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Archive for the ‘Health Reform’ Category

I’ve been fretting for a long time that poorly designed entitlement programs are going to turn America into a decrepit welfare state.

Medicare obviously is a big part of the problem, but the fraud-riddled Medicaid program may be even worse.

The program is a nightmare for both federal taxpayers and state taxpayers.

In an article for the Daily Caller, John Graham of the Independent Institute has some very grim analysis of the fiscal black hole otherwise known as Medicaid.

In 2014, total Medicaid spending is projected to grow 12.8 percent because Obamacare has added about 8 million dependents. A large minority of states have chosen to increase residents’ eligibility for Medicaid by expanding coverage to adults making up to 138 percent of the federal poverty level. Unfortunately, more states are likely to expand this welfare program. This is expected to result in a massive increase in the number of Medicaid dependents: From 73 million in 2013 to 93 million in 2024. Medicaid spending is expected to grow by 6.7 percent in 2015, and 8.6 percent in 2016. For 2016 to 2023, spending growth is projected to be 6.8 percent per year on average. This comprises a massive increase in welfare dependency and burden on taxpayers.

But the actual numbers may be worse than these projections.

…official estimates often low-ball actual experience. This is because it is hard to grapple with how clever states are at leveraging federal dollars. …The incentive lies in Medicaid’s perverse financing merry-go-round. In a rich state like California, for example, the federal government (pre-Obamacare) spent 50 cents on the dollar for adult dependents. So, if California spent 50 cents, it automatically drew 50 cents from the U.S. Treasury. And most states had a bigger multiplier. Which state politician can resist a deal like that? …The situation will deteriorate because Obamacare’s Medicaid expansion significantly increases states’ perverse incentives to game Medicaid financing. …Newly eligible Medicaid beneficiaries will be fully financed by the federal government for 2014 through 2016. Then, it slides down until the federal government funds 90 percent of their costs starting in 2020, with the states footing 10 percent. Recall the cunning with which states developed ways to abuse federal taxpayers when they could only double their money from Uncle Sam. The new normal is that they will be able to get nine times their money!

By the way, these numbers would be even worse if it wasn’t for the fact that many states refused the lure of “free” federal money to expand Medicaid.

So what’s the solution? Graham suggests federalism is the answer.

A reform in the right direction would be to get rid of the federal match in favor of a block grant, based on a simple measurement of the population in each state, and precisely define a limited federal commitment.

He’s exactly right, at least in the short run.

Let’s copy the success of welfare reform and turn over a fixed amount of money – along with concomitant authority and responsibility – to state governments and let them figure out the best way of delivering health care to lower-income populations.

In the long run, of course, I’d like to phase out the block grant so that states are responsible for both collecting the money and providing the services.

But before we get to the point of adopting health care policies for an ideal libertarian society, we first have to stop the bleeding (or, to be more accurate, hemorrhaging) and stabilize the program.

And that’s why I fully agree that the federalism approach, in the form of block grants, is the right policy.

Here’s my video on the topic.

And since I’m sharing videos, I can’t resist commenting on the latest “Gruber-gate” scandal. The MIT professor and Obamacare insider (he got $400,000 of taxpayer money to help design the plan) has become an embarrassment for the left because he has been caught on tape saying that the legislation relied on deception. He even said that proponents of Obamacare took advantage of the “stupidity” of American voters.

You can watch the most well-know example by clicking here. But he also denigrated supposedly “stupid” Americans in this video.

I want to defend one small component of Gruber’s statement.

But I want to be completely clear that I’m not defending his elitist disdain for ordinary Americans. Indeed, I don’t think voters are stupid. Instead, to the extent they’re uninformed, it’s the result of serial dishonesty from Washington or because they’ve decided it’s not worth their time to pay attention to the crowd in DC (the “rational ignorance” hypothesis).

The part of Gruber’s statement that has merit is that he’s talking about the fact that there’s a big loophole in the tax code for fringe benefits. To be more specific, tens of millions of Americans get part of their compensation in the form of fringe benefits such as health insurance. Yet while workers are taxed on their “cash” income, they are not taxed on their “fringe benefit” income (a policy sometimes called the “healthcare exclusion”).

And this has created, over time, a very inefficient system of over-insurance.

To understand why this system doesn’t make sense, just think about your homeowner’s insurance or auto insurance. Those policies, unlike health insurance, work reasonably well and costs remain relatively stable. Why is there a big difference?

The difference is that employee income that is diverted to health insurance avoids both income tax and payroll tax, so there is a significant monetary incentive for gold-plated plans. And these plans often include insurance coverage for ordinary medical expenses, which contributes to the problem of third-party payer.

