So in all fairness I did not write this post. I ran across it and felt like it needed permanent space on my blog. . . .
so without further ado. . . here is the re-post:
This morning I was awakened by my alarm clock powered by electricity generated by the public power monopoly regulated by the United States Department of Energy. I then took a shower in the clean water provided by the municipal water utility. After that, I turned on the TV to one of the Federal Communications Commission regulated channels to see what the National Weather Service of the National Oceanographic and Atmospheric Administration determined the weather was going to be like using satellites designed, built, and launched by the National Aeronautics and Space Administration. I watched this while eating my breakfast of United States Department of Agriculture inspected food and taking the drugs which have been determined as safe by the Food and Drug Administration.
At the appropriate time, as regulated by the United States congress and kept accurate by the National Institute of Standards and Technology and the United States Naval Observatory, I get into my National Highway Traffic Safety Administration approved automobile and set out to work on the roads built by the local, state, and federal Departments of Transportation, possibly stopping to purchase additional fuel of a quality level determined by the Environmental Protection Agency, using legal tender issued by the Federal Reserve Bank. On the way out the door I deposit any mail I have to be sent out via the United States Postal Service and drop the kids off at the public school.
After work, I drive my NHTSA car back home on DOT roads, to my house, that did not burned down in my absence, because of the state and local building codes and fire marshal's inspection, and which has not been plundered of all its valuables thanks to the local police department.
I then log onto the internet which was developed by the defense advanced research projects administration and post on freerepublic.com and fox news forums and blog about how socialsism in medicine is bad because the government can't do anything right.
Just saying. . .
Thursday, March 25, 2010
Wednesday, March 17, 2010
Universal Healthcare: A Liberal-Conservative Approach
I've spent my last year looking at healthcare from my perspective as a consumer.
1. It's over priced comparative to the rest of the civilised world.
2. It is rationed based upon wealth and class.
3. The Insurance industry is not regulated to prevent rapacious business practices.
4. Healthcare is not universal and portable.
As a Citizen, with a duty to the nation, I see that:
5. Healthcare is costing huge government expenditures on entitlement programmes that will assuredly bankrupt the nation as the baby boomers retire and join medicare.
6. Left unchecked medicare will cost more and more of my tax dollars to fund. Shrinking my pay cheque and enslaving the nation to ever increasing debt.
7. Big bureaucracies are very unresponsive to changes and market forces.
But what about my duel role in society as a business owner and an employer? As an employer and business owner I see that:
6. Healthcare is costing businesses vast expenditures making businesses non-competitive on the world market.
7. Small businesses get the shaft:
I own a small start up company. To buy health insurance in California through my business for myself and 3 employees, It would cost about $800-$1,200 USD a month per person for a 70/30 plan, with a 1.5 Million USD limit, and a $500 USD deductible, no dental, no vision, no negotiated discounts on non-covered routine surgeries like lasik.
8. Big business can negotiate steep discounts:
My boyfriend works for a large wall street investment bank, with offices nation wide. His company pays about 1/2 of what my company would pay, and they pass that savings on to their employees. For he and I to be each covered by his plan it would cost out of our pockets, about $130 USD a month each.
From the insurance companies' perspective:
9. Consumers want more coverage but continue to create more unnecessary risk, obesity, smoking, etc.
So what about trying something completely different?
I was thinking how in the hell will I afford health insurance for my employees in the next year? Then I started thinking. Why is it my responsibility as an employer to provide employees with their health insurance? Seems terribly cruel and mean, huh? But realistically, In my entire life I've never been covered by an employee plan.
When I lived overseas we were covered by national socialised health care.
When I was in the military I was covered by the military's socialised health care system.
As a civilian in the US, I've or my parents always maintained our own health coverage and been horridly subject to the market forces that price our health care.
I've never been covered by an employer benefit plan.
Never. . .
So as a small business owner, my American experience is different. It screams that I should be a conservative. And in fact I am. At least in the idea that IT IS NOT MY RESPONSIBILITY AS AN EMPLOYER TO PROVIDE YOU WITH HEALTH CARE COVERAGE.
But Im still a Social Liberal. I think Health care is an essential need that ought to be available and provided to everyone, Universal, and Portable. No one should ever go bankrupt because they cannot afford to pay for health care.
