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

This week's column...

 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?

This week's column...

 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.”

Proof that anarchy is more peaceful than government

HARBESON: Great debate: Bumper stickers or license plates?

By DEBBIE HARBESON Indiana columnist

 

> SOUTHERN INDIANA — People love to share messages and make personal statements by slapping bumper stickers on the backs of their cars. As we drive around and read bumper stickers we can learn a lot about a person, assuming the bumper sticker was placed there by the current owner.

We can discover important distinctions, such as whether someone is a cat person or a dog person. Name the subject or issue and you can find a bumper sticker about it. There’s probably even a bumper sticker out there somewhere that says “down with bumper stickers.”

The messages displayed on one’s car can sometimes be quite controversial and yet rarely do we hear about them being the direct cause of a conflict with others. Since everyone enjoys the same freedom to control the privately owned areas on their cars, people can and do tolerate differences and co-exist peacefully.

However, there’s one space on your car that is not so peaceful. Although it’s a relatively tiny space, measuring a mere 12 inches by 6 inches, it’s been the cause of huge conflicts. I’m talking of course about your government-issued license plate.

This tiny space, this piece of metal the government requires that you screw into the rear end of your car, became a source of conflict shortly after the government started issuing specialty plates intended to help raise funds for nonprofit organizations. The problem was easily predicted because anytime the government controls any boundaries, although they claim that their existence in the area brings peace, in reality it often only brings conflict.

Last year, people who didn’t agree with the messages being promoted by some groups began to moan and complain because those groups were being allowed to raise funds and spread their message on government property. These people were never concerned about the government handing out this special benefit as long as they had no problem with the organization’s message.

As a result of this controversy, arguments arose about who should be allowed to use the government property to raise funds and promote their cause and who shouldn’t. After the BMV found a way to remove one particularly controversial nonprofit from the program, it caused even more controversy.

So now specialty plates are suddenly a “big problem” which means politicians now “need” to work on “fixing” the situation. Indiana’s government has already spent time and money on a legislative interim study committee created specifically for this issue and they met early this month.

The politicians are spitting out their usual controlling language, saying specialty plates are a good idea but there just needs to be “tighter regulations” and “more oversight.”

This type of language almost always translates directly into more money being spent as the government defines, creates and administers current and new regulations. This will not only add to the bureaucracy but it will very likely also lead to costly lawsuits. [There have already been lawsuits over specialty plates before last year’s brouhaha began.]

Many people don’t have much problem with specialty plates particularly because the folks who get them pay $40 extra and the money goes to the nonprofit. Well, not all of it — $15 goes to the government for, you know, “administrative fees.”

To me, it makes much more sense to simply buy a $2 bumper sticker and donate $38 to the organization, removing the government completely from the transaction.

It’s very likely though, that plenty of time will be spent during this winter’s legislative session fussing about specialty license plates. Many nonprofits have become dependent on this form of government assistance and will fight to keep it. To remain relevant, politicians will fan the fires and push opposing groups against each other.

This issue is a great example to use to critically examine whether or not what you’ve been told all your life about governments is really true. The next time you are sitting in a traffic jam looking at bumper stickers and license plates, ask yourself this question — which area is more peaceful, the boundary that exists in a state of market anarchy, or the boundary that is controlled by government?

Sellersburg resident Debbie Harbeson has no bumper stickers on her car because she likes to keep her opinions to herself.

Evaluating Government School Teachers

HARBESON: There’s a lesson to be taught here

> SOUTHERN INDIANA — Why are so many government school teachers upset at the idea of being at least partly evaluated according to the test scores of the students they are supposed to be teaching? Isn’t that their job — to cram government-mandated curriculum into each child’s brain so they can pass a government-approved test?

Evaluating teachers by the test scores of their students makes perfect sense considering the factory-style setup of the school system. Each widget, I mean student, moves along the assembly line and is molded according to strict specifications set by the administrators and politicians who control these government school factories.

So it’s certainly logical to verify whether or not the student-widgets match the specs before they move farther along the conveyor belt to the next laborer who performs the next step in the process.

How can government school teachers complain about this? After all, by accepting these jobs, they are actively supporting the factory model of education and if a one-size-fits-all evaluation is valid for the students then why shouldn’t the teachers also be judged on the one-size-fits-all evaluation method?

If the kids have to endure year after year of standardized testing, shouldn’t the teachers, who dutifully play their part in this compulsorily funded scheme (happily collecting the pay and benefits), also have to endure being evaluated according to how well the students do on these things?

Teachers do not think it’s fair to be evaluated on how the student performs on the test because there could be lots of reasons why a child might not do well. They don’t want to be judged based on the performance of another individual.

