Book Review: John Goodman's "Priceless"

HARBESON: Learning more about health care

> SOUTHERN INDIANA — A couple of months ago, a reader contacted me and suggested I review a book that he thought more people should know about. I had previously read a few articles from the author which intrigued me so I agreed. The book’s topic covers what is arguably the most important service/product everyone purchases at some point — health care.

Everyone has at least one personal story about health care that left them feeling frustrated. Medical professionals and patients feel trapped by the current system. Various third parties (government, huge insurance corporations and employers) are so deeply involved in the process that normal market forces don’t even come into play. As my friend noted in his initial email, “What other service or product do we engage the services of without knowing what the price is?”

This book, titled “Priceless: Curing the Healthcare Crisis,” was written by John Goodman, an economist who is sometimes referred to as the “father of Health Savings Accounts.” Goodman has been deeply involved in the study of the health care system and has spent a lot of time thinking about how to improve it. After reading this book, which is loaded with footnotes and references, I can’t say I have a complete handle on this complex topic but I’m certainly more informed.

One aspect of health care that has always puzzled me is how health insurance developed in a way that it often isn’t insurance at all, at least in the traditional sense of being a product offered to protect against a possible and unpredictable catastrophic event.

Goodman writes: “Most people in health policy view health insurance as just a way to pay medical bills. This book is one of the very few places in all of the health policy literature where you will find a defense of the idea that there is a social need for real health insurance. It is also one of the few places you will find an argument that we need a real market for health risks to determine the best way to insure against them and to determine what is the best way to partition insurance products between self-insurance and third-party insurance.”

Goodman’s book examines how interference in the health market has created perverse incentives as patients, doctors, insurers and other third parties try to make it all work. Professional licensing laws, tax laws, labor laws and employee benefit laws have created unintended consequences which have played a large part in creating the health care system we see today.

These artificial laws create an atmosphere that attempts to defy and ignore economic laws. No matter how much we may want to, we simply can’t avoid basic economics. One of the best examples of this is the problem of pre-existing conditions. Goodman points out that “Most of the time, the problem of pre-existing conditions arises precisely because health insurance isn’t portable.”

The reason it’s not portable is because of laws interfering with market forces.

Interference in the market has changed the very idea of insurance in regards to health.

Goodman explains: “The casualty insurance market is a real market in which real insurance is bought and sold. The health insurance market, by contrast, is an artificial market in which the product being exchanged is not real insurance at all. To a large extent, it is prepayment for the consumption of health care.”

He goes on to explain how this has created many problems leading to the huge increases we have seen in health care costs. One of the most interesting statistics Goodman notes is that spending on health care has much less effect on mortality than we think: “Studies show almost no relationship between aggregate spending on health and population mortality. Lifestyle, environment and genes have far more influence on life expectancy than anything doctors and hospitals are doing.”

He also talks about equality in health care and mentions many studies done in Britain and Canada that show the poor still do not get the access and quality of care that everyone hoped. Britain even has a term for one aspect of the inequality that comes from location: “postcode lottery.”

My favorite chapter in this book was “Designing Ideal Health Insurance.” Starting from scratch and taking all the interference out, he asks the reader to think through the process of how 1,000 people might set up a health care plan that works. In addition, when discussing problems to consider he adds this point: “Since all agreements are voluntary in this imagined scenario, coercion is not an option.”

Although he doesn’t really take this idea through to the end (he appears to be more focused on reforming the current system) anyone who tries to help people think about social issues from a voluntary standpoint is certainly on a better track than most.

So if you are interested in learning more about health care, including how you will be affected by the Affordable Care Act, you may want to read this book.

— Clark County resident Debbie Harbeson would love to see a health care plan where coercion is not a pre-existing condition.

Cast of Characters in Clark County Government

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 HARBESON: M*A*S*H, Clark County style

I have to admit that I’m having trouble following the latest episode in the ongoing saga that is Clark County government. Was property improperly sold to a commissioner’s daughter? Did her father know about it? Did Erika’s long lost twin-sister’s deceased ex-husband come back from the dead?

Oh sorry, I think that one is from another soap opera. Maybe what I should do for now is see if I can just sort out the cast of characters.

To help put all of this together, I’m going to match them to characters in the television show M*A*S*H. The inspiration for this idea came from Clark County Commissioner Les “Col. Potter” Young. When asked about details surrounding his signing over deeds to a fellow commissioner’s daughter, he introduced M*A*S*H into this controversy by claiming that he may be the victim of the “Radar Treatment.”

He was apparently referring to County Attorney Greg “Radar” Fifer, since he was the person who presented the deeds to Young for his signature. “Radar” Fifer agrees that “Col. Potter” Young may not have completely understood the “significance of the deeds he was signing.”

