The Maanga

The difference between Conservatives and Liberals, we are often told, is their divergence in terms of tolerating the lack of equality in outcomes or opportunities in order to achieve the other. It’s a philosophical dichotomy that has been reduced to rhetoric in the modern American electoral politics, as one would have expected. And, if one were to look for academic vestiges of such a polity being put to popular vote, the Healthcare plans of Senators McCain and Obama offer a rare textbook case.

John McCain’s plan aims towards a fundamental change in process and hopes that will enable desired outcomes. At it core, the health plan is actually a tax plan. Currently, if you have an American job your employer typically contributes to a traditional plan[1] and that money is tax free. What McCain wants to do is eliminate this tax break and consequently generate an estimated $3.6 trillion over the next decade. This money, the plan claims, will be used to pay for refundable tax credits for Americans obtaining private insurance. That is, if you are one among the 50 million uninsured in America, you can use this credit to buy insurance for yourselves. If, on the other hand, you happen to have an American job that also provides insurance, which you are more likely to, you can use this credit to offset the cost of paying taxes on your employers’ premium or alternatively to buy coverage on your own. This is important — research has repeatedly shown that one of the reasons for the high cost of healthcare in America is the way insurance plans are designed and bundled. The McCain plan, I assume, will help individuals use their tax credits to buy CDHPs or Consumer Driven Health Plans to suit their specific needs and they  can design the plan themselves, online. Much like buying an air ticket or choosing a mutual fund. The campaign though does not harp on CDHPs or the individual design of the health plan — possibly for the fear of being labelled too close to the insurance companies.

Instead, the campaign focuses on how the current tax structure benefits the rich, since the real value is dependent on the employee’s tax bracket. Senator McCain argues, his plan will offer equal credit to all Americans. This it’s claimed is a just allocation of federal resources. Further, he argues, actually his plan does, that since the tax credit is refundable, even the poor qualify. In other words, the present tax structure benefits those who pay taxes and have a job — this plan instead works like a watered down negative tax structure where everyone receives a credit to purchase insurance regardless of where they obtain it. There is also a proposal for inter-state insurance purchases. This is put forward as a mechanism to circumvent the heavily regulated states that make the cost of premiums very high.

Barack Obama’s plan is simple. The onus is on the employer — as it has been for long time in America — the employer either provides the employee insurance cover or pays tax. That revenue, it is claimed, will finance the reminder. Senator Obama also does what most liberals instinctively desire: he will offer a new plan. A new federal health plan drawn along the lines of the existing Medicare program has been proposed in conjunction with a new national health insurance exchange that is modelled on the Massachusetts Connector. It’s a repository/counseling/grievance center that would offer a choice of private insurance. And then, there are mandates that are proposed to insurance companies — they need to change their underwriting practices such that they can’t leave those with existing conditions outside the net.

The universal adoption of electronic medical records(EHR) and improved disease management[2] practices are also touted as cost saving measures. Further, the Obama plan intends to pay providers on the basis of performance. How this is possible when the Senator wants to fundamentally change the single biggest incentive for these measures, namely better/more efficient underwriting, is something one can’t fathom. The plan also seeks to ‘negotiate’ prescription-drug prices and spend on research to study the relative merits of treatments plans. To work the numbers on this plan is impossible at this time because one does not know the tax rates for employers choosing the pay route — and the plan essentially assumes there is an optimal point which will enable the smooth rollover of funds into helping the uninsured.

It’s highly unlikely that someone decides to vote after a careful analysis of their health plan options which includes working their tax numbers and possibly answering several moral questions along the way. However, if one were to intuitively decide on a philosophical basis, this appears the most easy decision one can make.

[1] — Currently, most employers still offer traditional plans with HMO or PPO or POS. However, if research is to be believed, the next 5 years could see them being rapidly replaced with CDHPs.

[2] — Disease Management is another critical area that research has shown will reduce the cost of healthcare. About 3 out of four dollars that payers settled as claims were spent on treating patients with diabetes and heart diseases. A disease management program aims to target people with such specific illness and design incentives that will help bring down their visits to the clinic.