As a states rights thinker, I believe that the federal governments role ought to be limited to Foreign policy, guaranteeing universal Human rights, providing a stable interstate commerce environment where citizens are protected from rapacious practices that are perpetuated by both each other and non-human entities (businesses etc.).
As a Fiscal conservative, I do not think that The Federal Government should necessarily take on the cost of insuring people. One: the Federal government is TERRIBLE at managing its debts and obligations. Two: the Federal Government is too responsive to political whim. Three: the legislative process is not one that is geared toward the goals of either business (making money) or the art of medicine (healing people). Four: The Federal Government's irresponsible management of its current entitlements system tells me they cannot be trusted to manage yet another entitlement system.
Now i like to think Im a bit of a slice of America. Socially liberal, fiscally conservative, not particularly trusting of the Federal Government's ability to manage large undertakings that last more than about 6 years or 1.5 election cycles.
So how do we do this?
Based on MY political come-froms how would I structure health care?
First off with a degree in Government Admin/International Political Economy, one thing I know is that whilst other national governments were designed to work, ours was designed specifically not to work. Not that that is a bad thing. The founders designed our system so that the difficulty of passing legislation would be in and of itself, a check on the Federal Government's ability to interfere with the several states spheres of influence, and slow its expansion. The idea was to keep it simple.
But that doesn't lend itself to solving huge problems like health care in a way that is efficient or responsive.
So what to do?
A non-federal approach. Smaller systems are more responsive to change. And until we get this thing sorted out, then a one sized fits all system isn't going to do well for anyone except replace a bad system with a system that may or may not be bad.
I think that taking a few small states and allowing each of them to try a different approach almost like little laboratories. Might be a good start.
Take Utah for instance. It is geographically isolated, Has a highly concentrated population, and is a small population of 3M. It has a very conservative slant and they would be an excellent incubator to test the following:
1. No more employer based health care. It creates a false sense of economy because companies absorb the increases in costs that result from their employees accumulation of more risk. Since UT is so conservative, and is a state full of small businesses, doing away with employer based health care in UT would work splendidly.
2. Make every consumer buy their health care from the open market.
3. Create 3 private insurance exchanges that dictate what levels of coverage that insurance exchange will offer, let the state dictate via a board of Doctors, Lawyers, elected Citizens, and insurance representatives and have that board dictate what basic minimum coverage should be, then have intermediary recommended coverage, and then have a higher tier of recomended coverage.
3. Let major health insurance providers bid for the contract to cover the pool in each exchange. Let each exchange decide what it's level of the three coverages it will offer,
4. Allow everyone to buy their insurance those three exchanges. Since oligarchy creates economies of scale.
5. Medicare and medicaid participants should be required to buy into the exchanges as well, with medicaid supplying payment via those exchanges so as to keep those people in the insurance pool.
The idea here is to make people responsive to the ways in which their behaviours affect their health care costs.
In addition take the costs off of employers, Employees will start to demand higher pay once they have to bear the cost of insuring themselves.
So what about the young who then think they are invincible and dont have to buy insurance or the ones who wont buy in?
Employers can mandate that their employees have insurance. The same way that Universities mandate that their students buy insurance. The state that can mandate that persons using certain services must buy health insurance. Example. You want to have a drivers license. You must buy both liability insurance and health insurance. All of a sudden a large segment of society will be essentially forced to buy health insurance.
Now what about the ones who cant afford, or won't buy it and take their chances.
For the can't affords we create an income based buy in system that incentivises purchase of the insurance, but still helps them NOT to have to use a huge % of their income on premiums.
The low wage subsidy basically follows a chart that says if you make this much, you must contribute this much toward your premium, and then you can buy into the exchange, and the difference in your premium and the normal amount will be made up by a user fee on all the people who use the exchange. This covers people at the bottom of the barrel.
And the folks who dont use the exchange and dont buy any insurance cause they think they can skirt by? Make a large amount of societal priviliges contingent on carrying health insurance. So much so that the dis-incentive is huge and the incentive is great. like the drivers license requirement.
Then you have pretty much everyone covered, it's Not govt run, it is govt. monitored, its not too large to make changes to, It forces people to get SKINY and healthy because they will see how the cost in the market responds to their weight loss, and health factors. And it will allow doctors to only have to deal with three health insurance companies Not a Heap of them.
