Friday, April 29, 2011

Gray is a real color

Wide swaths of private liberty should never, ever fall to political oversight. Once politics engages, liberty, pretty much a black and white concept, becomes grayed through the political process.

“Gray or grey is a color seen commonly in nature. It is created by mixing white and black in different proportions. Depending on the amount of light, the human eye can interpret the same object as either gray or some other color.”[1]

Politics drives me crazy, in some measure because I can't rid myself of passion toward it. Otherwise, because it is an endless sea of gray coloration, and I want to be a black or white kind of guy. For those who see political theory through rose colored glasses, the truth is your vision is distorted.

Here is a great example. I see Medicare, just as ObamaCare, as unconstitutional. You might think I am irrational for thinking so: but the United States Constitution does not enumerate the power for the federal government to create a national health insurance program. If you find it, please tell me where and why you believe it to be true.

On the other hand, Medicare is engrained in our national psyche. Trying to save it by modifying it may send Republicans to the back bench. What are we who see black and white to do about this? Would we be better off with a rigid, perfectly white view of Medicare’s nature, and then tilt at windmills trying to undo it? Or, do we try, connive, coalesce, and work incrementally to remove some of its most perverse aspects? In other words, do we shade our black and white view to become more gray in the hope of eventually restoring some semblance of constitutional balance?

ObamaCare is patently unconstitutional, despite what the Supreme Court might eventually rule. But what if the Court only chisels away the individual mandate, and leaves the balance intact? Obama’s devotees, who also see things as black and white (I might have said red and white), argue that the mandate is required for the whole bill to work. Obama’s detractors argue that the mandate is required for the whole bill to work. This is about the only aspect of ObamaCare upon which they agree. This odd agreement could mean nothing to the Court.

The Court very likely could rule the mandate to be unconstitutional, and let the balance of the bill stand. Such a ruling would protect the federal government from endless state-led lawsuits on any new federal law a state despises, and upset federal sovereignty. My bet is the Court will finesse this gray decision, and leave the country in confusion.

We who prefer black and white politics to gray politics are likely to be engaged for the next 20 years trying to adjust the shade of gray to more closely match our own perspective. We may be forced to attempt to reform health insurance exchanges, or accountable care organizations, or defang the competitive effectiveness crowd, while at the same time making it appear we are not trying to rid ourselves of them. This is highly frustrating to a black and white guy which finally gets me to the whole point of this article.

As politics has touched health care, we have been subjected to an endless cycle of grayed policies that do nothing but pit freedom-loving people against powerful political factions and yes, the hated interest groups. If ObamaCare stands, we will have lost what little liberty remains.


Thursday, April 7, 2011

Cong. Ryan takes one step toward Medicare cure

If we want America to survive, we have to fix Medicare (and a host of other entitlement programs).

Since Medicare’s launch in 1966, politicians have continuously tinkered with health care and methods to pay for it. Today, reasonable and honest politicians (no, that is not always an oxymoron) realize Medicare threatens our children’s financial future.

The simple fact is that each person younger than 30 years old already owes $289,000 to pay the unfunded cost of Medicare. There is no equivocation on this: Medicare is broken, and we cannot afford it as it is currently financed.

What solutions can we offer, other than government rationing of health care to Medicare enrollees? Cong. Paul Ryan got us off dead center this week by recommending what he euphemistically calls “premium support” payments for those individuals enrolling in Medicare starting in 2022.

(Premium support is another name for tax subsidies which is another name for welfare payments, if I might be so bold. Why do I say welfare? Because Medicare enrollees today and tomorrow will receive medical services valued far beyond the dollars they contributed to the program. You can call it Medicare benefits, but I call it welfare for old folks, like me, in 2012.)

Now don’t get me wrong. I commend Ryan for taking the first step. But we must do more.

The Democrats’ answer to Medicare and health care’s soaring cost is to tax us more, create new government bureaucracies to launder the money, and then expand the programs. Reid, Pelosi, and Obama decided to pay for this the backs of “high” income earners and every day citizens. For “high income” earners, the Democrats increased taxes on their incomes – more income taxes and fewer dollars to invest in new businesses and jobs.

Democrats also added tens of billions in user taxes to fund Obamacare. These are taxes on consumable medicines and durable medical products, plus a tax on health insurance. These types of taxes better fit the Founding Fathers’ concept of taxation – excise taxes, user taxes, consumption taxes – but they never favored income taxes.

Fixing Medicare, in my humble opinion requires the following (although I hold my nose with anything smacking of income tax manipulation):

1.      Means test Medicare by requiring those with greater incomes and assets to pay a larger share of their own cost. This is not necessarily good, but it is better than having everyone regardless of income and assets pay the same. Why should Billionaire Warren Buffet qualify for the same benefit at the same price as Warren Smith, whoever that is?

If the idea of requiring individuals to spend down their personal assets for their own health care is repugnant to you, if it makes more sense for children yet unborn to pay these costs, then I will change my position on the death tax: If you want to stash your mattress with cash and use my grandson’s piggy bank to pay for your health care, then let’s take 50% of your estate in taxes when you die.

2.      As Cong. Ryan’s bill would do, let Medicare pay a flat amount to the health plan of your choice for coverage. If you want a rich plan, go ahead, but use your own money to pay the difference. If you want a stripped down plan, by all means, do so. You choose, not the government. However, being able to afford the coverage you want might mean tapping your own funds and that is why I added the next step.

3.      Expand the use of Health Savings Accounts (HSAs). HSAs provide a safe haven for your hard earned income, and allow you to accumulate money in a non-taxable savings account. This money can be used to pay all manner of health care related expenses.

4.      Allow doctors to “balance bill” their patients. This means that doctors would be allowed to charge you a real price for medical services instead of the reduced price the government allows them under Medicare today. Balance billing is currently illegal, and partly explains why nearly 30 percent of doctors will no longer see Medicare patients.

5.      Here is the toughest change. Extend the age of qualification to enroll. Start it now. Perhaps 67 for my age group, and then move it to 71 over the next 10 years. Then index it in relationship to life expectancy.

Medicare has become a pox on us. Of course, I understand it has provided health care to tens of millions of people. I get it. But it also opened the door to endless meddling by politicians and as a result, when compounded by other Great Society programs, today our nation faces financial ruin.

Let’s find the courage as a people to face the fact: Medicare, Medicaid, federal government solutions, threaten our liberty. Let’s get on with this first step toward sanity.