There’s no denying that there’s risk in taking a drug or medical procedure that hasn’t completed clinical trials. The question is: Who has the right to decide how much risk a person will take — he or some faceless Washington bureaucrat? In my opinion, the answer depends upon the answer to the question: Who owns you? If one owns himself, then it is he who decides how much risk he takes. If government owns you, then you don’t have the right to unilaterally decide how much risk you’ll take.
The FDA’s mission is to ensure the safety and effectiveness of pharmaceuticals. In doing so, FDA officials can make two types of errors. They can approve a drug that has unanticipated dangerous side effects, or they can disapprove or delay a drug that is both safe and effective.
FDA officials have unequal incentives to avoid these two types of errors. If the FDA official errs on the side of under-caution — approving a dangerous drug — the victims are visible, and he is held directly accountable. If he errs on the side of over-caution — holding up approval of a safe and effective drug — who’s to know? The cost and the victims are invisible. Politicians and bureaucrats prefer invisible victims.
None of [Obamacare’s most careful critics] denies that government can successfully use a mix of regulations, taxes, and subsidies to effectively mandate an increase in the number of Americans who have health-insurance policies. Instead, the real concern is that Obamacare will either diminish the quality or the accessibility of actual health-care provision (rather than of health insurance) or that the costs of the extra health-care provision made possible by Obamacare - costs reckoned as the value of other goods and services sacrificed as a consequence - will be excessive. Government’s success at mandating that more people have health insurance (or ‘better’ health insurance) no more implies that people thereby have better health care than would, say, government’s success at mandating that more people have jobs imply that people thereby have a higher standard of living.
None of [Obamacare’s most careful critics] denies that government can successfully use a mix of regulations, taxes, and subsidies to effectively mandate an increase in the number of Americans who have health-insurance policies. Instead, the real concern is that Obamacare will either diminish the quality or the accessibility of actual health-care provision (rather than of health insurance) or that the costs of the extra health-care provision made possible by Obamacare - costs reckoned as the value of other goods and services sacrificed as a consequence - will be excessive.
Government’s success at mandating that more people have health insurance (or ‘better’ health insurance) no more implies that people thereby have better health care than would, say, government’s success at mandating that more people have jobs imply that people thereby have a higher standard of living.
One of the smartest people I have ever met is a property and contracts lawyer, someone from whom I have gleaned countless and valuable insights over the years. He has advised me, among other things, to lead a “haggle-free” business life, where bids solicited from vendors are a “one chance” occurrence. There are no counter offers allowed. Over the years, this has ensured a good price and a mutually beneficial arrangement all at once at our surgery center.
He has also taught me what a contract breech looks like and how to think through the extent of damages. While I do not pretend to understand the tiniest fraction of his trade, I am confident that what I have learned from him has kept me out of hot water many times, particularly relating to business activities at the surgery center.
“People love to sue insurance companies because many times they deserve it,” he told me once. Paying insurance premiums to a company offering homeowner’s insurance, for instance, with the understanding that weather damage would be “covered” represents a contract. Any failure to make good on this “promise” by the insurance company exposes them to accusations of contract breech and fraud. Collecting premiums and paying no claims is always a moneymaker, until this fraud is exposed. Health insurance companies and many other types of insurance companies actively engage in practices that minimize or refuse payment of claims, bound only by what they feel they can likely get away with. I am convinced that this is one reason insurance companies change their names frequently, this practice allowing them to scam the same population, masked by their new name.
What do you do if you live in a country with “single payer” health insurance and realize that you have been scammed, paying premiums (taxes) for many years, only to find out that you have little or no benefit? You thought you were “covered” for various procedures or treatments only to find out that the treatment for your cancer was essentially in “layaway.” You can’t sue for damages. There is no recourse. There is nowhere to turn, other than to leave the country to purchase healthcare elsewhere. I am not sure there could be a better argument against single payer than an utter lack of recourse.
