Monthly Archives: July 2017

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Healthcare: A House Divided Cannot Stand

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The latest healthcare initiative from the Trump administration and the Republican Party’s leaders in Congress seems set to sink just like the last version. Mitch McConnell can’t seem to round up the votes to push it through the Senate, if anything the House is more likely to tear apart than pass the Senate version, and the White House isn’t getting anywhere with its attempt to mobilize the nation’s governors behind attempts to modify the Affordable Care Act, aka “ObamaCare.”

Good. Even the most ambitious proposal up for serious consideration —  repealing ObamaCare and reverting to pre-2010 rules — is just nibbling around the edges of the problems of maximizing care availability and minimizing costs, as was ObamaCare itself. Sooner or later (and the sooner the better) one of two radical solutions will be adopted.

Note: “Radical” does not mean “extreme.” Per Oxford Dictionaries, it means “relating to or affecting the fundamental nature of something; far-reaching or thorough.”

Let me define the problem by mangling a famous Abraham Lincoln speech: A house divided against itself cannot stand. I believe this healthcare system cannot endure, permanently, half government-run and half kind-sorta private. I do not expect healthcare to disappear — but I do expect it will cease to be divided. It will become all one thing or all the other.

The two real alternatives before us are:

Adopting a “single-payer” system in which the state takes complete top-to-bottom charge of healthcare; or

Radically reducing — even eliminating — the state’s role in healthcare.

As a libertarian, I support the latter course. Every government involvement in healthcare, starting with guild socialism and occupational licensure in the late 19th century (at the urging of the American Medical Association, to prop up profits for doctors) and proceeding through socialized healthcare for veterans (the VA), socialized healthcare for the elderly (Medicare), socialized healthcare for the poor (Medicaid) and partially socialized healthcare for everyone (from the Health Maintenance Organization Act to ObamaCare) has impeded care and raised costs at the expense of patients. A constitutional amendment requiring separation of medicine and state would be the best possible outcome.

But that seems unlikely to happen, doesn’t it? The big business players in healthcare (pharmaceutical companies, hospitals, “insurance” companies, et al.) would rather use government to protect their monopolies and pass burgeoning administrative costs on to the rest of us than compete in a free market. And the customers (patients) themselves have good reason to distrust what’s been falsely advertised to them as a “private sector” system.

I predict that the US government will adopt a “single-payer” healthcare system no later than 2030, and probably sooner. And while I oppose that outcome and believe its results will be far worse than a real free-market system would produce, I also suspect that those results will be better than the current half-fish, half-fowl, largely socialized but with fake “private” players sucking it dry, system.

Ultimately, it must be free-market or “single-payer.” Either way, I mostly just wish the politicians would stop tinkering and make up their minds.

Thomas L. Knapp (Twitter: @thomaslknapp) is director and senior news analyst at the William Lloyd Garrison Center for Libertarian Advocacy Journalism (thegarrisoncenter.org). He lives and works in north central Florida.

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Death Panels: Sarah Palin Was Right, Sort Of

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In 2009, former Alaska governor and vice-presidential candidate Sarah Palin raised the kind of ruckus she’s known for with her comment on the then-notional Affordable Care Act, aka “ObamaCare.” In a Facebook note, she wrote:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide … whether they are worthy of health care.”

Palin’s aim was rather off (she was grousing about an ACA provision allowing Medicare to reimburse patients for voluntary “end of life care” consultations), but as the world watches the unfolding tragedy of 11-month-old Charlie Gard’s terminal illness in the United Kingdom, “death panels” are suddenly newsworthy again. Palin’s core worry was relevant then and it’s relevant now. It’s also non-controversial, or at least it should be.

Healthcare is a “scarce resource,” by which I mean that there is more desire for it than there are doctor hours and hospital beds and bottles of medication to fulfill all that desire. In any healthcare system, therefore, care is going to be rationed. If people want or need ten units of health care and there are only nine units available, someone is going to lose out.