Yet teachers themselves push a common “real life” lesson on the students — group projects. I’ve heard many people complain about group projects they were forced to do in school. Everyone seems to have a story about a member of a group who did not do well with his or her part of the project and brought the final score down for everyone in the group. If this is valid “real life” experience for the students, then why isn’t it for the teachers? They’re all in this together, right?

The most common defense I’ve heard lately about kids who don’t do well is that it’s the parents’ fault. They are uninvolved, don’t care and don’t cooperate. This may indeed be a valid concern. But if it is, then the teachers can’t have it both ways. If they want to place the blame for low scores on the parents then they must also place the credit for good scores on the parents.

It’s one thing for teachers to say they don’t want to be evaluated in this manner and another for them to use unions and attempt to create barriers to prevent experimenting with this option. The whole idea of government unions is contradictory anyway. These unions are not fighting against “the man” — some capitalist pig of a business owner — they are merely making further demands on taxpayers who are already being coerced to pay their salaries in the first place.

However, there does not have to be a one-size-fits-all answer to the task of teacher evaluation. If we separated education from government and opened it up to the voluntary market, people who think standardized testing works well and would like to see teachers directly evaluated on those test results could set up and fund an organization built on that foundation. Those who don’t think standardized testing promotes learning could create and fund their own alternatives.

True education is unique to each individual and there are many different needs and desires within families. The most respectful way to help each family meet those needs is to set education free from government control so a wide variety of educational philosophies can flourish and compete. This would create unlimited benefits to society as education in general grows much stronger, healthier and more dynamic.

— Clark County resident Debbie Harbeson is tired of smelling the stagnant, stale air of government run factories called schools.

Does Government Enhance Quality of Life?

HARBESON: Quality is job one

> SOUTHERN INDIANA — New Albany City Council member Dan Coffey recently introduced a resolution to move city council discretionary funds to the Board of Public Works and Safety. When questioned by other council members for specifics as to how the money will be spent, Coffey said the money is intended for “quality of life” purposes.

This really confused several members and no wonder. “Quality of life” is one of those fluffy, fuzzy phrases politicians love to utter when they don’t want to answer a question. When pushed further though, Coffey did offer up an example — a recent “Beach Day” where the fire department turned on its hoses so kids in public housing facilities could splash in the water.

So I guess quality of life has something to do with being wet. That does make some sense and not just for kids. I know many men who would say their quality of life definitely goes up when women in T-shirts get wet.

Seriously though, if asked, we know the examples people would offer up as quality of life issues would be virtually unlimited. When it comes right down to it, quality of life is one of those vague terms that can vary widely between individuals. Your determination of quality of life may agree with mine and it may not.

For example I like to get up early and go on bike rides. But I know others who would rather go out dancing, stay up all night and sleep in. Still others don’t care if they have to get up early or stay up late, as long as they can see wet women in T-shirts.

Isn’t it contradictory for government entities to take your money through threats of force and then tell you they are going to spend it to improve your quality of life? Wouldn’t your quality of life go up if they just got out of the way so you can determine for yourself how to give your life quality? Isn’t quality of life built on a foundation of mutually respectful voluntary relationships with others — relationships without coercion and threats of violence?

Even with projects that we have been told are “necessary and proper” functions of government, it’s impossible to definitively determine quality of life to everyone’s satisfaction. For example, just last week a recent letter to the editor in this paper was from a New Albany resident who claims that the quality of life in the city will go up if all of the city government roads were two-way instead of one-way.

When the questioning members of the city council continued to push Coffey for specifics, he finally said, “You know what, figure it out.”

What does that mean? It can’t mean he really wants them to determine quality of life purposes because at a subsequent meeting the issue came up again when discussing the city’s portion of costs for a new air conditioner for the City-County Building.

Coffey said that would not be a quality of life issue and in response a council person said it is for the people who work in the building. That’s probably true, particularly if they also get the fire department in there to spray any woman wearing T-shirts.

Of course, we must remember that both sides are really just concerned about who gets control of other people’s money. After all, those skeptical, questioning council members who voted against the funds being moved do not appear to object to the concept of a discretionary fund. Yet a “discretionary” fund is as equally confusing, fluffy and fuzzy for a city council when it comes to determining “proper” spending.

At some point during the discussions about this money, it was mentioned that spending it on the upcoming city bicentennial celebration would be a nice quality of life expenditure. What do you think? Does government spending on items like bicentennial celebrations really improve anyone’s quality of life or is it just a local example of bread and circuses meant to appease and deflect from the reality that these people are bickering over spending money that no one gave them voluntarily?

— Southern Indiana resident Debbie Harbeson knows that if her T-shirt ever gets wet, it would probably not enhance anyone’s quality of life.