The lack of market competition and the recourse market failure represents, explains the failure of health care delivery in all socialized systems, whether in Canada or the VA system here, or the new Obamacare silliness. Canadians have to buy health insurance, basically by paying taxes earmarked for the small amount of health care placed in layaway on their behalf. People in the U.S. now must buy “insurance” or pay a penalty. Worse, employers must provide insurance to their employees or pay a penalty. What’s the difference? The “purchases” in single payer countries and those in the U.S. now both occur at gunpoint, both mandated payments to those in power or connected to power.
Before you lay the blame for Obamacare on all of the stupid people in Washington, consider for a moment, Rothbard’s historical method. The brilliant “Austrian” economist began every investigation of historical events with “cui bono,” or “who benefits.” In short, he identified the beneficiaries of a law or government intrusion and assumed the worst of them, rarely if ever mistaken in his provocative conclusions.
Similarly, I maintain that to truly understand the purpose of Obamacare one must, I believe, start with the end result, that is, lots of very identifiable people and businesses getting rich because of this “law.” In the private sector, a scam like Obamacare would of course be considered criminal, at least a breech of contract.
The victims of single payer healthcare, VA healthcare and increasingly, Obamacare, are learning these lessons in the hardest ways imaginable. The most difficult task it seems is to come to believe that the gang in D.C. knows exactly what they are doing and doesn’t care about broken promises or lives.
At the Surgery Center of Oklahoma we plan to continue trumpeting the power and the beauty of the market at work in health care, hoping that our facility’s success and wonderful patient success stories will more quickly bring an end to the idea that the provision of health care should be entrusted to the corrupt state.
G. Keith Smith, M.D.
For more information about free market health care visit:
Hobby Lobby is a much simpler and less important case than it’s been made out to be, for reasons the Court clearly spelled out today. Obamacare’s contraceptive mandate had to fall under the Religious Freedom Restoration Act (without even getting to the First Amendment) because it didn’t show – couldn’t show – that there’s no other way of achieving its goal without violating religious beliefs. Moreover, the fact that a for-profit corporation is asserting the statute’s protections is of no moment because neither the corporate form nor the profit motive undermines RFRA’s solicitude for the rights of humans – including owners, officers, and shareholders. In short, the mandate fell because it was a rights-busting government compulsion that lacked sufficient justification. Nobody has been denied access to contraceptives and there’s now more freedom for all Americans to live their lives how they want, without checking their freedom at the office door.
If one felt that veterans deserved some sort of lifelong benefit for military work, one could simply provide veterans with a stipend that they could use to procure health care. But this is not done.
The reason for this of course is that by providing health care directly through VA health care and VA hospitals, government can more easily subsidize and favor certain corporations and other government contractors who provide drugs, equipment and services to VA providers. If veterans were simply given stipends, then the veterans themselves might choose the “wrong” (i.e., not-politically-favored) providers.
We see this same process in the food stamp program which is designed to subsidize agricultural interests. This is partly why the food stamp program is administered by the Ag department and not by Health and Human Services.
Consequently, the real constituents of the VA are the corporate providers of health care supplies and services, not the veterans themselves. So who can be surprised when we find that the veterans are being treated like garbage? The political cost of doing so is quite low, while the political cost of running afoul of the corporate lobbyists who largely dictate VA contracts and services is quite high. Any intelligent VA official quickly figures out how to thrive in that system.
We have a new contender for most-telling-ever Obamacare quote this morning: “We have to break people away from the choice habit that everyone has.” That’s Marcus Merz, head of Minnesota health insurer PreferredOne, in a New York Timesreport on the increasing prevalence of narrow network health plans.
Merz is basically stating openly what the Obama administration won’t, which is that Obamacare is intentionally designed to narrow consumer choice and plan design within the health insurance market. The Obama administration doesn’t want to say this because it is bad politics generally, and also because President Obama specifically and repeatedly promised that, under the law, people would be able to keep their choice of health plans and doctors, not that they would be broken of their preference for medical choice. But the law’s authors and administrators have a pretty good idea of what kind of health insurance they want you to have, and that’s the kind of insurance that you’re going to get.
