The Case Against Public Health Insurance, in Five Minutes or Your Money Back

Of the many problems of living within sight of the U.S. Capitol and the seat of federal power, perhaps the worst is the tendency for serious, philosophical public policy debates to turn into wonkish statistics battles and scare-mongering. And nowhere in this town of wonks, wags and pols is this phenomenon more egregious than the fight over health care reform, and whether to create a "public option" to reduce the ranks of the uninsured. Given that this argument concerns a fairly momentous crossroads for our country, it would be nice to hear the opposing sides make their cases in clear-cut, conceptual terms that everyone can understand and evaluate. Right?

But alas. Where we need simple, objective facts, we get bewildering, and often contradictory, statistics, which can be distorted in any number of ways. Where we need broad, guiding principles, we get anecdotal horror stories intended to curtail debate.

Liberal proponents trot out a sob story about some poor single mom in Iowa bankrupted by 80 jillion dollars in hospital bills because she didn't have insurance when a piano fell on her. Conservatives counter with the story of some poor old man in Canada who had to wait a decade for a routine hip replacement because his country's public health bureaucracy wouldn't approve the procedure. Then some pointy-headed accountants from the Congressional Budget Office butt in with their estimates of what government health care will cost if hospitals are reimbursed at the current Medicaid rates, or at Medicaid rates plus 8.95 percent, or...

And the problem is, none of these anecdotes are false. None of the statistics are bogus. But they exist as individual trees in a vast forest, forever obscuring our view of What Really Matters. We could use a Health Insurance 101 curriculum, to serve as a starting point and a reality check for the politicians in Congress who, even as you read this, are busy debating how much control the government should exert over your physical well-being. Since no such remedial class seems to exist, I humbly offer the following as food for thought.

What the hell is insurance, exactly? Anybody with an age in two digits and an IQ in three digits will haughtily tell you they know all about something so part and parcel of boring adulthood, but judging by the tenor of today's health insurance debate, I'm inclined to think many could use a refresher.

In plain economic terms, "insurance" is a means of lowering risk. You insure yourself against things you hope won't happen, such as car crashes, house fires and sudden death. Insurance allows people to protect themselves from unlikely, but unpredictable, events that could very well ruin them financially. And insurers provide this protection when they judge that the premiums their customers pay will outweigh the costs of cleaning up after the rare but disastrous events they promise to insure against.

This is why drivers pay hundreds of dollars per month for car insurance, and why people with beach-front property pay thousands of dollars per year for hurricane insurance: They know a crash or a storm is unlikely, but they acknowledge that such things do happen. Insurers apply the exact same analysis: They'd rather not have to pay a claim, but they know they will have to sometimes. When the crash or the storm doesn't happen, everyone's happy.

The key here is that insurance is something that both you and your insurer hope you'll never need. Drivers with car insurance don't run red lights at 120 miles per hour, because they know insurance won't do them much good if they're dead. Thus arises another important feature of insurance: It should encourage people to avoid doing stupid things. This is the reason good drivers pay less for car insurance, and why nonsmokers pay less for life insurance. Insurers reward their customers in return for acting responsibly and lowering the risk of events the insurer doesn't want to pay for.

Then there's health insurance, which throws these basic principles out the window. In most employer-sponsored plans, each participant pays the same monthly premium, regardless of their likely health care costs. And in the current government-run health insurance programs (i.e., Medicare, Medicaid, SCHIP), beneficiaries receive coverage soley based on their age or economic status. In both cases, the insurer gives the insured no financial incentive to do the unpleasant things that minimize health costs, such as exercising, eating well or avoiding smoking. It should not be surprising that people respond by not doing these things. Meanwhile, health care costs explode.

So we have a health care system in which people ruin their health, because they have been given a blank check to do so. The negative effects of Marlboroughs, Big Macs and La-Z-Boy recliners are small, incremental, and difficult to see, so many Americans indulge in one or more of them with reckless abandon. When they need to see a doctor because of a lifestyle-related condition (think lung cancer, heart disease, Type II diabetes), they incur only a fraction of the cost, if they have insurance (with the notable exception of bogus policies that don't cover what they're supposed to cover).

