to the excellent public schools in their neighborhoods They thus increase government spending and withhold revenue from the private-school industry, but I've never heard anyone complain about that. A free public education is a right, or, if you prefer, an entitlement in America, because the nation long ago decided that an educated population is a national good.<br />
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You might think that the same logic would apply to providing children with health care, that the gains to the nation from having a healthy population would outweigh those of bolstering private health insurance companies in the name of laissez-faire ideology. According to President Bush and the hard-right wing of the Republican Party, though, you'd be sadly mistaken. Bush fears that expanding health care for children from uninsured families who can't afford to buy insurance on their own (it costs about $11,000 a year for a family of four) would enable some families, as he put it at a news conference last month, collectively to "move millions of American children who now have private health insurance into government-run health care."</blockquote>Nice try.<br />
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There is a fundamental, and in Myerson's case thesis-killing, distinction between public education and socialized medicine: The justification for public education is <b><i>not</i></b> that there is a "right to an education." There is of course no such right. The justification for public education is that there are positive externalities &mdash; large, objective, measurable positive externalities &mdash; to universal elementary and secondary education.<br />
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There are no &mdash; zero &mdash; positive externalities to socialized medicine generally and SCHIP specifically. It's just socialism: warm fuzzy feeling demands by "enlightened" folks like Myerson who wish to express their compassion for children via other people's wallets. How charitable of them.<br />
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The discussion could end there of course, but there are other reasons why SCHIP is hardly the economic, or moral, equivalent of public education.<br />
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For starters, public education is &mdash; well, was &mdash; locally funded via property taxes in almost all jurisdictions. The people who benefited from public education paid for it (net of the pesky problem of people without children paying for those who do, but that circles back to the externality argument, which is stronger the more localized the taxation is). SCHIP cannot make that claim: it is a federal entitlement, QED.<br />
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Similarly, public education is at least somewhat competitive. When a couple with or contemplating children decides to move, what is often the first question they ask of potential new homes? <i>"What are the schools like?"</i> Offset, naturally, by <i>"What are the taxes like?"</i> Again, SCHIP cannot make that claim: it is a federal entitlement, QED.<br />
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Likewise, people can, as my parents recently did, flee a local tax-for-schools regime that they find undesirable for their circumstance. It is much harder, and less reasonable to demand, that people flee the federal income tax, whether over No Child Left Behind or SCHIP.<br />
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To summarize: Public education* is a public good; health care &mdash; even health care for children &mdash; is not. Public education is not welfare; SCHIP is. Public education is not provided because it is a "right;" neither is SCHIP.<br />
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Like I said: Nice try.<br />
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There are far less "nice" tries in Myerson's piece: Health care for veterans <b><i>is</i></b> a public good (in the same sense that the military itself is a public good), so that's wholly inapposite to the SCHIP debate. And Medicare, qua a compulsory tax-and-participate scheme, is most definitely socialized medicine. It is pompous, insolent sophistry to suggest otherwise. Oh, and it's a <a href="http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/06/09/the_coming_crisis_for_medicare/">fiscal disaster</a>. Yet people like Myerson (and <a href="http://kipesquire.powerblogs.com/posts/1186848555.shtml">Hillary Clinton</a>) somehow consider Medicare a "counterargument"? Utterly mind-boggling.<br />
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*By which I of course mean public <b><i>financing</i></b> of elementary and secondary education, not public <i><b>provision</b></i>. And since there are no externalities to higher education, there should consequently be no &mdash; <a href="http://kipesquire.powerblogs.com/posts/chain_1097557278.shtml">zero</a> &mdash; taxpayer subsidization of colleges or college students.]]></content:encoded>
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<item rdf:about="http://kipesquire.powerblogs.com/posts/1190752356.shtml">
<title>Behold American "Poverty"</title>
<link>http://kipesquire.powerblogs.com/posts/1190752356.shtml</link>
<description>No wonder class warriors such as John Edwards and Barack Obama are so incensed. Just look at the absolute squalor now spreading across America:...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2007-09-25T21:09+00:00</dc:date>
<content:encoded><![CDATA[No wonder class warriors such as <a href="http://kipesquire.powerblogs.com/posts/1182455305.shtml">John Edwards</a> and <a href="http://gregmankiw.blogspot.com/2007/09/obama-on-social-security.html">Barack Obama</a> are so incensed. Just look at the <a href="http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aFNvVAEKzuck">absolute squalor</a> now spreading across America:<blockquote>Lori and Steven Siravo earn $56,000 a year and say they can't afford health insurance. <br />
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They consider themselves lucky to live in New Jersey, where the family's income isn't too high to qualify their 16-year-old daughter, Carlie, for U.S. government-subsidized coverage under the State Children's Health Insurance Program.<br />
...<br />
Steven, 49, drives a Chevrolet Caprice Classic that's almost 20 years old, and she drives a 5-year-old Chevy Monte Carlo. The above-ground pool out back is 17 years old, bought when "we had money" before Carlie was born, Lori said. <br />
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The one luxury is a full-size pinball machine Steven bought for his wife on her 40th birthday. <br />
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The family's monthly bills consume most of their take-home income. Pulling out her checkbook, Lori said there's the mortgage ($1,500), utilities ($743), phones and Internet service ($200), car insurance and gasoline ($205), property taxes ($230), basic cable television ($48), food ($600) and credit-card payments ($325) on an outstanding $11,000 balance. That's $46,212 a year, not including clothes, school books and extra-curricular activities for Carlie. <br />
