Negative rights vs. Positive rights

E. Thomas McClanahan explains an important distinction in the context of the health care reform law and the economic turmoil in Europe:

During the health care debate, it was common to hear people piously assert that health care should be a right, perhaps unaware of the full implications. The ongoing strikes and riots in Europe, however, represent the long-term risks of the progressive vision, in which government-delivered social benefits are portrayed as personal rights.

No wonder they’re rioting in Europe. They believe their personal rights are being violated by budget cuts brought on by the sovereign debt crisis.

Government benefits expressed in this way are known to political scientists as positive rights, which differ from the negative rights with which we’re more familiar. Negative rights generally describe things the government cannot do — take your stuff without due process, stifle your right to express your point of view, lock you up without cause, etc.

Positive rights describe things the government says it will do for you. A good example was the Second Bill of Rights pushed by President Roosevelt. Everyone, he said, should have the right “to a useful and remunerative job … to earn enough to provide adequate food and clothing … to adequate medical care … to a good education” and more. . . .

The problem is that elevating benefits to the level of rights confers an unlimited grant of power to the government. In the legislative process, laudable sentiments too often emerge as programs with unconstrained costs — or, in the case of the personal mandate in Obamacare, policies that rely on coercion. . . .
From government’s point of view, positive rights are marching orders. Heaven and earth must be moved to deliver the promises. The state grows rapidly and ultimately it outruns the capacity of the tax base to pay for it all, endangering the financial security of everyone.

Thirty years ago, Portugal’s government cost its taxpayers about 20 percent of GDP. Then a new constitution was written, chock full of positive rights — the right to housing, education, health, social security. The size of government doubled. Portugal’s borrowing costs, like that of Greece and Ireland, have ballooned.

It’s no coincidence that those who believe health care is a “right” were, like Pelosi, initially flummoxed by the notion that a serious constitutional challenge was even possible. Who could worry about legal niceties when the noble goal of universal health care is within reach?

Once upon a time, Barack Obama seemed to understand the kind of opposition a personal mandate would generate. That’s why when he ran for president, he was against it — and criticized Hillary Clinton for proposing such a thing.

via Obamacare and the risk of ‘positive rights’ – KansasCity.com.

Medicare crisis

Part of the new federal  health care plan will be funded by cuts to Medicare, the existing government program that pays for health care for the elderly.  Already, though, an increasing number of doctors are  refusing to take on Medicare patients because the payments are too low.  And starting on January 1 those payments are scheduled to be cut  a whopping 25%.   From The Washington Post:

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you’re a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he’ll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District’s Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

“It’s not easy. But you realize you either do this or you don’t stay in business,” she said.

Doctors across the country describe similar decisions, complaining that they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress.

And that’s not even taking into account a long-postponed rate-setting method that is on track to slash Medicare’s payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate (SGR) and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy’s overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors’ pay rates in 2002, Congress has chosen to put off the increasingly steep cuts called for by the formula ever since.

This month, the Senate passed its fourth stopgap fix this year – a one-month postponement that expires Jan. 1. The House is likely to follow suit when it reconvenes next week, and physicians have been running print ads, passing out fliers to patients and flooding Capitol Hill with phone calls to persuade Congress to suspend the 25 percent rate cut that the SGR method will require next year.

via Doctors say Medicare cuts forcing them to shift away from elderly.

Does anyone have a solution for this?

Why such a visceral reaction to the health care law?

Why do so many Americans have such a visceral reaction against the new health care law?   It seems to me like a bad law, poorly thought through and terrifyingly expensive, especially given our present deficits.  But I’m thinking that even if it were not so expensive and were not such a Rube Goldberg chain of complexities, that many of us would still be angry about the thing.

Is it that a  government-designed health care system makes us feel like wards of the state, dependent on the government for our health and thus our very lives?  Many of us don’t begrudge welfare to the truly needy, but recoil at the thought of being on welfare ourselves.  Does this new system put us, on some level, all on welfare?

Or is it that we don’t trust the government’s ability to run things effectively, and so are panicked at the thought that the government is now going to be in charge of our health?

Or is it that the health care law, perhaps coupled with the financial bailouts,  represents a repudiation of all that free market, new morning in America policy associated with the Reagan Revolution?  Are we perceiving this as a counter-revolution back to the welfare state ideology of LBJ and other Democratic social engineers?

