Monday, August 17, 2009

Universal Health Care: Rights

I've heard a number of arguments for universal health care that seem to all fall into the same category, that it is some kind of right. I've heard people say that health care is a human right. I've heard people say that it's provided for in the Declaration of Independence as part of the 'pursuit of happiness'. I've heard that it's provided for in the Constitution under article 1, section 8, where the government is to 'provide for the common defense and general welfare'.

As you might have guessed I disagree with these arguments and I want to explain why.

First, the Constitution. Here's a blurb that explains why this doesn't mean that the government can do whatever they want that might promote the general welfare. Our government is one of enumerated powers. Powers not granted in the constitution are reserved by the states. Powers not granted to the states are reserved by the people. If they could do whatever they want, we'd no longer have a government of enumerated powers. Or at least that's how it's supposed to work. Now, there are those that would love to just move past the constitution. "It was great for its time, but it's so 1790s; we've progressed since then," but that's another post.

Second, Pursuit of Happiness. Does my pursuit of happiness mean that I can do anything I want? I mean, if it's in my pursuit of happiness, who can deny me? Obviously there is a line. Where is it? I heard something I liked: "Your right to swing your fist, ends at my nose." Furthermore, if your pursuit of happiness requires that other people do something for you, how do you argue between receiving health care and having everyone you say hello to give you $10, or requiring the grocery store to give you your groceries free? Your pursuit of happiness does not allow you to force goods or services from other people, because by doing so you infringe on their pursuit of happiness.

Lastly, health care is a human right. Like we mentioned above, health care requires goods and services that don't belong to the one receiving care. A 'right' that requires action from others is called a positive right. What you might call the opposite, is a negative right, it requires the inaction of others, or freedom from others' actions. This is what I think the right to the pursuit of happiness really is, the freedom from others stopping your pursuit of happiness, as long as your pursuit doesn't stop someone else's pursuit. Other positive rights include the right of education, the right to clothing, the right to housing, the right to food, the right to a retirement (social security), and even the right to a minimum standard of living. Now don't confuse this list. As an example of possble confusion, the right to education means the right to have people teach you and provide everything you need to learn, not the right you have to pursue learning the best you can at your expense, free of interference.

I would argue that these positive 'rights' aren't rights at all. Let's look at health care. For the sake of argument let's say it was a human right. Suppose that you had a disease that can't be treated in the United States, is it your right to be flown, at someone else's expense, to the country with the specialist that can treat your disease? Suppose that you have a disease and there are doctors that can treat it, but not one wants to. Are they obliged to treat you because it's your human right? If they're forced to treat someone against their will, aren't their rights being diminished? Now, I don't think that would ever happen, but I think it illustrates that receiving health care isn't a human right. A human rights that require someone else to do something for me isn't a right at all. Health care is a voluntary transaction in the market place ultimately between two autonomous agents.

Suppose the disease you have isn't life threatening, say deafness, is society obligated to use all their resources to remedy your malady? What if the condition is brought on by choices you've made? This is where proponents of health care as a human right get into trouble. The line gets blurry. It seems though, that if it's a human right, it's a human right and the circumstances of how they got into the predictament shouldn't matter. This is another reason why I don't think it is a human right. It's not right to let society absorb the cost for consequences made by individuals. There can't be true freedom without the consquences of individual choices. Furthermore, the more society does absorb those costs, the more power they have over individuals to stop them from doing what society deems 'costly'. I would rather suffer the consequences myself and have the freedom to do what I want.

Now, does this mean that we don't provide some of these priveleges to our society? No, take education again; we provide a semi-free schooling through grade 12. What the person makes of it is largely up to them. I believe the goal is to help even out the starting point, providing equal opportunity. But it isn't a human right, it's a privelege provided by the community. If education was a human right, couldn't I demand to be admited to the college of my choice, free of charge? Couldn't I demand to be taught by the teachers of my choice? Couldn't I even demand to be taught by anyone that knew something I wanted to learn? I mean, it's my unalienable human right, right? No, of course not, because it isn't a human right. All these things that are classed as positive 'rights' are goods or services that are provided in the market place. The doctor studies a trade and then applies his knowledge for a fee. The college professor studies a trade and applies his knowledge for a fee.

