Minor Thoughts from me to you

America is a dream given form. It was built by men who only saw the dream through a glass darkly. They couldn’t see that it would one day apply to someone other than White men with a certain level of wealth. They couldn’t see that it would one day apply to their wives and daughters. Or to the “merciless Indian Savages” that they battled on the frontier. Or even—horrific thought—to their slaves, their slaves’ wives, their slaves’ daughters.

America is a dream given form. It was never a perfect realization of the dream. And we never can fully realize the dream, unless we’re willing to acknowledge the yawning chasm between the dream and the actual nation that the Founders built.

I can celebrate the red, white, and blue knowing of America’s flawed past. That doesn’t sap my fervor. But I can’t join in waving the flag and chanting “U-S-A”, when those with the biggest displays and the most fervor are the ones doing the most to deny the reality behind the myth.

“Making America Great Again” will take us back to a time when we were further away from realizing the dream than we are now. I cannot join their celebrations when doing so endorses their limitations for the country that I love.

When I celebrate Independence Day, I celebrate by both looking back and looking forward. I see America as it was, and I mourn for all of the mistakes that we’ve made. I see America as it could be, fully realized, welcoming and respecting everyone who shares the dream of liberty, equality, and opportunity, regardless of wealth, culture, religion, sexuality, national origin, or education. The dirt-poor, gay Guatemalan who just arrived, given as much preference as the White, middle class Christian, whose family has been here for 200 years.

For this Independence Day, I turn to the poem that’s come to signify patriotism to me. Let America be America again—the land that never has been yet—and yet must be.

Let America Be America Again
by Langston Hughes

Let America be America again.
Let it be the dream it used to be.
Let it be the pioneer on the plain
Seeking a home where he himself is free. (America never was America to me.) Let America be the dream the dreamers dreamed—
Let it be that great strong land of love
Where never kings connive nor tyrants scheme
That any man be crushed by one above. (It never was America to me.) O, let my land be a land where Liberty
Is crowned with no false patriotic wreath,
But opportunity is real, and life is free,
Equality is in the air we breathe. (There’s never been equality for me, Nor freedom in this “homeland of the free.”) _Say, who are you that mumbles in the dark?_
_And who are you that draws your veil across the stars?_ I am the poor white, fooled and pushed apart,
I am the Negro bearing slavery’s scars.
I am the red man driven from the land,
I am the immigrant clutching the hope I seek—
And finding only the same old stupid plan
Of dog eat dog, of mighty crush the weak. I am the young man, full of strength and hope,
Tangled in that ancient endless chain
Of profit, power, gain, of grab the land!
Of grab the gold! Of grab the ways of satisfying need!
Of work the men! Of take the pay!
Of owning everything for one's own greed! I am the farmer, bondsman to the soil.
I am the worker sold to the machine.
I am the Negro, servant to you all.
I am the people, humble, hungry, mean—
Hungry yet today despite the dream.
Beaten yet today—O, Pioneers!
I am the man who never got ahead,
The poorest worker bartered through the years. Yet I’m the one who dreamt our basic dream
In the Old World while still a serf of kings,
Who dreamt a dream so strong, so brave, so true,
That even yet its mighty daring sings
In every brick and stone, in every furrow turned
That’s made America the land it has become.
O, I’m the man who sailed those early seas
In search of what I meant to be my home—
For I’m the one who left dark Ireland's shore,
And Poland’s plain, and England’s grassy lea,
And torn from Black Africa’s strand I came
To build a “homeland of the free.” The free? Who said the free? Not me?
Surely not me? The millions on relief today?
The millions shot down when we strike?
The millions who have nothing for our pay?
For all the dreams we've dreamed
And all the songs we've sung
And all the hopes we've held
And all the flags we've hung,
The millions who have nothing for our pay—
Except the dream that's almost dead today. O, let America be America again—
The land that never has been yet—
And yet must be—the land where _every_ man is free.
The land that's mine—the poor man’s, Indian’s, Negro’s, ME—
Who made America,
Whose sweat and blood, whose faith and pain,
Whose hand at the foundry, whose plow in the rain,
Must bring back our mighty dream again. Sure, call me any ugly name you choose—
The steel of freedom does not stain.
From those who live like leeches on the people's lives,
We must take back our land again,
America! O, yes,
I say it plain,
America never was America to me,
And yet I swear this oath—
America will be! Out of the rack and ruin of our gangster death,
The rape and rot of graft, and stealth, and lies,
We, the people, must redeem
The land, the mines, the plants, the rivers.
The mountains and the endless plain—
All, all the stretch of these great green states—
And make America again!

