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Archive for the 'health care' Category

Sandra Fluke, Birth Control, and the Catholic Church

I’ve never heard of Dan Mitchell before, but apparently he’s a libertarian blogger. He’s also, apparently, an idiot. In this post he characterizes Sandra Fluke as wanting the government to pay for her birth control.

That might be a good idea, but it’s not what this controversy is about. Anuone who thought for 10 seconds would realize that this has nothing to do with the government’s paying for birth control. To sum up the obvious:

  1. Sandra Fluke is a student. Students are required to pay for health insurance as a condition of enrollment. That’s true today in Massachusetts, under Romneycare, and it will be true for the whole country once Obamacare is fully in effect.
  2. The Catholic Church, which owns Georgetown University, wants to take Sandra Fluke’s premium money, but deny her birth-control coverage. Note that this does not lead to a premium reduction, since covering birth control lowers health care costs rather than raising them.
  3. So what the church is saying is that it should be able to force its own beliefs on the students and employees of the universities (and hospitals) it owns, and should still be subsidized by our tax money (and universities are heavily subsidized – not just by grants, but federal financial aid and tax exemption for all their real estate).

A more intelligent libertarian view would be that our tax dollars should not go to subsidize sectarian institutions. If Catholic (or other religious) universities want to get all that federal aid, they should follow the same rules as everyone else.

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Hospitals Are Not “Religious Institutions”

Wow! I haven’t posted for a long time – so to get my feet wet again, here’s a quick comment on the current controversy over whether Catholic hospitals and universities should have to cover contraception in their employee health insurance.

The bishops are arguing that this requirement violates their religious freedom. In my view, freedom of religion applies to – religion! It does not mean that a church can run a business – and these days, hospitals and universities are businesses above all – and avoid obeying the law.

If a Catholic order offers free care as a mission, that is a religious activity. If the Catholic church owns a big hospital, hires people who are not Catholics to work there, offers care to the general public, and charges much the cost of that care to the government – that is not a religious activity. It is a business activity, and should follow the same rules as everyone else.

Similarly, if a group of Jesuit priests runs a seminary to train future priests, that is a religious activity. If they run a big university with athletic teams, faculty and staff from all religious beliefs and non-beliefs, and high tuition – that is not a religious activity.

It seems pretty clear to me.

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Class War – Good or Bad?

Today Representative Paul Ryan (R-WI) – the guy who wants to end Medicare – attacked President Obama’s proposal that people with incomes over $1 million a year should pay taxes at at least as high a rate as middle income people do. Obama cited the investor Warren Buffet’s statement that it is unfair that he pays 17% tax on his income, while his secretary pays 20% on hers, and called his proposal the “Buffett rule.”

Ryan, in response, told Fox News that Obama was taking the “class warfare path,” adding Class warfare … may make for really good politics, but it makes for rotten economics.”  Ryan offered the following explanation for his claim that it was ‘rotten economics:’

 If you tax something more, you get less of it. If you tax job creators more, you get less job creation. If you tax their investment more, you get less investment.

Not for the first time, Ryan displays his economic idiocy here. He is ignorant of the most basic economic categories. Specifically, taxing income is not the same as taxing the thing that produces the income. For example, imagine that I take advantage of owning a bike to get a job as a bike courier. When the income I earn is taxed, that is not a tax on my bike (I am not going to decide to give up my bike, because then I would have no income at all). It is just a tax on my income. (And the tax won’t make me want to stop earning income, either – if I earn $100 and have to pay $20 in taxes, I am still $80 ahead of where I would be if I hadn’t earned it). Similarly, a tax on the income earned from investment is not a tax on investment; and it is certainly not a tax on “job creation,” since most investment does not create any jobs.

(This is an aside – but if I invest money in the stock market, I am not creating any jobs – I am just buying someone else’s right to share in the profits of a company.)

Right now, there are two basic causes of unemployment: lack of consumer demand, and a shortage of government revenues.

  • Consumers are not buying at normal levels. This does not make investors stop investing (they have to invest – otherwise their money loses its value), but it does make them invest in something other than producing jobs – speculating, buying other companies, and the like.
  • Nevertheless, private sector employment has gone up over the last year. However, public sector employment has gone down. Teachers, police officers, firefighters, librarians, and others who perform necessary public services are being laid off and not replaced. Why? Not because their services are not needed – they are – but because governments (especially state and local governments) do not have enough revenue to pay them.

Government needs more revenues, and more government revenues will create more jobs, not decrease them. And government spending will put money in consumers pockets (and in their bank accounts), increase consumption, and create more private sector jobs as well.

So Ryan is making a idiotic argument – about on a par with his claim that he wanted to destroy Medicare in order to save it. But why?

