The Independent Institute


Scotland’s Looming Regulatory Hangover

12468974 - edinburgh, uk - july 24, 2010: inside view of a public house, known as pub, for drinking and socializing, is the focal point of the community, pub business, now about 53,500 pubs in the uk, has been declining every year.

In May 2012, Scotland’s parliament enacted a law setting a minimum unit price (MUP) for all alcoholic beverages sold nationwide. The MUP of 50 pence (about 72 cents) per 10 milliliters of pure alcohol applies to beer, wine and distilled spirits, but has not yet gone into effect because the legislation, not surprisingly, was challenged in court immediately by the Scotch Whisky Association and other industry trade groups.

Edinburgh’s Court of Session is expected to rule later this summer on the industry’s lawsuit. The decision will be watched closely not only in Scotland, but in England, where a similar proposal was shelved in 2012; in Canada’s Saskatchewan province, where MUP (with five price bands depending on alcohol content) already is in place; and in other nations, such as Estonia and Ireland, which are considering minimum prices for alcoholic beverages.

Proponents of establishing a floor price see it as a way of mitigating the social costs of alcohol abuse (e.g., drunk driving, wife beating, child neglect, absenteeism and publicly financing the treatment of alcohol-related diseases) by raising sharply the prices of the cheapest adult beverages on the Scottish market. Opponents have countered that MUP will “artificially distort trade in the alcoholic drinks market, contrary to EU law.”

Stop Coddling My College Students!

helicopter parentIt seems like every time I get online I see posts about college students advocating for the restriction of free speech on college campuses. From “safe spaces” to Emory students calling to evaluate teachers on their use of “microaggressions,” sometimes I feel like I’m living in the Twilight Zone. It certainly wasn’t that long ago since I was in college. My college was a place for people to explore new ideas, encounter people from a variety of backgrounds and, believe it or not, get acquainted with ideas that may make many people uncomfortable.

I’ve seen many people question these “social trends” in higher education. In particular, they’ve delved into how these movements threaten the very ideals of American society, namely, freedom of speech.

As anyone who knows me can attest, I am an ardent defender of liberty. You will find no one more dedicated to the preservation of individual freedom than myself. However, there is another problem with these trends I’d like to discuss. That is, what are the implications for this generation of college students? To answer this, I think we need to go to the genesis of the problem—parents.

On the first day of class I give my students their syllabus. I tell them several things. One thing I tell them is, “I’m not talking to your mom.” In fact, under federal law, I’m not allowed to do so unless a student waives his or her right to privacy. Even if they do, I can speak to a parent, but I don’t have to. I tell them that, as adults, if they have an issue with the class, that’s something for the two of us to discuss. If a parent has a problem with his child’s performance, that’s something he needs to discuss with his child.

I, Peach: A Lesson in Comparative Advantage

delicious peaches hanging on a tree branchAs part of my lunch today, I enjoyed a big, ripe, sweet, firm peach. “So what?” you may be asking. Well, my doing so is more remarkable than one might think. You see, I live at the extreme end of the road, near a remote, isolated village in the farthest southeast corner of the Mexican state of Quintana Roo; and the peach I ate was grown in California.

I acquired this fruit, as I acquire the bulk of the fruits, vegetables, and other fresh comestibles I consume, from Lucio, a man who rises each day at 4:00 a.m. and heads to the market in Bacalar, a town about 100 miles from my home. Lucio loads his pickup with fresh produce and other things, hauls these products for two hours, and offers them to those of us who live along a pot-holed road in this far-away place. The people who sell to him, in turn, acquire their inventory from other sellers, who are part of a perhaps lengthy supply chain whose specifics I do not know. I know only that each entrepreneur who participates in this amazing process makes considerable investments and bears substantial risk in the hope of pleasing those who might buy from him. No sales are assured; buyers are free at every point to take it or leave it, and leaving it entails leaving the would-be seller holding the bag in more ways than one.

