One Word

Yuck.

Posted on November 23, 2008 at 12:59 AM | Permalink | Comments (4)

Gut Them Like Trouts

Kevin Drum is glad the Democrats are ready to body-slam the health insurance companies, and is rooting them on:

It means the health insurance industry is scared that we might actually do something in 2009 and they want to be seen as something other than completely obstructionist. That means only one thing: they've shown fear, and now it's time to bore in for the kill and gut them like trouts. Let's get to it.

Because everyone knows that most of the costs of healthcare reform can be paid for by ripping the excess profits out of the health insurance business like a liver from a fish.  Just to remind everyone, these are net profit margins reported by Google Finance for 3Q2008 of the largest health care providers and insurers:

Cigna:  3.50%
United Health Group:  4.56%
Aetna:  3.64%
WellCare:  4.08%
Amerigroup:  3.51%
Humana 2.56%
WellPoint:  5.49%

Posted on November 20, 2008 at 04:06 PM | Permalink | Comments (4)

Wow, Obama Has Inverted the Supply Curve

I am having a blast at the Change.gov transition site for Obama, now that I have satisfied myself it is not a fake.  Those who doubt that Obama has super-human powers should read this, from the Obama site:

The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors and plans to implement the plan. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year.

If you don’t have health insurance, you will have a choice of new, affordable health insurance options.

Wow - so now you can go out purchase any care you want - any tests, any procedures, whatever - and no one is going to tell you no.  Everything is paid for.  You have a blank check to go spend.  And, by granting you an infinite supply of care, your cost is going to go down.  Obama is really superman, because no one else in history has figured out how to invert the supply curve or make 2x cost less than x.

You see, it's all about insurers' margins.  If we can just cut down on those fat margins, everyone can have full health care and a pony for less money.  You doctors who are worried about health care, you will have it better too:

Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.

All these years you thought malpractice insurance costs were high because of huge malpractice court settlements that usually bore little relationship to true malpractice, well, you were wrong.  Its because of the insurers and their margins.  We don't have to reform malpractice tort law (which is just as well since tort lawyers were so generous with donations to our campaign), we just have to get insurers to stop overcharging doctors.

To give you an idea of the absolutely huge amount of savings that can be extracted by just pounding on the insurers to give more coverage for less money, let's take a look at those outsized margins they are making.  These are net profit margins reported by Google Finance for 3Q2008 of the largest health care providers and insurers:

Cigna:  3.50%
United Health Group:  4.56%
Aetna:  3.64%
WellCare:  4.08%
Amerigroup:  3.51%
Humana 2.56%
WellPoint:  5.49%

Freaking robber barons!  Look at those outsized margins.  No wonder we have a health care crisis.  By cutting these guys margins in half, Obama expects to reduce the price of health care by 1-2%, which should be more than enough to pay for large increases in services and 30-50% price cuts.

Update:  Oh, its magic.  That explains it.

Update #2:  OK, the page has come down, as have most all the pages that had any kind of policy detail or promises in them.  I wish I had screen shots, but I can say everything above was cut and pasted directly form the web site.  Could I make that stuff up?  Too bad, there probably were another 10 blog posts in there somewhere. 

Posted on November 7, 2008 at 08:50 AM | Permalink | Comments (28)

Our Bodies, Ourselves

I have written on a number of occasions that I thought it odd that the left (and women's groups in particular) don't see a contradiction between their support for government health care and their long-held abortion beliefs that people should be free of government coercion when it comes to decisions about their body and their health.  These views certainly don't seem compatible in England:

A cancer charity has today published research that shows doctors are keeping   cancer patients in the dark about new treatments that could extend their lives.

Myeloma UK, which conducted the research, said a quarter of myeloma   specialists questioned in a survey admitted hiding the facts about   treatments that may be difficult to obtain on the NHS.

The main reason given was to avoid distressing or confusing patients.

Myeloma is a bone marrow cancer that affects around 3,800 people each year in   the UK. Of these, 2,600 are likely to die from the disease.

Posted on September 2, 2008 at 03:22 PM | Permalink | Comments (11)

Best Line of the Week

I thought this was pretty apt:

The Left’s approach to health-care cost containment is to give more health coverage to more people with more ailments, all the while making everyone pay less.

This kind of thinking should be familiar to the Arizona legislature, since they went into special session to close a $2 billion budget shortfall and ended up actually increasing spending!

Posted on July 9, 2008 at 11:43 PM | Permalink | Comments (4)

Danger. Danger. Danger.

If I had to name the one single biggest problem in US healthcare, it would be this:

"Twenty years ago, when I was in training, nobody really dealt with economics," says Stephen Hufford, an oncologist in San Francisco. The prevailing thinking, he says, was: "Cost should never be an issue in someone's care."

In a survey of 167 cancer doctors reported last year in the Journal of Clinical Oncology, 42% said they regularly raised the issue of costs when discussing treatment options with patients.

Which means that even today, 58% of oncologists did not raise cost or price issues with various treatment options, despite practicing in perhaps the most costly of medical fields.  What planet are we living on, here?  Can you imagine a survey in which 58% of car dealers refused to raise the issue of cost in a new car sale?   Or 58% of real estate brokers saying they never mentioned the prices of houses when discussing them with clients? 

This represents a process failure in the health care system on two levels.  First, not having any single person in the decision-making process making cost-benefit trade-offs is a recipe for disaster.   Insured customers will consume as much as they can when price is off the table.  Many folks in the health care debate recognize this.

But there is a second problem.  Even when there is a single entity making these trade-offs, it is almost never the patient.  Most "reformers" on both the left and the right want to place this decision-making authority in government bureaucrats, in insurance companies, in Congress, in doctors -- any place but in the individual patient herself.   This particular article discusses the role of doctors in this process:

Many health-policy experts say it's high time for American doctors to start considering costs when assessing treatment options. In 2007, the cost of cancer care alone reached an estimated $89 billion in the U.S., up from $72 billion in 2004, according to the American Cancer Society using data from the National Institutes of Health....

The study, conducted by Deborah Schrag, an oncologist at the Dana Farber Cancer Institute in Boston, found that 23% of oncologists said costs influence their treatment decisions, and 16% said they omit discussion of very expensive treatments when they know the cost will place great strain on patients' resources.

This misses the mark.  Doctors should be ready to inform patients of their options, but at the end of the day we need a system where the patient is making these tradeoffs.  Note the absolute, nearly criminal arrogance of doctors who don't suggest the best treatment regime because the cost might stress out the patients.  How does the doctor know what financial resources the person might be able to bring to bear?

Postscript:  In an adjoining article, the WSJ has an article on the wacky way the French government makes these cost-benefit trade offs in health care:

Since 1860, when Napoleon III appropriated this ancient Roman spa at the foot of the Alps for his empire, the National Baths of Aix-les-Bains have been a symbol of France's cushy health-care system.

On a recent morning, Jacqueline Surmont and her husband, Guy, a 77-year-old retired construction worker, headed for their daily mud wrap. The spa's rheumatism cures, thermal baths and 13-minute deep-tissue massage all are covered by France's national health-insurance system. Transportation and lodging are, too....

"For many people, it's like a free holiday," says Ms. Surmont, who says all her mud wraps and massages were properly prescribed by a doctor to soothe her ailing back. "Some patients go shopping in the afternoon. They're hardly in pain."

Wonderful.  This kind of BS is virtually inevitable in state-run systems.  I think one can already imagine a US health care system where taxpayers foot the fill for groovy treatments loved by the dippy left, from acupuncture to aromatherapy to homeopathy, while cancer patients are denied drugs and people have to wait months or years for elective surgery.

By the way, we get this in the "goes without saying" file from a state-run spa employee facing cutbacks:

"Of course we went on strike," said Martine Claret, a 52-year-old physiotherapist who has worked at the spa since 1979 and doubles as a union representative.

Posted on July 8, 2008 at 05:33 PM | Permalink | Comments (6)

Update on the Massachussetts Health Insurance Mandate

Via Michael Tanner:

  • Slightly less than half of Massachusetts’ uninsured population actually complied with the mandate. True, the number of people without health insurance was reduced from 13% of the state’s population to 7%, but when the bill was passed, advocates promised that “all Massachusetts citizens will have health insurance.”  Perhaps it depends on your definition of “all.”
  • Most of those who are signing up are low-income individuals, whose coverage is fully or partially subsidized, proving once again that if you give something away for free people will take it. It certainly appears that it is the expensive and generous Massachusetts subsidies (up to 300% of the poverty level), not the unprecedented individual mandate that is responsible for much of the increased coverage.
  • Adverse selection remains a big problem, with the young and healthy failing to comply with the mandate. The state refused to change its community rating laws which drive up the cost of insurance for young, healthy individuals. Not surprisingly, they don’t find this a good deal.
  • The program is far exceeding its projected costs, with at least a 33% budget overrun in its first year.
  • The program has increased demand for health care services without increasing the supply of providers. As a result, patients are having trouble finding providers and waiting lists (Canada here we come) are beginning to develop.

Posted on June 4, 2008 at 10:05 AM | Permalink | Comments (3)

The Health Care Trojan Horse, In Connecticut

The stories keep coming about using health concerns as the thin edge of the fascism wedge.  This time via Hit and Run:

Sheridan Communications and Technology Middle School eighth-grader Michael Sheridan was suspended from school for three days, barred from attending an honors student dinner and stripped of his title of class vice president.

     His offense?

     He bought a bag of Skittles.

The punishment was meted out because the New Haven school system banned candy sales and fundraisers in 2003 as part of the districtwide school wellness policy.

In fact, this school has outlawed an financial transactions whatsoever between students:

Turner had repeatedly warned students that she would not allow any candy to be sold in schools, nor did she want money changing hands in school, said Sullivan-DeCarlo.

Posted on March 12, 2008 at 11:50 AM | Permalink | Comments (12)

More Health Care Trojan Horse

This one comes via a reader, and is from Belgium:

Two sets of parents in Belgium were recently handed five month prison terms for failing to vaccinate their children against polio. Each parent was also fined 4,100 euros ($8,000)....

"Nobody has the right to unfettered liberty, and people do not have a right to endanger their kids," said John Harris, a professor of bioethics at the University of Manchester.

"The parents in this case do not have any rights they can appeal to. They have obligations they are not fulfilling."

Posted on March 12, 2008 at 08:39 AM | Permalink | Comments (1)

Health Care Trojan Horse, Canada Edition

Next in my series about the health care Trojan Horse for fascism, comes this story via Q&O in Canada  (McQ gives as good a definition of any of the Trojan Horse: "once government has control over your health care, it will use all sorts of justifications and excuses to exert more and more control over your life as a result.")

For 60 years or more, libertarians and conservatives have been arguing that government programs intended to promote the public welfare inevitably end by restricting freedom more and more: as the state does more for you, it finds itself doing ever more to you. Who would dare challenge that premise now, in the face of Judge James Blacklock’s decision? The man made no secret of the chief pretext for his ruling. Motorcycle riders who don’t wear helmets are more costly to the medicare system; therefore, in the name of reducing those costs, the government is free to require the wearing of helmets, even if that conflicts with a fundamental Charter right and interferes with the most personal and intimate sort of decision-making conceivable.

