376 (Author at Cato Institute) https://www.cato.org/ en Containing Coronavirus after FDA Missteps https://www.cato.org/multimedia/cato-daily-podcast/containing-coronavirus-after-fda-missteps Michael F. Cannon, Caleb O. Brown <p>Bureaucratic errors made containing the novel coronavirus considerably more difficult. Michael Cannon details some important next steps.</p> Wed, 25 Mar 2020 09:19:48 -0400 Michael F. Cannon, Caleb O. Brown https://www.cato.org/multimedia/cato-daily-podcast/containing-coronavirus-after-fda-missteps Michael F. Cannon discusses Medicare for all on KHOW’s The Ross Kaminsky Show https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannon-discusses-medicare-all-khows-ross-kaminsky-show Wed, 26 Feb 2020 13:42:38 -0500 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannon-discusses-medicare-all-khows-ross-kaminsky-show Sen. Chuck Grassley (R‑IA) cites Michael F. Cannon’s blog post, “Senate Finance Committee Considers Proposals to Cut Wasteful Medicare Spending,” on C‑SPAN 2 https://www.cato.org/multimedia/media-highlights-tv/sen-chuck-grassley-r-ia-cites-michael-f-cannons-blog-post-senate-0 Tue, 25 Feb 2020 12:56:31 -0500 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-tv/sen-chuck-grassley-r-ia-cites-michael-f-cannons-blog-post-senate-0 Association for Community Affiliated Plans v. Treasury https://www.cato.org/multimedia/cato-daily-podcast/association-community-affiliated-plans-v-treasury Michael F. Cannon, Caleb O. Brown <p>Congress has exempted some short‐​term insurance from the statutory requirements otherwise applicable to individual health insurance plans. A&nbsp;new lawsuit might end those plans entirely. Why does that matter? Michael Cannon explains.</p> Thu, 20 Feb 2020 17:03:10 -0500 Michael F. Cannon, Caleb O. Brown https://www.cato.org/multimedia/cato-daily-podcast/association-community-affiliated-plans-v-treasury Michael F. Cannon’s Obamacare research is cited on WBAL’s The Andrew Langer Show https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannons-obamacare-research-is-cited-on-wbal Mon, 10 Feb 2020 10:40:15 -0500 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannons-obamacare-research-is-cited-on-wbal Michael F. Cannon discusses the ideal healthcare system on WWL’s First News with Tommy Tucker https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannon-discusses-ideal-healthcare-system-wwls-first Thu, 06 Feb 2020 11:06:44 -0500 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannon-discusses-ideal-healthcare-system-wwls-first Buttigieg’s Rhetoric Emphasizes Choice. His Health Plan Would Eliminate It. https://www.cato.org/blog/buttigiegs-medicare-all-who-want-it-fraud Michael F. Cannon <p>Advocates of government‐​run health care have an ignoble tradition of cloaking their ideas in the rhetoric of choice:</p> <ul><li>In 2009 and thereafter, President Barack Obama <a href="https://www.politifact.com/obama-like-health-care-keep/">repeatedly promised</a>, “If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.” He promptly threw millions of Americans out of health plans they themselves chose, liked, and wanted to keep.</li> <li>Sen. Bernie Sanders <a href="https://twitter.com/berniesanders/status/1142107691671859200?lang=en">says</a>, “If you are a human being, regardless of your immigration status, you have a right to health care.” Sanders’ actual proposals, however, would take health care rights away from everyone. His “Medicare for All” proposal would take away Americans’ right to purchase the health care they want by increasing taxes so much the average household’s after‐​tax income would drop by <a href="https://www.whitehouse.gov/wp-content/uploads/2018/10/The-Opportunity-Costs-of-Socialism.pdf">an estimated <em>$35,000</em></a>. Just to be sure you cannot exercise your right to choose your health plan, Sanders would outlaw private health insurance. Finally, he would violate the right of immigrants to purchase the health care they want by stopping them at the border.</li> </ul><p>South Bend Mayor Pete Buttigieg, who <a href="https://www.cnn.com/2020/02/04/politics/iowa-caucus-delay/index.html">appears</a> to have won the Iowa Democratic presidential caucuses, carries on that ignoble tradition.</p> <p>Buttigieg proposes not a health care system of “Medicare for All,” but of “<a href="https://peteforamerica.com/policies/health-care/">Medicare for All Who Want It</a>.” Buttigieg purportedly proposes to turn Medicare into a “<a href="https://www.cato.org/publications/policy-analysis/fannie-med-why-public-option-is-hazardous-health">public option</a>” where all Americans the choice of participating in the program without compulsion. “I trust the American people to make the right choice for them,” Mayor Pete <a href="https://www.washingtonexaminer.com/policy/healthcare/buttigieg-makes-case-against-medicare-for-all-i-trust-the-american-people">says</a>. “Not my way or the highway.”<br /><br /> Buttigieg’s rhetoric obscures the fact that his plan would create a single‐​payer health program and reduce Americans’ health care choices no less than Sanders’ plan would.<br /><br /> Before we examine how Buttigieg proposes to reduce Americans’ health care choices, let’s examine what a program of “Medicare for All Who Want It” would look like.</p> <p>If Mayor Pete were really proposing Medicare for All Who Want It, he would let taxpayers choose whether or not they participate in the Medicare program. All who want Medicare could continue to pay taxes into the current system. All who <em>don’t</em> want Medicare could instead put those would‐​be tax dollars into a personal account they themselves own and control. Taxpayers who opt out of Medicare could invest those funds, use them to make their own health care decisions in their later years, and even pass them down to their children and grandchildren. All who want to remain in the current Medicare system would get the finest health care the government can deliver with whatever funds their neighbors are willing to hand over to the government voluntarily.</p> <p>If he were really proposing to turn Medicare into a “public option,” Buttigieg would also make it an option for current enrollees. Instead of pushing them into the traditional, fee‐​for‐​service Medicare program, Medicare for All Who Want It would subsidize current enrollees with a check–just like Social Security does–and let them choose whether to spend that money on traditional Medicare or other health‐​insurance options. To ensure equity, older and sicker enrollees will get bigger Medicare checks than younger, healthier enrollees. To ensure a level playing field, traditional Medicare will get no subsidies from the federal treasury aside from the funds that Americans who want Medicare voluntarily contribute to the program.</p> <p>Instead, Buttigieg proposes to continue to force taxpayers to participate in Medicare whether they want it or not. Indeed, he would ramp up the compulsion.</p> <ul><li>He would automatically enroll uninsured Americans in Medicare and <a href="https://www.washingtonpost.com/business/economy/buttigieg-health-plan-hinges-on-supercharged-version-of-unpopular-obamacare-mandate/2019/12/24/415ae876-21bb-11ea-9146-6c3a3ab1be6c_story.html">charge them up to $7,000 for the privilege</a> — whether they want it or not.</li> <li>He would force Americans to pay (at least) an additional <a href="https://finance.yahoo.com/news/health-care-plans-cost-candidates-122729847.html">$1.7 trillion</a> in taxes — more than all the on‐​budget tax increases in ObamaCare combined — whether they want to pay those additional taxes or not.</li> <li>He would use that money to undercut private insurers so much that it “<a href="https://storage.googleapis.com/pfa-webapp/documents/MFAWWI_white_paper_FINAL.pdf">will create a natural glide‐​path to Medicare for All</a>” where private insurance options no longer exist — whether you like it or not.</li> </ul><p>Buttigieg’s plan thus reaffirms that a “public option,” as its intellectual father Jacob Hacker <a href="https://www.youtube.com/watch?v=3sTfZJBYo1I">admitted</a>, is not about expanding choice but leaving Americans with no choice:</p> <blockquote><p>Someone once said to me, “This is a Trojan Horse for single‐​payer,” and I said, “Well, it’s not a Trojan Horse—it’s right there! I’m telling you: we’re going to get there, over time, slowly.”</p> </blockquote> <figure role="group" class="filter-caption"><div data-embed-button="embed" data-entity-embed-display="view_mode:media.blog_post" data-entity-embed-display-settings="https://www.youtube.com/watch?v=3sTfZJBYo1I" data-entity-type="media" data-entity-uuid="9c570adc-5b2e-4c9e-b9ad-4ba666d54542" data-langcode="en" class="embedded-entity"><a href="https://www.youtube.com/watch?v=3sTfZJBYo1I"> <div class="embed embed--youtube js-embed js-embed--youtube"> <div class="responsive-embed"></div> </div> </a></div> <br /><figcaption><div class="figure-caption text-sans-alternate">Prof. Jacob Hacker acknowledges the purpose of a “public option” is to eliminate private insurance and create a government‐​run single‐​payer health system. </div> </figcaption></figure><p>In the end, Buttigieg’s plan is <em>not “</em>Medicare for All Who Want It.” It is instead a single‐​payer, “Medicare for All” plan with additional layers of deceptive rhetoric. Both Buttigieg’s and Sanders’ plans would deny Americans the right to make their own health care decisions and hand those decisions to a government‐​run single‐​payer system. Mayor Pete is just doing more to hide the fact.</p> Wed, 05 Feb 2020 16:50:37 -0500 Michael F. Cannon https://www.cato.org/blog/buttigiegs-medicare-all-who-want-it-fraud Cato, Buckeye File Amicus Brief in Assn. for Community Affiliated Plans v. Treasury https://www.cato.org/blog/cato-buckeye-amicus-brief-association-community-affiliated-plans-v-treasury Michael F. Cannon <p>This week, the Cato Institute, the Buckeye Institute, and I&nbsp;filed <a href="https://www.cato.org/publications/legal-briefs/association-community-affiliated-plans-v-us-dept-treasury">an <em>amicus curiae </em>brief</a> in the case <em>Association for Community Affiliated Plans v. Treasury</em>. The plaintiffs in the case are challenging the Trump administration’s August 2, 2018 <a href="https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-16568.pdf">final rule</a> that allows greater consumer protections in short‐​term limited duration insurance (STLDI) plans. On July 19, 2019, The U.S. District Court for the District of Columbia <a href="https://affordablecareactlitigation.files.wordpress.com/2019/07/stld-memorandum-opinion.pdf">ruled</a> against the plaintiffs. The plaintiffs have appealed the district‐​court ruling to the U.S. Court of Appeals for the D.C. Circuit. Oral arguments will take place March 20, 2020.</p> <p>Congress has exempted STLDI from the statutory requirements otherwise applicable to individual health insurance plans. Since Congress has never defined the term or duration of STLDI, the Departments of Health and Human Services, Labor, and Treasury have filled that gap. Since 1997, with limited exception, these agencies have consistently defined STLDI as having, among other things, an expiration date that is “within 12 months of the date the contract becomes effective.”</p> <p>The sole exception occurred between December 30, 2016 and 2018, when the Departments limited the maximum term to less than three months. As the National Association of Insurance Commissioners warned in 2016, that cramped three‐​month limit would strip health insurance coverage from consumers after they fell ill, leaving them with a&nbsp;period of up to a&nbsp;year during which they faced expensive medical bills with no health insurance coverage.