Single-Payer and Circumcision in America

In my second response to Hanna Rosin’s posts on circumcision at The Daily Dish, I closed with this:

As a circumcised male, why do I care whether circumcision is mandated by the government or merely by my parents? The result – forced circumcision – is the same for me. Basically, Rosin engages in the “if you don’t like circumcision, don’t circumcise your son” defense. This is wrong. The case against circumcision centers on the boy as a (healthy) human being, not the boy as a son of parents making a choice.

This is the core of the ethical refutation of prophylactic infant male circumcision. Proxy consent cannot be justified on any grounds because the surgery is unnecessary, permanent, and carries an inherent risk of damage beyond what is deemed acceptable. On the last point, remember that no one considers the boy’s potential future disagreement with society’s definition of acceptable.

Ms. Rosin’s passage that prompted my comment involved the question of government-mandated circumcision. The CDC is not recommending that, of course. My point stands because, to the circumcised child, an influenced decision is no better than a required non-decision if he does not wish to be circumcised. But it does raise an interesting point for the current debate over health insurance reform that I’ve attempted to make in the past. From Ed Morrissey:

I’m neutral on the issue of circumcision, which has become a controversial practice, but find this idea of interventions very, very odd. In the first place, circumcision does not provide an immunity to STDs, not AIDS or anything else. Studies indicate that circumcised males may have less danger of acquiring an infection, but as the NYT points out, that’s from heterosexual relations — a very minor channel of AIDS communication in the US. Men have much better choices than circumcision for avoiding HIV infection, including the use of condoms (still not a perfect defense, but better than circumcision), refraining from intravenous drug use with shared needles, avoiding high-risk sexual practices altogether, and so on.

Why should the CDC push circumcision at all? The government has no business being in the middle of that decision. Under ObamaCare, however, when the government starts paying more and more of the health-care tab, they will point to ambiguous cost savings down the road — in this and other cases, decades down the road — to pressure Americans into surrendering their choices now. [ed. note: surrendering the choices of their children]

Apart from unnecessarily cluttering the single-payer issue with the “ObamaCare” phrase, this is exactly right, I think. How often do we need to see the public health community ramble on about the cost-benefit analysis “proving” that the net effect of prophylactic infant male circumcision is positive? How many lies pretending that non-essential and non-functional are synonyms will be necessary before we accept that not everyone shares the same view about what individuals should do and have, when those same people so often prove that they mistake their opinion for fact? Those people are at least as likely to make it to positions of power as anyone who considers the child’s lack of need and possible future objections.

It’s useful to highlight that most countries with an explicitly single-payer health care system have infant male circumcision rates that don’t approach 10%. Of course. But we can’t dismiss that the rates are greater than 0%. We must consider why.

I think the question of why narrows to culture. American culture places a high, irrational value on circumcision and its alleged wonders. Whether it’s the perceived health benefits for diseases that are already unlikely in a normal human state or a fear that schoolmates and sexual partners will laugh at him if he’s normal rather than common, we don’t evaluate circumcision factually. Ms. Rosin demonstrated this when she wrote that calling circumcision surgery is “a bit of an exaggeration.” No, it’s not, but our society possesses a strong anti-curiosity attitude on the topic. As Mr. Morrissey noted, the New York Times article provides all the necessary data to show that the CDC’s thinking is irrational. Yet, it’s picked up by people like Ms. Rosin who uncritically regurgitate only the parts they like and declare the resulting subset of findings uncontroversial. This is the low level of discourse in America surrounding circumcision and children.

If America had implemented a single-payer system at the same time England created its system, we could make a one-to-one comparison and the incidence of circumcision today would likely be close. But we didn’t. Instead, we have 60 additional years of circumcision to defend and justify. We have irrational beliefs to refute, should those holding those beliefs be willing to question them. We have a society that “knows” the foreskin is “just a flap of useless skin” and isn’t interested in hearing anything to the contrary, no matter how logical or based in scientific proof. A majority of our society still believes that the individual child is in the care of his parents for his medical decisions without a thought that this non-therapeutic surgical intervention is (social) experimentation, not medical care. The national discussion becomes about what people want to believe, not what is true. Cost is not a primary concern.

