Sorry, Sen. Akaka, “We’re helping people” isn’t Enough

Following the rules* has become a lost art among politicians, and that’s no more evident than in the health care debate.

A journalist asked Sen. Daniel Akaka (D-Hawaii) for the constitutional justification for requiring people to buy health insurance. His response was that Congress was going to “help citizens in our country to live a good life.”

Call it the “Good Intentions” clause of the Constitution, I guess.  “Good intentions” also legitimized forced sterilizations of the mentally ill and medical abuse of the Tuskegee Experiment. Some people even claimed to have good intentions in justifying the existence of slavery.

Members of the Senate ought to read any health care bill they vote on. But more importantly, they ought to read and think through the Constitution first.

* I wonder if the senator would be willing to discard Miranda rights or the exclusionary rule. After all, taking both steps would help most people through making it easier for criminals to be convicted.

Health Care in Hawaii: Can You Ride an Employer Mandate to Paradise?

The New York Times looks for lessons for health care reform from Hawaii. It focuses on the employer mandate, which requires that in most situations, employers offer health insurance to people who work more than 20 hours a week.

The Times may have found paradise in Hawaii, and I’m not talking about the weather: “If health care legislation passes in Congress, the rest of the country may barely catch up.”

It touts a number of favorable statistics about the 50th state: Medicare payments are among the lowest in the nation, as are insurance premiums.

But will mandatory insurance be the magic cure? Maybe not: “Why is Hawaiian care so efficient? No one really knows.”

They do somethings right. The BlueCross insurer, for example, pays for telephone consultations, so that “anyone for a nominal fee can talk by phone or e-mail, day or night, to doctors of their choosing.”

Still, tying insurance to employment so tightly not only puts a drag on job creation, it means that if you lose your job, you lose your insurance. Double whammy. Some employers, meanwhile, get around the mandate by — you guessed it — making sure their workers clock fewer than 20 hours per week. That’s effectively a 100% marginal income tax rate.

Meanwhile, research published in Health Affairs (cited here in a Powerpoint file) says that the employer mandate has reduced the number of uninsured by 8%–not bad, but not paradise.

The Grassroot Institute of Hawaii has more.

Hawaii Trims Coverage to Noncitizens

If you're living in Hawaii and you're not a citizen, you may still be getting state-funded health care. Coming that far, that benefit will become more restricted.

"About 7,500 people, mostly from Pacific island nations, will be transferred from comprehensive state-funded medical assistance to Basic Health Hawaii, a more limited benefit program, starting Sept. 1," according to the Department of Human Services.

The department chief said "What's so astonishing, is the state has been spending all state money to provide expansive Medicaid-like benefits for noncitizens in the Compacts of Free Association. We are still able to save by creating a new decent package of benefits with better pharmacy benefits than we are currently giving to U.S. citizens."

Even without the help of money from other states, Hawaii will extend 12 doctor visits a year, 10 hospital days a year, and other benefits to people who aren't citizens.

(What are the "Compacts of Free Association?" One official page says "The Compact of Free Association between the Federated States of Micronesia and the United States provide for U.S. economic assistance (including eligibility for certain U.S. federal programs), defense of the FSM, and other benefits in exchange for U.S. defense and certain other operating rights in the FSM, denial of access to FSM territory by other nations, and other agreements.)

U.S. Index of Health Ownership 2nd Edition Is Here

Pacific Research Institute has published the 2nd edition of the U.S. Index of Health Ownership, the only ranking of health care in the states that uses criteria of individual choice.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.

Hawaii’s Employer Mandate: An Evaluation

Hawaii has had a play or pay mandate for several years, requiring companies to provide insurance coverage to employees working 20 hours or more per week.

So how's that working out?

The Grassroot Institute of Hawaii recently published a report, called Hawaii’s Prepaid Health Care Act and Far-Reaching Costs.

One result of the law is that Hawaii leads the nation in part-time employment (surprise, surprise). In addition, the state's rate of uninsurance isn't much better than that of some states without an employer mandate.

The report is available in a PDF.

No Quarter

This 4/20 ought to have been a real heartbreaker for opponents of cannabis prohibition who’ve bought into the ocean of hype surrounding Obama’s assurances of change.

Or perhaps there was just a communication breakdown, because despite promising a whole lotta love for states’ rights regarding medical marijuana during the campaign, real reform is over the hills and far away.

Obama’s DOJ said over the weekend that after considering a California federal judge’s request for an explanation from the feds regarding their alleged new policy on the persecution of state-approved medical marijuana dispensaries and users, government attorneys have determined it’s basically not much different than the old policy. Furthermore, the Bush administration’s “investigation, prosecution, and conviction of (California medical marijuana distributer Charles Lynch) are entirely consistent with the policies of DOJ and with public statements made by the Attorney General with respect to marijuana prosecutions,” according to the DOJ brief (pdf).

