Setting the Record Straight

By Rob Schofield

As the North Carolina General Assembly begins to kick into high gear, lawmakers are confronting two important issues involving public health that could set the tone for the remainder of the session on a fundamental matter of governance – namely: Will North Carolina see a revival of can-do problem solving in which public institutions and investments are assertively targeted at what ails the state? Or will it fall back into the shortsighted habits of recent decades in which citizens are mere competitors in a dog-eat-dog “marketplace” and government is seen only as “the enemy.”

The two early-session test cases in this critical debate involve legislative proposals to: 1) Ban smoking in some public places; and 2) Enact a “high risk pool” for North Carolinians with serious medical conditions that are unable to obtain health insurance. Though both ideas have gotten off to fast starts, each remains under sustained attack from anti-public solutions/anti-government forces that have tried to obscure the truth behind a smokescreen of misinformation.

First the proposed smoking ban. Under a proposal currently before the state House of Representatives, North Carolina would follow the lead of nearly half the states in the union and hundreds of other jurisdictions by making smoking unlawful in most restaurants, bars and indoor workplaces. On Tuesday of this week, the bill was approved by a House committee on a 9-4 vote and appeared headed for swift consideration on the House floor. Since the committee vote, however, a concerted campaign has been underway to stop the bill.

Apparently orchestrated by a combination of the tobacco and restaurant lobbies, the campaign has adopted the language of the far right that the issue is about “property rights rather than public health.” According to this argument, it’s an infringement on the property rights of a business owner for government to regulate the use of his or her property in such a way. Given time, the “genius of the market” will sort the matter out and those who wish to be free from smoke will gravitate to the places that voluntarily go smoke free.

Opponents of the high risk pool continue to advance a similar argument — i.e., the solution to the problem of unaffordable health insurance for people with serious illnesses is to simply let them buy health insurance on a national market. A report from the J.W. Pope Civitas Institute (JWPCI) even went so far as to claim that “a high-risk pool could hurt high-risk patients.” According to this theory, costs of the high-risk pool will grow so fast that the pool “could become a trap for people with high health care costs.” The JWPCI report alleges that the cost of the High Risk Pool could grow by as much as $31 million per year.    

Setting the Record Straight…

…on the tobacco ban and “property rights” – Freedom of choice and the protection of civil liberties are cherished American values. The right of every American “to be let alone” and to enjoy personal privacy is central to our national identity. But, it is a giant and illogical leap to transform an effort to protect public health in places held open to the public into an assault on individual freedom.

It is, in fact, a long and well established constitutional principle that government may regulate such businesses for the public health and welfare. Everything from the regulation of the sale and consumption of alcohol to health, safety, food and workplace inspections to anti-discrimination laws to dozens of other legitimate government rules and regulations stand as precedent.  

As the smoking ban’s sponsor (and lung cancer survivor) Hugh Holliman has argued forcefully, protecting public health is the highest calling of government. It is precisely because the market often does a poor job of offering protection to large segments of the public that public institutions must act. The point of the a smoking ban is not to interfere in the private choices of individuals or to protect them from themselves; it is to protect innocent individuals – children, workers, and others who may be exposed to secondhand smoke against their will.

By the “logic” employed by the “property rights” defenders, there ought to be no laws requiring health inspectors for restaurants or other public accommodations since, given time, the “genius of the market” would identify all of the unsafe businesses and consumers would be “free” to avoid them. Indeed, Adam Searing of the N.C. Health Access Coalition has noted the parallels between the property rights argument on smoking and opposition to the Civil Rights Act of 1964.

…on the High Risk Pool proposal – Two points deserve to be highlighted:

1) As noted in this space a couple of weeks ago, the notion that people like breast cancer survivor Vicki Readling (a realtor from Salisbury profiled in the New York Times this week who could not afford a $27,000 health insurance premium on her $60,000 income) are going to find affordable insurance on any private market is just silly.

2) “Silly” is a polite word for the JWPCI allegations about the cost of the High Risk Pool plan. On March 13, the state Department of Insurance received a detailed and lengthy analysis from the nationally known private actuaries at Milliman, Inc. about the projected cost of the High Risk Pool.

As had been suggested by health advocates, actuaries confirm that the cost of the plan will be at levels well below the proposed statutory caps included in the proposed law. In other words, JWPCI’s assessment is way off when it assumes that the Plan will require assessments of 70 cents per month per insurance policy and grow to $2, i.e., the statutory maximums. According to Milliman, the real cost could be as low as four cents per insurance policy per month in year one and would grow much more slowly (to around 39 cents by 2013 – the year the Pope-Civitas report alleges a cost of two dollars). 

 

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This entry was posted on Thursday, March 22nd, 2007 at 1:55 pm and is filed under Setting the Record Straight. You can follow any responses to this entry through the RSS 2.0 feed.