"We’re all trying to break away from this fixation on open access and broad networks," Merz continues. "We"—by which I mean the insurance industry—tried this before, in the 1990s, when narrow-network plans referred to as Health Maintenance Organizations were all the rage. It didn’t go so well, and eventually insurers cut it out.
But this time it will be different, insurers tell The New York Times. Why? Because…look, it will just be different. Trust us.
Although a similar attempt to restrict choice failed in the early ‘90s, after opposition to H.M.O.s and managed care, insurers insist these efforts will not run into the same resistance because they are now working more closely with providers, and customers are more concerned about costs. “It’s a new era,” said Dr. Sam Ho, the chief medical officer for United Healthcare.
Others agree. “You’re going to see this as a dominant strategy,” said Jeff Hoffman, who works closely with hospitals for Kurt Salmon, a consulting firm.
And if insurance executives say it, well, it must be true, and the liberal health wonks who back Obamacare would never think to question them. Truly it is a new era.
Yes, obviously this time it is different, in the sense that there is now a mandate to buy insurance and a bevy of administration-enforced rules and regulations about what sorts of plans, covering what sorts of procedures, can be sold through the exchanges. Hence the necessary “breaking of the choice habit.” The law is written in such a way as to severely constrain and, as a result, practically predetermine which sorts of plans are available at any given price point. Insurers all end up offering what amounts to a few standard models, plus or minus a handful of decorative touches.
Given the limited choices and the requirement to buy, then, it’s not really surprising that many customers end up choosing cheaper plans—and the narrow networks that inevitably go along with them. Or, as Karen Ignani, the head of the insurance industry trade group America’s Health Insurance Plans, says in the article’s second best quote, “What we’re finding is individuals are experiencing a preference for affordability.”
It’s worth stopping for a moment to admire that quote. It is a minor masterpiece of lobbying communications nothing-speak. It is almost entirely removed from action or accountability. It’s like she’s talking about a new observational study on cloud formations.
But people shopping for insurance under Obamacare are not simply experiencing some mysterious condition. They are being required, by law, to purchase a product, and then deciding that for the money they have spent—which in many cases is merely a fraction of the total cost, the rest of which is being picked up by taxpayers—they do not like what they are getting in return. That is why the choice habit must be broken. We can’t have people’s quirky, complicated personal tastes and preferences messing up our perfect system.
Health care in the United States is stuck in a rut. Americans are spending more on the same old care. The disastrous Obamacare rollout creates more problems than the administration can spin that it “solves.” We have simply grown to accept rising prices and stagnating service as a fact of life.
It doesn’t have to be this way.
Imagine a world where everyone, not just the mega-rich, has access to modern, affordable, high-quality care. In this world, doctors don’t need to beg bureaucrats and insurance administrators for permission to save lives. Entrepreneurs here actively compete to lower prices and innovate novel solutions. Imagine, in other words, a world in which our health care system is dragged out of the Stone Age and into a modern, competitive market economy.
Up to nearly $25,000 per enrollee…
Obamacare appears to be in a fierce race to beat Cash for Clunkers to become the poster child for mismanagement of federal taxpayer resources:
- In the first open enrollment period, the State of Hawaii spent nearly $25,000 in federal funds per enrollee who signed up for coverage on its Obamacare Exchange.
- For every dollar in premiums for Exchange-provided coverage, federal taxpayers paid 94 cents in various subsidies to either enroll people or encourage them to purchase coverage on the Exchange.
