Health Care FARCE Voted Up Last Night

Do we live in a Constitutional Republic any longer?

The 16th Amendment made lawful the income tax – that is, a direct tax on Americans.

But nowhere in The Constitution is the power found to force people, under penalty of law (including fines and imprisonment), to pay private parties for services they do not desire to purchase.

Yet that is in the bill passed last night.

Yes, we have Congressfolk – both men and women, and all Democrats (save one Republican) who voted for this.

This sure appears to be blatantly unconstitutional – and, I would argue, those who voted for the bill know it.

If you watched CSPAN yesterday you heard the speeches.  All those who rose in favor of the bill talked not about The Constitution and how this bill was a solution to the problems facing America’s Health Care System – a system that consumes some 17% of our GDP – but rather it appealed to how individuals with specific circumstances would be helped.

But a desire to help someone is not the test for legislation.  All legislation by definition is designed to help someone.  The test is whether whatever is being proposed comports with the black-letter requires of The Constitution, and the even-blacker-letter requirements of the laws of mathematics. 

This bill meets neither essential test of all legislation; it instead proposes to destroy our Constitutional system of government.

Yet despite member after member rising last evening in opposition and stating that these mandates were unconstitutional not one rebuttal of that point was made by those in support.

The "Holy Grail" for the so-called "private" insurance businesses is forcing everyone onto one of their plans.  This is due to the problem of "adverse selection" – that is, you would not buy insurance until you got sick if it is quite (or very) expensive.  The more expensive the insurance gets the worse this problem becomes and the "insurance" ceases to be insurance at all.  Remember, "insurance" is a thing you buy to protect against an unlikely outcome – if you’re already ill or believe you will become ill the outcome isn’t unlikely – it is either probable or known.

Yet the desires and demands of private business do not give license to use The Constitution as toilet paper.

But the extra-constitutional game didn’t stop there.  Oh no.  This 1990 page monstrosity goes much further.  It mandates that employers not only cover everyone they hire and pay at least a specific percentage of their premiums (or face a fine) it also mandates that said employer cover all members of that employee’s family. While it is unlawful to discriminate against people based on their family status, what do you think is going to happen to salaries across the board to cover the risk of someone showing up for a job interview and having eight kids? 

Does Octomom become permanently unemployable – or does every employer in the nation reduce your salary offer now and forever to guard against the possibility of another Octomom showing up for a job interview?

You know the answer here – nobody is going to take the risk of a multi-million dollar discrimination lawsuit.  Your salary offer will be reduced, and if you are currently employed, you can forget about raises for a long time.

There are Constitutional solutions to this mess.  I have posted about them before. My chronicle of those posts in The Ticker is found here; it encompasses a reasonably small set.

Left un-addressed (intentionally, by the device and drug lobbies) are the reasons we spend so much on health care in this country.  Put simply, America pays for the development of every advanced treatment in the world and has for the last 30 years, yet every other nation’s citizens get to enjoy those advancements for free.

That’s right.  The Pharmaceutical and Device industry has managed to get legislation enacted prohibiting the re-importation of devices or drugs sold overseas.  These overseas markets demand price controls on the drugs and devices sold there, and get it.  We, on the other hand, have a "price at what the market will bear" system. 

The result is that the heart stent that is used in Canada costs a tiny fraction of what the same stent costs in The United States even though they are made by the same company.

Normally such distortions are instantly corrected by cross-border arbitrage.  That is, if I sell a widget in Canada for (US) $1.00, and for $10.00 here in the United States, someone will order 10,000 of them in Canada and ship them across the border back to the US, driving the price in the United State back down close to the Canadian price. 

In general, once I own a thing I have the right to dispose of it as I see fit.  Nobody would accept the idea that by purchasing a car I can not then sell it at some later point for whatever price I desire.  Nor would they accept this in the price of houses, lawn mowers, life jackets, boats, toothpaste, books or Christmas decorations.

Yet today it is not lawful for me to buy 100,000 doses of Viagra in Canada (where they sell for a fraction of the US price) and then ship them back to the United States.  This "unlawfulness" has been artificially created by the drug and device manufacturers, who claim concern for "purity" and "counterfeits" – a red herring and in fact a false claim.  There has never been a right to import or sell a counterfeit product; what these manufacturers have managed to prevent is the importation of lawfully-produced and properly labeled drugs and devices made in their own factories!

