Friday, August 17, 2007

A walk around the left side of the blogosphere

1. Michael J, Mathias is upset because WMC opposes a bill that would mandate coverage for autism, Asperger's Syndrome, and some similar disorders. His argument is, essentially, that these diseases are bad and treatment of them is good. Those who oppose ordering employers to cover it must be miserly and mean. Of course, WMC is not arguing that such coverage cannot be provided should employers and employees desire it, only that they shouldn't have that decision made for them by the government. For better or worse, insurance plans tend not to cover things that affect relatively few people and require extremely expensive treatment of uncertain effectiveness. (Exhibit A is drug and alcohol treatment although that seems to be more a function of the latter two factors and a judgment about the culpability of the patient.) Money is not in endless supply and decisions have to be made about what risks we are willing to pay to share. Employees don't demand coverage for these conditions and, therefore, are unlikely to get it.

Maybe they should. Maybe relatively rare tragedies like this are something we all should pay for. But the list of such is endless and it is unclear that government is in some uniquely good position to pick and choose among them, particularly when it does so by mandating that someone else pay the bill. That's cheap compassion.

2. Jay Bullock is disappointed that Republicans didn't show up at a Democrat hootenanny at Serb Hall. They all wanted to reason together. Really.

In response to Jay's question about the Assembly budget's impact on Milwaukee County, I am not prepared to defend everything in it, but two observations may help. The rest of the state does not exist to send money down south and Milwaukee County - and its wellbeing - is not solely, or even principally, defined by its need for government largesse.

3. Bill Christofferson thinks John McAdams forgot his evidence in his critique of the Governor's commission on racial disparities in the criminal justice system. John didn't have time to send Bill everything he was referring to because he is on vacation, although the stuff that he did send is fairly powerful support for his critique.

Bill does raise a worthy point in arguing that maybe John's evidence doesn't fully explain black-white incarceration differences because of the impact of more stringent enforcement of drug laws. There probably is more aggressive enforcement of drug laws in the black community but its not because, as Bill suggests, that there has been some decision to wage the drug war against African-Americans, Drugs tend to have a more debilitating impact in poor communities and drug offenders are less able to stitch together the treatment and social support network that would warrant more lenient treatment or, more significantly, keep them from the repeat offenses that will eventually get them locked up. While I am skeptical that the government knows how to - or even can - close that gap, it is not so much a matter of race as of economic and cultural(say social if you prefer)factors.

Paul Soglin promotes the left's "50 things you won't hear on talk radio" in response to Charlie Sykes' new book, 50 Rules Kids Won't Learn in School. Paul thinks Charlie's rules "will make you either groan or say “Duh!”

I have not yet read all of Charlie's rules (although I am apparently cited in support of Rule 21; I hope it's a good one) so I can't comment on whether the 50 rules will do either. I can say that the left list does both. I paticularily like the recital of the Beatitudes. But they forget the one that says "Blessed is he who takes from his neighbor to give to another and counts it as self righteousness."

That's not fair, you say. Precisely.

22 comments:

John McAdams said...

Actually, I do mention drug offenses in my article (which is forthcoming, but which I'm not supposed to release now).

I make points similar to yours. Pot smoking teenagers in the suburbs aren't the community threat that drug use in the inner city is.

It's also the case that the Congressional Black Caucus was keen, in the 1980s, to promote a tough line against crack cocaine. And public opinion polls show blacks as tough on drugs as whites.

Nick said...

"For better or worse, insurance plans tend not to cover things that affect relatively few people and require extremely expensive treatment of uncertain effectiveness."

I don't agree with government mandates on these things just to be clear. However, your thinking on insurance is clearly backwards.

The purpose of insurance is to cover things that are unforseen and expensive. However, the mantra of late has been that insurance balks at paying for that type of care, but has no problem paying for every little doctors office visit. It should be the opposite. Insurance shouldn't cover your annual doctors visits, shouldn't cover standard vaccines, etc.

jp said...

nick;

The purpose of insurance is to cover events (things) the purchaser deems desirable to insure.

Rick Esenberg said...

Nick

Your point on routine care is good but JP is right. There is a tendency not to include stuff that the average person does not believe he is at risk of. I might recognize the possibility,however small, that I may get cancer. I may not see becoming a heroin addict or schizophrenic as something that applies to me.

As for Professor McAdams' forthcoming piece in WI Interest, I look forward to it and commend the September issue to everyone. A guy named Esenberg has a piece in there as well.

Xoff said...

So it is perfectly appropriate that black adults are locked up at 10+ times the rate of whites, and that black juveniles are sent to adult correctional facilities at 19 times the rate of white juveniles in Wisconsin?

You don't see evidence, on its face, of any inequities?

Whether it is racism or some systemic problem, that kind of disparity is not acceptable.

Xoff said...

Are you under the illusion, Professor, that cocaine and crack cocaine are not found in the suburbs, but just a little harmless pot smoking?

What ivory tower do you live in?

Michael J. Mathias said...