- Premiums on the Exchanges would have more than doubled in 10 states had the federal amounts used to set up the Exchanges been incorporated into premiums rather than paid separately by taxpayers. …
We calculated a federal cost per enrollee consisting of a) the total amount paid to states in grants to set up and run Exchanges (including the federal dollars used to bankroll the federally-facilitated Exchange for the 29 states using it in 2014); b) premium subsidies used to encourage people to buy Exchange coverage; and c) the estimated amount of cost-sharing subsidies that will be available to low-income families who purchase Silver plans on the Exchange. Nationally, federal taxpayers have spent $4,633 per enrollee for each of the 8+ million who have signed up for Exchange coverage through April 19. But this ranges from a low of $3,038 in Tennessee to a high of $24,947 in Hawaii. …
Nationally, the amount paid by federal taxpayers to set up and operate Exchanges amounted to 19 cents per every premium dollar. Again, this does not mean federally-financed Exchange costs amounted to 19 percent of premiums paid. On federally-facilitated Exchanges, a 3.5 percent surcharge on premiums was permitted to help offset some of these costs, but in most states, the actual amount spent was well in excess of this amount. Florida (1 cent per dollar of premiums) and Texas (2 cents) had costs below the surcharge amount, but the median state, Kansas (ranked 26th) had federal costs (34 cents) nearly 10 times as large as the surcharge. And the worst-ranked state was again Hawaii, whose costs amounted to $6.11 per dollar of premiums.
Such costs were nearly 3 times as large in states controlled by Democrats (27 cents per dollar) as those controlled by Republicans (10 cents). This partially reflects another reality: administrative costs on the state-run Exchanges were more than double those on the federally-facilitated Exchanges. Since 13 of the 16 states controlled by Democrats ran their own Exchanges, the higher costs for SBM states translated into higher costs for these states. But this of course does not explain why costs were higher in states with their own Exchanges. As we’ll see shortly, mismanagement appears to be at least part of the explanation. While it might be tempting for partisans to assume that states controlled by Democrats are more prone to such mismanagement, we believe a simpler explanation may be at work: the perverse incentives arising from spending other people’s money.
The doctor confirmed that I had the gout. I was not pleased to find out, that in my case, the gout was probably brought on by another drug that I had been taking daily, against my better judgment. However, I was pleased to learn that I would no longer have to take it, that as part of my treatment I was being prescribed an ancient and natural drug, and that I would only have to take this drug “as needed.”
I was off to get my prescription filled at the pharmacy when a thought came to mind: if this drug was as natural and ancient as advised by my doctor, why did I need a prescription in the first place? Upon inspection the prescription was for Colcrys, the brand name of the drug colchicine. Furthermore, when I picked up my prescription the price was much higher than I anticipated given that it was a natural drug. When questioned, the pharmacy technician replied that the actual price was much higher and that my insurance paid for more than three-quarters of the bill. The cash price (without insurance) was $198.99 which is $6.63 per pill if taken daily, or nearly $20 per dose if used to treat flare-ups.
An extremely high price for an ancient natural drug? I knew I had a new case to solve and that the solution was probably the same old answer.
After conducting some research on Wikipedia, I learned the following: Colchicine can be used to treat gout, Behcet’s disease, pericarditis, and the Mediterranean fever. It has been in use as a medicine for over 3,000 years. After serving as ambassador to France, Benjamin Franklin brought colchicum plants back to America in order to treat his own gout. Modern science has further refined the drug for better medicinal use.
Colcrys has been used to treat gout for a very long time, although the Food and Drug Administration (FDA) had not approved Colcrys specifically for the treatment of gout prior to 2009. Alternative drugs, such as Allopurinal, are also used to treat gout and related ailments. Until recently, you could treat your own gout using one of these medicines for pennies a day.
In the summer of 2009, the Food and Drug Administration approved Colcrys as a treatment for gout flare-ups and the Mediterranean fever. The FDA gave pharmaceutical company URL Pharma an exclusive marketing agreement for selling Colcrys in exchange for completing studies on Colcrys and paying the FDA a $45 million application fee.
This deal effectively created a patented drug with no generic alternative. Therefore it gave the company a monopoly for the duration of the agreement. URL Pharma immediately raised the price from less than a dime to nearly $5 dollars per pill. Comprehensive medical insurance does substantially reduce the price to consumers, but it does not reduce the cost. Insurance only spreads the cost-burden across policyholders.
At the same time, doctors are encouraged by pharmaceutical companies to employ more expensive and profitable treatments. As a result the overall cost burden increases. Evidence suggests that doctors are prescribing Colcrys in large volumes to treat gout flare-ups and as a long-term preventative measure.