The fact of the matter is that if the world is to benefit from the innovation of US companies they should pay the same price as everyone else does – including the United States.  The solution to this sort of improper and outrageous forced subsidy by the American Consumer and Taxpayer is to remove the laws that bar importation of lawfully-produced and properly-labeled drugs and devices – that is, to enforce the general principle of common law that once I buy a thing to whom I resell it and under what terms is a right that I acquired in exclusivity through my original purchase. 

But fixing this distortion – one that costs Americans hundreds of billions of dollars annually – means removing a "special law" that is used by drug and device companies to screw Americans out of that money, and serves to force medical spending to the moon – all for the profit of a few oligarchs in the medical industry.

Also left unaddressed in The House Bill (again, intentionally) are two other factors that serve to together comprise more than half of our spending on medical care.  These are:

• The fact that 90% of your health care spending happens in the last year of your life.  We must have a societal conversation on this issue, and determine what society’s responsibility is for that last year.  I argue that the answer to that question is in fact zero – we all begin to die the moment we are born, and yet none of us know exactly when the clock will expire in advance. As a consequence a perfect separation at that "last year" is not possible, but there are some realities we can – and must – face.  First among them is that when you are in declining health, irrespective of your age, you do not have the right to impose your desire for additional hours, days or months of life on the back of others.  You have the absolute right to expend any or all of your own resources in pursuit of that goal, but you have no right to reach into my or anyone else’s pocket to do so.  There are literally thousands of instances every day across this nation where persons who are in their waning hours or days – persons where the outcome is, within medical certainty – known – are hooked to machines and monitors in hospital beds that cost tens of thousands of dollars a day, simply because they do not have to pay for that last hour out of their own resources.  This must end.  We are a compassionate nation, but this is not compassion – it is barbarism.  When my time comes I should be offered as much pain medication as I desire to take, including a sufficient amount to render me unconscious either in effect or fact – but I should have no right to expend any amount of society’s funds beyond that pallative medication and care.  While this would not save 90% of the nation’s health care expense, it would save 30% or more, and we can do it right now, without any impact whatsoever on treatment and care that has a reasonable chance of resulting in a cure of the patient’s condition.
   
• Tort reform.  Simply put, we call it "practicing" medicine.  There’s a reason for that.  The law must change, even though this will outrage attorneys and their lobbying interests.  A right of suit and recovery must remain for those cases in which gross negligence is shown; we have all heard of cases where the wrong arm or leg is amputated, the perfectly-good eye operated on rendering the patient totally blind, and other similar outrages.  No society can or should accept outrageously negligent activity as "the cost of doing business", including ours.  But most so-called "malpractice" isn’t of that form.  It is instead a lawsuit due to a bad outcome – an outcome that was known to be in the realm of possibility by the patient prior to the procedure, or due to an unforeseen risk.  Medicine is not a science; it is an art.  As an art we must accept that there is always the choice to do nothing and accept whatever outcome God (or Darwin if you prefer) ordains; it is by man’s intervention that one attempts to change that natural course of events.  Such an attempt will not always be successful.  Defensive medicine to avoid the possibility of lawsuit costs hundreds of billions of dollars, all occasioned not by medical necessity but rather by documenting evasion of all reasonably-foreseeable risks – a ridiculously expensive practice for which we all pay.  This must end.

If we cannot have a reasonable set of reforms as I have outlined in my "Wake up Washington" Ticker in September then we should instead pass a single-payer system such as exists in Canada, but (unlike Canada) let those who choose pay in cash for "excess services."  No, it’s not perfect, and yes, it is rationing.  But so is what The House passed – they’re just hiding it in their 1900+ page mess so you can’t easily find it.  A Canadian-style system, funded by general revenues, is Constitutional, unlike the outrage passed last night.

Either of those outcomes would produce marked improvements in the system we have now along with driving down costs dramatically – perhaps as much as 50% – from what is spent today.

The House Bill not only fails to address the problem but is an outrageously-broad and, I would argue, an unconstitutional reach into Americans most private parts.  The Administration’s own spokespeople admit this bill will cost us some 5.5 million jobs – on top of the 8 million we’ve already lost in the present economic malaise since the peak of employment in the summer of 2007.  My "back of the envelope" computations are similar – I come up with 5 million jobs lost with a 20% variance and 95% confidence level – that is, somewhere between 4 and 6 million should be the total.  Darn close, given that I’m not privvy to the Administration’s facts and figures and am forced to work off published information.

When Pelosi and her gang of thugs took their place behind you they didn’t even bother to snap on a glove first.

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