Tuesday, October 21, 2014

Would A Single-Payer System Have Stopped The Spread of Ebola?




Two medical stories are headlined in recent Oregon newspapers.  One is local,  but with national implications.  The other is national,  but with local implications.  A common denominator lies beneath both stories.

In Oregon more than ten thousand people got inflated tax credits when buying insurance through the exchange set up under Obamacare.  The excess credits may exceed $100 per month, so some people will have to pay substantial amounts back to the federal government.  

The national news is the death of Thomas Duncan from Ebola and the infection of several people who treated him.  Duncan was sent home, when he first visited a Dallas hospital’s emergency room, despite highly suspicious symptoms.  After giving conflicting answers to embarrassing questions raised by this situation, the hospital has hired a public relations firm and allegedly has prohibited staff members from talking to the press. 


Obamacare may have been a step in the right direction, but a common denominator underlying both of these stories is its inadequacy and poor design. Partly due to refusal by many states (including Texas) to expand Medicaid,   tens of millions remain uninsured.  And Obamacare excluded coverage for foreign visitors and undocumented aliens. 

Thomas Duncan,  visiting from Liberia,  had no insurance.  There is informed speculation that the Texas hospital had a policy of not admitting emergency room patients who lack insurance.   If this is true,  it is no wonder that the hospital would need to hire a P.R. firm and put a gag rule on its employees.

Obamacare’s basic problem is complexity.  Complexity made creation of  web-based portals very difficult, and complexity forces individuals and employers to make choices they are poorly equipped to make.  Much of this complexity flows from government subsidies, which allow people to purchase insurance, and especially from the need to document and monitor each person’s continuing eligibility. 

Subsidies are obviously needed.  Otherwise poor people who aren’t eligible for Medicaid would be unable to comply with the Obamacare mandate.  And it is obvious that the subsidy for each individual needs to be on a sliding scale based on that individual’s income.  But incomes can change,  thus changing how much subsidy someone is entitled to and sometimes causing loss of all eligibility. Furthermore,  as people’s changing fortunes move them in and out of Medicaid,  the doctors who are “in-network” for them can change, forcing them to find new providers. 

All of these problems---the need to reimburse the government for excessive tax-credits,  the “churn” as people drop in and out of eligibility for subsidies or for Medicaid,  the lack of universal coverage which may have started an Ebola epidemic in the U.S.---could have been avoided by enactment of a single-payer insurance system covering all people in the U.S. and financed by general taxes.

If Mr. Duncan had been covered by such an insurance system, he might well be alive today and he might not have exposed so many other people to Ebola. 

Under a single-payer system people would still receive implicit subsidies based on their income,  but this would be taken care of by the existing income tax system under which lower income people pay less tax and higher income people pay more.  The Supreme Court’s highly dubious reasoning by which it allowed states to opt-out of Medicaid expansion would become irrelevant,  since with universal coverage Medicaid would no longer be needed.  There would no longer be doctors who are “in-network” or “out-of network.”

A single-payer insurance system would not  solve all our problems, but the problems with Obamacare and the even bigger problems prior to Obamacare suggest we need to enact one as soon as possible.

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This op-ed has run in The Lund Report.

Tuesday, October 14, 2014

How a military draft could be legitimate (written in late 1970s)

I just typed this up to post on Facebook, responding to one of my former students who wrote an op-ed calling for reintroduction of military conscription in the U.S.  It is taken from the instructor's manual to my 1981 college textbook,  and I had to type it because the textbook and the manual were written before I could do computer editing.

"In the instructor's manual for my 1981 college textbook, I commented on how a LEGITIMATE draft could be done: Noting that conscription has always been "selective," I noted that "A less obvious alternative, for a truly colossal emergency, might be general or UNselective conscription. EVERYBODY, literally, would be drafted at the same moment---men, women, children, with no exceptions whatever. Thus THIS conscription could be accomplished by government-as-legislator rather than by government-as-bandit .... 

"Each person would then be subject to serving where ordered to do so. Young children would probably be ordered to continue playing or going to school. 'They also serve who only sit and wait.' Many people would be ordered to perform--perhaps continue performing--productive roles in farms, factories, and mines. 