Portability is an issue for out of staters coming to UT but the insurance can have an out of state supplemental coverage available to purchase OR each of the insurance companies can treat you in their provider network that is out of state.
I think this system would be far greater in terms of personal responsibility, coverage, and meeting the needs necessary. without a huge federal tax or a huge federal bureaucracy, and would provide the solution to the problem.
1. It's over priced comparative to the rest of the civilised world.
2. It is rationed based upon wealth and class.
3. The Insurance industry is not regulated to prevent rapacious business practices.
4. Healthcare is not universal and portable.
As a Citizen, with a duty to the nation, I see that:
5. Healthcare is costing huge government expenditures on entitlement programmes that will assuredly bankrupt the nation as the baby boomers retire and join medicare.
6. Left unchecked medicare will cost more and more of my tax dollars to fund. Shrinking my pay cheque and enslaving the nation to ever increasing debt.
7. Big bureaucracies are very unresponsive to changes and market forces.
But what about my duel role in society as a business owner and an employer? As an employer and business owner I see that:
6. Healthcare is costing businesses vast expenditures making businesses non-competitive on the world market.
7. Small businesses get the shaft:
I own a small start up company. To buy health insurance in California through my business for myself and 3 employees, It would cost about $800-$1,200 USD a month per person for a 70/30 plan, with a 1.5 Million USD limit, and a $500 USD deductible, no dental, no vision, no negotiated discounts on non-covered routine surgeries like lasik.
8. Big business can negotiate steep discounts:
My boyfriend works for a large wall street investment bank, with offices nation wide. His company pays about 1/2 of what my company would pay, and they pass that savings on to their employees. For he and I to be each covered by his plan it would cost out of our pockets, about $130 USD a month each.
From the insurance companies' perspective:
9. Consumers want more coverage but continue to create more unnecessary risk, obesity, smoking, etc.
So what about trying something completely different?
I was thinking how in the hell will I afford health insurance for my employees in the next year? Then I started thinking. Why is it my responsibility as an employer to provide employees with their health insurance? Seems terribly cruel and mean, huh? But realistically, In my entire life I've never been covered by an employee plan.
When I lived overseas we were covered by national socialised health care.
When I was in the military I was covered by the military's socialised health care system.
As a civilian in the US, I've or my parents always maintained our own health coverage and been horridly subject to the market forces that price our health care.
I've never been covered by an employer benefit plan.
Never. . .
So as a small business owner, my American experience is different. It screams that I should be a conservative. And in fact I am. At least in the idea that IT IS NOT MY RESPONSIBILITY AS AN EMPLOYER TO PROVIDE YOU WITH HEALTH CARE COVERAGE.
But Im still a Social Liberal. I think Health care is an essential need that ought to be available and provided to everyone, Universal, and Portable. No one should ever go bankrupt because they cannot afford to pay for health care.
As a states rights thinker, I believe that the federal governments role ought to be limited to Foreign policy, guaranteeing universal Human rights, providing a stable interstate commerce environment where citizens are protected from rapacious practices that are perpetuated by both each other and non-human entities (businesses etc.).
As a Fiscal conservative, I do not think that The Federal Government should necessarily take on the cost of insuring people. One: the Federal government is TERRIBLE at managing its debts and obligations. Two: the Federal Government is too responsive to political whim. Three: the legislative process is not one that is geared toward the goals of either business (making money) or the art of medicine (healing people). Four: The Federal Government's irresponsible management of its current entitlements system tells me they cannot be trusted to manage yet another entitlement system.
Now i like to think Im a bit of a slice of America. Socially liberal, fiscally conservative, not particularly trusting of the Federal Government's ability to manage large undertakings that last more than about 6 years or 1.5 election cycles.
So how do we do this?
Based on MY political come-froms how would I structure health care?
First off with a degree in Government Admin/International Political Economy, one thing I know is that whilst other national governments were designed to work, ours was designed specifically not to work. Not that that is a bad thing. The founders designed our system so that the difficulty of passing legislation would be in and of itself, a check on the Federal Government's ability to interfere with the several states spheres of influence, and slow its expansion. The idea was to keep it simple.
But that doesn't lend itself to solving huge problems like health care in a way that is efficient or responsive.
So what to do?
A non-federal approach. Smaller systems are more responsive to change. And until we get this thing sorted out, then a one sized fits all system isn't going to do well for anyone except replace a bad system with a system that may or may not be bad.