Once again government has taken something that was both cheap and beneficial and turned it into a monopoly that hurts the general public and drives up the cost of medical care to the benefit of Big Pharma.
Turning to government to bring down costs in health care is like turning to a hammer to fix a window it just smashed.
Have you ever had a friend who is chronically about to start a diet? Yes, he admits, he needs to reduce his calorie consumption, and he has for a while. That’s why he’ll be starting a new eating regime tomorrow, or maybe next week. And because he knows how hard it is to cut back—he’s tried before—he’s not planning on making major changes, just trimming a little bit over time until he hits his goals. But tonight, he’s hungry, and his stomach is grumbling rather loudly, so why not feast a bit more before the fast?
Even if you’ve never met someone like that, you can get a similar experience just by following various attempts to cut Medicare spending. Yesterday, for example, the Centers for Medicare & Medicaid Services (CMS) announced that a proposed 1.9 percent cut to Medicare Advantage, which allows seniors to get Medicare benefits through privately run plans, would not go into effect. Instead, the new rates for the program will likely result in a 0.4 percent spending increase.
This is not the first time that Medicare Advantage cuts have conveniently transformed into increases. Last year, CMS initially proposed a 2.2 percent cut—which, over the course of a few months, evolved into a 3.3 percent hike.
In both years, what happened between the initial proposal and the final was the same: an intense lobbying campaign by insurers who get paid by the program, as well as heavy political pressure from both sides of the aisle.
Insurers began their campaign in January this year, before the proposed cuts were even formally announced. A bipartisan group of 40 senators, led by Sen. Mike Crapo (R-Idaho) and Sen. Chuck Schumer (D-N.Y.), sent a letter to CMS head Marilyn Tavenner expressing concern about the cuts. “Given the impact that payment policies could have on our constituents,” the letter said, “we ask that you prioritize beneficiaries’ experience and minimize disruption in maintaining payment levels for 2015.”
The stomach grumbled, and CMS listened.
The Medicare Advantage reversals in many ways recall the long-lived saga of the Sustainable Growth Rate (SGR), a formula put in place in the late 1990s to keep Medicare payments to physicians in check.
The original thinking was that the formula, which is designed to keep physician payments on a steady trajectory in line with the overall economy, wouldn’t require cuts. But in 2002, when the economy didn’t keep growing at late-90s rates, and the formula began to call for cuts, Congress balked, replacing the cuts with short-term increases—a pattern it has repeated over and over again, for more than a decade. Indeed, yet another one-year patch to the SGR, overriding a large scheduled cut, was passed just last week—in a deal worked out between Republican Speaker of the House John Boehner and Democratic Senate Majority Leader Harry Reid.
The fast can always come later.
This is a debate that sometimes scrambles easy assumptions about party roles in the entitlement fight: Republicans, from presidential candidate Mitt Romney down to Florida special election victor David Jolly have been quite successful at hammering the Obama administration for cutting Medicare in order to pay for Obamacare.
At the same time, it exposes the hollowness of both parties’ claims to fiscal responsibility. The Obama administration is counting on $156 billion in Medicare Advantage cuts by 2022 in order to help finance Obamacare; but the strength and influence of the opposition, which includes more than a few prominent Democrats, means no cuts to the program are ever a sure thing. Republicans, meanwhile, make the already treacherous path to Medicare reform even more difficult with their constant complaints about Democratic cuts to the program. For both parties, the time to feast is always now. The time to diet, or cut Medicare, is always later.
There are never cuts.
The first hint that the real goal of occupational licensing isn’t to protect consumers’ health and welfare is that far too many of the professions that are licensed pose practically zero risks to ordinary people. Among the professions that are licensed in various U.S. states are florists, hair braiders and casket sellers. What are the chances that consumers will be wounded by poorly arranged bouquets of flowers or that corpses will be made more dead by defective caskets?