No wonder health insurance is so costly. After all, imagine what would happen to the price of your homeowner’s insurance if it had to cover the cost of a new couch? Or repainting the hallway? Or what about the cost of your auto policy if it covered the cost to fill up with gas or get an oil change?

We instinctively recognize that this would be insanely inefficient and expensive, yet that’s how our health insurance system operates thanks to a giant tax preference.

So Gruber was right to say it’s a problem. And I’ve even said that addressing the exclusion is a very tiny silver lining in the awful dark cloud of Obamacare.

But now that I’ve bent over backwards to say something nice, now let me point out that Gruber (and Obama and other statists) didn’t have the right solution. Yes, they wanted to cut back on the tax exclusion, but only because they wanted to use the money for other purposes (such as subsidies that also exacerbate the third-party payer problem).

The right approach, by contrast, is to phase out the healthcare exclusion and use every penny of revenue to “pay for” lower tax rates. That way you get a win-win situation for the economy. A more rational, market-based healthcare system and a less punitive tax code for productive behavior.

Now that we’ve addressed a serious point, let’s laugh about the fact that Gruber’s comments have created a big headache for the White House. We’ll start with this Steve Kelley cartoon.

And here’s Gary Varvel’s take on the honesty of the Obama White House on the topic of health care.

Last but not least, Lisa Benson optimistically suggests that the serial dishonesty of Obamacare supporters may be undone by the Supreme Court.

Which would be poetic justice, since Professor Gruber also was caught on tape – over and over again – stating that Obamacare only allowed subsidies for people getting insurance policies through state-based exchanges.

And now the Supreme Court will decide whether those subsidies, notwithstanding statutory language, can be provided via the federal exchange.

Though I’m not holding my breath since certain Justices on the Court already have demonstrated that they’re willing to put politics above the law.

P.S. Just in case I wasn’t sufficiently clear, good tax reform also is good health reform. That was one of the points I made in my tax reform speech at the Heritage Foundation and I suspect I’ll continue making that argument until we win or I’m dead (and I don’t want to take odds on which happens first).

P.P.S. On a more upbeat note, the House of Representatives approved budgets in 2011, 2012, 2013, and 2014 that assume Medicaid gets block-granted to the states. So that reform may actually happen while I’m still breathing.

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Wow, Barack Obama and the Democrats suffered a thermonuclear butt kicking. This was 1994 and 2010 put together.

When the dust settles after recounts and run-offs, it appears that the GOP will have picked up 9 Senate seats. That’s one more than I predicted, and I thought I was probably overstating the GOP wave.

The House results are equally remarkable. There are a handful of close races that haven’t yet been decided, but it seems that Republicans will control at least 246 seats and may even hit or exceed my prediction of 249 seats. And that estimate at the time was way too high, based on what almost all the experts were predicting.

So what lessons, if any, can we learn from these results (other than that I do a decent job of predicting mid-term elections)?

1. Obama has been a disaster for his party. At their high point in 2009, Democrats controlled 60 seats in the Senate and 257 seats in the House of Representatives. But thanks to unpopular and misguided policies such as Obamacare and the faux stimulus, the President created conditions for GOP landslides in 2010 and 2014. And don’t forget that Republicans also have made huge gains in state legislatures during Obama’s presidency. I already joked that libertarians were going to give the President a “man of the year” award for reawakening interest in the principles of liberty, but Republicans may want to give him an even bigger award and make it official rather than satirical.

2. Obamacare is still deeply unpopular. It appears that at least 17 Democratic Senators since 2010 have been replaced by anti-Obamacare Republicans. That’s a remarkably large number of casualties. And don’t forget what happened to House Democrats in 2010. Some advocates of government-run healthcare claim that voters are no longer agitated about Obamacare and that Republicans didn’t make it a big issue. But if that’s the case, why did Republicans dramatically increased their focus on Obamacare as the elections got closer?

If you want an example of whistling past the graveyard, considering this blurb from an article in The Hill last April.

White House senior adviser Dan Pfeiffer on Sunday rejected the suggestion that Republicans will take control of the Senate in the midterm elections, saying that the GOP argument to repeal ObamaCare is a “political loser.”

I wonder what he would say if asked about Obamacare today?

3. The government shutdown was almost certainly a net plus for the GOP. Back in 2011, I explained that Republicans could play hard ball, largely based on what really happened during the 1995 government shutdown. And in 2013, I again defended a shutdown, pointing out that voters probably wouldn’t even notice that some government offices were closed, but they would remember that the GOP was branding itself as the anti-Obamacare party. The establishment, by contrast, thought the shutdown was a disaster for Republicans. Here’s some of what one academic wrote last October.