I think that taking a few small states and allowing each of them to try a different approach almost like little laboratories. Might be a good start.
Take Utah for instance. It is geographically isolated, Has a highly concentrated population, and is a small population of 3M. It has a very conservative slant and they would be an excellent incubator to test the following:
1. No more employer based health care. It creates a false sense of economy because companies absorb the increases in costs that result from their employees accumulation of more risk. Since UT is so conservative, and is a state full of small businesses, doing away with employer based health care in UT would work splendidly.
2. Make every consumer buy their health care from the open market.
3. Create 3 private insurance exchanges that dictate what levels of coverage that insurance exchange will offer, let the state dictate via a board of Doctors, Lawyers, elected Citizens, and insurance representatives and have that board dictate what basic minimum coverage should be, then have intermediary recommended coverage, and then have a higher tier of recomended coverage.
3. Let major health insurance providers bid for the contract to cover the pool in each exchange. Let each exchange decide what it's level of the three coverages it will offer,
4. Allow everyone to buy their insurance those three exchanges. Since oligarchy creates economies of scale.
5. Medicare and medicaid participants should be required to buy into the exchanges as well, with medicaid supplying payment via those exchanges so as to keep those people in the insurance pool.
The idea here is to make people responsive to the ways in which their behaviours affect their health care costs.
In addition take the costs off of employers, Employees will start to demand higher pay once they have to bear the cost of insuring themselves.
So what about the young who then think they are invincible and dont have to buy insurance or the ones who wont buy in?
Employers can mandate that their employees have insurance. The same way that Universities mandate that their students buy insurance. The state that can mandate that persons using certain services must buy health insurance. Example. You want to have a drivers license. You must buy both liability insurance and health insurance. All of a sudden a large segment of society will be essentially forced to buy health insurance.
Now what about the ones who cant afford, or won't buy it and take their chances.
For the can't affords we create an income based buy in system that incentivises purchase of the insurance, but still helps them NOT to have to use a huge % of their income on premiums.
The low wage subsidy basically follows a chart that says if you make this much, you must contribute this much toward your premium, and then you can buy into the exchange, and the difference in your premium and the normal amount will be made up by a user fee on all the people who use the exchange. This covers people at the bottom of the barrel.
And the folks who dont use the exchange and dont buy any insurance cause they think they can skirt by? Make a large amount of societal priviliges contingent on carrying health insurance. So much so that the dis-incentive is huge and the incentive is great. like the drivers license requirement.
Then you have pretty much everyone covered, it's Not govt run, it is govt. monitored, its not too large to make changes to, It forces people to get SKINY and healthy because they will see how the cost in the market responds to their weight loss, and health factors. And it will allow doctors to only have to deal with three health insurance companies Not a Heap of them.
Portability is an issue for out of staters coming to UT but the insurance can have an out of state supplemental coverage available to purchase OR each of the insurance companies can treat you in their provider network that is out of state.
I think this system would be far greater in terms of personal responsibility, coverage, and meeting the needs necessary. without a huge federal tax or a huge federal bureaucracy, and would provide the solution to the problem.
Tuesday, March 9, 2010
Substantive Due Process - Showdown at the OK Coral
Last week the Attorney General of the Commonwealth of Virginia, the state of my origin, sent a letter to State Universities telling them that State Universities are the equivalent of state agencies not state owned corporations and as such they cannot set their own hiring and firing and equal protection policies for LGBTQ people so long as the state legislature does not approve further protections. This was only a few weeks after the governor executed an executive order declaring that only the legislature could enumerate what constituted a discrete and insular minority group that is eligible as a suspect class. And in so doing, the Governor stripped LGBTQ people of all state protections. Since the federal government hasn't yet begun to protect LGBTQ people, The states are presently free to do what they want in that arena. And the Governor and Attorney General of VA are doing exactly what they want to. . . and like in other states that have been wrestling with the same issue. . .
It is a Showdown at the OK Coral. And it is ALL about which government body, the Legislature or the Courts, has the power and authority to enumerate what rights are inalienable as part of the liberty Interest in the Substantive Due Process clause.