Or what?  I know you can say something like “all of the above,” but I would find it helpful to know not just what you are thinking but what you are feeling, down in your gut.  I’m not looking for policy analysis but psychoanalysis.  (Not that you are psychos. . . You know what I mean!)  I would welcome hearing from tea partiers and also those of you who are all for the bill, whether this makes you feel better about America, or better about reversing the culture of conservatism that has reigned since Reagan, or whatever.

Obamacare is the law of the land

The President has signed the healthcare reform bill.  It is now the law.

How do you think this will shake out? Some conservatives feel glee, thinking they will now trounce the Democrats for pushing through this unpopular proposal. Democrats, though, are going on the offensive, launching a big PR campaign to win over the public.

Another view I’ve heard is that the public will actually like the provisions that go into effect early (see below). The big taxes and expense, the surge in insurance premiums, and the possible disruptions in health care won’t kick in until 2014 and so won’t trouble the current administration all that much. And once the system gets going, so the theory goes, Americans will become as dependent on it as they are Social Security and no one will dare tamper with it.

What do you think will happen?

What goes into effect now

The major parts of the new health care reform law won’t go into effect until 2014 or later, with some kicking in during 2012.  But some measures go into effect either now or in a few months:

Indoor tanning salons will charge customers a 10 percent tax beginning today in just one of the changes Americans will see as a result of the U.S. health-care overhaul signed into law by President Barack Obama.

Insurers will be required by September to begin providing health coverage to kids with pre-existing illnesses and allow parents to keep children younger than 26 on their plans as the clock has begun ticking on many of the law’s provisions. Medicare recipients will receive a $250 rebate for prescription drugs when they reach a coverage gap called the donut hole if the Senate passes and the president signs companion legislation approved March 21 by the U.S. House.

Within 90 days, the law will provide immediate access to high-risk insurance plans for people who can’t get insurance because of a pre-existing medical problem, Harris said. These high-risk pools will be funded by $5 billion in federal grants.

Companies led by Minnetonka, Minnesota-based UnitedHealth Group Inc., the largest health insurer, will be banned within six months from dropping a person’s coverage because of severe illness and from limiting lifetime or annual benefits.

Participants in Medicare, the U.S. government’s health coverage for those 65 and older, are expected get a $250 rebate toward prescription drugs once their benefits run out — a coverage gap know as the “doughnut hole.” The benefit is part of the package of amendments to the legislation now pending in the Senate. Drugmakers led by New York-based Pfizer Inc. will have to offer discounted drugs to Medicare recipients next year, according to an analysis of the legislation by the Kaiser Family Foundation, a nonprofit group based in Menlo Park, California. . . .

Insurers also will have to reveal how much of members’ premiums they spend on medical care, as opposed to executive salaries or other administrative costs. Next year, they’ll owe a rebate to customers if the insurers spend less than 80 percent on benefits for people in individual or small-group plans. . . .

The legislation also creates an Independent Payment Advisory Board to suggest cuts in spending by Medicare, the government health program for the elderly and disabled, that could threaten payments for drug and device-makers.

via Health-Care Overhaul Changes to Start Taking Effect This Year – Bloomberg.com.

From insurance companies to utilities

If an insurance company is not allowed to factor in risk but instead is forced to cover everyone, regardless of physical condition, and charge them all the same rates, it ceases to function as an insurance company. Instead, it becomes a government-directed utility that just pays people’s medical bills. This is not really any different from government-run health care; it just uses private companies to administer the benefits. This is the point made by Charles Krauthammer:

By essentially abolishing medical underwriting (actuarially based risk assessment) and replacing it with government fiat, Obamacare turns the health insurance companies into utilities, their every significant move dictated by government regulators. The public option was a sideshow. As many on the right have long been arguing, and as the more astute on the left (such as The New Yorker's James Surowiecki) understand, Obamacare is government health care by proxy, single-payer through a facade of nominally “private” insurers.

Perhaps that’s what we want. If so, we might as well just adopt a nationalized one-payer system and cut out the middle-man.

via Charles Krauthammer – One year out: President Obama’s fall – washingtonpost.com.


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