Topic: Political Philosophy

Update on the Anti-Universal Coverage Club

Joining the Anti-Universal Coverage Club this week is a list of organizations that have formed a new group called The Health Care Freedom Coalition.  Here are a few lines from their agenda:

Most Democratic presidential candidates, one Republican presidential candidate, many business trade associations, and unions have endorsed “universal health insurance” as the solution to our nation’s health care problems.

With 46 million Americans who don’t have health insurance, these politicians and special interest groups have concluded that covering everyone will magically make health care affordable.

“Universal health insurance” is a myth. The only way to make health care “affordable” under a “universal health insurance” scheme is through price controls and limiting access. Any proposal claiming to provide “universal coverage” is nothing more than a system that must rely on private and/or public entities to administer government-run health care. 

Emphasis added.  The Health Care Freedom Coalition includes:

  • 60 Plus
  • Alabama Policy Institute
  • American Conservative Union
  • American Shareholders Association
  • Americans for Prosperity and AFP Foundation
  • Americans for Tax Reform
  • Center for Freedom and Prosperity
  • Christus Medicus Foundation
  • Commonwealth Foundation for Public Policy Alternatives
  • Consumers for Health Care Choices
  • Council for Affordable Health Insurance
  • Fairness Foundation
  • FreedomWorks
  • Grassroot Institute of Hawaii
  • Illinois Policy Institute
  • Indiana Family Institute
  • Medical Savings Insurance Company
  • Mississippi Center for Public Policy
  • National Center for Policy Analysis
  • National Taxpayers Union
  • Pacific Research Institute
  • Public Interest Institute
  • Rio Grande Foundation
  • Small Business Entrepreneurship Council
  • The James Madison Institute
  • Washington Policy Institute

Not joining the Anti-Universal Coverage Club this week are the U.S. Senate and House of Representatives, which approved legislation to expand government health insurance to people who don’t need government assistance, and the Galen Institute’s Grace-Marie Turner, who reiterated in her weekly newsletter:

The question isn’t whether children should or should not have health insurance. The question is how do we achieve that goal.

Illegal Manicure in the ‘Live Free or Die’ State

In response to to my post about a (possibly) illegal hairdresser in Massachusetts, Michael Hampton of Homeland Stupidity forwards a link to a priceless local New Hampshire news report. (It’s two years old, but it’s new to me and to this blog.)

Free State Project member Mike Fisher performed an illegal manicure right in front of the “Live Free or Die” state’s Board of Barbering, Cosmetology and Esthetics. (Motto: Yew Best Drop That Thar Em’ry Board, Son.)

When the police asked Fisher if he had a license to perform that thar manicure, Fisher said no. When the police issued him a summons and asked that he stop performing that thar manicure, Fisher refused. So the cops slapped handcuffs on this dangerous outlaw and put him in a squad car. Fisher reportedly received a 30-day suspended sentence, with a vow from the judge that if Fisher receives so much as a traffic ticket, it’s off to the pokey he goes.

I wonder what the Granite State wasn’t doing with the time and resources used to arrest and prosecute Fisher.

Still No Consensus

A headline in the Washington Post (the actual newspaper, not the online version) reads:

Montgomery Still Lacking Consensus on Growth Policy

The article explains that officials in Montgomery County, Maryland, are having trouble agreeing on rules for limiting economic growth while leaving room for development. “I don’t think there is consensus on much of anything at this point,” said County Council member Nancy Floreen.

One reason that there’s no consensus, of course, is that there’s no consensus. The county’s 900,000 residents don’t all agree on who should be allowed to build new homes and businesses, who should have their property rights limited, who should pay the bills, and so on. This is why Hayek said that planning was not compatible with liberal values. The only values we can agree on in a big diverse society, he wrote, are “common abstract rules of conduct that secured the constant maintenance of an equally abstract order which merely assured to the individual better prospects of achieving his individual ends but gave him no claims to particular things.” That is, you set up property rights and the rule of law, and you let people run their own lives without being allowed to run other people’s lives. Try to go beyond that, and you’re going to infringe on freedom.

As I wrote a few months ago, another newspaper story reported

“As a consensus builds that the Washington region needs to concentrate job growth, there are signs that the exact opposite is happening.

Over the past five years, the number of new jobs in the region’s outer suburbs exceeded those created in the District and inner suburbs such as Fairfax and Montgomery counties … contradicting planners’ ‘smart growth’ visions of communities where people live, work and play without having to drive long distances.”

Maybe if tens - hundreds - of thousands of people aren’t abiding by the “consensus,” there is no consensus: there is just a bunch of government-funded planners attending conferences and deciding where people ought to live. It’s like, “Our community doesn’t want Wal-Mart.” Hey, if the community really doesn’t Wal-Mart, then a Wal-Mart store will fail. What that sentence means is: “Some organised interests in our community don’t want Wal-Mart here because we know our neighbours will shop there (and so will we).”

