Month: June 2012

The ACA and the Future of Infant Circumcision

I’ve made the argument that a government-run single-payer health care system in America would not automatically result in non-therapeutic infant circumcision rates comparable to other Western nations (e.g. United Kingdom), probably most directly here. I stand by that for the reasons I’ve stated. But now that the Affordable Care Act has been upheld by the Supreme Court, I want to explore a possible (though unlikely) unintended consequence of encouraging the government to control more health care.

As I understand it, the government has now been given what amounts to unlimited power to incentivize (i.e. compel) activity to achieve a public policy goal where some (or many) may prefer inactivity. Congress merely needs to establish a “Do X or Pay T” regulatory scheme. Many, although not a majority of Americans, approve of this for health care. This is presumably a statement on the value of the goal rather than an explicit endorsement of the means. But the means matter.

Extending this thinking, what now prevents the Congress from implementing “Circumcise your newborn son or Pay a Tax”? It now has that power. And the logic is no different. Congressman Brad Sherman endorsed the political thinking that would encourage such a policy during last year’s discussion of the San Francisco ballot initiative. He declared that “Congress has a legitimate interest in making sure that a practice that appears to reduce disease and health care costs remains available to parents”.

I do not believe this is politically likely. With any extension of this newly-expanded power, Congress will need the political cover to pass a new tax. They swore the ACA wasn’t a tax, though, so lying is an option. They’re politicians, after all. It would still face challenges. But it is possible, and we’ve seen the lengths to which politicians will fall over themselves to avoid offending the status quo on non-therapeutic infant circumcision.

I think my argument holds up. If nothing else, the ACA almost certainly slows future progress on ending this violation of male children. Cultural circumcision has a new god in the perceived¹ reduction in future health care costs. There are means available within government control to pursue that. If we get further “reform”, it’s likely to offer even more control to the government. That is a problem. This seems obvious to me. As long as the government has a power and a willingness to ignore facts, the possibility of consequences exists, both intended and unintended. We should be careful which methods we endorse.

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¹ The time value of money must be included. A dollar spent today on health care is not the same as a dollar that might be spent twenty, thirty, or more years from today. The number of adult circumcisions needed would have to be greater than it is to justify this public purse argument. It still wouldn’t be ethical to circumcise healthy infants, of course.

Accountability to Those Who Pay the Buck-O’-Five

Ken at Popehat has a perfectly concise take-down of LZ Granderson’s ridiculous CNN essay arguing against seeking too much information from our government about “Fast and Furious“. I won’t be able to say it better than Ken, so here are his words. (And if you’re not reading Popehat, correct that in your RSS reader.)

But to go much beyond the criticism of these men runs the risk of learning that this great nation of ours is heavily involved in doing some things that are not so great.

It would be nice to see this as a wry comment on American willingness to overlook lawbreaking by the government when it is committed (at least nominally) in service of goals of which we approve.

But the straight-faced reading is too similar to what I have come to expect from the media to be certain of my hoped-for satirical reading. Right now scandals over both Fast and Furious and the government response to it are being spun in many places as a cynical partisan obsession. I have not the shadow of the doubt that many of the loudest critics of the government have partisan motives. But if we dismiss criticism of government misbehavior because of partisan motivations, we’ll never entertain significant criticism of the government. We’ll always have partisanship. We can’t let it be an excuse to abandon our obligations as citizens to monitor and criticize the government.

Like Granderson, I know that “freedom isn’t entirely free”. It’s not “squeaky clean”. Unlike Granderson, and like Ken, I expect America to strive to be as squeaky clean as possible. Where we (allegedly) can’t be, I want to know why. I want to know what my government is doing in my name. I do not want elected dictators.

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LZ Granderson has exhibited questionable critical thinking skills in the past. A year ago he wrote an essay against the San Francisco ballot initiative that aimed to prohibit non-therapeutic male child circumcision. It was awful in nearly every paragraph. His arguments were either incomplete or idiotic in every case.

Five Year Olds Believe in Free Lunches

With the Supreme Court expected to rule on “Obamacare” (i.e. PPACA) tomorrow, I want to consider this reddit thread asking to explain it to a 5-year-old. There’s a long list of what PPACA does, and will do, if the Supreme Court upholds it. Some may be wise, while others are surely not. The overwhelming point, though, is that none of this is free. Consider this, for example:

Employers need to list the benefits they provided to employees on their tax forms.

That costs money. Even if the change is minor, computer systems have to be reprogrammed and tested. Multiply that across every employer in the U.S. How much productivity is being consumed by this instead of something else that may provide more wealth? What improved health outcomes will this generate?

Or consider:

It creates a new 10% tax on indoor tanning booths. ( Citation: Page 923, sec. 5000B )
…

A new tax on pharmaceutical companies.

A new tax on the purchase of medical devices.

A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they’ll get taxed.

Those taxes are taxes on consumers. I suspect many people reading the list, and maybe its author, don’t grasp that. All taxes are on individuals. Consumers will pay higher costs or receive fewer services.

The real beauty of the list comes when the author injects opinion.

The biggest thing opponents of the bill have against it is the mandate. They claim that it forces people to buy insurance, and forcing people to buy something is unconstitutional. …

Yes.

… Personally, I take the opposite view, as it’s not telling people to buy a specific thing, just to have a specific type of thing, just like a part of the money we pay in taxes pays for the police and firemen who protect us, this would have us paying to ensure doctors can treat us for illness and injury.

I don’t see the distinction between buy and have when the only way to get a thing is for someone to buy it. This is the “I like it” and “by whatever means” arguments in favor of constitutionality.

I expect the Supreme Court to strike down the mandate. I suspect the rest will go down, as well, because it’s the least controversial and problematic path if the mandate goes. The rest of the act needs the mandate to achieve the remaining cost savings (that it won’t actually achieve, even with the mandate). The least “activist” thing to do is for the Court to let Congress start over.

None of this is to suggest that we should do a victory dance in favor of the old status quo if the mandate goes down. We need reform within health care. Such as untying insurance from employment, which our current unemployment rate suggests would be wise. We won’t get responsible reform, because we’ll get more rent-seeking like PPACA instead. But if Congress has to start over, there’s a chance, however small.

Link via Wil Wheaton, who should heed his own “Don’t Be A Dick” suggestion. Blaming the constitutional challenge to PPACA on “the Koch Brothers and their Tea Party Rubes” as an attempt to “get the Supreme Court to take away” what PPACA legislates is dickish partisanship. Calling one’s opponents names and implying they’re stupid merely based on group affiliation is being a dick.