My Answer to Paul Krugman
In responding to Peter's request that I address the question posed by Paul Krugman, I can do no better than to quote extensively from a piece entitled What is Wrong with the Individual Mandate? that I posted last December in response to a similar question posed by ParisParamus:
There is a simple answer to the question . . . . Government exists first and foremost for the sake of our protection. Without it, our lives and our property would not effectively be our own. Government exists also to promote our well-being. For its support, however, taxation is necessary, and we have tacitly agreed that, to be legitimate, these taxes must be passed by our elected representatives. By our own consent, we give up a certain proportion of our earnings for these purposes.
The money left in our possession, however, is our own -- to do with as we please. It is in this that our liberty largely lies. Romneycare and Obamacare, with the individual mandate, changes radically our relationship vis-a-vis the government. The former presupposes that state governments have the right to tell us how we are to spend our own money, and the latter presupposes that the federal government has that right as well. Both measures are tyrannical. They blur the distinction between public and private and extend the authority of the public over the disposition of that which is primordially private. Once this principle is accepted as legitimate, there is no limit to the authority of the government over us, and mandates of this sort will multiply -- as do-gooders interested in improving our lives by directing them encroach further and further into the one sphere in which we have been left free hitherto.
Managerial progressives see only the end -- preventing free-riders from riding for free. And they ignore the collateral damage done by way of the means selected. . . . For . . . social engineers, citizens are subjects to be worked-over by the government for their own good. [Managerial progressives] are inclined to treat us as children subject to the authority of a paternalistic state under the direction of a benevolent and omniscient managerial class. . .
Raising taxes to reward free riders is, of course, objectionable. We should oppose it on principle. But it does not in and of itself narrow in any significant fashion the sphere of our liberty. It is a question of the proper use of the public purse. The individual mandate sets a new precedent. It extends government control to the private purse.
The point I made in that can be put in another way, and this has been done. As George Will recently reported, the Institute for Justice (IJ), a libertarian public interest law firm, has argued that the individual mandate is "incompatible with centuries of contract law," which regards "a compulsory contract is an oxymoron." Here again, the point is that the individual mandate blurs the distinction between public and private:
The brief, the primary authors of which are the IJ’s Elizabeth Price Foley and Steve Simpson, says that Obamacare is the first time Congress has used its power to regulate commerce to produce a law “from which there is no escape.” And “coercing commercial transactions” — compelling individuals to sign contracts with insurance companies — “is antithetical to the foundational principle of mutual assent that permeated the common law of contracts at the time of the founding and continues to do so today.”
In 1799, South Carolina’s highest court held: “So cautiously does the law watch over all contracts, that it will not permit any to be binding but such as are made by persons perfectly free, and at full liberty to make or refuse such contracts. . . . Contracts to be binding must not be made under any restraint or fear of their persons, otherwise they are void.” Throughout the life of this nation it has been understood that for a contract to be valid, the parties to it must mutually assent to its terms — without duress.
Here again the key fact is that the government is intruding in a sphere where, in principle, the government cannot intrude. It is not protecting our liberty -- which consists in the right to dispose of our own property as we see fit and to enter into contracts or not enter into contracts as we see fit. It is violating that liberty.
If Krugman cannot see this, it is because he does not care one whit about our liberty. He sees himself -- no doubt rightly -- as a member of the managerial class, and he believes that he can run our lives better than we can do so ourselves, that he can spend our money in a more rational fashion than we can, and that he can make contracts for us in a more rational fashion than we can. The authors of Romneycare and Obamacare entertain a similar presumption.
There is one problem with all such arguments, and it is insuperable. Even if Paul Krugman were more rational than each and every one of us -- and his columns raise grave questions about that presumption -- he does not care as much about our welfare as individuals as each of us does.