The Regulatory State Reaches the Wellness Industry

young medical doctor with a stethoscope around his neck holding a black folder

The Equal Employment Opportunity Commission (EEOC) has finalized rules on how employers can use wellness programs. By current federal standards, the rules are concise: 19 pages pertaining to the Americans with Disabilities Act and 17 pages pertaining to the Genetic Information Nondiscrimination Act. Both laws are extremely popular. The ADA (1990) passed by 91-6 in the U.S. Senate and 377-28 in the U.S. House of Representatives. The GINA (2008) passed by 95-0 in the Senate and 414-1 in the House.

These laws are meant to prevent discrimination. However, this purpose bumps against the real world, where health insurers cannot charge different premiums to individuals who are sick. The Affordable Care Act (2010) allows employers to offer incentives to workers who participate in wellness programs, and can offer financial incentives up to 30 percent of premium (or up to 50 percent for anti-smoking programs). However, participation in a wellness program also necessitates surrendering personal health information to an employer who would otherwise be barred from having it (under the Health Insurance Portability and Accountability Act, 1996).

Because employers cannot use underwriting for medical risk to charge different premiums to different employees, it is hard to avoid the conclusion that wellness programs are designed less to make or keep employees well than to ensure healthy people are attracted to the employer and sick people are not. Evidence suggests this is the real consequence of workplace wellness programs.

ACA-related rules attempting to triangulate these contradictions were published in 2013 (the “tri-department rule”). However, the Obama administration recognized that these two previous laws also had to be reconciled with the ACA. So, more regulations had to be emitted. Professor Timothy Jost summarizes the rules at Health Affairs blog:

Unlike the tri-department rule, which applies only to wellness programs connected with employer-sponsored health insurance or health plan coverage, the EEOC ADA and GINA rules apply to employer wellness programs whether a wellness program is part of employer-sponsored health plan, is offered to employees whether or not they participate in a health plan, or is offered by employers that do not sponsor a health plan or health insurance.

There is no hiding place. We have come a long way from ensuring people in wheelchairs can enter buildings. Laws intended to prevent discrimination are now being used to regulate corporate yoga classes.

The Real Lesson of John Oliver’s Medical Debt Forgiveness Stunt

John Oliver_MLLate-night TV host John Oliver recently caused a stir by attacking debt collectors in a clever way. He set up his own collection agency, bought $15 million of medical bad debt, and then forgave it all. This was all done on TV, to the cheers of his audience.

Oliver claimed to have outdone Oprah Winfrey, who once gave a car to each person in her studio audience. Oprah’s car giveaway cost $8 million, just over half of Oliver’s buyout. So, Oliver wins the charitable ego competition, right?

Nope. Oliver did not forgive $15 million of medical debt. That was the face amount of the accounts receivable. He bought them for about half a cent on the dollar, or about $60,000 total. The lesson of Oliver’s stunt is that medical accounts receivable are very hard to collect. That is why they trade so cheaply in the secondary debt market.

Oliver said the portfolio comprised about 9,000 deadbeat patients. So, the average debt was $1,667 (although, I am sure there was a large variance around the mean).

Seven of ten hospitals report they collect less than one-third of patients’ fees at the time of service. No wonder they have so much trouble collecting. Then, they futilely sic debt collectors on patients whom they know are unlikely to pay. It causes a lot of pain for little benefit. As I discussed previously, Medicare regulations force providers to perform this pantomime, instead of writing off charitable care efficiently and effectively.

The real lesson of John Oliver’s stunt is that government regulations make it nearly impossible for patients to discharge their debts in an orderly and responsible way.

Four Questions for the Rulers

1. In what way(s) have I violated your natural rights?

2. If I have not violated your natural rights (as I believe to be the case), thereby prompting you to retaliate against me in defense of them, why are you violating my natural rights in such a great variety of ways?

3. If you regard natural rights as intellectually incoherent—as Jeremy Bentham pronounced them, nonsense upon stilts—what justification, if any, do you have for your unprovoked abuse, punishment, and plunder of me and countless others subject to the exercise of your power?

