The Republicans’ Magic Budget Machine

In an article on the 2007 Virginia legislative elections, the Washington Post reports:

GOP candidates will also make the argument that if the party retains control, it would mean lower taxes, controls on development and more education spending.

Lower taxes AND more spending on good stuff – it’s hard to beat that combination. And it’s worked so well at the federal level. But it may be harder to deliver in a state that’s required to balance its budget.

Romney’s New Rx

I’ve got an op-ed out about Mitt Romney’s new health care plan.  Short version (192 words) here.  Long version (745 words) here.

One amusing aspect that I don’t mention in the op-ed: after criticizing Rudy Giuliani for relying on tax breaks to make health insurance affordable to more Americans, Romney proposes doing just that.

It’s going to be a fun campaign.

America’s Longest War

In the current issue of Foreign Policy magazine, Ethan Nadelmann, head of the Drug Policy Alliance, has a brisk, powerfully written piece calling for the legalization of drugs. Unfortunately, it’s subscriber-only, but here’s one of the more provocative passages:

Looking to the United States as a role model for drug control is like looking to apartheid-era South Africa for how to deal with race. The United States ranks first in the world in per-capita incarceration–with less than 5 percent of the world’s population, but almost 25 percent of the world’s prisoners. The number of people locked up for U.S. drug-law violations has increased from roughly 50,000 in 1980 to almost 500,000 today…. In 2005, the ayatollah in charge of Iran’s Ministry of Justice issued a fatwa declaring methadone maintainance and syringe-exchange programs compatible with sharia law. One only wishes his American counterpart were comparably enlightened.

A few weeks ago, the Washington Post’s Outlook section featured an indictment of drug prohibition written by Misha Glenny: “The Lost War.” Glenny concludes with the following:

In Washington, the war on drugs has been a third-rail issue since its inauguration. It’s obvious why – telling people that their kids can do drugs is the kiss of death at the ballot box. But that was before 9/11. Now the drug war is undermining Western security throughout the world. In one particularly revealing conversation, a senior official at the British Foreign Office told me, “I often think we will look back at the War on Drugs in a hundred years’ time and tell the tale of ‘The Emperor’s New Clothes.’ This is so stupid.”

How right he is.

For some of Cato’s 30 years of work on this issue, start here.

Bonus Friday Fun Link: go to page 4 of this document [.pdf] to read about how Richard Nixon’s Archie-Bunker-style social theories led him to ramp up the war on marijuana.

Some Bad Ideas That Won’t Help Solve the Organ Shortage

In “The Solvable Problem of Organ Shortages” [New York Times, 8/28/07], Jane Brody makes suggestions which, if implemented, will rob Americans of fundamental rights and do nothing to solve the organ shortage. Her suggestions may even make the problem worse.

The organ shortage can only be solved by increasing, not decreasing, the control people have over the disposition of their organs. Only an increase in liberty, not a restriction of liberty, has any chance of solving the organ shortage. New and innovative ways to motivate individuals to donate, including the option of compensation for donation both in the case of deceased and live organ donation, are what we need, not new ways to take organs without people’s consent.

One option Brody discusses is donation after cardiac arrest. There is nothing wrong, in principle, with retrieving organs after cardiac arrest, but what defines death and when to give up on a patient are not decisions that should be motivated by a need for organs. It is never appropriate for a doctor to alter how he treats one patient in order to provide an organ to save another patient. Just last month, a San Francisco transplant surgeon was charged with three felonies for allegedly hastening the death of a patient in an attempt to harvest his organs.

A policy of donation after cardiac arrest will drastically erode an already waning trust in the medical profession. Such a policy is likely to result in a backlash both against the medical profession in general and organ donation in particular. People will see such a policy as encouraging doctors to give up on patients when in fact there might still be some hope of improving their condition, just in order to harvest their organs. The net result will be a decrease, not an increase, in organs available for transplant.

The other major option discussed by Brody is presumed consent. Presumed consent is no consent at all, it is taking organs without asking unless an individual knows enough to follow the government’s predetermined method for objecting.

 Brody writes: “In Europe, where you are considered a potential donor unless you expressly declare[s] that you do not want to be one, more than 90 percent of people are organ donors.” Americans, unlike Europeans, will not give up their right to self-determination so easily. There will be an outcry both on religious grounds and from those who believe in patient autonomy. Americans will demand to be asked, let alone the question of whether such a law would even be constitutional.

Now these proposals, as great an affront to human dignity as they are, could perhaps have some utilitarian appeal if they had the slightest chance of solving the organ shortage, as Brody’s title suggests. Donation after cardiac arrest and presumed consent, even if implemented simultaneously and without the predicted backlash, would do very little to solve the organ shortage.

