Fallout

David Bernstein at Volokh poses a rhetorical question:

But seriously, I’m really wondering, if you were among my liberal interlocutors who adopted the line that Medicare Part D was a malevolent “giveaway” to the drug companies, how are you feeling about Obamacare?

What the health care bill means to the Humble Libertarian:

In response to the passage of H.R. 4872, the “Health Care and Education Affordability Reconciliation Act of 2010,” (full text here) the Internet is abuzz with questions like “What does the health care bill mean to me?” which is a trending topic on Google, along with “new health care bill pros and cons,” “healthcare bill summary,” and “obama health care plan explained.”

Oh now you’re interested? You couldn’t have bothered to search for these questions before the bill passed, and determine your opinion in time to make a difference in its passage? Hmm? Okay. Whatever. At least you’re paying attention now.

Let’s break it down:

Asshat playing Calvinball.

The Dialectical Playa, King of Rants:

How did Obamacare pass? Quite simply it came down to this: the American people voted for the government they deserved. In the aftermath of extinguishing life, liberty, and the pursuit of happiness for the slavery of entitlements and big government, we can now comfortably focus on the important things, like who wins American Idol or why Jesse James cheated on Sandra Bullock. What? You’re somewhat disconcerted by Obama’s and the Democrats’ vision for America? Get used to it because to the Left, Obamacare is, as Obama himself so aptly described it last night, “what change looks like”. And you’ve still got some change-you-can-believe-in coming with “Cap-and-Trade” and “Immigration Reform”. So while all those disturbing thoughts and images may compel you to wring your hands, you would be much better off by becoming, like the Stupak Bloc, sellouts and embracing the new reality that “We’re all Socialists now.” But rest assured, however you reconcile the fact that the advent of the United Socialist States of America is as equally your fault as it is Barack Obama’s and the Democrats’ . . .

I thought “reform” was the misnomer in “health care reform,” since the bill entrenches the existing health care industries’ oligopolistic relationship with the federal government.  Apparently, I was half wrong:

The “reconciliation bill” is not a “health bill” but an anti-health bill.  It relies heavily on price controls, taxes and fines to punish doctors, hospitals and formerly innovative companies the produce prescription drugs and medical devices.  If we treated farmers, food companies and grocery stores the way Congress threatens to treat the health industries would anybody expect food to become better or cheaper?

Ludwig Von Mises weighs in on Obamacare, sort of:

In the words of Dr. Oreschenkov in conversation with Lyudmila Afanasyevna, a longtime patient and herself a physician in the cancer ward: “In general, the family doctor is the most comforting figure in our lives. But he has been cut down and foreshortened. . . . Sometimes it’s easier to find a wife than to find a doctor nowadays who is prepared to give you as much time as you need and understands you completely, all of you.”

Lyudmila Afanasyevna: “All right, but how many of these family doctors would be needed? They just can’t be fitted into our system of universal, free, public health services.”
Dr. Oreschenkov: “Universal and public—yes, they could. Free, no.”

Lyudmila Afanasyevna: “But the fact that it is free is our greatest achievement.”

Dr. Oreschenkov: “Is it such a great achievement? What do you mean by ‘free’? The doctors don’t work without pay. It’s just that the patient doesn’t pay them, they’re paid out of the public budget. The public budget comes from these same patients. Treatment isn’t free, it’s just depersonalized. If the cost of it were left with the patient, he’d turn the ten rubles over and over in his hands. But when he really needed help he’d come to the doctor five times over…

“Is it better the way it is now? You’d pay anything for careful and sympathetic attention from the doctor, but everywhere there’s a schedule, a quota the doctors have to meet; next! . . . And what do patients come for? For a certificate to be absent from work, for sick leave, for certification for invalids’ pensions: and the doctor’s job is to catch the frauds. Doctor and patient as enemies—is that medicine?”

“Depersonalized,” “doctor and patient as enemies”—those are the key phrases in the growing body of complaints about health maintenance organizations and other forms of managed care. In many managed care situations, the patient no longer regards the physician who serves him as “his” or “her” physician responsible primarily to the patient; and the physician no longer regards himself as primarily responsible to the patient. His first responsibility is to the managed care entity that hires him. He is not engaged in the kind of private medical practice that Dr. Oreschenkov valued so highly.