Sarah Holder writes at CityLab about a change in policing, in Camden, NJ.

In 2013, the Camden Police Department was disbanded, reimagined, and born again as the Camden County Police Department, with more officers at lower pay—and a strategic shift toward “community policing.”

That meant focusing on rebuilding trust between the community and their officers.

“For us to make the neighborhood look and feel the way everyone wanted it to, it wasn’t going to be achieved by having a police officer with a helmet and a shotgun standing on a corner,” Thomson said. Now, he wants his officers “to identify more with being in the Peace Corps than being in the Special Forces.”

A conversation with Thomson about community policing is likely to involve many such catchy maxims. “Destabilized communities,” he told me, “need guardians, not warriors.” He explained the “Back to the Future Paradox”—use technology wisely, but pair it with regular-old “Bobbies on the street.” And he stressed the idea that public safety is about access to social services, economic rejuvenation, and good schools, not just cops: “Nothing stops a bullet like a job.”

As someone committed to seeing what the data shows, I do have to point out that—as of 2 years ago—it was too early to definitively call Camden's experiment a success.

The numbers themselves can be potentially misleading: Homicide rates, for example, aren’t necessarily a complete measure of urban violence. Just because fewer people are dying from gunshot wounds doesn’t mean fewer people are getting shot: It could also mean they’re getting better treatment, faster. One of Thomson’s Camden policies, nicknamed “Scoop and Go,” may be at work here, which mandates officers to personally drive victims to the hospital if ambulance wait times are too long. That saves lives, without really addressing the source of the violence itself. (Another possible factor: More victims are just getting to the hospital faster by calling an Uber.)

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Qualified Immunity gives police officers blanket protection from being sued for their bad behavior, no matter how egregious it is. I hope the Supreme Court cleans up this mess that it created.

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Records released last week in the lawsuit revealed that Turner had a decade-long history of inmate complaints against him alleging excessive force, sexual abuse and misconduct, racial slurs, and sadistic punishments that included leaving a handcuffed woman in 93-degree heat for 3 hours while calling her a "fat pig." Another inmate told sheriff's deputies that she witnessed Turner and another officer trading contraband cigarettes for oral sex.

None of that stopped Turner, who at some point was promoted to lieutenant, until this August.

Weimar's hospitalization sent shockwaves through the state, drew national media coverage, and put a gruesome spotlight on Florida's problem-ridden and wildly expensive prison system, especially Lowell, where inmates have long alleged sexual abuse and violence by guards.

Last August, the Justice Department launched a civil rights investigation into pervasive misconduct and sexual assaults by correctional staff at Lowell. A 2015 Miami Herald investigation found numerous accusations of assaults, retaliation, filthy conditions, inadequate healthcare, and suspicious deaths at the prison, as well as "an inadequate number of cameras," which allows guards to hide brutality.

Democratic Florida state Rep. Dianne Hart said in a statement today that she applauds the Marion County Sheriff's Office for making the arrest. "However, with over 130 pages of documented official FDOC incident reports detailing the horrors that Lt. Turner inflicted on the women of Lowell Correctional sitting on my desk and Cheryl Weimar with a broken neck," she continued, "I find it absolutely disgusting that Lt. Keith Turner still has a place at FDOC, and I pray that justice is served in all cases involving Lt. Turner."

After Weimar's hospitalization, the state launched several investigations into the incident, and Turner and the other guard were reassigned to jobs where they would not have contact with inmates.

Following his arrest, the FDOC says it is moving to fire Turner immediately.

"The Sheriff's findings in this case against Mr. Turner are abhorrent and in complete contrast to the values and integrity held by our staff," FDOC Secretary Mark Inch said in a press statement. "We are moving forward with his immediate dismissal."

Apparently not. It certainly looks as though FDOC Secretary Mark Inch didn't have any problem with Lt. Turner using excessive force, sexually abusing inmates, using racial slurs, and handing out sadistic punishments. For some reason, the Florida Department of Corrections chose not to act against this piece of trash until he'd crippled an inmate. From where I sit, Floridians need to clean house throughout the entirety of the Department of Corrections, starting with Secretary Inch and working their way down to Lt. Turner.