…the shutdown leveled the House playing field in a rather unexpected manner. …in a Congressional election today, Democrats would retake the House with >90% probability and a 50-seat margin.

And remember that many establishment Republicans felt the same way, excoriating Senator Cruz and others who wanted a line-in-the-sand fight over government-run healthcare. The moral of the story isn’t that shutdowns necessarily are politically desirable, but rather that it’s very important for a political party to find visible ways of linking itself to popular causes (such as ending Obamacare, fighting big government, etc).

4. Voters still hate taxes. I’m stunned that Governor Brownback won reelection in Kansas, but I’m even more surprised that pro-tax Democrat gubernatorial candidates lost in deep-blue states such as Maryland, Illinois, and Massachusetts. The one common theme is that voters – when given a real option – generally prefer candidates who will let them keep more of their money. We also can learn something by reviewing the outcome of various ballot initiatives. By a 2-1 margin, Tennessee voters amended their constitution to prohibit an income tax from every being adopted. And by a 3-1 margin, Georgia voters made sure the top tax rate could never be raised. On the other hand, more than 60 percent of voters in Illinois voted for an advisory referendum that called for a class-warfare tax hike (even though they voted for a governor who will block that from happening).

A few other observations.

Scott Walker’s victory, along with the outcome of gubernatorial races in places such as Michigan and Illinois, suggests that unionized state bureaucrats no longer have carte blanche to pillage taxpayers. Or at least they no longer have the necessary political muscle to endlessly line their pockets at the expense of the overall electorate.

Rand Paul gets points for the most clever political satire of the evening, popularizing the #hillaryslosers hashtage along with some amusing images. Here’s the one for Kentucky.

Let’s close by reveling in some Schadenfreude. Here are some excerpts from a story in the Washington post in early 2013.

President Obama…is taking the most specific steps of his administration in an attempt to ensure the election of a Democratic­-controlled Congress in two years. …Obama, fresh off his November reelection, began almost at once executing plans to win back the House in 2014, which he and his advisers believe will be crucial to the outcome of his second term and to his legacy as president. …Obama has committed to raising money for fellow Democrats, agreed to help recruit viable candidates, and launched a political nonprofit group dedicated to furthering his agenda and that of his congressional allies. The goal is to flip the Republican-held House back to Democratic control, allowing Obama to push forward with a progressive agenda on gun control, immigration, climate change and the economy during his final two years in office… Obama has committed to eight fundraisers for the Democratic Congressional Campaign Committee this year… The president has also pledged to put his formidable campaign organization, now known as Organizing for Action, behind Democratic House candidates and to find ways to share its rich trove of voter data with the party’s campaign committee. …“If 2012 was a referendum on President Obama, then 2014 will be a referendum on the tea party Congress,” Israel said. “And the president and House Democrats are joined at the hip on this.”

Gee, things didn’t exactly turn out the way Obama hoped.

But Congressman Israel was right. Obama and the Democrats were joined at the hip.

Now the big question is whether voters will get a clear choice between big government and small government in 2016. If they do, this hypothetical poll shows the outcome.

But if it’s another Tweedle Dee vs Tweedle Dum election, then Washington’s ruling class will win regardless.

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It’s time to extend the tradition of sharing politics-related Halloween humor on October 31.

Though this is only my fourth year, so maybe it’s not quite a tradition yet.

Nonetheless, we’ve had some good material.

There were two Halloween posts in 2011, including a cartoon about what happens when kids trick-or-treat at a statist’s house, as well as a comic’s very clever and amusing analysis of taxes and Halloween.

In 2012, I shared several Halloween-themed cartoons, mostly about Obama’s spendaholic tendencies.

Last year, Obamacare was the unifying theme in the cartoons I shared.

This year, we have six more political cartoons.

The first bunch focuses on scary political figures.

We’ll start with a cartoon from Henry Payne, who suggests that Democrats are the ones who are most fearful of Obama.

Larry Wright, meanwhile, warns children that some costumes won’t produce much candy.

But Obama isn’t the only hobgoblin scaring people. Here’s Hillary Clinton, courtesy of Ken Catalino.

The following Halloween cartoons all share a common theme, which is that Obamacare is generating much higher prices for health insurance.

Here’s Steve Breen’s contribution. Democrats are scared, to be sure, but consumers are the real victims.

Lisa Benson weighs in. I particularly like the candy bar in the cartoon.

Last but not least, Gary Varvel has a similarly amusing perspective.

Thought there is a serious point to make about this last cartoon.