Posted on March 11, 2008 at 08:52 AM | Permalink | Comments (10)

With Universal Health Care, It's No Longer Your Body

I have chided women's groups for the inconsistency of supporting choice and freedom from government coercion when it comes to decisions about their bodies, but at the same time lobbying for universal government health care.  If after my previous posts you still fail to see the inherent contradiction, try this story:

A Winnipeg case currently winding its way to its grim conclusion pits the children of Samuel Golubchuk against doctors at the Salvation Army Grace General Hospital. According to the pleadings, Golubchuk’s doctors informed his children that their 84-year-old father is "in the process of dying" and that they intended to hasten the process by removing his ventilation, and if that proved insufficient to kill him quickly, to also remove his feeding tube. In the event that the patient showed discomfort during these procedures, the chief of the hospital’s ICU unit stated in his affidavit that he would administer morphine.

Golubchuk is an Orthodox Jew, as are his children. The latter have adamantly opposed his removal from the ventilator and feeding tube, on the grounds that Jewish law expressly forbids any action designed to shorten life, and that if their father could express his wishes, he would oppose the doctors acting to deliberately terminate his life.

In response, the director of the ICU informed Golubchuk’s children that neither their father’s wishes nor their own are relevant, and he would do whatever he decided was appropriate. Bill Olson, counsel for the ICU director, told the Canadian Broadcasting Company that physicians have the sole right to make decisions about treatment — even if it goes against a patient’s religious beliefs — and that "there is no right to a continuation of treatment."...

The claim of absolute physician discretion to withdraw life-support advanced by the Canadian doctors would spell the end of any patient autonomy over end-of-life decisions. So-called living wills, which are recognized in many American states, and which allow a person to specify in advance who should make such decisions in the event of their incapacity, would be rendered nugatory.

I find the discussion of the "duty to die" to save the state money especially chilling.  This story is also in the save vein.

Posted on February 21, 2008 at 10:28 PM | Permalink | Comments (1)

The Health Care Housing Project

The looming federal government takeover of health care as proposed by most of the major presidential candidates will be far worse than anything we have seen yet from government programs.  Take this example:  In the 1960's, the federal government embarked on massive housing projects for the poor.  In the end, most of these projects became squalid failures.

With the government housing fiasco, only the poor had to live in these awful facilities.  The rest of us had to pay for them, but could continue to live in our own private homes.

Government health care will be different.  Under most of the plans being proposed, we all are going to be forced to participate.  Using the previous analogy, we all are going to have to give up our current homes and go live in government housing, or least the health care equivalent of these projects.

Think I am exaggerating
?

One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor. “He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview...

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament.

Here is the poll question I would still love to see asked:

Would you support a system of government-run universal health care that guaranteed health care access for all Americans, but would result in you personally getting inferior care than you get today in terms of longer wait times, more limited doctor choices, and with a higher probabilities of the government denying you certain procedures or medicines you have access to today.

Posted on February 20, 2008 at 07:37 PM | Permalink | Comments (8)

My Health Care Poll Question

I was going back through my archives and I found a health care poll question I suggested about a year ago that I would still love to see asked.  I believe it accurately reflects the reality that most middle class Americans face with various universal health care plans:

Would you support a system of government-run universal health care that guaranteed health care access for all Americans, but would result in you personally getting inferior care than you get today in terms of longer wait times, more limited doctor choices, and with a higher probabilities of the government denying you certain procedures or medicines you have access to today.

I have said a number of times that health care is not like failed Great Society housing programs.  In those housing programs, only the poor got crappy government housing -- the rest of us kept what we had.  Universal health care is different, because it will effectively be like forcing everyone to move into the housing projects.

Posted on February 5, 2008 at 09:17 PM | Permalink | Comments (10)

Aren't These the Same?

I saw these two posts one after the other on Q&O.  One is about Chavez's food regulations in Venezuela, the other is about a government health care plan in California.  One is about government takeover of a critical industry, price controls, supply rationing, and demonizing large private corporations, and the other is about the same thing, but in Venezuela.  Since Chavez is further along with his program, we might see how things are working out for him:

Venezuela’s top food company has accused troops of illegally seizing more than 500 tonnes of food from its trucks as part of President Hugo Chavez’s campaign to stem shortages.

The leftist Chavez this week created a state food distributor and loosened some price controls, seeking to end months of shortages for staples like milk and eggs that have caused long lines and upset his supporters in the OPEC nation.

The highly publicised campaign has also included government crackdowns on accused smuggling, with the military seizing 1,600 tonnes of food and sending 1,200 troops to the border with Colombia....

He also threatened to expropriate companies selling food above regulated prices.

"Anyone who is distributing food ... and is speculating, we must intervene and we must expropriate (the business) and put it in the hands of the state and the communities," Chavez said during the inauguration of a new state-run market in Caracas.

Yep, sounds about the same.  Fortunately, people in the West can still travel across borders to get health care when government rationed and price-controlled services are not available, as many Canadians and British do. So in the US, when we implement all these same steps, we'll be able to travel to..., travel to...  Where will we be able to go?

Posted on January 29, 2008 at 08:23 AM | Permalink | Comments (4)

More Command and Contol Health Care in Massachusetts

Well, I can't blame this bit of command and control on Mitt Romney, but it is still a great example of politicians doing exactly the opposite of what is needed to making US health care even more convenient and affordable.

In-store health care services offer cheap primary care, ease the burden on emergency rooms, and help people who can’t afford health insurance–or who have insurance but can’t find a decent primary care physician. They also boast stratospheric customer satisfaction ratings. 

So why is idiot Boston Mayor Thoma Menino against them?  Because they’re driven by profit!

The decision by the state Public Health Council, “jeopardizes patient safety,” Menino said in a written statement. “Limited service medical clinics run by merchants in for-profit corporations will seriously compromise quality of care and hygiene. Allowing retailers to make money off of sick people is wrong.”

This is as opposed to doctors in hospitals, who everyone one knows don't make any money off of sick people.  Seriously, who in their right mind could possibly oppose a free market solution to cleaning out these non-life-threatening type cases from hospital emergency rooms?

Posted on January 13, 2008 at 10:19 AM | Permalink | Comments (8)

Question for Romney Supporters

I just don't understand the enthusiastic support for Mitt Romney and his description as an heir to the Reagan legacy.  In particular, he claims to single-handedly have implemented HillaryCare in Massachusetts, the program that was arguably responsible for sweeping the Republicans into Congress in 1994.  My sense is that Hillary in the intervening years has moved on to an even more socialist plan, but everything I see in the Romney plan looks very much like Hillary's original proposal. 

The plan is command and control at every turn -- for example, I am a huge believer in high deductible health insurance.  My family has saved a ton with it, and it shifts health insurance to be more like, you know, insurance -- meaning it covers catstrophic, bankrupting problems but not day to day expenses.  Well, this sort of very reasonable plan, which has the added benefit of bringing some price competition to medicine because people like me now care about prices, was made illegal in Massachusetts by Romney and Company.  Romney strikes me as just another 1970's-style big government Nixonian Republican, like nearly every other Republican in the race this time around.

Previous posts on Romney's plan here and here and here.

Posted on January 11, 2008 at 09:01 AM | Permalink | Comments (17)

Time to Move on From Blaming Thimerosal

Kevin Drum observes that yet another study has put to rest the theory that Thimerosal, a preservative that used to be put in some childhood vaccines, causes autism:

However, despite the equivocal (at best) scientific evidence linking thimerosal to autism, conspiracy theories abounded and the issue deeply split the autism community. Firm evidence in one direction or the other, though, had to wait until now. Thimerosal was ordered removed from most childhood vaccines in 1999, and by the early 2000s children had stopped receiving virtually all thimerosal-based vaccines. If autism rates then decreased, it would be good evidence that thimerosal really had been to blame.

But that didn't happen. Interim studies have shown no decrease in autism rates, and a study released today puts the nail in the coffin of the thimerosal story. It tracks children born in California and includes enough years of data to show pretty definitively that autism diagnoses continued to rise even after thimerosal was removed

I thought it was time to move on from this theory years ago, but Drum says that it continues to be carried forward by parents desperate to find an explanation for their child's autism.  I guess I am a bit more cynical, for I would argue that this bad science of Thimerosal has been carried forward, just like the bad science of breast implant caused immune deficiencies, by trial lawyers desperate for another easy extortion target.  And, just as medical studies did not stop lawyers from pressing forward implant lawsuits, I am sure the Thimerosal lawsuits are not going to go away either.

Posted on January 8, 2008 at 10:42 AM | Permalink | Comments (1)

The Health Care Trojan Horse in France

More on state-run health care as a Trojan horse for fascism, this time from France:

Writing in the left-wing Liberation newspaper, sociologist Henri Pierre Jeudy suggested the ban marked "the end of an era" for France -- and a danger for personal freedoms.

"Public health costs are being used to justify an ever more coercive control over our private lives," he said, with France's yen for smoky cafes now cast as "an unhealthy mistake".

My other posts on the same topic here.

Posted on January 3, 2008 at 11:02 AM | Permalink | Comments (30)

Government Health Care: Trojan Horse for Fascism

In about the hundredth post in this series, yet another example of government health care costs being used to micro-regulate even the smallest personal lifestyle decisions:

The city that banned plastic grocery bags and styrofoam take-out containers has found a new cause: your favorite soft drink. San Francisco may impose a new fee on those big retail stores that sell them. The purpose is to curb the obesity problem among kids and adults. Such fee or tax would be the first in the nation.

 

San Francisco says the obesity problem is costing the city too much money in health care costs. Studies have linked obesity to diabetes and heart disease.

"One third of all of our new on-set diabetics are type 2 because of obesity and this is in children now," says Robert Lustig, M.D., Endocrinologist, UCSF.

It is perhaps appropriate, given the polls in Iowa, that Mike Huckabee precipitated one of the earliest posts in this series:

Mike Huckabee, the Governor of Arkansas, now requires annual fat reports. These are sent to the parents of every single child aged between 5 and 17; a response, he says, to “an absolutely epidemic issue that we could not ignore” in the 1,139 schools for which he is responsible.

I just cannot craft any reasonable theory of government where this is the state's job.   The "obesity" crisis in this country just amazes me. "Experts" every few years broaden the definition of who is overweight or obese, and suddenly (surprise!) there are more people defined as overweight.  Even presuming it is the state's job to optimize our body weights, is it really the right approach to tell everyone they are too fat?  Having known several people who were anorexic, including at least one young woman who died of its complications, is it really a net benefit to get young people more obsessed with looks and body style? And what about the kids that are genetically programmed to be overweight?  Does this mean that years of taunting and bullying by their peers is not enough, that the state's governor wants to pile on now?

It is interesting to note that governor Huckabee apparently started this initiative after his own personal battle with weight loss:

[Huckabee] lost 110lb after being warned that his weight, more than 280lb after a life of southern fried food, was a death sentence. A chair even collapsed under him as he was about to preside over a meeting of state officials in Little Rock.