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I dislike Congressional earmarks, as I dislike all wasteful government spending. I've long viewed them as bribes that corrupt the political process, by inducing Congressmen to vote for legislation that they'd otherwise oppose.

I'm rethinking my opposition, after reading Tyler Cowen's essay at Bloomberg View.

In essence, earmarks give congressional leaders more control over individual members. Recalcitrant representatives can be swayed by the promise of a perk for their district. That eases gridlock and gives extreme members of Congress something to pursue other than just ideology.

But is more legislation always a good result? Advocates of smaller government should keep in mind that reforming spending and regulation requires some activism from Congress. Gridlock today is not the friend of fiscal responsibility, coherent policy, or a free, well-functioning capitalist economy.

…

Most of all, I think of earmarks as recognizing that compromise and messiness are bound to remain essential features of American government, and that, whether we like it or not, there is something inherently transactional about being governed. Earmarks are a risk insurance policy against extreme outcomes, and like many other insurance policies, in any given year they may appear a pointless waste of resources. Still, we should keep in mind they may be protecting us against the very worst outcomes.

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For the past two days, I've been listening to Dan Carlin's conversation with Sam Harris. This morning, I heard an exchange around the Confederate Flag that caught my attention. First, Dan floated the thought of a redesigned Confederate flag, to show regional pride without showing racism.

I would love to interview these folks, because whenever someone writes me a letter about this, they always say "It's not about the slaves and it's not about the racial situation, it's about the right to seceede, to protect your life, it's a right to do all ...", in other words, take every reason for the civil war besides the slavery aspect and they will say it's about that because nobody's, or very few people I've ever spoken to, say "Yeah, I fly the flag because black people are inferior and blah, blah, blah." I would love to see a notation then to the flag, you know there's a lot of flags from other countries where something will happen and a new regime will take over or something will change and they'll alter the flag slightly, you know we'll always put another star on our flag when a new state came in. Seems to me you could put something like a chain being snapped or something in the center of the flag or something that indicated that this flag isn't in favor of slavery or this is the post-slavery Confederacy or "Welcome back black people to the New South", whatever. Something that just sort of said, "You know the little chain on the flag being freed, yeah, that shows that this flag does not represent something that said that the slavery was the part that we would like to see returned."

A few minutes later, Dan came back to that thought and expanded on it a bit more.

In the emails that I'll get about this people will talk about "It's just a pride in your heritage sort of thing". I think the pity then is that there isn't an alternative symbol that if you wanted to say "I'm a Southerner and I'm proud of it" that you could show that didn't have the same overtones, that didn't appear to some people that you're not just saying "Yes, I'm proud of the South but I'm proud of things the South did before the Civil War". I mean the United States for example has a whole bunch of other flags that we've flown at one time or another, the Gadsen Flag, all those kinds of things, which different people can appropriate to show different aspects or different ideas. Seems to me, if you're into Southern pride—and I don't think there's anything wrong with having pride in your heritage, or your grandfathers, or anything like that. It's a pity that the symbol you could use to show that has all sorts of other overtones that are not just deeply offensive but that make people who are valued members of your community feel, not just like second class citizens, but maybe even a little afraid. Who would want to show that in a way that took other Southerners and, instead of making them feel proud, would make them feel the opposite of proud?

I decided to take that idea and run with. What if I took the Confederate flag and changed the colors? I decided to keep the basic elements, to represent some continuity of Southern culture, but change the colors to signify that this is a New South that doesn't embed the racism and hate of the past.

Original Flag

I think the defining features of the original flag are the bold, red field that dominates the flag and the two blue bars that crisscross the field. That's what I need to change, to make this feel like an updated, more modern, version of the flag.

Redesign 1

For my first attempt, I wanted to deemphasize the red. I moved the blue from the bars to the field and moved the red from the field to the stars and the outline of the bars.

Redesign 2

I didn't like how bright (eye searing?) the red and white bars were. I decided to make the field white and match blue bars with white stars. I deemphasized the red even more, relegating it to the outline of the bars.

Redesign 3

The second attempt was better than the first, but I didn't like the bright expanse of white, now that the entire field was white. I made the field blue again and decided to get rid of the red entirely, replacing it with green. Now the stars are green and the outline of the bars is green.

I'll say that the green is there because it can represent the rebirth of the South into the new South.