If every single American were an organ donor, the U.S. implemented universal organ harvesting after cardiac arrest, and adopted European style presumed consent, there would still be people dying on the transplant list waiting for organs that never come. This would be so because of the simple fact that not enough Americans die each year under conditions that make harvesting their organs for transplantation feasible. Estimates very greatly, but there is no doubt that even if every death that could possibly result in a donation resulted in the maximum number of harvestable organs, we would still not have enough organs for everyone that needs one.

The real solution is to find new ways to ask and motivate Americans to donate, not to take their organs earlier than they may wish and/or to take them without asking. First, abolish the National Organ Transplant Act of 1984’s prohibition on compensating people for their organs, and be creative in putting together incentive packages to encourage people to donate. Offer them life-time health insurance, seed money for health-care savings accounts, long-term care insurance, scholarship money to send their kids to college, a combination of these or any number of other creative ways to encourage people to donate. Along with these incentives, there should be an effort to increase people’s trust in their healthcare professionals by promising Americans that they will always be asked – And that their organs will never be taken without their consent!

 Furthermore, efforts must be made to assure that informed consent is a real and effective tool for assuring that people know what they are agreeing to, whether they are agreeing to donate their organs at death or to a live-kidney or liver donation (the two types of live donation that can currently be done relatively safely).

Only if these measures are taken to increase options, not limit them, is there any chance that the organ shortage can be solved. Hopefully, unlike this week’s article, Brody’s column on live organ donation, promised for next week, will offer some more realistic and liberty-friendly solutions.

Stossel Critiques Commonwealth Fund Study

John Stossel has a good column on a recent Commonwealth Fund study comparing the U.S. health care system to those in Australia, Canada, Germany, New Zealand and Great Britain.  That study reports, “Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries.”

But Stossel observes that the United States does well in some measures while other measures are practically stacked against us:

The proportion of patients who say they got infected at a hospital counts about the same in the “quality” measure as the proportion of doctors who use automated computer systems to remind them to tell patients their test results. Those things aren’t equal in my book.

The study’s authors also consider having high administrative costs and spending the largest share of GDP on health care worse than having the highest share of patients who wait four months or more for surgery. This seems designed to make the U.S. look bad.

Finally, the study penalizes nations for having large numbers of patients who spent more than $1,000 on medical care out of pocket, as if third-party payment is somehow superior.

Stossel made one imprecise claim about the uninsured.  He writes, “The same people are not uninsured year in and year out.”  That’s mostly true.  The estimate that there are 47 million uninsured Americans includes a lot of people who are temporarily uninsured and will regain coverage even if we do nothing.

But a lot of people are uninsured year in and year out.  Government surveys estimate that 9 million to 26.4 million Americans are long-term uninsured (i.e., have spells without coverage that last more than two years). 

That doesn’t mean those chronically uninsured people aren’t eligible for government programs.  Many are.  Nor does it mean that they can’t afford health insurance.  Many can.  But they do exist, and we should be scrapping the government regulations and subsidies that make coverage and care unnecessarily expensive for them.

Richard Jewell, RIP

There were scores of federal agents working at the 1996 Summer Olympics, but it was a private security guard named Richard Jewell who spotted the suspicious backpack loaded with explosives and sounded the alarm–sparing countless lives and injuries.  For his good deed, Jewell found himself in the crosshairs of a desperate FBI investigation.  Federal agents leaked his name to media outlets and Jewell was smeared as a killer who only wanted to pose as a hero.  The feds had to back up when the actual evidence pointed to someone else, but a lot of damage had already been done.  The life that Jewell had been hoping for was gone.  People treated him as if he had the plague.  Sadly, Jewell died yesterday.  He was only 44. 

The Jewell case serves as a reminder that the government has the power to inflict serious damage on the lives of people–even when there is no conviction in court, and even where there is no indictment.

Note that Cato will be hosting this forum about the Duke University students who got smeared in another investigation that went awry.

Note also the dismissal of charges against Frank Quattrone.  The indictment was a page one story, but the dismissal is found in section D, page 2.

Krugman on Education, Health Care

A few days ago, New York Times columnist Paul Krugman drew an equivalence between government provision of education and medical care for children:

We offer free education, and don’t worry about middle-class families getting benefits they don’t need, because that’s the only way to ensure that every child gets an education — and giving every child a fair chance is the American way. And we should guarantee health care to every child, for the same reason.

His argument would have more force if government actually ensured that every child gets an education. 

I once attended a dinner discussion with a bunch of health care big-wigs.  One highly educated woman – she is both an M.D. and a J.D. – began the dinner by declaring, “We need to make health care a right in this country, just as we make education a right.”

Later in the dinner, she complained that her organization’s materials must be written at an 8th-grade level to be understood by their target audience. 

I interrupted to ask how she reconciled those two statements: if we really have created a right to education, why the poor reading comprehension?  And if we create a parallel right to health care, how many people’s medical care will be stuck at an 8th-grade level?  Her answer was non-responsive.

It would be nice if Krugman and others would at least acknowledge that tradeoff.