The Freedom Bulletin

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.

Last week, Paul Krugman wrote in the New York Times that “patients are not consumers.” He asks,

“Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as ‘consumers’? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.”

My question is, how did it become acceptable to refer to people who receive health services as “patients” and to refer to the services themselves as “care”? Why did society decide to think and speak about health services as if they are fundamentally different from other goods?

I’m assuming that if Krugman objects to health services being treated the same as other services and products, he must be in favor of the prevailing system, in which people are widely presumed to be incapable of making decisions about their health and are expected to obey whatever doctors tell them to do. But this paternalistic view deprives people of dignity and freedom.

Krugman gives the following reasons for his view:

“Medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.”

Perhaps medicine is an area where decisions tend to have weighty consequences and professionals tend to have extensive training. But this doesn’t make it fundamentally different from other professions. Chefs, photographers, interior designers, personal shoppers, and investment bankers all have training and expertise, and their work affects people’s well-being to various degrees, but people who use their services are still considered consumers, and it is also considered perfectly acceptable, by the law and society, for people to cook their own food, take their own photos, decorate their own houses, buy their own clothes, and invest their own money.

In all areas, people should have the right to make any decision they want, as long as it does not violate the rights of anyone else. This includes making decisions that are risky, unwise, or based on non-expert knowledge. I think that ordinary people are more capable of making medical decisions than Krugman gives them credit for – almost anyone can read about the benefits and risks of a medicine or procedure and decide whether they want it or not. But even if specialized knowledge is required to make certain decisions “intelligently,” people have a right to make unintelligent decisions. For situations where a person is incapacitated, we could create a system in which people can easily register their medical preferences ahead of time and know that they will be respected. Even when a person “needs” medical attention immediately, they should still be free to take as long as they want to decide (even if this is unhealthy), to make a quick decision themselves (even if it may be the wrong one), or defer to a doctor’s judgment if they so choose. And severe stress is certainly no reason for people to be unable to make their own decisions.

“The idea that all this can be reduced to money — that doctors are just ‘providers’ selling services to health care ‘consumers’ — is, well, sickening,” Krugman writes. No, the idea of doctors and their customers as equals, engaging in voluntary transactions, is beautiful. What is truly sickening is a society and legal system that considers it inappropriate for people to make decisions about their own bodies. Any change toward viewing people who receive health services as consumers is a good change, which the world desperately needs more of.

Fighting back against Obamacare and its individual mandate is not just for Republicans. Attorney General Chris Koster of Missouri, a Democrat, filed an amicus curiae brief in the 11th Circuit Court of Appeals, supporting the lawsuit by 26 states against the largely Democrat-supported health insurance reform law:

“Within the health care arena, the power to penalize one’s decision not to purchase health insurance is indistinguishable from granting Congress the power to penalize individuals for not obtaining an annual check-up or prostate exam, for not vaccinating one’s children, or for not maintaining a specific body-mass,” Koster wrote.

And what a sad state of affairs that would be. Thank you, AG Koster.

Amicus curiae brief (PDF)

The Defense of Marriage Act (DOMA) and the Affordable Care Act (ACA), also known as Obamacare, have both been in the news recently – DOMA because the Obama administration announced on Thursday that they would no longer defend it against lawsuits, and the ACA because a judge upheld its constitutionality against a religious-freedom-based challenge a week ago. Other than that, these two laws don’t have much in common. But this made me think, why did the Obama administration decide DOMA was unconstitutional while enthusiastically defending the constitutionality of the ACA?

DOMA defines marriage as between one man and one woman and, as a result, denies same-sex spouses of federal employees some benefits that are given to opposite-spouses. The Obama administration decided it violates the Equal Protection Clause of the Fifth Amendment. As Attorney General Eric Holder wrote, “The record contains numerous expressions reflecting moral disapproval of gays and lesbians and their intimate and family relationships – precisely the kind of stereotype-based thinking and animus that the Equal Protection Clause is designed to guard against.”

The Democrats’ health reform law, the ACA,  makes it illegal (for the vast majority of people) not to buy health insurance, and punishes people who disobey this requirement with fines. The Justice Department’s website has a prominent page dedicated to its “vigorous” defense of the law in federal courts.

Why does the Obama administration believe Obamacare is constitutional but DOMA is not? DOMA merely stops some people from partaking in a benefit offered through their spouse’s employment with the federal government. It might be fairer if both same-sex and opposite-sex couples  were offered the same benefits, but (a) the fairest thing for gay, straight, bisexual, asexual, married, and unmarried people would be not to offer benefits to spouses at all but only to actual employees; and (b) people don’t have a fundamental right to government-given health benefits based on their spouse’s employment. The ACA, on the other hand, outlaws the decision to opt away from health insurance and instead pay for all of one’s health services oneself. In other words, it takes away the ability to spend one’s own money as one chooses, which is a fundamental right.

