Health Care, Fairness, and Regaining Our Freedom

The growing evidence-based consensus on Obamacare is that it is unworkable.  It has failed in its primary objective of making insurance affordable and used by all, while at the same time it worsens or destroys the healthcare and insurance of those it should have left alone.  Total enrollment is only half the 22 million that the Congressional Budget Office promised three years ago for 2016; all five of the largest insurance companies say they are losing money on their Obamacare policies;1  three of these have announced they are reducing participation in the Obamacare exchanges; other insurance companies have left the insurance pools, and premiums nationwide are up more than they would have been in the absence of Obamacare.  Going forward, 2017 premium increases are scheduled to be 58 percent in some places and are expected to average 23 percent!2  Worst of all is that Americans, who love freedom, are being subjected to some of the most oppressive interferences into their private lives ever. 

Documenting the failures and inconsistencies of Obamacare would take many pages.  In contradiction of the Pollyannaish pronouncements claiming victory by its supporters, the facts are that 70 significant defects in the legislation have already had to be legally changed, altered by the Supreme Court, or even illegally ignored by the President.3  This includes, for example, annulling the Community Living Assistance Services and Supports program for government-subsidized insurance, which Sen. Kent Conrad (D-ND) dubbed a “Ponzi scheme of the first order.”  However, if Hillary Clinton is not elected president in November, if Democrats control neither the House nor the Senate, and if the 60-vote supermajority cloture rule is wisely jettisoned by the Senate, the US will have its best possibility to fix the problems of health care going forward.  What should we do?

In what follows I provide a rationale, a fairness principle that everyone should be able to support, and an application of it to a glaring health care problem. 

The rationale:  Start from the obvious truth that any policy which for its success requires people to do what is against their own interest is not as good as policy that benefits everyone.  Good policy is analogous to setting fair rules of the game.  Fair rules prevent cheating and incentivize all contestants to play the game to the fullest on their own behalf.  Bad policy advantages some by stripping advantages from others. 

The principle:  The fairness principle that follows is that a public program should be designed so that every citizen receives fully what they pay for, and pays fully for what they receive unless what is under consideration is charity, and charity is reserved to voluntary private organizations and individuals in the private sector.  Government, of course, can assist the function of voluntary private organizations and individuals in various ways that are consistent with the principle.  Notice that a marketplace satisfies the fairness principle automatically.  If you pay for three eggs, you get three eggs, and if you want two eggs you pay for two eggs.  In insurance contexts, the principle would imply that actuarial fairness needs to apply to all age groups and both sexes. 

The healthcare application:  Obamacare provisions should be replaced with ones that align with the fairness principle.  A number of changes follow, the first of which is described below because it speaks directly to the most prominent objective stated for Obamacare, which was incentivizing everyone to hold health insurance.  As it now stands, that incentive is absent.

The Emergency Medical Treatment and Labor Act (EMTALA) should be rewritten so that emergency care for the episode in question must be administered regardless of ability to pay at the time as is the case now, but

  • provision be made for tracking non-paying recipients into the future so those who can pay back in the future are required to do so, and
  • prices charged for EMTALA-based care may not exceed the best prices charged by the supplier to the most favored of its customers.  I.e. the prices non-paying recipients are required to pay out of their future resources must match the lowest offered by the supplier to anyone else.

There are various ways that government can be helpful to the tracking process.

These small changes satisfy the principle, but do what Obamacare does not do.  They create the right intertemporal motivation so that everyone will have the incentive to be insured, but without the freedom-destroying mandates of Obamacare.  It is a short step to extend the principle to deal with the temporary need for help with insurance that will be paid back by those who may need to be tracked to make future payment.  Those who do not need subsidies or credits are left entirely alone to pursue health care and health care insurance (both are private goods which are the proper sphere for us to provide for ourselves) in competitive actuarially fair private markets that are personally responsive to us, satisfy the fairness principle, keep costs low, and restore freedom to we the people.

Earl L. Grinols

Distinguished Professor of Economics

Hankamer School of Business, Foster  320.13
Baylor University

Footnotes:

1. Greg Ip, The Unstable Economics in Obama’s Health Law, The Wall Street Journal, 17August 2016, http://www.wsj.com/articles/the-unstable-economics-in-obamas-health-law-1471452938.