</p> <p>That’s exactly what happened to 61‐​year‐​old Arizona resident Jeanne Balvin, who found Affordable Care Act (ACA) coverage unaffordable and instead <a href="https://www.consumerreports.org/health-insurance/short-term-health-insurance-isnt-as-cheap-as-you-think/">purchased</a> an STLDI plan for one third of the cost of an ACA plan. Balvin’s STLDI plan provided excellent coverage for her emergency surgery and hospitalization; she paid far less than she would have with an ACA plan. But then, the three‐​month limit cancelled her STLDI plan, thereby stripping her of coverage that could have and would have covered two subsequent hospitalizations. The three‐​month limit left Balvin uninsured with a&nbsp;preexisting condition and $97,000&nbsp;in unpaid medical bills.</p> <p>In 2018, the Departments rescinded the three‐​month limit and reverted to the prior 12‐​month limit. The Departments also allowed STLDI issuers to renew the initial contract up to a&nbsp;total of 36 months and to offer renewal guarantees that would allow enrollees to keep purchasing STLDI plans at healthy‐​person premiums, even after they get sick.</p> <p>The plaintiffs in <em>ACAP v. Treasury</em> are primarily private insurance companies who sell ACA‐​compliant plans. They are asking the courts to reinstate the three‐​month limit because they fear that otherwise, their customers would find STLDI plans more attractive than their ACA‐​compliant plans. I&nbsp;am not making this up. They are literally asking the court to reinstate the three‐​month limit and inflict real harm on patients like Jeanne Balvin in order to pad their bottom lines.</p> <p>The Cato Institute, the Buckeye Institute, and I&nbsp;support the district court’s proper decision that the Departments acted within the scope of their statutory authority in reinstating the 12‐​month maximum term for STLDI plans.</p> <p>For more information, read:</p> <ul> <li>My <a href="https://www.cato.org/publications/public-comments/comments-short-term-limited-duration-insurance-cms-9924-p">comments on the proposed STLDI rule</a>;</li> <li>My <em>Washington Examiner</em> oped on <a href="https://www.washingtonexaminer.com/opinion/obamacare-is-now-optional">how the STLDI final rule made ObamaCare optional</a>;</li> <li>My blog post on <a href="https://www.cato.org/blog/short-term-plans-rule-flips-political-narrative-health-insurance-protections">how the STLDI rule flips the political narrative on health insurance</a>;</li> <li>My blog post on <a href="https://www.cato.org/blog/short-term-plans-reducing-uninsured-protecting-conscience-rights-improving-obamacares-risk">how the STLDI final rule will increase coverage, protect conscience rights, and improve ObamaCare’s risk pools</a>;</li> <li>My <em>Wall Street Journal</em> oped on <a href="https://www.wsj.com/articles/first-do-no-harm-to-obamacare-1539298783">Democrats’ attempts to reinstate the three‐​month limit</a>; and</li> <li>The&nbsp;<a href="https://www.cato.org/publications/legal-briefs/association-community-affiliated-plans-v-us-dept-treasury">Cato‐​Buckeye‐​Cannon <em>amicus</em>&nbsp;brief</a>.</li> </ul> Thu, 30 Jan 2020 10:07:06 -0500 Michael F. Cannon https://www.cato.org/blog/cato-buckeye-amicus-brief-association-community-affiliated-plans-v-treasury Association for Community Affiliated Plans v. U.S. Dept. of the Treasury https://www.cato.org/publications/legal-briefs/association-community-affiliated-plans-v-us-dept-treasury Michael F. Cannon, Robert Alt, John J. Park, Ilya Shapiro <div class="lead text-default"> <p>Congress has allowed short‐​term, limited duration insurance (STLDI) to be exempt from the statutory requirements applicable to other federally recognized individual health insurance plans. While Congress has known of and provided for such insurance, it has never defined the term or duration of STLDI. That left a&nbsp;gap that the administrative agencies have filled, and, since 1997, with limited exception, federal regulations have consistently defined STLDI as having, among other things, an expiration date that is “within 12 months of the date the contract becomes effective.” See 29&nbsp;C.F.R. § 2590–701‑1 (2019). Nothing in the Health Insurance Portability and Accountability Act (HIPAA) or the Affordable Care Act (ACA) compels setting aside this consistent regulatory practice. See 29&nbsp;C.F.R. § 2590.701–2 (2019).</p> </div> , <div class="text-default"> <p>The sole exception occurred between December 30, 2016 and 2018, when the Departments limited the maximum term to less than three months. See 81 Fed. Reg. 75,316, 75,317 (Oct. 31, 2016). In 2018, the Departments reversed that limitation and reverted to the prior rule after the President pointed to the term limits on STLDI as one area “where current regulations limit choice and competition” and targeted them for change. 82 Fed. Reg. 48,385 (Oct. 12, 2017).</p> <p>As the district court observed, “[I]t is not my role to interfere with or disrupt the balance struck by policymakers” in this case. Ass’n for Associated Community Plans v. Dep’t of the Treasury , 392&nbsp;F. Supp. 3d 22, 45 (D.D.C. 2019). It shouldn’t be the role of this Court either. Limiting the term of STLDI as the Association Appellants desire doesn’t just “limit choice and competition.” It threatens to inflict real harm on real people, as the experience of Arizona resident Jeanne Balvin typifies. As the National Association of Insurance Commissioners explained in 2016, the cramped three‐​month limit then proposed and later adopted stripped health insurance coverage from consumers after they fell ill, leaving them with a&nbsp;period of up to a&nbsp;year during which they faced expensive medical bills with no health insurance coverage. If the longstanding policy of the 12‐​month term is once again abandoned in favor of a&nbsp;shorter 3‑month term, the experience of Jeanne Balvin will befall many more sick Americans.</p> </div> Tue, 28 Jan 2020 09:00:29 -0500 Michael F. Cannon, Robert Alt, John J. Park, Ilya Shapiro https://www.cato.org/publications/legal-briefs/association-community-affiliated-plans-v-us-dept-treasury The ACA Expanded Insurance Coverage of Contraceptives. Prices Soared. https://www.cato.org/blog/aca-expanded-insurance-coverage-contraceptives-prices-soared Michael F. Cannon <p>In today’s <a href="https://www.latimes.com/opinion/story/2020-01-27/birth-control-pill-over-the-counter"><em>Los Angeles Times</em></a>, Cato senior fellow Dr. <a href="https://www.cato.org/people/jeffrey-singer">Jeffrey A. Singer</a> and I note that once the Affordable Care Act’s contraceptives‐​coverage mandate took full effect in 2014, “prices for hormones and oral contraceptives stopped falling and instead skyrocketed. By 2019, they had risen three times as fast as prices for prescription drugs overall.” Here we provide the underlying data.</p> <p>The Affordable Care Act (ACA) dramatically expanded insurance coverage for prescription contraceptives such as “the pill.” From August 2012 through January 2014, the federal government phased in the ACA’s requirement that nearly all private health insurance plans must cover all Food and Drug Administration‐​approved prescription contraceptives with no cost‐​sharing. In addition, from 2014 through 2017, the ACA enrolled an <a href="https://www.guttmacher.org/article/2018/12/gains-insurance-coverage-reproductive-age-women-crossroads">estimated</a> 5 million previously uninsured women of child‐​bearing age in either private insurance plans subject to that mandate or in Medicaid, which also covers prescription contraceptives with no cost‐​sharing.</p> <p>As a result of these changes, the share of consumers who are sensitive to the price of contraceptives plummeted. The Kaiser Family Foundation <a href="https://www.kff.org/womens-health-policy/fact-sheet/oral-contraceptive-pills/">reports</a> that, among women with large‐​employer coverage who use oral contraceptives, “the share experiencing out‐​of‐​pocket spending…declined from 94 percent in 2012 to 11 percent in 2017.” From 2012 through 2014, ACA‐​mandated <a href="https://www.kff.org/womens-health-policy/issue-brief/private-insurance-coverage-of-contraception/">coverage</a> of contraceptives all by itself “account[ed] for nearly two‐​thirds (63%) of the drop in out‐​of‐​pocket spending on retail drugs” across all consumers.</p> <p>The ACA’s reshaping of the market for oral contraceptives precisely coincided with a dramatic increase in prices for those items. Since December 2009, the U.S. Bureau of Labor Statistics’ (BLS) Producer Price Index (PPI) has measured the prices manufacturers receive for a sample of domestically produced hormones and oral contraceptives. The nearby figure shows what happened to real prices for hormones and oral contraceptives before and after the ACA’s contraceptives‐​coverage mandate took effect.</p> <p>Before the mandate took effect—i.e., during a period when consumers more often paid for oral contraceptives directly—price changes for hormones and oral contraceptives generally followed a path similar to that of non‐​prescription drugs, which insurance typically does not cover, and which also fell in real terms. Prices for hormones and oral contraceptives actually <a href="https://fred.stlouisfed.org/series/WPU06380105#0">fell</a> by 12 percent in real terms.</p> <p>As the mandate began to take effect and as the ACA made oral contraceptives seem “free” to more purchasers, prices for hormones and oral contraceptives began to rise. By the time the mandate took full effect in early 2014, prices for hormones and oral contraceptives reversed five years of real reductions and caught up to the 17 percent growth in real prices for other prescription drugs.</p> <p>Once the mandate took full effect, prices began to rise rapidly. From May 2013 through May 2019, while real prices for non‐​prescription drugs and prescription drugs overall rose just 12 percent and 37 percent, respectively, prices for hormones and oral contraceptives rose 108 percent. That’s nearly three times the rate of price growth for other prescription drugs.</p> <p> <div data-embed-button="embed" data-entity-embed-display="view_mode:media.blog_post" data-entity-type="media" data-entity-uuid="abaee153-e26c-4a9a-aa5b-1f9a3d4732c8" data-langcode="en" class="embedded-entity"> <div class="embed embed--infogram js-embed js-embed--infogram"> <div class="infogram-embed" data-id="_/wcsntHzMdkSKWKZT3yc0" data-type="interactive" data-title="Drug Reformation, Figure 1"></div> </div> </div> </p><p>The PPI for hormones and oral contraceptives has limitations as a measure of prices for hormonal contraceptives in general and oral contraceptives in particular. First, it samples and estimates changes in the initial prices drug manufacturers receive, not the ultimate prices insurers and consumers pay. Second, it samples and estimates changes in prices only for domestically produced drugs, excluding drugs produced in other countries and Puerto Rico. Third, it encompasses drugs other than contraceptives that may have an important influence on the index.</p> <p>Unfortunately, the BLS neither discloses which drugs it samples nor the relative contributions of contraceptives versus other hormonal drugs. The PPI for hormones and oral contraceptives is therefore an imperfect measure because it does not necessarily reflect the changes in consumer prices for all hormonal contraceptives available to consumers, and may instead reflect changes in (non‐​consumer) prices for non‐​contraceptive hormonal drugs. The BLS’s Consumer Price Index (CPI) for prescription drugs lacks some of these shortcomings. Unfortunately, the BLS does not publish CPIs for prescription drugs at the level of therapeutic class.