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Patrick Appel posted the Ed Morrissey link at The Daily Dish, where I found it. Mr. Appel writes:

The CDC is thinking of promoting circumcision, not requiring it. Whether or not you agree with the procedure, this controversy has nothing to do with health care reform. If single-payer leads to more circumcision, then how come America has among the highest rates of circumcised men in the world, much higher than most if not all countries with socialized medicine?

Mr. Appel makes the same mistake. The argument isn’t that single-payer leads to more circumcision. The argument is that American single-payer will not lead to a decrease in male circumcision. Either the system will pay or parents will pay. My view is the former because public health officials invariably think about the public rather than the individuals in the collective and politicians do not have the moral framework to say “no” to the inevitable backlash that would occur. Without legal reform recognizing the same rights for boys that we’ve already codified for girls, circumcision will continue in America, regardless of who pays.

Hanna Rosin Is Still Mistaken On Circumcision

Hanna Rosin summarizes the responses to her circumcision post from yesterday “into three basic categories”:

1. How can we do this to a child without his consent? There are so many things we do to children without their consent – change their school, banish their friends, give them drugs, abandon and neglect them. Removing a foreskin should not even fall in the top 20 ways to ruin your child’s life.

Right, ethics. She again fails to address this valid concern. Stating that “X is worse than Y” grants no legitimacy to Y.

2. “Foreskins are, well, fun,” writes one gay reader. My authority here is obviously limited. That said, all that research of specific areas of male sensitivity (Andrew cites some here) has always struck me as dubious. Erotic pleasure is a rich and complicated thing. Specific percentages of sensitivity can’t possibly sum up the experience.

Those last two sentences are true. Yet, she’s said nothing in defense of infant circumcision with either statement. Even if she’d explained why the research of specific areas of male sensitivity strikes her as dubious, what would that prove about infant circumcision? An extension of the ethical argument she’s failed to confront involves each individual deciding what constitutes preferred pleasure and sensitivity from and for his normal body. Erotic pleasure is a rich and complicated thing unique to the individual. Specific percentages of sensitivity evaluated by another can’t possibly sum up the experience for the individual.

3.Preventative surgery is a “bizarre notion.” This is somewhat more convincing. But for one thing, “surgery” is a bit of an exaggeration. We certainly cause infants minor pain for the greater public good many times, in the form of vaccines. It depends, I suppose, whether you consider HIV and STD’s a widespread public health crisis, or something affecting only a very few. I could get into the specifics of the research here, but I won’t.

Why is surgery in quotes? It is not an exaggeration to call circumcision surgery. Even her source from yesterday’s article, WebMD, defines circumcision as “the surgical removal of the foreskin, the tissue covering the head of the penis.” If there is a risk of death, no matter how small, circumcision is surgery. Her statement suggests a lack of curiosity on the subject for anything beyond what she wants to believe.

The vaccine argument is interesting and related. However, circumcision is the (surgical) removal of healthy, functioning tissue. The associated pain is a separate, secondary aspect for consideration. Our ability to control pain and its temporary presence are not defenses for performing the offending surgical procedure. Controlling pain does not render the intervention humane.

Nor are a boy’s genitals subject to the alleged needs of the public good. STDs require specific, individual actions. Those are actions that infants will not be undertaking for many years. When they begin engaging in those actions, they must use condoms, regardless of whether or not they still have their foreskin. Conveniently, a condom’s effectiveness is considerably higher than that of circumcision.

On the specifics of the research, it would be useful for her to state them. I’ll probably agree with her. It’s not necessary, though, because the discussion must circle back to ethics because she’s advocating circumcision on healthy infants, not adult volunteers. What we can do is not synonymous with what we should do.

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I didn’t include this in my objection yesterday because it disappears as an issue once we get the question of infant circumcision correct, but it’s an interesting point to pursue because a willingness to comprehend circumcision from perspective of the child’s rights is essential to ultimately grasping why circumcision is wrong. From her entry today:

…, my post defending circumcision taps into the current fears about “big government trying to mandate certain types of medical procedures,” as one reader wrote in.

