The Sacramento Bee, despite the sad state of its Op-Ed columns, seems to do pretty well in its actual reporting.  For example, here’s a handy thumbnail sketch of the competing proposals for infrastructure spending. [Graphic will open in new window]

Now we know what the fuss is about, at least at a high level.

I have to confess, I’m a sucker for a good insurance story, and a real sucker for anything having to do with Proposition 103.  Between my first and second year of law school, I was a summer associate for the private law firm that defended Proposition 103 when then-Attorney General Dan Lungren essentially refused to help regulate the insurance industry.  I suspect I was of little to no use, though I do recall reading one insurance company’s brief which argued that the company was constitutionally entitled to a forty percent return on investment.  Insurance companies.  Oy.

All of which is by way of introduction to this Chron Op-Ed about John Garamendi’s return to a fair insurance rating system for automobile insurance:

In December 2005, Insurance Commissioner John Garamendi announced his intent to end a “grossly unfair and irrational system” in which companies charge vastly different rates on drivers in neighboring ZIP codes.

Garamendi has come up with a sensible plan to base auto premiums on the three factors designated in Prop. 103: driving record, miles driven and years of driving experience. Insurers could still consider other factors, but their rate formula could not give any criterion more weight than the three factors in the initiative.

Not surprisingly, the insurance industry responded with “a campaign to scare the bejesus out of Californians,” Garamendi said.

One of its main scare tactics is a warning that diminishing the ZIP-code factor will force rural and suburban drivers to pay higher premiums to subsidize drivers in urban areas with greater congestion and higher accident rates.

However, a study by the Department of Insurance showed no statistical justification for ZIP-code pricing across the state. In many cases, in fact, such disparities worked against rural drivers. Garamendi pointed out that rates in Modesto were cheaper than in La Grange, a ghost town 30 miles down the road that has “more jackrabbits than cars.”

This is noteworthy not just for the straight news value and the sensible policy outcome.  What’s really interesting here is the penultimate graf in the quote.  The insurance industry pulled a straight-up Republican move:  pitting the “good” rural folks against the “bad” urbanites.  And just like when the Republicans do it, it’s pure propaganda.

I’m not saying there aren’t real differences between rural and urban communities; there are.  But the differences aren’t as great as people think.  We have more things in common than differences, and the big-money interests who are trying to divide us don’t mean anyone well.

[Originally posted 11/05/2005 on NorCal Politics by LSchwark.]

Beyond the criticisms of the proposition as being detrimental to the health and safety of California teens, Proposition 73 is also a stealth initiative to criminalize abortion, amending the state constitution to define abortion as infanticide.

From the text of the initiative (emphasis mine):

This initiative measure is submitted to the people in accordance with the provisions of Article II, Section 8 of the California Constitution. This initiative measure expressly amends the California Constitution by adding a section thereto

…

(1) “Abortion” means the use of any means to terminate the pregnancy of an unemancipated minor female known to be pregnant with knowledge that the termination with those means will, with reasonable likelihood, cause the death of the unborn child, a child conceived but not yet born.

I would have thought this was obvious to Californians by now. Unfortunately, the LA Times conducted a poll this week that indicates Prop 73 is running at 51% approval by likely voters.

This is not the first go around with notification laws. In 1953, the constitution was amended to allow minors to have the same access to medical care as adults, without notification. In 1987, the legislature added a parental notification amendment in the case of abortions for minors. The state supreme court struck it down as being unconstitutional. So, now they anti-choice forces are trying to amend the constituion.

As they always do, the anti-choice agenda is acting by stealth because people in the US, and even more so in California, are pro-choice. Therefore, they’re trying to nibble away piecemeal the underpinnings of abortion access and availability. Much like the Intelligent Design advocates argue they just want to allow their side to be heard alongside evolution to get their foot in the door, the same is the case with parental notification. Conservatives understand the game, moderates are often fooled into supporting the idea as if that were the only issue involved. But it’s not the only issue, it’s just part of an ongoing campaign. The graphic snipped from the LA Times poll shows why this tactic can work. While pro-choice voters outnumber anti-choice voters 58% to 39%, there’s a swing 19% that is open to some limitations on abortion. If they can be convinced that one measure or another is reasonable, the anti-choice forces can sneak through a trojan horse.

There are plenty of conscientious and well-meaning people who take a principled stand against abortion. Many of them are also against the death penalty and concerned with the general social welfare. But the anti-choice activists who put things like Proposition 73 forward are the people who also oppose birth control, sex education. These anti-abortion activists are now debating whether they should oppose the addition of the HPV vaccine that prevents most cervical cancer to the routine child vaccination schedule. Their argument, predictably, is that immunizing girls aginst HPV will encourage sexual activity. You see, HPV is communicable much more easily than most STD’s and thus condoms aren’t effective. So the fear of cancer is their ally in promoting abstinence only education.

There are plenty of other arguments against Prop 73.

• It most affects the vulnerable teens who live in abusive or unstable home environments.
• It institutes a government bureaucracy that receives notifications of teens seeking abortions. Think about that one for a minute.
• The measure criminalizes doctors and health care providers who provide abortions to teens unless they participate in the notification bureaucracy.
• Expecting vulnerable teens to go to court to get a waiver is ridiculous. Imagine yourself as a poor 16 year old with an unstable home environment. Are you going to be going to court to get a waiver? Again, the idea is ridiculous on its face.
• Most teens seeking abortions do, in fact, already discuss it with their parents.
• The state Supreme Court, in rejecting the last attempt at notification laws, included the opinion that such laws do, in fact, put teens in danger.

Vote NO on PROPOSITION 73.

