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POLICY: PRI has a blog, almost.

Sometimes you just wonder how these press release lists get put together. The Pacific Research Institute, which with its fellow traveler organization the Fraser Institute, has been issuing nutty and just plain wrong "research" about Canadian health care for years, decided to start sending me press releases today. They now have their own blog (well it’s not alive yet but a press release is as good as, dontcha think?). The blog will explain why importing drugs from Canada is a bad idea and why paying more for drugs is a good idea.

Well as they’re nice enough to send me the release I went and looked at their annual report, and if you like pictures of Maggie Thatcher you should go look there too. It does worry me a little when Sally Pipes can only find Rick "Man on Dog" Santorum to quote effusive things about her health care work, but I guess you get praise where you can.

However, their press release also says that they solicit corporate contributions from the health care industry. No biggie, as I do that too (although I call it consulting work!), but you might get the impression that the "research" PRI conducts probably fits the views of certain parts of the health care industry very well. So well that I’m a little surprised PRI only manages to get 15% of its $4.1m budget out of the corporate sector–although it gets another $2m odd from "foundations" which may well be corporate-controlled ones too. But they’re not honest enough in the report to say who it is who’s coughing up.

What you really see from reading the report is that PRI has been somewhat effective in turning a small amount of money into either effective policy interventions or totally muddying the policy waters (take your pick). The end result is that whenever Canadian health care comes up, there is a loony cry from the right that manages to obscure a few basic facts, and makes sure that no rational conversation can be had here about real health reform. Even though the genuinely independent Lewin group showed that single payer would save money in California–a report that sank without trace. So to that extent, this little corner of the vast right wing conspiracy (in San Francisco no less!) is doing its job. Pity that PRI’s claim about individual freedom being the be-all and end-all don’t appear to have transmuted over to a stated position on the drug war or medical marijuana.  Perhaps they don’t notice where they are. The Independent Institute, a more intellectually honest libertarian think tank across the Bay has no such qualms.

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  1. Matthew is great.
    Your letter to the editor yesterday in the “Atlanta Journal-Constitution” was good too. I personally didn’t like the fact that you said, “It may pain conservatives to admit it, but the argument exists that a civilized society must contribute publicly to health care for groups such as the poor or elderly.”
    President Bush has said that in many speeches. I suspect you know that and this was just a trick to get your letter published.
    You end with, “The conservative health care platform may require less time to convince the left if it experiments with new market-based approaches to old public health problems like private Medicaid and Medicare accounts for the poor and elderly.”
    This is correct. Iowa just passed HSAs as a new option in Medicaid. President Bush said, “I believe in more options, more choices, more freedom in Medicare, including Medical Savings Accounts (MSA).”
    In Medicare I believe the HSA is called “Medicare Savings Accounts” or MSA once again. The rules were written in the Balanced Budget Agreement of 1997 and the limitation on the number of Medicare participants was increased from 390,000 in the Medicare Rx Bill that was passed on 12/08/2003.
    My wife asked Dr. John Goodman a couple of years ago, “Why hasn’t the first senior been enrolled into the Medicare MSA program that was passed way back in 1997?” Dr Goodman said, “I have no idea.”

  2. I know you are not advertising. It’s just something that is said here a lot.
    Your articles are a nice addition. The article about tax credits not helping New York is exactly correct. New York’s premiums are very high and tax credits that will help most of the uninsured in America mean less in that highly regulated state.
    If employers consider employee health insurance costs, New York is not the state at the top of the list.
    You beat this blog in discussing tax credits.

  3. Mr. Greiner,
    I will try and “do better.” I understand that there are many discontents of HSAs, HDHPs, CDHPs, group insurance, employer insurance, individual insurance, the Golden Rule company, etc… The purpose of my blog is to collect relevant news; relevant because it might be good and right and also because it may be bad and wrong. I hope you realize that unless I explicitly advocate the awful scenarios you noted, I don’t, and neither do others. In fact, I hope to contribute to avoiding them.
    Trapier
    http://www.isemmelweis.com
    Ps…I am not advertising anything.

