A new book is out entitled, Age of Anger: A History of the Present. By Pankaj Mishra. Farrar, Straus and Giroux. The Economist has an interesting article on the book: http://www.economist.com/news/books-and-arts/21715636-original-attempt-explain-todays-paranoid-hatreds-deep-roots-modern-resentment

What the authors call "liberalism" is the old focus on individual liberty. In the US, this term has been co-opted by the left. Far from protecting individual rights, this group likes to use the power of government to coerce people into doing what they deem as "right." Usually trying to save something. This savior premise becomes part of their psychological identity. Any debate with these folks brings out anger and labeling one as homophobic, racist, misogynist, suffering from Islamophobia, climate denier, etc. To enter a debate of reason, would bring into question their very identity. A dangerous proposition for one expecting a civil debate of ideas. On the other hand, if you debate with someone who believes the role of government is protect people from each other, provide a system for justice, and to help ensure that markets are free from manipulation, these issues do not strike at the identity of one who hold these beliefs. If you proclaim that you are a socialist, these folks would merely wonder if you understand economics and the nature of man. Have you paid attention to spectacular failures of socialism in the last few centuries. Or that socialism is the road to serfdom as noted by FA Hayek. Hayek wrote this about the National Socialists in Germany, also known as NAZIS. These nuts were leftists, they were considered "right" of the communists in Germany. It is amusing to see leftists labeling people who don't agree with them as Nazis or Fascists. One can only conclude that this is psychological projection, projecting onto others what their goal of central planning and coercive power has in mind for the rest of us.

Do we have a right to health care or a free college education?

The following quote has often been attributed to Benjamin Franklin. I am not sure who said it, but it certainly fits with the aim of the founders relative to our rights:

“The U.S. Constitution does not guarantee happiness, only the pursuit of it. You have to catch up with it yourself." --

Lately this word has been thrown around quite a lot. Politicians under pressure to shout about a right to a “free college education” or a right to healthcare. What do we mean by the word “rights?” Who has them? Who is obligated to see that the right is fulfilled and not infringed upon? Many of us first heard the word “right” as it was used in the Declaration of Independence; we have the right to life, liberty, and the pursuit of happiness.  Let us consider this word “right” as we use it in four ways:

Claim right:  A claim right is a right which entails responsibilities, duties, or obligations on other parties regarding the right-holder. If I hold the “mineral rights” to my property, then I must be paid by someone who expects to extract these minerals.

A liberty right or privilege, in contrast, is simply a freedom or permission for the right-holder to do something, such as freedom of speech, press or assembly. There are no obligations on other parties to do or not do anything. I can show up at “Speaker’s Corner” in London and talk about anything from the demise of the earth according to the Mayan Calendar to monetary policy in the US.

Natural rights: Natural rights are rights not contingent upon the laws, customs, or beliefs of any particular culture or government, and therefore universal and inalienable; are rights which are "natural" in the sense of "not artificial, not man-made.”[i] They're sometimes called moral rights or inalienable rights.  John Locke (1632–1704) proposed that there are three natural rights[ii]:

• Life: everyone is entitled to live once they are created.
• Liberty: everyone is entitled to do anything they want to so long as it does not conflict with the first right.
• Estate: everyone is entitled to own all they create or gain through gift or trade so long as it does not conflict with the first two rights.

Legal rights, in contrast, are based on a society's customs, laws, statutes or actions by legislatures. Legal rights are sometimes referred to as civil rights; the right to vote, serve on juries, etc.

Many people in politics and government routinely refer to healthcare as a right. If healthcare is a right, who is obligated to give you healthcare? How did you earn this right? What are you giving in return? In 2009, John D. Lewis, PhD, at Duke University wrote:[iii]

“…the very idea that health care -- or any good provided by others -- is a 'right' is a contradiction. The rights enshrined in the Declaration of Independence were to life, liberty, and the pursuit of happiness. Each of these is a right to act, not a right to things...”

Professor Lewis elaborates further:

“These two concepts of rights -- rights as the right to liberty, versus rights as the rights to things -- cannot coexist in the same respect at the same time...To reform our health care industry we should challenge the premises that invited government intervention in the first place. The moral premise is that medical care is a right. It is not. There was no 'right' to such care before doctors, hospitals, and pharmaceutical companies produced it. There is no 'right' to anything that others must produce, because no one may claim a 'right' to force others to provide it. Health care is a service, and we all depend upon thinking professionals for it. To place doctors under hamstringing bureaucratic control is to invite poor results."