</p> <p>Even with these limitations, these data suggest that trying to make oral contraceptives “free” for insured consumers had the unintended consequence of making them far more expensive for insurance companies and women who buy them without insurance, including young women who prefer not to purchase them through their parents’ insurance.</p> <p>In the Cato Institute book <a href="https://www.amazon.com/Overcharged-Americans-Much-Health-Care/dp/1944424768"><em>Overcharged</em></a>,<em> </em>Cato adjunct scholars <a href="https://www.cato.org/people/charles-silver">Charles Silver</a> and <a href="https://www.cato.org/people/david-hyman">David Hyman</a> explain why paying for health care through insurance often causes prices to rise. Despite the supposed purchasing power of third‐​party payers, insurers are not very good at reducing prices. When consumers don’t care about prices, they actively resist attempts by third‐​party payers to negotiate lower prices. This dynamic gives providers, including manufacturers of oral contraceptives, free rein to raise prices.</p> <p>In a forthcoming Cato Institute white paper, Singer and I propose taking away the FDA’s power to require women to obtain a prescription before purchasing birth control pills.</p> Mon, 27 Jan 2020 08:57:57 -0500 Michael F. Cannon https://www.cato.org/blog/aca-expanded-insurance-coverage-contraceptives-prices-soared Birth Control Should Be Available Over the Counter. How Congress Can Make That Happen https://www.cato.org/publications/commentary/birth-control-should-be-available-over-counter-how-congress-can-make-happen Michael F. Cannon, Jeffrey A. Singer <div class="lead text-default"> <p>Congress should revoke the Food and Drug Administration’s power to require women to obtain prescriptions to purchase hormonal contraceptives, a&nbsp;change that would reduce the price of birth control pills and finally allow consumers to buy them over the counter. Congress should make this move without requiring insurers to cover over‐​the‐​counter contraceptives, which would cause prices to increase.</p> </div> , <div class="text-default"> <p>Daily‐​use oral contraceptives offer tremendous benefits and are no more dangerous than countless other drugs, such as&nbsp;<a href="https://www.nejm.org/doi/full/10.1056/NEJMp1114439" target="_blank">acetaminophen</a>, which the FDA allows even children to buy over the counter. Many in Congress, from progressive Rep.&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FAOC%2Fstatus%2F1137100279894224896&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C0%7C637141108076246961&amp;sdata=Ge4Dsey6mmqV8Urnsif6h7WacRzImrI2GueRLwe9CtY%3D&amp;reserved=0" target="_blank">Alexandria Ocasio‐​Cortez</a>&nbsp;(D‑N.Y.) to conservative Sen.&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2Ftedcruz%2Fstatus%2F1138840867777712128%3Fref_src%3Dtwsrc%255Etfw%257Ctwcamp%255Etweetembed%257Ctwterm%255E1138899256062988294%26ref_url%3Dhttps%253A%252F%252Fthinkprogress.org%252Fted-cruz-says-he-wants-to-expand-access-to-birth-control-heres-his-chance-murray-pressley-bill-aoc-56702fc32603%252F&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C0%7C637141108076256955&amp;sdata=%2FWhO57KEb4MGFCiyyWjaLGc%2FFXcg5WyFUV45EYfGagY%3D&amp;reserved=0" target="_blank">Ted Cruz</a>&nbsp;(R‑Texas),&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.politico.com%2Fstory%2F2019%2F06%2F13%2Fted-cruz-alexandria-ocasio-cortez-partnership-1364592&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C1%7C637141108076266954&amp;sdata=PS710H%2F%2BXTJcloEufEIhOt2fjoN9Wv6csq4liwrcyX4%3D&amp;reserved=0" target="_blank">support</a>&nbsp;making “the pill” available without a&nbsp;prescription.</p> <p>While women in a&nbsp;<a href="https://www.contraceptionjournal.org/article/S0010-7824(12)01029-3/fulltext" target="_blank">majority of countries</a>&nbsp;can purchase birth control without a&nbsp;prescription, neither party’s leading reform bill would give American women that ability.</p> </div> , <aside class="aside--right aside pb-lg-0 pt-lg-2"> <div class="pullquote pullquote--default"> <div class="pullquote__content h2"> <p>Women have a&nbsp;right to purchase contraceptives without government either forcing them to obtain a&nbsp;doctor’s permission or increasing the price of their birth control.</p> </div> </div> </aside> , <div class="text-default"> <p>The current prescription requirement is a&nbsp;significant impediment to reproductive freedom. Nearly a&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F26666711&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C1%7C637141108076266954&amp;sdata=wyxy4wB0h6BjkTFDbvEstkYghngaIvYSxBoF6RLtJKQ%3D&amp;reserved=0" target="_blank">third of women</a>&nbsp;report difficulty obtaining prescriptions. The doctor visit alone might cost up to&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmoney.usnews.com%2Fmoney%2Fpersonal-finance%2Ffamily-finance%2Farticles%2Fthe-cost-of-birth-control&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C1%7C637141108076276952&amp;sdata=c7t8eKT3B%2BCyshiesAcgeCMTegIcXr9FiEVmOJCmJmY%3D&amp;reserved=0" target="_blank">$200</a>. In a&nbsp;2016 survey of barriers to accessing contraception,&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F26666711&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C1%7C637141108076276952&amp;sdata=G2pOURpRA9HrlYs8LSACl99fFnwcbHx64VkI89DYhgw%3D&amp;reserved=0" target="_blank">women cited such obstacles</a>&nbsp;as scheduling and getting to their appointments twice as often as they cited difficulty paying for the visit or the prescription.</p> <p>The&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.acog.org%2F-%2Fmedia%2FCommittee-Opinions%2FCommittee-on-Gynecologic-Practice%2Fco788.pdf&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C1%7C637141108076286945&amp;sdata=%2BJ5BP4%2B%2FXBmMi%2Fv06X2%2FSdOZVEkd1F9yrsZj%2B39uQ4Y%3D&amp;reserved=0" target="_blank">American College of Obstetricians and Gynecologists</a>&nbsp;and the&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.aafp.org%2Fabout%2Fpolicies%2Fall%2Fotc-oral-contraceptives.html&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C1%7C637141108076296931&amp;sdata=9YcM2JKWQKNejCfUpzgwLJLqDhOO3eXNmIHuoNckiCw%3D&amp;reserved=0" target="_blank">American Academy of Family Physicians</a>&nbsp;support eliminating the prescription requirement. A&nbsp;2016 survey of reproductive healthcare providers found&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.whijournal.com%2Farticle%2FS1049-3867(15)00140-1%2Ffulltext&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C0%7C637141108076296931&amp;sdata=TlHh8IFWBgRSoTcD8y8pyqTsAp00mTetXM9tUSitTgk%3D&amp;reserved=0" target="_blank">a&nbsp;majority support</a>&nbsp;over‐​the‐​counter status, which would probably&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fjournals.lww.com%2Fgreenjournal%2FFulltext%2F2011%2F03000%2FContinuation_of_Prescribed_Compared_With.6.aspx&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C1%7C637141108076306928&amp;sdata=E6OzQAbWTZfRrlKPJMGcaKmwoys%2FRE3zqaiR%2B6Szz8A%3D&amp;reserved=0" target="_blank">increase adherence</a>.</p> <p>Switching a&nbsp;drug from prescription to over‐​the‐​counter status also typically causes its price to fall. For instance, the price of a&nbsp;day’s supply of the anti‐​heartburn medication omeprazole fell&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.jmcp.org%2Fdoi%2Fpdf%2F10.18553%2Fjmcp.2004.10.5.449&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C1%7C637141108076306928&amp;sdata=%2FShqEsUW2lokE6uOGa8janbEBzgIWpqrRu968vYtzMw%3D&amp;reserved=0" target="_blank">nearly by half</a>, from almost $4.20 to $2.35. The&nbsp;<a href="https://www.jmcp.org/doi/pdf/10.18553/jmcp.2004.10.5.449" target="_blank">price of the antihistamine loratadine</a>&nbsp;also fell by half, to just $1 per pill. Prices for&nbsp;<a href="https://www.drugtopics.com/new-products/health-plans-pleased-allergy-drugs-otc-switch" target="_blank">drugs that become available over the counter</a>&nbsp;often fall below what many insured patients had been paying in copays.</p> <p>Neither the Republicans’ bill nor the Democrats’ would deliver lower prices because neither would make the pill available over the counter. Instead, each leaves that decision with the executive branch — the same branch that blocked access to “Plan B” emergency contraception (a.k.a. the morning‐​after pill) — for political reasons for more than a&nbsp;dozen years under Republican and Democratic administrations.</p> <p>Adding insult to indifference, the Republicans’ bill would entrench existing prescription requirements, while the Democrats’ bill would increase prices for contraceptives.</p> <p>The FDA imposed the current prescription requirement, which means the agency has the authority to remove it. The Republicans’ bill would lock in that requirement with regard to minors by requiring an act of Congress to remove it — a&nbsp;much higher hurdle.</p> <p>This makes no sense. The American College of Obstetricians and Gynecologists urges over‐​the‐​counter access to all hormonal contraceptives “without age restrictions.” Congress already leaves minors free to purchase Plan B— and even&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.nejm.org%2Fdoi%2Ffull%2F10.1056%2FNEJMp1114439&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C1%7C637141108076336915&amp;sdata=fTh6AvNxzBkLPyqr%2Bhof%2FdkdmcARgSUBpXEEqTZ%2BN2M%3D&amp;reserved=0" target="_blank">lethal doses</a>&nbsp;of acetaminophen, aspirin and other over‐​the‐​counter drugs — without a&nbsp;prescription. Yet the GOP bill would deny minors access to a&nbsp;low‐​risk drug that prevents them from getting pregnant and reduces the incidence of abortion.</p> <p>The Democrats’ bill attempts to expand access by requiring insurers to pay 100% of the cost of over‐​the‐​counter contraceptives for their enrollees. But after the government phased in an identical requirement for prescription contraceptives in 2014, prices for hormones and oral contraceptives&nbsp;<a href="https://fred.stlouisfed.org/series/WPU06380105#0" target="_blank">stopped falling</a>&nbsp;and instead skyrocketed. By 2019, they had risen three times as fast as prices for prescription drugs overall.</p> <p>Again, the Democrats’ bill would not make birth control available over the counter. But if it did, such a&nbsp;mandate would make it more expensive. Higher prices would reduce access for consumers who purchase contraceptives without health insurance, including minors who don’t want to purchase them through their parents’ insurance.</p> <p>Women have a&nbsp;<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.amazon.com%2FPharmaceutical-Freedom-Patients-Right-Medicate%2Fdp%2F0190684542&amp;data=02%7C01%7Cvalerie.nelson%40latimes.com%7C929185c1e3ee42bb7f0308d79476495a%7Ca42080b34dd948b4bf44d70d3bbaf5d2%7C0%7C0%7C637141108076356910&amp;sdata=zqK7O7%2B%2F35ewClbIAUDdmk%2FE%2B72cW3bXZFpc3dHamGQ%3D&amp;reserved=0" target="_blank">right</a>&nbsp;to purchase contraceptives without government either forcing them to obtain a&nbsp;doctor’s permission or increasing the price of their birth control.</p> <p>Congress should revoke the FDA’s power to require women to obtain a&nbsp;prescription to buy contraceptives, whether or not their insurance covers them. If Congress fails to act, the FDA should use its authority to eliminate the prescription requirement.</p> <p>Birth control should be affordable and so easy to access that women can simply send the men in their lives to the store to buy it.