As a circumcised male, why do I care whether circumcision is mandated by the government or merely by my parents? The result – forced circumcision – is the same for me. Basically, Rosin engages in the “if you don’t like circumcision, don’t circumcise your son” defense. This is wrong. The case against circumcision centers on the boy as a (healthy) human being, not the boy as a son of parents making a choice.

Hanna Rosin Is Mistaken On Circumcision

Hanna Rosin, guest-blogging for Andrew Sullivan, attempts to dismiss opposition to yesterday’s news about the CDC potentially recommending infant male circumcision.

But the procedure is only “controversial” because people have emotional, psychological and religious reactions to it. Scientifically speaking, it’s not remotely controversial. …

Ms. Rosin’s statement is nonsense because she ignores the ethics of implementing the findings. Her statement is nonsense because it ignores the evidence-based reality for infant males. The child’s genitals are healthy at the moment of surgery. This is not “emotional,” it is fact. Potential benefits do not make the surgical intervention on healthy infant males any more defensible.

Ms. Rosin continues:

… The anti-circumcision sites always refer to the American Academy of Pediatrics’ 1999 policy statement on circumcision, which declined to recommend the procedure. But that statement was issued before the most compelling studies emerged about the role circumcision plays in reducing the risk for transmission of HIV and other STD’s. …

The “most compelling studies” from Africa were performed on adult volunteers, which is the key point before we get to an assessment of the significant differences in the HIV epidemics in sub-Saharan Africa and the United States. The ethical issue can’t be resolved simply by noting that American culture already values the circumcision of males. American culture gets it wrong on what should be permitted on healthy children who do not need medical intervention and can’t consent to cosmetic surgery. Proxy consent must require medical need first, and medical ethics should demand only the least-invasive effective treatment for sick children. Prophylactic infant male circumcision fails both standards.

Ms. Rosin later acknowledges the differences between Africa and the United States, but she seeks to pretend that “the evidence is still pretty strong, and even stronger for STD’s” qualifies as a rebuttal. It doesn’t. The only supported suggestion is that adult male circumcision reduces the risk of female-to-male HIV transmission. Even if that accurately described the American situation, which it doesn’t, wasting finite medical resources on infant males who will not be engaging in any sexual activity, protected or not, for many years is asinine. And unethical, since we must loop back to the evidence-based reality that healthy infant males do not need circumcision.

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At the end of her post, Ms. Rosin raises a separate issue, apparently as a “gotcha”.

Over on DoubleX, KJ Dell’Antonia makes the good feminist point. With the HPV vaccines, conservatives raise a fuss that removing the risk of STD’s will make girls more sexually promiscuous. In the circumcision debate, silence on the promiscuity front.

There’s a double standard. What does that prove with respect to justifying infant male circumcision? Because a group of people make a stupid, sexist assertion about one point, their silence on another human sexuality topic confers credibility to the intervention? Focusing on this gives the unserious nutters too much credit.

Anyway, it’s far more logical to highlight the double standard inherent in having anti-FGM laws in America that prohibit parents and doctors from altering the genitals of female minors for any reason other than medical need, including the cultural and religious claims of the parents, while leaving open the option for parents to circumcise healthy male minors for any reason. There are important caveats to raise in the differences in male and female genital cutting, but the ethical question involves basic human rights. When considering that less invasive cutting is prohibited on female minors compared to what is permitted (and potentially encouraged) on male minors, the difference is in degree, not in kind, and can’t be swept away with the same tired deference to potential benefits. But that would involve addressing the issues rather than side-stepping them to score cheap rhetorical points and declaring victory.

I Do Matthew Yglesias’ Homework

Last week, in a post lamenting the not-odd fact that the words and actions of politicians do not match, Matthew Yglesias wrote this:

My personal feeling, the longer I spend in DC and working in the political domain, is that I get better and better at understanding other people’s ideologies. I also feel that people writing about politics often caricature opponents’ views as part of a rhetorical strategy. But I’ve been back-and-forth on the main issues long enough that I’m pretty sure I could switch this blog’s point of view and do a credible job of offering critiques-from-the-right of the progressive liberal health reform movement and the progressive liberal approach to domestic policy generally. One happy consequence of this is that I find the stubborn persistence of principled disagreement less mystifying than I once did, and have a greater appreciation for what I now think of as a certain irreducibly Kierkegaardian element to ideological commitment that, in turn, helps explain why so many “normal” people have such fuzzy political views.