While the political rhetoric sounds good when the politician declares that we have a “right to health care” or a “right to a free college education,” we should be on guard. Who is obligated to pay for this positive right in our society, a society based on the protection of liberty for the individual?

Government cannot give you anything unless they take it away from you or someone else first. Shouting for free stuff is treading on the liberty of your fellow citizens.

---

[i] Natural Rights: http://en.wikipedia.org/wiki/Natural_and_legal_rights

[ii] John Locke on natural rights: http://en.wikipedia.org/wiki/Natural_and_legal_rights

[iii] Aug. 12, 2009 Huffington Post article "Health Care, Why Call It a 'Right'?" by John David Lewis

Mystery of Language in Health Care: Prices or Costs?

       Health Care in the United States has a language that is very different from the rest of us. David Goldhill has referred to this as “island speak” in his wonderful book, Catastrophic Care.  Goldhill discusses the use of the word “cost” in place of the word “price” and maintains this choice of language is purposeful: “The distinction isn’t just a linguistic one— with “cost” serving as a polite synonym for “price.” Calling costs “prices” would recognize that they are in fact the industry’s active and calculated responses to incentives created by us.

        So what? Goldhill observes in the same year that gas prices went up 1200 dollars for the average American household, we had a national outcry for action to find out what was wrong. Congress had hearings with the major oil companies summoned before House Committees. Our government wanted answers! However, health care costs increased $1110.00 for the average American household in the same year and there was not a peep of protest; it all seems so inevitable; these “costs.” Prices on the other hand have an evil hand at work. More recently, when oil prices plummeted and gas prices followed, there were no calls to find out what evil was at work behind this scheme. Apparently, the market is only a problem when prices are going up.

 

       The use and misuse of the word costs provides good cover. Many providers and others have no idea of what their costs are in the US health care system. Historically, since the US government took over 40% of the health care system in 1965, this has not been necessary. The large hospital systems have learned to overcharge on their “charge masters,” then the patient surrogates, insurance companies and CMS, tell the providers what they will pay; typically this is a third of the bill being charged. Instead of a market using price to regulate what is produced in terms of health services, we have centralized planners establishing prices. Recently, CMS decided not to reimburse for “readmissions.” A good decision. Now the unintended consequences: the providers, being more of them and certainly more creative than the planners at CMS, have now framed a “readmission” to be an “observation” so they can get paid. CMS is now trying to figure out what to reimburse for an “observation.”

 

       This charade reminds me of the observation from Dr. Thomas Sowell in his book Basic Economics on the role of central planners in the former Soviet Union tasked with setting prices:

 

        “The significance of free market prices in the allocation of resources can be seen more clearly by looking at situations where prices are not allowed to perform this function. During the era of the government-directed economy of the Soviet Union, for example, prices were not set by supply and demand but by central planners who sent resources to their various uses by direct commands, supplemented by prices that the planners raised or lowered as they saw fit. Two Soviet economists, Nikolai Shmelev and Vladimir Popov, described a situation in which their government raised the price it would pay for moleskins, leading hunters to get and sell more of them:

 

       State purchases increased, and now all the distribution centers are filled with these pelts. Industry is unable to use them all, and they often rot in warehouses before they can be processed. The Ministry of Light Industry has already requested Goskomtsen twice to lower purchasing prices, but the “question has not been decided” yet. And this is not surprising. Its members are too busy to decide. They have no time: besides setting prices on these pelts, they have to keep track of another 24 million prices.

 

       However overwhelming it might be for a government agency to try to keep track of 24 million prices, a country with more than a hundred million people can far more easily keep track of those prices individually, because no given individual or enterprise has to keep track of more than the relatively few prices that are relevant to their own decision-making. The over-all coordination of these innumerable isolated decisions takes place through the effect of supply and demand on prices and the effect of prices on the behavior of consumers and producers. Money talks— and people listen. Their reactions are usually faster than central planners could get their reports together.”

 

       A simple solution is to post prices for all providers. Why is this never on the agenda? Singapore spends about 4% of their GDP on health care and is one of the wealthiest countries per capita on the planet. The following link will take you to a price table that is impossible to find in the United States: http://polyclinic.singhealth.com.sg/Pages/FeesAndCharges.aspx

 

       This is just the top level of prices for one provider. The Ministry of Health provides transparency on pricing for all providers and typical operations. Patients are free to choose where they spend their health care dollars. Singapore’s 4% compares to our 16%-18%. Countries in Europe spend on average about 8-9%. Singapore’s market approach, putting the patient in charge, outperforms the socialist countries and certainly our crony capitalist approach in the US.

