The United States National Health Insurance Act (USNHI) – H.R. 676

On January 27, 2008, U.S. Representative John Conyers Jr. (D-MI) introduced a new version of a previously unsuccessful bill before Congress that would turn America’s health care system into a socialized, not-for-profit, singer-payer system.  Previous iterations of the bill had few co-sponsors (25 in 2003), and the current version (H.R. 676), has gained a modicum of traction thanks to Michael Moore‘s film documentary, Sicko, which contends that the United States is the only developed country that does not currently have “universal health care.”

As an advocate for market-based health care (which we currently do not have), obviously I have problems with 676.  A few days ago I attended a lecture and discussion about the bill, presented by advocates in favor of it, to an audience of comprised mostly of naive first and second-year medical students…with one of two true skeptics interspersed within.  Below I present a few of the problems with 676 and with single-payer health care in general.

First, the highlights of the proposed law.  676 purports to cover the following: primary care and prevention, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, the full scope of dental services (other than cosmetic dentistry), substance abuse treatment services, chiropractic services, basic vision care and vision correction (other than laser vision correction for cosmetic purposes), and hearing services including coverage of hearing aids.  Basically everything.  And you can go to any doctor or provider you want.  And there’s no deductibles, copayments, coinsurance, or other cost-sharing to be imposed with respect to covered benefits.  Sounds nice doesn’t it?

The cost.  I haven’t read the feasibility studies, but the text of the bill says all of this wonderful stuff, for every American citizen, will be paid for with income tax increases on the top 5% of earners, a progressive excise tax on payroll and self-employment income, existing government health care revenues, and a tax on stocks and bonds.  Additionally, the bill foresees a 15-year integration process, which will be paid for by issuing Treasury Securities.  Congress reserves the right to decide how much to tax the American public, it’s a basic tenet of our system of government…and with the guidelines above, we’re looking at a legislated equivalent of a blank check.  Why?  Because providing comprehensive, quality, accessible care to every citizen will command a budget possibly larger than any other ever conceived by man.  The U.S. Treasury will issue hundreds of billions upon hundreds of billions in debt to fund the 15 year transition period.  Just to “integrate” the new system, we are looking at compounding our debt (which is owned mostly be foreign investors), by nightmare proportions.  We will no longer own our own country.  Our grand-children and great-grandchildren will spend their lives paying interest to Dubai, India, China, Russia, and Japan.  The dollar will continue to weaken…perhaps it will reach parity with the Mexican peso.  Additionally, depending upon the size of the taxes necessary just to drive the operational side of this beast, there will be significantly less incentive for businesses to continue to exist on U.S. soil.  An excise tax on self-employment income is the government’s way of telling entrepreneurs and business owners to get f***ed.  

Medicare is poised to make up a record amount of our GDP in a few years…it’s already unsustainable and will soon be bankrupt in its current form.  It should be noted that the current form of Medicare covers only elderly people, and only pays for a fraction of the services listed above.  The USNHI proposes no revolutionary way to reduce the costs associated with administering an undertaking, which expands Medicare’s coverage on a exponential scale.  This is an atomic bomb. 

Private insurance becomes illegal if 676 is passed.  We use the term “universal health care” in quotations to describe countries like Israel and the United Kingdom, because these countries HAVE private insurance options.  People who can afford to, pay for supplemental private insurance, because even with smaller, more homogenous populations, these countries are not able to provide a fraction of what 676 promises.  And that’s with high personal income taxes, and very little defense spending (with the exception of Israel, most countries with quasi-socialized medical care depend on us for this).  In Canada, people routinely pay bribes to skip the line. 

This brings me to my next point.  Banning something the market is screaming for is like leaving picnic food at a park and putting up a “no ants” sign.  It’s a comical act of futility.  And it costs billions of dollars.  We have a country with a revolving door border policy.  Our government has spent hundreds of billions on drug enforcement…how well is that working?  How many people in this country own firearms purchased without proper licensing on a black market?  If you don’t allow for a private tier of health care payership, you force a black market to form.  Then you have to create government agencies to enforce and prosecute illegal “pushers” of private health care.  This cost isn’t factored into 676. Perhaps we could charge a “modest” excise tax…

Doctors will have no opportunity to attain true wealth.  Under 676, providers may elect to be paid government-dictated salaries, or reimbursed at government-dictated rates for services rendered.  Current private Health Maintenance Organizations (HMOs), who are the target of 676 supporters, reimburse doctors at a MULTIPLE of Medicare reimbursement rates.  This is because doctors cannot afford to stay in business strictly on Medicare payments.  With skyrocketing malpractice premiums forcing many doctors into retirement, we could be looking at a future with no domestic doctors.  676 does not (and legally cannot) address medical malpractice – medical licensing and tort reform are handled on a state level.  Doctors have little incentive to exist in this environment, particularly those doctors facing hundreds of thousands in student loans…which is most of them.  676 does not address medical school tuition.  With no primary care physicians, the queues will grow quickly.  In Canada it takes 10.1 weeks to get a CT scan.  How long will it take in a country our size?

Then there’s the problem of illegal immigrants.  676 only covers American citizens.  Are we prepared to deny all care to illegal immigrants?  I doubt so.  The cost of providing similar care to this demographic (making up a significant chunk of the population), has not been factored into the bill.  Taxes go up more.  A true welfare state. 