  4. Trapier,
    Thanks for being an HSA supporter. However your first article on your site this morning discusses a group employee health plan that is combined with an HSA. Of course you know if the employee is diagnosed with ovarian cancer and can’t work the employee will be put to COBRA for insurance termination. The HSA is portable but the insurance is not. Terminating young women with no hair leads to depression and depression and cancer is a deadly mix. You might consider discussing how dangerous a group plan is if you become sick. Also, the group plan mentioned has only 14 employees. To be eligible for 18 months of COBRA extension the employer would need 20 employees under federal law.
    I realize that you can’t find articles about employees losing their health insurance because they were too sick to work because of the media’s censorship of that topic. So you will just have to use your own brain power, good luck.
    Also, you do discuss Golden Rule which is individual health insurance where the insured can’t be singled out for termination due to a relationship with some employer. However, here again I think you could do better. You should consider a a dependent child who is diagnosed with cancer. Golden Rule’s termination policy is:
    “Continued Eligibility Requirements
    A covered person’s eligibility will cease on the earlier of the date a covered person:
    Ceases to be a dependent; or”
    So you can advertise Golden Rule if you want but I would point out that if a dependent child becomes sick they will be fried at a majority age. I mean really, what parent would put insurance on a child that they lose if they become sick or hurt?
    Other than that, keep up your good work.

  5. Dear Matthew,
    Let me be clear that I do not speak for any of the institutions mentioned. But, in general, Cato does not comment on the drug war as a subset of health, but rather “nanny state,” policy. Cato has an entirely distinct department of Health Policy Studies committed to consumer freedom within the medical process, and I support the logic of that separateness.
    Meanwhile, Roger Pilon, Cato’s VP for Legal Affairs, does advocate lifting the re-importation ban with “Drug Reimportation: The Free Market Solution,” Cato Policy Analysis No. 521: http://www.cato.org/pubs/pas/pa-521es.html
    Its stated purpose is not, however, to serve “an already exceedingly powerful special interest.” The analysis contends to not even champion reimportation foremost for its own sake. “The current ban should be lifted, therefore,” Pilon writes, “not to encourage reimportation, but to allow the incentives to surface that will ‘force’ wider use of market practices.” Perhaps this is in the spirit of safely and fairly applying incentives towards the relief of policy problems, as many Nobel Laureates in Economics have done.
    I agree with you, Matthew, that there are dollar-chasing, self-serving, commercial creatures in the world who understand markets and employ that knowledge to their benefit at the loss of others. Yet, I would argue there are some (though fewer in number) who want to use the rigorously defended theories of market economics to improve our ability to heal society. It may be easy to place all apologists of free exchange among the first, but some of those included in the second eagerly wait for your invitation to ally toward the noble and arduous effort of improving the defunct healing process we all share.
    Regards,
    Trapier
    http://www.isemmelweis.com

  6. Trapier. While I applaud you for your well reasoned argument, I must fault you on the basic facts. Despite a world of opportunity, Cato manages to spell out its opposition to the drug war and MM ban in many places, as does II. PRI, as far as I can tell, doesn’t mention it. Furthermore, several free-marketers (including some at Cato) are in favor of parallel imports, describing it as part of free trade. So PRI’s opposition to Canadian imports, which is the major thrust of their to-come blog, must be seen in the context of who else supports that position. And there is plenty of time, effort and money going behind their position from many in the US, notably PhRMA. Added to the paucity of some of their research on Canada, until confronted by further evidence that I’m missing, I’m inclined to believe that, despite what their propaganda says, promoting human freedom (such as advocating access to MM) is lower on their priority list than parotting the interests of an already exceedingly powerful special interest.

  7. Trapier. While I applaud you for your well reasoned argument, I must fault you on the basic facts. Despite a world of opportunity, Cato manages to spell out its opposition to the drug war and MM ban in many places, as does II. PRI, as far as I can tell, doesn’t mention it. Furthermore, several free-marketers (including some at Cato) are in favor of parallel imports, describing it as part of free trade. So PRI’s opposition to Canadian imports, which is the major thrust of their to-come blog, must be seen in the context of who else supports that position. And there is plenty of time, effort and money going behind their position from many in the US, notably PhRMA. Added to the paucity of some of their research on Canada, until confronted by further evidence that I’m missing, I’m inclined to believe that, despite what their propaganda says, promoting human freedom (such as advocating access to MM) is lower on their priority list than parotting the interests of an already exceedingly powerful special interest.

