Friday, August 13, 2010
Saturday, August 7, 2010
Why Wait For a Convention, New York?
Every year when the budget deadline passes without a budget, or whenever there is a stalemate between the Governor and the only two legislators that actually wield legislative power (I speak of the Assembly Speaker and Senate President), someone asks, "Why don't we amend the state Constitution to fix this?"
And then the news stations dig up a softspoken constitutional scholar from a SUNY basement somewhere and he explains, with great solemnity, why amending the Constitution now is just not possible. According to the state Constitution itself (Art. XIX Sec. 1), he says, amending the document first requires legislative approval in two consecutive legislative sessions, then approbation by popular ballot, and then a delayed effective date. Figure three years minimum, likely more. The most we can do right now, he says in so many words, is wring our hands and hope for the best.
And then someone says, "well then let's have a convention and write a new constitution," and the constitutional scholar goes even grayer as he explains that under the Constitution (Art. XIX Sec. 2) this is something the legislature must first consent to be put on the ballot, or else we must wait up to 20 years for the question of a convention to be put on the ballot automatically, and we should then hope everyone's paying attention and still angry enough about the legislature's antics from 10 or 12 or 18 years ago to vote for a convention.
And through all of this the newscaster will nod in understanding until it's time to go back to the anchor desk for the weather or a reel of the latest fire, and that is that.
Now in my mind, that approach puts the relationship entirely backwards.
That approach has so-called "experts" looking no further than the state Constitution for the origin and definition of their powers of self-governance.
In my mind, it is the citizens' powers of self-governance that give rise to the Constitution, not the other way around. It is the citizens' ability to say for themselves how they wish to be governed that gives birth to a constitution of government. It is not for the constitution of government to define that ability, or to so limit it as to the point of virtual extinguishment.
If the document by which we govern ourselves can provide no genuine redress for the ineffectiveness of our elected officials, is it truly a democratic document? No. Is a document that so severely limits our ability to exercise the powers of self-governance that we cannot act even in the face of impasses that threaten to close down our government truly a democratic document? No.
If the legislature has the power to cancel, for the span of 20 years, any initiative that would alter its composition or powers, then where is its incentive to act appropriately? If the ridiculous antics of the legislature of late are any indication, there is no such incentive.
We should not be so quick as to assume that our form of government has not become a perverted form of democracy. What we have in New York is at least this:
Do we not have the right, arising from our own powers of self-governance, to collectively rip up the current Constitution and begin anew?
Of course we do. Of course we can.
It is a bold idea, yes, to abolish a government by replacing it with a new one. But it is certainly not a new idea. Each year on the Fourth of July we celebrate and pay homage to the men and women who were brave enough to carry out that idea even in the face of armed resistance from the old government. Are we less brave?
Adherents to the current government will poo-hoo the idea, claim that it is too radical, too disruptive, would never work, isn't possible, etc. Look carefully and you will see in all instances that they speak either out of a vested interest in the current government or else out of pure fear.
And before you poo-hoo the idea yourself, ask whether the current government is working for you, or for some other interest?
A convention of the people to form a government is indeed a radical concept, but it is the very mechanism on which our state and our federal governments were born. Could anyone legitimately challenge such a mechanism? We have so many examples in our national history that we need not question the validity of the process. And we can look to the process by which those conventions were held for guidance on how to compose the convention and ratify its product, if the product is indeed worth ratifying.
We have only to find the bravery to do it.
And then the news stations dig up a softspoken constitutional scholar from a SUNY basement somewhere and he explains, with great solemnity, why amending the Constitution now is just not possible. According to the state Constitution itself (Art. XIX Sec. 1), he says, amending the document first requires legislative approval in two consecutive legislative sessions, then approbation by popular ballot, and then a delayed effective date. Figure three years minimum, likely more. The most we can do right now, he says in so many words, is wring our hands and hope for the best.
And then someone says, "well then let's have a convention and write a new constitution," and the constitutional scholar goes even grayer as he explains that under the Constitution (Art. XIX Sec. 2) this is something the legislature must first consent to be put on the ballot, or else we must wait up to 20 years for the question of a convention to be put on the ballot automatically, and we should then hope everyone's paying attention and still angry enough about the legislature's antics from 10 or 12 or 18 years ago to vote for a convention.
And through all of this the newscaster will nod in understanding until it's time to go back to the anchor desk for the weather or a reel of the latest fire, and that is that.
Now in my mind, that approach puts the relationship entirely backwards.
That approach has so-called "experts" looking no further than the state Constitution for the origin and definition of their powers of self-governance.
In my mind, it is the citizens' powers of self-governance that give rise to the Constitution, not the other way around. It is the citizens' ability to say for themselves how they wish to be governed that gives birth to a constitution of government. It is not for the constitution of government to define that ability, or to so limit it as to the point of virtual extinguishment.
If the document by which we govern ourselves can provide no genuine redress for the ineffectiveness of our elected officials, is it truly a democratic document? No. Is a document that so severely limits our ability to exercise the powers of self-governance that we cannot act even in the face of impasses that threaten to close down our government truly a democratic document? No.
If the legislature has the power to cancel, for the span of 20 years, any initiative that would alter its composition or powers, then where is its incentive to act appropriately? If the ridiculous antics of the legislature of late are any indication, there is no such incentive.
We should not be so quick as to assume that our form of government has not become a perverted form of democracy. What we have in New York is at least this:
- inequitable ballot access laws that protect entrenched political parties
- a campaign finance process that obscures the public's view
- a budget process that all but guarantees a late and irresponsible budget
- a partisan legislative districting process that protects incumbents
- most egregiously, a manner of amending the Constitution to more accurately reflect the will of the people that, in operation, sets itself against the will of the people.