The 14th Amendment reads in pertinent part:
“All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”
Wikipedia - one of my favourite basic starting points, sums up how the U.S. Supreme Court evaluates substantive due process:
Today, the Court focuses on three types of rights under substantive due process in the Fourteenth Amendment,[citation needed] which originated in United States v. Carolene Products Co., 304 U.S. 144 (1938),
Those three types of rights are:
-the rights enumerated in and derived from the first eight amendments in the Bill of Rights (e.g., the Eighth Amendment);
-the right to participate in the political process (e.g., the rights of voting, association, and free speech); and
-the rights of “discrete and insular minorities.”
The Court usually looks first to see if there is a fundamental right, by examining if the right can be found deeply rooted in American history and traditions. Where the right is not a fundamental right, the court applies a rational basis test: if the violation of the right can be rationally related to a legitimate government purpose, then the law is held valid. If the court establishes that the right being violated is a fundamental right, it applies strict scrutiny. This test inquires into whether there is a compelling state interest being furthered by the violation of the right, and whether the law in question is narrowly tailored to address the state interest.
In This Corner:
On the right is the GOP who proclaim that judges have no authority to enumerate previously unenumerated rights, that such should remain the realm of the legislature, and when those judges do enumerate rights they are "activist Judges" This has been the traditional battle cry when ever the enumeration of rights seems to upset the cultural norms that conservatives generally do not like to disrupt.
This is particularly the case with the rights of discrete and insular minorities. Jim Crow is the first thing that comes to mind, But you could pick just about any political hot button issue that affects, previously unenumerated fundamental rights, or minority rights: the right to have control over how you raise your children, abortion, sexual privacy, privacy over one's body, right to reproduce or not reproduce, right to chuse the gender of one's sexual partners. the list goes on.
In each of these cases the Court has acted, and in each of these cases conservatives for the most part have railed against the Court for acting, claiming that the legislature is the proper body to act.
In The Opposite Corner:
On the Left are the Dem's who say that both Judges and the Legislature should be allowed to enumerate what rights are inalienable under the liberty interest of the Substantive Due Process Clause. The Dems argue that the legislature is feckless with respect to protecting the inalienable rights of discrete and insular minorities (the majority doesn't usually trample their own rights).
Dems argue that it is left to the Court to decide. That with respect to unpopular minorities the legislature, who has to face popular election, will always be feckless. They, by nature, cannot with impunity ignore the majority's will. Unfortunately the majority's is not always in line with the rule of law. Nor has the majority's will traditionally been as respectful of the minority's right to equality under the law, as have the courts. It was the failing of the legislature, after all, that declared African American's 3/5 of a person.
So now that the stage is set. The crowd is gathered and the the showdown is starting. . . .
The Strategy & Weapons:
Electing Legislatures:
Due to our governmental system of checks and balances electing a legislature that fits which ever of these two agendas they are committed to, is one of the first ways in which to bring about their agenda. The legislature can use all type of procedural and substantive moves to forward the goal.
State Agencies & Executives:
Agency Rules and Executive Orders allow manipulation to the maximum of those rules of governance that interact with peoples lives on a daily basis. By creating a hedge of rules around the outcome that you would like to see, you can effectively control the forum/issue.
Stacking Courts:
To insure that those courts will either enumerate further substantive rights as being fundamental, recognise new discrete and insular minorities, or further protect currently named discrete and insular minorities, OR staking the courts to insure that these things do not happen. Amending Constitutions:
By amending constitutions to insure the outcome that they wanted they can make an end run around the checks and balances of the system, and an end run around substantive due process or lack thereof. An example of this was The 14th amendment. We fought a war and then made the rebel states ratify the amendments in order to be re-admitted to the union. Or Equal Rights Amendment which was in response to the Court chusing not to act. Or in the case of Prop 8 and its sister amendments (attempts by states to avoid full faith & credit by establishing anti-gay policies as their states fundamental policy) 
Who the hell cares?
Well, I care for starters. First off, I fit into three discrete and insular minority groups. I'm Gay, I'm Latino, and I'm Mormon. In case anyone hasn't noticed, none of the three are particularly popular groups. lol Secondly, I'm very interested in insuring that my fundamental rights are preserved, and that the government gets the hell out of regulating them, but is fearless in protecting them.
I've blogged a fair bit on Gay rights. It's been an issue for me. In part because it affects my daily life, my culture as a gay man, and in part because my LDS Culture and church affiliation has decidedly declared war on my gay culture. Leaving me and so many other LDS people caught in the cross fire.
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