July 24, 2009 03:45 PM ET

As many of you know, I'm on Facebook (and IFL has a facebook group - please befriend me, and join our group!).  I've always been pleased that my Facebook page has been a sort of "town square" for public policy and political debates.  I have friends who are on all points on the political spectrum, and the debates have been lively.

Many of my friends from high school are on the far left of the political spectrum.  There are a host of reasons for this, you can read a lot about it on my old blog (just do a search for Fieldston, and you'll find it), and as you can imagine, many of them post from that perspective in discussions on Facebook.  One of these friends is a very talented actor by the name of Ian Kahn.  Ian, in responding to a "tweet" about a speech that I was giving yesterday, wrote:

"Health care for all Americans. It's the Patriotic choice."

I didn't quite understand that, so I wrote:

"And just what does that mean, Ian? Because, after all, the option being put on the table by the Democrats and the President ISN'T "heath care" for all Americans. It's "health insurance" for all Americans. That's not the same thing, and, in fact, the latter could lead to the destruction of the former."

Ian responded, "Do you have health care or health insurance? Because that line, while it makes a great sound bite, is equivocal at best. For one of the 47 million Americans without health insurance I’m fairly sure that would be a tough, and probably insulting distinction, to make. The point is this... there is a proposition out there that intends to take steps to reform our system by improving quality, expanding coverage, lowering costs, honoring patient choice and holding insurance companies accountable. You can agree with it. Or disagree with it. And it may or may not succeed at achieving all its arguably quixotic aspirations, but what is the alternative being presented? It seems incredibly easy to stand by and take pot shots at an approach to deal with one of the most difficult issues in recent American times, but where are the alternative proposals? There are lives, most literally at stake here and we are playing politics rather than coming together to find a solution.

"Senator Jim DeMint said at a recent speech, "If we're able to stop Obama on this, it will be his Waterloo. It will break him." Disgraceful. American soldiers in time of war fight for all Americans. They fight for the Americans that can’t fight for themselves. They even fight for the Americans who disagree with the fight itself. They fight because they believe it is in the best interest of the Nation. Their Nation. They spill their blood for those who are not able or not willing to spill their own. That is the very definition of patriotism. How is that different than those of us (myself included) who are being asked to give a little more to help those who cannot help themselves? It is time for action. Action is what is being offered... and if the Republicans or anybody else has a suggestion in facing this national dilemma, I am absolutely willing and eager and open to it."

I thought a great deal about this, and happened to read it before I was about to give my speech, so it was weighing on my mind as I spoke.  This morning I wrote a response to Ian, and one of my readers wanted to share it with others.  So here is my response in its entirety:

If I were one of the millions of Americans without access to health _insurance_, Ian, what would insult me would be to find out that the health "care" being promised to me isn't health "care" at all. Or to find out that health care costs aren't going to go down. Or to find out that medical care is going to become harder to find as a result of this legislation. Or to find out that one one of a number of the promises being made by this legislation are a mere fiction...

Fiction. As in "not true". As in "not true" because what's being proposed is belied by the facts. The economic analyses say that costs are going to go up, not down. History has shown us that government intervention into health care does not increase access to it. The current statistics are showing us that we simply do not have enough medical care to go around.

Medical "care". As in, we do not have enough doctors, nurses, and medical technicians to meet the demands for care that we have today. It's Resource Economics 101 (or, probably 201): declining supply + increased demand = increase in price.

And why do I say "declining supply"? Because more and more doctors are leaving the medical profession each year, and we aren't backfilling enough to meet demand - especially in those all-important primary care specialties (family practice, internal medicine, etc).

Not only is government fiat not going to change that, it's going to exacerbate the problem. The increase in patient "panels" (the number of patients seen by each and every doctor), combined with the decrease in reimbursement from the government that has to come from cost-cutting, combined with having to deal with additional bureaucracies from government (what is it - 87 different agencies that will be involved in this "Rube Goldberg-like" scheme?), and you'll see the rate of medical professional departures increase at an alarming rate.

No doctors + no nurses + no medical technicians = no health care. Insurance or no insurance.

My wife is a doctor, Ian. As it happens, she's a doctor employed by the federal government. So the government administration of health care is something I'm intimately familiar with.

And as for your assertion that there are no alternative proposals, you might try doing a little research before parroting the party line on this. From 2001 to 2009 there were a series of meaningful health-care reform proposals that dealt with increasing access to health insurance, increasing the supply of medical care, and bringing greater cost-transparency and consumer choice into the marketplace. Those alternatives continue to be on the table, such as:

- Association Health Plans: These would have allowed small businesses (which comprise 90+ of all employers and provide 2/3 of all new jobs) to band together across state lines in order to create risk pools for the purposes of buying insurance. This would have driven down the cost of employer-provided insurance plans and allowed for greater numbers of small businesses to provide health insurance to their employees.

How did it fare? Defeated by the Democrats at the behest of their special interest donors, the AARP and the Service Employees International Union

- Tort Reform: A key component of what's driving doctors out of the medical field is the cost of doing business, especially the cost of malpractice insurance. Reforming the penalties that can be levied in malpractice cases would drive those premiums down (which can amount to thousands PER MONTH), and keep Doctors in business.

How did it fare? Defeated by the Democrats at the behest of their special interest donor, the American Trial Lawyers Association.

- Medical Savings Accounts: An alternative to high-cost health insurance is the Medical Savings Account or Health Savings Account, a tax-free option which allows people to pay for their primary care directly, creating cost transparency and true competition in the marketplace. Because doctors who take MSAs aren't doing complicated insurance or government billing, it eliminates tremendous amounts of expensive paperwork, thus further driving down costs.