The real goal of occupational licensing is to protect not consumers, but incumbent suppliers. Most occupational-licensing schemes require entrants into a trade to pass exams — exams designed and graded by representatives of incumbent suppliers.
To see the folly of such schemes, ask yourself: If no new restaurant could enter the fast-food industry unless it first got the approval of McDonald’s and Burger King, how many new fast-food restaurants would you expect to see? And with incumbent restaurants exercising government-granted power to exclude new rivals, what do you predict would happen to the price of a Big Mac or to the quality of a Whopper?
But what about more “significant” professions, such as doctors and lawyers?
The case for licensing these professions is no stronger than is the case for licensing florists and hair braiders. The reasons are many. Here are just two.
First, precisely because medical care and legal counsel are especially important services, it’s especially important that competition to supply these services be as intense as possible. If the price of flowers is unnecessarily high or the quality poor, that’s unfortunate but hardly tragic. Not so for the prices and quality of the services of doctors and lawyers.
Too high a price for medical visits will cause too many people to resort to self-diagnosis and self-medication. Too high a price for legal services will cause too many people to write their own wills or negotiate their own divorce settlements. Getting matters wrong on these fronts can be quite serious.
Won’t, though, the absence of licensing allow large numbers of unqualified doctors and lawyers to practice? No.
People are not generally stupid when spending their own money on themselves and their loved ones. Without government licensing, people will demand — and other people will supply — information on different physicians and attorneys. Websites and smartphone apps will be created that, for a small fee, collect and distribute unbiased information on doctors and lawyers. People in need of medical care or legal advice will be free to consult this information and to use it as they, rather than some distant bureaucrat, choose.
And competition among physicians and lawyers — made more intense by the absence of government licensing — will drive these professionals to offer high-quality services at affordable prices.
The same open competition that leads supermarkets, restaurants, dry cleaners and department stores to constantly improve their offerings and lower their prices will do the same for all those occupations that are now licensed by government.
"How Do We Stop Rising Healthcare Costs?" | Peter G. Klein
EconPop: The Economics of Dallas Buyers Club
EconPop is the YouTube series that sifts through the haystack of popular culture to find the needle of economics within . . . and then stabs you with it!
Starring comedian Andrew Heaton, EconPop takes a surprisingly deep look at the economic themes running through classic films, new releases, tv shows and more from the best of pop culture and entertainment. Heaton brings a unique mix of dry wit and whimsy to bear on the dismal science of economics and the result is always entertaining, educational and irreverent. It’s Econ 101 meets At The Movies, with a dash of Monty Python.
In this premiere episode of EconPop, Andrew discusses the economics of Academy Award winner Dallas Buyers Club. Subjects include public health and safety regulations, crony capitalism and the role of regulatory capture, the emergence of black and grey markets, and commercial exchange as a means for increased social tolerance.
Obamacare’s conservative critics sure know how to make themselves look out of touch. From Sarah Palin’s 2009 warning about “death panels” to last week’s headlines that a new CBO report said the Affordable Care Act would kill more than 2 million jobs, the law’s critics keep telling whoppers.
Say this much for the critics, though: At least they’re just bungling the facts.
Facts are easy. You can check facts. What supporters of the law are doing, on the other hand, transcends factual bungling. It’s far more advanced: a warping of reality so debauched it looks like something out of a tale by H.P. Lovecraft.
Christina and Timothy Sandefur offer a perfect example in the latest issue of Regulation magazine. The fine levied for failing to purchase insurance, they note, is a “penalty that’s a tax but doesn’t raise revenue.”
Cast your mind back to those halcyon days of yore, when the law was first being debated. Democrats were keen to insist, as President Obama did in an interview with George Stephanopoulous, that the penalty was “absolutely not a tax increase.” On the other hand, the law’s proponents worried the Supreme Court would not buy the line that Congress had the power to impose the levy under the Commerce Clause. (They were right about that.)
