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I recently heard a representative of a non-profit organization committed to stemming the rising cost of healthcare interviewed on a local public radio program.  She said that her organization has launched a state wide program which is patterned after a national initiative implemented by the American Board of Internal Medicine Foundation.  The goal of the program is to ensure that health care providers are providing necessary treatments and therapies efficiently and only as actually needed.  During the interview, she gave an example of the type of activity and interaction the program is designed to achieve.  Paraphrasing, she said that “if a doctor orders a test or some treatment, we want the patient to inquire whether this is really the best thing to do or should I just wait to see if it gets better on its own”.  Because her comment was “off the cuff” and not well measured, we should not take it literally.  I don’t imagine the primary focus of this program is to induce patients to question their doctor’s judgment with respect to every test or therapy the physician might prescribe.

What is interesting isn’t the program or its specific focus but the underlying truth her comments reveal.  Because our healthcare is generally paid for by employer or government provided “insurance”, the end users (the patients) have had little incentive to monitor the price of medical care.  As a result, the role of prices in determining demand is muted.  The consumer of healthcare is not as directly interested in the price of his treatment because he does not directly pay it.  In a free market, higher prices result in lower demand which in turn keeps prices in check.  When the healthcare consumer doesn’t pay for the healthcare he receives, his demand is not nearly as affected by increasing prices.  As prices go up, his demand does not decrease as it normally would.

The program discussed by the representative of the local non-profit apparently seeks to redress the problem by artificially inducing consumers to act as though they have the same interest in health care pricing as they would if they paid for it directly.  It is hoped that sufficient numbers of patients can be coached to act like paying consumers so as to reintroduce the effect of diminishing demand into the economic equation.  Though this is no doubt a well intentioned effort, it ignores human nature and history.  We know from the communist experiment that individuals cannot be prodded en masse to act in the “best interest of the collective”, at least not for long.  Ultimately, the vast majority of individuals are rational economic actors, which means that they act in accord with their own perceived best interests.  For this reason, the percentage of people who can ever be expected to pressure their doctors about the real need for suggested therapies pales in comparison to the number of individuals who will do so when they are actually responsible to pay for the therapy out of their own pockets.  Even at that, the few who are initially willing to question their doctors in this fashion will lose the initiative to do so going forward.

Try as we have, mankind has not been able to efficiently plan a route around human nature.  Government restraint and coercion gives rise to unintended consequences.  In this case restraint and coercion in the form of redistributing and regulating health care gives rise to the unintended consequence of inflexible demand for healthcare which in turn gives rise to higher and higher prices.  Asking and expecting the citizenry to act in contradiction to their nature is not the answer to the problem.  The answer to the problem is a return to the free market, the natural state of society in which human nature flourishes.

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On her September 8 show, Greta Van Susteren was dismayed over the fact that the federal government is going to spend about a half of a million dollars on art work for an upgrade project to the border crossing for the San Diego –Tijuana region.  You can read the text of her justified rant where to Buy Fildena 100 mg.  The overall project is to cost $735 million and it seems the General Services Administration allocates one half of one percent of construction projects to “art work” pursuant to the GSA’s “art in architecture” program.  In short, Greta is incensed by the fact that this is the same crossing where Sergeant Tahmooressi made a wrong turn and ended up in Mexico.   Greta asks rhetorically why the government wouldn’t spend that money on improving the road signage so people stop making wrong turns into Mexico.

Her frustration is justified because it is unjust for the federal government to tax American citizens or borrow from future generations to purchase artwork for anything, not because the government failed to improve the road signage.  If the GSA spends one half of a percent of every construction project on “art in architecture”, how many millions of taxed or borrowed taxpayer dollars are spent on art overall?  Worse, the big picture implications are far more severe.

We are often incensed at relatively small and insignificant injustices that are tangible but seem oblivious to larger problems that are less obvious.  The purchase of $500,000 worth of art for a border crossing is a specific, tangible, actual event we can all appreciate and evaluate on its own merits.  It is relatively easy for us to size up this issue and make a human judgment that it is wasteful and improper to tax citizens or borrow from future generations to spend money on something as frivolous as art for a border crossing.  It’s harder to consider the implications of such waste and inefficiency on a grander scale.