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There's also $352 a month on a home-equity loan the Siravos took out to send Carlie to a private Catholic high school.</blockquote>Read that again: Apparently "poverty in America" now means having "only" two cars, "only" basic cable, "only" an above-ground pool and "only" a private education. Oh, and "only" one pinball machine.<br />
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If that's your (deprived) lifestyle, then you are, to SCHIP apologists, "poor" and in need of health insurance welfare underwritten by other people's taxes.<br />
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This is what Democrats decry as "poverty in America." These are the people to whom President Bush is being "<a href="http://thehill.com/leading-the-news/bush-renews-threat-to-veto-childrens-health-legislation-2007-09-21.html">cruel</a>" by threatening a veto of SCHIP expansion. These are the miserable, contemptible, utterly hopeless forty-something whiner-brats who lay claim to other people's income, insisting that &mdash; their words &mdash; "life is stressful enough without worrying about your health."<br />
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Or, apparently, worrying about being middle-class leeches on other taxpayers.<br />
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<b>UPDATE:</b> Just to be clear, this family is <i><b>not</b></i> "uninsurable." They have access to typical, ordinary private health insurance. They choose, however, to opt -- immorally if not irrationally -- to enroll in SCHIP for less than one-third the cost of private, middle-class health insurance. Behold "enlightened" socialized medicine schemes -- corrupting otherwise reasonable people into becoming welfare bums.<br />
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Madness. Sheer madness.<br />
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(Via <a href="http://feeds.feedburner.com/~r/Cato-at-liberty/~3/161089051/">Cato@Liberty</a>.)]]></content:encoded>
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<item rdf:about="http://kipesquire.powerblogs.com/posts/1189558870.shtml">
<title>The ___-Industrial Complex?</title>
<link>http://kipesquire.powerblogs.com/posts/1189558870.shtml</link>
<description>WashingtonWatch.com has released its analysis of the FY2008 federal appropriation bills (none of which have yet been passed, incidentally, despite the fact that FY2008 begins October 1, 2007 &amp;mdash; less...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2007-09-12T13:09+00:00</dc:date>
<content:encoded><![CDATA[WashingtonWatch.com has released its <a href="http://www.washingtonwatch.com/articles/show/25.html">analysis</a> of the FY2008 federal appropriation bills (none of which have yet been passed, incidentally, despite the fact that FY2008 begins October 1, 2007 &mdash; less than three weeks from today).<blockquote>The twelve pending appropriations bills amount to more than $15,000 in spending per U.S. family. At this late date, Congress is likely to pass these important bills hurriedly and without careful consideration, perhaps in an omnibus package.</blockquote>Of course, "spending per family" is crude scalpel with which to dissect a two trillion dollar federal budget (give or take). First and foremost, a better metric would be "spending per <b><i>taxpayer</i></b>," since about half of all households pay no federal income tax in the first place.<br />
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But more intriguing is this pair of numbers:<blockquote>Defense - Costs: $4,625.93<br />
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Labor/HHS/Education - Costs: $5,861.36</blockquote>The overwhelming bulk of the HHS budget is of course Medicare and Medicaid. Our federal "socialized medicine lite" system is already bigger than the Pentagon. Which doesn't stop supposedly "enlightened" liberals from insisting that we "don't have our priorities straight" or some equivalent form of gobbledygook.<br />
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So remind me again how "the government isn't spending enough on health care"?]]></content:encoded>
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<item rdf:about="http://kipesquire.powerblogs.com/posts/1188857242.shtml">
<title>John Edwards: Two Americas, One Health Care Totalitarian</title>
<link>http://kipesquire.powerblogs.com/posts/1188857242.shtml</link>
<description>I'm too drained after my last post to give John Edwards' outrageous, terrifying and patently un-American (un-Two-American?) proposal to establish health care totalitarianism &amp;mdash; in the form of compulsory...</description>
<dc:creator>Kip</dc:creator>
<dc:date>2007-09-03T22:09+00:00</dc:date>
<content:encoded><![CDATA[I'm too drained after <a href="http://kipesquire.powerblogs.com/posts/1188847259.shtml">my last post</a> to give John Edwards' outrageous, terrifying and patently un-American (un-Two-American?) <a href="http://news.yahoo.com/s/ap/20070903/ap_on_el_pr/edwards">proposal</a> to establish health care totalitarianism &mdash; in the form of compulsory preventive care &mdash; the proper critique that it so obviously deserves.<br />
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So I will settle for posting this comment I left on <a href="http://www.concurringopinions.com/archives/2007/09/the_libertarian.html">another blog</a>:<blockquote>There is a fundamental and self-apparent difference between Medicaid and universal health care: Medicaid is not universal &mdash; it is welfare. It is those who don't benefit from it paying for those who do. So there is of course a basis &mdash; perhaps a heartless one, but a basis nonetheless &mdash; for attaching strings to Medicaid eligibility that do not carry over to bona fide universal health care (including Medicare).<br />
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Socialized medicine (including Medicare) is different from Medicaid: it is taxing people to fund a compulsory universal scheme, then saying that because the health care is "free" (!), the government can attach strings on the very people who (involuntarily) paid for the coverage in the first place.<br />
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So the government takes my money, and then demands that I conform to its (i.e., politicians' and bureaucrats') standards of "correct" lifestyle choices in order to get my money back. All in the name of establishing a "compassionate" and "enlightened" paradigm.<br />
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This is what I have previously dubbed "<a href="http://kipesquire.powerblogs.com/posts/1120844441.shtml">The Krugman Lie</a>."</blockquote>The era of Big Government is what?<br />
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More thoughts from <a href="http://www.thelibertypapers.org/2007/09/03/john-edwards-youll-go-to-the-doctor-whether-you-want-to-or-not/">Liberty Papers</a>, <a href="http://www.poliblogger.com/?p=12467">PoliBlog</a>, <a href="http://www.cato-at-liberty.org/2007/09/04/john-edwards-nurse-ratched-plan/">Cato@Liberty</a>.]]></content:encoded>
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