So they came up with the bright idea of calling the penalty an “excise tax on individuals without essential health benefits coverage.” That was pretty sketchy, since an excise tax applies to the purchase of goods, not to individuals who haven’t bought a good. But it worked: In 2012 the Supreme Court’s majority rescued Obamacare by agreeing to call the penalty a tax.
At the same time, the Court also insisted that the penalty was not a tax. This was the only way to get around the Anti-Injunction Act, which generally requires someone to pay a tax before he can challenge the collection of it. Since the mandate penalties originally did not kick in until 2014, that would have prevented the Court from ruling on the law’s merits until much later.
But wait, there’s more!
The Constitution says “all bills for raising revenue” must originate in the House of Representatives. But the ACA originated in the Senate, when Majority Leader Harry Reid took a House-passed measure, deleted its text, and substituted what became the Patient Protection and Affordable Care Act for the original bill.
The Pacific Legal Foundation is challenging the constitutionality of Obamacare on Origination-Clause grounds. In response, the Obama administration claims the ACA not only originated in the House, but also that it is — wait for it! — “not a ‘Bill for raising Revenue.’ ”
So is the penalty a tax or not? Answer: Pick a color between one and 10.
And this is only the beginning. Consider the ACA’s other controversial mandate — the contraception mandate, now being challenged by (among others) Hobby Lobby, a company called Conestoga Woods, and Little Sisters of the Poor, a Catholic charity. They do not want to be forced to provide or arrange for contraception, which violates their religious beliefs.
In response, Obamacare defenders could simply say that life is full of trade-offs, and ensuring access to free contraception is more important than religious liberty. Instead, they want to claim both sides of the argument by insisting that those who object to the mandate are the ones violating religious freedom. Not buying your employees contraception, their argument goes, violates the employees’ freedom of religion. How? Because, um … hey, look, a squirrel!
The other day The New York Times took this absurdity another step further. The paper argued — you might want to grab a chair — that not forcing companies to furnish contraceptives for their employees violates the Establishment Clause of the First Amendment.
Moving on: The Affordable Care Act says people who qualify can obtain subsidies to buy insurance through an exchange “established by the state.” Thirty-four states have no exchange of their own; they have exchanges established by Washington. This means the people of those states are ineligible for subsidies. According to the law’s defenders, though, the language of the law does not say what it says, because we all know what Congress really meant. Or something like that.
Which brings us to last week, and the CBO’s projection that Obamacare will induce more than 2 million people to quit working or cut back their hours to take advantage of the law’s subsidies. Conservatives initially misread this as saying the law would destroy 2 million jobs, which was wrong of them; employers will not lay off 2 million people.
But if conservatives were too quick on the trigger, what excuse do liberals have? Not content to point out the truth, they have tried to spin the news as good: Isn’t it wonderful that those who could work will choose not to so they can reap benefits from the shrinking cohort of the employed? Obamacare is liberating people from the tyranny of gainful employment! What could be better?
Answer: “a comprehensive national health care system and a guaranteed basic income,” according to Alex Pareene of Salon, because “people should be free from [lousy] jobs.” If they were, then they could “spend more time with their families,” enrich themselves, get educated, “and even just … [fool] around a little more.” (No word on who, exactly, will be left to provide the income in this non-worker’s paradise.)
A world in which nobody has to do unpleasant work is a world in which you ride to the park on a unicorn. But that is a world many of Obamacare’s supporters inhabit: a place where the individual mandate is both a tax and not a tax; where the First Amendment’s Establishment Clause requires religious people to violate their faith; where “the state” means “the federal government”; where taking a job is wage slavery, but taking a handout is freedom.
Makes you wonder what color the sun is there, doesn’t it?
Pick a color between one and 10.
Policymakers and anti-addiction advocates now want to suppress opioid use, and to impose even greater restrictions on people who live with chronic pain. This isn’t going to address the addiction and overdose problem. Studies are now showing that when opioids aren’t as available and prices go up, addicts just switch back to street heroin. Pain patients, however, simply suffer. Their plight shouldn’t be an afterthought and shouldn’t be relegated to comments sections to stories that failed to consider their perspective. They are a crucial part of this story.