Do we not have the right, arising from our own powers of self-governance, to collectively rip up the current Constitution and begin anew?
Of course we do. Of course we can.
It is a bold idea, yes, to abolish a government by replacing it with a new one. But it is certainly not a new idea. Each year on the Fourth of July we celebrate and pay homage to the men and women who were brave enough to carry out that idea even in the face of armed resistance from the old government. Are we less brave?
Adherents to the current government will poo-hoo the idea, claim that it is too radical, too disruptive, would never work, isn't possible, etc. Look carefully and you will see in all instances that they speak either out of a vested interest in the current government or else out of pure fear.
And before you poo-hoo the idea yourself, ask whether the current government is working for you, or for some other interest?
A convention of the people to form a government is indeed a radical concept, but it is the very mechanism on which our state and our federal governments were born. Could anyone legitimately challenge such a mechanism? We have so many examples in our national history that we need not question the validity of the process. And we can look to the process by which those conventions were held for guidance on how to compose the convention and ratify its product, if the product is indeed worth ratifying.
We have only to find the bravery to do it.
Monday, August 2, 2010
How To Cut Health Care Costs By 64%: Let The Patient Ask
For some months now I have been suggesting on this blog (and everywhere else I can) that the best mechanism for exerting downward pressure on health care costs (meaning, the price of care) is to have the ultimate consumer (meaning, the patient) pay for the services.
Republicans and Democrats alike seem to be bent on ignoring such a tactic in favor of other approaches that cater to their pet constituencies.
In today's Kaiser Health News columnist Lisa Zamosky relates a real-life example of what happens when you force health care providers to justify their prices in the harsh light of day. The story involves a patient who has a high-deductible health plan, requiring her to pay on her own for the first $5,000 of care she gets in any year. When the patient went for an annual checkup and was handed a $350 bill (which she described as "ridiculous"), she asked for a discount. Removing a few routine tests from the bill brought it down to $125, which the patient then paid.
That's a discount of 64%.
Detractors from the market approach would likely suggest that a 64% discount is not a result that could be achieved on a large scale. The primary care industry would evaporate if it were forced to take a pay cut of approximately 2/3 of their income.
Which is true to this extent: the primary care industry as we currently know it would evaporate. In its place, I have no doubt at all, some enterprising individuals would figure out how to package primary care services in a way that deliver value to the patient and still allow physicians and nurses to eat. I don't think for a moment that the system will look anything like what we currently have. But why should it? The current system is both overpriced and inefficient; why should we continue to prop it up?
Health care reform proponents squawk about "access" and how free market solutions will fail to provide universal access to care. I wonder at that. It did not require massive government spending programs to make cellphone ubiquitous; it did not require impinging on personal liberties to put televisions in every home; it did not require nationalizing an industry to make personal computers affordable.
Imagine a sprawling government system whose purpose was to extend the life of the recording industry at a given point in time, say, the year 2000. We would be stuck with regulations forcing us to buy overpriced CDs and CD players, perhaps even cassette tapes, in order to keep the music stores open, while foreclosing the development of the iPod and other forms of music content delivery yet to be thought of. Why would we agree to such a thing? Why did we agree to such a thing?--because that's exactly what we have now.
Reform advocates posed this question may cough nervously and suggest that health care is different. But they can't quite say how.
I saw pshaw.
By the millions, Americans have concluded that the current third party payor system does not deliver the care they need at the price they can pay. The reformer's response: buy it anyway.
That's the definition of a command market.
Why would we agree to such a thing. Why did we?
Republicans and Democrats alike seem to be bent on ignoring such a tactic in favor of other approaches that cater to their pet constituencies.
In today's Kaiser Health News columnist Lisa Zamosky relates a real-life example of what happens when you force health care providers to justify their prices in the harsh light of day. The story involves a patient who has a high-deductible health plan, requiring her to pay on her own for the first $5,000 of care she gets in any year. When the patient went for an annual checkup and was handed a $350 bill (which she described as "ridiculous"), she asked for a discount. Removing a few routine tests from the bill brought it down to $125, which the patient then paid.
That's a discount of 64%.
Detractors from the market approach would likely suggest that a 64% discount is not a result that could be achieved on a large scale. The primary care industry would evaporate if it were forced to take a pay cut of approximately 2/3 of their income.
Which is true to this extent: the primary care industry as we currently know it would evaporate. In its place, I have no doubt at all, some enterprising individuals would figure out how to package primary care services in a way that deliver value to the patient and still allow physicians and nurses to eat. I don't think for a moment that the system will look anything like what we currently have. But why should it? The current system is both overpriced and inefficient; why should we continue to prop it up?
Health care reform proponents squawk about "access" and how free market solutions will fail to provide universal access to care. I wonder at that. It did not require massive government spending programs to make cellphone ubiquitous; it did not require impinging on personal liberties to put televisions in every home; it did not require nationalizing an industry to make personal computers affordable.
Imagine a sprawling government system whose purpose was to extend the life of the recording industry at a given point in time, say, the year 2000. We would be stuck with regulations forcing us to buy overpriced CDs and CD players, perhaps even cassette tapes, in order to keep the music stores open, while foreclosing the development of the iPod and other forms of music content delivery yet to be thought of. Why would we agree to such a thing? Why did we agree to such a thing?--because that's exactly what we have now.
Reform advocates posed this question may cough nervously and suggest that health care is different. But they can't quite say how.
I saw pshaw.
By the millions, Americans have concluded that the current third party payor system does not deliver the care they need at the price they can pay. The reformer's response: buy it anyway.
That's the definition of a command market.
Why would we agree to such a thing. Why did we?
Subscribe to:
Posts (Atom)