The words I placed in bold are important to remember while reading an entry Mr. Yglesias posted¹ yesterday (archived version:

There’s lots of great stuff in this Ed Pilkington story about the dark side of free market health care (via Tomasky) but my favorite bit was this part:

Eventually his lack of motor control interfered with his work to the degree that he was forced to give up his practice. He fell instantly into a catch 22 that he had earlier seen entrap many of his own patients: no work, no health insurance, no treatment.

He remained uninsured and largely untreated for his progressively severe condition for the following 11 years. Blood tests that could have diagnosed him correctly were not done because he couldn’t afford the $200. Having lost his practice, he lost his mansion on the hill and now lives in a one-bedroom apartment in the suburbs. His Porsches have made way for bangers. Many times this erstwhile pillar of the medical establishment had to go without food in order to pay for basic medicines.

This is the kind of thing that makes it so hard for me to take seriously the idea that we can’t have the government give people health care because it might subject them to “rationing.” Depending on the details, it may or may not be correct to believe that any particular government program is being too stingy. But how does giving people nothing at all resolve that problem?

There are two issues here, closely related to Mr. Yglesias’ entry from last week linked above. The initial problem is glaring but only if you follow the link to the Ed Pilkington story. You wouldn’t know this from his excerpt, but the paragraph continues (emphasis mine):

He remained uninsured and largely untreated for his progressively severe condition for the following 11 years. Blood tests that could have diagnosed him correctly were not done because he couldn’t afford the $200. Having lost his practice, he lost his mansion on the hill and now lives in a one-bedroom apartment in the suburbs. His Porsches have made way for bangers. Many times this erstwhile pillar of the medical establishment had to go without food in order to pay for basic medicines. In 2000 Manley finally found the help he needed, at a clinic in Kansas City that acts as a rare safety net for uninsured people. He was swiftly diagnosed with Huntington’s disease, a degenerative genetic illness, and now receives regular medical attention through the clinic.

Mr. Yglesias’ excerpt is an incomplete representation of the complex facts, presumably to make the point – a caricature, if you will – that the free market has failed. But has it really failed?

Mr. Manley probably should’ve saved his money for potential later-life crises rather than buying a new Porsche every year, as the article states he did when his practice was strong. That is a relevant point, but it’s little more than a distraction to the real issue underlying Mr. Yglesias’ belief that everyone has an obligation to pay for everyone’s care, especially where the free market (allegedly) fails. Regardless, we have the system we have, not the one either side wishes. It shouldn’t have taken so long for Mr. Manley to receive the care he needed. Stating this needn’t be considered a concession or profound.

What Mr. Pilkington, and subsequently Mr. Yglesias, failed to explore is the care that Mr. Manley eventually received.

[Dr. Sharon] Lee’s clinic, Family Health Care, is a refuge of last resort. It picks up the pieces of lives left shattered by a health system that has failed them, and tries to glue them back together. It exists largely outside the parameters of formal health provision, raising funds through donations and paying all its 50 staff – Lee included – a flat rate of just $12 an hour.

Unlike Mr. Yglesias, I researched Family Health Care. It took approximately 10 minutes. Mr. Manley is getting care thanks to the “dark side of the free market.” Consider the clinic’s financial profile for 2005-2007:

The clinic receives 0% of its funding from government, meaning that the remaining 100% of its budget comes from the bank accounts of individuals, corporations, and non-profit organizations. Where is the free market failure to provide health care to those in need?

The structure of the American health care and insurance system is idiotic and needs reform. We should talk about that. The article even includes anecdotal stories to suggest problems that need to be addressed within the views of each side’s extremes. But presumably that wouldn’t have made the point for Mr. Pilkington or Mr. Yglesias that government needs to step in to protect the poor from the free market’s alleged failures, which are, we are told, ignored by the mean-spirited right-wing capitalist liars opposed to President Obama’s proposal. A neat, tidy box, indeed. That reaches closer to ideological commitment – propaganda, if you will – than journalism.