 

        Just post the prices…please! Put the patients in charge of choosing their health care services.

 

References:

Goldhill, David (2013-01-08). Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It (pp. 22-23). Knopf Doubleday Publishing Group. Kindle Edition.

Sowell, Thomas (2010-12-28). Basic Economics: A Common Sense Guide to the Economy, 4th Edition (pp. 17-18). Basic Books. Kindle Edition.

 

 

 

Reform Health Care - Let's Truly Get Patient Focused - Time for Action

When the Federal government took over 40% of the healthcare system with Medicare in 1965, the industry has bordered on crony capitalism. Costs have continued to rise. This combined with idea that employers should provide health care insurance had eroded the wealth of the middle class in this last decade; what would have been wage increases have instead gone to pay for enormous increases in health care prices (costs are really not known in health care in the US).  Most of the American public are unaware that they are paying for the entire bill; "The employees ultimately bear the full cost of of the health insurance plan they get form their employer," says Kate Baicker, a Harvard economist who served on President George W. Bush's Council of Economic Advisers from 2005 to 2007. "Even though they're only writing a check for a part of it, they're bearing the full cost."

Here are some immediate fixes:

1. Post prices (not the inflated Charge master) for services to be delivered at hospitals and clinics. Singapore does this on a regular basis. Being patient focused means more than giving a survey at the end of the service. Here is link that shows the prices for SingHealth on regular services: http://polyclinic.singhealth.com.sg/PatientCare/Fees/Pages/Home.aspx

The Ministry of Health also post prices for particular operations and procedures. Much of this can be read in the free Kindle book from Amazon entitled, Affordable Excellence by William A. Haseltine. From the book: “Services at the outpatient clinics had been free-of-charge— modeled after the practice of the British healthcare system. But the government quickly changed that. As Lee Kuan Yew recalled in his memoirs: The ideal of free medical services collided against the reality of human behaviour, certainly in Singapore. My first lesson came from government clinics and hospitals. When doctors prescribed free antibiotics, patients took their tablet or capsules for two days , did not feel better, and threw away the balance. They then consulted private doctors, paid for their antibiotics, completed the course, and recovered. Lee's government imposed a fee of 50 cents for each attendance at the clinics, doubled during public holidays. 11 This bold move reminded Singaporeans that healthcare is not free, and that the nation would not be building a welfare system such as Britain's. People would be expected to a large degree to pay their own way.”

2. Post the quality of the service delivered by institution; if 1 & 2 happen, then the consumer/patient can work the equation: Value = Quality/Price; without this transparency, there is NO MARKET.

3. Change the language; health care loves to throw around the word, "cost," as if this calamity that has absorbed income from the middle class for the last 10 years was foreordained. People who write about health care avoid the word "price" because their costs are not known. If the price of gas goes up, people are ready to riot, while health care "costs: go up, we shrug our shoulders. Nonsense! Let's try a real market!

In my junior high days at South Gate Jr. High, I was fortunate to have a homeroom teacher by the name of Mr. Leeds. Each morning he would greet us with the following statements: Good morning Gentleman (homeroom was all boys in a drafting class)! Remember two lessons:

1.    The government cannot give you anything unless they take it away from you first.

2.    The older you get, the worst you get.

After 3 years, I understood the first lesson. Since I have hit 60 years of age, the second lesson is coming home to roost.

References:

1.    Haseltine, William A. (2013-04-15). Affordable Excellence: The Singapore Health System (Kindle Locations 308-315). Brookings Institution Press with the National University of Singapore Press. Kindle Edition.

2.    You’re spending way more on your health benefits than you think by Sara Kliff (August 30, 2013): http://www.washingtonpost.com/blogs/wonkblog/wp/2013/08/30/youre-spending-way-more-on-your-health-benefits-than-you-think/

The Need for Teaching Civics:  Some of our students can Identify Snookie, but they do not know the name of the current Vice President or who won the Civil War…

Richard Dreyfus is under the impression that we need to start teaching civics again. What are the duties and obligations of citizens in understanding their government? Recently, a project was conducted at Texas Tech to see how much history and other facts that college students should know. Here is the clip from NPR at Texas Tech:

It would be convenient to lay off all this ignorance to Tech, unfortunately, there is evidence from all over the country. Here is a sampling.