Rick—Insurance coverage mandates have been a politically tenable method of providing care for people who need it in the absence of our country having no plan in particular to deal with the health needs of the citizenry. It’s weak beer (your line) to argume that it shouldn’t be up to other people to pay for someone else’s healthcare. We all pay for it through increased costs to public programs, the affects uncompensated care has on the system, and the elevated expense of providing treatments to individuals who avoided seeking help early on in their illness. (The sheer immorality of a system that bankrupts people for only being ill is another worthy debate.)

I would prefer that insurance companies go away and are replaced by some fashion of single-payer system, but given the urgent need to treat children with autism, mandates are all we got.

Dad29 said...

Of course, an HSA plan may well be used to cover Augism, Asperger's, etc.

It would be helpful if Doyle would allow Wisconsin to catch up with the REST of the country on HSA deductibility, of course.

Dad29 said...

So it is perfectly appropriate that black adults are locked up at 10+ times the rate of whites, and that black juveniles are sent to adult correctional facilities at 19 times the rate of white juveniles in Wisconsin?

Prima facie, it seems that 10X and 19X blacks v. whites are CONVICTED.

Usually, that's a pre-requisite for being in lockup.

John McAdams said...

Xoff:

Are you under the illusion, Professor, that cocaine and crack cocaine are not found in the suburbs, but just a little harmless pot smoking?

What ivory tower do you live in?


Are you under the illusion, Bill, that suburbs have a huge problem with druggies shooting each other, and killing innocent people who are caught in the crossfire?

It doesn't matter what the exact substance is. Drugs are much more of a community problem (and not merely a personal vice) in the inner city.

What liberal ivory tower do you live in?

John McAdams said...

From Xoff:

So it is perfectly appropriate that black adults are locked up at 10+ times the rate of whites, and that black juveniles are sent to adult correctional facilities at 19 times the rate of white juveniles in Wisconsin?

You don't see evidence, on its face, of any inequities?

Whether it is racism or some systemic problem, that kind of disparity is not acceptable.


It seems you have realized how tenuous the "racism" thing is, and have retreated to a "systemic problem."

Is the racial disproportion the result of (say) the lack of intact families, or the cultural attitudes common in the inner city?

Quite probably.

But until we solve these "systemic problems," let's lock up people who commit crimes.

Failing to lock up criminals merely makes all those "systemic problems" worse.

Michael J. Mathias said...

Dad29--How much is in your HSA? $100K? $200K? Those things are great for the unexpected root canal, but they can't possibly be useful for anything like the care children with autism need.

BlueBlogger said...

Rick-

Is it your argument, then, that autism shouldn't be covered because it's relatively rare and the treatment isn't proven effective? I ask because I'm curious as to what you consider "widespread." Autism currently affects 1 to 1.5 million Americans, and 1 in 150 births will be affected by autism and related spectrum disorders. Additionally, a study in Britain showed the cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention. When I hear the WMC's argument against covering autism, I can't help but wonder if they've ever heard the saying about an ounce of prevent.

Dad29 - I appreciate the fact that you're a supporter of HSA's, but unless you're independently wealthy - which unfortunately isn't the case for most parents with autistic children - HSA's simply won't cover the cost of the treatment.

Maybe when someone you know is affected by autism you'll develop a little more compassion and empathy for those affected by autism.

joe cisewski said...

Nick

You said: "The purpose of insurance is to cover things that are unforeseen and expensive...insurance balks at paying for that type of care, but has no problem paying for every little doctor’s office visit. It should be the opposite."

I think that this is a really important point. The routine coverage issues do much to interfere with the efficient allocation of health care services. In addition, routine coverage presents a moral hazard problem.

Counter Argument.

The "pure" insurance ideal was shared by the American health insurance carriers immediately after World War Two.

Why is it that those carriers yielded to the Health Maintenance Organization (HMO) movement? The motivating argument for the HMO shift emphasized prevention (through routine coverage), not treatment post facto.

I think the solution will have to be a hybrid of the pure insurance and HMO model, which necessitates difficult (and probably arbitrary) choices as to what is covered and what is not.

Dad29 said...

Joe C: The HMO movement was legislated by Ted Kennedy. Nobody got a 'choice' in the matter.

Mike: if early intervention is optimal for treatment of autism, it's ALSO likely the CHEAPEST route. I don't think HSAs are the end-all/be-all; but they are better than nada.

Blue: so happens I DO know a couple of families with autism situations. Sympathy is one thing; robbing Peter to pay Paul is another thing entirely.

So long as proponents of State-run systems (and by extension, state-mandated bennies) wish to eliminate ALL cares, woes, and hardships from life, they will remain Romantic idealists. They represent the (ideal) victory of emotion over reason--which cannot, in the long run, prevail.

By the way, bankruptcy happens to be the victory of reason over emotion. State bankruptcy is just the largest example thereof.

Anonymous said...

When is the "guy named Esenberg" going to talk about his involvement on behalf of Wisconsin Right to Lie in the awful case in La Crosse?

From the La Crosse Tribune:

"A 54-year-old La Crosse woman is being kept alive at Gundersen Lutheran Medical Center only by continuous sedation and a feeding tube.