So the question is, should we provide some form of health care as a privelge to members of our society? That's what the debate should really be about. I think it's called a human right by the proponents because our 'rights' are so sacred to us and evoke such strong feelings. Also, if you call it a human right, how can anyone be against it? "What are you some hatemongering, human-right violating, totalitarian?" No I'm just someone that believes a lot of the health care problems could be solved by the market place, if we'd let it work, and those that can't could be solved with a couple new laws and the abolishment of some older ones.

Friday, August 14, 2009

Universal Health Care: Competition

The President claims one of the reasons we need a government run program is so that we get more competition going in the insurance market. That would be great if the competition were fair. But forgive me if I'm skeptical about how fair that competition would be. The government is the one setting all the rules, and in the insurance business there are lots of them. Now they also want to get out onto the field. Imagine if all the referees in the NBA got together and said, "We're starting our own team and we'll still be officiating all the games." Do you see the conflict of interest? Is it a foregone conclusion that the refs will cheat? No. Is it possible? Yes. Has our government ever done anything like this? *cough* Freddie and Fannie *\cough*

I would be all for a government run option if it could do the following things.
  1. To start the taxpayers could give it a loan, but it must be repaid, lets say over ten years.
  2. Besides the start up loan, no taxpayer subsidies. It has to sink and swim like everyone else on the premiums it collects. This includes paying the salaries of all the people that work for what would undoubtedly be a huge corporation. It also includes purchasing or paying rent for the office space they use. Paying for the office supplies, computers, servers, and infrastructure a huge company would need.
  3. It has to live and die by the same rules as everyone else in the market. And those rules can't be changed just to favor the government insurer. That also means anything the government run plan can do, the private insurers can do too.
Is this possible? I don't think it is, but I think these are pretty reasonable requirements if there is going to be fair competition. That's why I don't think a government run insurer would be a fair competitor.

Government run businesses often run at a deficit for years and years, something a private company can't do. A private company would fail (or at least should be allowed to!) if it ran like that. It's like the government and government business play by a different set of rules.

For instance, one of the cool things the government option could do is enroll a really large group of people (from all over the country) to help spread the risk. This is something the private insurers can't do. Our government has restricted private health insurers from insuring outside of their state, which limits how big a pool they can enroll from. Would that be changed if we started a government option? I doubt it, but that would be unfair competition. The purpose of more competition is to bring costs down. Why don't we just remove this restriction? That would bring down costs.

Currently our government dictates the minimal amount of things a health insurer has to insure. Which means you can't purchase just catastrophic insurance (which would bring down the cost). If we really want to bring down costs, why don't we remove that restriction?

Because government businesses don't play by the same rules as private industry, people are wary of a government run health insurer. Unfair competition means the private insurers would have a tough time staying in the industry. I think that as the government option got stronger, the private options would find it harder and harder to compete, until they were eliminated and then ta-da! Single-payer system! Which has been amazing for Canada and the UK. I don't know about you but waiting months to see a doctor and then getting in the back of the line to get the actual treatment I need sounds fantastic. And then if there's any kind of healthcare crisis, the care rationing will be sweet. I just hope I'm not old when that crisis hits, I'm not looking forward to that state-sponsored dirt nap.

Sunday, August 9, 2009

The Poor

One of my biggest "why"s is "Why are there poor?" What do you think? Why are there poor here in the United States? I don't pretend to know. It's something I ask myself fairly frequently. Let's think about it some. We'll call our example person Bob. There are really only two sides to the equation for Bob, the income and the outgo. If Bob doesn't have any money coming in, he's poor. If Bob has more money going out than coming in, he's also poor. So for Bob to turn things around He would either need to get the income up or the outgo down and he is currently poor because one or both of those sides is out of balance.