Wouldn’t it make more sense to allow people to form whatever romantic relationships they want (or none at all) without government labels or interference, and to choose whether to buy insurance or pay for health services in cash? I sure think so, but I guess that’s just me.

I spent all of yesterday on a train which had no WiFi, and as a result I missed out on some truly awesome news. Why, you may ask? I had to travel for work, and I decided I would rather have a long, somewhat boring train ride than be subjected to pat-downs or virtual strip searches. I don’t regret my decision at all, and despite the lack of WiFi, I would recommend it to anyone. The satisfaction of acting according to my beliefs far outweighs the inconvenience. Go Amtrak! 

Enough about me. Now for the news: Judge Roger Vinson of the Northern District of Florida ruled yesterday that the individual mandate is unconstitutional! Not only that, but he threw out the entirety of the Patient Protection and Affordable Care Act, going even further than Judge Henry Hudson of Virgina, who in December also called the mandate unconstitutional.

He didn’t seem thrilled about his own ruling, but he did the right thing:

“I must reluctantly conclude that Congress exceeded the bounds of its authority in passing the Act with the individual mandate…Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void. This has been a difficult decision to reach, and I am aware that it will have indeterminable implications. At a time when there is virtually unanimous agreement that health care reform is needed in this country, it is hard to invalidate and strike down a statute titled ‘The Patient Protection and Affordable Care Act.’”

He also wrote:

“It would be a radical departure from existing case law to hold that Congress can regulate inactivity under the Commerce Clause…It is not hyperbolizing to suggest that Congress could do almost anything it wanted.”

This is a victory for Florida and the other 25 states that sued the federal government over Obamacare (and really, all people who love freedom). Unfortunately, however, the federal government is appealing, and this issue is all but certain to eventually wind up in the Supreme Court.

Read the whole (long) opinion (PDF).

As everyone knows, the House of Representatives voted yesterday to repeal the health non-reform bill. All 242 Republicans voted for the repeal, as well as Democrats Mike Ross, Dan Boren, and Mike McIntyre. Although, sadly, the repeal has little chance of passing the Senate or overcoming President Obama’s veto, all who voted for the repeal yesterday should be commended for standing up for individual rights. Here are a couple of my least favorite and favorite moments related to yesterday’s vote.

Least favorites:

Rep. Steve Cohen (D-TN) said on the House floor, “They say it’s a government takeover of health care, a big lie, just like Goebbels. You say it enough, you repeat the lie, you repeat the lie, you repeat the lie and eventually people believe it.” So after Sarah Palin and the Tea Party movement have been dragged through the mud for the past week and a half for using “divisive” military metaphors, a Democrat compares his opponents to a Nazi propagandist. Nice.

Rep. John Lewis (D-GA) argued that the “pursuit of happiness” part of the Constitution (it’s actually the Declaration of Independence) justifies the health non-reform bill. “I think people should be required to get health insurance,” he said. What about people who decide that it would make them happier to pay separately for each health procedure they receive than to buy health insurance?

David Lazarus of the LA Times compares the GOP to “a bunch of spoiled children throwing a tantrum because they didn’t get their way” and tells them to have “the maturity to deal with the new status quo and move on” and to ”Deal with it. Work with it. Grow up already.” So let me get this straight: Lazarus thinks it is mature to accept whatever happens to be the current policy, regardless of how good or bad it is? I’m not sure what a person’s age has to do with any of this, but if by maturity he means mindlessness and cowardice, then he might make sense. What is the point of having a legislature (or a brain for that matter) if you aren’t supposed to debate whether a policy is good or bad? Unfortunately, the previous Congress decided to pass a law that violates the rights of every single person in the United States. The best way to deal with such a law is to get rid of it.

Favorites:

Rep. Mike Pence (R-IN) said (above), that by passing the health non-reform bill, “We broke with some of our finest traditions – limited government, personal responsibility, and most profoundly the consent of the governed.” I love this speech!

Rep. Steve Scalise (R-LA) said (above), “Anybody who contends that Obamacare would save jobs and money must be an Enron accountant.”

And finally, in other Obamacare-related news, there are now 27 states suing the federal government over the health non-reform bill. Hooray!

Edit: I should mention that Rep. Pence’s speech above is from two weeks ago. His (also awesome) speech from Wednesday can be heard here, along with those of other Republicans (and some Democrats).