Redesign 4

This is nearly identical to the third redesign. In this one, I removed the outline of the bars, to make for a starker contrast against the blue field and a further distancing from the Old South design.

What do you think? Can you imagine seeing one of these flags as a common symbol of the New South, one not associated with racism and hate?

The biggest problem in healthcare is that providers—doctors and hospitals—are allergic to straightforward pricing and refuse to give actual prices before providing services. This idea for a solution isn't perfect but I think it's worth trying.

Perhaps a solution in the healthcare arena would be to institute binding arbitration in cases where providers refuse to agree on prices before providing service. And perhaps the binding arbitration could be based on the fee the patient offered to pay upfront, but declined by the provider in favor of bureaucratic claims processing. For example, if a patient had offered (in good faith) to pay $5,000 for the surgery; but the EOB and claim came in at $50,000, the arbitrator would award one or the other. Common sense tells us that the arbitrator will almost always award the patient’s upfront offer.

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Senator Rand Paul, at the Washington Times:

For these reasons and others, last week I joined my colleague Sen. Patrick Leahy, Vermont Democrat, in introducing a bill that would authorize judges to disregard federal mandatory-minimum sentencing on a case-by-case basis.

Some might think it is unusual for a conservative Republican to join a liberal Democrat on such a bill, but contrary to popular belief, the protection of civil liberties and adherence to the Constitution should be a bipartisan effort.

In my younger days, I would have regarded this as rank liberalism and heresy. Now it just seems like common sense. I'll stand with Rand on this one.

Read the whole thing. His reasons are dead on.

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Michael Solon, writing in the Wall Street Journal:

Why? A more progressive tax code now leverages the negative impact of slow economic growth. The share of all individual income taxes paid by the top 1% has risen to 41.8% in 2008 from 17.4% in 1980—but almost two-thirds of the income from the top 1% comes from nonwage income, including capital gains, dividends and proprietor's profits.

Individual income taxes as well as corporate taxes are now far more rooted in the shifting sands of volatile business income and capital profits rather than in the terra firma of wage income that stabilizes payroll taxes. From 1960 to 2000, payroll taxes were never lower than in the previous year, individual income taxes dipped only twice, and corporate taxes dropped 11 times. Since 2000, individual income and corporate tax revenues dropped five times, while payroll taxes fell twice. Not only do revenues from individual tax returns drop more often now. They fall more severely, with recent collapses of 14%-20% versus the 3%-5% range before 2000.

If "the rich" pay all of the taxes (and they pay a massive share in the U.S.) than tax revenues will be directly tied to the fates of the rich. Right now, the federal government needs high income earners to continue earning high incomes. As soon as the high incomes take a hit, tax revenue takes a massive hit.

We now have a government that has a massive incentive to ensure that "the rich" never see their incomes drop. We might have a more just government if we evened out the tax code, so that income taxes were spread more broadly and more evenly over the entire country instead of being concentrated over a very small portion of the country.

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From Patrick O'Connor, at the Wall Street Journal:

During Jeb Hensarling's first congressional bid, a man at a campaign stop in Athens, Texas, asked the Republican if he was "pro-business."

"No," the candidate replied, drawing curious stares from local business leaders who had gathered to hear him speak, a former Hensarling aide recalled. "I'm not pro-business. I'm pro-free enterprise."

Now, more than a decade later, that distinction has Wall Street on edge. The new chairman of the House financial services committee wants to limit taxpayers' exposure to banking, insurance and mortgage lending by unwinding government control of institutions and programs the private sector depends on, from mortgage giants Fannie Mae and Freddie Mac to flood insurance.

Banks and other large financial institutions are particularly concerned because Mr. Hensarling plans to push legislation that could require them to hold significantly more capital and establish new barriers between their federally insured deposits and other activities, including trading and investment banking.

A Republican who wants to make banks play by the same rules as the rest of a us? A Republican who wants to lets bad businesses fail? A Republican who believes it's a profit and loss system not just a profit system? Okay, I can buy that. But how'd he get to be chair of the House financial services committee? That seems too good to be true.

I'll have to keep an eye on Congressman Hensarling.

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From Matt Taibbi, at Rolling Stone:

Despite the passage in late 2012 of a new state ballot initiative that prevents California from ever again giving out life sentences to anyone whose "third strike" is not a serious crime, thousands of people – the overwhelming majority of them poor and nonwhite – remain imprisoned for a variety of offenses so absurd that any list of the unluckiest offenders reads like a macabre joke, a surrealistic comedy routine.