Rationing can be handled in a number of ways: Pricing in an entirely free-market system, quick triage in an emergency situation with multiple victims presenting varying levels of injury,  alleged experts in systems ranging from the bureaucratic mess of an “insurance” system in the US to the “single-payer” systems in the United Kingdom and other countries. While I favor a free-market system, my intention here is not to argue that point, but rather to point out that “death panels” are inherent in the overall situation.

While it’s heartbreaking that young Charlie likely faces death from mitochondrial DNA depletion syndrome, and soon,  that would likely also be true in the US. Most insurance companies would balk at paying for the experimental treatment his parents seek, and their ability to raise funding for it through charity is not the usual course of things.

The instant problem here is not that a panel of alleged experts at London’s Great Ormond Street Hospital or at some other level of the UK’s National Health Service reached the painful decision to allocate the scarce resources at their disposal to someone or something other than prolonging Charlie’s life.

The problem is that, having taken that decision, those experts demanded that Charlie’s parents accept their authority in the matter, and successfully fought them in to court to prevent them from seeking treatment for him elsewhere.

While it so happens that Charlie is an infant whose parents are claiming the rightful authority to make that decision, the “death panel” precedent here could just as easily be applied to a terminally ill adult: “We can’t treat you any more, and we’re not going to let you seek treatment elsewhere either.”

That way lies the darkest evil and savagery. Free Charlie Gard.

Thomas L. Knapp (Twitter: @thomaslknapp) is director and senior news analyst at the William Lloyd Garrison Center for Libertarian Advocacy Journalism (thegarrisoncenter.org). He lives and works in north central Florida.

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Circumcision: One Woman’s Piercing Commentary

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Baby with fake cheek piercing

When Enedina Vance posted a photo of her smiling baby with a pierced cheek on Facebook, she expected — and wanted — a reaction. She probably didn’t expect the reaction to be so vehement.

She received death threats. Some commenters claimed to have called government “child protective services” to come take the child away from an “abusive” mother.

When Vance revealed that the photo was fake (no, she hadn’t really had her child’s dimple pierced) and intended as social commentary, the hate level seemingly went up rather than down. Her target topic: Circumcision. If her goal was to fire up debate on the issue, mission accomplished.

Statistics vary by area and timeframe, but  the bottom line is that more than half of American male infants are subjected to circumcision, a painful genital mutilation ritual in which part of the penis (the foreskin) is amputated.

In some cases, the ritual is religious. In America the justification usually goes back to the Old Testament covenant between God and Abraham. Religious Jews practice circumcision, and many Christians, because our religion is an offshoot of Judaism,  consider it non-controversial (we’re not so tolerant of Muslim equivalents as applied to female infants).

In most cases, the ritual is medicalized — conducted at a hospital, by a doctor, based on one or more sketchy claims of health benefits. That started in the 19th century when masturbation was considered unhealthy and circumcision was thought to minimize it. In recent years, circumcision advocates cite research claiming benefits from reductions in penile cancer (which only affects 1-2 males per 100,000 anyway) to reductions in HIV transmission (that claim remains in dispute) and so forth.

If I started a new religion which required its adherents to cut each infant child’s left little toe off, those adherents would go to prison if they tried to live their faith.

As for the medical excuses, hey, I know how we can eliminate carpal tunnel! All we have to do is amputate each newborn’s arms right below the elbows! I’m kind of guessing that suggestion’s not going to fly with the American Medical Association.

The reason — the ONLY reason — infant male genital mutilation is tolerated (even justified and promoted!) in America is that it’s a millennia-old custom, “grandfathered in” to our culture. If we set aside the age of the habit, it stands revealed as nothing more than a brutal assault on a helpless victim.

Let’s cut circumcision out.

Thomas L. Knapp (Twitter: @thomaslknapp) is director and senior news analyst at the William Lloyd Garrison Center for Libertarian Advocacy Journalism (thegarrisoncenter.org). He lives and works in north central Florida.

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