VDH:

Do Democrats realize that we really have crossed the Rubicon? In the future when the Republicans gain majorities (and they will), the liberal modus operandi will be the model—bare 51% majorities, reconciliation, the nuclear option, talk of deem and pass, not a single Democrat vote—all ends justifying the means in order to radically restructure vast swaths of American economic and social life. Is someone unhinged at the DNC? They just blew up any shred of bipartisan consensus when their President polls below 50%, the Democratically-controlled Congress below 20%, and health care reform less than 50%. Usually unpopular leaders and their unpopular ideas seek the shelter of minority rights and prerogatives. What will they do when they are in the minority—since they’ve entered the arena, boasted “let the games begin” and shouted “by any means necessary”?

Aloha ‘oe, small insurance companies – the big insurance company oligopoly has got you now:

“The support for the bill coming from the major insurers should be one piece of evidence that they expect it to be good for them, particularly due to the provision that requires Americans to buy health insurance. In addition, as is the case with almost all regulation, larger firms are better able to absorb the fixed cost of compliance than are smaller firms. Given that this bill authorizes the hiring of over 16,000 new IRS agents to enforce its tax code provisions, such compliance costs are sure to be high, which will have a higher relative burden for the smaller firms.” * * *

“The irony, of course, is that the very same progressives who have supported this bill will be summarily outraged by the decline of small health and dental insurers and the oligopolistic behavior of the remaining large ones. Not that they will accept it, but they have no one to blame but themselves for supporting this bill as its changes will be the cause of those problems.”

The disconnect between economics and politics:

Economics is the study of the whole system of exchange relationships. Politics is the study of the whole system of coercive or potentially coercive relationships.  In almost any particular social institution, there are elements of both types of behavior, and it is appropriate that both the economist and the political scientist study such institutions.  What I should stress is the potentiality of exchange in those socio-political institutions that we normally consider to embody primarily coercive or quasi-coercive elements.  To the extent that man has available to him alternatives of action, he meets his associates as, in some sense, an ‘equal,’ in other words, in a trading relationship.  Only in those situations where pure rent is the sole element in return is the economic relationship wholly replaced by the political.” Buchanan CW, Vol. 1, p. 40.

Government’s track record in health care when it controls all the chips: The VA’s inability failure to provide:

While the VA’s budget, payroll, and number of facilities expanded rapidly to become “by far the most extensive [medical program] in the country,” its standard of care stagnated, and complaints of inefficiency and negligence mounted. A 1949 commission “uncovered a staggering amount of waste,” a result of the highly political nature of the VA’s health care system.

The VA was raised to a Cabinet department in 1989, although Hamowy argues that there was “not one substantive argument put forward” that justified doing so. The Cabinet position offered no lasting changes to address the extensive waste and inferior care. Conditions further deteriorated as the U.S. began to intervene in Iraq and Afghanistan, “substantially increasing the number of veterans needing medical care” from an already dilapidated system. Hamowy finds that “the lifetime costs of providing disability benefits and medical care to the veterans of these two wars . . . will amount to between $350 and $700 billion.”

The VA has clearly overstepped its original role as a health care provider for veterans with service-related disabilities, a raison d’être that the author believes “was extremely weak to begin with.” As new evidence of the VA’s inefficiency reaches the news daily, such as having to reconsider the Gulf War syndrome cases, Failure to Provide presents a compelling examination of the rationale behind the administration that “paved the way for instituting a national system of socialized medicine.”

Obamacare promises decreased medical costs; market betting otherwise:

One of the promises of Obamacare has been that it would reduce health care costs.  The day after the House passed the Senate’s version of health care reform, this headline says “Health Care Companies Pull Stock Market Higher.” Clearly, money is being bet on health care costs increasing, putting more money, not less, into the health care sector.

That should not be surprising.  In a free market setting, individuals decide how much they want to spend on various services, including health care.  With increasing government control, spending on health care will increasingly be a political decision, not the aggregation of individual decisions.  Health care companies already have their lobbyists, who pull for more generous reimbursements.  Consumers (the elderly on Medicare, the poor (and increasingly middle class) on Medicaid, etc.)  will exert political pressures for more benefits.  Political allocation of resources will surely increase costs.

Taxpayers won’t like the idea of higher taxes, already a part of Obamacare, so expect the bulk of the increased cost to push the budget deficit higher.  Essentially, Congress has looked around the world and decided they’d like to shape our public sector to be more like Greece. At least, by not being on the leading edge here, we can see what’s coming.

Finally, five days to Obama is three, tops.

Contests, Health Care, Socio-Political