What’s more, the proposals would make it more difficult to get some of the options that are available now — particularly the low-cost insurance plans that cover only catastrophic health events and have substantial cost-sharing features.  And, depending on which bill would eventually be enacted into law, Congress, state insurance commissioners, and/or a federal Health Choices Commissioner would get to dictate what benefits have to be covered in every policy, and would be empowered to determine whether any given plan even qualifies as health insurance.  The end result will be considerably higher costs for almost every person living in the country.

On the other side of the equation, the Democratic proposals would mandate that every insurance company has to issue a policy to anyone who wants to enroll, and would forbid premiums from being based on the enrollee’s health status.  The expectation is that healthy young people would subsidize the health care costs of those who are older or sicker.  But states that have enacted these guaranteed issue and community rating mandates see premiums rise and healthy individuals drop their coverage.  After all, if insurers must issue a policy to all comers, why not wait until after you get sick to sign up?

Early on in the health care debate, the insurance industry agreed to support guaranteed issue and community rating, but only if Democrats would implement the mandatory purchase requirement.  That made Democrats happy because the number of uninsured Americans would fall if being uninsured were made illegal.  (So much for “my body, my choice,” eh Nancy Pelosi?)  And the insurance industry was happy because more people would be forced to buy their products, hyper-inflated prices or not.

Trouble is, in all of this back-door finagling, someone forgot about ordinary Americans.  It turns out that most people don’t like the idea of being fined for choosing not to buy health insurance.  In turn, Democrats were forced to lower the penalty on people who choose to go without it.  And that means there will be fewer healthy people in the system to subsidize the rest.  All of which leaves the insurance industry holding the bag.

Janet Trautwein, CEO of the National Association of Health Underwriters, has an op-ed in today’s Wall Street Journal whining that a weak individual purchase mandate is bad for everyone, and insisting that Congress give people less choice, not more.  It’s unfortunate, to be sure, that hundreds of millions of Americans will face higher health insurance premiums generated by ill-considered legislation.  But, no one should feel bad for those in the health insurance industry who tried to cut this lousy deal.

Someone should tell Janet Trautwein that, if you lie down with dogs, you might get fleas.

That day, November 9, 1989, will be remembered forever as one of the greatest in the history of human liberty.  Throughout the East Bloc, communism would begin to fall.  Millions would begin to experience political and social freedom for the first time. Families, separated for nearly 30 years would be reunited. And, throughout Eastern Europe, the fall of the Berlin Wall would create an opportunity to expose communism’s violent and merciless legacy.

In the United States, though, the anniversary will pass with barely a mention.  With a few noteworthy exceptions (see here and here), the American media has treated the event as an opportunity to praise Mikhail Gorbachev, condemn the West, and lament the coming of crony capitalism in Russia.

Not wanting to let the opportunity pass, some of my colleagues at the Competitive Enterprise Institute have produced a short video commemorating the fall of the Berlin Wall .

The fight for freedom is not over, of course.  There remain in the world such tyrannies as China, North Korea, Cuba, Venezuela, and far too many others.  Let us not forget this singular event, nor forget that the price of liberty is eternal vigilance.

Now, Brand has written a new book, called Whole Earth Discipline: An Ecopragmatist Manifesto, in which he takes on these environmental shibboleths in a more concerted fashion.  On American Public Radio’s Marketplace program yesterday, host Kai Ryssdal discussed the new book with Brand.  Asked what prompted him to write the book, Brand said that,

“My fellow environmentalists have been wrong about a couple of issues and were getting in the way of important things we should be doing, both with biotechnology and with nuclear technology, and in terms of how we think about cities, and in terms of how I know we’re going to think about geoengineering–that is, direct intervention in the climate.”

 

Ryssdal contrasted Brand’s earlier support for the back to the land movement with his current belief that big cities are better for the environment.

“Not only big cities, but big slums … that’s how [poor people in the developing world] are getting out of poverty.  They’re emptying out a lot of the subsistence farms that have been tough on the landscape all over the world, moving into towns for opportunity, building jobs for each other.  They’re also moving up what’s called the energy ladder, toward more and better grid electricity.  By and large the cities are probably the greenest thing that humans do.”

On his support for biotech crops, Brand said,

“Already, the crops we have now, the herbicide-tolerant and the insect-resistant crops … [are] getting what amounts to higher yields. You can raise more food on less land, and all of that is good for ecology in general and the climate particularly.”

Challenged that critics call them Frankenfoods, Brand replied,

“The idea there was that Dr. Frankenstein was doing something against nature, and that somehow the genetically engineered food crops are against nature.  And as a biologist, I’m just baffled by that line of argument because agriculture has been in that sense against nature for 10,000 years. That we’re finally able to do more precise tuning of the crops is a huge gain, not a loss.”

As I explain in a new Competitive Enterprise Institute paper, “A Cure Worse than the Disease: Obama Care Won’t Cut Costs, But May Cut Quality,” most of the alleged cost-cutting measures in the Baucus bill merely shift costs from the federal government onto the states or private payers, without affecting long-term health care inflation.  The only measures that could reduce the annual rate of growth in health care costs would erect government barriers between patients and their doctors, while jeopardizing long-term medical innovation.

Skeptics have made hay arguing that the so-called Sustainable Growth Rate can’t be counted on to cut $245-billion in Medicare spending. But Senate Finance Committee negotiators have designed a Medicare Commission—what the White House previously called an Independent Medicare Advisory Commission—to make similar cuts in physician and hospital payment rates in a more opaque way.

In an April New York Times interview, President Obama suggested that such a group, working outside of “normal political channels,” should guide decisions regarding that “huge driver of cost…the chronically ill and those toward the end of their lives.”  That’s not exactly a death panel roving the country to pull the plug on innocent grandmas who’ve survived past their sell-by dates, but the effects could be equally pernicious.

What the Medicare Commission is likely to do is work with the Patient-Centered Outcomes Research Institute also established by the Baucus bill to incorporate comparative clinical effectiveness recommendations into Medicare and Medicaid payment policies.

In theory, there’s nothing wrong with comparative effectiveness research, or what used to be called evidence-based medicine.  Good research comparing the clinical effectiveness, risks, and benefits of two or more medical treatments can help doctors better understand the likely benefits of the treatments they prescribe and improve the quality of care they deliver.  But patients vary substantially in their individual physiology, their response rates to drugs and surgical procedures, and their willingness to tolerate side effects.  Doctors know this, and they realize that one size definitely does not fit all. That’s why, in practice, evidence-based medicine in the U.S. and abroad has produced incrementally useful information, but has failed to systematically change the practice of medicine.

Generally, we should encourage efforts to eliminate waste and reduce the use of ineffective treatments, especially when we’re talking about public programs and taxpayer money.  But the CBO estimates that voluntary adoption by physicians of comparative effectiveness recommendations would reduce federal spending by just 1/100th of 1 percent, and that the Medicare Commission’s payment policies would save $22 billion over the ten year budget window.  The only way these programs would result in significant savings–that is, “bend” the cost curve downward–is if legislation or subsequent implementation tries to force the square peg of comparative effectiveness research results into the round hole of clinical practice by requiring physicians to always pick the treatment deemed best for the average patient.

That’s not just bad for patients in the near term, it would also wreak havoc on long term medical innovation.  If every new medicine were required, immediately upon gaining regulatory approval, to be effective and cheap enough to get the support of bureaucratic bean counters, research on the next generation of treatments for cancer, heart disease, and countless other serious conditions would slow to a snail’s pace.

Get used to the innovative medical treatments that we already have today.  If these programs become part of our health care system, we’ll be seeing a lot fewer treatment innovations tomorrow.