Would Daschle’s Federal Health Board Ration Medical Care?

Matthew Holt implausibly says no.

Tom Daschle is a former majority leader of the U.S. Senate, and president-elect Barack Obama’s pick to head the Department of Health and Human Services.  Daschle will also head up the Obama administration’s health care reform efforts.

Which is why Daschle’s proposal for a Federal Health Board has received so much attention. Holt reports:

the main role of the Federal Health Board would be as a cost-effectiveness review organization with teeth—in that Medicare, Medicaid & FEHBP would all be bound to follow its guidelines.

Holt continues:

Critics on the loony right … will call this rationing.

What’s interesting about that comment is that Holt merely associates the “rationing” claim with people who are loony.  He doesn’t actually say they’re wrong.  In fact, Holt himself writes:

we need to make cardiologists in Miami behave like cardiologists in Minnesota with a consequent impact on the incomes of doctors, hospitals and stent & speedboat salesman in high cost areas … If the Federal Health Board has teeth, that’s what it’ll do, and the AMA, AHA, AdvaMed, PhRMA et al know it. Which is why the PhRMA front organizations have been railing against cost-effectiveness for so long.

So Holt acknowledges that the point of comparative- and cost-effectiveness research – and Daschle’s Federal Health Board – is to do something that would reduce the incomes of doctors, hospitals, and drug/device manufacturers.  That something would be so dramatic that it has the providers and manufacturers up in arms and funding front organizations.  If that something is not refusing to pay for some medical services – i.e., rationing – then what is it?

Rationing medical care is not just essential, it’s unavoidable.  And the way we ration medical care today is unconscionable.  But so too would be having the government ration medical care.  Which is probably why proponents of government rationing don’t want to call it that.

Too Close for Comfort

NPR reports on the Illinois legislative debate about impeaching Gov. Rod Blagojevich:

Their case for impeachment goes beyond criminal allegations. They say he abused the power of his office: bypassing the Legislature to create new programs he couldn’t pay for; circumventing hiring laws to give jobs to political allies; and misappropriating taxpayer funds.

“He has snubbed his nose at that oath of office and, therefore, snubbed his nose at the people and the constitution,” said Republican Rep. Mike Bost.

It’s a good thing for presidents that members of Congress don’t apply such standards in Washington.

Who’s Blogging about Cato

  • While running an online poll on Sanjay Gupta’s appointment, Ann Althouse quotes Michael D. Tanner on his views about the office of surgeon general.
  • Jason Shafrin cites a December Cato forum in which panelists Glen Whitman and Ezra Klein debated the state of the nation’s health care. A podcast from the forum, “Does America’s Health Care Sector Produce More Health?” is available here.

  • Insider Online contributor Alex Adrianson blogs about the most recent edition of Cato Journal, with an article by J.R. Clark and Dwight R. Lee that examines the relationship between government interference in the market and censorship.

The Measure of Our Own Liberties

As you may have heard, the Supreme Court recently granted certiorari to Ali Saleh Mohamed Kahlah al-Marri. The unclassified version of the evidence against him is available in the Rapp Declaration. It reads like a movie plot; I recommend it to you.  


After the 9/11 attacks, the FBI arrested al-Marri, an exchange student at Bradley University in Peoria, Illinois. The government indicted him for using false identification, bank fraud, giving false statements to the FBI, and possession of counterfeit credit card numbers. The government alleges that al-Marri met with Osama Bin Laden, was working with senior Al Qaeda organizers, has a more-than-casual interest in poisons, and was told by his handlers to be in America before September 11th or to forget about executing his mission here. 

Before al-Marri began trial, the government removed him to military custody and asked that the charges against him be dismissed with prejudice (meaning that they cannot be re-filed upon his release). He has since remained in a naval brig in South Carolina. He holds the distinction of being the only domestically detained enemy combatant in U.S. custody.  

The Fourth Circuit heard his habeas claim, releasing a fractured opinion. The panel found, 5-4 on each issue, that (1) the government can detain al-Marri as an enemy combatant; and that (2) al-Marri is owed more process to contest his status as an enemy combatant. 

Wrong on the Law

What happens to al-Marri is important because, according to Bush administration attorneys, the treatment he gets is what any American citizen would get if detained by the government as an enemy combatant. Congress did not give the president domestic carte blanche in the Authorization for Use of Military Force (AUMF) passed after 9/11. Detention of al-Marri as an enemy combatant is directly contrary to Senate rejection of proposed domestic military powers and Patriot Act provisions providing for temporary detention of “terrorist aliens.” 