Update: I’ve struck the reference to propaganda. This isn’t that. Rather, Mr. Yglesias’ ideological commitment is more likely laziness embracing the appearance of victory.

¹ Normally I refuse to reprint an entire entry because links are survival. In this case, I can think of no other way to make my points.

Because… HIV!

It’s easy to talk about “public health” as if we’re all in one giant collective, with the same needs and desires. But that’s not true. We are each an individual, with specific, unique considerations. It is foolish to pretend that one approach is sufficient for everyone. It is offensive to behave as though the recipient of that one approach is irrelevant to whether or not it should be applied. Consider:

Public health officials [at the Centers for Disease Control and Prevention] are considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS.

The article is little more than the latest 6th Grade Current Events drivel churned out from the New York Times’ “Promote Infant Male Circumcision” template. Guess where the author/editor placed this paragraph in the story:

Circumcision is believed to protect men from infection with H.I.V. because …

The paragraph demonstrating that scientists do not yet understand how circumcision is supposed to reduce the risk of female-to-male HIV transmission should probably appear early, before the committed sentiments from those wishing to transfer the findings on adult volunteers in Africa to infant non-volunteers in America. Yet, it’s the last paragraph in the article. 916 words precede the significant fact that advocates do not yet know the relevant fact to support what they now wish to force on children.

Unsurprisingly, the word ethics appears nowhere in the article. The mere suggestion of potential benefits, despite the irrefutable fact that they are not needed and the high probability that they would not be desired, is enough to take pro-infant circumcision advocates seriously when the logic of basic human rights and medical ethics demands that we dismiss them from polite company. Instead, this passes for “serious”:

But Dr. Peter Kilmarx, chief of epidemiology for the division of H.I.V./AIDS prevention at the C.D.C., said that any step that could thwart the spread of H.I.V. must be given serious consideration.

“We have a significant H.I.V. epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic,” Dr. Kilmarx said. “What we’ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.”

Does “any potential intervention” have any ethical limitation? Removing the boy’s penis would surely solve the transmission problem. Is that acceptable?

I am, of course, being intentionally ludicrous. Removing a boy’s penis is not what Dr. Kilmarx is suggesting. Yet, he is promoting a mentality that how he fears HIV and values prevention is the only acceptable approach. Therefore, any intervention he deems appropriate must be appropriate. Because… HIV!

It will not work, for several key reasons, all easily identifiable and critical to the process:

He and other experts acknowledged that although the clinical trials of circumcision in Africa had dramatic results, the effects of circumcision in the United States were likely to be more muted because the disease is less prevalent here, because it spreads through different routes and because the health systems are so disparate as to be incomparable.
…

There is little to no evidence that circumcision protects men who have sex with men from infection.

Another reason circumcision would have less of an impact in the United States is that some 79 percent of adult American men are already circumcised, public health officials say.

Add to that the reality that any infant male circumcised today to prevent reduce his (already low) risk of HIV will not be sexually active until approximately 2024 or beyond. When he is sexually active, he’ll still need to wear a condom. Circumcision will have added nothing to his life as an HIV prevention. It’s success, however limited it would be, depends upon the male behaving irresponsibly. An assumption that a boy will be irresponsible is not a valid justification for the surgical removal of a healthy, functioning body part.

Yet, that basic human right – the same right accepted and codified for female minors – is denied to male minors for nonsensical reasons:

The academy is revising its guidelines, however, and is likely to do away with the neutral tone in favor of a more encouraging policy stating that circumcision has health benefits even beyond H.I.V. prevention, like reducing urinary tract infections for baby boys, said Dr. Michael Brady, a consultant to the American Academy of Pediatrics.

He said the academy would probably stop short of recommending routine surgery, however. “We do have evidence to suggest there are health benefits, and families should be given an opportunity to know what they are,” he said. But, he said, the value of circumcision for H.I.V. protection in the United States is difficult to assess, adding, “Our biggest struggle is trying to figure out how to understand the true value for Americans.”