I may at times be mistaken but I am a far better judge of what is good for me than is someone who cares far less for my well-being than I do. That is the ground for our right to life, liberty, and the pursuit of happiness, and it can be preserved only if we have the right to dispose of our property as we see fit and the right to enter into contracts or to refuse to enter into contracts as we see fit. Running roughshod over forms and formalities is fatal to liberty.
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Re: My Answer to Paul Krugman
I must confess that I do not understand Joseph Eagar's argument. We do not have a failing medical-delivery system; we have one that is damaged. Reforming Medicare and Medicaid should be a priority.
I find it fascinating that the conservative supporters of socialized medicine (of which Romneycare & Obamacare are variants) always cite the European example -- as if we should follow them. Europe is collapsing -- demographically and financially. It has an unsupportable entitlements state.
Where we went wrong in the first place was in following the European model. Social security, Medicare, Medicaid are all disasters, and Romneycare is no better.
Joseph, you need to rethink from the bottom up the entitlements model. That is where the failure lies. Instead of digging in deeper, as Romney and Obama have, we should fill in the hole.
May '10
Re: My Answer to Paul Krugman
One of the things I find dismaying about the individual mandate is when I hear those on our side speaking of it as a matter of "personal responsibility." Romney does it. So has Newt. This is an Orwellian perversion of language--the kind that sets us up for abuse.
Government mandates are the opposite of personal responsibility.
The whole concept of self-government relies on a culture that encourages true personal responsibility. You can't have one without the other.
And personal responsibility requires that people be left to enjoy the rewards of good decisions and suffer the consequences of bad decisions—including, especially, decisions about their lifestyle and about their planning for the future.
Government health care massively undermines personal responsibility by coming between citizens and the natural consequences of their choices and actions. That, in itself, renders a person less the citizen and more the dependent.
May '10
Re: My Answer to Paul Krugman
Does anyone doubt, for instance, that obesity rates would be go way way down if people had to pay for their own healthcare?
May '10
Re: My Answer to Paul Krugman
I just want to make clear that I never said I supported a/the mandate; just that I saw no difference between a "tax" you're forced to pay that goes to funding healthcare, and a mandate that says you must buy insurance or else you will be charged a penalty; both are equally coercive and not the business of Washington.
Nov '10
Re: My Answer to Paul Krugman
Paul A. Rahe: I must confess that I do not understand Joseph Eagar's argument. We do not have a failing medical-delivery system; we have one that is damaged. Reforming Medicare and Medicaid should be a priority.
. . .
Where we went wrong in the first place was in following the European model. Social security, Medicare, Medicaid are all disasters, and Romneycare is no better.
Professor Rahe, I'm sorry to say that while I think you are right that we initially went wrong when we started following the European model, you are wrong when you say we do not have a failing medical-delivery system. Ask any physician and you will hear the same answer. Medicare, the mentality that preventive or routine care should be free, and the price-fixing established by the Medicare bureaucracy and transmitted throughout the system have so thoroughly warped provider behavior that it is hard to imagine that it can be undone. Huge systems exist to meet bureaucratic requirements, and things for which actual demand exists may not exist at all--and training doctors takes years and years. It is an unbelievable mess.
Oct '10
Re: My Answer to Paul Krugman
Lucy... "Professor Rahe, I'm sorry to say that while I think you are right that we initially went wrong when we started following the European model, you are wrong when you say we do not have a failing medical-delivery system."
You cite some of the perversions of a once great medical delivery system and then conclude that the total perversion of the system into the NHS model will somehow restore sanity to the system?
To paraphrase Dr. Rahe from an earlier post, it is time to stop digging the hole and to start filling it in.
Prior to the advent of the genius generation in the 1960s, medical services were far more similar to a capitalist model than not. The main flaw, that of medical insurance provided by employers was hardly 2 decades old, and was the result of yet another government instituted perversion of capitalism.
Simple medical care; you go to the doctor with an ailment and he prescribes treatment and/or medication. You purchase said provision for money and apply yourself to that treatment, or you disregard the doctor and accept personal responsibility for said decision. That simple.