The Supreme Court should reject this watering down of our essential civil liberties. Judge Motz of the Fourth Circuit does the math for us at page 45 of the Fourth Circuit’s opinion. Four justices (Stevens, Souter, Breyer, and Ginsburg) found in Rumsfeld v. Padilla that the AUMF “does not authorize … the protracted, incommunicado detention of American citizens arrested in the United States.” Justice Scalia filed a dissenting opinion in Hamdi v. Rumsfeld, holding that absent a suspension of the writ of habeas corpus, citizens cannot be held domestically as enemy combatants and must be tried in civilian courts. 

Wrong on Policy

The course we have taken with al-Marri is as wrong on policy as it is on the law. Rather than give suspected Al Qaeda operatives the opportunity to play the martyr and wage propaganda warfare against us, we should be putting them in their proper place. Nobody’s heard from or cared about would-be shoe bomber Richard Reid since his conviction. He received the life sentence he deserved and we all went on with our lives. As Judge William Young said at Reid’s sentencing, “we all know that the way we treat you, Mr. Reid, is the measure of our own liberties.”

The future of counterterrorism policy will be discussed at Cato’s upcoming conference, Shaping the Obama Administration’s Counterterrorism Strategy. Click here for more information.

Meet the New Boss…

Speaking at George Mason University (oh, the irony) today, President-elect Barack Obama urged “Congress to act without delay” to pass his still-undisclosed economic stimulus package, with a pricetag that’s drifting toward $800 billion.

“We should have an open and honest discussion about this recovery plan,” Obama allowed, but America faces a grim future “if we don’t take dramatic action as soon as possible. … It is time to set a new course for this economy, and that change must begin now.”

Where have I heard this “We must act now!” refrain before? Perhaps when the USA Patriot Act was on the floor? Or legislation authorizing the president to invade Iraq? Or congressional deliberation of the FISA amendments and their wiretaps? Or last year’s economic stimulus bill? Or the $700 billion TARP legislation?

The president-elect is about to submit legislation to pile nearly $1 trillion (if we’re lucky — who thinks the final cost will be that low?) in new liabilities on future generations in order to fund an economic strategy that has a poor track record. This is exactly the time for a careful, clear public discussion of the Obama proposal, so Americans will understand what we’re signing on to, its cost, and its uncertain prospects. The last thing we need is to continue the “Don’t just stand there — spend something” philosophy of the last eight years.

I Hope for Change.

You Say McCaskill, I Say McCaskill

A headline from yesterday’s online version of the St. Louis Post-Dispatch:

McCaskill joins McCain in anti-earmark effort, announces local grants

Ugh.  One of my chief policy pet peeves is the idea that congressfolk earmarking money to special interests is bad, but having bureaucrats dole out the same sort of cheese through grants and loans is A-OK.

Says Sen. McCaskill (D-MO):

We are looking at deficits in the trillions, and I think Americans are fed up with the way Washington has been spending their money…. Changing the earmark culture is not the whole solution to bringing fiscal responsibility back, but it’s a start.

So far so good, but then:

Also Wednesday, McCaskill announced two grants from the U.S. Department of Agriculture (USDA):

  • A total of $752,560 to the city of Silex in Lincoln County. “The money is being provided through the United State’s Department of Agriculture’s Rural Development funding initiative, which works to improve the economy and quality of life in rural communities by supporting and providing government loans and grants…. According to the USDA, the city will receive a grant of $387,560 and a low-interest government loan of $365,000. The funds will be used to upgrade the centralized sewer system, providing improved water treatment facilities and adding thousands of feet in main line.”
  • $50,000 to the city of Berger in Franklin County. The money comes from the same USDA program targeting rural communities. “According to the USDA, the funding will be used to provide a centralized sewer system that will improve the health and sanitary conditions of the area by providing water to residents who currently rely on failing septic tanks,” the senator’s office said.”

So, if another member of the Missouri congressional delegation had instead instructed the USDA to redistribute taxpayer money to these two Missouri communities via language in a piece of legislation it would have been bad?  According to Sen. McCaskill, the answer is apparently “yes.”

Look, I’m happy Sen. McCaskill is on board the anti-earmark train.  Kudos to her.  But whichever means Congress chooses, the end is the same: taxpayers on the hook for special interest spending.