To Mitt Romney, $10,000 is no big deal.
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Health Care
Podcast: How States Can Shut Down ObamaCare
Here’s a podcast on how states can shut down ObamaCare.
And here are links to additional material, including an op-ed that provides an overview, a blog post about Sen. Orrin Hatch (R‑UT) getting involved, a blog post on how presidential candidates could get involved, and finally a blog post on what the Obama administration has to say about all this.
Med Mal Reform: Manhattan Institute v. Cato II
The debate between Cato adjunct scholar Shirley Svorny and the Manhattan Institute’s Ted Frank continues today over at PointofLaw, as Svorny points out that while no system is entirely rational, a liability system offers certain benefits that the alternatives proposed do not.
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Med Mal Reform: Manhattan Institute v. Cato
Cato adjunct scholar Shirley Svorny’s recent paper, “Could Mandatory Caps on Medical Malpractice Damages Harm Consumers?,” has sparked a debate with the Manhattan Institute’s Ted Frank at PointOfLaw.com.
ObamaCare’s Preventive-Care Subsidies: Neither Free nor Cost-Effective
Matt Yglesias criticizes my comment in today’s USA Today when he writes, “making preventive health care free to the patient is…very cost-effective.”
Except it isn’t “free” to the patient.
And it isn’t cost-effective. The evidence strongly suggests we would “buy” as much health if we just waited for people to get sick and treated them then.
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Ninth Circuit Gets It Right, Deregulates the Bone Marrow Market
This blogpost was coauthored by Cato legal associate Chaim Gordon.
Thanks to the Institute for Justice, those suffering from leukemia and various other ailments that require them to wait for a bone marrow match to miraculously appear have new hope. Yesterday’s unanimous opinion by the Ninth Circuit in Flynn v. Holder effectively deregulates the bone-marrow market—and may even encourage lawmakers to rethink the disastrous federal prohibition on compensating organ donors. (I previously wrote about the case here and here, and you can watch Cato’s forum on it here.)
At issue here is the National Organ Transplant Act, which prohibits patients from compensating would-be donors of life sustaining organs. The Ninth Circuit ruled that NOTA does not apply to blood (or blood subparts), and so it is entirely legal to sell bone marrow stem cells if those cells are extracted from the blood—as they are in 70% of donations—instead of from the bone marrow itself.
Unfortunately, the Ninth Circuit rejected IJ’s argument that Congress has no legitimate authority to interfere with the right to participate in safe, accepted, lifesaving, and otherwise legal medical treatment. In rejecting this argument, the court effectively held that NOTA’s ban on the sale of actual bone marrow was constitutional because an unregulated market posed certain dangers (especially of the exploitation of desperate patients).
It is highly unlikely that such exploitation could occur under current market conditions, however, because donors and patients have no way of contacting each other without the National Registry system that matches them. And, of course, the choice is not between a prohibition on compensation and complete non-regulation; some regulation may be appropriate, whether by legislation or simple action of the common law akin to how it operates to prevent extortion in other contexts.
The good news is that, with the bone marrow market effectively deregulated, Congress may now be motivated to reexamine its misguided ban on compensating organ donors. One of the greatest obstacles to reforming the prohibition on organ sales is the fortunate fact that relatively few Americans require organ transplants in any given election cycle. According to government statistics, 112,546 Americans are currently on some kind of organ transplant waiting list. That means only around 1 in 3,000 Americans (and their families and friends) would be seriously motivated to demand organ transplant reform from Congress. Congress will now be forced to grapple with its policies regarding bone marrow transplants, which may be an opportune time for advocates to push for wider organ transplant reform.
The Ninth Circuit’s opinion also clears the way for Supreme Court review of NOTA. If this case reaches the high court, IJ can press its constitutional arguments more forcefully. And even if the Supreme Court merely affirms the Ninth Circuit’s opinion on statutory grounds, we will inevitably learn much about the justices’ views on the constitutionality of NOTA more broadly.
For the moment, Flynn v. Holder means that, for the first time in over 25 years, a spotlight has been shined on NOTA and its disastrous effects on Americans’ medical liberty. And that is why the Ninth Circuit’s narrow bone marrow opinion may actually be a significant step toward the rational regulation of organ markets.
For more of Cato’s work in this area, see, for example, this paper and this op-ed.
The Presumption of Liberty?
Check out NPR’s Morning Edition today, at least at 8:00 a.m., and you’ll find the lead item isn’t the impending jobs report, the European economic crisis, or even President Obama’s latest campaign speech. No, it’s “Catholic Groups Fight Contraceptive Rule.” Sex, women, discrimination, religion, and health care: What could be more natural for NPR, more right down its alley? Yet the issues the story raises—not broached in this story, of course—go well beyond those pegs. What we have here, in microcosm, is a conflict with a thousand and one variations in the modern ubiquitous state.
New regulations under ObamaCare, it seems, will require employers, universities, and others who offer health insurance benefits covering prescription drugs to cover prescription contraceptives as well. For many Catholics, of course, that’s a concern. As Catholic University President John Garvey wrote recently in The Washington Post, “if we comply, as the law requires, we will be helping our students do things that we teach them, in our classes and in our sacraments, are sinful—sometimes gravely so.” He and others are asking for a religious liberty exception.
But why stop there? The issue is perfectly generalizable. And it arises in the thousand and one ways it does because our ever-expanding anti-discrimination laws, as they restrict private parties, conflict directly with our liberties—in particular, with our right to associate, or not, with anyone we wish, for any reason, good or bad, or no reason at all.
Currently, the story notes, 28 states require contraceptives to be offered in health plans, eight with no exception for religious organizations. Some have tried to get out from under those laws by self-insuring, but that’s where the federal Pregnancy Discrimination Act of 1978 kicks in. Still, the story adds, an EEOC ruling under that statute binds only if the people being discriminated against take action. Hence the ObamaCare rule, which compels up front.
And what’s the rationale for the anti-discrimination rule? “Prescription contraception is a form of health care that is unique to women,” says the ACLU’s Sarah Lipton-Lubet, “and the consequences of the inability to be able to access contraception, those fall primarily on women.” Women would have no access to contraceptives, we’re invited to believe, if their health insurance plans didn’t pay for them—or access as well to anything else not covered, presumably. That’s how we’ll all end up with “Cadillac plans,” until employers, unable to afford them, will stop providing any health insurance benefits at all—yet then will have to pay the penalty ObamaCare exacts for opting out.
But Ms. Lipton-Lubet’s rationale doesn’t stop there: “What the bishops and their allies are asking for is the ability to impose their religious beliefs on people who don’t share them,” she says. Think about that. It’s the bishops who are forcing their beliefs on others, not the government that is forcing employers to pay for coverage they oppose. That’s what we come to when, as Obama has repeatedly said, “we’re all in this together.” Opting out, cost free, is not an option—it’s discrimination, whether in health care, or housing, or lending, or college admissions, or employment, or any other private endeavor that today is so highly regulated by our anti-discrimination laws. Freedom of association is today the exception, not the rule, with government in charge of dispensing the exceptions.