The White House appears to be hiding some of the negative effects of Obamacare until after the election. Here’s some of what the U.K.-based Daily Mail has reported.

The open enrollment period for federal Obamacare plans will begin more than a month later than it did last year, with this year’s start date coming after the midterm elections. …the White House and the Department of Health and Human Services have said politics aren’t at play. …Still, the move has the added convenience of allowing insurers to keep next year’s rates a secret until voters have already cast their ballots for or against Democrats who voted for or support the health care law.

Gee, that’s convenient…if you’re a Democratic political operative.

Not surprisingly, some folks are skeptical.

In a statement released last Friday Americans for Prosperity President Tim Phillips claimed, ‘the President sold ObamaCare to the American people on the false promise that it would make health care more accessible and more affordable for those who needed it most. ‘Sadly, ObamaCare has actually put affordable health care even further out of reach for millions of Americans,’ the conservative non-profit head claimed.The administration’s decision to withhold the costs of this law until after Election Day is just more proof that ObamaCare is a bad deal for Americans.’

For what it’s worth, I share these concerns. By arbitrarily deciding what parts of Obamacare to enforce and when to enforce them, the White House already has made a mockery of the rule of law.

So what’s another politically motivated change in the rules, a la Argentina?

P.S. Now let’s shift to the elections. A few days ago, I made my initial projections for the House and Senate elections that will take place on Tuesday.

I predicted that Republicans would control the Senate 52-48 and the House 246-189.

Having looked over some of the polling data, I’m going to stick with my Senate prediction.

Though I’ve made a change. I still think the GOP will win the same 8 seats that I projected last time, but now I’m predicting that Republicans will hold on to their seat in Georgia while losing a seat they hold in Kansas.

So still a net gain of 7 seats for the GOP.

Here are the Senate seats that will change hands.

2014 Senate Elections

I also admitted last time that I’m not overly confident in my predictions and that the final outcome could be anywhere between 52-48 Democrat control and 55-45 Republican control.

In other words, I thought there were a bunch of races that could go in either direction.

For what it’s worth, I think the trend is against the Democrats, so I’ll now predict that the final results will be somewhere between a 50-50 split (in which case Biden casts the tie-breaking vote) and 56-44 GOP control.

In the House of Representatives, the pro-Republican trend leads me to predict the GOP ultimately will have 248-187 control, which would be the most Republicans since 1930.

P.P.S. Just as I warned last time, don’t hold your breath waiting for big changes in policy if the GOP winds up in control of both chambers of Congress.

Even assuming they want to do the right thing, Republicans won’t have the votes to override presidential vetoes. So there won’t be any tax reform and there won’t be any entitlement reform.

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In the last few months of 2013, Obamacare suffered a series of embarrassing setbacks dealing with everything from a clunky website to plan cancellations to the White House feeling compelled to arbitrarily ignore the law.

Since that time, though, people seem to have adapted to this new burden.

But adaptation doesn’t mean approval. There are still serious problems with Obamacare, as evidenced by the fact that the Obama Administration has postponed implementation of various provisions 38 times!

However, the White House wants us to believe the law is a success, even if that requires statistical contortions.

So let’s look at the record.

My Cato colleague Mike Tanner argues that Obamacare has been a disaster, writing for Townhall that “…in the last year we’ve also seen plenty of bad news for consumers, providers, employers and taxpayers.”

In his column, he looks at various groups and assesses whether Obamacare has succeeded or failed.

What about universal coverage?

…the best estimates suggest that roughly 8 million people gained insurance under ObamaCare, but roughly half of those were enrolled in Medicaid (outside of the exchanges), which isn’t really health-care reform so much as adding people to government welfare. And it still leaves 41 million American adults uninsured.

That doesn’t sound too impressive, particularly when you consider all the damage that Obamacare has imposed.

What about keeping your health plan?

…roughly 6 million Americans were kicked off their insurance because their plans failed to offer a lengthy-enough maternity stay, didn’t provide sufficient drug and alcohol rehabilitation benefits or otherwise fell short of the insurance that federal bureaucrats thought that they should have. …on average, ObamaCare plans were worse than the plans they replaced, in terms of both providers covered and cost-sharing. A new wave of cancellations is about to begin as well.  …In several states, insurers have dropped plans that they offered on the exchanges or even withdrawn from the market altogether. And if that was not bad enough, Americans with employer-based insurance may find out their insurance has to be changed starting next year.

So we pay more and get less, while also dealing with lots of uncertainty.

What about consumers?