We all have friends who have lost weight or gotten into homeopathy or became a vegan and simply cannot stop trying to convert their friends now that they see the light.  Now we have the spectacle of elected officials doing the same thing, but on a broader scale and with the force of law, rather than  just mere irritation, on their side.  One can only imagine what report cards kids would be carrying home if Huckabee had instead had a successful experience with penis enlargement.  What's next, negative reports for kids with bad acne? For women whose breasts are too small?  For kids who are unattractive?

Update: I see Q&O posts on the same issue

Posted on December 18, 2007 at 08:18 AM | Permalink | Comments (2)

Eliminating the Reference Points

I really wanted to make a serious point about TJIC's post on Medicare overpaying for medical devices.  However, that may be nearly impossible because the post selects "penis pumps" as the example medical device, and it is difficult to have a meaningful political dialog over penis pumps:

amount Medicare spent last year on penis pumps so that old can could stand at attention: $21 million

average price/ pump Medicare paid: $450

cost of the identical pump online: $108

Well, I will try anyway.  I am sure if someone pointed this out in the Democratic debate as a potential issue with letting the government, famed for buying $800 hammers, run our health care system, they would all have stated piously that such things would not happen under their plan.  But how?  I mean, this kind of government waste has been going on for time immemorial.  It is so closely tied to the unchangeable incentives of government managers that it could rightly be called a feature of rather than a bug in the system.

But I think I have figured it out.  This is why most socialized health care systems do not allow one to go out of system to get private care.  By banning all private care, the government eliminates all those irritating private analogs that might demonstrate they are inefficient.  So, in the example above, the government typically tackles the problem not by reducing the $450 paid by Medicare, but banning the private sales of such devices so no annoying snoop can uncover the fact that a private system could have delivered it for 1/4 the price.  Genius!

Posted on December 2, 2007 at 05:18 PM | Permalink | Comments (4)

Romney-Care Already in the Red

Romney-care, which looks surprisingly like v1.0 of Hillarycare, is over-budget by $135 million (and counting*) in Massachusetts.  TJIC is stunned.

* must be pronounced in that deep eastern European voice from the early James Bond films, where in the bad guy's lair the PA system kept saying "one minute, and counting."

Posted on November 18, 2007 at 11:21 AM | Permalink | Comments (0)

Remembering East Berlin, With a Thought about Health Care

I remember in about 1978 going on a bus tour into East Berlin through checkpoint Charlie.  It is hard to describe to my kids what a creepy experience this was.  The state-run tour was clearly run by the propaganda ministry, and they really pulled out all the stops to convince you that life was great in the East.  The interesting part is that all this propaganda failed miserably.  No matter what streets they took you down, you couldn't help but notice the stark contrast in prosperity between East and West.  East Berlin was full of buildings in 1978 that still had not been rebuilt from WWII bomb damage  (this actually might have been a plus, since much of West Berlin was rebuilt in that hideous 50's European public architecture).

The most amazing statement was when the tour guide bragged, "And over 70% of everyone in the city has running water."  It was just so clueless and pathetic, to be so out of touch that what Westerners considered a statistic indicating poverty was hailed as one they thought indicated wealth.

I was reminded of this story when I read the British NHS response to an article that over 70,000 Britons a year travel abroad for health care.  Their response was:

A Department of Health official said the number of patients seeking treatment abroad was a tiny fraction of the 13 million treated on the NHS each year.

Waiting times had fallen. Almost half of patients were treated within 18 weeks of seeing a GP. Most people who had hospital care did not contract infections.

I had exactly the same response as I did to the East Berlin tour guide.  Half within 18 weeks?!  That's PATHETIC.  Again, what we Americans know to be awful service is being bragged about as a sign of excellence. 

The really creepy part, though, is that America is the last place on Earth that people understand that a medical system can do much better than 18 weeks.  But we are likely to elect a President in the next election whose goal is to bring our system down to the level of the rest of the world.  Unfortunately, someday our grandkids may not know any better.

Posted on October 29, 2007 at 10:03 AM | Permalink | Comments (5)

Maybe They Choose to be Uninsured

Via Arnold Kling, Maggie Mahar writes:

Some citizens of the Commonwealth don’t even want to pay for their own health care insurance. Under the plan, everyone in Massachusetts is required to buy insurance (or pay a penalty), with the state providing a 100% subsidy for those who earn less than 150% of the poverty level. Those receiving the full subsidy are enthusiastic. The state had hoped to sign up 57,000 uninsured and they’ve over-shot their target: 76,200 of Massachusetts’ poorest citizens have enrolled.

At the other end of the spectrum, the program isn’t doing as well. Uninsured citizens earning more than 300% of the poverty level are expected to buy their own insurance. Here, the state hoped that 228,000 of its uninsured citizens would sign up. So far, just 15,000 have enrolled.  Apparently, they’ve done the math and decided that it would be cheaper to pay the penalty.  But their premiums are needed to keep the program going.  If more in this group don’t sign up, it is not at all clear how the state will be  able to continue subsidizing the poor.

All of this adds up to "people without health insurance are so because it is not worth the price."  If they get it free, fine, they will use it like crazy, but they won't pay for it.  So I should for them?

Posted on October 25, 2007 at 08:36 AM | Permalink | Comments (4)

Update on the Health Care Trojan Horse

I have argued on numerous occasions that government-funded health care is a Trojan Horse for detailed regulation of how we treat our bodiesThe Economist Blog has a great post on this topic:

Why exactly is obesity a public health issue? Well, when, by force of law, you externalise responsibility for providing a good, such as health care, then the effects of all individual choices that affect the cost of providing that good for the individual are thereby transformed from internal to external effects. If you, like Mr Dubois, are in the grip of the blithe assumption that reducing negative externalities by raising the cost of the behaviour that causes them is simply what government does, then obviously my gluttony and sloth are public problems. Because public policy made them public problems! So, obviously, it's up to the government to fiddle with prices to manipulate our behavior in order to minimise its impact on the tax-financed national budget.

This sort of thing drives me crazy because it's just so thoughtlessly arbitrary -- intellectual empty calories. Why specifically a tax on junk food? Yes, one of the causes of obesity is "the consumption of too many calories." Another is the failure to burn the calories one consumes. So why not levy huge fines on people for not showing up at "voluntary" government-funded yogalates classes? Or if people are consuming too many calories, then just put a tax on calories. Why tax some calories but not others? You can get fat eating steak, too. Maybe a national "cap and trade" system of calorie credits would do the trick. Hey, do you know who's healthy? Mormons are. Maybe the government should provide giant tax credits for being Mormon. Or perhaps it would be easier if the national health care system could just deny services for ailments it judged to be obesity-related.  You could even decide not to have a national health care system at all and allow insurance premiums to reflect the actuarial risk of individual behavior! But that would be crazy. 

Hat tip to TJIC, who has more.  I think this would be a great anti-universal-coverage T-shirt:

Tskyl2

Ironically, this shirt is produced by the National Organization of Women, who are strong government health care supporters.  Go figure.

Posted on October 21, 2007 at 09:25 AM | Permalink | Comments (5)

Really Awful Article on Dentistry

The NY Times outdid itself last week with a truly awful article on dentistry.  They started with just one fact:

Previously unreleased figures from the Centers for Disease Control and Prevention show that in 2003 and 2004, the most recent years with data available, 27 percent of children and 29 percent of adults had cavities going untreated. The level of untreated decay was the highest since the late 1980s and significantly higher than that found in a survey from 1999 to 2002.

They then apply the patented NY Times class-based story-generation model to assume a cause for this rise that is not supported by the study itself:

But many poor and lower-middle-class families do not receive adequate care, in part because most dentists want customers who can pay cash or have private insurance, and they do not accept Medicaid patients. As a result, publicly supported dental clinics have months-long waiting lists even for people who need major surgery for decayed teeth. At the pediatric clinic managed by the state-supported University of Florida dental school, for example, low-income children must wait six months for surgery.

So is the rise in untreated dental problems concentrated in the poor?  Well, they don't say, and there is not data for that in the study, but that does not prevent the NY Times from just assuming it to be so.  In fact, the article itself contradicts this premise, by noting that the problem is not limited to the poor:

The lack of dental care is not restricted to the poor and their children, the data shows. Experts on oral health say about 100 million Americans — including many adults who work and have incomes well above the poverty line — are without access to care.

By the way, how did they figure a 100 million don't have "access"?  I don't know, but the figure is suspiciously close to this one:

With dentists’ fees rising far faster than inflation and more than 100 million people lacking dental insurance...

Anyone want to bet that the NY Times just made its usual logical fallacy of equating lack of insurance with lack of access?  And by the way, dental insurance is a HORRIBLE investment.  I have priced it many times myself and for a normal family, it is much cheaper to just pay the dental bills, particularly since there are not that many things in your mouth that can go wrong that will be bankrupting.  Trying to push everyone to dental insurance is a terrible idea.  Every time there is a dental procedure in our family, it turns out there are several options for fixing it at different prices.  We actually have the incentive to ask for these alternatives and make trade offs.  What do you think would happen if we had insurnace?

In fact, I can think of a LOT of reasons why people don't go to the dentist as often as they should.  One reason is that no one like the dentist.  Another is people's busy schedules.  And certainly rising costs are a factor -- As I mentioned before, our family makes very different decisions about treatment options than we used to with a fat corporate dental plan.  Which is as it should be. 

By the way, note the screaming socialism here:

The dental profession’s critics — who include public health experts, some physicians and even some dental school professors — say that too many dentists are focused more on money than medicine.

“Most dentists consider themselves to be in the business of dentistry rather than the practice of dentistry,” said Dr. David A. Nash, a professor of pediatric dentistry at the University of Kentucky. “I’m a cynic about my profession, but the data are there. It’s embarrassing.”

I wonder.  Does Dr. Nash accept a salary for being a professor?  Then I guess he is focused more on the business of education than the practice of educating.

Oh, and by the way, how is socialism in dentistry working out?

In a survey of 5,000 people in the UK, six percent claimed that they had done DIY dentistry, including yanking their own teeth and fixing cracked crowns with glue. Apparently they resorted to such self treatment because they couldn’t get in to see a National Health Service dentist …

One respondent in Lancashire, northern England, claimed to have extracted 14 of their own teeth with a pair of pliers. In Liverpool, one of those collecting data for the survey interviewed three people who had pulled out their own teeth in one morning.

“I took most of my teeth out in the shed with pliers. I have one to go,” another respondent wrote.

Posted on October 15, 2007 at 11:33 AM | Permalink | Comments (21)

Money Laying on the Sidewalk

For years I had some kind of corporate health plan.  When I started my own business, I bought a Blue Cross plan that roughly mirrored the corporate health plan I used to have -- very low deductible, lots of coverage.  And it had very high premiums. 

