A Swift Boat Kick in the Teeth
I can find only one place in Matt Welch's "A Swift Boat Kick in the Teeth" (November) where Welch actually addresses something he found to be untrue in the swift boat vets' claims: "For instance, in the original commercial, military doctor Van O'Dell said, 'John Kerry lied to get his Bronze Star….I know, I was there, I saw what happened.' In fact he wasn't there, neither when Kerry was wounded nor when he gave his account of the incident."
If Welch is such a great chaff separator, what are his sources for this statement? Did Van O'Dell ever change his claim? Welch has a Maureen Dowdish ellipsis in there. What did he cut out from what Van O'Dell said?
Welch never addresses the most damning claim of the swift boat vets, that Kerry behaved traitorously after returning from Vietnam. His statements on the record to Congress are an excellent illustration of a drunken (on the possibility of power) sailor in a bar reporting something he has "heard," not what he has witnessed. That these statements were used by North Vietnamese on our POWs is a matter of record as well.
Iowa City, IA
Matt Welch replies: Luke Granfield is correct, and I am in error. Van O'Dell was there; I mixed him up with swift boater Louis Leston, who was not. I regret the foul-up.
Mandatory Health Insurance Now!
Ronald Bailey advocates "Mandatory Health Insurance Now!" (November). So did some Republicans in Congress during the height of the Billarycare proposal 10 years ago, and so has The Economist. Here's why they're all wrong.
Bailey likens a mandate that adults buy health insurance to requirements for car and home insurance. This is a bad analogy. If you don't drive or own a car, you don't have to buy auto insurance. If you aren't actually paying a mortgage, you don't have to buy home insurance.
Bailey is also guilty of bad math. He claims policies covering catastrophic expenses "typically" cost less than $300 per month for a family of four. A typical figure for just a married couple (no children, both in excellent health) is actually over $400 a month. The Richmond Times-Dispatch just mentioned the case of one couple who were quoted $1,700 per month for full coverage by Anthem, the health insurer of last resort in Virginia. Oh, and good luck getting coverage at any price if you have any pre-existing conditions or a child with medical problems. Don't forget the market: Impose a mandate, and watch premiums skyrocket as insurers take advantage.
Bailey mentions couples with income of more than $50,000 a year who "choose" to go without health insurance. Someone working for a company making that amount typically would have employer-provided insurance. A little checking would reveal that many of these people are self-employed, trying to run small businesses, or working several part-time jobs to make that amount, and that this is not what they necessarily make every year. Fifty grand is not a lot of income any more: In many areas of the country it is not enough to qualify for a home mortgage, for example. Impose a mandate, and see a lot of struggling small businesses close.
Realistically speaking, what would Bailey propose doing with those who lose their jobs and are unable to pay for this mandated health insurance? Throw them in jail? Fine them? If they can't afford insurance, how will they afford a fine? Mandating health insurance in response to the ongoing crisis in medical care is like solving the problem of affordable housing by mandating that everyone buy a house. Such a mandate is unworkable, unconstitutional, and unlibertarian.
Edwin Krampitz Jr.
The Ronald Bailey article is interesting, but there seem to be two striking flaws in the proposal. Group health insurance in large companies protects the individual with costly conditions by including him with the less costly. As an individual, he will be dropped or his rates will soar.
As for a large deductible making people smart consumers, this only applies to people who are already putting the least strain on the system. People with big medical costs know that they are going to fulfill the deductible at the start of the year, so they have no incentive to shop around. Truth is, the healthy will not give much thought to cost until they get a nasty health surprise, and that's not the time to shop.
San Francisco, CA
By endorsing mandatory health insurance, Ronald Bailey grabbed hold of an important plank in any effective platform of an improved health care system. But he may have promised more than it will likely deliver.
The best analogy is to the workers' compensation system in the United States, in which I have worked for some time. Coverage is not perfect, but almost all civilian workers enjoy adequate protections, including defined benefits and assurance that the employer has the financial means to honor its obligations. Gaming by workers, employers, and insurers is constrained. Except in pockets, there is no crisis of the uninsured or underinsured.
For a telling exception, look to asbestos-related diseases, which are almost entirely work-related. To sighs of relief from the state workers' comp systems, but ultimately great disturbance to the American judicial system and economy, asbestos lawyers in the 1970s won the ability to file much more open-ended product liability suits. Had asbestos been kept within workers' compensation and had personal injury law firms been less lubricated from asbestos settlements, we might today have a smaller personal injury suit problem in the nation.
But the history of workers' comp has not shown that open competition among private insurers is more successful than single payer or a mix of private and government insurance. Washington and Ohio, for example, are two of the handful of states with single-payer workers' comp systems. In numerous other states, large state-sponsored insurers compete against private insurers. At day's end, how insurance is organized does not seem to make much of a difference in employer and worker satisfaction or in relative costs.
Ronald Bailey replies: First, I want to stress that mandatory health insurance is a second-best proposal. A totally free market system would be preferable; it's just not likely politically. Mandatory health insurance is a way to stop creeping socialization and preserve private medicine.
Regarding my math, Edwin Krampitz must be thinking of low-deductible insurance. I got my figures from Golden Rule Health Insurance but found, with just a few clicks, quotes for 11 high-deductible policies for a family of four ranging from $155 per month to $290 per month, with many more offered for below $400 per month. (As for the $50,000 figure, I simply quoted Sen. Bill Frist as evidence that pressure to require people to buy insurance is building.)
Krampitz should also think about just how many small businesses are being bankrupted by our current dysfunctional health insurance system. And there is no need for fines or jail under my proposal. If he had read a bit more carefully, Krampitz would have found that I suggest that people have health savings accounts that could be used to pay for health insurance premiums while they are between jobs, and as a last resort that the federal government provide vouchers for our poorest citizens to purchase private health insurance.
Richard Bellerose's point that current group plans offered by companies cover costly individuals is well taken. Mandated catastrophic health insurance will have to be offered under some sort of community rating system so that the level of risk an individual consumer poses to an insurer does not affect the premium paid. With regard to his second objection, individuals would be required only to buy insurance to cover catastrophic health costs. If they want low-deductible policies, they will have to pay more based on their actual risks and/or save for their additional expenses in their health savings accounts. This is not a perfect system, just a hell of a lot better than the likely alternatives.
To Peter Rousmaniere: Don't get me started on tort reform.