Economically, this makes no sense. Consumers don't see the true costs of their purchases, because doctors, hospitals and pharmacies send the bills to a third party, the insurance company (or the government). Of course, many Americans understand the effects of smoking, junk food and sloth; they avoid these things, and thereby support their less-conscientious co-workers and neighbors. Insurance companies actually compete for healthy customers, because they offset the unhealthy customers, who pay the same rates but need lots of costly care.

Unfortunately, the healthy still need insurance, to do what insurance is supposed to do: avoid the costs of unpredictable disasters, such as getting run over by a bus and needing expensive surgery. In the process, they pick up the tab for the avoidable expenses regularly incurred by the people who eat too much, drink too much and smoke too much. This is nothing more than a legalized protection racket that preys on anyone who pays more in premiums than they receive in needed health care.

Somehow, health insurance has morphed from "protection against things I try to avoid anyway" to "the way I get someone else to pay for the consequences of my bad decisions." Remember this as liberals in Congress, along with our president, lobby to expand this perverse system further and put government more fully in charge of it.

Dude, Where's My Objectivity?

Last week, an 88-year-old anti-semite made headlines by walking into the U.S. Holocaust Memorial Museum with a rifle, apparently intent on violently protesting a museum dedicated to an event he maintains didn't happen, and ended up gunning down a black museum guard who challenged him at the door. Given the short-term memory of the media, I imagine the news cycle will linger on this ugly story for another day or two, and then move on to the next episode of public bloodshed, be it airline crash, school shooting or another such tragedy.

For me, the impact of the shooting will linger a bit longer, if for no other reason than its proximity to my office building in Washington. I pass the Holocaust Museum every morning and evening; the day after the attack, I saw the FBI trucks and agents fanned out around the taped-off building, presumably performing post-shooting ballistics analysis, to figure out exactly where each shot was fired, and more chillingly, perhaps checking for bombs (the shooter, James von Brunn, apparently had drawn up a list of other "targets" in the DC area shortly before his attack).

The natural reaction to this fizzled attempt at mass murder, the one I've heard most people express, is simple disgust: disgust at an angry, demented old man brimming with racial hatred taking the life of a young security guard with a wife and son, whom acquaintances roundly described as a class-act, and doing so in a place created to preserve the memory of millions of other victims of that same hatred.

But for a certain, enlightened, moralizing faction of the left-wing punditry, this isn't enough. Von Brunn's lunacy can't be abominated in isolation; rather, it must be seen in a larger context. For you see, this ugly episode is the product of the "hate" spewed by right-wing ideologues in the media. Sound like cheap political opportunism? Judge for yourself.

Intones the Washington Post's Eugene Robinson:

"What we don't know is whether all the blast-furnace rhetoric coming from the right is giving validation and encouragement to some confused, angry man or woman with a rifle or a truck full of fertilizer -- the next 'lone wolf,' preparing to howl."

Quoth The New York Times' Paul Krugman, who deviated from his usual columns extolling the virtues of Keynesian economics and massive government deficits with this sermon on political ethics:

"Today, as in the early years of the Clinton administration but to an even greater extent, right-wing extremism is being systematically fed by the conservative media and political establishment."

Both these and other liberal pontificators have seized on a recent report from the Department of Homeland Security, warning that domestic terrorist groups motivated by neo-Nazism and other charming fringe dogmas pose a real threat. Further, DHS noted that the election of an African-American president is sure to rile this motley claque, potentially leading to more violence.

So along comes octogenarian loon von Brunn, hot on the heels of the murder of noted Kansas abortionist George Tiller only a few weeks ago, and now the Paul Krugmans of the world are connecting the dots and tracing them back to Fox News, Rush Limbaugh, and other perfidious sources of murder-inducing rhetoric. Writing in this week's Wall Street Journal, Thomas Frank (who failed to return my e-mail to him on an unrelated column) even goes so far as to suggest that "maybe [certain pro-lifers] deserved some of the blame for [Tiller's] murder," because they had the audacity to protest and condemn his practice of performing late-term abortions that almost no other doctor in the country will touch, thereby inciting a crazed gunman to take him out.

