Nevada Governor: Health Care Bill Unconstitutional

I love the irony: “Nevada will sue if health care bill becomes law.”

That’s the Las Vegas Sun-Review, channeling Gov. Jim Gibbons. There’s partisan sniping, to be sure–Gibbons is a Republican, the Congress, controlled by Democrats, including Harry Reid, one of Nevada’s two U.S. senators.

But there’s also money at stake: “Nevada government administrators have estimated that the reform bill would cost the state $613 million over six years, after the federal government’s 100 percent subsidy for the first three years expires.”

Gibbons also makes constitutional claims, “‘[Reid's] health care bill is not only ill-conceived, but I believe it is illegal.” The United States Constitution makes numerous references to states having ‘equal standing’, also duties, imposts and excises are to be “uniform throughout the United States.’ ‘After Senator Reid reads his unhealthy healthcare reform bill, he should read the United States Constitution.’”

It’s not clear to me that the claims will amount to much, but it’s fascinating to see some constitutional arguments being brought forth.

Senator from Nevada Attacks Nevada Finances

The Nevada Policy Research Institute points out that Sen. Harry Reid, the Senate majority leader who hails from the state of Nevada, is pushing federal legislation that will inflict a great deal of damage on the Nevada state budget and the state’s taxpayers:

Says Geoffrey Lawrence, a policy analyst with the institute, “the state that would be most heavily penalized by Reid’s legislation is his home state of Nevada.” That’s because state obligations for Medicaid will, according to the Nevada Department of Health and Human Services, increase by 98%.

The governor, according to Lawrence, says “the bill would make “the Grand Canyon out of this recession”–and still leave 23 million people acrossthe country without insurance.

Nevada Medicaid Enrollment Could Double

On the heels of the last post about governors concerned about the cost of expanding Medicaid, here’s an article from Las Vegas, focusing on Nevada. The state’s Medicaid enrollment could nearly double under plans now being discussed in Congress.

It brings back David Strom’s comments about Nevada and the danger of letting six people determine the fate of the nation: “Harry Reid, the  Senate Majority Leader is in trouble in his home state and as details came out about the bill it became clear that a number of provisions weren’t favorable to his state. So what was Reid’s response? He wants the plan changed to be more favorable to Nevada. And why is this likely to happen? Because he is the Senate Majority Leader. Isn’t it comforting to know that health care policy for the entire country will be shaped to ensure that Nevada does better than most states? (No offense Nevada.)

The Moral imperative of Getting Health Reform Right

Where's a separation-of-church-and-state crowd Democrat when you need one?

Sen. Harry Reid (D-Nevada) recently appeared at an event designed to gin up support for congressional plans to further inject government into medicine. "Health care is a moral issue," he said.

Strictly speaking, health care is no more of a moral issue than cell-phone service, small appliance-repair, or the growing and distribution of food, all items that are part of modern life.

Now I would agree that our public policies can be evaluated, in part, through a set of moral questions: Do they promote individual dignity and choice? Are they financially sustainable?

I would argue that our current approach falls short. It ties people to specific jobs (job lock), encourages wasteful spending, and promotes political control over the lives of citizens.

So if Reid wants to argue that health care policies should in part be evaluated by their moral qualities, I'm in. But turning health care over to government (that is, what it doesn't already control), isn't exactly the morally admirable thing to do.

One wounded veteran who showed up outside the meeting to show his displeasure with Reid's recommendations did a decent job of expressing some concerns: "Government health care, as evidenced by the VA, Medicare and Medicaid, is a financial and health care disaster. It is rationed care. There is no other way you can handle infinite demand. When the cost is zero, demand will be limitless."

Is going down that path moral?

There are much better alternatives to the status quo than what's being talked about these days.

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.

The ‘Drive Doctors Out’ Bill Advances

The Nevada Assembly voted to remove a cap on "pain and suffering" damages in medical malpractice claims.

The Nevada Policy Research Institute calls it the "Drive Doctors Out of Nevada" bill.

Smoke and Drink for the Children?

The Nevada Policy Research Institute notices that politicians in the state with Sin City would like people to sin a bit more.

AB277 and AB255 would more than double the current excise tax rates on cigarettes and alcohol. The cigarette tax rate would rise from 80 cents per pack of 20 to $1.80 — an increase of 125 percent. The excise tax on liquor would rise by 115 percent, while the tax on other alcoholic products such as beer would riSse by 331 percent.