"One startling aspect of such a total draft would be that people already IN the armed forces would also have to be drafted. No exceptions means NO exceptions! Thus generals and admirals would be drafted. The enthusiasm of such professional officers (as well as congressmen and other top government officials) at being drafted might be minimal because of another feature of this draft. Since a draft is based on repudiation of the market (during the emergency) as a means of raising and allocating manpower, all draftees must receive exactly the same compensation (cash plus fringes) while the emergency continues. The impossibility of providing everybody with an admiral's standard of living is self-evident; hence admirals will have to live like privates while the draft remains in effect. Of course the top brass, military and civilian, are all very patriotic and would undoubtedly be willing to sacrifice for the national welfare if necessary. But they might be somewhat more conservative in their willingness to decide that an emergency exists."

Monday, July 21, 2014

Postlude for organ: O God of Every Nation

On July 13 I premiered my  new organ piece,  playing it as the postlude at the Corvallis (Oregon) First Congregational Church (UCC). 

For a video of this,  click here.

The music for this piece,  which is not copyrighted and can be freely used,  can be seen and printed from my website.

Tuesday, July 8, 2014

The Declaration of Independence Was A Mistake


This op-ed was published by the Gazette-Times (Corvallis, Oregon) on June 30, 2004.  I am posting it here because that website may no longer be accessible by non-subscribers.
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The Chinese Communist leader Mao Tse-Tung once observed that, "There is nothing as practical as a good theory." Unfortunately for China, he didn't have one. Even more unfortunately, Americans don't have one, either. (Just because we correctly disagreed with Mao's perverse principles doesn't mean that ours are correct. It is possible for both sides of a disagreement to be wrong.)

The fundamental error in U.S. political doctrine is our assumption¸ never adequately examined, that nations and "peoples" ought to have a right to independence and "self-determination." Although this principle was best articulated by President Woodrow Wilson during World War I, its roots go clear back to the Declaration of Independence and the subsequent war by which we tore ourselves loose from British rule.

The problem with a claimed right of self-determination is that government isn't like that. Political philosophers have long understood that the essence of government is its power to impose sanctions on people, the power in the inspired language of the Constitution to deprive people of life, liberty or property. Since nobody will consent to a transaction in which they are to be executed, imprisoned, or fined, our basic relationship with government is an involuntary association, not a voluntary one.

St. Thomas Aquinas was pointing out this unpleasant fact about government when he noted that "Taking away justice, then, what is government but a great robber band?" Everybody understands that the relationship between a robber and his victim is an involuntary association. Even Mao Tse-tung, who being merely human could not always manage to be wrong, got something right when he observed that "All political power grows out of the barrel of a gun."

It is perverse to claim a right to voluntarily select the people with whom we are going to be involuntarily associated. Any foreign policy based on such a belief cannot help but confuse and disorient us and our leaders. And it throws us seriously off-balance when we are dealing with terrorists.

It is often said that organizations like the PLO, the ETA (Basque separatists in Spain), the IRA (Catholic separatists in Northern Ireland), the Chechen separatists in Russia, etc., are pursuing legitimate goals with illegitimate means. This is incorrect. These organizations are pursuing illegitimate goals - national independence - with illegitimate means - terrorism.

The people for whom these organizations claim to speak may indeed have legitimate grievances. But if they are being singled out for unjust treatment by the governments they are currently under, the proper remedy is to demand that they be treated equally under the law along with everyone else in their country, not that they be allowed to go their own way.

Americans have seen how well this reformist approach works. Black people in America historically suffered from intolerable injustices, but mainstream black leaders correctly resisted the bad precedent set by the Declaration of Independence and demanded equality before the law rather than separation.

It may take Americans some time to recognize that my argument is a correct one. Understanding this will not be easy for people whose principal political holiday is Independence Day!

Of course, it is too late now to repudiate the Declaration of Independence and submit once again to British rule. But the vigor with which the United States stomped on the attempt by its southern states to secede implicitly admitted that we recognize no right to self-determination when it is directed against our own government. It is high time that we explicitly admit that our revolution was a mistake, and stop condoning efforts to secede from other countries, too.