The next question is "why?". Let's assume that the outgo is ok, why is the income down? Is Bob working? Hey, it's a valid question, there are people that just don't work for varied reasons from drug and alcohol abuse to plain laziness. Let's assume that isn't Bob, he'd work if he could. Great, then why isn't he working? Maybe he can't find a job. That can be really discouraging, but why can't he? If I was Bob, I'd probably say, "Because there aren't any jobs out there!" Do you think that's true? Really Bob, there aren't any jobs out there? Here are the things that could be going on:
1. Bob's right, here in town, there aren't any jobs. But the world is bigger than this town, county, state, or country. Maybe Bob needs to cast a wider net (and move).
2. Bob's right, nobody is hiring for the exact job Bob wants to do, but there are other jobs that Bob could take if he were more flexible. I really respect people that do what it takes to take care of their family. They're working crazy hours with multiple part-time jobs to make ends meet. That shouldn't be a way of life and doesn't have to be a way of life, but sometimes, for the short term, you gotta do what you gotta do. People that do that are awesome in my book.
3. Bob's right, there aren't any jobs Bob wants for people with Bob's skill-set. He isn't educated or experienced enough to get one of the jobs available. I have to ask the question here, why, because this is one of the reasons I worked my tail off in school. Our state provides a basic education and there are ways to work your way through upper education (I did it). But even now it's not too late for Bob, if he can read there is much self-education available. If he mixed #2 with a little education on the side he could work his way up to a better job.
4. Bob's right, of the three places he's looked, none of them were hiring. As a teenager my wife applied for many summer jobs that she was qualified for but was turned down again and again. She was different from Bob in that she kept looking and eventually found a job.
5. (very unlikely) Bob's right, our economy and country are in complete and utter collapse and there is no more "means of production". Armageddon is knocking on our door.

Even if we wanted to concede to Bob that he can't get a job, there is still another way. What would be wrong with Bob going into business for himself? Being an entrepenur is scary to some people but there is a lot to be said for being your own boss. Starting a business doesn't require mountains of capital (money) or a group of investors. In fact, most busisnesses in the United States are small, a handful of people providing a good or service. How did they get started? It looks like they're making a go of it. Find someone in a neighboring town that is doing what you'd like to do and ask how they got started.

Going back to Bob, let's assume that he's still poor but he has a job. Why is he still poor? Well, maybe the income still isn't high enough. He would probably benefit from some of the things we mentioned before, another part-time to cover the gaps and education on the side so that he doesn't have to do that forever.

But what if Bob really does have a pretty good job, then the problem is the outgo. What does Bob need to do? He needs to make a budget and live on it (lots of people do it). He needs to make his money behave. If he does indeed have a good job, he needs to squeeze the excess out of his life. Why? Because he can't afford it. I think that as a society we don't like to say "No". We don't want to say no to ourselves (I know it's hard). We don't want to say no to others. But the reality is, if you can't afford it, you shouldn't buy it. Part of Bob's problem might be that he has prior obligations that he can't meet. Bob is in debt. Because he didn't say no to himself, the outgo is bigger than the income.

Huge aside: You know, I was thinking about debt and it's really the most expensive way to buy something. You see something you want. You don't have the money but they'll sell it to you if you pay them even more than what they're selling it for but they'll collect the money in payements over time. If the sticker had the actual price on it including the interest and fees you'll pay with payments, would you still buy the item? We do this with bonds and public projects. "We'll not only pay top dollar for this public works project but we'll even pay more for it in interest", and then your state is short cash and wondering where they'll get it. You can work this the other way. You see something you want. You don't have the money so you start saving while accumulating interest. In the end the actually amount you pay for the item is less than sticker because you received the interest instead of paying it.

This is part of the problem with cash advance places. The interest is ridiculous and the people that use such places are already in a tight spot. Places like this keep the poor, poor. Now I'm not arguing that they should be shut down, I'm arguing that they shouldn't be patronized.

Ok, going back to Bob. Let's say he's really doing well with is his money. He's living on a budget and making his money behave. But still he's having trouble. Bob may have a good job, but where he is living is too expensive. In some parts of the country the cost of living is so high that even with a good job things can be tight. What would you do in a place like that? Maybe Bob needs to look for an even better job. Or maybe he needs to look for a different place to live.