How did it fare? Watered down by the Democrats at the behest of a variety of their special interest donors.

There were other options: tax credits for the costs of health insurance for small business (as opposed to what they want to do now: jack up costs and penalize businesses that can't afford them); finding ways to decrease the costs of medical school, increasing service opportunities to pare down medical school debt, etc.

These have all been defeated, one way or another, by those who want to force everyone into a one-size fits all approach to medical care.

I'm not being "asked" to give a little more, Ian. I'm being forced. There's a tremendous difference. Volunteerism, especially voluntary giving to charity, is a high moral aspiration. State coercion is the opposite.

Every increased dollar that the government takes from me is one less dollar that I can give to charities. Charities who can provide that medical care (again, NOT insurance) to those who cannot otherwise afford comprehensive insurance.

I found it galling when Sen. Ben Cardin on Monday chastised a young man who didn't want to be penalized for making the choice to not have health insurance. He didn't deny that the man would be penalized (to the tune of $200+ per month, money he may not otherwise have), he essentially said, "How dare you!"

That's disgraceful, Ian. An elected official hectoring a constituent for exercising his free will is disgraceful. An elected official laughing when asked if he would pledge to read a thousand-plus piece of transformational legislation is disgraceful. Hoodwinking the American public into believing that this piece of legislation will solve their health care woes is disgraceful.

And that last point isn't working. I'm not going to call this the President's Waterloo - and about that, Waterloo wasn't Wellington's personal "beef" with Napoleon (no pun intended). Waterloo was about putting a stop to the spread of French imperialism.

But the bottom line is that this isn't what Americans voted for in November (and not what they voted for in 2006, either)--which is why an ever-increasing number of them are opposing this plan.

Sotomayor Does Not View the Constitution as "Settled Law"

The nomination of Sonia Sotomayor has brought all manner of reaction from across the political spectrum, positive and negative, liberal and conservative. The comment was raised on my Facebook page that Sotomayor was "inspiring and refreshing", to which someone responded, "Inspiring and refreshing is for the newest "fashiontini" not a Supreme Court Justice."

I'm not a lawyer, but between the ages of 16 and 28 I worked for and with lawyers, and for 4 years was the reader to a blind environmental lawyer. One of his areas of expertise was private property rights, and I developed a real passion for the subject.

I have continued to be dismayed with what Justice Scalia termed as the "relegation of property rights to the status of a poor relation". We were warned about Justice Roberts' view of the mutability of private property rights, even coming on the heels of the Kelo decision, and our concerns were justified when Roberts paved the way for further erosion of property rights in the Jones v. Flower decision (I wrote on that here: http://langrrr.blogspot.com/2006_05_01_archive.html ).

And now we have Judge Sotomayor, who, apparently, could be even worse. The noted law professor, Richard Epstein, has this to say in a piece at Forbes (http://www.forbes.com/2009/05/26/supreme-court-nomination-obama-opinions-columnists-sonia-sotomayor_print.html ):

"Here is one straw in the wind that does not bode well for a Sotomayor appointment. Justice Stevens of the current court came in for a fair share of criticism (all justified in my view) for his expansive reading in Kelo v. City of New London (2005) of the "public use language." Of course, the takings clause of the Fifth Amendment is as complex as it is short: "Nor shall private property be taken for public use, without just compensation." But he was surely done one better in the Summary Order in Didden v. Village of Port Chester issued by the Second Circuit in 2006. Judge Sotomayor was on the panel that issued the unsigned opinion--one that makes Justice Stevens look like a paradigmatic defender of strong property rights.

"I have written about Didden in Forbes. The case involved about as naked an abuse of government power as could be imagined. Bart Didden came up with an idea to build a pharmacy on land he owned in a redevelopment district in Port Chester over which the town of Port Chester had given Greg Wasser control. Wasser told Didden that he would approve the project only if Didden paid him $800,000 or gave him a partnership interest. The "or else" was that the land would be promptly condemned by the village, and Wasser would put up a pharmacy himself. Just that came to pass. But the Second Circuit panel on which Sotomayor sat did not raise an eyebrow. Its entire analysis reads as follows: "We agree with the district court that [Wasser's] voluntary attempt to resolve appellants' demands was neither an unconstitutional exaction in the form of extortion nor an equal protection violation."

"Maybe I am missing something, but American business should shudder in its boots if Judge Sotomayor takes this attitude to the Supreme Court. Justice Stevens wrote that the public deliberations over a comprehensive land use plan is what saved the condemnation of Ms. Kelo's home from constitutional attack. Just that element was missing in the Village of Port Chester fiasco. Indeed, the threats that Wasser made look all too much like the "or else" diplomacy of the Obama administration in business matters.

"Jurisprudentially, moreover, the sorry Didden episode reveals an important lesson about constitutional law. It is always possible to top one bad decision (Kelo) with another (Didden). This does not augur well for a Sotomayor appointment to the Supreme Court. The president should have done better, and the Senate, Democrats and Republicans alike, should subject this dubious nomination to the intense scrutiny that it deserves."

Over the weekend the McClatchy news chain reported that supporters of Supreme Court nominee Sonia Sotomayor were urging members of the Senate Judiciary Committee to attack "troubled and litigious work history" of firefighter Frank Ricci, the lead plantiff in the workplace discrimination case upon which, in essence, Judge Sotomayor recently ruled - and on which she was overturned by the United States Supreme Court.

To be clear -- attacking first responders in an effort to burnish the credentials of a presidential nominee for any office is a bad strategy.

http://www.mcclatchydc.com/227/story/71660.html