The Freedom Bulletin

If one thing is for sure, it’s that medical costs have gone up recently. A new study showed that health insurance prices rose, on average, 9% in the past year. The Affordable Care Act may very well share the blame for this, and so might the fact that doctors perform too many medical procedures (surprisingly, doctors themselves admit to this).

But logic indicates that the main cause of how much something costs is…well…the price the seller chooses to charge. You wouldn’t think the New York Times would have to do an article on this obvious fact, but they did.

The reason why doctors and hospitals charge so much for their services is simple: because they can do so without losing customers. If you have cancer, for example, you might need chemotherapy to live, and if you have a broken bone, you need to get a cast. People don’t have the option of going without these things if they decide they cost too much money. In economic terms, the demand for health services is inelastic. Governmental policies have exacerbated this problem – for example, the Durham-Humphrey Amendment by requiring people to visit a doctor and get a prescription before being allowed to buy medication, and the individual mandate by actually requiring people by law to buy health insurance.

The only solution to this problem, in my opinion, is price ceilings. This idea has been floated around a little bit, including in California where a bill called AB 52 would limit health insurance price increases, by Massachusetts Governor Deval Patrick, who created a similar policy, and more recently, State Rep. Ron Mariano, who more sensibly focused on the prices of health services themselves, proposing a bill that would limit prices paid to the costliest hospitals. This bill is definitely a step in the right direction.

As such an ardent advocate of liberty, it might appear strange to support government telling businesses how much money they can charge. Shouldn’t people be able to engage in any transactions they choose? But I look at excessive prices as akin not to consensual transactions but to extortion. People have a right to their own money, and doctors do not have a right to suck a person dry of all their money for performing a medical procedure that the person needs to live. Doctors, just like any other merchant, deserve compensation for the services they sell, but because their customers are not truly choosing to purchase those services, doctors should not be allowed to take so much money that people have no more money left to spend on anything else. It would be impossible for everyone to agree on a particular price at which a transaction becomes extortion. But people should certainly be discussing this question and working toward instituting a price ceiling on medical services, instead of continuing to let doctors and hospitals extort people.

There’s nothing wrong with the government setting maximum prices that sellers are allowed to charge for goods and services that have inelastic demand. The Boston Herald called Mariano’s idea “a move toward government price controls, plain and simple.” But I believe there is nothing wrong with that.

Good news for liberty from the 11th Circuit Court of Appeals – in a 2-1 opinion, the three-judge panel ruled that it is unconstitutional for the federal government to require Americans to have health insurance. The decision was part of the lawsuit by 26 states against the Patient Protection and Affordable Care Act (“Obamacare”).

According to the majority opinion written by Judges Joel Dubina and Frank Hull:

“This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives.”

Read the full opinion (PDF).

…is the Obama administration’s decision to force health insurance companies to provide free birth control and preventative services for women, as well as this editorial in support of it by Health and Human Services Secretary Kathleen Sebelius.

The new policy requires insurance companies to cover, with no co-pays, co-insurance, or deductibles, a variety of services including contraception, sterilization, checkups, domestic violence screenings, STD and contraception counseling, HPV testing, gestational diabetes screening, breastfeeding counseling, and breastfeeding equipment. The reasoning behind this, Sebelius writes, is that women “have unique healthcare needs” and “are more likely to need preventive healthcare services.”

Feminism is the belief that men and women should be treated equally. Although many people extol how good the new policy is for women, it is anti-feminist to give women special attention and care and to make generalizations about how many health services they need. It is sexist to cover gender-specific health services for women but not men. It is also sexist to cover gender-neutral health services – including checkups, STD counseling, sterilization, contraception, and domestic violence screening (men can be abused too) – when women use them but not when men use them, as the new policy seems to do.

This brings me to another reason why “free” birth control is wrong: as I explained earlier and will repeat only briefly, it is unfair. The purpose of health insurance is to cover catastrophic medical expenses that cannot be prevented. Using birth control, becoming pregnant, and even going for a checkup are choices that people can make, and are therefore inappropriate for insurance. There is a completely free way of preventing pregnancy; it is called abstinence. Sex is important to many people, but that is not a good reason for everyone to be forced to subsidize it. After all, guns are important to many people (and protected by the Second Amendment), but I have never heard anyone suggest that every American be provided with a free gun. News articles and scholarly research are important, but the Obama administration has not announced any plans to force websites to provide these for free. Why is sex considered worthy of subsidizing, while research and the right to bear arms are not? Birth control, STD testing, and breastfeeding equipment are all goods that people should be free to purchase if they would like, but there is no right to get them for free.

Fairness demands that people have the option of purchasing health insurance plans that do not cover services related to contraception, STDs, or pregnancy, and gender equality demands equal insurance coverage for both genders. Despite what so-called advocates for women think, providing “free” birth control (and all the other free services included in the Obama administration’s policy) is both anti-feminist and unjust.

In yesterday’s Globe, there were two stories that made me kind of mad, for reasons that are, in a strange way, related.

One was about a federal government panel’s recommendation to require all insurance plans to ”offer female patients free coverage of prescription birth control, breast-pump rentals, counseling for domestic violence, and annual wellness exams and HIV tests,” as well as ”screening for gestational diabetes in pregnant women; more sophisticated testing for a virus, known as HPV, that is associated with cervical cancer; annual counseling for sexually active women on sexually transmitted infections; and multiple visits to obtain preventive services if they cannot be provided in one annual examination.”