2. ACASignups.net, “The 2017 Requested Rate Hike Challenge!! (currently: 23.3% across all 50 states + DC)” http://acasignups.net/16/05/24/presenting-aca-signups-2017-requested-rate-hike-challenge, 13 May 2016.

3. Grace-Marie Turner, 70 Changes That Make Obamacare a Very Different Law than Congress Passed, Forbes, 26 January 2016, http://galen.org/topics/70-changes-that-make-obamacare-a-very-different-law-than-congress-passed/.

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Impact of the Election on Liberty

Perhaps no election in modern history is more important than this year's. Public confidence in institutions is at an all time low. Congress, the media, large business, regulators and even the election process itself are all suspect. The integrity of the  political primary processes of both major political parties have been called into question therefore bringing the legitimacy of their nominees into question. Economic uncertainty, illegal immigration and fear of terrorism have made people more vulnerable to authoritarian leadership and perhaps more accepting of centralize control.

The importance of adherence to principles of liberty, a constitutional government and protection of individual rights has never been greater. There is a desire among people for someone to "do something". Indeed, we are entering dangerous times. The failures of big, centralized government have become quite obvious to the electorate. We need to support principled leaders who understand the constitution and will govern by it.

Ed Rankin
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Whither DHS?

It’s been 15 years since that fateful September day in 2001 when the world changed for America when 19 terrorists crashed airplanes into the World Trade Center towers and the Pentagon (one plane did not make it to its intended target – thought to be the White House or Capitol Building – and was crashed in Shanksville, PA), killing nearly 3,000 people . In a rush of adrenaline beginning on September 12, 2001, there was a crash effort to confront the threat of terrorism and make America more secure. A spigot of government spending was turned on and $1 trillion has been spent since 9/11 to defend against the likes of al Qaeda, ISIS, and other terrorist threats. Part of that $1 trillion includes the creation of the Department of Homeland Security (DHS) in 2003. With more than 240,000 employees and a budget of over $60 billion, has DHS made us more secure?

That we have, fortunately, not suffered a second large-scale terrorist attack is often cited as evidence that the efforts of homeland security have worked and that the spending has been worthwhile. But it could also be the case that – whether it’s al Qaeda or ISIS – terrorists have chosen not to attack us. Reality is probably somewhere in-between. Conversely, the fact that there have been – thankfully, relatively few – smaller acts of terrorism (mostly lone wolf and homegrown, such as Orlando nightclub shooter, Omar Mateen, who killed 49 people and wounded another 53) doesn’t mean that homeland security has utterly failed. Perfect security is a Quixotic quest and it would be unfair to expect such from DHS.

DHS’s proposed fiscal year 2017 budget is $66.8 billion – more than double the department’s first budget of $31.1 billion in 2003. DHSs’ main operating components – Citizenship and Immigration Services (CIS), Customs and Border Protection (CBP), Federal Emergency Management Agency (FEMA), Immigration and Customs Enforcement (ICE), Secret Service, Transportation Security Administration (TSA), and U.S. Coast Guard (USCG) – command the lion’s share of the DHS budget. But while homeland security spending has increased nearly two-fold in 13 years, the way the money is spent has remained more or less the same based on how the budget is allocated (the only real changes being an increase for FEMA and a decrease for TSA in terms of their share of the budget).

DHS Component 2003 2016
CIS 5% 4%
FEMA 17% 21%
CBP 19% 21%
ICE 10% 9%
Secret Service 4% 3%
TSA 15% 11%
Coast Guard 20% 15%

Of course, one could argue that the relatively constant budget allocations means that DHS has the formula for homeland security spending correct. However, given that the department was created hastily by cobbling together 22 federal agencies, it seems unlikely that 13 years of “more of the same” is the right formula. More likely, it reflects bureaucratic infighting, with each component trying to keep its respective budget share – much the same as the military services do with the Defense Department budget.

Also, the fact that CIS, CBP and ICE have the terms customs and immigration in common begs the question of whether three separate agencies, which together account for over a third of DHS’s budget, are necessary to accomplish what seem to be overlapping missions – especially when one of the arguments made for creating DHS was that it would eliminate bureaucratic redundancies.

The DHS Office of Inspector General (OIG) reviews the department’s programs and operations and recommends needed improvements to ensure that money is spent effectively and efficiently, but this is not the same thing as determining whether money is being spent rationally. Homeland security programs and program budgets should be fulfilling requirements linked to capabilities to conduct missions that enable the department to achieve its strategic goals and objectives. That is the essence of performance management that is outcome based. Moreover, program choices and budget decisions need to be made with cost-effectiveness, risk and other tradeoffs in mind.