Have you heard the one about the guy who got life for stealing a slice of pizza? Or the guy who went away forever for lifting a pair of baby shoes? Or the one who got 50 to life for helping himself to five children's videotapes from Kmart? How about the guy who got life for possessing 0.14 grams of meth? That last offender was a criminal mastermind by Three Strikes standards, as many others have been sentenced to life for holding even smaller amounts of drugs, including one poor sap who got the max for 0.09 grams of black-tar heroin.

Justice should be blind but it shouldn't be deaf, dumb, and stupid too. Shame on the politicians who passed these laws and more shame on the voters who supported them. I was one. As a kid, I thought Three Strikes and mandatory sentencing guidelines were a great idea to crack down on soft judges. I was wrong. These laws are wrong. And the people unjustly imprisoned for long sentences deserve release, apology, and restitution.

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Conn Carroll, writing for the Washington Examiner:

Huelskamp and his Republican colleagues changed all that. The 2011 Budget Control Act cut spending by $1.5 trillion, and the sequester cut it by an additional $1.2 trillion. At the same time, House Republicans were able to preserve nearly all of the expiring Bush tax cuts and cut the debt.

The CBO's Budget and Economic Outlook for fiscal years 2013 through 2023 shows just how much House Republicans have actually accomplished. The federal government is now on track to spend just $46.2 trillion through 2021. That is a $3.6 trillion spending cut. And instead of taxes eating up 21 percent of the U.S. economy in 2021, now the government is set to take in just 18.9 percent. The 2021 national debt is projected to be a bit lower, too, down from the earlier $18.25 trillion in 2011 to just $17.87 trillion today.

Despite all of this supposedly economy-killing "austerity," unemployment has steadily fallen, too. When Republicans took control of the House in 2011, the nation's unemployment rate was 9 percent. Today, it has fallen to 7.7 percent.

This is why I'm not entirely pessimistic about working in politics. Change is slow and hard. But that's a feature of the system, not a bug. If the American populace wants to get engaged and fight battles over the long term, they will be able to have success. The key is not just getting engaged but also staying engaged over a long period of time.

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Alex Tabarrok, of George Mason University, shares an interesting account of regulation, deregulation, and increased safety. In the mid-90's, Piper, Cessna, and Beach were no longer producing small airplanes for the general public. They were too afraid of lawsuits over planes that were decades old.

Congress eventually responded by saying that "manufacturers could not be held liable for accidents involving aircraft more than 18 years old". The result: an increase in overall safety.

a significant (on the order of 13.6 percent) reduction in the probability of an accident. The evidence suggests that modest decreases in the amount and nature of flying were largely responsible. After GARA, for example, aircraft owners and pilots retired older aircraft, took fewer night flights, and invested more in a variety of safety procedures and precautions, such as wearing seat belts and filing flight plans. Minor and major accidents not involving mechanical failure—those more likely to be under the control of the pilot—declined notably.

When it cames to safety regulation, more is not always better. Sometimes it's just more. People are more likely to be cautious if they believe that they bear risk themselves rather than believing that someone else bears all of the risk.

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Americans in urban areas think of dental services as a kind of regular maintenance. It's little different than changing the oil in your car and occurs about as often. But that's not true for everyone.

According to the Pew Center on the States, more than 40 million Americans reside in areas with a shortage of dentists. And individuals without dental health access often end up in the emergency room, which is more expensive for everyone.

Advocacy groups and some state legislators think an alternative type of dental provider, often called a dental therapist, can fill the void. Dental therapists don’t receive as much training as a dentist. But they can perform some of the same basic services — such as pulling teeth and filling cavities — under the supervision of a dentist.

In Minnesota and Alaska, the two states that have practicing dental therapists so far, some of the therapists are able to take their work on the road, traveling to rural areas to treat those who have little or no access to dentists — or who have limited dental coverage. The dental therapists charge less than dentists and are able to take all types of insurance, including Medicaid and Medicare.

“The bottom line is that it will cost a state significantly less to hire dental therapists to provide basic restorative care to the underserved,” said Julie Stitzel, manager for the Pew Children’s Dental Campaign.

How are America's dentists responding to this? Not well.

“The No. 1 obstacle has been organized dentistry,” Pew’s Stitzel said.

