More Red/Blue dialogue on health care

Check out Colin's latest post here.

Colin, I agree with you that government can do both good and bad. Without government, we would have anarchy and chaos, with no national defense, no law enforcement, and no protection of our essential national interests and individual rights. There are some things that government does better than individuals could do for themselves, such as providing fire stations and roads. These are things that everyone benefits from. I agree entirely with your statement "I believe we must be eternally vigilant about monitoring 'government creep' -- the tendency of government to overreach and regulate things it has no business regulating." I agree in the abstract with your next statement: "But I also think there is a clear and compelling case for government intervention in very proscribed and constrained ways to achieve certain socially beneficial objectives." However, I don't know how a reasonable person can look at the proposed legislation and describe it as "modest" or "proscribed and constrained". If a program spending $1.6 trillion over ten years can now be described as modest, the word has surely been redefined when I was not paying attention. How is it "proscribed and constrained" to mandate that everyone get health insurance, fine those who don't get it, and throw those who don't pay the fine in jail? The good news is that once you're in jail, you get free health care! Surely there are more onerous ideas out there, but if Obamacare is modest, hardcore Marxism must be the dividing line for truly ostentatious. Not only will they fine people who don't buy enough insurance, they'll fine people who buy too much! Since when can Max Baucus decide how much insurance you should buy, and punish you if you buy too little or too much? When the government claims the power to determine who gets medical care and who doesn't, and by extension, in many cases, who lives and who dies, what greater control over your life could there be? This bill is an authoritarian power grab bigger than any in American history. James Madison said that, "If Congress can employ money indefinitely to the general welfare, the powers of Congress would subvert the very foundation, the very nature of the limited government established by the people of America." As you say, "The vigilance of American citizens will always be a powerful bulwark to the overreaching of government." That vigilance is driving the groundswell of opposition to Obamacare. It remains to be seen if Congress will remember that they work for us, not the other way around.

I think that you need to re-examine your history about the source of American exceptionalism. Europeans did not leave home and venture to the New World in droves to find a place with more government interference in their lives. They came looking for freedom and opportunity. America is the greatest country on earth not because of centralized control and collectivism, but because of individualism and liberty. Your suggestion that America's success if due to government management doesn't fit at all with the facts. Certainly we were able to coordinate better, be more productive and more innovative, operate more efficiently, and create more wealth than Europe, but that was due to capitalism, not because of government, and often in spite of it. Government does not produce wealth, it only moves it around. The larger the segment of our economy is government run, the smaller the segment which must produce all the goods and services that we consume or trade. Government now makes up about 40% of our economy, meaning that 100% of the people must live on what 60% produce. The fact that Europe is closer to a 50/50 ratio has a lot to do with why we have surpassed them, so moving more in their direction is certainly not a good idea.

Regarding your two added goals, I agree with number two. For a free market to work, consumers must be able to move from one provider to another. Finding ways to allow people who currently have insurance to switch to another provider is very important, and can be accomplished without government mandates. Number one, on the other hand, requires either a public option or a preexisting conditions mandate. I've made my case against both of those options. If we strengthen the rules so that insurance companies cannot drop coverage unfairly or deny coverage for non-material reasons, anyone can avoid the situation of being without coverage due to a preexisting condition by purchasing insurance when they are young and healthy and keeping it.

Although our goals are fairly similar, our approaches to reach those goals are day and night. Certainly my proposal is not "95% in sync with what is being discussed." I flatly reject a public option, mandates on individuals to buy medical insurance, mandates on employers to provide it, mandates on insurance companies to cover preexisting conditions, and fines for buying too little or too much insurance: all the centerpieces of the various bills proposed by Congress. A public option does not increase competition. It is anti-competitive. Government interference in the market is not competitive, it squashes competition and subverts market forces which stabilize and regulate the market. Look at government-chartered Fannie Mae and Freddie Mack, major players in destroying the mortgage market, with disastrous results. These semi-government, semi-private entities were created with the virtuous intentions of helping people who might not otherwise qualify for a mortgage to buy a house. Like the public option or "co-ops" they took on the risky cases that no one else would touch, hid the inherent risk, and undermined the entire market. You yourself make the case to prove that the public option could not possibly operate on a standalone basis as Obama claims, with premiums paying for the coverage of expenses: "so that's why some sort of public or co-op option makes sense, to cover the folks that are likely to require more funds to be cared for than they're going to put into the pool." How can that happen without the public option being subsidized? But Obama vehemently insists that claims that the public option will be subsidized are a myth. Is he saying that when the public option runs out of money, he will let it go bankrupt and will not bail it out? Of course not.

You are right that a partial implementation of medical savings accounts exists. It just needs to be made available to everyone, and extended to allow money to be carried over from year to year.

I think I was not clear enough about why I propose implementing insurance subsidies as advanceable, refundable tax credits. First, that does not mean that each individual would have to get the money from the government and then pass it on to the insurance company. That would be a mess, just as you say! The government would pay the insurance companies directly, and the individual would pay the difference. What it does mean is that people who receive a subsidy would be required to declare it on their tax return. Connecting an insurance subsidy to a tax return would help to reduce fraud by making it possible to verify that real, legally eligible people who are paying their taxes are getting the subsidy.

While I agree with the principle of helping those in genuine need to pay for basic insurance, I have an issue with the Baucus proposal, which would subsidize insurance for people making as much as $85,000. According to a 2005 Census Bureau report, 80% of the population makes less than that amount. This is a far cry from a last resort safety net. My comments about families and people in a local community taking care of one another were in the context of a social safety net, not fighter jets and so forth. It is not meant to suggest that there should not be a safety net at the Federal level, but that should be a last resort, only when the local safety net has failed. Washington has spent years convincing people that the Federal Government should be the primary safety net, and that because we pay taxes, our obligation to the needy is fulfilled. I personally reject that idea, and believe that politicians should stop their self-serving promotion of dependence on government as a natural and normal state for most of the people most of the time.