So 13 years after the creation of DHS we have more security at our airports and borders, but we don’t really know if we’re truly more safe and secure. And we don’t know whether the money being on homeland security (putting aside whether $60 billion is too much or too little for DHS) is being spent in the best way to enhance security or whether what amounts to “more of the same” is just bureaucratic inertia.

# # #

Charles V. Peña is a senior fellow with the Defense Priorities. He has more than 25 years of experience as a policy and program analyst and senior manager, supporting both the Department of Defense and Department of Homeland Security. Peña is the former Director of Defense Policy Studies at the Cato Institute and author of Winning the Un-War: A New Strategy for the War on Terrorism.

 

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Saudis Must Face Consequences for Promoting Extremism

Last December, Farah Pandith of the Council on Foreign Relations, who was the first State Department special representative to Muslim communities, called for Saudi Arabia to face consequences if it did not stop promoting extremism.

She wrote: "I traveled to 80 countries between 2009 and 2014 as the first ever U.S. special representative to Muslim communities. In each place I visited, the Wahhabi influence was an insidious presence, changing the local sense of identity; displacing historic, culturally vibrant forms of Islamic practice; and pulling along individuals who were either paid to follow their rules or who became on their own custodians of the Wahhabi world view. Funding all this was Saudi money, which paid for things like the textbooks, mosques, TV stations and the training of Imams…We should expose the Saudi financing of extremist groups masquerading as cultural exchanges and 'charity' organizations and prevent the Saudis from demolishing local Muslim religious and cultural sites that are evidence of the diversity of Islam. If the Saudis do not cease what they are doing, there must be diplomatic, cultural and economic consequences." [1]

Eight months later, the New York Times reported: "Hillary Clinton and Donald Trump don’t agree on much, but Saudi Arabia may be an exception. She has deplored Saudi Arabia’s support for 'radical schools and mosques around the world that have set too many young people on a path towards extremism.' He has called the Saudis 'the world’s biggest funders of terrorism.'" [2]

But neither Clinton nor Trump has addressed the conclusion of what Farah Pandith wrote eight months ago: there must be consequences for the Saudis if they do not cease what they are doing.

Instead of sanctioning the Saudis, the Obama Administration is rewarding them. On August 8, the administration notified Congress of intent to sell $1.15 billion of weapons to Saudi Arabia. Senator Paul and Senator Murphy are expected to introduce a bipartisan resolution to disapprove the administration's Saudi arms deal. [3]
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DEAR WILLIAM (Letters to Bill O'Reilly)

Dear William,
Two-term Gov. Gary Johnson has a brain freeze when asked what he will "do about Aleppo", and you decide he's not ready to be President. Yet you give non-stop coverage to Donald Trump, who didn't know what the "nuclear triad" is, thinks the Constitution has twelve articles (it has seven), and just the other night told Matt Lauer it might be a good idea for the military to establish a system of justice and courts! Talk about being unready to assume the role of leader of the free world. That's hypocrisy. Admit it. You're just a shill for Trump. 

--Jeffrey Singer, MD
Phoenix, Arizona

 

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Paul Gessing's Reasons for Supporting Gary Johnson

1) Foreign Policy: In today's America, Congress has utterly abandoned its role in foreign policy and declaring war. We know Hillary Clinton will be awful on foreign policy. She is far more hawkish than Obama and was in charge of Benghazi, the worst foreign policy moment of his presidency. Trump is a wildcard. He blusters and changes his positions almost daily. It is hard to trust someone like that with nuclear weapons. Only Gary Johnson has advocated for a responsible, non-interventionist, but far from isolationist foreign policy.
2) Economists from across the political spectrum support free trade. American consumers and workers benefit from access to different and better products than they'd otherwise have access to. Tariffs and trade restrictions are nothing but new taxes and regulations on American consumers. Only Gary Johnson appreciates the benefits of free trade. 

3) America must address its massive debt problem by reforming entitlements like Medicare, Medicaid, and Social Security. Only Gary Johnson approaches these issues with the seriousness necessary to solve the problems. Trump and Hillary either want to expand them or refuse to discuss them even though they are the most serious budgetary issues facing our nation.  