If judged against President Obama’s promise that health-care reform would save us all at least $2,500 through lower premiums, ObamaCare deserves an F. …In states where the individual market was not already dysfunctional, there were significant premium increases.

So the President was lying? I’m shocked, shocked.

What about taxpayers?

This summer the Congressional Budget Office announced that it had given up trying to score the cost of ObamaCare, given the frequency with which the administration was making unilateral changes to the law. …roughly 85 percent of those enrolled through exchanges are receiving subsidies, higher than predicted. Overall, the best estimates suggest the law will cost $2.63 trillion over the next 10 years. That will be paid for by $1.38 trillion in new taxes and at least $1.25 trillion in additional debt.

Imagine that. A new entitlement is going to be a fiscal boondoggle. Who could have predicted that outcome?

What about jobs?

…surveys from Federal Reserve Banks in New York, Philadelphia and Atlanta confirmed that businesses are cutting employment and shifting workers to part-time positions because of ObamaCare. According to the New York Fed, 21 percent of manufacturers and 17 percent of service companies have reduced the size of their workforce because of the law. In addition, roughly 20 percent of both manufacturers and service companies said that they have shifted workers from full- to part-time jobs.

The overall impact on employment could be as high as two million workers.

But there is a tiny sliver of good news. Or, to be more accurate, there’s a tiny sliver of not-as-bad-as-we-thought news.

…some costs are lower because so many states have chosen not to expand Medicaid.

In other words, the Obama White House thought it could bribe states to expand the welfare program that provides health care.

And some statist governors, such as John Kasich, rolled over for Obama.

But many states realized it would be a long-term fiscal disaster to expand Medicaid, notwithstanding promises that Washington would pick up the tab in the short run.

Let’s close with a video on one of the more bizarre aspects of Obamacare. Apparently, people are getting screwed out of their healthcare plans because of strange rules that all plans have to fit within certain bands.

I can’t imagine why the politicians wanted the law to work this way, other than the statist instinct to micro-manage other people’s lives. You have to watch the video to grasp the inanity of the policy.

And if all this isn’t sufficiently depressing, keep in mind that the White House wants to use your tax dollars to bail out the big health insurance companies.

P.S. I’ve written several times about the horrifying practice of “civil asset forfeiture,” which happens when the government decides to seize the property of people without bothering to convict them of any crime.

Well, now we have a humorous – yet still outrageous – look at the practice from John Oliver.

If you want some additional (and more substantive) analysis of asset forfeiture, watch videos here, here, and here.

And if you want to increase your blood pressure, read horror stories about government theft here, here, here, here, and here.

No wonder even the people who first developed the program now want to shut it down. And it is encouraging that there finally is a backlash against this odious practice.

P.P.S. If you like Oliver’s humor, here’s his very funny analysis of how Obamacare is working in Oregon.

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I’m a huge fan of Switzerland, largely because its voters approved a spending cap that should be a role model for other nations.

It’s called the “debt brake” and it has helped reduce the burden of government spending in Switzerland at a time when most nations in Europe have been moving in the wrong direction.

But that’s not the only reason I like Switzerland.

I also appreciate the fact that Swiss voters seem to be much more sensible than voters in other nations.

Every so often I see polls, for instance, suggesting that French voters overwhelmingly want less government spending. But then they go out and elect statist presidents such as Sarkozy and Hollande.

In Switzerland, by contrast, voters are sensible where it counts most – in the voting booth.

Earlier this year, 76 percent of voters rejected a minimum wage hike.

Back in 2010, nearly 60 percent of voters shot down a class-warfare proposal for higher taxes on the rich.

And they’ve done it again. In a recent referendum, they defeated a government-run healthcare system by a landslide.

Here are some excerpts from an AFP report.

Swiss voters on Sunday rejected a plan for a seismic shift from the country’s all-private health insurance system to a state-run scheme. Referendum results showed that almost 62 percent of voters had shot down a reform pushed by left-leaning parties. …”The Swiss population does not want a single national scheme,” said the Swiss Insurance Association. “Our health system is among the top performers in the world. Competition between health insurers and freedom of choice for clients play a major role in this,” it added. …The rejection of the plan by nearly two-thirds of voters is a major blow for pro-reform campaigners, given that opinion polls had shown the ‘No’ vote was likely to be around 54 percent. In a 2007 referendum, 71 percent of voters rejected similar reforms. …for Switzerland’s cross-party government and its right- and centre-dominated parliament, the current system has proven its mettle and is debt-free, unlike the health services of France, Italy or Britain.

Though it seems that speaking French is somehow linked to economic illiteracy.

German-speaking regions voted against the plan, while their French-speaking counterparts were in favour.