</p> </div> Mon, 27 Jan 2020 08:57:17 -0500 Michael F. Cannon, Jeffrey A. Singer https://www.cato.org/publications/commentary/birth-control-should-be-available-over-counter-how-congress-can-make-happen John Lewis, Libertarian Hero https://www.cato.org/publications/commentary/john-lewis-libertarian-hero Michael F. Cannon <div class="lead text-default"> <p>The Civil Rights Movement was a&nbsp;citizens’ rebellion against one of the longest, most brutal episodes of oppression the United States has seen.</p> </div> , <div class="text-default"> <p>Nearly 100&nbsp;years after the 14th and 15th Amendments to the U.S. Constitution supposedly made African‐​Americans free and equal citizens and guaranteed them the right to vote, Southern states denied African‐​Americans the most basic protection governments owe their citizens—protection of bodily integrity—as well as their rights to speak, protest, vote, work, exchange, travel, and marry. Government officials routinely used violence against black Americans who tried to claim equal status or equal protection of the laws. Government officials tolerated and even encouraged groups of white racists that terrorized and murdered black Americans. White majorities in Southern states denied African‐​Americans the right to vote precisely because allowing blacks to vote would threaten this deliberate system of apartheid. Not unimportantly, this system also violated the rights of other Americans to marry, work, exchange, and travel with African‐​Americans.</p> <p>The Civil Rights Movement, whose goal was to enforce the rights of all Americans to be secure in their persons, to vote, to work, to exchange, to travel, and to marry, was a&nbsp;libertarian force. It did more to advance freedom within the United States than any other movement in the past century.</p> <p>One of the last surviving leaders of the Civil Rights Movement is John Lewis of Georgia.</p> </div> , <h3 class="heading"> John Lewis’ Contributions to Human Freedom </h3> , <div class="text-default"> <p>John Lewis has made courageous and principled contributions to human freedom. He has been a&nbsp;libertarian force in his campaigns for individual rights, his advocacy for freedom in moral terms, his commitment to peaceful protest, and his fight to save American society from the forces of savagery.</p> <p>Few in the libertarian movement have suffered as much as Lewis for the cause of freedom. Lewis offered his voice and his body—and sacrificed his right to self-defense—to make Americans confront the violence inherent in the Southern system of government‐​imposed white‐​supremacist tyranny.</p> <p>In the early 1960s, Lewis was sacrificing his body and liberty to protest laws restricting the freedoms of movement, association, and exchange. As an undergraduate at Fisk University in Nashville, Lewis organized non‐​violent sit‐​ins at segregated lunch counters</p> </div> , <figure class="figure overflow-hidden figure--default responsive-embed-no-margin-wrapper"> <div class="figure__media"> <img width="700" height="540" alt="Two Nashville Police officers carry John Lewis after he refused to obey orders during a protest at Herschel’s Tic Toc restaurant in Nashville in 1962." class="lozad component-image" data-srcset="/sites/cato.org/files/styles/pubs/public/2020-01/Lewis-John_Nashville-arrest1961-1170x903.jpg?itok=YOY22hfb 1x, /sites/cato.org/files/styles/pubs_2x/public/2020-01/Lewis-John_Nashville-arrest1961-1170x903.jpg?itok=5_uiPiE0 1.5x" data-src="/sites/cato.org/files/styles/pubs/public/2020-01/Lewis-John_Nashville-arrest1961-1170x903.jpg?itok=YOY22hfb" typeof="Image" /> </div> <figcaption class="figure__caption"> <div class="modifiers modifiers-id-paragraph-110416 modifiers-type-paragraph modifiers-bundle-caption modifiers-display-default figure-caption text-sans-alternate"> <p>Photo: The Tennessean</p> </div> </figcaption> </figure> , <div class="text-default"> <p>As a Freedom Rider, Lewis spent years putting himself in danger to protest laws prohibiting blacks and whites from sitting beside each other on public transportation. He was the first Freedom Rider to encounter violence by white supremacists, who bludgeoned him on multiple occasions. <a href="https://www.smithsonianmag.com/history/the-freedom-riders-then-and-now-45351758/?c=y&amp;page=1"><em>Smithsonian</em></a> magazine reports that in 1961:</p> <p><blockquote>While trying to enter a whites-only waiting room in Rock Hill, South Carolina, two men set upon [Lewis], battering his face and kicking him in the ribs. Less than two weeks later, Lewis joined a ride bound for Jackson.</blockquote></p> </div> , <figure class="figure overflow-hidden figure--default responsive-embed-no-margin-wrapper"> <div class="figure__media"> <img width="700" height="392" alt="John Lewis 2" class="lozad component-image" data-srcset="/sites/cato.org/files/styles/pubs/public/2020-01/t_1470669143142_name_20160908_FreedomTN.jpg?itok=-B7dIJ4k 1x, /sites/cato.org/files/styles/pubs_2x/public/2020-01/t_1470669143142_name_20160908_FreedomTN.jpg?itok=-KKdHyLq 1.5x" data-src="/sites/cato.org/files/styles/pubs/public/2020-01/t_1470669143142_name_20160908_FreedomTN.jpg?itok=-B7dIJ4k" typeof="Image" /> </div> <figcaption class="figure__caption"> <div class="modifiers modifiers-id-paragraph-110433 modifiers-type-paragraph modifiers-bundle-caption modifiers-display-default figure-caption text-sans-alternate"> <p>(Birmingham Public Library)</p> </div> </figcaption> </figure> , <figure class="figure overflow-hidden figure--default responsive-embed-no-margin-wrapper"> <div class="figure__media"> <img width="700" height="350" alt="John Lewis 3" class="lozad component-image" data-srcset="/sites/cato.org/files/styles/pubs/public/2020-01/635676614304984377-80364-1.jpg?itok=KRzifwuX 1x, /sites/cato.org/files/styles/pubs_2x/public/2020-01/635676614304984377-80364-1.jpg?itok=OVkw4nCP 1.5x" data-src="/sites/cato.org/files/styles/pubs/public/2020-01/635676614304984377-80364-1.jpg?itok=KRzifwuX" typeof="Image" /> </div> <figcaption class="figure__caption"> <div class="modifiers modifiers-id-paragraph-110434 modifiers-type-paragraph modifiers-bundle-caption modifiers-display-default figure-caption text-sans-alternate"> <p>Photo: AP Photo / The Tennessean</p> </div> </figcaption> </figure> , <div class="text-default"> <p>As Lewis later <a href="https://www.cnn.com/2001/US/05/10/access.lewis.freedom.rides/">explained</a>, the violence followed them across the South:</p> <blockquote><p>It was very violent. It was 13 of us on the original ride—seven whites and six blacks…</p> <p>We were beaten in Birmingham, and later met by an angry mob in Montgomery, where I&nbsp;was hit in the head with a&nbsp;wooden crate. It was very violent. I&nbsp;thought I&nbsp;was going to die. I&nbsp;was left lying at the Greyhound bus station in Montgomery unconscious.</p></blockquote> <p>In 1961, Lewis spent 37&nbsp;days in Mississippi’s Parchman Penitentiary after his arrest for violating a&nbsp;segregation law. He had <a href="https://www.vox.com/2014/7/7/5877957/rep-john-lewis-memories-of-a-mississippi-prison-during-the-freedom">used</a> a&nbsp;whites‐​only restroom.</p> </div> , <figure class="figure overflow-hidden figure--default responsive-embed-no-margin-wrapper"> <div class="figure__media"> <img width="680" height="522" alt="John Lewis Mug" class="lozad component-image" data-srcset="/sites/cato.org/files/styles/pubs/public/2020-01/Br8gBJnCcAAo_Ig.jpeg?itok=XIkIv4Yp 1x, /sites/cato.org/files/styles/pubs_2x/public/2020-01/Br8gBJnCcAAo_Ig.jpeg?itok=MkKMg9Jv 1.5x" data-src="/sites/cato.org/files/styles/pubs/public/2020-01/Br8gBJnCcAAo_Ig.jpeg?itok=XIkIv4Yp" typeof="Image" /> </div> <figcaption class="figure__caption"> <div class="modifiers modifiers-id-paragraph-110435 modifiers-type-paragraph modifiers-bundle-caption modifiers-display-default figure-caption text-sans-alternate"> <p>@repjohnlewis via Twitter</p> </div> </figcaption> </figure> , <div class="text-default"> <p>On August 28, 1963, Lewis at the age of 23 was the youngest <a href="https://en.wikipedia.org/wiki/March_on_Washington_for_Jobs_and_Freedom#/media/File:March-on-washington-jobs-freedom-program.jpg">speaker</a> at the March on Washington for Jobs and Freedom.</p> </div> , <figure class="figure overflow-hidden figure--default responsive-embed-no-margin-wrapper"> <div class="figure__media"> <img width="700" height="470" alt="John Lewis MOW" class="lozad component-image" data-srcset="/sites/cato.org/files/styles/pubs/public/2020-01/DL_1963.08LewisMOW.jpg?itok=ZnzUstmB 1x, /sites/cato.org/files/styles/pubs_2x/public/2020-01/DL_1963.08LewisMOW.jpg?itok=FUZdVlZN 1.5x" data-src="/sites/cato.org/files/styles/pubs/public/2020-01/DL_1963.08LewisMOW.jpg?itok=ZnzUstmB" typeof="Image" /> </div> <figcaption class="figure__caption"> <div class="modifiers modifiers-id-paragraph-110436 modifiers-type-paragraph modifiers-bundle-caption modifiers-display-default figure-caption text-sans-alternate"> ©Danny Lyon / Magnum Photos </div> </figcaption> </figure> , <div class="text-default"> <p>He was <a href="https://snccdigital.org/events/march-on-washington/" id="E488" target="_blank">the most forceful</a> of the day’s speakers in demanding freedom for African‐​Americans. In terms that will be familiar to libertarians, he <a href="http://voicesofdemocracy.umd.edu/lewis-speech-at-the-march-on-washington-speech-text/" id="E494" target="_blank">implored</a> his countrymen to fight the tyranny under which African‐​Americans lived, and called on them to fulfill the ideals of the American Revolution:</p> <blockquote><p>While we stand here there are students in jail on trumped‐​up charges. Our brother James Farmer, along with many others, is also in jail…</p> <p>It is true that we support the administration’s civil rights bill. We support it with great reservations, however. Unless [Congress <a href="https://www.justice.gov/crt/title-iii-civil-rights-act-1964-42-usc-2000b" id="E527" target="_blank">strengthens</a> the bill], there is nothing to protect the young children and old women who must face police dogs and fire hoses in the South while they engage in peaceful demonstrations. In its present form, this bill will not protect the citizens of Danville, Virginia, who must live in constant fear of a&nbsp;police state. It will not protect the hundreds and thousands of people that have been arrested on trumped charges. What about the three young men, SNCC field secretaries in Americus, Georgia, who face the <a href="https://www.crmvet.org/docs/641205_sncc_pr_americus.pdf" id="E536" target="_blank">death penalty</a> for engaging in peaceful protest?…</p> <p>By and large, American politics is dominated by politicians who build their careers on immoral compromises and ally themselves with open forms of political, economic, and social exploitation…</p> <p>Where is the political party that will make it unnecessary to march in the streets of Birmingham? Where is the political party that will protect the citizens of Albany, Georgia? Do you know that in Albany, Georgia, nine of our leaders have been indicted, not by the Dixiecrats, but by the federal government for peaceful protest? But what did the federal government do when Albany’s deputy sheriff beat Attorney C.B. King and left him half‐​dead? What did the federal government do when local police officials kicked and assaulted the pregnant wife of Slater King, and she lost her baby?