Here we have one, certain isolated event—the GSA is spending $500,000 on art for a border crossing.  We also have a slightly less specific, but far further reaching and equally certain series of events—the GSA spends one half of one percent of every construction project on art.  Certainly, the magnitude of the GSA’s spending on art dwarfs the $500,000 to be spent on the border crossing.  More broadly, we have hundreds of government programs spending taxed or borrowed money on tens of thousands of different expenditures.  We can not begin to know much less evaluate each agency, each program or each expenditure.  Despite the certain, isolated examples of government waste and inefficiency we see on a daily basis, we too often ignore the larger implications.  Somehow many among us remain convinced that government can do a better, more efficient job than the free market in providing services we need or desire.

Individual citizens do not have the wherewithal to conduct the exhaustive research of a well funded political think tank or a major university.  But individual citizens can think for themselves.  If a parent has a child that mismanages his own money by spending it wildly and regularly misplacing or losing it, that parent would not be inclined to trust that child with taking charge of the family bank account and paying the mortgage and the other monthly bills.  Yet that is exactly what we do as a society when we give a wasteful, inefficient government control over more and greater aspects of our lives and well being.

Too many of us trust in the promise of the good that government might do if given the opportunity but close our eyes to our actual experience. Our actual experience is that the free market delivers goods and services extremely efficiently and progress in the improvement of those goods and services is swift and consistent.  Our actual experience is that the government delivers services expensively and wastefully and progress in the improvement of those services is slow or nonexistent.  Let us be frustrated with the $500,000 to be spent on art for a border crossing, but let us be frustrated for the right reasons.  It is but one of thousands of examples of our misplaced reliance on government.

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The grass roots effort to defeat the Common Core might be interpreted by many as a sign of hope.  In an age when federal overreach is routine and the centralization of governmental authority in Washington is widely accepted or even welcomed by the States, the media and a great portion of the citizenry, a proponent of decentralized government and constitutionalism might find the opposition to the Common Core a welcome reason for optimism.  Perhaps not since the advent of the Tea Party movement has there been an issue that coalesced individuals in a cause against centralized government on such a wide spread basis.

To be sure, the reasons for the movement against the Common Core are many.  Not all are motivated by concern over the potential for the centralization of education in Washington or the potential loss of local control over curricula.  Some are motivated by concern over the testing protocol, others by the collection and consolidation of personal information and privacy issues implicated thereby and still others by the perceived lack of rigor embodied in the standards. But it is clear that the “federalization” of education is among the primary concerns giving cause for the movement. For this reason, constitutionalists might be heard to breathe a sigh of relief.  Sadly, further reflection leads me to conclude the opposite—the grass roots movement to defeat the Common Core illustrates the magnitude of the centralization problem and the revelation is disheartening.

One would have a difficult time identifying an issue that could be more important to people than education.  The public apathy for political issues is widespread and obvious, but Americans still love their children and grandchildren and we still go to great lengths to plan their futures for the best and to manage their lives while they remain under our care.  During the debate over the Affordable Care Act, it occurred to me on many occasions that there are not many issues more personal and thus, of greater importance than health care.  It seems to me that maintaining the ability to influence public education is one such issue.

Unfortunately, the debate over the ACA became bogged down in the minutia over the efficacy and costs of the plan.  Rather than focus on the free market and constitutional principles involved and the implications for human liberty, the debate was too much based on the pragmatic; would the ACA improve healthcare, how much would it cost, and how would it be paid for.  Happily, it does seem that the debate over the Common Core may be developing somewhat more of a focus on the fundamental principles involved.  Certainly the proponents of Common Core would be happy if the debate could be made to focus on pragmatic issues.  Arguing about the supposed benefits of nationwide standards or a technical debate over the details of the standards themselves would suit their purpose.  If the debate can be made to be technical and obscure they know that most eyes will glaze over and they’ll be far more likely to get the result they want—people leave it to others to figure out the best approach and bow out of the debate.  As long as a substantial focus of the debate remains on the ability to affect decision making at the local level, the grass roots is more likely to remain interested and engaged.

For today, my sad point is this: If it is this difficult to gain sufficient widespread support to defeat Common Core, an issue which implicates our ability to influence and affect our children’s education, how far removed must we be from an age where constitutionalism and widely dispersed government are generally appreciated and ultimately demanded?  If Americans will not “wake up” in sufficient numbers to protect the free market in health care or demand a continued say in the education of their children, what will be required to awaken them to all the other benefits of constitutionalism?  The decades long trend of diminishing State sovereignty and federalism in favor of growing and centralized power in Washington must be broken if we are to enjoy the larger liberty, free markets and individual role in self government contemplated by the founders. That it is so difficult and effortful to engage sufficient numbers of Americans in the effort to ensure the continued local control of public education does not bode well for breaking that trend without some larger, likely terrible eventuality to trigger a national introspection on the slow decay of our first principles.