-- 
Paul J. Gessing
President
Rio Grande Foundation
 
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Basic Income Guarantee

It is unfortunate that so many libertarians are supporting, or entertaining support for, a Basic Income Guarantee  Pushing this idea in any shape or form would be especially regrettable for the Gary Johnson campaign.  It represents a "something for nothing" approach and serves to undermine goals that libertarians have long championed including self-help, mutual aid, and entrepreneurship

A Basic Income Guarantee also runs counter to Gary's repeated opposition to the use of government to give away "free stuff."   It is not something "better" than the status quo, or a "transition" to a libertarian alternative but rather a giant step backward.

A far better anti-poverty alternative to the status quo, which plays to our strengths as libertarians, is to push for an end to regulations which interfere with self-help and mutual aid such as zoning, building code regulations which hamper construction of modular and other forms of affordable housing, the war on drugs, licensing laws which protect the prosperous from competition, and eminent domain which has destroyed countless poor neighborhoods.

There are many distinguished scholars, such as Phil Magness and David Henderson, who can provide the campaign with additional powerful reasons for why a Basic Income Guarantee is a terrible idea. 

Of course, there are also compelling political reasons to oppose this idea.  Embracing a Basic Income Guarantee will alienate libertarians, conservatives, and others who fear, rightly, that it will strengthen big government and undermine liberty.

David T. Beito

Professor

Department of History

University of Alabama 
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Impact of the Election on Liberty in Washington State

Members of the Libertarian Party of WA and Our American Initiative-WA are closely watching the current election with an eye towards whom we can collaborate with for a slam-dunk in the 2017 Legislative season in Olympia.

Certificate of Restoration of Opportunity (CROP), which would allow non-violent felons to regain career licenses, continues to be a statewide concern that stalled the last two seasons but continues to have support from Columbia Legal Services and the Association of Washington Businesses. Libertarian candidates who have made it past the Top-Two Primary on to the November ballot have further expressed a need to have an expiration date on non-violent criminal records, and a more streamlined process to record blocking and expungement. Common Core and its related SBAC test continue to frustrate parents and educators alike. The SBAC requires as many as 17 unpaid man-hours in teacher preparation, and violates state employment laws as a result. The Washington OAI Outreach Coordinator (who is both Native American and holds an advanced degree in Education) has provided several pro bono hours to office of the Washington State Department of Hispanic Affairs, to assist the Executive Director in fighting what he has accurately called “the school-to-prison pipeline” in Washington State where minorities are concerned.

Other concerns on the table for the upcoming legislative season include full restoration of medical marijuana, a flat sales tax rate to increase sales—so-called ‘sin tax’ items included, and turning around our continued lagging economy by simplifying of business licensing to open employment opportunities—even in such perceived ‘minor’ areas as classifications, which directly impact available grants and loans. For example: Indigenous minorities from Central and South America are not currently recognized by the state, and cannot receive cultural funding for any businesses they want to start. This excludes trades businesses that focus on cultural designs or supplies from bidding on projects within their expertise due to their classification status.

Additional immediate and long-term concerns are increased involvement with state and tribal governments to improve the community at large in areas of housing, clean water, and the access to basic rights and needs of every human being, realizing that we all have a similar struggle and real improvement will not happen unless we are literally all in this together. Tolerance (which is just a polite way of putting up with something) and division among ethnic and socioeconomic groups continue to impede an atmosphere of comradery and inclusiveness, stonewalling learning from each other’s expertise and cultures. We all have something to contribute that can move our state forward and improve the quality of life for every resident. Every Washingtonian matters. Not one should be left behind or forgotten. Education reforms will secure quality leaders across the board for our future, and the other reforms will quickly put every resident to work, creating a solid foundation of liberty for our bioregion.

Diana Schooling is the OAI Outreach Coordinator for Washington State, the Tribal Liaison for the Libertarian Party of Washington, and a freelance Education Instructional Designer. She is the author of “Changing the Indian Education Paradigm: A Foundation in Culture and Law,” published by Hills Wealth LLC on iTunes. A direct descendent of three Southeastern tribal nations, she holds a Masters in Education, specializing in Curriculum & Instruction, with double minors in Equity Ethics & Justice and English for Speakers of Other Languages, from Concordia University-Portland, and is an entering student at the University of Oklahoma School of Law for the M.LL-Indigenous People’s Law program. 
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WHY THE FREEDOM MOVEMENT DOES NOT SUPPORT VACCINE MANDATES