So I finally got serious and went out and did something 99% of Americans never do or never have to do:  I went out and really researched my health care options.  And what I found was that to raise our family's deductible from $500 a year to $2000 a year would save me over $3000 a year in premiums.  In fact, if I switched plans, I would get just as high of a maximum payout and I would get a better gaurantee on future pricing and a commitment never to drop my coverage from a large, well-rated insurance company.

There's an old joke about an economist and another fellow walking down the street.  There was a $10 bill laying on the ground, but the economist just walked right past it.  The other fellow said "what are you doing, you just passed up $10."  And the economist replied "It can't be a real $10 bill, because in an efficient market someone would have already picked it up."

That was my reaction to my health care options.  I asked my broker, "you mean that if I increase my deductible $1500 I can save $3000 a year?  Even in a worst case year I am better off, and in a healthy year I am MUCH better off."  He replied "Yep."  I asked, "But why doesn't everyone do this?"  He just shrugged.  As my Harvard investment management professor used to say, as he wrote up a market situation on the chalkboard to begin each class, either this is an opportunity, of there is something we don't understand.  As I have gained more experience with my new health plan, I have become convinced it is the former.

McQ over at Q&O
has a great post on insurance vs. insulation.  I won't quote it all, but it is well worth your read.  Towards the end, he quotes John Stoessel on my particular conundrum:

But people are so conditioned to expect others to pay their medical bills that they hate high deductibles: They feel ripped off if they must pay a thousand dollars before the insurance company starts paying.

But high deductibles may be the key to lowering costs and putting you in charge of your health care.

I am absolutely convinced that the best possible step for US health care is to expose more users to the market and price-value trade offs, while providing high-deductible insurance that shelters people from bankrupting unusual events.  More here, here, and here.

Posted on October 3, 2007 at 10:45 AM | Permalink | Comments (17)

But No One Shops for Health Care

For a while, I have been trying to highlight that the real problem with health care is that consumers who receive the service do not have any incentive to shop for the best price or to make trade offs on marginal procedures based on price.  The only people who have any incentive to shop are 1) people without insurance and 2) people with high deductibles (like me).  Politicians are trying to eliminate the former group, even if they don't want insurance, and programs like Romney's in Massachusetts actually ban high deductible insurance.

Now, Obama is worried about anti-trust:

The consequences of lax enforcement for consumers are clear. Take health care, for example. There have been over 400 health care mergers in the last 10 years. The American Medical Association reports that 95% of insurance markets in the United States are now highly concentrated and the number of insurers has fallen by just under 20% since 2000. These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed, increasing over 87 percent over the past six years. As president, I will direct my administration to reinvigorate antitrust enforcement. It will step up review of merger activity and take effective action to stop or restructure those mergers that are likely to harm consumer welfare, while quickly clearing those that do not.

How can these mergers harm consumers when consumers don't shop for the service and don't care about price in the first place?  Candidates like Obama and Clinton are threatening to create single payer systems that use monopsony power combined presumably with the coercive power of government to hammer suppliers.  Is it any wonder that they are joining together to try to gain some sort of bargaining position for themselves?  In the context of what Obama wants to do with health care buying, this can be thought of more as unionizing than merging.

By the way, does anyone else note the irony of Obama, who wants to create a single supplier for health care (the US Government) lamenting concentration in the health care field?

Posted on October 2, 2007 at 09:06 AM | Permalink | Comments (4)

Declaring Imminent Doman over My Body

Via Q&O:

Again, the grand claim of such a system is it will be more efficient and less costly. Nary a one of the systems in existence today that I’ve read about has lived up to the "efficiency" claim, if access and waiting times are a measure of efficiency. Every one of them seems to suffer from lack of access.

Secondly, the "less costly" claim seems to be accomplished by limiting access and limiting treatment. A rigid structure with prescribed treatments which disallow deviation. Imagine the sort of cancer treatment forced on the Japanese attempted here. Now imagine it with any other chronic disease you can name.

What’s the premise at work in a system like that?

Commenting on the WSJ article, Craig Cantoni, a columnist in Scottsdale, Ariz., writes: "Like nationalized health care in other countries, the Japanese system is based on the premise that the state owns your body." Therefore, "the state can dictate what medical care can be withheld from you, either by policy or by making you wait so long for care that you die in the mean time."

We see all sorts of bloviation by the left about attacks on our liberty. Yet, for the most part, they are supportive of the most insidious attack on our liberty you can imagine with their call for some form of universal health care system here. And make no mistake, all of the leading Presidential candidates are talking about an eventual government-run system despite their obvious spin.

I've said something similar for years.  As one example, I have pointed out that the National Organization of Women's strong support for national health care just demonstrates their utter intellectual bankruptcy, as I wrote here:

What this article really shows is that by going with a single-payer government system, each of us would be ceding the decisions about our health care, our bodies, and even lifestyle to the government.  So surely women's groups, who were at the forefront of fighting against government intrusion into our decisions about our bodies, is out there leading the fight against government health care.  WRONG! Their privacy arguments stand out today as sham libertarian arguments that applied only narrowly to abortion.  It's clear that as long as they can get full access to abortion, women's groups are A-OK with government intrusion into people's decisions about their bodies.

Don't miss their web site, which has sales offers for "Keep your laws of my body" T-shirts right next to appeals to "demand health care for all now."

Posted on September 29, 2007 at 09:02 AM | Permalink | Comments (5)

Follow-up on Essent Healthcare Attacking Blogger

I will admit I don't even know who Essent Healthcare is.  I don't know if they do a good job or a bad job.  I do know that there is a blogger dedicated to sounding the alarm about Essent.  But there are such gadflies for nearly every major corporation.  But in this case Essent is making the classic PR mistake of trying to silence a blogger by taking expensive-to-defend-against legal action against the blogger.  Specifically, Essent is trying to force the blogger's ISP to reveal the identity of the blogger and his confidential informants, many of whom are employees of Essent likely to face retaliation (more here).

I made the point that this kind of thing always backfires, as publicity tied to such suits and the inevitable backlash from bloggers tends to greatly expand the audience of these small bloggers from a few people who are already disgruntled with the target company to a much wider and more damaging audience.

Case in point:  Look who is suddenly the #1 & #2 Google search return for "problems at essent healthcare."  Neither site was in the top 100 a few days ago.

Posted on September 24, 2007 at 11:31 PM | Permalink | Comments (1)

Too Many Insured

I have written on a number of occasions that the real problem in American health care is the insulation between the person who receives the services and the true cost of the services.  Other than a few folks like me with high deductible policies, there is no incentive to shop around and no incentive to eschew certain avoidable and high cost procedures.

Marc Cooper complained that he went to the hospital for a day and it ended up costing the insurance company over $100,000.  His take-away form this is that the government needs to step in.  My take-away was different:

Did he ask for a price estimate in advance? Did he ask, as most of us do with all of our large purchases, for a written estimate or quotation? Did he get such estimates from two or three competitors? Did he shop around?

Of course not! Because in a system where someone else is paying the bills, we have no incentive to shop around. So providers have no incentive to compete on price or to worry about productivity and cost control.

Sure, this looks like a rip-off.  But if you went in to buy a car, concerned only with the quality of the car, and never asked the price and then got a bill for $100,000 a few weeks later, would you be surprised?  Would anyone give you sympathy if you complained you paid $100,000 for the car but admitted you never asked what the price was?

So I was very pleased to see this from John Stossel:

America's health-care problem is not that some people lack insurance, it is that 250 million Americans do have it.

You have to understand something right from the start. We Americans got hooked on health insurance because the government did the insurance companies a favor during World War II. Wartime wage controls prohibited cash raises, so employers started giving noncash benefits like health insurance to attract workers. The tax code helped this along by treating employer-based health insurance more favorably than coverage you buy yourself. And state governments have made things worse by mandating coverage many people would never buy for themselves.

Competition also pushed companies to offer ever-more attractive policies, such as first-dollar coverage for routine ailments like ear infections and colds, and coverage for things that are not even illnesses, like pregnancy. We came to expect insurance to cover everything.

He concludes:

Imagine if your car insurance covered oil changes and gasoline. You wouldn't care how much gas you used, and you wouldn't care what it cost. Mechanics would sell you $100 oil changes. Prices would skyrocket.

That's how it works in health care. Patients don't ask how much a test or treatment will cost. They ask if their insurance covers it. They don't compare prices from different doctors and hospitals. (Prices do vary.) Why should they? They're not paying. (Although they do in hidden, indirect ways.)

Posted on September 24, 2007 at 08:43 AM | Permalink | Comments (1)

You Better Shop Around

From Kevin Drum:

Marc Cooper spends 20 hours in the hospital and tells his story here.  Price of stay without insurance: $116, 749.  Price with insurance: $4,730.  Only in America, folks.

He's not very clear if this was an emergency situation -- like, did he have a heart attack and get rushed to the hospital in an ambulance -- or an important but non-emergency situation.  I will assume the latter by the tone of Marc Cooper's detailed post.

If so, then my first comment is, indeed only in America would he have gotten this procedure without waiting twelve weeks or without traveling to, say, America to get it done more expeditiously,

Second, I wonder:  Did he ask for a price estimate in advance? Did he ask, as most of us do with all of our large purchases, for a written estimate or quotation? Did he get such estimates from two or three competitors? Did he shop around?

Of course not! Because in a system where someone else is paying the bills, we have no incentive to shop around. So providers have no incentive to compete on price or to worry about productivity and cost control.

Sure, this looks like a rip-off.  But if you went in to buy a car, concerned only with the quality of the car, and never asked the price and then got a bill for $100,000 a few weeks later, would you be surprised?  Would anyone give you sympathy if you complained you paid $100,000 for the car but admitted you never asked what the price was?

So this is a dead-obvious outcome from the health care system we have, where no one has the incentive to shop. By the way, I have a high-deductible policy which causes me to shop around, because costs come out of my own pocket. I ask questions like, is that extra CT scan really necessary?

It's incredible to me that given this situation, the solution for this blog's author and most of his readers is not "we should find a way to have individuals experience both the cost and benefits of care, because only they can make these tradeoffs for themselves and shop around for better options" but is instead "lets just turn it over to the government, since they do such a good job with Iraq and the mail and our schools."

Finally, I would point out that the author is making some wild assumptions about an insurance statement he probably does not understand (I say that with confidence since no one understands health insurance statements).  His assumption that the walk-in poor would have had to pay $100,000 for the procedure or would have been left to die are demonstrably untrue, since there is just not that much evidence that either outcome is occuring with any regularity.  That is why health care socialization supporters always talk about the number of people uninsured, which is almost irrelevant, instead of the number of people who don't get care, which is a much much smaller, almost vanishingly small number.

Posted on September 6, 2007 at 11:44 AM | Permalink | Comments (11)

Why Aren't Women Fighting the Health Care Trojan Horse?

Reader Robert Hammond, who always sends me good stuff, pointed out this article from the Evening Standard about proposed new health care rules in England.  Frequent readers will know that I have long argued that nationalized or single-payer health care is a Trojan Horse for fascism (and much more here) in the form of micro-management of individual decisions.  If your personal choices that in the past only put yourself at risk now cost other taxpayers money, then those other taxpayers are going to try to redirect your choices.

