I'm James Maxey, the author of numerous novels of fantasy and science fiction. I use this site to discuss a wide range of topics, with a heavy emphasis on cranky, uninformed rants about politics and religion and other topics that polite people attempt to avoid. For anyone just wanting to read about my books, I maintain a second blog, The Prophet and the Dragon, where I keep the focus solely on my fiction. I also have a webpage where both blogs stream, with more information about all my books, at jamesmaxey.net.


Saturday, March 27, 2010

Legally Enforcing Responsible Behavior

So, Obama finally has a health care bill he can sign. I confess, I was certain the whole affair was doomed after Scott Brown was sworn in and Republicans had the power to filibuster again. But, in a truly amazing display of legislative force, Nancy Pelosi found the votes to pass the already passed senate bill. You can complain about backroom deals and legislative tricks all you want, but you have to respect the fact that Pelosi wasn't afraid to use the power available to her at this moment. This is probably the high water mark of Democratic power for at least a decade. If she couldn't pass this law now, then it would never be passed. Even if you completely disagree with the law, you have to admire Pelosi's political talent and courage. She knew democrats were going to lose seats whether or not this passed. A more timid politician might have tried to cut their losses. She instead got the bill passed, and seems willing to deal with the political consequences. If she was doing this in support of something I was enthusiastic about, like deficit reduction, I would sing the praises of her great leadership. Even though I don't like where she's heading, I still recognize that this was an act of leadership that will go down in the history books.

One of the curious things about this bill is that its most important element is essentially very conservative. There is now a federal requirement that all adults purchase health insurance. This is solid, responsible behavior, the kind of thing that the vast majority of adults already took steps to secure for themselves and their loved ones. It's closest parallel that I can think of are seat belt laws and helmet laws for motorcycles. Intelligent, responsible people were already going to be doing these things. But, because the number of stupid, irresponsible people isn't trivial, we wind up with laws on the books requiring us to do what's obviously right. Not having health insurance in today's world is an increasingly risky gamble that gets subsidized by the higher and higher health care costs of those of us who do bother to pay thier bills.

On a purely libertarian level, I have a philosophical stake in defending the rights of people to behave irresponsibly. But, my theoretical libertarianism often crashes up against my real world pragmatism. For instance, on an abstract level, I believe that people should be as free from micromanagement of their activities as possible. But, a few years ago, I got rear-ended by another driver who was distracted by his cell phone. Now, if the state banned cell phone use in cars, and especially text messaging, the libertarian philosopher in my brain would go, "Tsk, tsk, what a shameful incursion on individual liberty," while the real world commuter inside me would go, "Yeah! And outlaw eating and driving while you're at it!"

So, on a purely practical level, I think the individual mandate to purchase health care is a good thing. Where it goes off the rails, of course, is that the government is going to step in and subsidize it. The problem with this is that we are, as a nation, living so far beyond our means it's really just not funny anymore. We have to borrow money just to keep the lights on in our federal offices. It's nice that the government wants to do good things for people. But, once you start doing it on borrowed money, doing good quickly becomes a form of doing bad. It's nice that some additional people will have health insurance. It's not so nice that we will be facing future tax rates of twice what we pay today, if not more, or else experience hyper inflation that renders the money I've managed to save to date worthless.

It would be nice if Congress, while it's passing laws mandating that the citizens behave like responsible adults, would show a little inclination toward responsibility as well. But, of course, they would, if more citizens would behave responsibly by staying informed on the issues and, you know, voting. Congress would be a much more functional institution if more than 20% of the citizens in a congressional district could actually identify their congressman by name.


怡如 said...
This comment has been removed by a blog administrator.
Izgad said...

As a libertarian, I have no problem with the government not allowing people to use cell phones on a government owned road. (I am against government roads, but that is a different issue.) Using a cell phone while driving puts other people in physical danger without their consent.

If people do not want health insurance that is their right. It is also the right, even the duty, of the government to not help them if they get sick and just let them die. (Private charity is of course a different issue.)

James Maxey said...

Izgad, my libertarian tendencies are pretty strong, and at first glance the health care issue seems pretty straightforward. I buy my insurance and pay my bills, you buy your insurance and pay your bills, and John Doe buys his insurance and pays his bills. Where it gets tricky, though, is if I decide not to buy insurance or pay my bills. If I'm in an automobile wreck, they don't find out if I can pay to my arm sewn back on before they rush me off to the ER for emergency surgury. Then, assuming I skip on the bill, the hospital is out for the ambulance services, the surgeons services, the gauze, blood, etc. that was used to keep me alive. So, to recover the cost, they jack up prices across the board so that you and John Doe and your insurance companies pay to cover my deadbeat ass.

Essentially, health care services can and are legally shoplifted. If you walk into a store and leave with a pair of pants without paying, you can go to jail. If you walk into an ER and leave with an appendectomy scar that you don't pay for, you might wind up with some collection agencies hounding you, but you won't face any criminal penalties. Imagine how much blue jeans would cost if people could shoplift them with no fear at all of arrest.

In a purely libertarian universe, doctors and hospitals would be free to say no to anyone without cash in hand. However, I'm not certain that's the world I want to live in.

I don't know if Obama's health care bill will change things. In theory, if everyone actually bought insurance and no one stiffed the system, it could spread costs and bring down prices. But, gut instinct and real world experience tell me that it won't be that simple, and that unintended consequences of this reform are going to wind up costing honest people a lot of money. That's just they way the world works, alas.

Izgad said...

This is why we need to resurrect debtor’s prison. In my version of debtor’s prison, prisoners would be allowed to work off their debt. People who cannot pay their hospital bills will be allowed to work off their debt by changing bed pans and other such desirable jobs.