John Edwards’ Nurse Ratched Plan

John Edwards says that his universal health care plan will be mandatory not just for taxpayers and doctors, but for patients: You will get preventive care, and you will like it:

“It requires that everybody be covered. It requires that everybody get preventive care,” he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. “If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”

He noted, for example, that women would be required to have regular mammograms in an effort to find and treat “the first trace of problem.”

As Jon Henke notes, Edwards also proclaims that “the right to choose and the right to privacy are fundamental constitutional rights.” But apparently abortion is the only thing you have a constitutional right to choose. You have no fundamental right to choose not to get a mammogram. Or any other kind of preventive care. Shades of This Perfect Day and Brave New World.

This is, of course, a fundamental problem with socialism, or with socialization of the cost of anything. Edwards sincerely believes, with good reason, that preventive care helps to reduce costs by catching problems early and helping people stay healthy. (Though he may not be right about that.) But why is my health care budget his concern? Because he plans to socialize the costs of health care. So indeed, if I fail to take care of myself, I’m imposing costs on the collective. And as the collectivist-in-chief, Edwards wants to treat me as a national resource, not as a free adult individual.

This isn’t the first time such arguments have been made. What’s the argument for requiring adults to wear bicycle helmets and seat belts? That otherwise the taxpayers might have to pay for the costs of injury. Activists who want to restrict smoking, trans fats, and other unhealthy habits make the same argument: The collective is going to be paying for your health care, so you owe it to us to hold down our costs.

When we realize that socializing costs creates such unpleasant conflicts, we can respond in one of two ways: We can move away from socialization and allow people to make their own decisions and bear the consequences, or we can increasingly restrict freedom in order to hold down collective costs. Libertarians prefer the former approach, John Edwards the latter.

In One Flew over the Cuckoo’s Nest, Nurse Ratched was a tyrannical nurse who forced medical care on people who didn’t want it. She was known as “Big Nurse,” which might be a better metaphor for our increasingly therapeutic state than “Big Brother.” Democrats love Hollywood celebrities (and vice versa). Maybe Edwards can get Louise Fletcher to do a health care tour with him. She could wear her state nurse’s uniform and sing “You Belong to Me.”

The Reagan Revolution Sweeps the World

Steve Moore’s Wall Street Journal column celebrates the global shift to lower tax rates and free markets. To be sure, most foreign politicians are adopting pro-growth policies because of tax competition, not because they share Ronald Reagan’s vision. But the end result is a much stronger global economy:

…the Reagan economic philosophy of lower taxes, less regulation and free trade has never been more in vogue abroad – so much so that it has become the global economic operating system. …nations of old-Europe seem to be in a sprint to see which country can get their tax rates lowest quickest. Nicholas Vardy, the editor of “The Global Guru” economic newsletter calls the phenomenon “Europe’s Reagan Revolution.” …Austria cut its corporate tax rate to keep pace with its neighbor, Slovakia which recently adopted an 19% flat tax. Singapore is cutting taxes to compete with its 16% flat-tax rival Hong Kong. Northern Ireland wants to cut its tax rates so that it can compete with the economic gazelle of Europe, the Republic of Ireland. In 1988 Ireland was a high-unemployment stagnant economy with a 48% corporate tax rate, today that rate is 12.5% and the rest of the world is now desperate to match its economic results. Meanwhile German Finance Minister Peer Steinbrueck sold the latest tax cuts as “an investment in Germany as a business location.” …it is a testament to the Reagan economic revolution launched in 1981 that, a quarter century later, global tax rates are 25 percentage points lower on average today than in the 1970s. And those figures don’t even include this latest round of chopping under Reaganomics 2.0. The enactment of supply-side policies is helping ignite one of the strongest and longest world-wide economic expansions in history.

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.