Go after Free-Riders, Not Freedom

My friend John McClaughry of the Ethan Allen Institute has a novel approach for preventing the uninsured from free-riding on the generosity of others, while preserving an individual’s freedom to choose whether or not to purchase health insurance:

Faced with the steep cost of insurance, many people - especially healthy young people - choose to go without. Fine - but if they then incur high medical expenses, they ought to accept the primary responsibility for paying for the services they have received.

Consider this proposal: If an uninsured person incurs medical expenses and leaves an unpaid balance, the provider must try for 90 days to collect. At that point the unpaid balance is posted to an account in the patient’s name, managed for the government by a credit-card company. Each year the account manager reports to the patient his or her balance, on the equivalent of an IRS 1099 form. When preparing that year’s taxes, the individual must include a stated fraction of that amount in his or her gross income. (The same result could be achieved with an inverse tax credit.)

The fraction reported would be graduated according to the patient’s income and the amount of the balance due. For a high-income taxpayer with a low account balance, the amount subject to tax the first year might be 100 percent of the balance. For a taxpayer with minimal income, the balance would carry over undiminished to the following year.

Thus the uninsured patient would be required to pay off the unpaid balance via income-tax payments year after year until it is retired. Whether the account balance would be adjusted upward annually to match the depreciation of the dollar, whether interest would be charged on the average balance, whether the IRS would have a claim on a decedent’s estate for the unpaid balance, and whether such liabilities would survive bankruptcy are questions for policymakers to decide. A further question is how much of the tax payment collected the government would deduct to cover administrative costs before remitting the remainder to the providers who weren’t paid for their services.

In sum, the proposal says to the person who prefers not to obtain insurance: “Your government will not fine you for failing to buy health insurance. But if you are unlucky enough to run up a big medical bill that you can’t pay from your assets, you will be paying a piece of it off every year at tax time, possibly for the rest of your life. Are you sure you wouldn’t prefer to invest in a high-deductible insurance policy with limited mandates, with a cap on out-of-pocket payments, and with your own tax-free Health Savings Account?”

As I explain in the latest issue of National Review, the correct response to the problem of uninsured people who can’t pay their medical bills is not an individual mandate that allows the government to take over the private health-insurance market.  It is to collect from the would-be free-riders as much as possible, and write off any remaining uncompensated care as the price of living in a free and decent society.

Health Care Reform: WWJD?

Today’s post comes from my theologian father:

There was a man (M) going down from Jerusalem to Jericho who needed health care (Luke 10:25-37).  All bypassers were free to provide for him or keep walking.  The Priest (P) and the Levite (L) used their freedom in one way and the Samaritan (S) used his the another way.

WWJD?  He said do what S did.  (M’s quality of care was outstanding.)

WWJND?  He did not say that S, P, and L should agree on the level of care and funding for M and chip in.  Maybe He realized that P and L had a bullet-proof majority.  Maybe He realized the time, attention, care, funding, and personal touch of S were very important.  Maybe He realized that even if M got to an inn, the innkeeper would be at risk for exceeding guidelines and would have to wait longer to be reimbursed.  Maybe He realized the devil was in the details and could complicate or possibly compromise M’s care: the timely availability of government run donkeys (ambulances); inns (hospitals); professionals at every point in the chain and in between; plus, auditors to prevent fraud and abuse.  The moral lesson Jesus drew was: use your freedom to care for your neighbor and do not hand it over to P and L if you want your neighbor and yourself to get to Jericho.

Today, millions of Ms are by the side of the road in nursing homes, and the Ps and Ls have already said they want to shrink their funding so they can fund care for the rest of us.  Sympathy and sentiment are wonderful but do not always work well as criteria for good policy.

Jesus was a magnificent policy wonk.

For more on how the Parable of the Good Samaritan applies to health policy, click here and here.

Harold Meyerson is Part of the Problem

I have argued time and again that America’s growing aversion to trade during the past few years is the product of myth perpetuation by campaigning politicians, captured policymakers, TV media charlatans, and woefully ill-informed newspaper columnists. Harold Meyerson always comes to mind as emblematic of this last category, so his fallacy-laden diatribe about the decline of U.S. manufacturing in yesterday’s Washington Post is par for the course.