4. If you have no morally defensible justification, but are simply plundering and bullying me and others to gratify your own ravenous greed and unprincipled maliciousness or, perhaps, in the service of an intellectually bankrupt notion such as the aggregate utility or welfare of society, will you be surprised if I and others respond to you as we would to the attack of a wild animal?

The Stanford Sexual Assault Case and the Limits of the Incarceration State

Between 12% and 20% of women are sexually assaulted while in college.

Between 12% and 20% of women are sexually assaulted while in college; between 3% and 10% might be raped or experience attempted rape.

Perhaps the most striking void left in the aftermath of the Brock Turner sexual assault trial—the Stanford rape case—is the utter lack of resolution for the victim and the degree to which the human harm created by his actions has gone unaddressed.

This is extraordinary given the apparent success of the case. Fewer than 10% of cases referred to prosecutors secure a conviction on the underlying assault or rape charge. The jury saw through the manipulations and smoke screens deployed by the defense attorneys, weighed the evidence, and found that Turner had committed three felonies, including attempted rape, beyond a reasonable doubt. This case should have been a poster child for the anti-sexual assault movement.

Instead, the case has ignited a firestorm of controversy, in no small part because of the power of the victim impact statement. Turner doesn’t “get it,” she writes, referring to the defendant’s comments that seem to deflect responsibility and his focus on intent, rather than the harm he created. The victim wasn’t “hurt,” she was emotionally and psychologically devastated. Turner still doesn’t understand the depth of the damage his actions caused to another human being.

Obamacare Slightly Increased Short-Term Uninsured

Are you insured_MLThe best measurement of people who lack health insurance, the National Health Interview Survey published by the Centers for Disease Control and Prevention (CDC), has released early estimates of health insurance for all fifty states and the District of Columbia in 2015. There are two things to note.

First: About 70 percent of residents, age 18 to through 64, had “health insurance” in 2015, which is the same rate as persisted until 2006. Obamacare has not achieved a breakthrough in coverage. It has just restored us to where we were less than a decade ago.

What has also happened is a significant change from private coverage to government welfare (primarily Medicaid). The shift has been about five percentage points since 2006, and ten percentage points since 1997. (That is, there was no net change in coverage before the Great Recession, but there was crowding out of private coverage in favor of welfare.)

Confirmed: Obamacare’s 2016 Average Rate Hike Was Eight Percent

healthcare cost increase_MLWe are already anticipating double-digit premium hikes for Obamacare plans in 2017, based on insurance filings in a sufficient number of states to show the trend.

Obamacare’s defenders point out two limits to these leading indicators. First, they are requested, not approved rate hikes. Second, Obamacare beneficiaries can trade down. A person whose plan raises premiums by double digits can switch to a plan with a lesser increase. Both criticisms are fair.

Nevertheless, now that the dust has settled on 2016, and all the data on this year’s enrollment analyzed, we can confirm from two pro-Obamacare sources that premiums in Obamacare’s exchange plans increased by an average of eight percent from 2015 to 2016. General measures of price changes, such as Consumer Price Inflation, were effectively flat over the period. That is, the eight percent Obamacare premium hike was a real, not nominal, price hike.

In April, the Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health & Human Services reported:

Two-thirds (67 percent) of consumers selected a new plan in 2016: all new consumers, plus 43 percent of returning consumers. Taking into account shopping, the increase in the average premium was 8 percent between 2015 and 2016.

What Bible School Taught Me About Taxes

Kid Counting Money_MLOne of my first lessons in economics and politics came from an unlikely place—vacation Bible school.

I must have been about six or seven. For a week, I went to church to learn with other children my age about our faith and the Church.

Throughout the week we had the opportunity to earn stickers. For things like good behavior, helping the teachers, participating, and playing games, we received small happy face stickers. At the end of the week, we could “spend” these stickers at their store—exchanging what we’d earned for trinkets. (It’s amazing what a second grader will do for a plastic slinky.)

I remember the day all my work was going to pay off. I’d accumulated a good amount of stickers and I was so ready to use what I’d worked for to get what I wanted.

Then came the catch.