Staircase in Berlin, Germany, October 5, 2009 (Martin Teschner)

It is very understandable when citizens resist government force that compels them to violate their religious principles. If the teachings of, say, Zoroaster, are incompatible with ObamaCare, we shouldn’t have to reassess our views of Zoroastrianism in order to maintain our health or our principles.

But that misses the point. We have reached a very sorry state in America if the basis for preventing government intrusion in our decisions about our own health care is an appeal to religion.

The writers of the United States Constitution and Bill of Rights did not expect or want Americans to share the same religious view. Based on the American experience, they expected the exact opposite, or there would have been no need to protect the practice of any religion—conventional or not. They required the government to stay out of decisions about religion and views on any subject expressed by speech or in the press.

The value on which all of this was based is individualism. Our defense of freedom, religious or otherwise, must be based on this fundamental value.

Individualism remains the best tool to deny government the power to force us to buy health insurance in general or forbid the purchase of the kind of health care plan we prefer. Individualism is the basis on which to resist any government decree about the medical services or medications we must accept or those that must be forbidden.

Individualism is the basis on which to deny state insurance commissioners the ability to forbid purchase of health insurance approved by insurance commissions in other states. (None of the state insurance commissioners trust the other commissioners, although the rest of us are forced to abide by the one in our state.) Individualism requires us to deny the power of those commissioners or ObamaCare bureaucrats who require us to buy only policies with a long list of coverage requirements inserted by providers who have successfully lobbied politicians to force everyone to pay for their services.

When government violates the principle of individualism, it harms everyone, including the religious. But when people defend their rights only on the basis of their religious views, they become targets for those who would otherwise leave them alone. Freedom of religion (or freedom of anything) enrages the collectivist, intellectual, political and journalist elites if it stands in the way of their control over every detail of our daily lives. That makes religion itself the target of this rage for reasons having nothing to do with the merits or faults of any particular religion, resulting in vicious attacks on the religious for political reasons. It distracts the public and media from the real issue, which is not whether particular religious ideas are true or false, wise or absurd, but the matter of who has the right to make such evaluations.

Defending our rights on the basis of individualism forces these intellectual thugs to attack all of us who want to make our own decisions and manage our own lives—and exposes them for doing exactly that.

All Americans can unite on the importance of the freedom of us all to make our own decisions about insurance and medical care, and of the freedom of all physicians to make medical decisions based on their own best judgment, without government intervention.

The Supreme Court of the United States in Washington DC, March 16, 2009 (Stephen Masker)

The Supreme Court of the United States later this week will hear the first arguments in the case against President Barack Obama’s signature health care reform law. The individual mandate, which compels citizens buy insurance at the risk of a financial penalty, is at the core of the constitutional argument against “ObamaCare,” as the law has been dubbed by opponents. But there are more, practical problems as well that will not be solved with repeal of the mandate alone.

Because government is inherently incapable of effectively regulating, let alone controlling, any sector of the economy, it should come as no surprise that in many instances, the health care law only made a bad situation worse by trying to solve problems that were created by government intervention with more government intervention.

Health care comprises nearly a fifth of the American economy. The notion that central planners in Washington can somehow better manage it than the millions of health care consumers and providers who constitute the market every day is so delusion that the collapse of the Soviet Union should have put it to rest entirely.

Yet America attempted programs premised on the same notion if executed on a smaller scale before. Medicaid, Medicare and an array of smaller health care entitlements combined accounted for half of all medical spending in the United States before the Democrats enacted their reform measure which will all but destroy the limited free market that still existed in health care and insurance.

That is not to say that American health care was fine before March 2010 but many of the problems associated with it were the government’s own doing.

After creating two health care entitlements, one for seniors and one for the poor, in the mid 1960s, public health care spending soared to such an extent that Congresses repeatedly intervened with price controls and regulations to try to control costs. Meanwhile, the more fundamental impediments to competition and efficiency were ignored.

Americans can buy health insurance policies only from companies that are licensed by the states in which they live. There is no nationwide insurance market, let alone foreign competition.

State governments, moreover, mandate that insurers cover all sorts of treatments that the consumer may not require nor wish to buy, including prenatal and psychiatric care. In most states, it was impossible for a people to insure themselves again medical catastrophe alone.