There’s a slippery slope here.  At some point you have to decide whether you’re country’s mission is Capitalism (the American Dream), or Communism (from each according to his ability to each according to his need).  I don’t think we’re ready to give up the ghost quite yet.  The great empires of the world had much longer tenures than 200 years.  Are we ready to become a welfare state, and give the crown to a new empire?  The next empire probably isn’t going to be as nice as us.  It probably isn’t going to drop food and vaccines on African villages…

Finally, the perfect irony.  The purveyors of USNHI tout it as the answer to large for-profit HMOs that put shareholder interests and CEO salaries before patient well-beings.  What?!  By putting the government in charge of it?!  The same government that takes handouts from special interests groups that represent all kinds of nasty interests perpendicular with those of individual American health care users?  Corruption was invented in Congress.  Congress created the original food pyramid to promote the interests of the U.S. Agricultural industry, not our health.  That’s why it recommended 5-11 servings of starch per day.  One could cogently argue that the government created type II diabetes to help the American farmer.  If you read history, governments, especially those with absolute power, don’t have the best track record in the human rights category.  There was this guy named Stalin, maybe Michael Moore should do a documentary…

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Are Free Markets a False Idol? Or is Regulation a Trojan Horse?

Peter Goodman of the New York Times writes an interesting retrospective of free markets entitled “The Free Market: A False Idol After All?”  The article’s basic conclusion is that unfettered free markets (unhampered by regulation)…systems merely based upon ideology, cannot stand without some basic rules of government.  And I don’t disagree.  In the short run, the market can be as fickle and irrational as Lindsay Lohan after a few Vicadin, some blow, and a rude text from her boy-toy of the week.  Just watch any blue-chip stock get slaughtered after missing some analyst’s quarterly earnings estimates by 2 cents.  But Adam Smith’s invisible hand, in the long run, will put resources where they can be invested most efficiently…creating the most value.  And I truly believe that.

The problem illuminated by Goodman’s article isn’t that we have government regulation…it’s that the same knee-jerkedness that renders a short term market stupid is what’s driving legislation through Congress.  Politicians are elected for a term of years, not decades, and in order to make a difference…an elected official must be able to pass a bill quickly, no matter how hastily researched or ill-conceived.  Republicans and Democrats alike are killing America’s competitiveness in an increasingly globalized world.

The latest disgrace is the Bush Administration’s efforts to freeze adjustable mortgage rates for families who cannot afford the contractual step-ups in rate that will soon torpedo many of them into foreclosure.   Bill Gross, who manages one of the largest bond funds in the world at PIMCO (Pacific Investment Management Company), is one of the most brilliant minds in the world when it comes to markets and capturing value…and even he is pro-bailing out the American Idiot.  Now, Gross, who is quite possibly the greatest bond trader alive today, may have some super-complicated, multiple-degrees-of-separation reason for why this will create value that none of us can see…but based upon the interviews he has given, and the articles he has written, it’s just plain ole bleeding heart self-defeating behaviour.

To bail out people who borrowed more than they can afford is to teach America that the government will always be there to bail them out.  There’s no way a society who doesn’t have to develop its own good judgement will ever compete in a global economy.

To quote the article: “Every regulation reduces people’s freedom,” said David R. Henderson, a libertarian economist at Stanford University’s Hoover Institution. “The more regulation we get, the worse we do.”

Enron and Worldcom cooked their books and stole from their employees.  The government’s knee-jerk reaction was Sarbanes-Oxley, which is so cumbersome and expense to comply with, that companies are leaving the U.S. rather than spend the billions required to comply.  Two bad apples (really bad apples, granted), sparked hastily drafted regulation that is making good companies so uncompetitive in a global market, that they are actually leaving the country for freer markets.  

There’s a fantastic, tongue-in-cheek article written by former bond trader and author of “Liar’s Poker,” Michael Lewis, where he jokes about how an overly paternalistic America has dared him and his wealthy, productive friends to up and move to Dubai.  His point is that pandering politicians can scapegoat successful people, because they are easy targets, and work to tax the hell out of them…b/c they must be doing something evil…making so much money in the first place.  How can these select few entrepreneurs and hedge fund managers earn so much money?  They must be unethical and worthy of our scorn.  As soon as someone makes $100mm, a mentality has been created that has trained people to try to pull them down.  Its driven by jealousy, guilt, and in the case of people like Hillary Clinton, pathological ego (and hypocrisy).  Michael Lewis ends his comedic piece daring the IRS to tax him more…he’ll always stay a step ahead.  And if not, its a mobile world.  There are plenty of places with low taxes who will encourage the forward-thinkers, the innovators, thecreaters of wealth and value.  Are free markets a false idol, or is the belief in the notion an expression of envy and a lack of foresight?

If these sentiments trickle into health care, we will be a third-world, possibly Arabic-speaking country withing a few generations..

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The Call of the Entrepreneur

There’s a fantastic new documentary film, The Call of the Entrepreneur, which is currently touring major cities with limited special previews. The makers of the film expect it to be released (most likely in independent film houses) shortly after the tour. The film follows three entrepreneurs whose businesses range from small and rural to very large and international. The common thread tying the owners together is the presence of “entrepreneurial spirit,” which is something few people have. It’s a combination of economic foresight, creativity, persistence, and most importantly, a willingness to take huge calculated risks.

Why do I want you to see this film? Well, without giving too much away, it’s because I want you to see how over-bearing governments push the smartest and most creative people, the innovators, away. One of the business owners in the film is international media mogul Jimmy Lai, whose family’s wealth was stolen by Mao Zedong’s Communist China. Working as a train porter in mainland China in the 1950’s, Lai only learned of a world outside the People’s Republic when he tasted a Hershey Bar given to him by Hong Kong business man whose luggage he carried. His family scraped together about $300 to smuggle him to Hong Kong at the age of 12. He risked never seeing his mother again for the mere possibility that outside world had something more to offer.

Lai credits Democracy and free markets for his success as the founder of one of the largest listed media companies in Hong Kong. He calls Communist China “a monopoly that charges a premium for lousy service.” When people ask him what his media and clothing companies do, he says that he is “selling freedom.“

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