As a quick follow-up to my post about Daniel Weintraub’s self-insurance advocacy, I offer a challenge.  Weintraub’s employer has an editorial today concerning the price of health care:

Avistan as a colon cancer medicine has been costing about $50,000 a year. The cost of the same medicine as a breast and lung cancer treatment is expected to be $100,000 a year.

The dosage will be higher for these treatments, but the incremental increase in manufacturing cost is minimal. So what’s going on?

Genentech is signaling that the higher price to treat breast cancer reflects the higher value society places on fighting this disease. That’s different; the usual pharmaceutical industry response is that the high prices are necessary to recover the research and development costs.

That’s the free market in action, Mr. Weintraub.  Breast cancer is pricier than colon cancer.  Now, I don’t know anything about Mr. Weintraub’s financial situation, or his family’s.  But let’s imagine that his wife, mother, or sister is looking at a minimum $100K bill just for this pharmaceutical treatment for breast cancer.

I wonder if he’d so glibly to dismiss health insurance then?  Or is Mr. Weintraub’s family so rich that they would never feel a $100K bill for a drug?  If so, he doesn’t have much business lecturing the rest of us about how we ought to pay out of pocket for our medical care.

I’m beginning to understand the roles of the full-time Op-Ed writers at the Sacramento Bee. Dan Walters plays Dan Broder without the gravitas, while Daniel Weintraub plays a diet version of John Stossel. Today, we’ll have a quick look at Weintraub’s most recent oeuvre: an ode to his power to imagine a world without health insurance in response to Carole Migden’s introduction of a bill to require large corporations to provide health insurance.

Weintraub spends several paragraphs talking about how great the market is for delivering things like food, cars and houses, and painting a grim picture of how awful it would be if one’s employer controlled one’s access to those goods. That’s all true. The (regulated) market is really good at delivering those kinds of goods: lots of choices, fairly good information that regular folks can understand easily enough, prohibitions on adulteration and deceit, and generally, enough time to process the information one does get. One might note in passing that the regulation of these markets was fought hammer and tongs by the industries affected.

Then Weintraub gets to the nub of his argument:

[more on the flip]

While individuals once managed their health insurance themselves, paying for it out of their wages, employers began doing that for them during World War II as a backdoor way to increase compensation in an era of government-imposed wage and price controls. The custom stuck, the government rewarded it with tax breaks and today more than 60 percent of us have our health care managed through work.
…
Maybe, instead of trapping us into having our health care managed by others, we should emulate the ways we have more successfully provided food, shelter and transportation to almost everyone who needs it.

Individual choice. Individual responsibility. Voluntary transactions. And targeted help for the few who cannot afford to buy what they need on the wages they earn, with the burden of financing that assistance falling on all of society, not just on a few.

That all sounds great, don’t it? Forcing people to pay for their own medical care will provide great value for the dollar, and will keep prices down. Except that it’s utter hokum. First of all, Weintraub confuses the health insurance risk pooling allowed by the purchase of insurance through employers with “employer control”. While I’m not a fan of the current patchwork private insurance system, I hardly think that it amounts to “employer control”.

Second, the relevant markets for comparison are medical insurance vs. auto insurance and home insurance, not medical services vs. cars and houses. Medical services are potentially open-ended expenses that it’s hard to plan for. So are car accidents and fires. Cars and houses are known expenses that you can plan for; nobody buys “car-buying insurance” just in case someone unexpectedly forces you to own a new car.

You buy insurance in advance, because you don’t know when you’ll need it. The chances are that not everyone needs the payout at the same time, and the insurance company makes enough profit investing your money that it works for everyone. What employers provide with regard to medical insurance purchases is risk pooling and a form of bulk discount, neither of which you can get as an individual. In that sense, right at the outset, Weintraub’s comparison is inapt. People of moderate and more-than-moderate means do purchase their own medical insurance, either directly or risk-pooled through their employers. Poorer people get Medicaid, the elderly get Medicare (and supplemental insurance if they can afford it). That’s precisely the system that Weintraub proposes for spending on medical expenses, so apparently his whole beef is with the concept of health insurance.

Third, Weintraub pulls a classic Republican rhetorical trick: the hearkening back to the halcyon days of the Greatest Generation. Things were so much better back then. Except that medical science has advanced a great deal since 1941. We can do much more to save people with much more serious illnesses and injuries than we could in those golden-lit days of yore. And of course those new services mean that medical costs are higher. It’s not an apples to apples comparison to suggest that middle-class people can pay for the best medical service today (if they even could before World War II).

Last, if we were to compare apples to apples, medical spending is just plain different than most kinds of individual spending, even very large ticket items. It’s almost impossible to make truly informed decisions. The stakes are often life and death. The expenses are not optional.

• How much medical spending is too much? How much is too little? How do you know? Is that pain in your chest gas or a heart attack? Are you willing to bet your next mortgage payment on the answer?
• What is the best course of cancer treatment? The cheaper one, or the more expensive? You have to make that decision inside of a month, because your wife’s life depends on it. And so does your children’s college fund. And your house.
• Your son has a chronic illness. You can afford to pay for his care, but only by selling the house that your parents left to you. Of course, eventually you will become eligible for the subsidy that Weintraub believes the poor should receive.

Weintraub has an oddly active imagination. He imagines that health care is a largely optional service. He imagines that it’s possible for an individual heartsick with worry can be an informed consumer of health care, a field in which even the practitioners are hard-pressed to keep up with new developments. He imagines that health care costs would not bankrupt even upper middle-class families.

In fact, the only place that Weintraub’s imagination fails him is that he seems unable to imagine what it would be like for people to try to deal with a health emergency without insurance.