…</p> <p>We do not want our freedom gradually, but we want to be free now! We are tired. We are tired of being beaten by policemen. We are tired of seeing our people locked up in jail over and over again. And then you holler, “Be patient.” How long can we be patient? We want our freedom and we want it now. We do not want to go to jail. But we will go to jail if this is the price we must pay for love, brotherhood, and true peace.</p> <p>I appeal to all of you to get into this great revolution that is sweeping this nation. Get in and stay in the streets of every city, every village and hamlet of this nation until true freedom comes, until the revolution of 1776 is complete.</p></blockquote> <p>In 1964, Lewis organized voter‐​registration drives as part of the Mississippi Freedom Summer. Lewis sought to register previously disenfranchised black voters because he knew, as Friedrich Hayek <a href="https://books.google.com/books?id=EyNHBAAAQBAJ&amp;pg=PA110&amp;lpg=PA110&amp;dq=%E2%80%9Cis+an+obstacle+to+the+suppression+of+freedom%22&amp;source=bl&amp;ots=eCRk3U0zo8&amp;sig=dnj-BouOkzT65Lo__e56SFSm3n4&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwiEv-jr0tzXAhUpY98KHcCuBmwQ6AEILjAC" id="E588" target="_blank">explained</a>, “democracy…is an obstacle to the suppression of freedom.”</p> <p>On March 7, 1965, Lewis led a&nbsp;peaceful march across the Edmund Pettus Bridge in Selma, Alabama. The purpose of the march was to secure voting rights for African‐​Americans, in the hope of ending government tyranny against blacks.</p> </div> , <figure class="figure overflow-hidden figure--default figure--no-caption responsive-embed-no-margin-wrapper"> <div class="figure__media"> <img width="700" height="344" alt="John Lewis Selma" class="lozad component-image" data-srcset="/sites/cato.org/files/styles/pubs/public/2020-01/12328_2006_001_pr.jpg?itok=Kix_H7OK 1x, /sites/cato.org/files/styles/pubs_2x/public/2020-01/12328_2006_001_pr.jpg?itok=Gs0QENPD 1.5x" data-src="/sites/cato.org/files/styles/pubs/public/2020-01/12328_2006_001_pr.jpg?itok=Kix_H7OK" typeof="Image" /> </div> </figure> , <div class="text-default"> <p>Historians call that date “Bloody Sunday” because government agents, including many on horses, attacked the peaceful demonstrators with tear gas and billy clubs. An Alabama policeman fractured Lewis’ skull.</p> <p>Various government agents <a href="http://www.creativeloafing.com/news/article/13075925/congressman-john-lewis-adds-arrest-no-45-at-least-to-rap-sheet" id="E648" target="_blank">arrested</a> and imprisoned Lewis more than 40 times for peacefully protesting tyranny. Lewis watched government agents and domestic terrorists kill his friends, colleagues, political patrons, and mentors. Lewis knew these men would never face prosecution.</p> <p>Yet Lewis never responded with violence. He had a&nbsp;right to use violence to defend himself. He set aside that right to bring freedom to others.</p> <p>Instead, Lewis has demonstrated civility, magnanimity, and forgiveness toward his oppressors. Decades after two men assaulted him in that South Carolina waiting room, one of them apologized to him. Lewis did something he didn’t have to do. He graciously <a href="http://abcnews.go.com/print?id=6813984" id="E703" target="_blank">accepted</a> his assailant’s apology:</p> <blockquote><p>“I’m so sorry about what happened back then,” [Elwin] Wilson said breathlessly.</p> <p>“It’s okay. I&nbsp;forgive you,” Lewis responded before a&nbsp;long‐​awaited hug.</p></blockquote> <p>Lewis has advanced other libertarian causes. He peacefully protested South Africa’s policy of racial apartheid, leading to two <a href="http://www.creativeloafing.com/news/article/13075925/congressman-john-lewis-adds-arrest-no-45-at-least-to-rap-sheet" id="E726" target="_blank">arrests</a> outside that nation’s embassy in Washington, D.C. He peacefully protested Sudan’s genocide in Darfur, leading to two <a href="http://www.creativeloafing.com/news/article/13075925/congressman-john-lewis-adds-arrest-no-45-at-least-to-rap-sheet" id="E739" target="_blank">arrests</a> outside the Sudanese embassy. He has protested the Iraq War, <a href="https://www.youtube.com/watch?v=ThqtmcWoUg8&amp;feature=youtu.be" id="E747" target="_blank">introducing</a> legislation to postpone tax cuts until the United States ends its wars in Iraq and Afghanistan. He has protested in favor of immigrant rights, leading to his <a href="https://www.upi.com/8-members-of-Congress-arrested-at-immigration-reform-demonstration/88761381213800/" id="E756" target="_blank">arrest</a> near the U.S. Capitol.</p> </div> , <h3 class="heading"> Weighing Lewis’ Contributions </h3> , <div class="text-default"> <p>Some libertarians will protest that Lewis has taken un‐​libertarian positions over the course of his career. I&nbsp;certainly disagree with many of his positions.</p> <p>Yet libertarians routinely venerate the words and accomplishments of <a href="https://www.washingtonexaminer.com/jefferson-memorial-exhibit-update-will-acknowledge-slavery-record" id="E778" target="_blank">Thomas Jefferson</a>, <a href="https://www.montpelier.org/visit/mere-distinction" id="E781" target="_blank">James Madison</a>, and <a href="https://www.washingtonpost.com/local/education/gmu-to-erect-memorial-honoring-more-than-100-people-enslaved-by-george-mason/2019/09/28/5b993076-e142-11e9-be96-6adb81821e90_story.html" id="E785" target="_blank">George Mason</a>, even though these men enslaved other humans. Libertarians honor these men not because they are perfect, but because these imperfect men moved their imperfect world in the direction of greater freedom.</p> <p>Lewis’ contributions to human freedom likewise far outweigh his imperfections. If libertarians can honor Founding Fathers who participated in “<a href="https://avalon.law.yale.edu/18th_century/debates_606.asp" id="E819" target="_blank">the most oppressive dominion ever exercised by man over man</a>,” we can honor John Lewis even though he supports single‐​payer health care.</p> <p>In May, the Cato Institute will present its 10th biennial <a href="https://www.cato.org/friedman-prize" id="E836" target="_blank">Milton Friedman Prize for Advancing Liberty</a>. If I&nbsp;were on the selection committee, my vote would go to John Lewis.</p> </div> , <h3 class="heading"> Show a&nbsp;Little Love </h3> , <div class="text-default"> <p>Libertarians often wonder why our movement is not broader or more diverse. One reason might be that it has yet to honor the libertarian goals and successes of the Civil Rights Movement, or the sacrifices its <a href="https://www.crmvet.org/vet/vethome.htm" id="E850" target="_blank">participants</a> made.</p> <p>Libertarians often claim, for example, that Americans are less free now than they were 100&nbsp;years ago, when the federal government was smaller. Such claims either ignore or undervalue the <a href="https://reason.com/2010/04/06/up-from-slavery/" id="E862" target="_blank">tremendous</a> <a href="https://www.cato.org/blog/slavery-continued" id="E865" target="_blank">gains</a> in freedom African‐​Americans have seen over that time. When we casually elide the oppression others have suffered, they tend to notice. John Lewis was a&nbsp;driving force behind those gains.</p> <p>Lewis struggled long and hard to secure for African‐​Americans freedoms that most white Americans never lacked. Along the way, his efforts helped to expand the freedom of whites and others to speak, protest, vote, work, exchange, travel, and marry and procreate with African‐​Americans.</p> <p>At age 79, Lewis is the <a href="http://www.businessinsider.com/john-lewis-speech-march-on-washington-50th-anniversary-martin-luther-king-i-have-a-dream-2013-8" id="E896" target="_blank">last</a> surviving speaker from the March on Washington. He has beaten the <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_07-508.pdf" id="E899" target="_blank">actuarial tables</a> for African‐​American men. But he will not live forever. Last month, Lewis announced he has <a href="https://www.cnn.com/2019/12/29/politics/john-lewis-pancreatic-cancer/index.html" id="E905" target="_blank">stage four pancreatic cancer</a>.</p> <p>On this Martin Luther King Jr. Day, throw a&nbsp;little love to all those in the Civil Rights Movement who gave their minds, gave their bodies, and sacrificed for the cause of freedom. In particular, throw a&nbsp;little love to John Lewis. He could probably use it right now. He most certainly deserves it.</p> </div> Fri, 17 Jan 2020 16:14:43 -0500 Michael F. Cannon https://www.cato.org/publications/commentary/john-lewis-libertarian-hero Trump Clearly Doesn’t Care to Get His Facts Straight. Neither Do His Critics. https://www.cato.org/blog/trump-clearly-doesnt-care-get-facts-straight-neither-do-critics Michael F. Cannon <p>The public debate over how to protect patients with expensive medical conditions is so muddled and uninformed that sometimes President Trump’s critics end up matching his ignorance and muddle‐​headedness.</p> <p>The most recent controversy concerns (what else?) a pair of missives by the Tweeter‐​in‐​Chief.</p> <p> <div data-embed-button="embed" data-entity-embed-display="view_mode:media.blog_post" data-entity-type="media" data-entity-uuid="50c5af3c-8bb3-4608-961a-e24dd3fd43e2" data-langcode="en" class="embedded-entity"> <div class="embed embed--twitter js-embed js-embed--twitter"> <blockquote class="twitter-tweet"><p lang="en" dir="ltr" lang="en" lang="en">Mini Mike Bloomberg is spending a lot of money on False Advertising. I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now, while at the same time winning the fight to rid you of the expensive, unfair and very unpopular Individual Mandate.....</p>— Donald J. Trump (@realDonaldTrump) <a href="https://twitter.com/realDonaldTrump/status/1216716337822695425?ref_src=twsrc%5Etfw">January 13, 2020</a></blockquote> </div> </div> <div data-embed-button="embed" data-entity-embed-display="view_mode:media.blog_post" data-entity-type="media" data-entity-uuid="82212379-46ee-4f23-9712-a35c838a0ca1" data-langcode="en" class="embedded-entity"> <div class="embed embed--twitter js-embed js-embed--twitter"> <blockquote class="twitter-tweet"><p lang="en" dir="ltr" lang="en" lang="en">I stand stronger than anyone in protecting your Healthcare with Pre-Existing Conditions. I am honored to have terminated the very unfair, costly and unpopular individual mandate for you!</p>— Donald J. Trump (@realDonaldTrump) <a href="https://twitter.com/realDonaldTrump/status/1216872069591289858?ref_src=twsrc%5Etfw">January 13, 2020</a></blockquote> </div> </div> </p><p>It is hard to argue Trump’s words comport to reality. He seems to be taking credit for ObamaCare’s (<a href="https://www.healthaffairs.org/do/10.1377/hblog20180103.261091/full/">purported</a>) ban on insurers discriminating against enrollees with preexisting conditions. While he has seemed to suggest in the past that he likes those parts of the Affordable Care Act, his supporters have spun his remarks by saying, no, Trump wants to take care of people with preexisting conditions in a different way. Fine.</p> <p>The only credible claim Trump could make in this area, however, is that the changes his administration made to short‐​term, limited duration plans have improved access to care. But while such <a href="https://media4.manhattan-institute.org/sites/default/files/R-0519-CP.pdf">renewable term health insurance</a> can make coverage <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.3.w242">more secure</a> for those who develop expensive conditions in the future–and can therefore make the problem of preexisting conditions smaller–they can’t really help people who already have preexisting conditions, for the same reason fire insurance can’t really help someone whose house has already burned down. The phrase <em>preexisting conditions</em> rather unhelpfully clouds this fact that some medical conditions are simply not insurable. People who actually want to get sick people the health care they need should drop the phrase from their vocabulary and speak only of <em>insurable</em> versus <em>uninsurable </em>medical conditions.