Archives: 06/2009

Remember, Government Control Ensures Good Health Care

Well, sometimes maybe. 

Reports the National Post:

An investigation has been launched after a woman admitted to Montreal’s Royal Victoria Hospital for an induced birth was forced into a do-it-yourself delivery last month, with only her common-law partner to assist.

“We’re taking it very seriously,” Dr. Matt Kalina, assistant director for professional services at the McGill University Health Centre, said. “We’re reviewing the specific events thoroughly with the family…. We’re using the lessons to improve our systems.”

At about 5 a. m. on May 13, medical help failed to appear even after Karine Lachapelle’s water broke.

Despite attempts to summon help by partner Mark Schouls, who was pushing the nurse-alert button with increasing frequency as Ms. Lachapelle’s contractions became more intense and closer, the two delivered their new son, Kristophe, entirely on their own.

Ms. Lachapelle pushed the child out past his shoulders and face down– allowing Mr. Schouls to get a grip and pull the newborn the rest of the way out, he recounted.

Obviously, the U.S. system has its problems.  But it isn’t even really a private system, since the government pays for such a large share of medical costs and skews the entire insurance system through federal tax policy.  Nevertheless, there are far more private options and patients have far more control than in government-run systems.  It is imperative that any “reform” effort preserves both private alternatives and patient choice.  Indeed, the only real reform would be to make health care truly consumer-directed.

How Many Jobs Saved? We Do Not Know

In the past couple of days the administration has been discussing the employment impact of its stimulus package. Employment has declined steadily since adoption of the package, so it might seem odd to claim that it has already had beneficial impacts. The administration’s response is that employment would have declined even faster without the stimulus, so hundreds of thousands of jobs have been saved.

The administration might be right, but how can we know? The short answer is, we cannot know with any confidence because we cannot know what employment would have been in the absence of the stimulus. Thus, the concept of “jobs saved” is problematic; it allows the administration to conclude, no matter how bad things get, that the stimulus worked because the economy would have been even worse without the stimulus.

Ezra Klein: Socialized Medicine = Slavery

The Church of Universal Coverage really, really, really wants you to think that the Democratic health care reforms moving through Congress are not “socialized medicine.”  Last year, I wrote a paper about why they’re wrong. On June 25, I’ll be debating the issue at a Cato policy forum with the Urban Institute’s Stan Dorn.

Today, The Washington Post’s Ezra Klein lends his voice to the chorus of socialized-medicine deniers. Klein doesn’t add much to the discussion, except for this: Klein (correctly) observes, “Socialized medicine is a system in which the government owns the means of providing medicine” (emphasis his).  Single-payer systems, like the U.S. Medicare program or France’s health care system, are not socialized medicine because “the payer does not own the doctors.”

That’s right. Under socialized medicine, the government owns the doctors. When human beings can be owned, we call that slavery. Klein was probably just trying to do what other Church of Universal Coverage faithful have done over the past few years: narrow the definition of socialized medicine to the point where it has no meaning at all. (Duh, Canada doesn’t have socialized medicine – they don’t put Canadian doctors in chains, do they??)

Instead, Klein was inadvertently helpful because he clarified that the reforms he supports, and the reforms before Congress, would give the government ownership over the human capital of doctors and other clinicians. Whether we’re talking about wages, insurers’ assets, medical facilities, medical products, or even clinicians’ labor, ownership is a bundle of rights. If health care reform gives government the right to exclude people from using those resources in forbidden ways (e.g., retainer medicine, balance-billing, pure fee-for-service, whatever), then government gains control over a larger share of each bundle of ownership rights.  That equals more state ownership – of financial, physical, and even human capital – which is the very yardstick Klein uses to define socialized medicine.

If only all the socialists could be so helpful.

The Stimulating Story of Dr. Robert Felner

In 2003, after a stint heading up the school of education at the University of Rhode Island, Dr. Robert Felner took the same job at the University of Louisville. Two years later, he secured an earmarked  federal government grant for $694,000 from the Dept. of Education, ostensibly for a vast study of Kentucky public school performance. According to federal investigators, the money ended up in Dr. Felner’s pockets instead. In fact, investigators allege that Felner and a partner in crime managed to defraud taxpayers of $2.3 million by promising to deliver educational assessment services that never materialized.

The checks and balances you might expect to have stopped this from happening were seldom checked and never balanced. And that’s what’s so stimulating about this story: Felner allegedly duped everyone involved for nearly 3 years – at a time when the $100 billion federal education stimulus package wasn’t yet a twinkle in president Obama’s eye.

Given that officials couldn’t stay on top of millions of dollars in taxpayers’ money under normal circumstances, it’s unsettling to think what is going on right now as the system is suddenly flooded with billions of new dollars.

Europe Votes … For Something

The results are in after the Europeans voted in elections for the European Parliament.  But while they were voting for the European Parliament, they largely voted on national issues.  Ruling parties in Britain and Hungary were blasted.  The Spanish ruling party took a hit. Anti-immigration candidates in Britain, Denmark, the Netherlands, and Austria did well.  Ruling conservative governments in France, Italy, and Germany (in coalition) also prospered – after stealing the interventionist economic policies of their opponents.