Back in 2011, I wrote that there were five reasons why Switzerland was better than the United States.

But perhaps I wasn’t being sufficiently enthusiastic. Over at Being Classically Liberal, there’s an article entitled “9 Reasons Libertarians Should Love Switzerland.” Here’s the bottom line.

The Swiss are rich, happy, gun-owning, peace-loving people. The country has one of the freest market economies in the world and a relatively small and very decentralized government which hasn’t waged war since the early 19th century. In this libertarian’s eyes, Switzerland might just be the most awesome country in existence.

I’m agnostic on whether Switzerland is the “most awesome.” Hong Kong and Singapore, for instance, have smaller government.

That being said, Switzerland is much better on both guns and federalism.

And if you believe in grading on a curve, the burden of government spending in Switzerland is far smaller than it is in neighboring nations.

So it is a very admirable place.

Though I haven’t given up on America quite yet. And if I ever do, I’ll still choose Australia over Switzerland.

P.S. While it is encouraging that Swiss voters overwhelmingly rejected a single-payer healthcare scheme, I should acknowledge that their current system is not exactly libertarian Nirvana since it mandates that households purchase a health insurance policy.

P.P.S. But I don’t want to close on a bad point, so I’ll simply call your attention to the fact that Switzerland has one of the lowest levels of welfare spending among industrialized nations.

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America’s health care system is a mess, and we can assign almost all the blame on government. Simply stated, we don’t have functioning and efficient markets because Medicaid, Medicare, tax-code distortions, and other forms of regulation and intervention have created a system that is crippled by a third-party payer crisis.

There’s no logical reason to expect consumers to be smart shoppers, after all, when they’re only responsible for directly paying just 11 cents for every $1 of health care they consume. And providers have little reason to be efficient when they know that consumers are largely insensitive to price.

Let’s now apply these insights to the political controversy over birth control. Except, as I explained in July, there is no fight over birth control. As far as I’m aware, nobody is trying to ban birth control.

The real fight is whether the government should mandate that health insurance plans include coverage for birth control (and certain abortifacients).

Writing for Bloomberg, Megan McArdle explains that Obamacare’s birth control mandate is silly because a modest and routine expense shouldn’t be covered by insurance at all.

I am not very patient with the political fights over the Affordable Care Act’s contraception mandate. …Generic birth-control pills are a cheap, regular expense used by many millions of people, exactly the sort of thing that insurance is not designed for. All this does is spread the cost around a bit while adding administrative overhead for your policy.

Moreover, the better policy is to allow birth control to be purchased without a prescription.

In other words, address the issue by reducing government regulation rather than imposing a mandate!

…make birth-control pills available over-the-counter rather than a prescription item. This is an excellent idea. It was an excellent idea before Obamacare passed, and it will remain a fine policy even if Obamacare somehow vanishes into dust. Physicians assess the danger of giving you birth control by asking simple questions you can ask yourself: Are you over 35, a smoker or troubled by a family history of early stroke?

Seems like a good idea, right? Particularly since it should appeal to Republicans that want less regulation and also appeal to Democrats that want easier access to birth control.

The Republicans are on board, as Byron York reports.

…the GOP has a new policy response… The idea is to make the birth control pill available over the counter, to all, 24/7, without a prescription. It’s becoming a trend among Republican candidates in Senate races around the country. In North Carolina, GOP candidate Thom Tillis recently embraced it. So has Ed Gillespie in Virginia. Mike McFadden in Minnesota. Gardner in Colorado. And one of the leading proponents of the move is a potential 2016 GOP presidential candidate, Louisiana Gov. Bobby Jindal. …Gardner first rolled out the proposal in a Denver Post op-ed in June. The birth control pill has safely been in use since it was first approved 44 years ago, Gardner argued. “When other drugs have that kind of track record, we approve them for purchase without a prescription,” he wrote. “Name-brand drugs like Advil, Pepcid, Claritin, Prilosec and many others were once sold by prescription only, but moved to over-the-counter sale once they’d been proven safe and unlikely to be abused.”

But some Democrats are hostile.

Indeed, a columnist for the Denver Post is very upset that some GOPers are supporting over-the-counter access to birth-control pills.