</p> <p>Trump’s critics are little better. A smattering:</p> <p> <div data-embed-button="embed" data-entity-embed-display="view_mode:media.blog_post" data-entity-type="media" data-entity-uuid="b201c75c-9a3b-42cc-a074-31cf05cdcbc1" data-langcode="en" class="embedded-entity"> <div class="embed embed--twitter js-embed js-embed--twitter"> <blockquote class="twitter-tweet"><p lang="en" dir="ltr" lang="en" lang="en">Glad to see you're watching our ads, <a href="https://twitter.com/realDonaldTrump?ref_src=twsrc%5Etfw">@realDonaldTrump</a>. I know management isn't your strong suit, so perhaps you don't know your Justice Department supports a suit that would undermine protections for pre-existing conditions. Now that you know, why not ask them to drop the suit?</p>— Mike Bloomberg (@MikeBloomberg) <a href="https://twitter.com/MikeBloomberg/status/1216733637326012417?ref_src=twsrc%5Etfw">January 13, 2020</a></blockquote> </div> </div> <div data-embed-button="embed" data-entity-embed-display="view_mode:media.blog_post" data-entity-type="media" data-entity-uuid="44e35636-5f03-4445-a85e-576ed34c5251" data-langcode="en" class="embedded-entity"> <div class="embed embed--twitter js-embed js-embed--twitter"> <blockquote class="twitter-tweet"><p lang="en" dir="ltr" lang="en" lang="en">130 million Americans live every day with pre-existing conditions. They depend on knowing their health care, secured by protections in the ACA, is there when they need it. <a href="https://twitter.com/hashtag/ProtectOurCare?src=hash&amp;ref_src=twsrc%5Etfw">#ProtectOurCare</a></p>— Nancy Pelosi (@SpeakerPelosi) <a href="https://twitter.com/SpeakerPelosi/status/1216800116973211648?ref_src=twsrc%5Etfw">January 13, 2020</a></blockquote> </div> </div> <div data-embed-button="embed" data-entity-embed-display="view_mode:media.blog_post" data-entity-type="media" data-entity-uuid="3ff616dd-f935-4d7e-beb1-6533ee50e5ac" data-langcode="en" class="embedded-entity"> <div class="embed embed--twitter js-embed js-embed--twitter"> <blockquote class="twitter-tweet"><p lang="en" dir="ltr" lang="en" lang="en">Rather than amplify a baldfaced lie just going to reiterate the truth: Republicans, including Donald Trump, have engaged in an unrelenting campaign to rip health insurance, including protections for preexisting conditions, from tens of millions of people.</p>— Ezra Klein (@ezraklein) <a href="https://twitter.com/ezraklein/status/1216739630017470474?ref_src=twsrc%5Etfw">January 13, 2020</a></blockquote> </div> </div> <div data-embed-button="embed" data-entity-embed-display="view_mode:media.blog_post" data-entity-type="media" data-entity-uuid="c69f8357-964e-4f9c-98c2-4bae765d1afa" data-langcode="en" class="embedded-entity"> <div class="embed embed--twitter js-embed js-embed--twitter"> <blockquote class="twitter-tweet"><p lang="en" dir="ltr" lang="en" lang="en">Of all of Trump’s lies, his claim that Dems are trying to take away coverage for those with preexisting conditions is the most brazen. Whatever your view of policy, this is just trying to blunt a political weak point by pinning it on the other side. No one on his side flinches. <a href="https://t.co/NTXkLP1w6W">https://t.co/NTXkLP1w6W</a></p>— Orin Kerr (@OrinKerr) <a href="https://twitter.com/OrinKerr/status/1216753065950232576?ref_src=twsrc%5Etfw">January 13, 2020</a></blockquote> </div> </div> </p><p>Trump clearly does not care to get his facts straight. But neither do his critics. They ignore the critical distinction between insurable and uninsurable medical conditions. They ignore that markets have done a better job of <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.3.w242">preventing preexisting conditions</a> than the government on which they pin their hopes for the sick. They ignore that the ACA’s (purported) protections for people with preexisting conditions literally <a href="https://www.consumerreports.org/health-insurance/short-term-health-insurance-isnt-as-cheap-as-you-think/">ration care</a> to the sick outside the law’s “open enrollment” period. They ignore that those same “protections” are forcing ACA plans into a <a href="https://www.healthaffairs.org/do/10.1377/hblog20180103.261091/full/">race to the bottom</a> on coverage for multiple sclerosis and other illnesses. Finally, they ignore that <em>Democrats are literally trying to throw people with preexisting conditions out of their health plans and leave them with no coverage for up to 12 months</em>, while Republicans have prevented Democrats from throwing people with preexisting conditions out of their health plans. I wrote about those efforts in the <em><a href="https://www.wsj.com/articles/first-do-no-harm-to-obamacare-1539298783">Wall Street Journal</a> </em>in 2018. The <em>New York Times </em>reports on those efforts <a href="https://www.nytimes.com/2019/05/09/us/politics/democrats-health-trump.html">here</a>.</p> <p>Like I said, it’s a muddle. Trump makes so many errors because he just assumes he’s right. Trump’s critics make so many critical errors because that’s how orthodoxy works. So long as everyone you like agrees, you don’t have to think too much. Which is really not all that different from Trump’s approach.</p> Tue, 14 Jan 2020 11:28:08 -0500 Michael F. Cannon https://www.cato.org/blog/trump-clearly-doesnt-care-get-facts-straight-neither-do-critics Michael F. Cannon discusses the 10 years of the ACA on Fox Nation’s Deep Dive https://www.cato.org/multimedia/media-highlights-tv/michael-f-cannon-discusses-10-years-aca-fox-nations-deep-dive Wed, 08 Jan 2020 11:42:48 -0500 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-tv/michael-f-cannon-discusses-10-years-aca-fox-nations-deep-dive Michael F. Cannon discusses price transparency on KFTK’s The Randy Tobler Show https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannon-discusses-price-transparency-kftks-randy-tobler Fri, 20 Dec 2019 12:06:51 -0500 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannon-discusses-price-transparency-kftks-randy-tobler Michael F. Cannon discusses health care on The Bob Harden Show https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannon-discusses-health-care-bob-harden-show Thu, 21 Nov 2019 10:07:50 -0500 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannon-discusses-health-care-bob-harden-show Michael F. Cannon discusses Elizabeth Warren’s healthcare plan on WWL’s First News with Tommy Tucker https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannon-discusses-elizabeth-warrens-healthcare-plan-wwls Tue, 05 Nov 2019 13:26:38 -0500 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-radio/michael-f-cannon-discusses-elizabeth-warrens-healthcare-plan-wwls Sen. Chuck Grassley (R‑IA) cites Michael F. Cannon’s blog post, “Senate Finance Committee Considers Proposals to Cut Wasteful Medicare Spending,” on C‑SPAN 2 https://www.cato.org/multimedia/media-highlights-tv/sen-chuck-grassley-r-ia-cites-michael-f-cannons-blog-post-senate Tue, 05 Nov 2019 11:17:04 -0500 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-tv/sen-chuck-grassley-r-ia-cites-michael-f-cannons-blog-post-senate Republican Study Committee Proposes an $11 Trillion Tax Cut https://www.cato.org/blog/house-conservatives-health-plan-includes-828-billion-effective-tax-cut Michael F. Cannon <p>The Republican Study Committee, a&nbsp;group of conservative House Republicans, has issued a&nbsp;health reform proposal. It’s not the first thing on <a href="http://rsc-johnson.house.gov">the RSC web site</a>, but scroll down and you’ll find it. The proposal has much to commend it.</p> <p><strong>Freeing Consumers from Harmful Regulations</strong></p> <p>Notably, it would repeal the Affordable Care Act’s <a href="https://0776ee3c-67a0-42b8-9612-92234ccfdd01/health%20care%20survey%20cato%202017">consistently</a> <a href="https://www.cato.org/blog/poll-acas-pre-existing-conditions-regulations-lose-support-when-public-learns-costs">unpopular</a> preexisting‐​conditions provisions, which not only <a href="https://www.healthaffairs.org/do/10.1377/hblog20180103.261091/full/">make coverage worse for the sick</a> but <a href="https://www.healthaffairs.org/do/10.1377/hblog20180103.261091/full/">leave <em>every </em>ACA enrollee with inadequate coverage</a>. (Can you say, “junk insurance”?) One of the reasons Republicans <a href="https://nypost.com/2018/11/09/why-republicans-lost-the-pre-existing-conditions-war/">suffered losses</a> in the 2018 mid‐​term elections was their failure to expose how those <a href="https://www.healthaffairs.org/do/10.1377/hblog20180103.261091/full/">supposed consumer protections</a> are harming the very patients they purport to help. Had they done so, they could have turned independents and even many Democrats to their side.</p> <p>Ironically, after launching a&nbsp;full‐​throated denunciation of those provisions, the RSC plan then turns around and proposes to apply a&nbsp;modified version of them to consumers who switch from one private health insurance plan to another.</p> <p>One can perhaps forgive this harmful inconsistency, though, because the RSC plan would codify the Trump administration’s <a href="https://www.washingtonexaminer.com/opinion/obamacare-is-now-optional">rules regarding short‐​term plans</a>. Embedding those rules in statute would free consumers to avoid the RSC plan’s harmful regulations; allow consumers to purchase affordable, <a href="https://media4.manhattan-institute.org/sites/default/files/R-0519-CP.pdf">renewable term health insurance</a>; and improve the functioning of that market by providing regulatory certainty to insurers.</p> <p><strong>A Missed Opportunity on Government Spending</strong></p> <p>The RSC plan gets stuck in the mud when it proposes to repackage the ACA’s Exchange subsidies and Medicaid spending into per‐​capita “block” grants, which states could use to expand Medicaid or to create high‐​risk pools for consumers with preexisting conditions.</p> <p>Turning an existing stream of federal spending (the Exchange subsidies) into an intergovernmental transfer (the per‐​capita grants) is a&nbsp;bad move. It diffuses responsibility for that spending and the taxes (or deficits) that fund it. It is likely that spending would grow at a&nbsp;much faster rate under the RSC plan, as states are much more powerful/​sympathetic/​effective lobbyists than the private insurance companies that receive Exchange subsidies. As much as insurers abuse that stream of federal spending, the abuses will only get worse under the RSC proposal.</p> <p>A per‐​capita block grant, moreover, is not a&nbsp;block grant at all. It would preserve the existing Medicaid matching grant system’s incentives to increase enrollment, because expanding enrollment is how states would get more money from the federal government.</p> <p>Congress should eliminate that spending, or at the very least use it to reform Medicaid with a&nbsp;system of zero‐​growth block grants as a&nbsp;step toward eliminating it. States that want such programs should fund them with their own tax revenues and bear full responsibility for the results.</p> <p><strong>A Transformational Tax Cut</strong></p> <p>The RSC also includes a&nbsp;sleeping giant of a&nbsp;proposal, one that would deliver the largest effective tax cut any living American has ever seen, on the order of $11 trillion over the next decade..