I propose a new solution. A separate mass of land for all traitors. I shall be its President.

One of the problems the government faced was opposition from legions of mothers whose sons had been maimed or died in the war. To confront this problem, the government-controlled TV would parade a mother whose son had died in the war in front of the TV on a regular basis. Invariably, this “show mom” would be carrying an infant child and a few other siblings with her. And invariably, she would say something to the effect that “I have given one child to this ’sacred’ war, and I am ready to give the next one.” Almost always, there would be an adoring crowd who would follow her statements by chants of “Allaho-Akbar” (God is Great). And again invariably, her statements would follow by a not-so-veiled threat from her and the adoring crowd. She would say something like “I and my family would not tolerate traitors and betrayals to the faith and country”. Then the crowd would break into several standard chants such as “Death to traitors” or “War, war, until victory.”

Sarah Palin was much better dressed than the average show mom paraded on Iranian TV more than 20 years ago. The show moms were typically dressed in a black veil. But that’s about the biggest difference. The rhetoric was eerily familiar. When she was finished, I knew I had seen her before. Only that it wasn’t her. It was her ideological predecessors at a different time in a different country.

I wanted to write a brilliant essay on on how all of India’s problems today and especially those that will come tomorrow are based on one fundamental conflict: between territorial integrity and individual liberty. Later, I realized, someone greater had done that better a long time ago. In 1849. Here is Henry David Thoreau,

After all, the practical reason why, when the power is once in the hands of the people, a majority are permitted, and for a long period continue, to rule, is not because they are most likely to be in the right, nor because this seems fairest to the minority, but because they are physically the strongest. But a government in which the majority rule in all cases cannot be based on justice, even as far as men understand it. Can there not be a government in which majorities do not virtually decide right and wrong, but conscience? — in which majorities decide only those questions to which the rule of expediency is applicable? Must the citizen ever for a moment, or in the least degree, resign his conscience to the legislator? Why has every man a conscience, then? I think that we should be men first, and subjects afterward. It is not desirable to cultivate a respect for the law, so much as for the right. The only obligation which I have a right to assume is to do at any time what I think right. It is truly enough said that a corporation has no conscience; but a corporation of conscientious men is a corporation with a conscience. Law never made men a whit more just; and, by means of their respect for it, even the well-disposed are daily made the agents of injustice. A common and natural result of an undue respect for law is, that you may see a file of soldiers, colonel, captain, corporal, privates, powder-monkeys,(5) and all, marching in admirable order over hill and dale to the wars, against their wills, ay, against their common sense and consciences, which makes it very steep marching indeed, and produces a palpitation of the heart. They have no doubt that it is a damnable business in which they are concerned; they are all peaceably inclined. Now, what are they? Men at all? or small movable forts and magazines, at the service of some unscrupulous man in power? Visit the Navy Yard, and behold a marine, such a man as an American government can make, or such as it can make a man with its black arts — a mere shadow and reminiscence of humanity, a man laid out alive and standing, and already, as one may say, buried under arms with funeral accompaniments, though it may be

“Not a drum was heard, not a funeral note,
As his corse to the rampart we hurried;
Not a soldier discharged his farewell shot
O’er the grave where our hero we buried.”(6)

That healthcare in America has become prohibitively expensive was neither avoidable nor is it reversible in the long term. It is a result of the modern human being’s progress that will prove to be eventually self-defeating. Simply because, the modern man’s lifestyle is an evolutionary dead end — much like the peacock’s feathers.

Example: The average use of a CT Scan quadruples when the Medicare program pays for ‘procedures’ and not patients. The physician who uses conventional diagnostic techniques is simply called a bad doctor because he isn’t “thorough”.

Five years on, where is the oil? And, why are the idiot Americans wanting change and not cheaper fuel?

Like a policeman in Pondicherry said, vellaya iruntha foreign kaaran.