That such arguments imply a bizarre transfer of responsibility for acts of violence from the people who actually commit them to the politically influential right-wing media outlets that Krugman, et al, detest is bad enough. But there is a larger issue at play here: namely, the left's utter myopia regarding extremist, irrational language creeping into political discourse. And as if he knew all about my humble little blog and wanted to give me a helping hand, Times columnist Frank Rich kindly bloviated on this very issue last Sunday, perfectly demonstrating the one-way street that he and his ilk apparently live on. In regard to an obscure Michigan Republican party figure who has criticized Obama as a fascist, Rich huffily announced:

"He didn’t seem to grasp that 'fascism' is nonsensical as a description of the Obama administration or that there might be a risk in slurring a president with a word that most find 'bad' because it evokes a mass-murderer like Hitler."

Really, Frank? We shouldn't "slur" a sitting president by likening him to Hitler? Then where exactly were you when liberal protesters routinely toted "Bush = Hitler" placards at anti-war rallies? For that matter, where were any of these champions of fair-minded, dispassionate political discourse for the last eight years, when Bush was accused of letting 9/11 happen to serve as a pretext for war in the Middle East, or when Bush was accused of botching the post-Katrina rescue operations in New Orleans because he "doesn't like black people"? Or how about the 10 billion other mindless rants spewed by the left blaming Bush for anything that happened to make them unhappy?

I didn't vote for George Bush. Nor do I listen to a minute of Rush Limbaugh, or watch a minute of Fox News, largely because I don't care for sensationalized news; but last I checked, none of these blowhards has harmed anybody, or called for the harming of anyone. Meanwhile, liberal audiences guffaw at Wanda Sykes' cheerful hope for Rush's kidneys to fail, rap artists glorify urban gang violence, and liberals in Congress drag bankers into show-trials and browbeat them on national television for supposedly wrecking the economy to arouse populist anger. The Times doesn't bat an eye. Apparently all speech is free, but only right-wing speech can be condemned as hateful or inflammatory.

The left's sudden rediscovery that nasty political rhetoric is, well, nasty, reminds me distinctly of the last time we had a Democrat in the White House whom Republicans dared to attack. I will never forget watching a clip of Alec Baldwin on the Conan O'Brien show in 1998, at the height of the impeachment frenzy resulting from Bill Clinton's dalliance with a White House intern. Working himself into a genuine lather, warm, fuzzy liberal Baldwin ranted in regard to Republican Henry Hyde, the Representative who led the impeachment hearings in the House:

"If we were living in another country, what we, all of us together, would go down to Washington and stone Henry Hyde to death, stone him to death, stone him to death! Then we would go to their house and we'd kill the family, kill the children."

Not to be outdone, alleged comedian Chris Rock announced, in 1999, "If Clinton would pardon me, I would whip [Independent Counsel Ken] Starr's ass right now. I will get a crew from Brooklyn and we will stomp him."

Apparently, liberals are authorized to call for acts of violence against specific politicians; they are permitted to traffic in nonsensical conspiracy theories and histrionic accusations of sitting presidents; and when their party wins an election, they acquire the moral authority to abjure these self-same antics as "hateful." Thus can an unhinged old man's act of violence be hung around the neck of anyone who dares to oppose the new administration's agenda. A new syllogism is emerging: "If you're not part of the Obama solution, you're part of the problem."

iPod, Real Headphones Obviate Need for Bus Suicide

When it comes to technological gizmos, I'm not much of an enthusiast. I have a computer with Internet because modern life is too inconvenient to navigate without one; I have a cellphone, grudgingly, because it's the cheapest way I can make and get the calls I need; and I will sooner take up scrimshaw than shackle myself with a goddamned Blackberry or iPhone like every other DC office chattel who cherishes these electronic yokes.

But when Apple came out with its teeny, tiny iPod shuffle a couple years ago, I caved. Something the size of a matchbook that can hold a dozen albums worth of music? For $79? Where do I sign up?

So I put in my order before the new shuffle even came out. And for a while, I loved the novelty of so much music in such a handy little device. But then physical reality reasserted itself.

Because the ear pieces that come standard with an iPod almost negate the very concept of music as a pleasurable experience. They emit a tinny, buzzy tone, with no bass, and not very much treble either. Apparently Apple developed them to produce frequencies that only dogs can hear, except when you turn the volume up all the way, when they become all too audible to human ears. I heard that when water-boarding was outlawed at Guantanamo, the CIA switched over to interrogating terrorists by forcing them to listen to Kelly Clarkson on a maxed out iPod Touch with standard Apple ear buds.