Particularly noteworthy is the continuing fall in voter turnout.  Barely 43 percent showed up at the polls last week.  The Eurocratic elite is worried, as they should be.  As decision-making increasingly flows to Brussels, and to unelected institutions in Brussels, people perceive government to be less accountable.

Czech President Vaclav Klaus observed earlier this year:  “There is no European demos – and no European nation.” Alas, the divide between governed and governors is only going to increase if the Irish people ultimately approve the Lisbon Treaty, which further consolidates power in Brussels.  It is a worrisome trend for anyone concerned about liberty, as I discuss in a new article on American Spectator online.

Cyber Security “Facts”

National Journal’s “Expert Blog” on National Security asked me late last week to comment on the question, “How Can Cyberspace Be Defended?” My comment and others went up yesterday.

My response was a fun jaunt through issues on which there are no experts. But the highlight is the response I drew out of Michael Jackson, the former #2 man at the Department of Homeland Security.

It does little to promote serious discourse about the truly grave topic of cyber security threats to begin by ridiculing DHS and DOD as “grasping for power” or to suggest that President Obama has somehow been duped into basing his sensible cyber strategy on “a lame and corny threat model called ‘weapons of mass disruption.’” It shows ignorance of the facts to deny that cyber vulnerabilities do indeed present the possibility of “paralyzing results.”

Jackson neglects to link to a source proving the factual existence of “paralyzing” threats to the Internet – he’d have to defeat the Internet’s basic resilient design to do it. (Or he has collapsed the Internet, the specific way of networking I was talking about, with “cyber” – a meaningless referent to everything.) But the need for tight argument or proof is almost always forgiven in homeland security and cyber security, where the Washington, D.C. echo-chamber relentlessly conjures problems that only an elite bureaucracy can solve.

In another comment – not taking umbrage at mine, but culturally similar to Jackson’s – Ron Marks, Senior Vice President for Government Relations at Oxford-Analytica, says, “Cyberterrorism is here to stay and will grow bigger.” The same can be said of the bogeyman, but the bogeyman isn’t real either.

(To all interlocutors: Claiming secrecy will be taken as confessing you have no evidence.)

Jackson’s close is the tour de force though: “Good people are working hard on these matters, and they deserve our unwavering financial and personal support. For now and for the long-term.”

A permanent tap on America’s wallets, and respect on command? Sounds like “grasping for power” to me.

Cooper vs. the Services

Congressman Jim Cooper (D-Tenn.) has a fairly radical proposal for reforming defense acquisition in Politico.

Cooper wants to put the military services’ acquisition staffs under the direct control of the Secretary of Defense. The idea is to liberate the staffs from the parochial perspectives that cause various pathologies in acquisition programs.

The oped implicitly blames large and consistent cost overruns in weapons programs on the services’ interests, which manifest in excessive requirements for platforms. For example, the Air Force’s religious attachment to the over-designed and thus wildly expensive F-22 has its origin in a peculiar self-image, one that sees the establishment of air superiority for strategic bombing as the Air Force’s main mission. You can tell a similar story about another contender in the Pentagon’s biggest white elephant sweepstakes: the Marine’s amphibious Expeditionary Fighting Vehicle.

Cooper is rejecting the more popular view that the trouble in acquisition is the lack of independent cost estimates and other failures in the contracting process. That technocratic view underlies the acquisition bill that just became law. Cooper is saying that the trouble is more what we want than how we buy it, and what we want is a consequence of the services’ power. To deal with that, you must either change the services’ conception of their interests (and note that such efforts are arguably underway, especially in the Air Force) or take power from them. He’s pushing for the latter.

The weakness in the oped is a failure to explain how moving the military’s acquisition personnel to OSD would change the incentives that cause officers to do their service’s bidding. They would still work for a service, after all, and face its promotion board. A more radical proposal would be to hand more power over acquisition to the civilians in OSD and remove redundant positions from the services.

Cooper also takes (another) shot at constant service shares – the tradition, dating to the Kennedy Administration, where the Army, Navy and Air Force all get consistent shares of the budget each year. That tradition stifles interservice competition and therefore innovation. Giving the lion’s share of defense spending to the ground forces would be a sensible outgrowth of our current defense strategy, which is manpower-intensive. The Navy and Air Force might then be forced to scramble for relevance, causing them to initiate many of the reforms to their procurement programs that Secretary Gates has proposed. (An even better tact would be to cut the defense budget massively but give more of it to the Navy, given that our current strategy encourages dumb wars).

Note that the suggestion to enhance service competition relies on decentralized institutions competing, whereas the main suggestion of the oped is to heighten the centralized authority of the Secretary. Whether these are contradictory ideas is academic, for now, because at least one is not going to happen soon. The service’s would go the mattresses to protect their control of their acquisition programs, and there is a no sign of a political constituency willing to pick that fight.