With ObamaCare, it will be impossible across the country because it, too, forces insurers to offer a basic plan that covers ambulatory services, hospitalization, maternity and mental health care as well as rehabilitative services.

Health insurance costs can only rise as a consequence. The administration and others proponents of the health reform measure have pointed out that millions of Americans were uninsured and people with preexisting conditions denied coverage before the law came into effect.

As recent as 2001, just 1 percent of Americans reported to have ever been denied health insurance. If they had preexisting conditions, they were probably charged higher premiums but this isn’t unfair. Premiums that are based on risk incentivize people to buy insurance while they are healthy and encourage insurance companies to develop innovative products that protect against the risk of rising premiums. The real problem, again, was created by government when it tried to provide people insurance through their employer. This denied consumers choice and further undermined competition.

It’s not just the health insurance market that’s limited by mandates and perverse tax incentives. Providers of health care, too, can only operate with a state license and states typically require a licensed physician to carry out procedures that an experienced nurse can otherwise perform without supervision. Because a doctor is more expensive than a nurse, the costs of treatment are far higher than they would be if care were unregulated.

In both health care and health insurance, the laws of supply and demand do not apply because government rations the supply on many levels. With ObamaCare, it will even ration specific procedures if they are deemed too costly. At the same time, demand is rising. No wonder costs skyrocket!

Democrats insisted that ObamaCare would somehow reduce the federal deficit by $1 trillion but it bankrupts the states.

Half of all the net gain in insurance coverage will be due to higher enrollment in Medicaid, including its Children’s Health Insurance Program. Medicaid is administered by the states but federally funded. ObamaCare forces the states to cover all persons with incomes up to 138 percent of the poverty level and prohibits them from setting their own eligibility criteria at the risk of losing their entire Medicaid funding.

The Federal Government will pay the increased costs until 2016 after which date the burden is gradually put on the states. Already, Medicaid costs, which are rising at more than 7 percent per year, are crowding out state investment in education and infrastructure. The additional costs will devastate state budgets unless they raise taxes substantially or chose to leave their poor without care entirely.

There is no way of salvaging whatever “good parts” may be in the reform bill while repealing the rest. The law should be overturned in its entirely once the Supreme Court rules the individual mandate unconstitutional. That should only be the start of a comprehensive deregulation of American health care and health insurance. Doing away with ObamaCare will only bring back a system that was in need of repair. What’s needed is not more entitlements and “rights” but fair and free competition.

The White House deemed it “unfortunate that a small group of senators obstructed his nomination, putting political interests above the best interests of the American people,” but from this blogger’s perspective, it’s exactly the interests of the American people they had at heart.

This was the man who professed any health care plan “that is just, equitable, civilized and humane, must redistribute wealth from the richer among us to the poorer and the less fortunate.” Good health care, he stressed, “is by definition redistributional.”

So he loved Britain’s collectivized health care system which he described as “not just a national treasure” but “a global treasure” that should serve as a model for the “bloated” American health insurance market. The United States, he added, were trapped in “the darkness of private enterprise” whereas the British model was “generous, hopeful, confident, joyous, and just.”

Which is odd given that Britain’s ombudsman determined this year that the very system was “inhumane” and failed to meet “even the most basic standards of care.”

But wait, it gets worse. Berwick lamented the fact that “the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out there.” He foresaw the need for what he called “a very difficult democratic conversation,” adding: “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.”

Suddenly, Sarah Palin’s “death panels” didn’t seem so preposterous when Berwick’s nomination was announced. This man shouldn’t be anywhere near making health care decisions for anyone. Good riddance indeed!

Defenders of “ObamaCare,” which is how the Patient Protection and Affordable Care Act of 2010 has become known, argue that the Commerce Clause in the Constitution grants the Federal Government the authority not just to regulate interstate commerce but all commercial activity, including health insurance. Forcing people to purchase insurance, they say, is not just legal; it’s the right thing to do because millions would otherwise fail to insure themselves against medical catastrophe.

The appellate court in Atlanta, Georgia on Friday decided otherwise, opining that the Commerce Clause should not be interpreted “in a way that would grant to Congress a general police power.”