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Paul F. deLespinasse of Corvallis is a retired professor of political science from Adrian College in Michigan. His e-mail address is pdeles@proaxis.com

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Tuesday, January 7, 2014

How to increase the real minimum wage


Proposals to increase the minimum wage are being debated again, with both sides treating us to the usual arguments. Those favoring increases note the impossibility of supporting a family on the current minimum:  $7.25 an hour federally up to around $10 in some states.  This is obviously true. Opponents say increasing labor costs will reduce the number of workers hired, increasing unemployment.  This also is true, though the extent of the damage is unclear. 

We need a policy that would increase the prevailing minimum wage to a decent level selected by the government,  perhaps $15 hourly,  without increasing unemployment.

Of all places,  North Dakota may suggest the way.  The oil boom there has produced such a labor shortage that some McDonalds are paying rank and file workers $15 to $20 per hour. Some even offer signing bonuses.

North Dakota undermines claims that increasing the legal minimum would drive fast food establishments out of business.  McDonalds pays less in the rest of the country, not because it can’t afford to pay more,  but because conditions allow it to get workers for much less.  Most places the supply of low-skill workers is greater than the demand for them, and employers are not in business for their health.

We seem to be in a trap:  Unemployment could be reduced by reducing the minimum wage,  but this would aggravate already intolerable economic inequality.  A higher floor under wages could reduce economic inequality (for those with jobs) but reduce the number of jobs. 

We can avoid this trap by make the whole country more like North Dakota.  This would require a federal program offering full time jobs for everyone over 18  for (say) $15 an hour plus legally-required fringe benefits like health insurance.   Those hired would do things that need doing but are not getting done—helping old people,  maintaining parks,  picking up litter,  tutoring kids,  keeping an eye out for vandals, taking care of invalids,  comforting the dying,  you name it. 

Given such a program, places like McDonalds would have to pay staff at least as well as the federal program does to get enough workers.  And if employers reduce staffing because of increased costs, it wouldn’t increase unemployment; the government program would pick up the slack.  There would in fact be no unemployment.  None! 

The biggest disadvantage of this program is that it would visibly cost taxpayers something.  But it is more honest than minimum wage laws which promote noble objectives without apparently costing anybody anything and which do not guarantee a job,  just  minimum hourly pay if you can find a job.    

Benefits like improved personal security against unemployment would be an offset against the costs. The services provided by people working under the program would also be a plus.  And the program could partly be paid for by eliminating or reducing the Earned Income Tax Credit,  food stamps,  unemployment compensation, and other federal benefits.  Minimum wage laws could be repealed, eliminating the costs of enforcing them,  and no one would notice. 

It is time to put a real floor under wages and eliminate the scourge of unemployment once and for all.  North Dakota proves that this is not impossible as a matter of economics.  Now all we need is leaders who will make it politically possible.

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This piece has run in the Grand Forks Herald.  


Wednesday, December 18, 2013

Catching up on postings to this blog

I have just posted a number of op-ed articles and 3 published letters to the Wall Street Journal that I have written during the last year but not gotten around to posting.  

Obamacare and Part-Time Work----letter to the Wall Street Journal

To the editor:

Andrew Puzder argues correctly that Obamacare encourages employers to add more part-time and fewer full-time workers.  But he pushes his argument too far. 

When the mandate finally kicks in,  employers who must start providing insurance for their higher-paid workers can reduce cash wages by the amount of their premiums and thus incur no increase in their total cost of labor, as those who already supply insurance are doing now.    

Employers with low-paid workers cannot reduce wages below the legal minimum and will therefore reduce them to part-time.  These are the businesses for which Puzder’s analysis is correct.

Employers with higher-paid workers would not save money by making them all part-time.  Such a strategy would ignore the value placed by workers on insurance. To be equally attractive to newly part-time workers,  such employers would have to increase wages by more than their decreased insurance costs since individually purchased insurance costs more and would not be tax-sheltered.  And their management expenses would increase because of the need to supervise more workers.    

Mr. Puzder is chief executive of a restaurant chain, and restaurants do employ large numbers of  low-wage workers,  but his analysis cannot be extended to  the economy in general.

Paul deLespinasse

CorvallisOregon

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A version of this letter was published by the Wall Street Journal