"She has had seven strokes since 1995, the most recent of which on April 23 caused a violent dementia with severe agitation, fear, anguish and delirium. She also has diabetes, anemia, pneumonia, respiratory failure and other medical conditions.

"She refuses to eat or drink, and tore out feeding tubes in the past. The only way to keep feeding her, her doctors say, is to keep her sedated."

"Pro-Life Rick" has been retained by Wisconsin Right to Lie to intervene in this case. According to Wisconsin Right to Lie, this woman should be kept alive at all costs, even though she rips out her feeding tube and the only way to keep the tube in her is to knock her out and force-feed her.

From folks who brought you the federal intervention in the Terry Sciavo case, we now have this outrage, and our own Ricky Esenberg has chosen to be smack-dab in the middle of it.

That's a pretty slimy group of low-lifes you choose to hang with, Ricky.

And it's too bad the woman didn't have an HSA, according to DAd29.

joe cisewski said...

Dad29

I think you are referring to Kennedy's amendments to the Nixon initiative.

But, my question remains:

"Why is it that those carriers yielded to the Health Maintenance Organization (HMO) movement? The motivating argument for the HMO shift emphasized prevention (through routine coverage), not treatment post facto."

If on point, your argument suggests that the AMA and the insurance industry adopted a "can't beat 'em, join 'em" stance on the matter.

Surely, the insurance industry was not a pawn to BOTH political parties; that is, unless the "pure" market delivery of health care services was in such disrepair that even the industry knew it was futile to argue against the motivating arguments of the HMO bill.


Anonymous 10:38AM

I believe Rick addressed his role in that case in an earlier blog.

Dad29 said...

Nick's snapshot, "pure" insurance being for major work, while office visits were not covered, happens to be a good analogy for the HSA/High-Deductible model.

And I think it ought to work.

I can't address the motives of insurers following the introduction of HMO's, but my bet is that they intended to retain the market share, so adding HMO options was defense (or offense.)

Wiki (http://en.wikipedia.org/wiki/HMO#History) tells us that employers were REQUIRED to offer HMO coverage if they had more than 25 employees. That's the "Kennedy" part of the HMO story, I think.

But there's another reason that HMOs became popular:

"Under ERISA, an enrollee bringing an action against a health plan is limited to the actions and remedies enumerated in the law itself. Section 502(a) permits the participant to sue the plan fiduciary to recover the benefits that were denied or to enforce rights under the plan.3 However, it does not permit other types of compensation, such as lost wages, additional medical expenses to treat an injury, or punitive damages for pain and suffering. Such forms of compensation are provided for in medical malpractice law that resides under the jurisdiction of state tort law. If an ERISA plan makes an error and is sued under section 502(a) in federal court, it is potentially liable only for the amount of benefits that it should have provided in the first place.4 Ironically, instead of acting as a protector of employees, it has become a shield that protects plans and employers from accountability for their own wrongdoing.5 No other organizations are exempt from lawsuits for business decisions they make that result in harm to people." (http://216.109.125.130/search/cache?ei=UTF-8&p=ERISA+and+Health+Care&fr=b1ie7&u=hcs.harvard.edu/%7Eepihc/currentissue/fall2000/housman.html&w=erisa+health+care&d=I2F28uljO-C5&icp=1&.intl=us)

This is a "doh" decision.

BlueBlogger said...

dad29-

I'd like to take a moment to address your points.

if early intervention is optimal for treatment of autism, it's ALSO likely the CHEAPEST route. I don't think HSAs are the end-all/be-all; but they are better than nada.

Autism therapy - the kind that's typically done after an early intervention - may be more cost-effective than caring for an autistic persons who can't care for themselves later in life, but that's not to say the therapy is expensive. The most effective autism therapy currently runs in the thousands of dollars per year, and that puts it out of reach to most average families.

Blue: so happens I DO know a couple of families with autism situations. Sympathy is one thing; robbing Peter to pay Paul is another thing entirely.

I'm not asking anyone to rob Peter to pay Paul; I have health insurance, and I pay for that health insurance. I'm not looking for a handout from anyone; I'm just looking for my insurance company to have a little compassion. Refusing to cover autism therapy for children may save us all a few dollars now, but that kind of shortsightedness is only going to cost us more money down the road.

Joe Cisewski said...

Dad29

"I can't address the motives of insurers following the introduction of HMO's, but my bet is that they intended to retain the market share, so adding HMO options was defense (or offense.)"

You're probably right about this.

The ERISA comment is disturbing news to me. Essentially, the law encourages the denial of rightful claims by lowering the costs of wrongdoing.


Blueblogger

You said, "Refusing to cover autism therapy for children may save us all a few dollars now, but that kind of shortsightedness is only going to cost us more money down the road."

Every argument for the additional expenditure of money is premised on the fact that "down the road" even more money will be saved.

Where are these savings?

There may be additional costs "down the road" in Mequon, but that will probably result from the decision to spend, not the costs of the decision not to spend.

Joe Cisewski said...

I just want to note that it is possible to be penny wise and pound foolish.

In general, though, I think it better to defend spending on economic or moral grounds.

Lance Burri said...

Whatever Rule 21 is, I'm sure it's nowhere near as good as Rule 32.