Failing to follow a healthy lifestyle could lead to free NHS treatment being denied under the Tory plans. 

Patients would be handed "NHS Health Miles Cards" allowing them to earn reward points for losing weight, giving up smoking, receiving immunisations or attending regular health screenings.

Like a supermarket loyalty card, the points could be redeemed as discounts on gym membership and fresh fruit and vegetables, or even give priority for other public services - such as jumping the queue for council housing.

But heavy smokers, the obese and binge drinkers who were a drain on the NHS could be denied some routine treatments such as hip replacements until they cleaned up their act.

Those who abused the system - by calling an ambulance when a trip to the GP would be sufficient, or telephoning out of hours with needless queries - could also be penalised.

The report calls for a greater emphasis on the "citizen's responsibility" to be healthy and says no one should expect taxpayers to fund their unhealthy lifestyles.

Here is the real problem:  This is absolutely logical.  There is nothing at all incorrect about the last statement for example.  This is not an abuse or an excess.  This is a completely predictable result of single-payer health care.  Any single-payer is going to have these incentives, but when the single-payer is the government, they not only have the incentives but the full coercive power to do something about it.  I am exhausted with the statist defense against such outcomes that "well, its just the particular individuals in charge -- if we could get the right guys in there, it would work great."  No.  The right guys are never in there, despite technocrats' big dreams, in part because the incentives in place turn even the right guys into the wrong guys. 

One of the reasons we spend so much on health care today is because most of us can do so without any personal financial cost.  Few of us (I am an exception, with a very high deductible policy) actually have to make cost-benefit trade offs in each of our health care purchases like we do in contrast for ... absolutely everything else we buy except health care.   The results are predictable.  We get pissed off when our insurance company denies coverage on some procedure or cost, we is part of the base-level of discontent that health care "reformers" draw on.  But it is stunning to me that people who have discontent with their current insurer feel like things will be better with the government!

Hey, this sounds like a women's issue!

What this article really shows is that by going with a single-payer government system, each of us would be ceding the decisions about our health care, our bodies, and even lifestyle to the government.  So surely women's groups, who were at the forefront of fighting against government intrusion into our decisions about our bodies, is out there leading the fight against government health care.  WRONG!  Their privacy arguments stand out today as sham libertarian arguments that applied only narrowly to abortion.  It's clear that as long as they can get full access to abortion, women's groups are A-OK with government intrusion into people's decisions about their bodies.

So please, dedicated feminists are urged to comment.  How do I relate this T-shirt from the NOW web store:
Tskyl2
With this button from the NOW home page:
Codebluebutton

And a bit of text from their site:

People need and deserve universal, continuous, and accessible health coverage that is provided by a single payer and does not require full-time employment and a beneficent employer. Learn more with our action toolkit....

With the recent release of Michael Moore's new movie, "SiCKO", and the introduction in Congress of a bill to provide health insurance to all U.S. residents, the movement for universal single-payer health insurance is gaining momentum. This toolkit is provided to help you take action on this important issue....

Health care is a right, not a privilege.

Posted on September 5, 2007 at 09:20 AM | Permalink | Comments (7)

Government Health Care and Efficiency

I am always absolutely amazed when advocates of some form of national or single-payer health care argue that such a system would be more efficient.  For example, Kevin Drum argued:

A few days ago, during an email exchange with a friend, I mentioned that I don't usually tout cost savings as a big argument in favor of universal healthcare. It's true that a national healthcare plan would almost certainly save money compared to our current Rube Goldberg system, but I suspect the savings would be modest. Rather, the real advantages of national healthcare are related to things like access (getting everyone covered), efficiency (cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies), choice (allowing people to choose and keep a family doctor instead of being jerked around everytime their employer decides to switch health providers), and social justice (providing decent, hassle-free healthcare for the poor).

I don't think any of these are true.  For example, let's take access.  Yes, everyone in a universal health care system would have a piece of paper that says they have health care, and the left seems really focused on that piece of paper.  But that paper has about as much value as my piece of paper that says I own a hundred shares of Enron.  Because someone has to redeem that piece of paper and actually provide the care, and there is the rub, is it not?  Canadian David Gratzer writes (vis Q&O):

My book’s thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada’s population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays....

Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren’t available. And so on.

I had forgotten about the heat wave.  Could you imagine backwards old America having 15,000 people die when the temperature got into the 90's?

As to efficiency, which Drum defines as "cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies," does anyone really ascribe these characteristics to the government?  Really?  Even European health care bureaucrats would not agree with this statement:

This privatizing trend is reaching Europe, too. Britain’s government-run health care dates back to the 1940s. Yet the Labour Party—which originally created the National Health Service and used to bristle at the suggestion of private medicine, dismissing it as “Americanization”—now openly favors privatization. Sir William Wells, a senior British health official, recently said: “The big trouble with a state monopoly is that it builds in massive inefficiencies and inward-looking culture.”

I won't get much into the last two, except to say that we actually have a ton of health care choice in the US today, far more than any other country.  And even if we did not, what does doctor choice mean if the best people are driven away from being doctors, as they are in socialized medicine.  And social justice?  Well, the poor get care in the US, the key is the "hassle-free" in his statement.  Would you immediately assume that a government-run service is going to involve less hassle than a private service?  Have you renewed your drivers license lately?  It may well be that the poorest 10% have such an awful health care experience that they will see things better.  But almost assuredly the other 90% are going to be worse off.

Remember this -- Universal health care is NOT a system in which the majority of us who are satisfied with our care can keep our current system, while the poor get a better one.  It is a system where all of us are thrown out of our current system and given the same care the poor get.  It is roughly equivalent to a Great Society housing program in which not just the homeless get housing, but everyone in the country are forced to give up their current house and live in public housing.

Postscript:  There is great improvement to be had in the health care system.  It revolves, though, around making the payer for health care the same person who receives the service, as it is for every other product and service we buy in this country.  We already have too much single-payer.  We need multi-payer.  I won't go there today, but I explained here.

Another Thought:
A huge pillar of the women's movement was that the government should not make decisions for a woman and her body (e.g. by banning abortion).   All well and good.  But I have never understood how this was consistent with support, say, for the FDA, which tells women exactly what they can and can't put in their body.  And now women's groups are all for universal health care, where government will make all the medical decisions about what procedures one can and can't have, and when.  Consistency please?

Posted on July 31, 2007 at 08:00 AM | Permalink | Comments (5)

Mental Image of the Day

James Christopher via Kurt Loder via Cattalarchy:

After marveling at Moore's rosy view of the British health care system in "Sicko," Christopher wrote, "What he hasn't done is lie in a corridor all night at the Royal Free [Hospital] watching his severed toe disintegrate in a plastic cup of melted ice.  I have."

The whole review is worth reading.  Many folks seem to think Michael Moore is brilliant until he makes a film about something with which they are actually familiar.  Which, come to think of it, encapsulates my entire view of the media, not just Michael Moore, as well.  Nothing will reduce your confidence in the media more than reading an article on a topic about which you have intimate knowledge.

Posted on July 3, 2007 at 08:47 AM | Permalink | Comments (2)

Anti-Universal Coverage

Michael Canon has proposed for principles of an anti-universal health care coverage club:

  1. Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
  2. To achieve “universal coverage” would require either having the government provide health insurance to everyone or forcing everyone to buy it.  Government provision is undesirable, because government does a poor job of improving quality or efficiency.  Forcing people to get insurance would lead to a worse health-care system for everyone, because it would necessitate so much more government intervention.
  3. In a free country, people should have the right to refuse health insurance.
  4. If governments must subsidize those who cannot afford medical care, they should be free to experiment with different types of subsidies (cash, vouchers, insurance, public clinics & hospitals, uncompensated care payments, etc.) and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.”

You know I'm in;  after all, I am the one that has said that "universal coverage is as if, in the Great Society public housing programs, everyone in the country, not just the poor, had been required to tear down their current houses and enter monolithic public housing structures."

However, I would have added a fifth principle:  Health care decision-making and tradeoffs amongst cost, quality, and content of care should belong to the individual, except when an individual delegates this decision in some way by his own choice (say by joining a very structured HMO program).

I wrote about the joys of actually shopping for health care under a high-deductible policy here and here.  Michael Canon also has a new post on shopping and HSA's here.

Posted on June 27, 2007 at 03:12 PM | Permalink | Comments (4)

HMO's at 15% Approval

Apparently, HMO's only have a 15% approval rate with Americans.  People don't like the waits, and the institutional service, but, more than anything, they don't like someone in the HMO back office rationing their care based on pre-set formulas about what care or test is appropriate in each given situation.

All well and good.  However, if this is so, then why does the idea of universal government health care appeal to so many people?  Because if universal health care turns out as well as it possibly could, then the best we could expect is that it will resemble... current HMO's.  And unfortunately, it will probably be worse.  Because today, the guy in the HMO back office who is setting up the allowed care formulas knows that if he cuts things back too far, you will go to another competitor.  No such threat or incentive will exist for the government bureaucrat, who will be setting the formulas based on stupid mindless rules and interst-group pressures and absolutely no concern about your satisfaction.

Posted on June 20, 2007 at 10:39 PM | Permalink | Comments (8)

Universal Health Care Leads to Speech Limitations

As I wrote in a previous post, state-run health care tends to act as a Trojan Horse for increased government micro-management of our lives by giving the government a financial interest in our health and risk-related decision-making.  A reader sends along this article demonstrating this effect yet again:

An attempt to revive famous TV adverts from the 1950s that encouraged people to "Go To Work On An Egg" have been blocked by regulators on health grounds.

The British Egg Information Service (BEIS) had wanted to bring back the adverts featuring comedian Tony Hancock to mark the 50th anniversary of the British Lion mark.

But the Broadcasting Advertising Clearance Centre (BACC) said the famous commercials could not be repeated because eating eggs every day went against the policy of encouraging people to eat a varied diet.

"The concept of eating eggs every day for breakfast goes against what is now the generally accepted advice of a varied diet and we therefore could not approve the ads for broadcast," a BACC spokesman told the BBC.

PS-  Readers who send me stuff - let me know if I can use your name when you email me the post.  When I sit down to blog in short bursts, I am happy to give specific credit but I am always unsure whether to use your real names or not.

Posted on June 20, 2007 at 10:05 PM | Permalink | Comments (0)

The "Crisis" Looks a Lot Like State-Run Medicine

The USAToday published a front-page story today arguing that a health care "crisis" looks a lot like Houston, Texas.  I would argue, from their descriptions, that a health care "crisis" looks exactly like state-run medicine.

Ijeoma Onye awoke one day last month short of breath, her head pounding. Her daughter, Ebere Hawkins, drove her 45 minutes from Katy, Texas, to Ben Taub General Hospital, where people without health insurance pay little or nothing for treatment.

Onye, 62, waited four hours to be seen. Still, going to the emergency room was faster than getting an appointment. For that, "you have to wait months," Hawkins says....

