Tag: proposal

Give Me Liberty or Give Me Death Panels

“Death panels” are a dominant motif in the debate over health care regulation, a fact that spins off political flares like a roman candle.

Extremists on both sides have taken their extreme positions: Some literally fear President Obama and his health regulation plans; others are outraged that anyone could possibly feel that way.

Charges of special-interest organizing meet counter-charges of unfairness and false accusation. Good video from town hall meetings and volleys of “Nazi” and “socialist” give cable news networks another short reprieve from their long slow decline. It’s all manna for the writers at Comedy Central.

But let’s talk substance: Health care is a scarce good, so it will always be rationed. The core question is whether government should take the dominant role in health care rationing over from insurance companies, or whether reform should restore rationing decisions to patients advised by doctors. 

Though they would never have the name or the form, the “death panel” label roughly (and unfairly) describes what would happen if health decisions were turned over to government bureaucrats under the leading proposals today. The bureaucracy would do exactly what “reform” asks it to do(!): prioritize cost savings and efficiency over the unique, individual interests of patients and their families.

The bureaucracy would serve its own interests too. Bureaucracies are subject to capture by special interests, of course, and they can be corrupted. These things are easier when the people who might die look like statistics.

Many people feel very strongly that problems with health care today indicate the need for President Obama’s and Congress’ health care plans. But what’s wrong with health care doesn’t mean that these proposals would make things better. Because they would move control of health care in the wrong direction, they would make things worse.

Everyone has a personal story about health care, and I have one too. On the day my mother passed away, my family and I were called to the hospital and met by a social worker. He showed us to a small anteroom at the entrance to the intensive care unit, where he guided us through a lengthy conversation about my mother’s wishes and the family’s circumstances. He then called in the doctors to offer their prognosis and advice, which we took.

It was a death panel. It was our death panel – because my parents had fully prepared for this eventuality by buying insurance.

Just like health care will always be rationed, there will always be death panels. The question is who runs them. To the extent our public policy drives people away from financial responsibility for their own health care, it sets them up for death panels that are administered by government bureaucrats, not by loved ones and doctors.

Political debate is rollicking and unfair and full of inaccuracy. And in the terms of today’s health care debate, we don’t want “rationing” – meaning we don’t want government rationing. And we don’t want death panels – meaning we don’t want government death panels, because government death panels will deny people and their families an essential dignity of life: choosing how it ends.

In that sense I say with apologies to Patrick Henry: Give me liberty or give me death panels.

Then Let’s Call the Whole Thing Off

According to CNS News:

In a sign that intra-party negotiations continue to drag on, [House Democratic Majority Leader Steny] Hoyer [MD] declared that no single provision was sacred, not even President Obama’s coveted government-run “public option” plan.

“I want to see the Senate give its proposal so that in September we can contribute to having a conference that’s productive and results in health care reform,” said Hoyer. “I don’t think there’s any specific item that is absolutely essential to reform.”

You can say that again.

Assessing the Claim that CDT Opposes a National ID

It was good of Ari Schwartz to respond last week to my recent post querying whether the Center for Democracy and Technology outright opposes a national ID or simply “does not support” one.

Ari says CDT does oppose a national ID, and I believe that he honestly believes that. But it’s worth taking a look at whether the group’s actions are consistent with opposition to a national ID. I believe CDT’s actions – most recently its support of the PASS ID Act – support the creation of a national ID.

(The title of his post and some of his commentary suggest I have engaged in rhetorical excess and mischaracterized his views. Please do judge for yourself whether I’m being shrill or unfair, which is not my intention.)

First I want to address an unusual claim of Ari’s – that we already have a national ID system. If that is true, his support for PASS ID is more sensible because it is an opportunity to inject federal privacy protections into the existing system (putting aside whether it is a federal responsibility to manage a state system or systems).

Do We Already Have a National ID?

I have heard a few people suggest that we have a national ID in the form of the Social Security Number. I believe the SSN is a national identifier, but it fails the test of a national identification card or system because it is not used for identification. As we know well from the scourge of identity fraud, there is no definitive way to tie an SSN to a person. The SSN is not used for identification (at least not reliably and not alone), which is the third part of my national ID definition. (Senator Schumer might like the SSN to form the basis of a national ID system, of course.)