Libertarians cannot, consistent with basic principles, support vaccine mandates, since such mandates must ultimately rest on agents of government forcing people to do the government's bidding, even though vaccines are uninsurable risks that have been held to be "unavoidably unsafe."
The Nuremburg Code makes it quite clear:
“The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved, as to enable him to make an understanding and enlightened decision.”
More about the international law of Informed Consent here: http://drrimatruthreports.com/a-brief-for-informed-consent/ 
In 2011 Gary Johnson supported the libertarian position on Informed Consent, when he said, “No to mandatory vaccines.”  When he met with myself and a group of health freedom advocates at the Players Club in New York City in 2013 he was equally strong in his support for basic libertarian health freedom values. See: https://youtu.be/cI0FgSCht2s 
Recently outlets such as Rumor Mill News and other have alleged that Johnson said, “You know, since I’ve said that … I’ve come to find out that without mandatory vaccines, the vaccines that would in fact be issued would not be effective, so … it’s dependent that you have mandatory vaccines so that every child is immune. Otherwise, not all children will be immune even though they receive a vaccine.” I could not believe that Johnson might have forgotten his libertarian principles. I am happy to note that the rumors are erroneous.
 
It is false science to claim that "all must be vaccinated" for vaccines to "work." If vaccines provide immunization (an unproven assertion) the unvaccinated could not threaten the vaccinated. See, for example, Dr. Laibow's paper, presented to an international congress:http://tinyurl.com/DrRimaIndiaPaper
In historic fact, vaccination, as this graph demonstrates, had nothing to do with the decline in infectious disease pandemics. Better hygiene, sanitation and nutrition saved humanity from those diseases of overcrowding and poverty.
Image
The strongly libertarian health freedom community will continue to support people like Johnson who support Informed Consent. We know the real science, not the crony-corporate pseudo science touted by the corrupt CDC, does not support vaccine mandates.
I could never vote for any candidate who supports forced vaccination. Since Hillary Clinton and Jill Stein are both pro-vax and since Donald Trump, while acknowledging the risks of vaccination, has not addressed the universal right to Informed Consent, there is only one candidate who has clearly committed to opposing forced vaccination: Gary Johnson.
For health and freedom,
Ralph Fucetola JD
President
Institute for Health Research
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Should we be worried about North Korea's latest missile test?

North Korea's leader, Kim Jong Un, recently celebrated the test firing of a submarine launched ballistic missile (SLBM) -- a "success of all successes" -- and claimed that the U.S. mainland was now within striking distance. Like much else that North Korea's dictator claims, this is largely hyperbole. First, the estimated range of the North's SLBM is about 600 miles, which means that a submarine would have to get relatively close to the U.S. just to be able to strike a coastal target -- and even if parked right off the coast would not be able to reach very far inland. Second, there's no evidence that North Korea has the ability to build a nuclear warhead small enough to fit on an SLBM.

That is not to say that we should be completely unconcerned about this latest development. But neither does it mean that we should be shaking in our boots.

If the Missile Defense Agency is to be believed, all the money that's been spent on missile defense research and development (more than $150 billion since President Reagan gave his "Star Wars" speech announced the Strategic Defense Initiative 33 years ago) has produced an effective missile defense that works. So if that's true (and that's a big if), then the would-be threat from North Korea is less of a threat.

But regardless of the effectiveness of missile defense (which is certainly questionable), the reality is that the U.S. has over 1,400 deployed nuclear warheads capable of striking pretty much anywhere in the world. North Korea has a few warheads (probably less than 10), but -- at least right now -- no ability to strike the U.S. That is what is called overwhelming strategic nuclear superiority. Even if North Korea had a nuclear weapon (or weapons) that could strike the United States, the U.S. could retaliate with devastating effect, i.e., to put it simply: the ability to completely destroy North Korea. This is what is called deterrence. And what kept the U.S. and former Soviet Union from engaging in nuclear war (when both sides had over 10,000 warheads pointing at each other) during the Cold War.

But isn't Kim Jong Un crazy and unstable? Therefore, deterrence wouldn't work. Well, in their time both Stalin and Mao were considered crazy and unstable leaders with nukes, yet they were deterred.

To believe that North Korea would launch a nuclear weapon against the United States is to believe that the regime in Pyongyang is suicidal. Yet, like most dictators, Kim Jong Un ultimately seems more concerned with self-preservation and indulging in guilty pleasures rather than punching a one-way ticket to early oblivion.

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