This is the coward’s path¹. They won’t recommend it, but they’ll tell parents it’s really wonderful and prevents all these scary things. They’ll dismiss the risks and ethics involved, and they’ll ignore the statistics in context. For UTIs, the statistics show that all males, circumcised and intact combined, face approximately a 1% risk of UTI in the first year of life. The majority of those UTIs are easily treated without circumcision. Those that are not are generally caused by anatomical abnormalities, not the presence of the normal foreskin. [ed. note: Links when I can find them. It’s late.]

But none of that matters to those who believe that parents should decide what is best for their family regarding their son’s foreskin. We don’t extend this appalling idea that the family owns the foreskins of its sons to the genitals of its daughters. No, a female minor’s genitals belong to her, regardless of the parents’ opinions. That’s critical in displaying the hypocrisy and cultural blinders because the advocates are only discussing opinion. They’ve established a perceived value to non-therapeutic male circumcision. They’ve endorsed that with the power of their titles to those parents who want to believe the same illogical conclusion. Because they value it, they can’t conceive that the healthy child who will be surgically altered could possibly mind. He wants it, don’t you know, because dad likes it and mom likes it and what if his classmates laugh at him or girls won’t have sex with him? He needs to have less to be enough. And because… HIV! That he could conclude that non-therapeutic circumcision performed on him as an infant is mutilation is inconceivable. The person who believes that is allegedly the fringe lunatic who rejects the public health. Because… HIV!

To the CDC: My non-therapeutic circumcision as an infant was mutilation. My parents had no legitimate authority to request it. The doctor had no legitimate authority to perform it. I do not value circumcision for me. I never will, no matter how much your unethical experts tell me I should. I have never and will never need any HIV risk reduction because I do not engage in unsafe sex. Should I encounter any of the other medical maladies discussed in relation to circumcision, I will prefer the least-invasive effective treatment available. I believe in evidence-based medicine, particularly the simple-to-understand truth that healthy genitals are evidence that no surgical intervention is ethical on a child. Not even on the genitals of American boys.

¹ It is also why appeals to the authority of an organization like the AAP are unwise. They may present a (barely) acceptable tone today, but tomorrow is always a new day to be irration
al.

Training To Do As We’re Told

I haven’t blogged nearly enough recently, or in the last year. Blah, blah, blah. The only reason I’m raising that point is because today’s the 6th anniversary of Rolling Doughnut. I’ll only remark in jest that I should wipe one of those years off, given the breaks I’ve taken recently. But that’s not fair to myself since I’ve still managed nearly 200 entries in the last year. I just need to be more consistent.

That’s a meta way to advance to today’s story, which is strangely related to my post marking last year’s anniversary. Last August 16th, you’ll remember, I had an adventure with TSA and an experimental, voluntary search that I refused because I could. They didn’t like that, not that it surprised me. But it made the point that we’re becoming a more complacent society, that we’ve agreed to stop valuing liberty when it comes to being searched. The appearance of safety is enough for most.

Today, I purchased Madden 10 at Best Buy. This should be a simple process. Instead, it involved asking for it at the register, the cashier charging me for it, me paying, the cashier giving the game to the security person at the door, and me showing my receipt to the security person. This is two¹ steps too many.

I stated my displeasure to the security person. I’ve done this before, so I knew I’d get the same explanation. Best Buy (or any store) can explain that it’s to guarantee the customer gets what he paid for, which is nonsense. Even if that’s true, my perception is that the store doesn’t trust its customers. At best it suggests they don’t trust their cashiers. If that’s the case, they should spend the time they’re wasting with me on training or different oversight.

When I told the security person all of this, he tried to deflect by saying that many stores are doing this. True, and I don’t have to shop at them or Best Buy. To this he responded: “It’s just like you have to stand in line for security at the airport.”

Buying Madden for the Xbox 360 is not like boarding an airplane. Entertaining the notion that it is demonstrates the extent to which we’ve accepted every intrusion, no matter how stupid, inefficient, and unproductive. When a business says “Line up,” we can so “no” by requesting a refund. I didn’t today, but I have in the past. I’m sure I will in the future. But that’s a low cost process. I can always go to Game Stop or Target to buy Madden. If we won’t challenge those without guns, we should expect no better treatment from those with guns.