“What we’re opposed to is the delegation of surgical procedures,” Faiella said. “Everyone deserves the treatment of a dentist and the care of a dentist.”

He says ADA is developing a range of programs to address the gap — pushing prevention measures such as fluoride and dental sealants, emergency room diversion programs in which dentists partner with community health clinics to ensure people needing dental care don’t end up in the emergency department — and an ad campaign to encourage parents to make sure their kids brush twice a day.

An ad campaign. That'll certainly take care of the dental problems of America's rural population. After all, they deserve a dentist not a less personage. And if they can't have a dentist? They're better off having nothing.

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Wisconsin's School Choice Demonstration Project (SCDP) recently finished a 5-year study of the effectiveness of Milwaukee's voucher program.

After five years, the SCDP team found:

Statistically significant gains for voucher users in reading compared to matched Milwaukee Public School (MPS) pupils (with the important caveat that the introduction of program wide WKCE testing in the final year of the evaluation could be responsible for some of the gains);

• Statistically similar impacts on math test scores for matched MPS and MPCP users;
• A modest positive impact on public school tests scores as more private schools participated in the MPCP;
• Statewide taxpayer savings, though not in Milwaukee;
• Higher graduation rates for voucher users compared to MPS;
• Higher rates of four-year college enrollment for voucher users;
• Evidence that closed schools in both MPS and the MPCP were the lower performers;
• High levels of parental satisfaction;
• No impact on housing prices or racial integration;
• High rates of school switching;
• Wide variation in achievement levels between schools.

So what are the practical lessons from the SCDP for other communities considering vouchers? Don’t expect the introduction of a voucher program to sizably increase test scores across the board for voucher users, or students in public schools. It’s safe to expect no negative impact on test scores, but any gains will likely be substantively small. So if the primary consideration in a community is raising test scores, a voucher program like Milwaukee’s may not be wise.

However, if you are a community struggling with high school graduation rates, particularly for low-income pupils (like Madison and Green Bay), a Milwaukee style voucher program could be a viable strategy to raise attainment.

I think this evidence justifies expanding the voucher program state wide. I'd love to see that happen.

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I was ecstatic when I read this yesterday.

the Republican Study Committee expresses support for expanding fair use, treating the reduction of statutory copyright damages as a kind of tort reform, punishing false copyright enforcement claims, and limiting copyright terms to twelve years, with increasingly expensive extensions available for no more than 34 years.

It is the most radical proposal for overhauling copyright that we have seen in recent years — and the most head-turning change of direction in decades for either party on intellectual property issues.

This would have been a major step forward for the Republican party in two crucial areas. First, it's an issue that is important to many younger voters, a demographic that has little affection for Republicans. Second, it would have demonstrated that the Republican party is something other than a reflexive protector of big businesses.

Sadly, the Republican Study Committee withdrew their brief within 24 hours.

”Yesterday you received a Policy Brief on copyright law that was published without adequate review within the RSC and failed to meet that standard. Copyright reform would have far-reaching impacts, so it is incredibly important that it be approached with all facts and viewpoints in hand.”

Yes, the Republican Party has just caved to a major big business (Disney) representing a major industry (Hollywood) that hates Republicans. In the process, angering many younger voters and technology savvy voters. How, exactly, do the idiots running the party think that this will help them out? This only proves, again, that the Republican party protects big businesses no matter and cares nothing for other Americans.

Worse, our cultural heritage is rapidly disappearing. Virtually the entire cultural output of the 20th and 21st centuries—movies, music, art, literature—is locked up in restrictive copyright. All of these works will be lot forever, unless the copyright owner sees a clear, commercial benefit to keeping these works available. Copyright reform—and limiting the term of copyright—is a vital part of preserving our cultural heritage.

From a political, cultural, and policy standpoint, this is an absolutely stupid decision. I'm furious with the Republican Study Committee and the craven cowardice that they've spinelessly demonstrated.

John Cochrane recently wrote about healthcare reform. This is the direction we need to go in, not Obamacare.

First, he talked about the insurance side of health care.

To summarize briefly, health insurance should and can be individual, portable, life-long, guaranteed-renewable, transferrable, competitive, and lightly regulated, mostly to ensure that companies keep their contractual promises. “Guaranteed renewable” means that your premiums do not increase and you can’t be dropped if you get sick. “Transferable” gives you the right to change insurance companies, increasing competition.

