Thursday, October 30, 2008

Stand up for your health: Vote "Yes" on Proposition 101

That I wholeheartedly support Proposition 101, the Freedom of Choice in Health Care Act, should come as no surprise. I was the first to post the text of the initiative on the Web, I wrote an early article endorsing the measure for Associated Content, I circulated petitions in support of this measure, and I recruited others to do the same. Proposition 101 is Arizona's and perhaps the entire Republic's most important ballot question in the 2008 election cycle.

We can all agree that the health care market in the USA needs serious reform. Economists studying the problem in earnest usually conclude that the root of our trouble is a tax code which ties, for most people, health care to employment, and encourages the purchase of "insurance" plans which aren't insurance at all but instead provide "comprehensive" coverage. As a result, we don't shop for either health care or health insurance the way we shop for housing, automobiles, food, eyeglasses, or dental care (I could go on, but I think you get the picture.) When B tells A what A needs and C pays B for it, B is totally insulated from competative forces and A is insulated from costs. Moreover, insurance companies which appeal to employers don't always provide good service to insurance consumers; who would purchase insurance on his own from a company known for denying to pay for treatment or dropping coverage?

There are other problems, too. In many states, mandates drive up the cost of both insurance and care. Think of a coverage mandate as equivalent to a law saying that if one purchases an automobile, one must purchase a Lexus or better. The Ford Focus is cheaper, even gets better mileage, but the state says you must have heated leather seats. These mandates also make it nearly impossible for those with pre-existing conditions to get policies with "riders".

Many of our best minds are at work on the problem, proposing ways to decouple insurance and employment and wean ourselves off of comprehensive care. (For those interested in the topic, Arnold Kling's Crisis of Abundance is as good a place to start as any.) The experiments we have seen with health savings accounts and other forms of consumer-driven healthcare are the beginnings of the effort to work out partial solutions independent of legislative reform, but it will ultimately take a few acts of Congress and state legislatures to straighten out the mess.

Getting those legislatures to straighten out the mess is more difficult than it needs to be, due to the presence of a strong contingent who'd rather smooth over the problem than fix its root causes. Some are driven by a radical ideology, a belief that all should be equal. Others simply want to do something good for the unwillingly uninsured in the short-term and don't have an eye to long-term fixes. Still others obsess too much over how much "we" spend on health care and health insurance--as though it matters--and seek to rein it in. All are violating what should be a ground-rule for the discussion, an Hippocratic Oath for legislatures: don't make those who are already well-served worse off. All support a form of rationing-by-queueing euphemistically called "Single Payer Health Care."

In Arizona, Phil Lopes is the main "Single Payer" culprit, introducing bills to establish such a program session after session. Most recently he was joined by some of the legislature's other ideologues, including, predictably, Steve Farley and Kyrsten Sinema, in proposing such a scheme that would outlaw the private purchase of health insurance (see section 36-3132) and let the State make health care decisions for patients to control its costs. The bills have, so far, gained little traction in our Republican-dominated legislature, but they may do so in the future, as public frustration with Congressional inaction begins to outweigh reports of waiting lists and denial of treatment from Canada and cost overruns from Massachusetts.

Proposition 101 does not fix health care in the State of Arizona; it would take an act of Congress to truly straighten things out. It does not inhibit Congress or the State Legislature's ability to enact health care reform. Instead, by guaranteeing that consumers can always pay directly for medical services or purchase private health insurance, it takes the most harmful "solution"--rationing--and the second-most harmful solution--"play or pay", a system of compulsory insurance purchase and fines designed to crowd out market mechanisms--off the table. It protects one of our most basic rights and sets the terms of the debate in a way that will make us all better off. AZ Republic columnist Robert Robb suggests that it may also do away with those pesky mandates that make insurance prohibitively expensive or even inaccessible to some. I can't speak to that, but if a court were to rule that that is so, I'd welcome the decision.

You can often tell a great initiative by the opponents' tactics; when they must simply tell fairy tales, the initiative's backers are on the high ground. It happened in 2006, when opponents of Prop. 207 claimed that counties and municipalities would have to bribe property owners to comply with existing regulations, and it's now happening with Prop. 101. The principal opponents claim that unnamed "experts" predict that passage of Prop 101 will cost $2 billion, a number they don't explain and seemingly made up out of thin air. They deliberately omit the text of the measure from a webpage and then claim that because the "descriptive title" lacks detail the measure itself is vague and that its meaning will be wholly made up by judges. Anthony Rodgers, director of AHCCCS, sent around memos making the bizarre claim that passage Prop 101 would require the state's subsidized indigent-care program to pay for any treatment enrollees desire. (The claim is bizarre because enrollment in AHCCCS is voluntary, not compulsory, and thus rather obviously not covered by the measure.) He possibly violated state electioneering law in the process, and Medical Choice AZ had to sue to stop him.

Eyes are on Arizona. George Will has remarked that passage of Proposition 101 may also impede federal Single Payer or Play-or-Pay.

This is the most important ballot question of the election cycle, and perhaps of our generation. Vote for Proposition 101. Vote to protect your own and your family's health care from those who would make it worse in the name of equality. Vote to take Phil Lopes's rationing scheme off the table permanently. Vote to establish Arizona as a bulwark against bad ideas at the Federal level. Vote to force the legislature and Congress to consider real reforms, not fumbling quick fixes. Vote to inspire other states to pass similar measures in 2010.

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