So, yeah, I’m still here.

¹ Three, really, but I’ll skip the idiocy of the first step.

Always Ask Who Will Pay for Free

In a mostly terrible article on President Obama’s town hall tour in The Washington Post, this:

Randy Rathie, the welder, told Obama that explanations of how reform would be funded have been lacking. “You can’t tell us how you are going to pay for that,” Rathie said. “The only way you are going to get that money is to raise our taxes.”

Obama told Rathie that the money for the changes would come from efficiencies and other savings and from people who make more than $250,000 a year.

The “efficiencies and other savings” canard is pleasant to hear, but debunking that is for another time when the details can be explored. The last claim is the low-hanging fruit I’m aiming for here. How is it not a tax increase to state that people who make more than $250,000 per year will pay for the costs of health insurance “reform”? Because they aren’t The People, somehow, so they don’t count? Even if that could be answered, what obligates those individuals, by mere status as financially successful in the president’s non-cost-of-living-as-a-consideration-view, to pay for the health insurance of those who are not financially successful? And how is it reform to further entrench the mentality that third-party payment is the way to control the costs of medical care?

Taking from those making more than $250,000 – despite their being evil for stealing from the poor, of course – is flawed because it still encourages the mentality that someone else is responsible for taking care of you.

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Also in the article:

He tried to rebut the notion that health-care reform represents a “government takeover,” noting that most people’s coverage would remain what it is today.

“I don’t want government bureaucrats meddling in your health care, but I also don’t want insurance bureaucrats meddling in your health care,” he said.

If someone else pays for your care, be it government or an insurance company, a bureaucrat will “meddle” because that is the entity with the financial incentive to do so. This is neither complicated nor contentious. There is no such thing as “free”. The more we attempt to pretend that is not true by having another pay for what we want, the worse our health care system will become.

Bill Clinton Supports Bill Clinton

Former President Bill Clinton is now offering something resembling support for same-sex marriage:

After speaking at the Campus Progress National Conference in Washington, DC, on July 8, the former president was asked if he supported same-sex marriage. Clinton, in a departure from past statements, replied in the affirmative.

Clinton opposed same-sex marriage during his presidency, and in 1996, he signed the Defense of Marriage Act, which limited federal recognition of marriage to one man and one woman. In May of this year, Clinton told a crowd at Toronto’s Convention Centre that his position on same-sex marriage was “evolving.” [ed. note: more commonly described as gauging the political winds]

Apparently, Clinton’s thinking has now further evolved. Asked if he would commit his support for same-sex marriage, Clinton responded, “I’m basically in support.”

Any guesses on whether the key word is basically or support in his statement? You don’t need proof, but here it is:

This spring, same-sex marriage was legalized in Iowa, Vermont, Connecticut, Maine and New Hampshire. In his most recent remarks on the subject, Clinton said, “I think all these states that do it should do it.” The former president, however, added that he does not believe that same-sex marriage is “a federal question.”

I’m supposed to get excited because Bill Clinton endorsed the status quo?

Of course, because it’s not only a Clinton, but the Clinton, organized advocacy groups must fawn over these statements as if the the common meanings of words are irrelevant.

“Bill Clinton joins other important public figures in stepping solidly into the twenty-first century in support of same-sex marriage equality,” said the National Gay and Lesbian Task Force’s executive director Rea Carey. “We certainly hope other elected officials, including President Obama, join him in clearly stating their support for equality in this country. Same-sex couples should not have to experience second-class citizenship.”

He’s not stepping “solidly” into the twenty-first century. He’s dipped his toe in the late twentieth century to test whether he can continue coasting on perceptions rather than actions. Hence, his endorsement of treating same-sex couples like second-class citizens for federal purposes.

[From the libertarian perspective, of course the state shouldn’t be involved in marriage. It is, and that’s not changing any time soon. Thus, federal recognition is a defensible goal.]

Via Conor Clarke, guest-blogging at The Daily Dish. He has more faith than I do that Clinton is “on the right side of this issue.”