  8. You criticize PRI for its silence on the Drug war and medical marijuana. Have you seriously thought of an explantion for it?
    As an honest libertarian interested in health policy the first questions I often field, especially from other libertarians not knowledgeable in healthcare, is “what are your thoughts on medical marijuana?” Here’s what I say:
    “It’s true that the argument for freedom would extend to the use of marijuana, not just for medicinal purposes, but, in any form. And this could in turn extend to other illicit drugs. Yet I don’t plan on making my living fighting for heroine.”
    In a world that is 85% free, the areas in which a libertarian can argue are often uncomfortable. Last fall a NYTimes article covered a group of girls promoting eating disorders as a lifestyle choice rather than a disease. We know the costs, they said, and we know the benefits; society values body image and we take that the gains are greater than the losses.
    This is awkward, because the DSM-IV categorizes anorexia as a disease of the mind, not a viable, conscious choice that belongs to adolescent girls, or anyone for that matter. Still, I found myself arguing with a class of 17 pre-meds and one academic surgeon that these girls make a powerful argument given that we live in a free society. This was the honest thing to do, but did I like doing it? No. Do I want my sister behaving like this? No. Is it an interesting libertarian argument? Yes.
    Thankfully, in healthcare there are much more palatable stands to take for freedom. Is there a moral argument for extending the power of choice over routine care to consumers? Yes; political philosophers, including the founders of our constitution, include freedom as a natural, moral, birthright. Is there an economic argument? Yes; an army of Nobel Laureates in Economics have concluded in other fields that the market process, driven by an informed and active consumer class, is much more desirable than a planned economy, though they have no problem pointing out the discontents of free exchange.
    Yet there are differences between the Nobelists who point out where markets fail us and those fundamently opposed to the entire market process in healthcare who do the same: the first try to better harness the power of free exchange; the second are committed to killing it. And Nobelists have made us better when they have seen market weaknesses and earned their prizes for moving us towards better understandings of what a good market process would look like.
    Interestingly, there has never been a Nobel Prize awarded specifically in Health Economics (though the ’72 prize went to Kenneth Arrow whose 1963 paper continues to influence how we think about health insurance today despite the fact that he completely whiffed on the concept of moral hazard, a mistake Mark V. Pauly corrected in 1968.) And there probably never will be a prize awarded in Health Economics as long as policy “wonks”, providers, and the populace retain market disdain.
    The goal of PRI, the I.I., or Cato, is to change that, to make the market argument. That will be a life’s work for the freedom fighter(s) who achieve(s) it. The trouble is, there aren’t that many of us and we tend to be comparatively less skilled in some areas since it is the temptation of the most knowledgeable to believe themselves all knowledgeable and qualified for the job of planning an economy as complex as healthcare. We have limited resources and in the face of scarcity we are forced to choose. We just can’t afford to fight for those who want to get high while millions upon millions daily inherit a defunct economy, costly, of poor quality, and without choices, and suffer needlessly for it.
    Trapier K. Michael
    http://www.isemmelweis.com

  9. I assumed he was talking about Rick “Man on Dog” Santorum. If that is the case he better not read any blogs if he is that tender.

  10. So is “forgetit” talking about me or you, Ron. Whatcha think?
    And of course the US raiding Canada for drugs would be bad for Canada. Nice to know that you feel that the US should run policies that are good for other countries!

  11. I see name calling in place of arguments. Insinuation replacing logic. First visit here and the last one as well.

  12. Matthew writes, “The blog will explain why importing drugs from Canada is a bad idea and why paying more for drugs is a good idea.”
    Bad for who? The drug companies are warning the Canadians that if they sell to Americans they will be cut off from their low drug prices. So selling drugs to Americans will be bad for those Canadians.

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