Supporters of these recommendations say that they will improve people’s health, prevent unintended pregnancies, and possibly prevent large expenses in the long run. But what people really need to think about is what is fair. None of these services will be truly free, of course. Requiring insurance companies to cover them with no co-pays or deductibles equals requiring everyone, regardless or whether or not they use them, to pay for them. This is simply not fair. Contrary to what many people seem to think, sex is not something that people need to live; it is an activity that people can choose to participate in, or not, just like playing sports, reading, blogging, or buying a house, for example. It is unfair for everyone to be required to subsidize some people’s choices.  These recommendations would force people who do not have sex (who may be a tiny minority but do exist) to pay higher insurance prices with no added benefits.

It is also worth mentioning that because the U.S. Preventive Services Task Force “has historically paid less attention to gender-specific recommendations, the law’s drafters required that the Department of Health and Human Services issue a supplementary list for women.” This is extremely sexist. Men and women should be treated equally in all respects, and giving women special treatment and attention is both unfair and insulting. Would men have to pay for contraception and STD treatment under the new recommendations, while women wouldn’t? That is precisely the kind of thing feminists should oppose.

The second article in the Globe that made me mad was Jeff Jacoby’s column arguing in favor of population growth. He writes that ”the birth of virtually any baby is cause to rejoice” because ”human beings…usually create more than they destroy” and “when human beings proliferate, the result isn’t less of everything to go around.” He quotes economist Bryan Caplan, who said, ”The world economy is not like a party where everyone splits a birthday cake; it is more like a potluck where everyone brings a dish.”

While possibly true about some things, for the world’s most important resources this is completely false. No matter how inventive, hardworking, and talented people may be, they cannot create more land, more water, more oil, or more coal. There is simply a finite amount of these things, and it is a mathematical fact that the more people there are, the less of these things each person will have. I have seen with my own eyes houses being torn down to make way for condominiums, more people packed into the same amount of space. The Earth is not merely full, as Thomas Freidman at the New York Times wrote, it is beyond full. Although Jacoby calls opposition to population growth a “persistent and popular superstition,” I believe it is unpopular but right. He may call people like me “churlish” and “misanthropic,” but he is the real misanthrope for wanting people to be condemned to a world with inadequate space, nutrition, and fuel.

This might seem like an odd pair of beliefs for one person to have: opposing making birth control free but also opposing population growth. But it really isn’t. I thought of two ways to solve the problem of overpopulation which may not be practical or popular, but which I believe are truly fair:

1. Health insurance should only cover medical services that are necessary and that were not directly caused by a person’s own actions. Some of the things mentioned in the recommendations, such as domestic violence and STD counseling, are not exactly health services. Others, such as contraception and pregnancy-related services, are not needed to live, because the decision to have sex and/or have children is a choice. And others, like STD testing and treatment, are only needed as a result of certain decisions that people make. The purpose of insurance is to cover large, unexpected expenses. Covering things that are discretionary or that are predictable and preventable results of people’s actions, is unjust to all of the people who pay into the insurance pool.
2. If making birth control more easily available is unfair, how can the world solve the problem of overpopulation? In my opinion, the best solution is simply to enact a tax on having babies. Creating a new person is not a fundamental right; it is a choice that has negative externalities because it reduces the available amount of land, water, and fuel. Internalizing this externality is a perfectly fair way to get the world’s population under control.

July 22 update: The L.A. Times has an op-ed about exactly this topic, arguing that population growth is a huge problem that the public and the media ignore. I really like most (but not all) of it; check it out!

On Thursday, former Massachusetts governor Mitt Romney gave a much-publicized speech about health insurance policy…but the speech ended up being a repeat (with a little more detail) of what he’s been saying for a while now. Romney is standing by the Massachusetts law he signed in 2006 requiring all residents to have health insurance (the individual mandate) while condemning the law President Obama signed doing the same thing nationally.

In the speech (and accompanying PowerPoint presentation), Romney said that apologizing for the law he signed as governor might make him more popular with conservatives but “It wouldn’t be honest.” (I couldn’t help thinking for a second, “Well, that hasn’t stopped him before…”) Kudos to Romney for sticking to his guns instead of flip-flopping, but his speech showed that while at least somewhat consistent, he is not a friend to liberty.

Somehow, to Romney, requiring everyone in a state to buy health insurance is a way to “help people get and keep their health insurance,” while doing the same thing nationally is a “government takeover.” He (and his supporters, such as State House Minority Leader Brad Jones) emphasized states’ rights, the new taxes, spending, Medicare cuts, and bureaucracy of Obamacare, its unpopularity with voters, the way it was passed, and its impact on jobs. They argue that the individual mandate is the only way, besides letting people go without needed health services, to prevent the free rider problem where poor people get sick and receive health services that they cannot (and do not) pay for.

But as a Boston Herald reader points out, choosing not to have health insurance is not the same as relying on taxpayers to bail you out. It is conceivable that a person could choose, instead of buying insurance, to simply pay for any health services he or she may receive. This is a risky option and many people would not consider it a good one, but people should have that option, and banning it, as Romney did in Massachusetts and Obama and the Democrat-controlled Congress did nationally, violates everyone’s rights. As long as payment is strictly enforced, a small amount each month if necessary, this would be a better solution to the free rider problem than the individual mandate system, where poor people’s health insurance is still subsidized by tax money. (Price ceilings would make such a system even better and more affordable for everyone, but I digress).

People should oppose the national health insurance “reform” law because it violates people’s rights. People’s rights should never be violated, whether by the United Nations, the federal government, state governments, local governments, or other individuals. Romney may oppose that law, but (as Jeff Jacoby pointed out back in December) he does not oppose it for the right reason. If he did, he would have to oppose the Massachusetts law as well.