But Ari says something different. He does not claim any definition of “national ID” or “national ID system.” Instead, he appeals to the authority of a 2003 report from a National Academy of Sciences group entitled “Who Goes There?: Authentication Through the Lens of Privacy.” That report indeed says, “State-issued driver’s licenses are a de facto nationwide identity system” – on the second-to-last substantive page of its second-to-last substantive chapter

But this is a highly selective use of quotation. The year before, that same group issued a report called “IDs – Not That Easy: Questions About Nationwide Identity Systems.” From the beginning and throughout, that report discussed the many issues around proposals to create a “nationwide” identity system. If the NAS panel had already concluded that we have a national ID system, it would not have issued an entire report critiquing that prospect. It would have discussed the existing one as such. Ari’s one quote doesn’t do much to support the notion that we already have a national ID.

What’s more, CDT’s own public comments on the proposed REAL ID Act regulations in May 2007 said that its data-intensive “one person – one license/ID card – one record” policy would ”create a national identification system.”

If a national ID system already existed, the new policy wouldn’t create one. This is another authority at odds with the idea that we have a national ID system already.

Support of PASS ID might be forgiven if we had a national ID system and if PASS ID would improve it. But the claim we already have one is weak.

“Political Reality” and Its Manufacture

But the heart of Ari’s claim is that supporting PASS ID reflects good judgment in light of political reality.

Despite the fact that there are no federal politicians, no governors and no appointed officials from any party publicly supporting repeal of REAL ID today, CDT still says that repeal is an acceptable option. However, PASS ID would get to the same outcome, or better, in practice and has the added benefit of actually being a political possibility… . I realize that Harper has invested a lot of time fighting for the word “repeal,” but at some point we have to look at the political reality.

A “Dear Colleague” letter inviting support for a bill to repeal REAL ID circulated on the Hill last week. How many legislators will hesitate to sign on to the bill because they have heard that the PASS ID Act, and not repeal of REAL ID, is CDT’s preferred way forward?

The phrase “political reality” is more often used by advocates to craft the political reality they prefer than to describe anything truly real. Like the observer effect in experimental research, statements about “political reality” change political reality.  Convince enough people that a thing is “political reality” and the sought-after political reality becomes, simply, reality.

I wrote here before about how the National Governors Association, sensing profit, has worked diligently to make REAL ID a “political reality.” And it has certainly made some headway (though not enough). In the last Congress, the only legislation aimed at resolving the REAL ID impasse were bills to repeal REAL ID. Since then, the political reality is that Barack Obama was elected president and an administration far less friendly to a national ID took office. Democrats – who are on average less friendly to a national ID – made gains in both the House and Senate.

But how are political realities crafted? It has often been described as trying to get people on a bus. To pass a bill, you change it to get more people on the bus than get off.

The REAL ID bus was missing some important riders. It had security hawks, the Department of Homeland Security, anti-immigrant groups, DMV bureaucrats, public safety advocates, and the Bush Administration. But it didn’t have: state legislators and governors, privacy and civil liberties groups, and certain religious communities, among others.

PASS ID is for the most part an effort to bring on state legislators and governors. The NGA is hoping to broker the sale of state power to the federal government, locking in its own institutional role as a supplicant in Washington, D.C. for state political leaders.

But look who else was hanging around the bus station looking for rides! – CDT, the nominal civil liberties group. Alone it jumped on the bus, communicating to others less familiar with the issues that PASS ID represented a good way forward.

Happily, few have taken this signal. The authors of PASS ID were unable to escape the name “REAL ID,” which is a far more powerful beacon flashing national ID and all the ills that entails than CDT’s signal to the contrary.

This is not the first time that CDT’s penchant for compromise has assisted the national ID effort, though.

Compromising Toward National ID

The current push for a national ID has a short history that I summarized three years ago in a righteously titled post on the TechLiberationFront blog: “The Markle Foundation: Font of Evil II.”

Briefly, in December 2003, a group called the Markle Foundation Task Force on National Security in the Information Age recommended “both near-term measures and a longer-term research agenda to increase the reliability of identification while protecting privacy.” (Never mind that false identification was not a modus operandi of the 9/11 attacks.)

The 9/11 Commission, citing Markle, found that “[t]he federal government should set standards for the issuance of birth certificates and sources of identification, such as drivers licenses.” In December 2004, Congress passed the Intelligence Reform and Terrorism Prevention Act, implementing the recommendations of the 9/11 Commission, including national standards for drivers’ licenses and identification cards, the national ID system recommended by the Markle Task Force. And in May 2005, Congress passed a strengthened national ID system in the REAL ID Act.