</p> <p>A quirk in the federal tax code (the tax exclusion for employer‐​paid health premiums) allows employers to control <a href="http://files.kff.org/attachment/Report-Employer-Health-Benefits-Annual-Survey-2019">roughly $15,000</a> of the earnings of workers with family coverage and <a href="http://files.kff.org/attachment/Report-Employer-Health-Benefits-Annual-Survey-2019">$6,000</a> of the earnings of employees with self‐​only coverage. Those numbers represent the average amounts employers pay toward health benefits for their workers. Even though employers are signing the checks, those funds <a href="https://read.dukeupress.edu/jhppl/article-abstract/33/4/707/73093/Health-Economists-Views-of-Health-Policy?redirectedFrom=fulltext">come out of workers’ wages</a>. Absent the exclusion, labor markets would force employers to provide those funds to workers as cash or other forms of compensation. Under the current exclusion, if workers insist on receiving that compensation as cash wages, they must pay income and payroll taxes on it. In effect, the tax exclusion for employer‐​paid health premiums penalizes anyone who does not purchase a&nbsp;government‐​approved health plan.</p> <p>Across all workers with employer‐​sponsored health insurance, that’s a&nbsp;lot of employee earnings the exclusion allows employers to control: <a href="https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html">$828 billion</a> in 2019 alone, or nearly one‐​quarter of total U.S. health spending. Over the next decade, it adds up to nearly <a href="https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html">$11 <em>trillion</em></a>. (If you want to know why the U.S. health care sector is so <a href="https://www.amazon.com/Overcharged-Americans-Much-Health-Care-ebook/dp/B07CRR42TS">expensive and unresponsive to consumers</a>, consider who is controlling the money. Spoiler alert: government directly controls <a href="https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html">a&nbsp;further one‐​half</a> of national health expenditures.)</p> <p>The RSC proposal would free workers to control <em>their</em> $14,000 for the first time ever. It would do so by <a href="https://nypost.com/2019/09/21/how-expanding-health-savings-accounts-could-cure-americas-sick-health-care-system/">expanding tax‐​free health savings accounts (HSAs)</a>.Workers could use that money to purchase medical care, to purchase the health plan of their choice, or to save for future medical expenses, all tax‐​free. Over the next decade, it would return <em>$11 trillion </em>to the workers who earned it. Giving consumers control of the nearly one‐​quarter of U.S. health care spending that employers currently control cannot help but make the markets for health insurance and medical care more responsive to consumers. It would also represent an effective tax cut 38 percent larger than President Reagan’s tax cuts and <em>four times </em>the size of President Trump’s tax cuts.</p> <p>The RSC has not yet indicated how it would keep this proposal budget‐​neutral, which regrettably puts them in the same camp as Medicare for All supporters like Democratic presidential candidate Sen. Elizabeth Warren (D‑MA).</p> <p>Even so, the RSC proposal creates a&nbsp;stark contrast going into the 2020 election cycle.&nbsp;Medicare for All supporters want to give that $11 trillion to the federal government. ‘Large’ HSAs would give it back to the workers who earned it.</p> Wed, 23 Oct 2019 16:05:44 -0400 Michael F. Cannon https://www.cato.org/blog/house-conservatives-health-plan-includes-828-billion-effective-tax-cut Michael F. Cannon discusses the issue of healthcare in statewide elections on CBN’s The 700 Club https://www.cato.org/multimedia/media-highlights-tv/michael-f-cannon-discusses-issue-healthcare-statewide-elections-cbns Wed, 23 Oct 2019 10:53:28 -0400 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-tv/michael-f-cannon-discusses-issue-healthcare-statewide-elections-cbns Michael F. Cannon participates in the event, “Who benefits? The winners and losers of Medicare for All, Obamacare, and other health care proposals,” on C‑SPAN 2 https://www.cato.org/multimedia/media-highlights-tv/michael-f-cannon-participates-event-who-benefits-winners-losers Thu, 10 Oct 2019 10:52:27 -0400 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-tv/michael-f-cannon-participates-event-who-benefits-winners-losers Big Brother in the Exam Room: The Dangerous Truth about Electronic Health Records https://www.cato.org/multimedia/events/big-brother-exam-room-dangerous-truth-about-electronic-health-records Twila Brase, Edward Lee, Michael F. Cannon <p>The American Recovery and Reinvestment Act of 2009 included a&nbsp;requirement that Medicare‐​participating providers use electronic health records by January 1, 2014, or face financial penalties. Passed and signed into law just four weeks after the inauguration of President Obama, this expensive requirement, which had almost no public debate, forced hospitals, doctors, and clinics to move confidential patient information into digital format.</p> <p>Twila Brase, author of the 2018 book <em>Big Brother in the Exam Room: The Dangerous Truth about Electronic Health Records</em>, says the electronic health record (EHR) is not what patients think it is. It interferes with patient care, is being used to violate patient rights, it makes sensitive data vulnerable to hackers, and it is threatening patient safety and medical excellence. She claims that what the government calls privacy rules are actually data‐​sharing rules. Furthermore, standardized treatment protocols and burdensome data‐​entry requirements are causing physician burnout and physician exodus from the practice of medicine. Government‐​mandated EHRs are an untested experiment that gives government and other self‐​interested parties outside the exam room significant control over private medical decisions.</p> Wed, 25 Sep 2019 10:19:49 -0400 Twila Brase, Edward Lee, Michael F. Cannon https://www.cato.org/multimedia/events/big-brother-exam-room-dangerous-truth-about-electronic-health-records How Expanding Health Savings Accounts Could Cure America’s Sick Health Care System https://www.cato.org/publications/commentary/how-expanding-health-savings-accounts-could-cure-americas-sick-health-care Michael F. Cannon <div class="lead text-default"> <p>Since&nbsp;World War II&nbsp;or&nbsp;even earlier, the US tax code has offered workers the following deal: Either (A) let your employer control thousands of dollars of your earnings, which your employer will use to enroll you in a&nbsp;health plan of your employer’s choosing; or (B) take those earnings as taxable cash wages instead, in which case you will lose thousands to additional payroll and income taxes. In effect, those additional taxes penalize anyone who doesn’t let their employer control their money and health‐​insurance decisions.</p> </div> , <div class="text-default"> <p>It’s an effective incentive. An estimated&nbsp;<a href="https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdf" target="_blank">180 million US residents</a>, or 56 percent of the population, surrender control of a&nbsp;total&nbsp;<a href="https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html">$828 billion</a>&nbsp;of their earnings each year to employers because Uncle Sam otherwise threatens them with&nbsp;<a href="https://www.whitehouse.gov/wp-content/uploads/2019/03/ap_16_expenditures-fy2020.pdf" target="_blank">$203 billion</a>&nbsp;in higher taxes. Workers with employer‐​sponsored family coverage surrender an average&nbsp;<a href="http://files.kff.org/attachment/Report-Employer-Health-Benefits-Annual-Survey-2018" target="_blank">$14,069</a>&nbsp;to avoid paying&nbsp;<a href="https://www.taxpolicycenter.org/model-estimates/baseline-effective-marginal-tax-rates-august-2018/t18-0107-effective-marginal-tax" target="_blank">$4,500 or so in additional taxes</a>. Workers with self‐​only coverage surrender an average $5,711 to avoid paying $1,800 or so in additional taxes.</p> <p>For 70&nbsp;years, that tax penalty has fueled the problem of preexisting conditions. Unlike coverage you purchase directly, employer coverage drops you when you leave your job. Data show workers with expensive illnesses were therefore&nbsp;<a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.27.3.w242">more likely to wind up uninsured</a>&nbsp;if they had employer coverage versus coverage they purchased directly. This tax penalty thus took what otherwise would have been insured medical conditions and turned them into uninsured and uninsurable preexisting conditions.</p> </div> , <aside class="aside--right aside pb-lg-0 pt-lg-2"> <div class="pullquote pullquote--default"> <div class="pullquote__content h2"> <p>Congress can deliver this enormous, effective tax cut without increasing the deficit.</p> </div> </div> </aside> , <div class="text-default"> <p>The Trump administration has&nbsp;<a href="https://www.hhs.gov/about/news/2019/06/13/hhs-labor-treasury-expand-access-quality-affordable-health-coverage.html" target="_blank">taken a&nbsp;small step in the right direction</a>. Starting in 2020, new rules for health reimbursement arrangements (HRAs) will let certain workers avoid that penalty when purchasing portable coverage directly from insurers — whether a&nbsp;costly ObamaCare plan or (in limited cases) affordable, renewable‐​term health insurance that is exempt from ObamaCare’s hidden taxes.</p> <p>But HRAs don’t let workers save that money and take it with them from job to job.</p> <p>Congress should go further and totally eliminate this tax penalty by expanding health savings accounts (HSAs) — tax‐​free accounts that consumers own and can take with them from job to job. Congress should apply the tax exclusion that exists for employer premium payments instead to HSA contributions; increase HSA contribution limits so employers and/​or workers can contribute, say, $18,000 per year tax‐​free; let workers use these “large” HSA funds to buy coverage tax‐​free; and eliminate any requirement that HSA holders carry health insurance.</p> <p>With these changes, the tax code would no longer force workers into health plans they don’t want. Workers would be free to remain in their employer’s plan; to buy ObamaCare plans; to buy ObamaCare‐​exempt plans that make coverage more&nbsp;<a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.27.3.w242" target="_blank">secure for the sick</a>; or just to save their money tax‐​free for future medical expenses.</p> <p>If employers want to stay in business, they would have to give that $828 billion back to the workers who earned it, either as tax‐​free HSA contributions or higher wages. When a&nbsp;tax change leaves workers with more control over their earnings, that’s a&nbsp;tax cut. Workers with family coverage would see their cash compensation rise an average $14,069. The effective tax cut would be 38 percent bigger than Ronald Reagan’s 1981 tax cuts and four times the size of Trump’s 2017 tax cuts.</p> <p>Congress can deliver this enormous, effective tax cut without increasing the deficit. HSA contribution limits would act as an adjustable cap on what is currently an uncapped tax exclusion.</p> <p>Economists of all political stripes agree the tax preference for employer coverage is ailing America. Large HSAs are the cure.</p> </div> Sat, 21 Sep 2019 10:30:42 -0400 Michael F. Cannon https://www.cato.org/publications/commentary/how-expanding-health-savings-accounts-could-cure-americas-sick-health-care VHA Doc’s 3,000 Errors, DHS Docs’ ‘Dual Loyalties’ https://www.cato.org/blog/vha-docs-3000-errors-dhs-docs-dual-loyalties Michael F. Cannon <p>It has been a rough news day for government‐​run health care. But not nearly so rough as government‐​run health care has been to its victims.