In her book It Takes a Village, Hillary Clinton calls for “a consensus of values and a common vision of what we can do today, individually and collectively, to build strong families and communities.” But there can be no such collective consensus. In any free society, millions of people will have different ideas about how to form families, how to rear children, and how to associate voluntarily with others. Those differences are not just a result of a lack of understanding each other; no matter how many Harvard seminars and National Conversations funded by the National Endowment for the Humanities we have, we will never come to a national consensus on such intimate moral matters. Clinton implicitly recognizes that when she insists that there will be times when “the village itself [read: the federal government] must act in place of parents” and accept “those responsibilities in all our names through the authority we vest in government.”

Governments would do better to set a few rules of the game and let market enterprises respond to what people really rather than try to push people into conforming to planners’ visions and phony consensuses.

Science, Values and Politics

Today’s NYT features a front page, above-the-fold story about former surgeon general Richard Carmona’s charge that the Bush administration interfered with his office by (in the words of the NYT) ”repeatedly [trying] to weaken or suppress important public health reports because of political considerations.” He made the charge yesterday in testimony before the House Committee on Oversight and Government Reform.

Carmona described Bush administration behavior that ranged from petty (urging him not to attend Special Olympics events because of the Kennedy family’s connection to the program) to outright worrisome (directing him, again in the words of the NYT, “to put political considerations over scientific ones”). His claims add to the image of a Bush White House in which political considerations and ideology trump all others.

However, Carmona’s prepared statement suggests that the Bushies aren’t the only folks caught up in ideology.

Carmona considers himself a person of science, and scientists have an important role in policymaking. They try to determine the existence of various empirical relationships (e.g., certain emissions trap heat in the atmosphere; exposure to tobacco smoke increases the risk of cancer) and use those determinations to make predictions about the future (e.g., ongoing emission of greenhouse gases at certain levels will affect the climate; reduced tobacco use will decrease the incidence of cancer). In this way, science informs policymaking by predicting the outcomes of various policy choices.

But though science informs policy choices, it cannot make those choices. Science is a non-normative endeavor, and cannot answer such questions as whether climate change should be avoided, and whether reducing tobacco use should be used as a means to reduce the incidence of cancer. Those are the subject of value judgments — and, for public decisions, of politics.

Many “people of science” do not appreciate this limit on science’s role in policymaking. They assume that once a relationship is established scientifically, policy choices cogently follow. In making this assumption, they enter their own value judgments as suppressed premises in their analyses. Many doctors see bad health outcomes as not just undesirable, but so undesirable that they should be avoided even at high costs; many environmental scientists have the same opinion about environmental damage. Hence, they would argue that “objective, nonpartisan science” calls for policies to limit greenhouse emissions and reduce smoking. In fact, science can do no such thing; value judgments call for (or against) various choices.

To better understand this, consider the role of a doctor. Five separate times in his testimony, Carmona refered to the surgeon general as “the nation’s doctor” (conjuring the image of 300 million Americans sticking out their collective tongues and saying “ahh”). I trust my doctor to make a scientific determination of the state of my health and to lay out various courses of action concerning my health (e.g., lose weight, take medication, exercise more, quit smoking). But I am the one who sets policies concerning my health — I decide whether the costs of some course of action (e.g., the side effects of some drug, or the pleasure forgone by dieting) is worth the health benefits. Likewise, public health policy should be set by elected representatives who are directly accountable to the citizenry, not by “the nation’s doctor.”

But Carmona apparently wants the surgeon general to become a policymaker. He told the House committee:

[T]he Surgeon General [should] speak and act openly and as often as necessary on contemporary health and scientific issues so as to improve the health, safety, and security of the nation.

Indeed, that role may be too modest for Carmona’s surgeon general; he repeatedly argued that the surgeon general should “serve the people and the world.” He offered lawmakers a five-point plan for the U.S. Public Health Service that included the following:

  • Recognize and plan for the fact that tomorrow’s best hope to achieve millennium goals, extinguish asymmetries, eradicate social injustices, and make the world [a] healthier, safer and more secure place may be the newer, softer force projection of health diplomacy via prospective ongoing sustainable missions globally.

So, instead of just being the nation’s doctor (with policymaking power), Carmona’s surgeon general would be a force projector for the world.

Carmona is correct that politicians should not interfere with the scientific analysis of the surgeon general — the surgeon general should follow an empirical question wherever the science leads. And he may even state his personal opinion — couched as such — on the value judgments that ensue from the science. But the surgeon general should not supplant the politicians in making public policy decisions, nor supplant private individuals in making personal health decisions. And, of course, the surgeon general should not doctor scientific findings to conform them to his own value judgments.