The huge number of uninsured residents here means that health officials must make tough decisions every day about who gets treated and when. "Does this mean rationing? You bet it does," says Kenneth Mattox, chief of staff at Ben Taub, the Houston area's pre-eminent trauma care facility.

The article goes on and on like this.  The problem is delays and queuing in facilities that provide free care.   And the difference between this and state-run health care is what exactly?  When a product or service is free, people will tend to over-consume the supply, with rationing taking place via queuing rather than price.  This is how every state-run supply system works, from food in the Soviet Union to health care in Canada.  And by the way, exactly how upset should I be about people receiving an extraordinarily valuable and costly service for free but having to wait a while to get it?

This article is actually a great rebuttal of the inherent message in the health care debate that "uninsured" means "denied health care."  In fact, it is clear that even in the spot USAToday picked out as the worst in the country, the uninsured are in fact getting health care.  It is tedious with long waits, but there are no examples in the long article of people going without.  Yes some people consume less than they might if it was free and convenient, but that is just the rationing at work.  Anyone who says that rationing goes away in a state-run system is bald-faced lying to you.

Remember that national health care does not eliminate queuing and waits for the poor -- it just institutionalizes these waits for the rest of us.   Universal Health Care is equivalent to a Great Society housing program where everyone, rich and poor, have to give up their house and move into a crappy public apartment block.

Postscript: By the way, I am sympathetic to certain hospital administrators who have a "crisis" on their hands because the mass of uninsured show up in their emergency rooms.  That, however, is a problem manageable far short of government-run health care.  They want to blame diversions of critical patients away from over-crowded emergency rooms on the "uninsured" but it is really a function of their own faulty triage.

Update: Michael Moore will soon argue that its better in Cuba.  Hah! That is funny.  If people really want to believe this, then it is another reason is is way past time to open up our relations to Cuba, so people can see for themselves what a lying sack of poop this filmmaker is.

Posted on June 19, 2007 at 09:46 PM | Permalink | Comments (7)

Universal Health Care Trojan Horse

For quite a while, I have been arguing that universal health care is a Trojan horse for freedom-robbing government interventions into our personal habits (and micro-habits).  Suddenly activities that used to be personal choices that affected only ourselves (e.g. unhealthy diet) become public interest questions affecting government-funded health care costs.

Jonah Goldberg, via Ronald Bailey, seems to agree:

The British government recently unveiled plans for a massive crackdown on "excessive drinking," particularly among the middle class. It will include all of the familiar tactics of public health officials: dire new warnings on wine bottles, public-awareness campaigns, scolding from men and women in lab coats...

Britain still subscribes to a system where health care is for the most part socialized. When the bureaucrat-priesthood of the National Health Service decides that a certain behavior is unacceptable, the consequences potentially involve more than scolding. For example, in 2005, Britain's health service started refusing certain surgeries for fat people. An official behind the decision conceded that one of the considerations was cost. Fat people would benefit from the surgery less, and so they deserved it less. As Tony Harrison, a British health-care expert, explained to the Toronto Sun at the time, "Rationing is a reality when funding is limited."

But it's impossible to distinguish such cost-cutting judgments from moral ones. The reasoning is obvious: Fat people, smokers and — soon — drinkers deserve less health care because they bring their problems on themselves. In short, they deserve it. This is a perfectly logical perspective, and if I were in charge of everybody's health care, I would probably resort to similar logic.

But I'm not in charge of everybody's health care. Nor should anyone else be. In a free-market system, bad behavior will still have high costs personally and financially, but those costs are more likely to borne by you and you alone. The more you socialize the costs of personal liberty, the more license you give others to regulate it.

Universal health care, once again all the rage in the United States, is an invitation for scolds to become nannies. I think many Brits understand this all too well, which is one reason why they want to fight the scolds here and now.

I like his term "socializing the costs of personal liberty."  Its a good description of much of what is wrong with government today.

Posted on June 17, 2007 at 10:22 PM | Permalink | Comments (5)

The Health Care Difference

While it may have been unintentional, a quote in New York magazine helps make the point I have been trying to make about universal health care (HT: John Scalzi)

"With universal [health care], you’d get the same kind of mediocre shittiness that you’d get in all other kinds of standardized approaches. But for millions of people, that would be a big upgrade."

Americans are unbelievably charitable people, to the extent that they will put up with a lot of taxation and even losses of freedoms through government coercion to help people out.

However, in nearly every other case of government-coerced charity, the main effect is "just" an increase in taxes.  Lyndon Johnson wants to embark on a futile attempt to try to provide public housing to the poor?  Our taxes go up, a lot of really bad housing is built, but at least my housing did not get any worse.  Ditto food programs -- the poor might get some moldy cheese from a warehouse, but my food did not get worse.  Ditto welfare.  Ditto social security, unemployment insurance,and work programs. 

But health care is different.  The author above is probably correct that some crappy level of terribly run state health care will probably be an improvement for some of the poor.  But what is different about many of the health care proposals on the table is that everyone, not just the poor will get this same crappy level of treatment.  It would be like a public housing program where everyone's house is torn down and every single person must move into public housing.  That is universal state-run health care.  Ten percent of America gets pulled up, 90% of America gets pulled down, possibly way down. 

I don't think most Americans really know what they are signing up for.  Which is why it is so important for health care socialists to have people like Michael Moore running around trying to convince the middle class they will be getting better health care.  Because there is almost no possibility of this being true, and health care proposals will never pass if people realize it.

More here.

Posted on June 14, 2007 at 03:28 PM | Permalink | Comments (5)

Shopping for Health Care

I missed this article the first time around, but Arnold Kling makes a point that I have been trying to make coherently for a long time:  The biggest problem in health care is not under-insurance or efficiency or drug company profits.  The biggest problem is the insulation of the consumer from health care prices.

For health care providers, insulation is a bonanza. Because consumers are not spending their own money, they accept doctors’ recommendations for services without questioning them and without concern for cost. Faced with an insured patient, a health care provider is like a restaurant catering to convention-goers with unlimited expense accounts. The customer will gladly take the most high-end recommendation and not worry about the price.

Consumers are happy as well. Insulation relieves the patient of the stress of making decisions about treatment. The patient also does not have to worry about shopping around for the best price.

The problem with insulation is that it is not a sustainable form of health care finance. Individuals, employers, and government are all under stress.

Health care plans on the table basically put decision making for a) making price comparisons and b) deciding if a given procedure is worth the price -- in one of two people's hands:

  • The individual being cared for or
  • The government

That's it.  Its one or the other.  The current system of "nobody" is not sustainable.  To the extent that people have grief about their employer or their insurer, it is usually because the insurer is trying to make these decisions (someone has to) and the individual is resentful that the insurer is not making decisions the way the individual might like.  In this context, it is nuts that many people see the solution not as "let individuals take over this decision" but as "let the government do it."  I'm sure that will turn out well.

By the way, I have been with a high deductible policy for a while now, and the medical care shopping process is a real eye-opener.  I really highly recommend it -- not only am I managing the costs but I am learning more about the care itself.  For those of you who don't want to price compare,  Michael Cannon of Cato makes the very good point that everyone does not have to price shop - only a few people need to for all of us to get the benefit.  I never even look at the price of toilet paper, but I know it is probably a good price because there are folks out there who DO compare.

Posted on June 7, 2007 at 08:31 PM | Permalink | Comments (3)

What He Said

From Michael Cannon at Cato:

There’s a lesson here for those who want to cover the uninsured: focus on the incentives facing the 250 million Americans who have health insurance, not on the estimated 45 million who don’t. If the federal government stopped encouraging people with health insurance to be less careful consumers, then coverage would be more affordable, the number of people without coverage would shrink, and the quality of care would improve.

My family just switched to a high deductible policy, and its amazing how much our behavior has changed.  We question doctors now -- do we really need that?  We had to take my son in for a CT scan on his head (he got hit by a line drive at the hot corner the other day) and we actually asked the price before we scheduled an appointment.  When was the last time you asked the price of any medical procedure or visit?

PS- The son is fine, but half his face looks like its been inflated with a high-pressure pump.

Posted on April 23, 2007 at 08:24 PM | Permalink | Comments (9)

Update on the Macular Degerneration Drug

After the post below, several have written to ask about the procedure itself.  My dad wrote with details, which I believe are from Science magazine:

The drug for treating macular degenerations is ranibizumab, sold under the brand name "lucentis" by genetech, its developer and manufacturer.

It is "a monoclonal antibody - made by using biotech methods, from genetically engineered bacteria that attacks a protein responsible for the leading cause of blindness in seniors.  In clinical trials with Lucentis, the eyesight of about 95 per cent of AMD patients either improved or stopped getting worse."

Lucentis was created by tweaking the molecular structure of another, older drug Avastin, which itself was originally approved for colorectal cancer but now has been approved for certain kinds of lung cancer, and has been submitted to Food and Drug Administration to be used against breast cancer and possible kidney cancer as well.

The editors of Science magazine, the widely respected journal of the American Association for the Advancement of Science, selected ten "breakthrough" discoveries of the year last December.  No. 6 on the list was the results of the clinical trial results for Lucentis.

PS:  My son and I often joke that they have run out of car names.  With a name like ranibizumab, they seem to have run out of drug names too.  I can must see the ad campaign:  "With a name like ranibizumab, it's got to be good."

Posted on March 31, 2007 at 02:31 PM | Permalink | Comments (1)

Please Get This Image Out of My Head

The good news is that they have, for the first time, a treatment for macular degeneration.  My mom got her first treatment yesterday.

The bad news is that it involves getting a hypodermic needle stuck in your eyeball for a direct injection of the drug.

Eeeek.  Didn't want to think about that any more today, so I thought I would dump that image on you guys.

Update:  For those interested, I have an updated post on the details of the new drug.  I joked about the procedure, but in fact it is a god-send, and my mom says that the needle thing is a lot worse in anticipation than in reality.  Those with this same problem should definitely look into it.

Posted on March 30, 2007 at 01:06 PM | Permalink | Comments (8)

At What Point Does Atlas Shrug?

From the owner of Smartflix:

So, here I am, having risked absolutely everything I own, having gone with out salary for three years, and I am now being told that if I hire somebody, and he gets married in Vegas while drunk, then gets a divorce the next day, I’ve got to cover the bimbo into the next decade? (Feel free to add in the gender-reversed variation of that, as well - I’m equally apalled that I might have to pay for an employee’s ex-husband’s meds)....

It is a testament to the American character that even when we are this tightly bound by the chains of the State, we, as a people, still start new businesses.

That, or maybe it’s a testament to our stupidity.

Posted on March 30, 2007 at 08:54 AM | Permalink | Comments (3)

Another Leftish Howler on Government Health Care

From Kevin Drum, who I consider one of the smarter folks on the left (but not this time):

A few days ago, during an email exchange with a friend, I mentioned that I don't usually tout cost savings as a big argument in favor of universal healthcare. It's true that a national healthcare plan would almost certainly save money compared to our current Rube Goldberg system, but I suspect the savings would be modest. Rather, the real advantages of national healthcare are related to things like access (getting everyone covered), efficiency (cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies), choice (allowing people to choose and keep a family doctor instead of being jerked around everytime their employer decides to switch health providers), and social justice (providing decent, hassle-free healthcare for the poor).