Insurance should be insurance, not a payment plan for routine expenses. It should protect overall wealth from large shocks, leaving as many marginal decisions unaltered as possible.

Preexisting conditions, lack of insurance by the young and healthy, and spiraling insurance costs– the main problems motivating the ACA -- are neatly addressed by this alternative. Why do we not have a system? Because law and regulation prevent it from emerging. Before ACA, the elephant in the room was the tax deduction and regulatory pressure for employer-based group plans. This distortion killed the long-term individual market and thus directly caused the pre-existing conditions mess. Anyone who might get a job in the future will not buy long-term insurance. Mandated coverage, tax deductibility of regular expenses if cloaked as “insurance,” prohibition of full rating, barriers to insurance across state lines – why buy long term insurance if you might move? – and a string of other regulations did the rest. Now, the ACA is the whale in the room: The kind of private health insurance I described is simply and explicitly illegal.

He finished by writing about the supply of health care and why we have expensive, low quality options.

So, where are the Walmarts and Southwest Airlines of health care? They are missing, and for a rather obvious reason: regulation and legal impediments.

A small example: In Illinois as in 35 other states7, every new hospital, or even major purchase, requires a “certificate of need.” This certificate is issued by our “hospital equalization board,” appointed by the governor (insert joke here) and regularly in the newspapers for various scandals. The board has an explicit mandate to defend the profitability of existing hospitals. It holds hearings at which they can complain that a new entrant would hurt their bottom line.

Specialized practices that deliver single kinds of service or targeted groups of customers cheaply face additional hurdles, as they undermine the cross-subsidization provided by “full service” hospitals. For example, the Institute for Justice is bringing a major suit8 by a specialty colonoscopy practice in Virginia, which local “full service” hospitals managed to ban.

... The increasing spread of medical tourism to cash-only offshore hospitals is a revealing trend. Why does this have to occur offshore? What’s different about the hospital location? Answer: the regulatory regime.

So, what’s the biggest thing we could do to “bend the cost curve,” as well as finally tackle the ridiculous inefficiency and consequent low quality of health-care delivery? Look for every limit on supply of health care services, especially entry by new companies, and get rid of it.

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John Goodman talks about why Obamacare was flawed from the very beginning.

Do you remember the debates over the Affordable Care Act, aka ObamaCare? Now that repeal of the law has become a major campaign issue, it may be helpful to remember why Congress passed it in the first place.

Early in 2010, as the climactic votes neared, a parade of the legislation's defenders—from the House, Senate and Obama administration—appeared across the media. All had the same message: pre-existing conditions. They named the names of families "victimized" by companies that had refused to sell them insurance, had canceled their coverage or had refused to pay their medical bills.

The message surely resonated, but how many people have actually been affected since the law passed? The Affordable Care Act established a federally funded risk pool—the Pre-Existing Condition Insurance Plan—that allows individuals with such disqualifying conditions to buy a policy for the same premium a healthy person would pay. About 82,000 people have signed up as of July 31, according to the Kaiser Family Foundation's statehealthfacts.org.

That is not a misprint. Out of a population of more than 300 million, some 82,000 have the problem that was cited as the principal reason for spending $1.8 trillion over the next 10 years and in the process turning the entire health-care system upside down.

There is a much better way to ensure people with pre-existing conditions and you don't have to federalize health care in order to do it.

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Avik Roy, on a very promising development from the AMA.

At the Vice-Presidential debate last week, Joe Biden claimed that the American Medical Association sided with him, and against Paul Ryan, on the merits of the Romney-Ryan plan for Medicare reform. “Who do you believe?” exclaimed Biden. “The AMA [and] me? A guy who has fought his whole life for this? Or somebody [like Paul Ryan]?” Well, it turns out that the AMA’s key policy committee has come out in favor of premium support for Medicare, in a fashion that tracks closely with what Mitt Romney and Paul Ryan are proposing.

... The AMA Council’s report states that it came around to this view not at the behest of Republican operatives or candidates, but after speaking with Bill Clinton’s former budget chief, Alice Rivlin, who along with Paul Ryan proposed a version of this plan. “Dr. Rivlin emphasized that defined contribution amounts should be sufficient to ensure that all beneficiaries could afford to purchase health insurance coverage, and that private health insurance plans should be subject to regulations that protect patients and ensure the availability of coverage for even the sickest patients.”

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