Hillary the Neocon

Don’t miss Ed Crane in today’s Financial Times: “Is Hillary Clinton a neocon?” (Subscribers only, alas; you may have to run out and buy a copy.) Here’s a taste:

“You know, when I ask people, ‘What do you think the goals of America are today?’ people don’t have any idea. We don’t know what we’re trying to achieve. And I think that in a life or in a country you’ve got to have some goals.” Senator Hillary Clinton, MSNBC, May 11 2007

Senator Hillary Clinton’s worldview, as formulated above, is starkly at odds with that of America’s founders. The idea that the American nation had “goals”, just as individuals do, would have been wholly alien to them. For them the whole undertaking of government was to protect our “self-evident” rights to life, liberty and the pursuit of happiness. This emphasis on the primacy of the individual is the essence of true American exceptionalism.

National goals are a euphemism for concentrated national political power. The “Old World” was full of nations with goals, almost all pernicious. The concept of national goals is not so much un-American as it is non-American. But Mrs Clinton persists in promoting the concept, saying at a recent campaign speech in New Hampshire that rather than an “ownership society” she would “prefer a ‘we’re all in it together’ society”. She frequently invokes the notion that Americans want “to be part of something bigger than themselves”.

She has an unusual ally in this. The one other powerful political force in the US today that shares her frustration over the lack of national goals is neoconservatism.  …

UPDATE: Read the whole piece here.

The Anti–Universal Coverage Club Is Rolling Along

I started the Anti–Universal Coverage Club in part to make a point, but also because I was curious to see how many people agreed with its basic premises

I’m pleased to report that such people do exist. As of today, I count 86 club members.  Rather than list them all, I’ll run through just those who might be recognizable to the policy community. Affiliations are provided for identification purposes only and do not imply that any of those organizations agree with us. At all. Unless I list an organization by itself.

Nathan Benefield
Director of Policy Research
Commonwealth Foundation

Greg Blankenship
President
Illinois Policy Institute

David Brown
Editor
Laissez Faire Books Blog

Joseph Coletti
Health Care Policy Analyst
John Locke Foundation

Karla Dial
Managing Editor
Health Care News

Paul Gessing
President
Rio Grande Foundation

John Graham
Director, Health Care Studies
Pacific Research Institute

Curly Haugland
Republican National Committeeman
North Dakota

Carla Howell
President
Center For Small Government

Arnold Kling
Economist/Blogger
Cato Institute/Library of Economics & Liberty

Frayda Levy
President
Moving Picture Institute

Mark Litow
Consulting Actuary
Milliman, Inc.

Montana Liberty Project

National Review

Michael Ostrolenk
Director of Government Affairs
Association of American Physicians and Surgeons

Tom Patterson
Chairman
Goldwater Institute

Jared Rhoads
Director
Lucidicus Project

James Rottet
Legislative Specialist
The Heartland Institute

Herbert Rubin
Professor
UCLA School of Medicine

Thomas Saving
Professor of Economics
Texas A&M University

Greg Scandlen
Founder
Consumers for Health Care Choices

Greg Schneider
Health Care Fellow
Flint Hills Center for Public Policy

Jeffrey Singer
Contributing Editor
Arizona Medicine

Henry Stern
Blogger
Insure Blog

Mary Katherine Stout
Vice President
Texas Public Policy Foundation

Andrew Sullivan
Journalist
The Atlantic Online

The club has received a fair number of favorable mentions from blogs I had heard of (Coyote Blog, MooreWatch.com, SPN Blog, and Wisdom From Wenchypoo’s Mental Wastebasket) and some I had not (Blog of Bile, Chaos From Order, A Chequer-Board Of Nights & Days, Con Law Geek, DeadBeef.com, Health Care BS, I Was The State, and JasonPye.com).

Not everyone had a favorable reaction. Neil Versel’s Healthcare IT Blog described our one recruitment email as “unbelievably shocking.”  Ezra Klein of The American Prospect wished us well in recruiting members, I think because he’s happy to have someone else compile his enemies list for him. Matthew Yglesias of The Atlantic Online congratulated me for starting the club but then deftly missed the point when he wrote, “I’m fairly certain that, politically, ‘we don’t care if you can’t afford health insurance’ is a losing slogan.”

Some members (not listed above) asked that I not use their real names because they feared giving offense — or even receiving offense, in the form of professional reprisals.  Some think my name is spelled “Canon.” Others think my name is spelled “Tanner.”  That’s fine. I’m just happy to have them aboard.  I especially love that we have a Curly.

Not bad considering how little effort I’ve put into this.