<br /><br /> First, <em>The Washington Post</em> <a href="https://www.washingtonpost.com/politics/how-veterans-affairs-failed-to-stop-a-pathologist-who-misdiagnosed-3000-cases/2019/08/30/d66fc098-c5b9-11e9-9986-1fb3e4397be4_story.html">reports</a> on the matter of Robert Morris Levy, a former pathologist at the Veterans Health Admininstration hospital in Fayetteville, Arkansas who repeatedly showed up for work intoxicated and who “VA officials say…made 3,000 errors or misdiagnoses dating to 2005.” Levy showed up for work one day with a blood alcohol level of 0.4 percent, five times Arkansas’ legal limit. He misdiagnosed patients who actually had cancer and whose cancers spread untreated for years, leading to their deaths. “Federal prosecutors <a href="https://www.washingtonpost.com/politics/former-va-physician-charged-with-the-deaths-of-three-veterans/2019/08/20/0119ea16-c345-11e9-9986-1fb3e4397be4_story.html">charged</a> Levy, 53, last week with three counts of involuntary manslaughter in the deaths of three veterans. VA officials now acknowledge that he botched diagnoses of at least 15 patients who later died and 15 others whose health was seriously harmed.”</p> <p> </p><div data-embed-button="image" data-entity-embed-display="view_mode:media.blog_post" data-entity-type="media" data-entity-uuid="26947add-58c3-4ae8-878c-96eef9744466" data-langcode="und" class="embedded-entity"> <img srcset="/sites/cato.org/files/styles/pubs/public/download-remote-images/www.washingtonpost.com/5696021608/QZTHQUGF3II6TC7XZXRNTYEQKU.jpg?itok=bJn6-deq 1x, /sites/cato.org/files/styles/pubs_2x/public/download-remote-images/www.washingtonpost.com/5696021608/QZTHQUGF3II6TC7XZXRNTYEQKU.jpg?itok=yduc5ir1 1.5x" width="700" height="469" src="/sites/cato.org/files/styles/pubs/public/download-remote-images/www.washingtonpost.com/5696021608/QZTHQUGF3II6TC7XZXRNTYEQKU.jpg?itok=bJn6-deq" alt="Veteran Kelly Copelin, whose neck and throat cancer went misdiagnosed by a VHA hospital for 13 months. Photo credit: Bonnie Jo Mount/Washington Post" typeof="Image" class="component-image" /></div> <p><em>Veteran Kelly Copelin, whose neck and throat cancer went misdiagnosed by a VA hospital for 13 months. Photo credit: Bonnie Jo Mount/​Washington Post.</em><br /><br /> Levy continued to practice at the VHA for 15 years in part because, according to prosecutors, he easily defeated the agency’s quality controls for pathologists. While his actual error rate was “nearly 10 percent, more than 10 times the normal frequency of mistakes by pathologists,” Levy was able to make his error rate appear to be 0.7 percent or at times zero. So not only did the agency not fire him for showing up to work intoxicated (neither did Arkansas’ <a href="https://object.cato.org/pubs/pas/pa-621.pdf">medical licensing authorities</a>, for that matter), the VHA paid him multiple bonuses atop his $225,000 salary while his lower‐​income patients endured unnecessary suffering and “horrible” deaths. Your tax dollars at work.<br /><br /> It would have been fairly simple for the VHA to adopt quality‐​control measures that Levy could not have defeated and that therefore would have identified his errors earlier and saved lives. But the VHA faces insufficient incentives to adopt such measures. It does not operate in a competitive market and neither the agency nor its employees face the same sort of liability for malpractice that private actors do. In a competitive market, these sorts of horrible consequences would damage a company’s reputation and cause patients to flee. But the VHA is a near‐​monopoly government provider with a captive clientele who typically have no other options. As for liability, Cato adjunct scholar Shirley Svorny <a href="https://object.cato.org/pubs/pas/pa685.pdf">writes</a>: </p> <blockquote><p>The 1946 Federal Tort Claims Act (FTCA) shields government‐​employed physicians from medical malpractice claims. This includes medical professionals who work for the Department of Veterans Affairs, the Indian Health Service, the Department of Defense, and other federal agencies. The FTCA makes the federal government responsible for defending federal employees when malpractice claims arise, and makes taxpayers liable for harm due to negligence…<br /><br /> Shifting liability for malpractice from physicians to taxpayers shields government physicians from underwriting and oversight by private insurers. Federal agencies, such as the Department of Defense and the Indian Health Service, do often create risk‐​management programs. Yet government agencies have less of an incentive to reduce the risk of negligent injuries than private malpractice insurers do, because the money at risk in a malpractice suit is a common resource (federal revenues), rather than a privately owned one. Because private malpractice insurers have more at stake in a malpractice suit than government agencies do, the government’s risk‐​management efforts are likely to be less rigorous. Indeed, federal investigators have found that in some cases, such as community and migrant health centers, the government is ill‐​equipped to provide risk management. In most cases, consumers would be better off were government agencies not to shield their physicians from malpractice immunity.</p> </blockquote> <p>As an indication of whether the remaining incentives are enough to prioritize quality and patient safety, the <em>Post</em> reports:</p> <blockquote><p>Inspector General Michael Missal’s office in recent years has identified multiple VA physicians who continued to practice even after they were found to have compromised patient care. A report this year by the Government Accountability Office found weak systems for ensuring that problems are quickly addressed when a physician’s quality of care to veterans is compromised.</p> </blockquote> <p>Veterans thus get hit by a double‐​whammy. The VHA has insufficient incentive to change — that is, to save lives — because killing veterans really doesn’t affect the bottom line of the agency or of individual physicians. A single‐​payer, Medicare‐​for‐​All system would subject all Americans to the same double‐​whammy.<br /><br /> Second, the <em>Post</em> <a href="https://www.washingtonpost.com/immigration/johns-hopkins-professors-argue-dual-loyalty-compromises-health-care-in-migrant-detention-facilities/2019/08/30/bffd288a-cb38-11e9-a4f3-c081a126de70_story.html">reports</a> on a <em>Journal of the American Medical Association</em> <a href="https://jamanetwork.com/journals/jama/fullarticle/2749507">article</a> that alleges the Department of Homeland Security places unethical employment conditions on physicians who treat migrants in the agency’s detention facilities. The authors of the <em>JAMA</em> article write:</p> <blockquote><p>[P]hysicians and other health professionals are often put into situations in which they cannot fulfil their obligations to their patients because of competing obligations imposed on them by detaining authorities; this is often referred to as the problem of dual loyalty. Given the reports of inhumane, overcrowded, and unsanitary conditions, including insufficient water and toilets, lack of clean clothing and bedding, high exposure to psychological stress, and poor medical care in many of the DHS processing and detention facilities, how can and should needed medical care for detainees be structured, especially given the dual loyalty challenges that emerge if physicians are employed by the agency in charge of detaining migrants?<br /><br /> First and foremost, health care professionals should insist on and adhere to clinical independence to ensure they are able to provide the highest standards of care that are in the best interests of the patient. This independence also demands that physicians and other health care professionals are not subject to retribution for reporting, both in medical charts and openly and transparently to authorities, including legislative oversight bodies, about their evaluations of conditions of detention that impede their patients’ health and the availability of quality medical care. Currently, all DHS employees, consultants, and subcontractors are required to sign nondisclosure agreements that are quite strict and clearly state that if violated, the person “…could be subject to administrative, disciplinary, civil or criminal action…” Such nondisclosure agreements could conflict with physicians’ primary duties to the health of their patients.</p> </blockquote> <p>In addition, the <em>Post </em><a href="https://www.washingtonpost.com/immigration/johns-hopkins-professors-argue-dual-loyalty-compromises-health-care-in-migrant-detention-facilities/2019/08/30/bffd288a-cb38-11e9-a4f3-c081a126de70_story.html">reports</a>, the U.S. Customs and Border Patrol refuses to provide flu shots to detained migrants, even though influenza has been a problem in its facilities and “at least three children died of the disease, according to autopsy reports.” <br /><br /> Yet this “dual loyalty” problem is just another manifestation of the same problem we see at the VHA. Each agency has interests that are different from and often conflict with those of their wards. The VHA and the doctors it employs value their patients but they also value stable budgets and job security. DHS, CBP, and their employees value national security but also stable budgets and job security. The main differences are: VHA employees care about their wards, while DHS and CBP employees are openly hostile to theirs; the VHA has a figuratively captive clientele, while DHS and CBP’s clientele are literal captives; and yet, even so, the VHA probably does more to harm the health of its clientele. Such is the power of the principal‐​agent problem that it can overwhelm the agents’ intentions to act in the interest of the principals.<br /><br /> The principal‐​agent problem appears in private‐​sector health care, too, where the interests of the insurer often conflict with those of the patient. (So does the interest of the physician, for that matter, and not only because of the insurer.) The solution to the principal‐​agent problem is to let principals (consumers) choose among different agents (health care providers). The resulting competition rewards health care providers who devise the best ways to align their interests with those of consumers. The reason the principal‐​agent problem is manageable in the markets for haircuts and auto repair is not that those services are less complicated than health care. It is because those markets are <em>markets</em>. In health care, government has defeated the market mechanisms — principally, consumer choice and competition — that would otherwise keep the principal‐​agent problem in check. <br /><br /> There may be some scenarios where consumer choice and competition among health care providers may not work — for example, when the patient is someone the government is holding captive. Better health care then becomes one more reason why the government should hold fewer people captive.</p> Tue, 03 Sep 2019 10:14:05 -0400 Michael F. Cannon https://www.cato.org/blog/vha-docs-3000-errors-dhs-docs-dual-loyalties Chuck Grassley (R‑IA) cites Michael F. Cannon’s blog post, “Senate Finance Committee Considers Proposals to Cut Wasteful Medicare Spending,” on FOX’s Your World with Neil Cavuto https://www.cato.org/multimedia/media-highlights-tv/chuck-grassley-r-ia-cites-michael-f-cannons-blog-post-senate-0 Thu, 01 Aug 2019 10:31:00 -0400 Michael F. Cannon https://www.cato.org/multimedia/media-highlights-tv/chuck-grassley-r-ia-cites-michael-f-cannons-blog-post-senate-0