A Peculiar Concept of Freedom – Real Clear Politics – TIME.com

In criticizing Christopher Dodd as having a “peculiar concept of Freedom,” Real Clear Politics exposes a shallow understanding of freedom, not to mention the current system of health care.

Here is what Tom Bevan writes: “It’s troubling to watch Dodd celebrate a massive nanny-state solution to health care by suggesting it somehow expands the American public’s freedoms and liberties when in fact many of the provisions of the legislation do just the opposite. What about freeing people from the fear that medical care will have to be rationed under this plan? Or freeing them from the fear that they may not be able to visit the doctor of their choice? Or freeing them from the fear the government will levy a fine against them and possibly throw them in jail if they do not go out and buy health insurance they may neither want nor need? via A Peculiar Concept of Freedom – Real Clear Politics – TIME.com.”

Here is my responses to his questions.

1. Medical care is currently rationed according to how much you can pay. If your belief in freedom is that your amount of freedom is proportional to the amount of cash money you possess, then you agree with Bevan’s notion of freedom.

2. As with the current rationing of medical care, access to physicians–for adults–is determined by their access to wealth. Access to physicians–for children–is determined by their parents’ access to wealth. If one is unfortunate or has limited access to wealth, then you are limited in your choice of physicians. Again, freedom in this version is tied to wealth. That’s a shallow vision of freedom. The rich are free to find a physician, and the poor are free to go without health care.

3. The health care legislation demands that citizens buy health care so that the cost is reduced, because costs go down if the risk pool is larger. The state is asking citizens to participate, to take responsibility for the privilege of being born in the United States. The state does this in other contexts–car insurance (autos are, apparently, more important than people), jury duty, and military service. We on the left believe that health care is a right–the United States signed the Universal Declaration of Human Rights more than 50 years ago asserting that health care was a right–and a responsibility. The legal system is based on just such reasoning–of rights and responsibilities. To imagine that freedom does not come with responsibilities is the shallow version of freedom being articulated by the right wing. And, indeed, it threatens democracy itself, replacing it with a Hobbesian nightmare of every individual acting only for themselves–free to wage war on anyone or anything–which expands the rights of the wealthy and powerful and gives the rest of us the rights to be servants.

More egregious, and ahistorical, is Bevan’s vacuous invocations of the “Founders” horrors at “the size and breadth of the federal government.” The “Founders” were neither perfect figures of rationality nor were they a unified group whose ideals could be distilled into simple political slogans, for the right-wing to trot out when criticizing the nation’s political development. The “Founders” were complex socially and politically. They created a framework that future generations of Americans have used to shape and reshape our nation over time. Some might indeed be opposed to the “size and breadth of our federal government,” some might be appalled at the freedoms accorded to women and African Americans, some might be appalled at the expansionist military, and still others might be appalled at the horrible effects that unfettered capitalism has had on the landscape and values of community. I don’t presume to speak for these complex people, nor do I think Bevan should.

However, I would be the founders would be impressed by the vitality of a continuing democracy in which rights and responsibilities continue to be debated. After all, that is the fundamental character of the system that they left.

I ask that you not allow yourself to be fooled by the rhetoric of right-wing demogogues just because its wrapped in ahistorical psuedo patriotism.

Mankiw cooks the numbers to argue against expanded healthcare

In Economic View – Who Will Determine Who Pays for Equality in Health Care? – NYTimes.com economist N. Gregory Mankiw writes “Not long ago, I read a physician estimated that statins cost $150,000 for each year of life saved.” That number appeared to me to be a wild exaggeration, so I spent 30 seconds doing  a google search. The secon result produced an article, “Cost effectiveness of statins in coronary heart disease” from the Journal of Epidemiology and Community Health. I clicked through and read the whole thing (’cause I have access through the university system to this journal) and much of it was epidemiological and statistical, beyond my expertise, but here’s the crux, from the abstract:

“Methods: The review searched for studies comparing statins with no treatment for the prevention of either cardiovascular or coronary heart disease in men and presenting cost per years of life saved as outcome. Estimates were extracted, standardised for calendar year and currency, and stratified by categories of risk, age, and funding source

Results: 24 studies were included (from 50 retrieved), yielding 216 cost effectiveness ratios. Estimated ratios increase with decreasing risk. After stratification by risk, heterogeneity of ratios is large varying from savings to $59 000 per life year saved in the highest risk category and from $6500 to $490 000 in the lowest category. The pooled estimates show values of $21571 per life year saved for a 10 year coronary heart disease risk of 20% and $16862 per life year saved for 10 year risk of 30%.”

If I am not mistaken, the pooled estimate is $21,571 for life year, with costs actually decreasing as the risk increases. In either case, it is clear that Mankiw did not choose his number scientifically, but plunked it from one study. My guess is that the $150K number had to do with the fact that this is the low end of the income for the highest 3%-5% of American households.

I believe that his choice of numbers is not only deceiptful, but disingenuous. I normally read Mankiw and even when I disagree, I can see the logic of his arguments. Not this time…

UPDATE: Mankiw’s numbers are really goofy: check here, or here, or here. This is a very, very, bad example…