As for the mandate, the Eleventh Circuit considered not just the constitutionality of it “but also its implications for our constitutional structure.” If the Federal Government can force people to buy insurance, what can’t it do? There are, in fact, very clear restrictions on federal power in the Constitution and “while these structural limitations are often discussed in terms of federalism, their ultimate goal,” the court points out, “is the protection of individual liberty.”

Even in the face of a Great Depression, a World War, a Cold War, recessions, oil shocks, inflation and unemployment, Congress never sought to require the purchase of wheat or war bonds, force a higher savings rate or greater consumption of American goods, or require every American to purchase a more fuel efficient vehicle.

With the Environmental Protection Agency enforcing “fuel efficiency standards,” that may just be a matter of time but the court’s point is very clear—Congress never has, and never should, compel economic activity or transactions.

The individual mandate is but the most obvious affront to civil liberties that is embedded in the health care overhaul however.

Insurance companies are businesses like any other, entitled to charge premiums that reflect actual risk. ObamaCare would force them to cover almost every American, no matter how ill they are; no matter how bad their health habits; no matter how high the cost of their exotic treatments.

Premiums, logically, will rise for every consumer. In anticipation of the law’s full implementation, insurers are already raising premiums.

Like insurance companies, health care providers have a right to turn a profit. Doctors and nurses are not public servants. They are entitled to charge fees that reflect the value received by all parties to the transaction.

ObamaCare, by driving down permissible fees, will force physicians into a deadly conflict of interest—lose money by doing everything necessary to meet patients’ needs or make money by satisfying minimum bureaucratic standards.

The health care reform law moreover does nothing to address a major impediment to a full and free competition in the health insurance market—antitrust legislation that prohibits insurers from consolidating and operating freely beyond the boundaries of their state. People should be able to buy insurance from whatever company they want, wherever it’s settled. That will drive down premiums very quickly.

Over the next seventy-five years, Medicare’s unfunded obligations will add up to a grand total of $24.6 trillion under current projections. In reality the program, unless reformed, will be far heavier indebted as the official numbers assume $575 billion in savings included in President Barack Obama’s health reform law and a 29 percent reduction in physician reimbursements in 2012. That is unlikely to happen. Time and again, Congress has overwritten payment reductions and it’s almost certain to do so again, especially during an election year.

Democrats have no plan expect letting Medicare go bankrupt. Republicans have proposed privatizing care delivery for the next generation of seniors, offering them vouchers or “premium support” which is effectively a subsidy to cover part of their insurance costs.

According to economist Paul Krugman, that’s completely unnecessary. In his latest New York Times column, Krugman suggests that Medicare is sustainable “in its current form.” How? By rationing care.

Medicare will have to start saying no; it will have to provide incentives to move away from fee for service, and so on and so forth. But such changes would not mean a fundamental change in the way Medicare works.

It would to people on Medicare. They would not longer be able to afford the sort of medicine and treatments deemed unfit or too expensive by—whom exactly? Who is supposed to say “no”? Who will decide which medical care will be paid for and which will not? President Obama has answered that question already. He would let an “advisory board” of fifteen unelected bureaucrats decide how to trim Medicare spending.

Rationing care is the favorite resort of leftists who are confronted with the utterly unsustainable nature of their favorite government handouts. The current adminstrator of Medicare and Medicaid, Dr Donald Berwick, is no exception. He complained in 2008 about how America’s then relatively free health insurance market was trapped in “the darkness of private enterprise” and professed to be romantic about the British National Health Service which, he said, was “generous, hopeful, confident, joyous and just.”

Britain’s National Health Service Ombudsman disagreed. He found that medical care for seniors in the United Kingdom was inhumane and “failing to meet even the most basic standards of care.”

Britain already has a rationing board. It’s called the National Institute for Clinical Health (or NICE) and Berwick described it as “a national treasure.” Just how nice is this institute? According to its mandates, each year of added life is worth approximately $44,000 (or £30,000). NICE Chairman Michael Rawlins boasts that at times, his agency has approved treatments costing over $70,000 (£48,000) per year of extended life but the principle remains unchanged—NICE puts a price tag on life. A principle that is readily endorsed by Dr Berwick.

“The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out there,” said Berwick. He predicted the need of what he described as “a very difficult democratic conversation” without elaborating all too explicitly of course on what it would entail. But he did announce this:

The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.