Meyerson makes some claims that cannot be allowed to stand, such as.

“”We don’t [make things] any more – at least, not like we used to. Since 1987, manufacturing as a share of our gross domestic product has declined 30 percent.”

First of all, please note that Meyerson’s second sentence does nothing to support his first. A decline in the manufacturing sector’s share of the total economy speaks to the rapid growth of other sectors of the economy, but says nothing about the change in U.S. manufacturing output or value-added.

According to data from the 2009 Economic Report of the President, as gathered and reported yesterday by George Mason University Economics Professor Don Boudreaux, since 1987 real U.S. manufacturing output has increased by 81 percent – hardly a sign of manufacturing decline.

The facts – as reported by the Bureau of Economic Analysis – demonstrate that real manufacturing value-added reached a record high level in 2007 (the last year for which final data are available).  Notwithstanding the recent recession that has affected all sectors of the economy, U.S. manufacturing has been thriving in recent years.

Second, if the United States doesn’t “make things anymore,” then nobody does. According to data from the United Nations Industrial Development Organization, U.S. factories are the world’s most prolific, accounting for 25 percent of global manufacturing value-added. By comparison, Chinese factories account for 10.6 percent.

That may be hard to fathom, given that everyone’s favorite story about shopping in retail establishments these days is that it’s impossible to find anything labeled “Made in the USA.”  But that’s because, increasingly,  U.S. manufacturing produces sophisticated components, such as airplane parts, not consumer goods.

American manufacturing is by no means in decline.  What should be is Meyerson’s myopic way of seeing things.


Get Kids Out of the Detroit Public School System

Oh, the hits keep on coming out of Detroit. From the WSJ today:

Five employees of the Detroit public school system were charged Wednesday with multiple felonies as part of an investigation into alleged corruption and the loss of tens of millions of dollars in school funds.

Here’s my take on the depraved crapulence (not a scatological reference ;))

of the Detroit Public school system and its unions and what to do about it

(and an article here).

It’s Not So They Can Buy You Gender-Appropriate Birthday Gifts

ac_secure_flightStarting Saturday, U.S. airlines are going to start asking you for your birth date and gender when you go to buy tickets. They will hand this information over to the Department of Homeland Security for use in running your name (with these other identifiers) against their watch lists. This is the “Secure Flight” program moving forward.

I copied an image file from the Transportation Security Administration Web site that illustrates the problem TSA is trying to solve. Many different people have the same name. The government wants to do a better job of vetting you against their watch lists.

TSA has done a lot to keep Secure Flight going. It’s been a rolling failure for many years, and at least one serious problem remains: It doesn’t secure air travel. Watch lists don’t include unknown wrongdoers, and eluding identity checks will always be trivially easy (barring a bulletproof, national, cradle-to-grave biometric tracking system).

The privacy problem is simple: Giving better identifying information to the government reduces your privacy by an equivalent amount. Today, that’s not too concerning, and the TSA’s privacy impact analysis for Secure Flight promises they will keep data on most people’s travels for “a short period of time.” But promises can be broken—either in secret, or with the stroke of a pen. And you’ll have no effective recourse when that happens.

According to a Washington Post report, people will not be denied travel if they decline to provide this information. They will just be directed to secondary search. This points to a strategy that a small number of people—people like yourself—can use to have a large influence on this program.

If enough travelers decline to provide information—and threaten not to travel by air—the airlines will be forced into a privacy advocacy role.  To defend their bottom lines, they will lobby against making this data collection mandatory.

As always, protection of your privacy is up to you. Go ahead and indulge your prickly, obstinate side on this one.

It’s the End of the World as We Know it & I Feel Fine

In Florida, land of sunshine, oranges and signs of the apocalypse, a local teachers’ union and public school district have banded together to help make professional development programs available to… private school teachers.

Are you still there? I heard a thud….

This and other shockers have been brought to you by the Florida tax credit scholarship program. The credits give businesses a dollar for dollar tax cut if they donate money to k-12 scholarship granting organizations. The SGOs then help low-income families afford private schooling.

If chambers of commerce around the country want to know how to make real progress in education, they might want to have a look at the Sunshine state.