Name one industry the government has taken over in a monopolistic fashion and subsequently increased efficiency or individual choice?  Anyone?  Buehler?  In fact, I am not sure I can name one government program that even provides the poor with decent, hassle-free services. 

Lets take the most ubiquitous government monopoly, that on K-12 education. 

  • Efficiency?  My kid's for-profit secular private school has a administrator to student ratio of at least 1:15.  How many assistant principals does your public school have?  Many public schools are approaching 1 administrator for every 1 teacher.
  • Choice?  That's a laugh.  The government and its unions fight choice in education tooth and nail.  In fact, in the context of education, Drum and others have effectively argued that choice is the enemy of his last point, social justice, so it is absurd to argue that government monopolistic health care will optimize both.  Yes, people may be frustrated their insurance company does not cover X procedure, but this will only get worse when the government is making the choices for us.  Oh, and by the way, about the evils of those employers running our health plans?  They do so only because of WWII wage controls and decades of federal tax policy that have provided them strong incentive to do so. 
  • Decent, hassle-free service?  Ask a concerned black family in an inner-city school how good their kid's government-provided education is.  In fact, I will bet that most inner city parents get healthcare of better quality today despite the admittedly Rube Goldberg system we have (courtesy of years of silly government interventions) than the quality of education they receive from the government education monopoly.  After all, most of them walk out of the hospital today with their life, while many of their kids are walking out of worthless government schools with no life.

As to the claim that national health care would "almost certainly save money," that is hard to argue with for this reason:  The government, once in charge of health care choices, can simply start denying procedures and care ("rationing").  This is in fact how costs are managed in most socialist medical systems.  So while this statement is technically true, it would be very hard for anyone to really believe that for the same quality and quantity of care, the government could do it cheaper.

Posted on March 27, 2007 at 12:51 PM | Permalink | Comments (9)

Why I Worry About Single-Payer Health Care, Part #, Uh, Whatever

The best answer, of course, as to why single-payer is bad is that the single-payer will not be me, and therefore will not make trade offs about my health, money, time, etc. in the same way I would.  One of the many problems with polling on issues like this is that someone asks a question like "Are you satisfied with your health care" and when XX% of people say "no", the person using the poll goes on to postulate that the people are dissatisfied for Y reason.  But people may be dissatisfied for many reasons.  For example, I know that many people's main source of dissatisfaction is that their current insurance company was callous in rejecting them for so-and-so procedure.  But do they really think the government is going to be less callous?

Unfortunately, this best answer does not seem to be getting anywhere, so I will offer another answer.  Single payer health care will almost certainly lead over time to single provider health care.  What is my evidence?  Well, that is what happened in K-12 education.  And note the very very strong opposition to migrating education from single-provider to single-payer by the exact same people who are the intellectual driving force for some kind of massive new federal intervention in health care.  Kevin Drum and Matthew Yglesias both argue that single payer is inherently unfair.  So get ready, Walter Reed and the Post Office may soon be teaming up to provide your medical care. 

Posted on March 25, 2007 at 10:46 PM | Permalink | Comments (0)

Chicken Little Needs to Stay on Message

Michael Cannon had this funny reaction to the downward revision, by the Census Beaureu, of the estimated number of Americans without health insurance:

It is important that we not over-react to these numbers. The worst thing we could do would be to stop panicking about the uninsured. A lot of interest groups have spent a lot of money and misused a lot of data to convince the public that this mostly healthy bunch of people are America’s #1 health care problem. If we were to go off-message now, then Barack, Hillary, Mitt, Arnold, and all the other Chicken Littles we’ve created . . . well, they might get horribly confused. Thank you for your continued support.

I would add to this:  "And never, ever let anyone question the assumption that 'being uninsured' is the same as 'being without medical care' and never allow anyone to ask whether all of those uninsured are uninsured against their will, rather than by personal choice".

Posted on March 24, 2007 at 09:26 AM | Permalink | Comments (1)

My Health Plan Is Now Illegal In Massachussetts

Yesterday, I posited that current proposals for government health care are worse than other welfare programs, because they not only will cost a ton of money, but they will also, unlike say government housing, make my personal health care worse.

I only had to wait one day for an example
(actually, I didn't have to wait at all, since I could just mine Europe and Canada for examples).

Massachusetts has now set the minimum level of insurance required to comply with the state’s individual mandate. Not only will every resident of the state be required to have insurance by July of this year, but by January of 2009, no one in the state will be allowed to have insurance with more than a $2,000 deductible or total out of pocket costs of more than $5,000. In addition, every policy in the state will be required to cover prescription drugs, a move that could add 5-15 percent to the cost of insurance plans.

After a lot of study, my family chose a high deductible health plan combined with a medical IRA (they actually call them something else, but I can't remember the abbreviation).  We had a low deductible plan, but ran the numbers, and found we would save tons with a higher deductible plan, particularly if we dumped the savings into the IRA.  We set the deductible at the level of economic pain we thought we could bear in a bad year.  Even if we had a medical disaster once every three years, we would still be ahead with the lower premiums and the IRA-style tax savings.  And if we don't have a disaster that frequently (we never have had even one in our lives) then we will build up some nice savings for retirement.

Of course, this makes too much sense to be legal.  It actually involves individual choice and stuff, and god forbid we be allowed to exercise that.  For our own good, of course.

Posted on March 21, 2007 at 08:12 PM | Permalink | Comments (10)

Why the Health Care Issue is Different

I was sitting here today, and was trying to discern why the government-run health care issue made me more nervous than other government welfare programs.  I get ticked off, for example, about the horrendous rates of return (think negative interest rates) paid out by Social Security on what are nominally our retirement account premiums.  But I don't get nervous.  Why?

I think because unlike other welfare proposals that [just] cost us a ridiculous amount of money, the current plans for providing universal health care imply that my personal health care and health care options will get much worse.  When government provided housing, my housing did not get worse.  When government provided a ripoff retirement plan, my personal non-government retirement savings did not take a hit.  In all these cases, we paid out tons of money to provide some terrible base-level services for the poor and the true-government-believers in the middle class, but my options did not get worse.

However, in the case of health care, most proposals on the table will very likely result not only in much higher taxes, but also in my personal health care options getting worse.  The government will not want to provide multiple levels of service, and can't afford anything beyond "crappy", so as a result we will all end up with crappy service (Insert Rush song "trees" here).  A lot of crap is written about how great all these other socialized medicine services are, but thousands of people travel from other countries to have medical procedures in the states, and about zero travel the other way.  More on the topic of closing coverage gaps at the price of making your own personal care worse here.  More on why these gaps are not as large as advertised here.

Update:  Quick proof -- My chosen health plan is now illegal in Massachussetts

Posted on March 20, 2007 at 07:43 PM | Permalink | Comments (3)

Politically Correct Medicine

I am always floored by the number of progressives who embrace all kinds of wacky non-scientific health theories.  These are the same folks who criticize creationists as being anti-scientific.  I am not a creationist, but I might be able to embrace it faster than I could, say, the insanity that is homeopathic medicine**. 

Unfortunately, these are the same folks who will likely make up the backbone of the socialized medicine bureaucracy when and if the US finally decides to hand health care over to a consortium of the Post Office and Walther Reed.  So here is a preview of what we will get:

Tom and Donna (not their real names) are professional shamen. They teach classes in shamanism at a “foundation”, where you can learn “soul retrieval healing”, help the dead “continue their journey into the Hereafter”, and investigate “the Fairy Kingdom”. These soul retrievers and Fairy Kingdom investigators also work for the NHS — where, according to Tom’s foundation profile, they “use complementary therapies to help those with mental health difficulties”. Shaman therapies are not the only unorthodox treatments for which the NHS will gladly pay.

Taxpayers are also subsidising Emotional Freedom Technique (EFT) “therapy”, in which, according to one NHS trust, “subtle energies” are reordered via “tapping with the fingertips to stimulate certain meridian energy points while the client is ‘tuned in’ to the problem”. …If EFT doesn’t do the job, an NHS foot massage might help. Reflexologists believe that each part of the foot maps to a different organ, and that massaging a particular point can treat that organ. Medical doctors think it’s absurd. …Most depressing of all for the rational taxpayer is the NHS Directory for Alternative and Complementary Medicine, which aims to promote “dowsers”, “flower therapists” and “crystal healers”. We’ve just learnt that some hospitals are removing every third light bulb to save money, and that nurses are being paid half the minimum wage — or being asked to work for nothing — at others. That’s how bad the financial crisis has become. Meanwhile, the National Health Service is employing shaman fairy enthusiasts as psychological counsellors, enthusiastically providing treatments invented by “an ordained minister and a personal performance coach” who thinks tapping your body can cure diabetes, promoting dowsers and crystal healers and spending vast amounts on therapies that can’t be scientifically supported.

Just as with the Walther Reed mess, the left wants to write off this stuff as just bad management, as an exception.  But unfortunately, this is the rule for government management.  It always goes bad.  Mismatched incentives + lack of individual choice + strong unionized bureaucracy most concerned with its own job security + impossibly complex information flows = mess.  Always.  I get very tired of the excuse, as I wrote here, that "if only we were in charge, everything would work great." 

Throughout these years, libertarians like myself argued that there were at least three problems with all of this technocratic statism:

  • You can't make better decisions for other people, even if you are smarter, because every person has different wants, needs, values, etc., and thus make trade-offs differently.  Tedy Bruschi of the Patriots is willing to take post-stroke risks by playing pro football again I would never take, but that doesn't mean its a incorrect decision for him.
  • Technocratic idealists ALWAYS lose control of the game.  It may feel good at first when the trains start running on time, but the technocrats are soon swept away by the thugs, and the patina of idealism is swept away, and only fascism is left.  Interestingly, the technocrats always cry "our only mistake was letting those other guys take control".  No, the mistake was accepting the right to use force on another man.  Everything after that was inevitable.

Everyone has had a turn running the place (except libertarians, I might observe) and everyone has screwed things up.


** I am amazed I have not posted a rant on homeopathic medicine, but searching through my archives, I don't find anything.  If you don't know, here is the fast answer why homeopathy is silly.  Advocates of homeopathy argue that they can make certain substances more effective by diluting them, and the more they dilute them, the more effective they are.  Go to one of their web sites, and you will see dilution rations that translate into having less than one molecule of the active ingredient in a mass of water the volume of all the world's oceans.  Advocates argue that even though the molecules are gone, some sort of resonance remains.  Uhh, right.

Posted on March 16, 2007 at 11:17 PM | Permalink | Comments (2)

OOPS

Kevin Drum, six months ago:

THE BEST CARE ANYWHERE....Thanks to innovations introduced during Bill Clinton's administration, VA healthcare is now among the nation's best. It's cheaper than either private healthcare or Medicare, the quality is top notch, and it operates according to strict performance standards. Sounds like a great model, doesn't it?

That quality government management and incentives system will do it every time.