Thanks @katievs for your clear explanation of capitalism.
Mar '11
Re: My Answer to Paul Krugman
Joseph Eagar
DocJay: Raycon, DHS may get 450 million bullets but will they find enough free men willIng to use them on their own people? I would think this might be a good dept to defund though considering we have a military and I like and trust their leaders better. · 5 hours ago
Edited 5 hours ago
Excuse me? Are we supposed to take that seriously? · 2 minutes ago
Somebody at ATK thought so, otherwise they wouldn't have issued a press release.
Undoubtedly, there's nothing to be concerned about. 45,000,000 rounds would be over a five year period. That's about 37,000 individual combat loads per year.
Homeland Security is just gearing up for the Zombie Apocalypse.
Re: My Answer to Paul Krugman
All government is coercive, and some of it is legitimate. All that I insist upon is that there is a big difference between the government's expenditure of tax revenues and its forcing us to spend the money that is ours in the way that it sees fit. The first is part and parcel of government as such, and it can be consistent with individual and political liberty. The latter is not part and parcel of government as such, and it presupposes the presumption that our money is the government's to spend.
I do not mean to argue that every government expenditure of tax revenues is legitimate and proper. I mean merely that no government expenditure of my money or yours can be legitimate and proper.
Nov '11
Re: My Answer to Paul Krugman
Lucy Pevensie
Professor Rahe, I'm sorry to say that while I think you are right that we initially went wrong when we started following the European model, you are wrong when you say we do not have a failing medical-delivery system. Ask any physician and you will hear the same answer. Medicare, the mentality that preventive or routine care should be free, and the price-fixing established by the Medicare bureaucracy and transmitted throughout the system have so thoroughly warped provider behavior that it is hard to imagine that it can be undone. Huge systems exist to meet bureaucratic requirements, and things for which actual demand exists may not exist at all--and training doctors takes years and years. It is an unbelievable mess. · 1 hour ago
The absurd incentives introduced into healthcare provision by the absurd payment systems created by CMS are indeed changing physician behavior. There are actually cases where Medicare will pay more if you don't perform (or report, as the case may be) certain procedures. While there is much complaining about fee-for-service causing doctors to perform unnecessary tests, the other systems don't seem any better to me.
Dec '11
Re: My Answer to Paul Krugman
With profound respect, Dr. Rahe, it seems to me that this equates the delivery of medical services with the financing of medical services.
I disagree that our system of delivering medical services is damaged. It may not be perfect, but we have proof of its effectiveness: 5-year survival rates for cancer patients (we've stopped calling them "victims" ... if that's not progress, what is?), men walk after breaking their backs.
The way we finance medical services is causing our society great harm, though. Those who use the least medical care subsidize those who need it the most. There is no incentive to demand lower prices, so why are we surprised when prices go up? Obamacare exacerbates this market distortion, and therefore will cause our society even greater harm than the current model. Medicaid and Medicare are two of the most egregious examples of this distortion, and reform must be a priority, as you have stated.
Re: My Answer to Paul Krugman
Lucy, it strikes me that turning Medicare and Medicaid into Health Savings Accounts supplemented by an offering of major medical insurance would solve a lot of the problems you point to. This is the sort of thing that Mitch Daniels has experimented with in Indiana. It is what we do at Hillsdale, and I believe that it is part and parcel of what Paul Ryan is pushing.
Nov '10
Re: My Answer to Paul Krugman
This wonderful academic argument will be meaningless to the net-receiver class until the weight of it causes the collapse of the whole house of cards.
The net-receiver class -- those who receive more than what they put in, is almost half of the population. It will soon cross over the 50% threshold and the government of the managerial class will continue to expand until it can't and then it will collapse -- shockingly quickly -- as in the Soviet Union and the collapse will leave disaster in its wake.