That’s where class warfare comes in. I’ll write more about this later this week. But to start with, think about what a “class” is. It’s a group of people who get their income in (broadly speaking) the same way.

  • The working class is paid for the work it does. That work can vary a lot, but what makes the working class a class is that its income comes from selling its labor.
  • The capitalist class gets its income from investing its capital – that is, by using its money to hire other people (namely, the working class) to work for it, then selling the products of the labor it hires for a profit.

You can see from the above that the less the working class gets for working, the more the capitalists get from investing. Guess what? They want to get as much as possible; so they are trying to destroy unions, lower wages, and also lower the “social wage” – the benefits that government provides so that workers don’t have to pay for them directly, such as health care, education, and social security.

What Ryan is doing, then, is engaging in pure class warfare himself: trying to defend the outrageously high incomes of the rich by undermining not only social services but the jobs of working people. So we need a little class warfare on the other side. We need to understand that anyone who makes over $1 million a year has not earned all that money, and should be made to use more of it to support society.

T

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The Constitution, the Tea Party, and Health Care

The more I listen to the Tea Party, the more I realize that when they refer to the Constitution and the intent of the framers, they are really thinking of the Antifederalists – that is, those who opposed the Constitution because they thought it would lead to a tyrannical federal government.  When Tea Party people argue that health care, or environmental protection, or social security should be left to the states, they are basically arguing against federal authority over interstate commerce.

The point they are ignoring is that, by and large, the Antifederalists lost. Their arguments were rejected, and the Constitution was ratified.

However, their loss was not complete. One of their major objections to the Constitution was that it did not have a bill of rights; enough people agreed with that objection that the Bill of Rights was added to the Constitution. This was a victory for the Antifederalists; but it did not change the federal governments power to regulate interstate commerce.

The Tea Party points particularly to the Tenth Amendment, which says that any powers not given to the federal government are reserved to the people, or to the states. However, this really does not speak to the issues involved in the health care debate. The Obama administration is not claiming that there is a new federal power, the power to provide health care. It is claiming, instead, that the existence of a universal health care plan is vital to the maintenance of a free market in interstate commerce. Any debate about this issue was settled with the passage of Medicare and Medicaid in 1965 – and, in fact, had mostly been settled with the passage of the Social Security Act back in the 1930s.

There is much to admire in the Antifederalists’ vision of a small-scale, decentralized society. The world might be better off if the Constitution had not been ratified. However, it was – and its ratification led to the development of a centralized econcomy dominated by giant corporations.

Those corporations are the big threat to liberty today; we need a strong government to protect us from them. Fortunately, the Constitution allows such a strong government to develop.

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Health Care and the US Constitution

I was at the American Political Science Association all last week, but now I’m back, and getting into the swing of things once again. I’ve been wanting to say something about the Constitution and health care, and want to even more after reading Jeffrey Toobin’s piece about Justice Clarence Thomas in the 8/29/2011 New YorkerToobin points out that, while Thomas rarely asks questions, and is ridiculed for not doing so, he has actually had a lot of influence in moving the court to the right in its decisions. Among other things, Thomas is hoping to get a majority to rule that the health care law is unconstitutional.

I’ll leave the detailed analysis to Toobin (and others), but I want to state the simple case why, in historical context, the health care law is completely in accordance with the Constitution.

  • First, regulating health care, including the individual mandate (which requires everyone to be insured) is clearly constitutional for states, as opposed to the federal government. States have broad “police powers” to assure public health and safety, and this is one of them.  Mitt Romney’s first attempt to distinguish his plan from Obama’s was based on just this point – no one took him seriously, but he was correct.
  • So the issue comes down to whether health care is part of interstate commerce. In reality, it clearly is- health care is a major cost of doing business, as well as a big business itself, and people cross state lines to get health care all the time. The law does not always coincide with reality – but since the early 20th Century, the Supreme Court has held that all business above a certain size (usually defined by number of employees, or by total sales or revenue) is effectively in interstate commerce. I can open a bookstore on my corner, but I’ll be competing with Powell’s, Barnes & Noble, and Amazon. If health care is not constitutional, then neither is Medicare, or the federal minimum wage.
  • The point at issue is specifically the individual mandat. An individual who is not otherwise covered is required to purchase insurance. The argument for this is that the system won’t work without it – if people can choose not to get health insurance because they are healthy, then only the sick will get it and the premiums will soar out of reach.
  • Of course, if Obama had proposed a better plan (and got it passed, a big if!), such as “Medicare for all,” where everyone is taxed and everyone gets health care paid for by the government, there would be no constitutional question at all.

I’ll leave it to the lawyers to flesh out these legal arguments, this is just meant as a guide to the basic principles involved. It may help you understand the Constitutional debate.

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