Sunday, January 24, 2010

Principles are the Missing Ingredient in the Health Care Debate

In a Guest Commentary in Sunday's Telegraph, Dr. James W. Squires lamented the failure of the 2009 Health Care “reform” effort due to a failure to engage in a meaningful dialogue free from language that he complained stifled discussion and debate.  He complained that a focus on the principles underlying the policy served only to end the policy discussion.

I would argue that the reason that the current Health Care bills passed by the House and Senate will never be reconciled is because we did not reach agreement on the principles upon which that policy would be built.

Imagine the discussion between two honest, principled people about what the Giants needed to do to reach the playoffs next year.  Without taking the time to agree upon the framework of that discussion what follows would be an incoherent, frustrated cross-talk which fails to find agreement.  One argues that the Giants need to work on their pitching and infield play and the other argues that they need to improve their secondary and pass rush.  Without an understanding of whether they were talking about the baseball Giants from San Francisco or the football Giants from New York, any attempts at collaboration and agreement of ideas would be frustratingly fruitless.

So it has been with the 2009 Health Care discussion.  We couldn’t have a meaningful, fruitful discussion about heath care reform without first agreeing on the core principles and morality upon which any policy would be built.

Every honest poll – and the recent Senatorial election in Massachusetts - shows that most Americans disapprove of the policy contained in the House and Senate health care bills.  For the sake of argument, even if we stipulate that the Democrat leadership is motivated only by the noble objectives that they share with the public, let’s agree that resistance to the current bills is not because of any disagreement with their noble goals. Let’s simply stipulate that we disagree with the means by which the bills would attempt (and ultimately fail) to achieve those noble goals because of the violation of the core principles held by most Americans.

One step that “reform” advocates could take to reduce the cross-talk would be to refrain from conflating the premise that most Americans are opposed to the current policy being negotiated with the conclusion that most Americans are against true health care reform.

The reason most Americans reject the current bills in the House and Senate is an unacceptable infringement upon our personal freedom.  “Freedom” is not an “incantation” designed to stifle discussion as Dr. Squires mentions in his commentary.  Quite the contrary.  Reasoned Americans seek to understand how any policy will impact their freedom. The problem the Democrat leadership has created with its 2009 Health Care “reform” is that it has not paid sufficient regard to the concern that most Americans feel regarding the risk to their freedom inherent in these bills.

Most Americans understand that the only power in the world that can strip Americans of their freedom is government.  For a people to enjoy hundreds of years of freedom as we have in America is a historical anomaly – an aberration in the normal march of human history.  Generations of Americans have willingly risked their lives and livelihoods to secure their freedom and the freedom of the next generation.  Most Americans view the policy contained in the two health care bills to be an unacceptable risk to that precious freedom.  Voters of all political leanings sent this message last Tuesday in Massachusetts.  They felt their cherished principle of freedom was under attack by the current health care bills.

We have seen the enormous capacity of Americans to solve any problem when we work together.  Health Care reform should be no different.  President Obama and the Democrat leadership can find their place in the annals of history by making a substantive, sustainable improvement to our Health Care system, but they must first spell-out the principles upon which this policy would be built such as:

•    The government has no moral authority to compel any American to buy an insurance policy involuntarily and with costly provisions he does not want.  The current bills would mandate all Americans to buy insurance or face a fine.

•    The government has no moral authority to intercede in a private, voluntary exchange of values between a patient and a doctor by limiting the amount the doctor may receive for providing a service to a patient.  The current bills would limit the amount that doctors and hospitals could receive for a given service.

•    The government has no moral authority to coerce young people to pay a higher insurance premium based on their lower-risk profile in order to subsidize the insurance cost of older people who are higher users of health care.  In order to gain the buy-in from insurance companies to provide insurance to people who have pre-existing conditions, the government promised to coerce every American to buy health insurance.

•    The government has no moral authority to tell any business, such as a health insurance company, with whom it must do business.  The current bills would require health insurance companies to issue policies to risks that would reasonably guarantee that the health insurance companies would lose money.

•    The free market, if unfettered by destructive government mandates, mis-incentives and other distortions, is better able to provide health care better than a government-run system.  The free market has shown that it is the best vehicle for increasing the availability and quality of products and services while reducing the cost to the consumer.  The fact that it hasn’t (yet) been used in the health care industry is due solely to government barriers.

•    Providing health care insurance is not the same as providing health care service.  Health care service is a product that must first be produced before it can be delivered.  A government-issued “coupon” for “universal foot protection”, for example,  does not, by itself, produce a single pair of shoes. Similarly, a government-sponsored “coupon” for health insurance does not produce health care service. 

•    If you pay doctors and hospitals less than it costs them to provide the service, you will have fewer doctors and hospitals providing that service. Setting a price-cap that each person who has a “universal foot protection” coupon must pay for a pair of shoes will not increase the number of shoes manufactured. Quite the contrary.  Price-controls will, theoretically and in historical practice, reduce the amount of a good or service whose price is artificially controlled.

•    If you have fewer doctors and hospitals producing health care service and we provide “free health care coupons” to every American, either costs will go up or delivery delays will be experienced and / or both.

If the Democrat leadership or any health care “reform” advocate could please address these reasoned and reasonable concerns, then we promise not to mention the corrupt methods (Louisiana Purchase, Cornhusker kickback, $60 billion union buy-off, no CSPAN, etc) by which these unprincipled bills have been crammed down our throats.

We are concerned by the over-reach of Democrats in this health care debate because of the violation to our principles this policy represents.  We are concerned that the Democratic leadership is indifferent to the core principles of Americans and that “might makes right”.  In Oct 2008, Hillary Clinton sent an email to her supporters that said, “Sixty is the magic number.  If we reach 60 Democrats in the Senate, then the days of Republican obstruction are over…there’s nothing we can’t accomplish.” Chilling.

Ayn Rand wrote, “Reason is not automatic.  Those who deny it cannot be conquered by it.  Do not count on them.  Leave them alone.”  Principled, independent Americans wish to have a reasoned discussion about health care policy with the leadership in Washington.  We are asking for a discussion based on objective reason.  We ask that they respect our principles and do not dismiss our concerns as those of unhelpful obstructionists.  A reasoned, principled policy will stand on its own merits and its virtues will be easy to discern and discuss.  A reasoned, principled policy will “sell-itself” when presented in the disinfecting light of day to reasonable Americans.  Expensive buy-offs of critical votes, as we have witnessed, would not be required if the bills aligned with the principles of Americans.  Americans will support any policy that they think will benefit them.  Let’s have that dialogue.