CitizenshipTest in Philadelphia

Are you smarter than an American? Native-born citizens fail civics test

Dr. Walter Williams has observed that many people are graduating with fraudulent degrees. From the clips above, this might be the case. If you are not aware of Richard Dreyfus’s efforts to get the teaching of civics back into school, you may want to visit his web site. This is a noble effort; Dreyfus Initiative.

Dreyfus does an excellent job of explaining the need for civics relative to thought and the role of the citizen in this short video clip.  

For our students and others to know who Snookie is but cannot name the first President or the current Vice President, we may be in trouble. Dreyfus observed: “To teach our kids how to run our country, before they are called upon to run our country…if we don't, someone else will run our country.”

Some Guidelines for Voting in the Mid Terms; What candidates need to do to get my vote!

The Republican, Democrat or Independent Candidate needs to do the following to capture my vote in November:

1. Declare a flat tax; eliminate all the subtractions including the mortgage exemption. K street exists primarily to get tax breaks for their constituents. Kill the source.

2. Tell us the 10 programs that will cut or eliminated; prefer the latter.

3. Come out for declaring Jerusalem an International City; both Israel and the Palestinians can make it their capitol, cutting the embassy expense in half for all nations who otherwise would have to have two embassies.   

4. Move the United Nations out of New York to the new International City in Jerusalem. This way all the diplomats will be on the "factory floor" for most of their work. Most of us have to live close to our work.

5. Develop a strategy that allows us to stop tampering with the world. For example, the problems we have in the Middle East can be traced back to the attempts of the British and French to create spheres of influence in the Middle East after defeating the Ottoman Empire in 1916. The so-called Sykes–Picot Agreement ignored the promises made to the Arabs through Colonel T. E. Lawrence (Lawrence of Arabia); a national Arab homeland was promised in the area of Greater Syria, in exchange for their alliance with the British against the Ottoman Empire.

The illusion of creating nation-states where tribal communities dominate has been a continuing problem since 1916. Political leaders and others in the West have a bad habit of projecting on to tribal people their own values; for example, an interest in democracy. Dr. Michael Maccoby has developed a diagram that shows the continuum of the development of social character for a society. From Figure 1, you can see that as tribalism dominates it can slide toward human pathology, especially when driven by a 13th Century ideology and the fact that the tribes have been lied to for a century.

Figure 1: Social Character Continuum

 

6. Once we have a strategy for minding our own business and fixing our own problems, question why we need 900 military bases around the world in this day and age of jet travel. A few strategic bases yes; We no longer need to occupy Germany but we do need to fix Detroit and a few other bankrupt cities in the US. Moving the troops from Europe to our border would be good for security and the local economy; troops buying breakfast burritos in El Paso as opposed to apple strudel in Germany.

This would be a good start...

 

 

 

 

 

 

 

Learning from Washington's Farewell Address

Today David Brooks has a column in the NY Times that discussed American involvement in foreign affairs around the world. How did we get this far into entanglements with the politics of other nations. George Washington would have been appalled. But Washington never met Hitler, Stalin or Mao. It might be time to rethink our need to be involved in every country's internal affairs. So I pulled up the Address on Google. I found the original version here:

http://avalon.law.yale.edu/18th_century/washing.asp

Lovely writing. I then found this Cliff Notes version on Wikipedia:

http://en.wikipedia.org/wiki/George_Washington's_Farewell_Address#Foreign_relations_and_free_trade

Below are some summarized ideas relative to the establishment of political parties and advice on foreign relations from Wikipedia:


1.     Political Parties

Washington argues that “political parties must be restrained in a popularly elected government because of their tendency to distract the government from their duties, create unfounded jealousies among groups and regions, raise false alarms amongst the people, promote riots and insurrection, and provide foreign nations and interests access to the government where they can impose their will upon the country.”

2.     Foreign Relations

Washington advocates a policy of good faith and justice towards all nations, and urges the American people to avoid long-term friendly relations or rivalries with any nation. He argues these attachments and animosity toward nations will only cloud the government's judgment in its foreign policy. Washington argues that longstanding poor relations will only lead to unnecessary wars due to a tendency to blow minor offenses out of proportion when committed by nations viewed as enemies of the United States. He continues this argument by claiming that alliances are likely to draw the United States into wars which have no justification and no benefit to the country beyond simply defending the favored nation. Washington continues his warning on alliances by claiming that they often lead to poor relations with nations who feel that they are not being treated as well as America's allies, and threaten to influence the American government into making decisions based upon the will of their allies instead of the will of the American people.

It may be time for us as Americans to reevaluate our need to be a busy body with the rest of the world. To start minding our own business, we may have to examine what the political parties are stirring up.