Following the lead of Colorado U.S. Senate candidate Cory Gardner, a handful of Republicans in midterm races across the country are now embracing over-the-counter sales of birth control pills without a prescription. Don’t be fooled. It’s a disingenuous move that could actually make the pill more expensive for women… But women already pay for those pills as part of the health care coverage they purchase through employers. Why would we want to pay for them twice? …What happens, however, if birth control pills are sold over the counter? Insurance companies will likely stop covering them. That means women will keep paying health insurance premiums, plus an additional out-of-pocket fee for pills. …And free doctor visits to discuss birth-control risks could also be replaced with fee-based pharmacy consults to determine whether women have risk factors like smoking, hypertension or migraines that prevent safe use of the pill, reports the American College of Obstetricians and Gynecologists. That’s hardly a “cheaper and easier” alternative — which is why Politifact rates Gardner’s claim as “mostly false.”

I strongly suspect that the author simply wanted to make a partisan attack on the Republican Senate candidate in Colorado. After all, more substantive and serious people on the left, including those at both Vox and Think Progress, favor over-the-counter access to birth control.

But let’s assume she really believes what she wrote. In which case she would get an F from any economics professors because health insurance companies obviously include predicted costs when pricing their policies. So if the mandate disappears and birth control is available without a prescription, then insurance companies will be able to lower the cost of the policies they sell.

In other words, women wouldn’t be paying twice. Indeed, they’ll pay less, though that will only be obvious to those who understand that employer-provided health plans are part of overall employee compensation.

There is another reason, other than partisanship, for some on the left to oppose Republican proposals to allow birth control to be sold over the counter. And you won’t be surprised to learn that self interest is playing a role.

Writing for The Federalist, Ben Domenech notes that Planned Parenthood wants to retain the current prescription-only approach.

You may think Ben made a big mistake, or that I misinterpreted. After all, isn’t that contrary to the organization’s ostensible mission of reducing unwanted pregnancies?

Well, Ben points out that Planned Parenthood may be more interested in maximizing handouts than it is in reducing pregnancies.

…interestingly enough, Planned Parenthood is pushing back on over-the-counter contraception. Why is this? Why would Planned Parenthood want to decrease the availability of contraception, and require women to see a doctor in order to get it? That seems awfully paternalistic of them. …birth control is a major lead generator for Planned Parenthood, to the degree that they can’t afford to lose their existing purpose as a source of prescribed contraception without it hurting their status as an institution. …Now you can understand why they wouldn’t want potential customers to be free to go to CVS or Walgreens or Rite Aid instead of heading to Planned Parenthood – providing those and other services is worth a lot of taxpayer money, $540 million in FY 2012 alone. And if you don’t provide those services, you can’t bill the taxpayers for them. …That’s why they want to keep the government’s ban on over-the-counter birth control intact.

Here’s a chart from Ben’s article that shows “what percentage of Planned Parenthood’s “services” are related to contraception.” As he notes, “it’s over a third of their activity.”

So I guess it makes sense – at least from an amoral perspective – that the organization wants to limit access to over-the-counter birth control.

By the way, the GOP plan for easier access to birth control is not a move to uncharted territory.

Here’s a map from a pro-reform left wing group that shows that over-the-counter birth control pills are easily available to most of the world’s women.

Let’s close by sharing one final – and very persuasive – piece of information from the experts at Reason.

Women already have over-the-counter access to Plan B, which involves larger doses of the hormones that are present in birth control pills.

…the Food and Drug Administration (FDA) has been considering making oral contraceptives available over-the-counter (OTC) for more than twenty years. “Plan B,” an emergency contraceptive, became available OTC last year. That one-step pill is simply a more potent dose of the same hormones that make up regular birth control pills. There’s no good medical justification for the differentiation. Yet in America, regular birth control pills remain stubbornly behind the pharmacy counter and behind the times.

In other words, the usual pro-regulation argument is that prescriptions are necessary because consumers can’t be trusted to make their own decisions with strong doses of medicine.

But the government already has made Plan B available over the counter while blocking similar access to birth control pills. Go figure.

P.S. Planned Parenthood is not the only interest group that has behaved in a disreputable and dishonorable fashion.

P.P.S. If you want to know what happens to healthcare in the absence of pervasive third-party payer, check out this remarkable chart.

P.P.P.S. Since today’s topic was birth control, let’s use this opportunity to revisit our collection of Sandra Fluke humor. Just in case you don’t remember, she was the 30-year old college student who got her 15 minuted of fame by demanding that other people pay for her expenses. Anyhow, if you want to laugh, check out this great Reason video, this funny cartoon, and four more jokes here.

P.P.P.P.S. On a separate topic, I added my two cents late last year to a debate inside libertarian circles over whether America’s plethora of welfare programs should be replaced by a single “basic income” grant that would be given to all Americans. Sort of a guaranteed minimum income.

I acknowledged that the current system is a mess, but I suggested that decentralization was a better approach.

