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Saturday, January 8, 2011

Freedom of Consumption

The world is changing and so is America. The many freedoms we cherish are deteriorating and may soon evaporate all together. Generally these freedoms will not stop with the stroke of a pen or the report of a rifle. They will however slip into obscurity one inch at a time as the forces of nature, human nature, economic marketplace realities, and the march of time all take a bite out of our big sweet cookie.

The political right whines about the potential loss of such Constitutional Rights as Life, Liberty and the Pursuit of Happiness. They fret about the loss of unlimited possession of firearms, the right to do whatever they want on a parcel of land that they bought, whether a fetus is a person before it feels the light of day its head, and whether the union of two men or two women can be a marriage.

The political left does their whining about whether a person who does live and breathe has the right to eat, have shelter, protection from official repression. They fret about people being disenfranchised, marginalized and denied basic human needs such as medical care.

Each time one faction of the government attempts to remedy an inequity or injustice the other factions see it as a limit on freedoms, an attempt of the government to take over the country and rule by dictate. People who do have Health Insurance decry legislation that that tries to provide services to a larger subset of our population. They see those attempts as an expansion of government, an intrusion into their lives, and a possible limit on their own access to medical services. They want government out of their lives. On the other hand, almost no one decries the total domination of road building and maintenance by government who fund all such public works. The only time that anyone gets wrapped around the axle is when the funding source tries to alter the mix of what transportation projects receive funding. It appears that building another road constitutes a freedom of consumption, while supporting public transportation options is an intrusion and limit of those freedoms.

One must not forget that there are millions of people in the US, citizens and non-citizens alike, who do not or cannot drive an automobile. Road-only policies discriminate against those people and constrain their freedoms. Such policies misuse those people's tax dollars. Whether or not an individual pays a tax directly (real estate tax on their house) or indirectly (real estate tax paid through a landlord via the rent) it is all individual consumers who pay all the taxes. When their needs are compromised and marginalized and neglected, a fundamental inequity results. Their lack of access to what they pay for funds the ability of everyone else to get what they want at a lower price.

A simple example of this is when the Public Works Department builds a road without adding pedestrian walkways, the non-drivers receive a paucity of value even as the auto drivers get more roads on which to drive. Attempts to fund transportation and other non-automobile access is met with vocal resistance put up by the people who do own and drive automobiles. Their claims are that it is a waste of tax dollars to do anything other than provide them with lanes on which to drive and spaces on which to park their vehicles. Their freedom of consumption is threatened. So there you have it.

When there is plenty of money available, there is much less opposition to ideas that are not the mainstream and expedient. As resources become in short supply the larger majority population seeks to conserve the remaining amounts for themselves. They seek to protect their freedom to consume. Enter: the Health Insurance issue.

Before the health care reform legislation passed in 2010 we were estimating a physician near-future shortage of 40,000 doctors. That quantity was derived from a combination of a historic shortfall, our longer life expectancies, the population becoming progressively less healthy in general, physician retirement, curtailed income due to constrained payments for services, and fewer men and women choosing to enter the profession due to real and perceived legal and liability parameters. With the passage of the Patient Protection and Affordable Care Act," HR 3590, in March 2010, 31 million additional people will have access to healthcare services. Our freedom of consumption is therein compromised.

The new estimate is 60,000 physicians. A bad situation only gets worse. With one physician for each cohort of 1550 patients, 20,000 doctors are needed for the newly covered 31 million people.

Employees who do get health insurance paid for by their employers do not like the idea that they will have to share their doctors and medical services access until that shortage is resolved. Medicare enrolled people do not like those prospects either. All of these covered people bristle at the idea that someone, anyone will tell them that they cannot have the MRI that they believe they should be given. Whether it is a government bureaucrat or an insurer's bureaucrat making a decision, the patients don't like limits placed on their freedom to consume medical services.

Our world is changing in natural ways that impacts all institutions and civilizations at some point in their existence. The idea that our economy can infinitely expand to accommodate all spending, borrowing and delivery of services is like believing in perpetual motion. To attempt to do so is the same as setting up a Ponzi Scheme where all the new members pay for the older members. Those arrangements always fail because there are not enough humans on earth to support all the higher tier members. The pyramid always collapses. When it does collapse there are winners and losers, there are survivors and casualties. The survivors bury the dead and try to pick up the pieces. How well they do this is dependent on how much they learn from the experience.