Just what does “eyes open rationing” mean? Dr Berwick has yet to answer that question. What’s obvious though is that according to the Medicare and Medicaid chief, the chronically ill and elderly are taking up more than their fair share of America’s health care supply. It’s the government’s job to remedy that injustice.

“Any health care funding plan that is just, equitable, civilized and humane, must redistribute wealth from the richer among us to the poorer and the less fortunate,” said Berwick. Good health care, he stressed, “is by definition redistributional.” He added: “The simplest way to reach these goals is with a single payer system.” Which, as Krugman points out, is what Medicare is—and should remain.

Despite Democrats’ demonization of Paul Ryan, and some Republicans’ unwillingness to stand by him, his plan is currently the only one written by any politician that would save Medicare from bankruptcy.

Last week Medicare’s trustees warned that the program will run out of money in 2024—five years earlier than they projected last year.

Once the main trust fund is depleted, revenues from Medicare taxes will initially be enough to cover 90 percent of expenses but that share will decline to 75 percent by mid century, then rise to 88 percent by 2085.

Under these latest figures, a total worth of unfunded obligations of $24.6 trillion over the next seventy-five years is projected; a $2 trillion increase compared to last year’s estimate. In reality, the shortfall could be even bigger as official projections assume $575 billion in savings achieved under President Barack Obama’s health reform law and a 29 percent reduction in physician reimbursements in 2012. That is unlikely to happen. Time and again, Congress has overwritten payment reductions and it’s almost certain to do so again, especially during an election year.

Ryan’s plan, which the Republican majority in the House of Representatives approved last month, would end Medicare as it exists for anyone under the age of fifty-five and provide “premium support” to future retirees—a subsidy or voucher with which they could buy insurance on the private market. This, Ryan argues, would enable competition and restrain the increase in insurance costs while forcing insurers and health care providers alike to improve the quality of their services.

Democrats don’t think so. Senate Majority Leader Harry Reid said that Ryan would “turn over seniors’ health to profit hungry insurance companies” and “let bureaucrats decide what tests and treatments seniors get.” In fact, that is the president’s approach. He has suggested to restrain ballooning health care costs by allowing a panel of fifteen unelected and “independent” advisors “review,” i.e., ration care.

Other than that, the Democratic plan, according to House Minority Leader Nancy Pelosi, “is called Medicare”—which will be bankrupt before the next generation retires.

Recent NHS data reveals that 26 percent more English patients were forced to wait beyond the eighteen week threshold in March compared to the same month last year. The number forced to wait more than six months for treatment shot up by 43 percent.

Despite a rising demand for care caused by an increasing number of seniors, the NHS treated over sixteen thousand fewer patients in March 2011 compared to March 2010. According to the British Medical Association, a doctors’ union, the longer waits were inevitable, “given the massive financial pressures on the NHS.”

The shortcomings of Britain’s public health system are far from recent however. Earlier this year, the National Health Service Ombudsman lambasted the NHS for “failing to meet even the most basic standards of care.” He found an attitude, “both personal and institutional,” that failed “to recognize the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism.”

The reasonable expectation that an older person or their family may have of dignified, pain free end of life care in clean surroundings in hospital is not being fulfilled.

Britain’s coalition government has not quite singled out the NHS from budget cuts in the face of an unprecedented fiscal crisis but it is prevented by campaign promises from fundamentally reforming the system.

Deputy Prime Minister Nick Clegg explicitly vowed to protect the NHS from privatization two months ago, saying he would not let the “profit motive drive a coach and horses” through it. Prime Minister David Cameron at least recognizes that “a little bit of extra money” will not “smooth over the challenges” but believes that little reforms within the collectivist framework can somehow fix all that is wrong with the NHS.

Medicare, which finances health care for the elderly, is expected to run out of money in 2024, five years earlier than projected last year. Once the main trust fund is depleted, revenues from Medicare taxes will initially be enough to cover 90 percent of expenses but that share will decline to 75 percent by mid century, then rise to 88 percent by 2085.

As a result of the adjusted projections, Medicare’s trustees estimate a total worth of unfunded obligations of $24.6 trillion over the next seventy-five years; an increase of $2 trillion compared to last year’s estimate.

In reality the program, unless reformed, will be far more indebted as the official projections assume $575 billion in savings included in President Barack Obama’s health reform law and a 29 percent reduction in physician reimbursements in 2012. That is unlikely to happen. Time and again, Congress has overwritten payment reductions and it’s almost certain to do so again, especially during an election year.