And -- here the fault is mine -- I have never owned a decent pair of real headphones to pair with something like my oh-so-carryable iPod. This was a glaring oversight on my part, which I only very recently rectified with a pair of low-end Sony studio-quality phones, for the princely sum of $25. And suddenly, my iPod is worth owning. Not a moment too soon, either; if I hadn't dropped that $25 at Best Buy and dug my iPod out of storage this morning, I would not be here right now now to tell you about it. I would have killed myself while waiting for the 8:14 express bus to work this morning.

I ride the same bus to and from work every day, especially now that I've moved to an apartment located conveniently across the street from the bus stop. Because this is an express line with only a handful of buses during morning and evening rush hour, you tend to see the same faces every day. And mostly these faces belong to placid, mild-mannered commuters such as myself, who really like the fact that the bus requires half the time that the Metro ride would take, for about ten cents extra. We are mostly a quiet, unobtrusive lot. We smile and nod to one another; the more gregarious even carry on quiet conversations. In short, a bunch of decent office-bound creatures trying to get to and from our boring jobs as humanely as possible.

All of us, except one strident, shrill, oblivious wretch of a middle-aged woman who sometimes rides my bus. Without putting too fine a point on it, I hate this woman with unabashed passion. She is, without question, the most horrid human being I encounter in my day-to-day life, bar none.

She is the sort of person who must complain, loudly, about EVERYTHING, to ANYBODY who happens to be within earshot, myself included. If I encounter her at the bus stop in the summer, she tries to bitch to me about how hot it is; in the winter, how cold it is. She has demanded of me no fewer than 11 million times, in her harsh, nasal voice, "Are you waiting for the 11Y!?" You would think, after seeing me get on the 11Y bus 11 million times after seeing me waiting at a bus stop that says "11Y" she might put two and two together, but apparently she is too oblivious and self-centered to remember another human being for more than three consecutive seconds. On one of these occasions, after I affirmed that, Yes, just like every other 10,999,999 times you've asked me this, I am in fact waiting for the 11Y, she had the temerity to intone, in her sniveling, needy way, "It should come soon, right?" To which I calmly responded, "I'm sorry, but how in the name of Zeus' butthole do I know where, in this city of 45,000 motor vehicles, when accidents and presidential motorcades routinely stop traffic, the bus is?"

Last Friday after work, this woman, whom for convenience' sale I'll call Satan, clambered on to my bus just as I was thinking "Yes, Satan must have gotten the 5:05 today!" And for five solid minutes, she proceeded to badger the driver, and every single passenger, as to "Which bus this is." As in, "Is this the 5:05, or the 5:25, or the 5:40?" Never mind that this was the 5:25, right on time. Never mind that this woman rides these buses every day of her hideous life and should know the schedule. Never mind that the schedule is conveniently posted online. Never mind that SHE'S ALREADY ON THE BUS, WHICH IS ALL THAT MATTERS! For reasons of her own obsessive edification, Satan must know, NOW, which particular bus she is on, and she will not rest until she has withered the soul of every single occupant with her insipid prattle.

Suffice to say, this is not the sort of person whom Anton Chigurh would have offered a coin flip before deciding whether to kill her with his cattle gun.

So you can well imagine my reaction this morning, when who should saunter up to the stop, but Satan in all her frazzled, Monday morning glory. And when she proceeded to commence telling a fellow rider about some infraction that some occupant of her condo building had committed in the building's laundry room, in painstaking detail (among her other charming qualities, this woman despises everyone), I started reaching for my cyanide pill. On a beautiful Monday morning such as this, with the sun shining, the cool breeze blowing, and a long day of cubicle time ahead of me, this outpouring of petty, strident bile was just too much to bear. I was just putting the finishing mental touches on my epitaph, when I remembered: "My headphones! My iPod! Salvation!" Moments later, the soothing, dulcet tones of "Anything But This" blared in my ears, obliterating all other sound. And so I could go on living.

Thank you, Apple. Thank you, Sony.

And lest anyone think the hot, blinding rage Satan inspires in me is just a sign of what a crank I am, I received the following e-mail from my girlfriend, who rides the bus every morning with me, while I was writing this:

"That lady is horrible. Having had to listen/observe her nonsense for 25 minutes, I can say that I hate her. I left my stupid Ipod in my drawer here and I'm still mad at myself for it."