An earlier post, “The Markle Foundation: Font of Evil,” has more – and the text of a PoliTech debate between myself and Stewart Baker. Security hawk Baker was a participant in the Markle Foundation group, as was national ID advocate Amitai Etzioni. So was the Center for Democracy and Technology’s Jim Dempsey.

I had many reservations about the Markle Foundation Task Force and its work product, and in an April 2005 meeting of the DHS Privacy Committee, I asked Dempsey about what qualified people to serve on that task force, whether people were invited, and what might exclude them. A month before REAL ID passed, he said:

I think the Markle Task Force at least sought balance. And people came to the table committed to dialogue. And those who came with a particular point of view, I think, were all committed to listening. And I think people’s minds were changed… . What we were committed to in the Markle Task Force was changing our minds and trying to find a common ground and to try to understand each other. And we spent the time at it. And that, I think, is reflected in the product of the task force.

There isn’t a nicer, more genuine person working in public policy than Jim Dempsey. He is the consummate honest broker, and this statement of his intentions for the Markle Foundation I believe to be characteristically truthful and earnest.

But consider the possibility that others participating on the Markle Foundation Task Force did not share Jim’s predilection for honest dialogue and compromise. It is even possible that they mouthed these ideals while working intently to advance their goals, including creation of a national ID.

Stewart Baker, who I personally like, is canny and wily, and he wants to win. I see no evidence that Amitai Etzioni changed his mind about having a national ID when he authored the recommendation in the Markle report that ultimately produced REAL ID.

Other Markle participants I have talked to were unaware of what the report said about identity-based security, national identity standards, or a national ID. They don’t even know (or didn’t at the time) that lending your name to a report also lends it your credibility. Whatever privacy or civil liberties advocates were involved with the Markle Task Force got rolled – big-time – by the pro-national-ID team.

CDT is a sophisticated Washington, D.C. operation. It is supposed to understand these dynamics. I can’t give it the pass that outsiders to Washington might get. By committing to compromise rather than any principle, and by lending its name to the Markle Foundation Task Force report, CDT gave credibility to a bad idea – the creation of a national ID.

CDT helped produce the REAL ID Act, which has taken years of struggle to beat back. And now they are at it again with “pragmatic” support for PASS ID.

CDT has been consistently compromising on national ID issues while proponents of a national ID have been doggedly and persistently pursuing their interests. This is not the behavior of a civil liberties organization. It’s why I asked in the post that precipitated this debate whether there is anything that would cause CDT to push back from the table and say No.

Despite words to the contrary, I don’t see evidence that CDT opposes having a national ID. It certainly works around the edges to improve privacy in the context of having a national ID – reducing the wetness of the water, as it were – but at key junctures, CDT’s actions have tended to support having a U.S. national ID. I remain open to seeing contrary evidence.

Market Bets that ObamaCare Won’t Cut Costs

According to Don Johnson of The Health Care Blog:

Speculators seem to be betting that a watered down health insurance reform bill won’t hurt health insurers, hospitals, drug makers or medical device and supply manufacturers.

Stocks for almost all of these health sectors and for exchange trade funds that track health stock indexes turned higher last week.

In other words, those with real money at stake don’t believe that health reform will hurt the firms that make a living off of America’s highly inefficient health sector – President Obama’s assurances notwithstanding.

Johnson provides seven possible explanations for this development, including:

3. If the very liberal Coastal Democrats who lead Congress and most of the five committees drafting health insurance legislation want to get the support of Democrats from Western, Midwestern and Southern states, they’ll have to up Medicare payments to providers in those states. This is bullish for hospital chains, which operate mostly in the fly-over states…

6. Proposals to tax millionaires to pay for covering the uninsured and increasing benefits for others are in trouble, if not dead on arrival.  The economy’s in no shape to be stalled by tax hikes, and there appear to be enough Democrats opposed to the tax to stop it.

7. While the so-called Blue Dog Democrats are stalling health insurance reform for economic and ideological reasons, the Congressional Black Caucus has made it clear that it won’t support a bill that the Blue Dogs will support. Throw in the opposition by anti-abortionists who don’t want the legislation to use taxpayers money to pay for abortions, and you have a pretty complex political problem for President Obama, Sen. Majority Leader Harry Reid (D-NV) and Speaker Nancy Pelosi (D-CA). While the Speaker claimed Sunday that she has the votes to pass health insurance reform, few believe her.