Fifer has an even bigger part to play in this particular episode. The commissioners say they were following his specific recommendation to handle the sale of some of the private properties that did not receive bids during a 2010 tax sale.

According to the News and Tribune report, there were a total of 182 properties left over and Fifer recommended that the commissioners use a company called SRI Inc. which specializes in tax sales. However for some as of yet unknown reason, Fifer recommended they use this option for 130 of the properties. For the other properties, he recommended using a local law firm, one where he just happens to be a partner.

In addition, he may have made mistakes in following government regulations for advertising the properties. In the article, Fifer said, “I’m not perfect. Maybe I made a mistake, I don’t know.”

This is not a problem though because if he did make any mistakes that may end up costing the county money, surely he’ll step up, say he’s accountable for his actions, and take responsibility. After all, that’s exactly what he thinks Attorney Jack Vissing should do in regards to mistakes Fifer says Vissing made concerning the fiasco over property purchased for the Clark County airport.

But enough about “Radar,” next up in our cast of Clark County characters is Commissioner Ed “Maj. Frank Burns” Meyer. On the television show, Maj. Burns often hurled confusing comments at people who confronted him with questions about his actions. Similarly, when Meyer was asked to give his daughter’s contact information during a commissioner’s meeting, he said, “Don’t mess with my family.”

Meyer certainly is under no obligation to give out anyone’s contact information, but what is that comment supposed to mean? How is asking for contact information messing with someone’s family?

Meyer says that his daughter has the same right as any other adult citizen to bid on property. That’s true, and just like any other individual who wants to try to make a buck by taking advantage of tax sales on property claimed by government, she moves out into the public realm. Meyer cannot possibly be surprised that there might be increased scrutiny when a government entity makes property transactions with a close relative of a county executive, particularly if regulations on handling the sale may not have been followed properly.

To complete the cast, I should mention the third county commissioner, John Perkins. However I don’t think Perkins can be thought of as a major character, considering how he got the part of county commissioner. Since he was chosen by a tiny caucus to fill a vacated seat, he may be more like one of those characters who only play bit part and then go away, never to return again.

In addition, Perkins can’t be a main character in this episode because he says he has “no specific knowledge” about this deal. I believe him. After all, he’s been pretty busy handing out his own special benefits by ordering the county highway department to do work on his neighbor’s private property.

I don’t know, maybe Perkins should get higher billing because the more I think about it, he’s right there with the rest of them playing out the consistent underlying theme of any government show: Taking advantage of the power that comes with the monopoly on force.

— Clark County resident Debbie Harbeson has noticed that even when the cast of characters change, the government show is still predictable re-runs.

Telling Big Bird the Truth

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 HARBESON: What would Big Bird do?

CLARK COUNTY — This column is being brought to you by the letter “V.” V is the first letter of many wonderful words, but my favorite is voluntary. It’s not used much during political election seasons and is certainly not likely to be a word you’ll hear vociferously proclaimed during a presidential candidate debate — mostly because presidential debates are for discussing eight-foot tall yellow bird puppets.

Big Bird is a perfect symbol for politicians to exploit as they try to manipulate people in their quest to gain government power. Both parties benefit from the current hyper focus on their disagreement about funding this fowl because it keeps attention away from issues they heartily agree on, like the continued use and funding of other big birds, ones that are currently terrorizing, and sometimes killing, children.

Since they both endorse drones, the parties don’t want you to think about funding those big birds. They want you to focus on fighting with your American neighbor over funding the benign Big Bird.

But even that makes no sense. Why should the politicians be the ones to make any decisions about Big Bird? We should be asking Big Bird what he thinks.

I’m sure if someone on Sesame Street actually told Big Bird the truth and took the time to explain how the Corporation for Public Broadcasting [another example of the many bipartisan efforts from the 1960s] is funded, he would be shocked. From what I’ve seen, Big Bird is a peaceful fellow so once he learned the truth he surely would not want to accept any funds that were gained through threats of force.

Big Bird would want people to fund his work voluntarily, because they saw value. He wouldn’t be too worried about whether or not people would donate because he can see that many do so already. In addition, Big Bird and his buddies know how to sell lots and lots of branded products to children.

Big Bird would understand that not everyone will want to fund his work for a variety of reasons. He’d accept that some people prefer not to fund television shows like Sesame Street because they don’t care for passive learning and would prefer not to encourage parents to sit their young children in front of a blaring, flashing screen. He’d leave those people alone.

Big Bird would be annoyed that the Democrats want him to remain at least partially dependent on government funds and don’t want him to prove he can pay his own way. He’d be mad when he realized that they only want to use him to manipulate the voters so they can have control of government.