The increased revenues would go to (depending on who's talking) health care or education. So light up! It's bad for your health, but the future of the children is at stake.

Government gets into this situation when it takes over health care. Speaking of the Master Settlement Agreement with tobacco companies, Geoffrey Lawrence writes:

After socializing the cost of healthcare, the states were essentially complaining that the costs were socialized. Individuals who did not have to bear the financial costs of their actions directly, it was argued, became less averse to smoking than they otherwise would have been, driving up state-run healthcare costs.

Raid Numbers Don’t Lie; Does the President?

The Obama administration's declaration last week that it might someday start thinking about calling the federal drug-war dogs off state-approved medical marijuana dispensaries was certainly welcome news.

White House flack Nick Shapiro assured Americans the changer-in-chief "believes that federal resources should not be used to circumvent state laws, and as he continues to appoint senior leadership to fill out the ranks of the federal government, he expects them to review their policies with that in mind."

Again, good for him. Because as it stands now, just 23 days into the Obama years (I know, I know – it seems like so much longer), the Drug Enforcement Administration under the former Illinois Senator is on an early but unmistakable trajectory to surpass George W. Bush's two-term raid total, and do it in just two years.

DEA agents have committed at least five medical-marijuana facility burglaries since Inauguration Day. In the entirety of Bush's eight years in office (I know, I know – it seemed like so much longer), the DEA conducted 148 raids, said a spokesman from Americans for Safe Access.

By contrast, President Clinton's DEA looted voter-endorsed pot dispensaries on fewer than 20 occasions, according to the spokesman. (A bit misleading, that lower number by no means indicates some higher appreciation for individual rights or grassroots democracy on Clinton's part: States didn't even start legalizing medical marijuana until his second term. And, of course, it'd be difficult to conceive of a more fanatical living opponent of patient freedom and physician autonomy than Clinton's odious drug czar, Barry McCaffrey.)

Nevada Looking to Add Autism Mandate

Nevada is preparing to join the list of states considering mandating health insurance coverage of autism treatment. The appearance of these mandates in state legislatures is becoming so commonplace that it almost isn't noteworthy. What is noteworthy, however, is the quality of the news reporting about the Nevada law.

Unlike other reporters, J. Patrick Coolican of the Las Vegas Sun spends some time looking into the issue and provides a fairly even-handed story. He gets close to the heart of the story in this paragraph:

For their proponents, these laws offer a win-win: They gather support from an energized and well-organized constituency, and they force the insurance industry to pay for treatment that might otherwise fall to the state or school districts, and, in the case of the Silver State, Nevada Early Intervention Services.

To put it more bluntly, legislators who support these mandate laws get a lot of recognition from people who care passionately about the issue. They do so without having to spend money (or force local school districts to spend money) but instead "force the insurance industry to pay for treatment." In short, legislators get praise for doing something that causes them no pain. This is the first story I've read on the autism mandate that mentions this.

I also found this comment from a state legislator interesting:

Assemblyman James Ohrenschall, D-Las Vegas, said the insurance industry, which he called a “regulated monopoly,” is often guided by “perverse incentives” not to cover various conditions. He said it is time for government intervention.

If one looks at the health insurance industry, it's pretty clear that much of the blame for "perverse incentives" lay at the feet of government regulations. There is already too much government intervention in the health insurance market. It's unfortunate that legislators like Mr. Ohrenschall think the way to fix problems caused by government intervention is to have the government intervene even more.

Health Care is Not ‘Access to a Waiting List’

Here's another entry in the chapter that might be labeled "access to a waiting list is not health care." A man in Nevada has two minor children, both of whom need surgery. He's on Medicaid. So, isn't that great, he's "insured."

But what does that mean? Not much. The state has been trying to run Medicaid on the cheap (perhaps driven by the "get everyone insured" mantra, though I'm not familiar with the eligibility requirements of the program). The father can't find doctors willing to operate on his children, given the low rates of payment offered by the state.

Nevada officials are looking into the case, and are considering sending the girls to another state. Sounds a bit like Canadian-style "health care refugees," though if it works out, the family probably won't have to pay out-of-pocket for the care.

Still, the case is an illustration of the limits of "cover all kids" and other nostrums. Health care reform won't provide for human needs if it simply means expanding government programs.