Let's say that Bob is making it, it's tight but he's pulling through. Then disaster strikes, an unexpected event in the $1000-10000 range. Part of balancing that income/outgo equation is planning for the unexpected, and a credit card isn't a plan. And that's not just a glib statement. If you didn't have the money and you were just getting by, how are you going to afford the credit card payment?

I think about this a lot, especially after I moved to California. I believe you can make it in America, and not just make it, excel! Why are there still people that don't? I don't pretend to know. Here are some of my guesses.

They don't believe themselves that they can make it. That may sound cliche but really, if you don't think you can improve your situation yourself, why try? There are lots of misconceptions about wealth and money floating around in our society and I think a lot of people believe them. For example, to become really wealthy you have to inherit it or win it in the lottery or debt is best way to build wealth. Another one, some evil entity (business/socioeconomic group/race) is keeping all the poor down so that they can exploit them; essentially, it isn't their fault, they're victims and they need to be rescued. Because they don't believe they can make it, they don't see the opportunities that are right in the way.

Let's take a look at the evil entity thing. Do you think it's true that some people are poor because some entity has is in for them? I'm not trying to straw-man either. Are there groups that have perceptions about the poor and because of those perceptions unconsciously design a system that locks the poor out? I've heard some people accuse one group or another of doing that. Do you think it's true? Honestly, I have a hard time believing it. When I was very young, my family went through really hard times. My dad had no work, a failed business, and small family to take care of. Christmas was a box of blocks cut from 2x4's. It took my parents a while to dig themselves back out again, but they did it. Maybe I'm blind to what other people are seeing, but it seems clear to me that hard work, determination, and sacrifice can take you anywhere you want to be. Another old cliche, "Where there is a will, there's a way."

I think some people really don't know where to start to improve their situation. They just never learned about how to interview well for a job. They never learned how to be a good employee. They don't know how to fix some of the problems their in even though it's within their power. They honestly are lacking knowledge that would make a difference. The hard part is they don't know they don't know. I think there are also some that know some things but don't know how to apply it in their life. They need an example of how to grab that bull by the horns.

For sake of argument, assume I have it right, those that are poor, stay poor because of a lack of knowledge and example. We'll leave out the people that have no gumption, the beautiful thing about this country is it's your life and if you want to be poor you can be. If knowledge and example are what stand between poverty and not poverty, then we don't need a larger and larger government. We need more friends, mentors, and teachers.

This is an idea that I've been thinking about for a while. I'm always reminded of it when I see pan-handlers. What does that pan-handler need? Yeah, a little food would probably be good. Uh, some money might be good too, maybe. What does he really need? Assuming he is in need, he needs someone to sit down with him and find out what is going on. Why is he on the street pan-handling? Why doesn't he have a job (remember Bob)? Is he lacking knowledge? Does he need an example to show him how to do it? I wonder what would Jesus do? Yeah he might take care of his immediate need but he'd do so much more. I think Jesus would help the man become self-sufficient. What would that require? Someone taking a genuine interesting and offering help on those levels they see need help. That might extend to offering a job and then teaching them how to be an employee. What if I started a business that hired people that needed a chance to learn how to work. Then I could offer what some of these people really need. I have no idea what the business would do, but this is idea I've been kicking around.

Maybe you noticed throughout this post that I tried to look at a lot of the possible reasons someone might be poor. The point is there are lots of different reasons (I'm sure I'm missing some). Because the reasons are so varied, so are the solutions. I believe that there is a lot we can do for ourselves without help or intervention. For those that need help, I believe other helps should come first, before monetary help. Because individual problems require individual solutions and sometimes the best help isn't money, I think large government programs intended to help the poor are some of the worst help. If we insisted on giving money, I think local charities and churches would do a better job. Even local cities would do better than federal programs. No, I don't have any data on any of this, it's just my gut. And, absolutely, you can call my gut wrong, that's fine, but when I think about helping people the best help is personal and helping them change the things that have put them in the situation their in. In some cases, money is the worst thing you could do, because it enables the continuation of bad behavior. If you really cared about the person, you'd all you could to help them change.