If some people tried to convince Big Bird that he should continue accepting the coerced funds because it’s a relatively small amount that he gets, he would hang his head in disappointment. He’d tell them the specific amount is not the point. To someone like Big Bird, principles matter.

Big Bird would behave like this because he cares about how others are treated. So of course he would think that each person should decide for themselves whether or not to fund a television show.

Once he learned the truth, once his eyes were opened, Big Bird couldn’t go back. He could never feel good accepting money that was taken without consent from people on Sunflower Street so it could be redistributed to Sesame Street.

Although Big Bird would be irritated at people who are trying to keep him down, he would still understand their anxiety because his success could really change the way things are done. If Big Bird really can fly on his own, everyone would have to consider how many other full or partially tax-funded operations could also do just fine without government involvement.

— Clark County resident Debbie Harbeson is still wondering how to get to Sesame Street.

Prominent and Notable?

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 HARBESON: What the Internet thinks

> SOUTHERN INDIANA — Over the years, people have slapped a wide variety of labels on me. I thought I was used to it, but over the last month, I received two letters that put me into a category so horrendous I’m having trouble sleeping at night. Although I don’t see how this label could be even close to accurate, it’s truly shaken me to my core.

I know what you’re thinking. “Oh, how bad can it be? She’s probably already been called every name in the book and deserved most of them so what’s one more?”

Well, you won’t say that when you learn what these letters said. We’re talking one scary label, people.

According to one of these letters, I am apparently “one of America’s most notable Republicans.” As if that’s not bad enough, two weeks later, a second letter arrived, saying I am also one of the Republican Party’s “most prominent members.”

How can that be? What did I do to deserve such an accusation? I can’t think of anything that could equal that. Well, except being called a prominent Democrat.

I’ve been working at least 47 percent of my brain trying to figure out how I became a notable and prominent Republican. Yes, it’s true that I’ve done things in my past I’m not proud of, but that was way back in the 1980s when I listened to Rush Limbaugh. You must understand — it was that, or ’80s music. I simply chose the lesser of two evils.

As usual, when something happens to me that I don’t like, the first person I blame is my husband. I desperately wanted to put this all on him. I checked his Internet history and saw a link titled “Conservative Boobs,” and thought we probably got on a list after he did that. However, when I confronted him, he claimed that was just an article describing the latest slate of candidates so that couldn’t have led to the letters.

The truth is though, that even before I talked to him, I knew he didn’t have anything to do with it. I knew the letters couldn’t be his fault because they are addressed to me only. They don’t even say “Mrs.” on them. Plus, he didn’t receive a copy of these letters.

I suppose they could have just made a mistake. Republicans are known to do that. Yes that must be it. I mean really, look at the photo next to this column, does anyone really think that’s what one of America’s most notable Republicans would look like?

What the Internet thinks

I’ll probably never know for sure if those letters give any real indication of what Republicans think but thanks to a new website, I can finally learn what the Internet thinks. WhattheInternetthinks.net is a site that will tell you what the Internet thinks about anything. Type in any word and it uses an algorithm to give you a result of, well, what the Internet thinks.

When you enter a search term, the site calculates and returns a percentage for three categories: negative, positive and indifferent. After calculating it also states a conclusion.

When I first encountered the site, those letters were still weighing heavily on my mind, so the first term I entered was “Republicans.” This term came out as 93.9 percent negative and the site’s conclusion was “The Internet is very negative about Republicans.” After that, I didn’t dare search for “prominent” or “notable” Republicans because I was afraid my laptop might explode.

I did decide to risk it and enter “Democrats” though. The site calculated that term to be 73.9 percent negative with the conclusion saying, “The Internet is negative about Democrats.”

I then typed in “government” which calculated to be 42.1 percent negative, the conclusion being “The Internet is negative about government, but only just.”

Next I decided to see how consistent this site is so I searched for a similar term, “Mafia.” That one came out as 59.5 percent negative, concluding “The Internet is negative about the Mafia.”

OK, so the site appears to be somewhat consistent, at least in how it views organizations that collect revenue through force.

What does the Internet think about “politicians?” After I asked, the site lit up again, saying 94.2 percent negative. Then I decided to search for “lawyer” and it was nearly a dead heat with 49.6 percent positive and 49.6 percent negative and .8 percent indifferent. So the conclusion for lawyers was, “It seems the Internet cannot decide what to make of lawyers.”

Neither can I, Internet, neither can I.

Finally I tried one last search, “voluntaryism.” That term came out as 100 percent positive, with the site concluding, “The Internet is absolutely positive about voluntaryism.”

Me too, Internet, me too.

— Clark County resident Debbie Harbeson is very glad to learn that “the Internet is absolutely positive about big butts.”