Another Reason I Don’t Live in D.C.

I’ll preface this entry with the update from the article. What the Councilman proposes is – unsurprisingly – not lawful. Maybe that’ll change, maybe not. It should count as an extra strike against the councilman, regardless.

So, the proposal:

Council member Jim Graham (D-Ward 1) introduced a resolution today to rename Girard Park in Columbia Heights “Barack Hussein Obama Park.”

The recent renovated park, located at 14th Street and Girard, features a basketball court and play equipment.

“The park is a jewel,” Graham said. “I think the overwhelming point of view that has been expressed is that park should be renamed in honor of our president.”

How many of the idiots who propose (and support) such nonsense complained when Republicans demanded that every structure within the Washington, DC metro area be renamed to honor Reagan when he died? At least those lunatics had the ability to understand that waiting until the man died was necessary. Here, we’re just mythologizing the man with the most influence over ongoing policy. That’s dangerous.

To mock it appropriately, let’s start a Barack Obama Facts meme. I’m not connected to the Internets right now, since President Obama hasn’t gotten around to my right to universal broadband yet, so I can’t check that it doesn’t yet exist. I’m sure it does. Whatever. Here’s my entry:

Barack Obama can visit your park without leaving the White House.

That may not be a joke, so let’s have a care with small-r republicanism, please.

Via DCist.

The Market Does(n’t) Produce Non-Smoking Bars

Pulling again from the month-old-but-still-interesting Internet archives, Megan McArdle w;rote about smoking bans and the apparent market failure to produce the desired outcome commonly professed

Henry Farrell’s interesting post on smoking bans reminds me of an ongoing question that I have never heard a libertarian answer satisfactorily. Smoking in bars and so forth is dangerous to bystanders who have pulmonary disease (the dangers of secondhand smoke to those who are not already breathing-impaired seem to be largely mythical). It’s noxious to some other number of people who do not smoke. The libertarian rejoinder to the smoking bans is that bars could choose not to smoke if people wanted it. But in practice, despite the fact that smokers are a minority, and most people hate it, almost no establishment went non-smoking without government fiat.

I don’t see the flaw. People profess to want a lot of things. They don’t always back those claims with corresponding actions.

Here, the libertarian rejoinder should be that those who have pulmonary disease are not entitled to a smoke-free bar environment provided by another person. The same applies to healthy people (like me) who find cigarette smoke abhorrent. When bars were filled with smoke and I didn’t want to inhale smoke, I didn’t give smoke-filled bars my business. Since they survived, I assume enough people didn’t mind the smoke as they said or valued the overall bar experience more.

Lest I give you the impression that I’m trying to educate Ms. McArdle, she mostly gets to the same place in her next paragraph.

This seems like a market failure. You can explain it through preference asymmetry and the profitability of various customer classes: heavy drinkers are more likely to also be heavy smokers, and they are the most profitable customers. Bar owners don’t want big groups of people who are going to take up three tables for an hour and a half while nursing one white wine spritzer apiece. They want people who are there to drink. In a competitive equilibrium, they couldn’t afford to go non-smoking because they’d lose their most profitable customers to all the other bars.

Like I said, I don’t see the flaw. This is the free market responding. Want a smoke-free bar but none exist? Open a smoke-free bar. If there’s a market for it, it will survive without the force of a ban.

Again, Ms. McArdle understands this. But her last paragraph adds an incorrect assumption that allows her to get the idea that there is a flaw in libertarian thinking (emphasis added):

You can explain it, but this doesn’t seem like a good market outcome by any measure. Let me be clear, I’m still against the smoking ban, even though I personally vastly prefer smoke-free environments; I think interfering with property rights like this has even heavier costs. But I also recognize that I’m in a minority. And I think that politically, if not intellectually, the success of smoking bans is a heavy blow to libertarian credibility.

There are only market outcomes here. Good is a subjective evaluation, a declaration that what one expects to occur should occur. But why should it? People who like to smoke and drink in bars probably wouldn’t deem voluntary smoking bans a good outcome. Why don’t their opinions factor into good? I conclude that, while smokers are a minority, people who will tolerate smoking while having (or serving) a beer are not.