But even if the government’s actions don’t appear now to be exactly jiving with the political smoke blown by Obama and his attorney general, said Justice Department attorneys, it hardly matters. You see, the “enforcement policies of the Department of Justice, including those expressed by the United States Attorney’s Office, or by Attorney General Holder on this topic, do not confer any rights or defenses on any person.”

In other words, the song remains the same: Going to California, or any other state that’s legalized medical marijuana, provides no legal protection whatsoever against an individual’s rights getting trampled under foot by the federal government so long as the criminally incompetent drug war rambles on and the dogs of doom are howling “More.”

Swallowing up the Middle Class into Government Programs

The recently enacted expansion of SCHIP lets Hawaii expand the reach of its government health care to families of four with an annual income of $76,104. (Median household income in 2007, by comparison, was $62,613).

By letting the state dip into federal funds, the SCHIP expansion also enables Hawaii to expand programs for non-citizens, which have to date been funded by Hawaii-only money.

According to one news account,

Federal funds also will be provided for public health insurance for children, youths and pregnant women with green cards who have lived legally in the United States less than five years, Luksch said.

In Hawaii they have been covered with state-only funds since July 2000 ….

In addition,

"We're hoping with the $2.7 million we're saving, it may free up state funds to use for Keiki Care (for low-income families who do not qualify for the free health insurance programs), as well as enroll more children in health insurance programs ….

Lessons from Hawaii

If you start a government program that attracts a lot of public involvement–say, people sign up and decide to send off a portion of their money each month to participate–would you then call it a success?

Perhaps. But you should first ask if most of the people who signed up ditched a private-sector alternative. That's because government can be useful, but it should be a last resort.

Carrie Lukas, of the Independent Women's Forum, writes about Hawaii's insure-all-children experiment, and notes that 85% of children in the program already had insurance.

In other words, government was undertaking an unnecessary task, at great cost to taxpayers, not to mention disrupting the proper relationship of the political society to the civil one.

Judge on Feds’ New State-Friendly Medi-Pot Policy: Can I Get That in Writing?

A California federal judge has requested that U.S. Attorney General Eric Holder’s justice department explain, on paper and in black and white, just precisely what in blazes the administration has in mind regarding its much buzzed-about shift in medical marijuana policies.

Pot law reform advocates have been flying high on rumors that Obama’s kinder, gentler Drug Enforcement Administration – in a 180-degree reversal of Bush- and Clinton-era policies – is set to turn over a new leaf and start respecting the democratic wishes of state voters regarding cannabis laws.

However, the sentencing judge in a high-profile California medical marijuana case seems a tad skeptical – or maybe just a little confused. U.S. District Judge George H. Wu wants to know if Obama’s federal law enforcement braintrust has actually devised a legitimate, coherent new states’ rights-respecting prosecutorial policy.

Wu on Monday postponed sentencing the owner of a Morro Bay medical marijuana dispensary convicted of five federal counts, including distributing drugs.

(Wu) said he will hold off sentencing Charles Lynch, 47, until prosecutors provide a written clarification from the Justice Department on the Obama administration’s newly revised position that federal agents target marijuana distributors only if they violate state and federal law.

Judge Wu may suspect the administration is just blowing some capricious smoke into the air, hoping it’ll narcotize the medical marijuana activist constituency, most of whom no doubt Voted for Change, without actually doing or indeed changing anything of substance (or in writing) at all.

But if indeed there’s been a true and documentable shift in federal medical marijuana policy, then there are likely a whole lot of federal prosecutors around the country who aren’t even close to being on the same page as the newly minted higher-ups on the issue. For example, Thom Mrozek, a spokesman for the U.S. attorney in Los Angeles, was quoted just Monday after Wu issued his request saying that the Lynch case “involves a violation of federal law, and that’s really all that matters.”

Lynch’s attorney, Reuven Cohen, reminded reporters on Monday that throughout his client’s trial, the federal government did all it could to keep any discussion whatsoever of medical marijuana’s legality under California law entirely out of jury earshot.

“At least the statements that we have from Attorney General Holder thus far indicate that somehow state law is now relevant to these prosecutions,” said Cohen. “Well, the government, as everyone here who covered the trial knows, argued for days to keep state law out of it. And the reason they did that is that Charlie was in complete compliance with state law.”

A Database in Hawaii

The Hawaii legislature is considering a bill to push the use of electronic medical records. Such records are fine in theory, but I fear that too heavy of an involvement by government will produce something equivalent to a state agency mightily to produce, a BetaMax standard for videotape while the world goes to VHS–and then DVD and now BluRay.

There's also the possibility that government action would further enshrine the disconnect between patients and their own health:

The task of putting the system together would be enormous and require years of collaborative effort. The idea of a comprehensive medical database has been discussed for more than a decade and issues over who owns patient records, the healthcare provider or the patient, remain murky.

And then if government snooping bothers you in the least, consider the possibilities of something accessible to state government.

Electronic records are fine, though they're not the silver bullet they are sometimes promised to be. Further, there are plenty of ways for them to be developed outside of political influence–except that politics now permeates the health care industry.