…it seems that nothing could be worse than the current system. …But what about the idea of trashing what we have today and instead offering everyone some sort of basic income? …I agree, but only sort of. I like the idea of radical reform, but I think there’s a better road to Rome. It’s called federalism.

But what if someone held a gun to my head and said federalism wasn’t an option and demanded that I choose between the “basic income” and the status quo?

There’s not an obvious right answer, but I suspect I would prefer the devil I know because of fears that we might get more redistribution and even bigger government.

And I’m not the only one to have that opinion. Here’s what a proponent of more redistribution wrote about the concept.

Basic Income, unlike the programs we have now, will be politically easy to raise once it’s in place. …if you have one big, high-profile redistribution program, you can get enough popular support to overcome the concentrated opposition of the rich people footing the bill. …by endorsing Basic Income, libertarians are walking right into a trap. Anti-redistributionists’ great fear has always been that the masses will use the power of majority rule to simply vote themselves more money. As things stand, the fragmentation of our redistribution programs makes it easier for the anti-redistributionists to punch holes in the safety net. If the fragmented system were replaced with one universal, high-profile program, the result would be a huge political gift to redistributionists.

But maybe I’m just a pessimist. Tyler Cowen has a different perspective.

…let’s say a historical accident swept Basic Income proponents into power for a term and they passed that legislation.  Over time those income transfers would prove larger, more visible, and they would at least appear superficially more anti-work than the public stomach for them.  I predict they would be restricted along a number of possible dimensions, starting with (partial) work requirements for the able-bodied. Under most plausible assumptions about the Basic Income level, most people would not be recipients, nor would they expect to be potential net gainers from the program. …So I think the “why send money to people who aren’t working?” intuition will crowd out the “I want to think of myself as someone who helps other people” feeling.

I guess it depends on how the “basic income” is designed. If the government sends checks to everybody (as some are proposing), then Tyler’s “plausible assumption” about recipients would be wrong.

Which reinforces in my mind that my original idea was right. Let’s go with federalism and get Washington out of the business of redistribution.

The decentralized approach has been very successful in Switzerland and its also the system that’s consistent with the Constitution.

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It’s time to add to our collection of horror stories from the U.K.’s government-run healthcare system (previous examples can be found here, herehereherehereherehereherehere, here, here, here, here, here, here, and here).

What makes today’s story different, though, is that the bureaucracy not only is denying care to a small child, but also seeking to prevent the family from seeking treatment elsewhere.

Check out these excerpts from a blood-chilling story in USA Today.

The parents of a child suffering from a severe brain tumor signaled Monday they would defy efforts to force them to return to Britain, days after their family fled.

So why did they feel the need to escape a presumably civilized nation?

It seems government-run healthcare isn’t exactly on the cutting edge when it comes to life-saving treatments.

The family had fled to Spain in hopes of selling a property to obtain enough cash for a new treatment in the Czech Republic or the United States they hope will help their child. Police pursued them and issued an arrest warrant on suspicion of neglect after Southampton General Hospital realized their patient — Ashya King, 5 — was gone, without their consent. British authorities have made no apology for the warrant.

I can’t resist interrupting the main focus of the story at this point because the story then includes this line.

The case has riveted Britain, which is proud of a health service that offers universal care.

Maybe Brits are proud of their NHS, which would be a poor reflection on the collective IQ of the nation, but it certainly doesn’t offer universal care.

Unless, of course, you include neglect and torture in your definition of care.

Now back to our main story.

…the saga has…raised volatile questions of how much power authorities should have in interfering in some of the most sensitive of questions — and whether it has the right to insist that treatment dictates be followed. …Television images have shown the Kings being loaded into a Spanish squad car in handcuffs. When asked by the BBC on their views, the couple told the reporter they are just trying to help their child. …The family has criticized Britain’s health care system, saying he has a serious tumor that needs an advanced treatment option called proton beam therapy and that it wasn’t being made available to him. …Unlike other types of cancer treatment, it doesn’t indiscriminately kill surrounding healthy tissue, so there could be fewer long term effects.

But fear not. If little Ashya can somehow hold on until 2018, maybe the bureaucrats will be able to help.

Britain’s health department announced in 2011 it will build two treatment centers to make proton beam therapy available in London and Manchester from 2018. Until those facilities open, Britain will pay for patients eligible for the therapy to go to the USA and Switzerland for treatment. It wasn’t immediately clear why health care officials didn’t make this option available to Aysha.

As a parent, I know I would break the law if faced with the same situation.

It’s outrageous and disgusting, though, that such laws even exist.

P.S. I don’t mean to pick on the United Kingdom. We also have horror stories about government-run healthcare in the United States.

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