It is a sad reality that there are many (social) conservatives in the net-receiver class and they really don't understand where they are -- like the frog in the pot of water being raised to the boiling point. Many of them believe that socialized medicine is the Christian thing to do having totally compartmentalized Christ's statement that "My kingdom is not of this world".
Edited on March 31, 2012 at 5:49pmNov '10
Re: My Answer to Paul Krugman
It is the only direction that would help. I just find myself constantly overwhelmed by the complexity of the distortions that have been introduced into the system by 50-odd years of government meddling. If you're not in the system, you simply can't imagine it, and if you're in the system, not only can you not explain it to an outsider, you can't really figure out how much of what you're doing is driven by it.
Nov '11
Re: My Answer to Paul Krugman
Lucy Pevensie
It is the only direction that would help. I just find myself constantly overwhelmed by the complexity of the distortions that have been introduced into the system by 50-odd years of government meddling. If you're not in the system, you simply can't imagine it, and if you're in the system, not only can you not explain it to an outsider, you can't really figure out how much of what you're doing is driven by it. · 20 minutes ago
I agree with the second part of that statement. I think the absurdities of Medicare are so legion that nobody grasps them all, but it is important to try to explain to those who don't have to deal with this stuff on a regular basis as best we can.
Is anyone else looking forward to the effects of Medicare punishing hospitals that have higher than average readmission rates? I'd bet good money that the effects will be bad, and that they won't be properly studied.
Oct '10
Re: My Answer to Paul Krugman
How is the individual mandate socialized medicine? If the government regulates the industry to the point it has full control over it, then yes, that is socialized healthcare--which is why I always mention the insane level of regulation in ObamaCare.
The problem with your point on Europe is that not all of them practice socialized medicine. Switzerland and the Netherlands, specifically, have a market-based universal coverage scheme. Socialization and universal coverage need not go together.
Aug '10
Re: My Answer to Paul Krugman
Joseph Eagar
Except insurance companies can tailor their plans. Instead of one monopolistic public plan, consumers can pick the plan (and, implicitly, it's method of rationing) that best suits their needs.
You mean like not including contraception?
Apr '11
Re: My Answer to Paul Krugman
Interesting question. Government forces you to send your child to a government school. The private school option is effectively a mandate to purchase education services from a private business (vouchers are a tax refund).
One of the key arguments for a healthcare mandate is that medical care is a service that everyone needs at some point. This logic doesn't really apply to education. A person who will never have children still has to pay into this system.
There are other differences/angles to the education/healthcare comparison. My understanding is that basic education has traditionally been considered one of those special cases: an educated citizenry is essential to democracy.
Healthcare is tricky, because modern medicine is unique. Certainly a government mandate to purchase 18th century medical services would violate the 8th Amendment.
Had modern medicine existed in 1787 I don't see why the framers would have seen it as a federal matter. It's telling that most believed education was essential for the survival of a free republic, yet still respected this as a state and local matter.
Apr '11
Re: My Answer to Paul Krugman
The real problem is that political realities have forced conservatives to concede to grossly unconstitutional federal programs like Social Security, Medicaid and Medicare, so it's not easy for us to make a principled, strict constructionist case for anything. Is the Constitution even relevant when no one dares suggest that change as dramatic as a federal take over of the nation's healthcare system might warrant an amendment?
But this is where we are, so the fight is now to win a rhetorical game against Democrats who try to sell radical expansions of government as "market based," or "investments," etc.
Oct '10
Re: My Answer to Paul Krugman
Paul DeRocco
Joseph Eagar
Except insurance companies can tailor their plans. Instead of one monopolistic public plan, consumers can pick the plan (and, implicitly, it's method of rationing) that best suits their needs.
You mean like not including contraception? · 3 hours ago
That's a feature of ObamaCare and regulation in general, not health insurance systems.
Nov '10
Re: My Answer to Paul Krugman
Pet peeve...
It is medical insurance not health insurance.
Health insurance is an oxymoron unless the Underwriter is Divine.
Edited on April 1, 2012 at 5:19pm