Cato Institute to Launch Ad Campaign Against Government-Run Health Care

The Cato Institute will launch an ad campaign Thursday highlighting under-reported poll data showing Americans’ concerns that current health care reform plans will raise costs, limit choice and reduce the quality of their health care.

The campaign will feature full-page ads in major national newspapers, in addition to radio spots focusing on why government-run health care cannot address the problems of growing costs and lack of coverage for many individuals and families. The campaign will expand in the weeks ahead.

“Our goal is to help the American public navigate terms like ‘a public plan’ and ‘individual or employer mandates’ to understand what is really happening here,” said Ed Crane, founder and president of the Cato Institute. “The bottom line is, most of the plans coming from the White House and congressional leadership will result in a government-run health care system that is really not the best option for most Americans.”

A poll by the Washington Post and ABC News conducted June 18-21 showed that 84 percent of respondents were “very” or “somewhat” concerned that “current efforts to reform the health care system” would increase their health care costs. The survey also showed that 79 percent of respondents were concerned that current efforts would limit their choices of doctors or medical treatments.

As part of the campaign, Cato is running radio ads in major cities across the country. You can listen to them below, and embed them on your own blog using the code on the official campaign site.

Who Pays?

Download the MP3

Who Decides?

Download the MP3

Cato has also created a new website, Healthcare.cato.org, to promote more free market-oriented health care reform proposals.

My Question for the President

President Obama will hold a press conference tonight to answer questions about his health care reform proposal. This is what I would ask him:

Mr. President, during your campaign, you said, “I can make a firm pledge…Under my plan, no family making less than $250,000 a year will see any form of tax increase.”  You also said that “no one will pay higher tax rates than they paid in the 1990s.”

Your National Economic Council chairman, Larry Summers, has written that employer mandates “are like public programs financed by benefit taxes.”  Under the House health reform bill, an uninsured worker earning $50,000 per year, with no offer of coverage from her employer, would face a 15.3-percent federal payroll tax, a 25-percent federal marginal income tax rate, an 8-percent reduction in her wages (to pay the employer penalty), plus a 2.5 percent uninsured tax.  In total, her effective marginal federal tax rate would reach 50.8 percent.

Do you stand by those pledges, and would you therefore veto any employer mandate or individual mandate as a tax on the middle class?

(Add it to the questions I posed here and here.)

End the Credit Rating Monopoly

Earlier this week, SEC Chair Mary Shapiro appeared before Congress to suggest ways to fix the failings in our credit rating agencies.   Sadly her proposals miss the market, although that shouldn’t be so surprising as her suggestions appear to rest upon a misunderstanding of the problem.

The thrust of the SEC’s current approach is more disclosure, such as releasing “pre-ratings” that debt issuers may get before final issuance.  Additional disclosure of ratings methodology and assumptions is likely to be useless.  Almost all that information was available during the building housing bubble.  The problem is that the rating agencies had little incentive to go beyond the consensus forecasts of increasing to at most modest declines in home prices.  These same assumptions were the foundation of almost all government economic forecasting as well, yet few believe that forcing CBO or OMB to disclosure more of their forecasts will cure our budget imbalances.  What is needed is a change in incentives.

Here again the SEC seems to misunderstand the incentives at work, but then recognizing such would force the SEC to admit its own role in creating those some perverse incentives.  The SEC’s notion that agencies issue favorable ratings in order to gain business misses the most basic fact of the ratings business - they don’t have to compete for business, any debt issuer wanting to place “investment grade” debt has to use the agencies, and often has to use more than one of them.  Due to a variety of SEC and bank regulations, there is almost no competition among the rating agencies.  They have been given a government created monopoly.  If the rating agencies were, as the SEC proposes, competing strongly for business, then they wouldn’t have been earning huge profits on that business.  Competition erodes a business’ profits.  During the housing boom, the rating agencies continued to make ever more profits - more the sign of a monopoly than one of competition.

The truth is not that the agencies were captive to the debt issuers, but the other way around.  And like any monopolist, the agencies became lazy, slow and fat.  The real fix for the failure of the credit raters is to reduce the excessive reliance on their judgements inherent in most securities, banking and insurance regulations.  An investment grade rating should never serve as a substitute for appropriate due diligence on the part of investors (especially pension fund managers) or regulators.