Medicaid spending, which subsidizes health care for the poor, has exploded over the past two decades, from nearly $74 billion in 1990 to more than $427 billion last year. Because Medicaid is paid for by the states, its rising costs increasingly crowd out investment in other areas, including education and infrastructure. Yet under the president’s health reform law, some twenty million additional Americans would be eligible for coverage.

The Social Security trust fund is now projected to last until 2036 but once it is depleted, the annual payroll taxes that pay for the program will only be sufficient to cover 75 percent of the retirement benefits it is required to pay seniors.

In 2010, Social Security spent $49 billion more in benefits that it took in from its payroll tax. This year, that deficit will be approximately $46 billion. Between now and 2085, the pension program’s trustees estimate a $9.1 trillion deficit.

Republican lawmakers have offered a long term solution for at least one of the three entitlement crises. Their budget proposal for fiscal year 2012 includes a gradual privatization of Medicare that excludes citizens in or near retirement from any changes but provides “premium support” for future generations of retirees. While thus retaining a subsidy, opponents have lambasted the conservative plan as “extreme”, claiming that it threatens the “dignity” of American seniors.

Both Democrats and a number of prominent Republicans have been skeptical and unwilling to reform entitlement programs that are popular with their millions of beneficiaries. Former House Speaker Nancy Pelosi professed last year that reform should do “what is right for our seniors, who are counting on the bedrock promises of Social Security and Medicare.” Senate Majority Leader Harry Reid in January described Republicans’ efforts to repeal the president’s health reform law as “a gesture in futility” and said that Social Security was not in a crisis. “This is something that’s perpetuated by people who don’t like government,” he opined. Potential Republican presidential contender Newt Gingrich this weekend characterized his own party’s Medicare reform effort as “radical.”

A jury in St Louis rejected the hospitals’ claim. According to an official from Lorillard, one of the companies in the case, “evidence was presented to the jury, including testimony from hospital witnesses, that confirmed the hospitals were not financially damaged as they asserted.”

Whether they were or not, the notion that cigarette producers are to blame for the averse health effects of smoking is absurd. If people chose to smoke, knowing full well that it’s detrimental to their health, tobacco companies cannot reasonably be held accountable for the consequences.

Hospitals, moreover, have no moral obligation to treat patients who can or will not pay for health care. If they do, that’s their right and their choice but they should not expect others to foot the bill.

48 percent of those over the age of sixty-five favor the Wisconsin congressman’s approach that would privatize the program and entitle people to “premium support” or vouchers with which to buy health insurance on the private market. 42 percent support Barack Obama who has promised that he will not leave seniors “at the mercy of the insurance industry.”

You wouldn’t know it listening to Democrats though. They say the Ryan plan “ends Medicare as we know it” and claim that more seniors would “suffer and die” as a result of it.

In al local newspaper, New Jersey Congressman Steve Rothman forecast “suffering, pain and terror” for tens of millions of seniors this week. “Where would they turn?” he wondered. “Charity? Family members? Early death? And why?”

Rothman acknowledged that the country faces an unprecedented fiscal crisis and believes that “all options should be on the table”—except reforming Medicare.

He notes that under the Republican plan, “the average senior would see their out of pocket health care costs double to $12,150 per year, $6,400 more than today,” which is real money but far from condemning them to early death.

“Medicare is an essential and successful American program that has worked extremely well for the past forty-six years,” according to Rothman but it won’t anymore. The Congressional Budget Office predicts that before the end of this decade, Medicare will have bankrupted itself unless significant reforms are enacted.

In the demonization of Paul Ryan, Democrats won’t let facts stand in the way of scoring political points. They are trying to convince retirees that Republicans intend to take their health care away even though the Ryan plan wouldn’t change a thing for people over the age of 55. They are pretending that America won’t need to rein in entitlement spending even as the explosive growth of Medicare and Social Security is utterly unsustainable, if only because Americans live longer than they did half a century ago when these programs were created.

Paul Ryan’s plan has its shortcomings and doesn’t even attempt pension reform yet. For all the Democrats’ demagoguery, nearly half of all seniors fortunately realize that it may be the only way to preserve health support for the elderly well into the future.