Folks on the left are already gearing up to blame the current Walter Reed mess on the current administration, thus scoring points off Bush (fine with me) while not having to question the inherently poor quality of government-managed health care systems.

Posted on March 5, 2007 at 03:21 PM | Permalink | Comments (4)

What If They Had Asked the Question This Way?

A CBS poll says about 2/3 of Americans think the government should provide health care for all.  Many in the poll think the government would suck at it (about half said the government would do a worse job, and less than a third think it would do a better job). 

Given how important health care is to people, I find it hard to reconcile these two opinions.  If I had to guess, most people who say they are for government health care implicitly imagine a two-tier system, where they would still get the good care they have today, but poor people who people imagine are without care today (actually they tend to be without insurance, not without care) would get a suckier second tier of health care run by the government.

But I don't think this is a realistic view of what they will get with universal health care.  No government-run universal health care system is ever going to be politically stable with two tiers.  You are going to have to end up with a system that some poor people get better care but the rich and middle class end up with a worse system.  That is the reality of every government run health care system in the world.

I would love to see the answer to this poll question:

"Would you support a system of government-run universal health care that guaranteed health care access for all Americans, but would result in you personally getting inferior care than you get today in terms of longer wait times, more limited doctor choices, and with a higher probabilities of the government denying you certain procedures or medicines you have access to today."

Posted on March 3, 2007 at 07:46 PM | Permalink | Comments (11)

Blame It On The Profits

Steven Pearlstein has a column on the American health care system based on a recent study by the McKinsey Global Institute.  As Mr. Pearlstein reads it, the problem with the American medical system is all about the profit - it's all about the doctor profit stacked on the drug profit stacked on the insurance profit.  If the government would just take over and get rid of all that profit, the system would run smoothly and be much cheaper.  I am flabbergasted that anyone at Cato would remark on such an article with approval.

First, while I worked at McKinsey & Co, I never worked for the global institute.  However, though I have not yet read the study, it would be unusual to the point of uniqueness if their recommendation for the industry was more government control and less profit motive, but I guess it is possible.  More likely, Mr. Pearlstein is reading the study through his own progressive lens.  Anyway, let me deal with a few parts of the article:

Even after adjusting for wealth, population mix and higher levels of some diseases, McKinsey calculated that we spend $477 billion a year more on health care than would be expected if the United States fit the spending pattern of 13 other advanced countries. That staggering waste of money works out to 3.6 percent of the nation's entire economic output, or $1,645 per person, every year.

I will agree that for a variety of reasons, there is a lot of waste in the medical system.  We will get to "why" in a minute.  However, note that the author is taking a leap from "we spend more per capita than Europeans" to "staggering waste."  The US spends more per capita on a lot of things than the Europeans, in large part because we are wealthier (by a lot, and more every day).  One man's waste is another man's preference.  However, I would agree that health care is unique, in that it is the one industry where the decision maker(s) on whether to purchase a service is not the same person who is paying the bills.  I think we will find, though, that I and Mr. Pearlstein differ on who the person should be who should do both simultaneously (I say each person for himself, he says Nancy Pelosi and George Bush for everyone).

But let's get into all that money-grubbing.  Mr. Pearlstein reads the study as saying the problem is all that profit.  Because we have layers of profit in the distribution channel, our health care costs more than it does in Europe, where you have the efficiency [sic!] of government management.  Before we get into detail, I would observe that this fails a pretty basic smell test right off:  Nearly every single product and service we Americans buy, all of which are rife with layers of nasty profits in the supply chain, are cheaper than their counterpart services and products in Europe.  If this layering of profit without government management is a problem, why is it only a problem in health care but not a problem in thousands of other industries.  But anyway, to details:

Let's start with one the American Medical Association hopes no one will notice, which is that American doctors make a lot more money than doctors elsewhere -- roughly twice as much. The average incomes of $274,000 for specialists and $173,000 for general practitioners are, respectively, 6.6 and 4.2 times those of the average patient. The rate in the other countries is 4 and 3.2.

According to McKinsey, the difference works out to $58 billion a year. What drives it is not how much doctors charge per procedure, but how many procedures they perform and how many patients they see -- a volume of business 60 percent higher here than elsewhere.

Ooh, those greedy doctors.  They are the problem!  But read carefully, especially the last sentence.  He makes clear doctors in the US are not making more because they charge more, they make more because they see more patients --- ie, they work harder than their European counterparts.  Where have I heard this before?  Again, in every other industry you can name, the fact that our workers work harder than their European counterparts is a good thing, leading to lower costs and higher productivity.  So why is it suddenly bad in medicine?  For this I would instead draw the conclusion that their are perhaps too many procedures (an expected outcome of the screwy incentives in the system) and thus too many doctors.  Doctors, whom Mr. Pearlstein paints as enemy number one in the health care system, are actually its greatest asset, being 60% more productive than their European counterparts, certainly something to build on.

Don't be distracted by arguments that American doctors need to make more because they have to pay $20 billion a year in malpractice insurance premiums forced on them by a hostile legal system, or an equal amount for all the paperwork required by our private insurance system. The $58 billion in what the study defines as excess physician income is calculated after those expenses are paid.

Walter Olson, are you listening?  Since Walter is not here, I will say it for him.  Malpractice insurance premiums themselves are only a part of the cost of runaway malpractice.  Defensive medicine, including the overuse of tests, is another big cost.  Malpractice is one big reason doctors prescribe so many more tests and procedures than their European peers.

Proponents of a government-run "single-payer" system will certainly home in on the $84 billion a year that McKinsey found that Americans spend to administer the private sector portion of its health system -- a cost that national health plans largely avoid. But as long as Americans continue to reject a government-run health system, a private system will require something close to the $30 billion a year in after-tax profits earned by health insurance companies. What may not be necessary, McKinsey suggests, is the $32 billion that the industry spends each year on marketing and figuring out the premium for each individual or group customer in each state. Insurance-market reform could eliminate much of that expense.

What freaking planet does this guy live on?  Does he really think administrative costs are going to go down in a single payer system?  That's insane.  I am willing to believe that the number of procedures will go way down, as Congress starts to ration care in favor of building bridges for their constituents  (a savings likely offset as America's world-leading doctor productivity discussed above takes a nosedive).  Does he really think that administrative costs will go down?  Most administrative costs today are for satisfying government paperwork requirements - how is having the government run everything going to reduce these?   I would argue exactly the opposite -- that eliminating government from the equation would reduce private administrative costs substantially.

I won't bore you with any more, but he doesn't miss the chance to blame health care costs on drug and hospital company profits as well.  Just for entertainment value, I urge the reader to look up a few P&L's of some of these companies.  The profit as a percent of sales for Humana is 2.3% of sales.  So if you wiped out all that egregious profit at Humana, you would save all its customers a whopping 2.3% (before, of course, the incentives problems take over and costs bloat for the lack of a profit incentive to manage them). Insurer CIGNA's profit is a bit under 10%.   Merck's profit is a more comfortable 19% of sales, which means that by cutting their profit to zero we could get nearly a 20% discount on drugs.  Of course, new drug development would cease, but the AARP doesn't care about drugs that won't be on the market after their current constituency is dead.

Isn't it more reasonable, as I am sure the McKinsey study actually concludes, that the problem is not in companies making profits or doctors working hard, it is in having a health care system, built the way it is through distortive tax law, that gives neither patient nor doctor any reason to consider costs when deciding on care?  Can you imagine such a screwed up system in any other industry?  How inefficient would retail be in the US, for example, if we all had a "shopping policy" that paid for all our purchases.  Would you give a crap about the price of anything?  Would you hesitate one second buying something you may not need but is covered by your "policy"?

Mr. Pearlstein sortof agrees, but its hard to find this incentives point in the middle of all his blame-it-on-the-profits progressive rhetoric.  Here is our one hint that Mr. Pearlstein understands that the true problem is this mismatch between payer and decision-maker.  Unfortunately (emphasis added) he has a really destructive perspective on the issue:

What we have here is pretty good circumstantial evidence of Pearlstein's First Law of Health Economics, which holds that if you pay doctors on the basis of how many procedures they do, and you leave it to doctors and their insured patients to decide how much health care they get, consumption of health services will rise to whatever level is necessary for doctors to earn as much as the lawyers who sue them.

Mr. medico-fascist Pearlstein thinks the big system problem is leaving it to you, the patient, to decide what health care you get.  The solution for him is to have the person spending the money, preferably the US Congress, decide how much health care you get.  I think a much saner solution, and the only one consistent with a free society, is to get back to a system where the same person who gets the care, pays for the care.  If its a good enough system for 9,999 things we purchase each year, its good enough for health care too.

Posted on February 14, 2007 at 11:02 PM | Permalink | Comments (8)

The Bizarro World of Health Care

Can you imagine any other product or service you buy for which you would have to sign this release, which was part of my health insurance application (emphasis added):

You understand and agree that you are applying for individual health insurance for you (and your family).  You further understand that this application for health insurance will be fully medically underwritten and that coverage is not guaranteed. You are personally paying the entire premium for this health insurance coverage.  Your employer is not contributing in any way to the payment of premium, either directly or indirectly.

Do you agree with these statements?

You mean my company is not paying for my new Taurus?

Posted on February 8, 2007 at 04:04 PM | Permalink | Comments (3)

What Does "Negotiate" Mean in this Context?

Via Hit and Run:

As part of their 100 hours, the House plans to pass legislation that would enable the federal government to negotiate Medicare Part D drug prices.

My experience is that when the government "negotiates" prices via their standard procurement processes, they end up paying higher prices than a private firm might (see "$6000 hammer").  I am not a very experienced political observer who understands all the insider-speak, so maybe someone out there can tell me.  In this context, does "negotiate" actually mean "use the government's fiat power to demand that prices be set at whatever hell level they want?"

If it is the latter, then does anyone really believe that with populist political pressures, prices are going to be set anywhere near high enough to continue to justify intense drug R&D?  Already most of the world pays just above marginal cost for drugs, such that we in America pay for most all the drug R&D that occurs  (a form of charity we never get credit for).  If the US government "negotiates" US drug prices down to marginal cost, who will be funding the new life extension therapies I will be needing in about 20 years?

Update: One clarification based on the comments.  There is nothing wrong per se with American drug companies selling pharmaceuticals outside the US near marginal cost.  Profit is where you find it.  However, the issue is that US politicians tend to use these international drug prices as a benchmark, as in "US customers should get the same low price foreigners are getting."  The result is all the drug re-importation battles we have from time to time.  (By the way, its funny that politicians who support drug re-importation to reduce the US drug price differential vs. other countries never seem to apply the same solution to the entirely parallel situation of other countries having much lower labor costs than ours -- in fact in these cases they actively resist labor re-importation, which we also call immigration or outsourcing.)

A second point I want to make is that we cannot say for certain whether US customers are getting a good value or a bad value at current drug prices, though both supporters and opponents of the current health care system try to draw conclusions about the "fairness" of drug prices.  This is an odd situation to be in.  In other situations when people challenge the "fairness" of pricing, say gasoline prices, we libertarians can always retort "Well, buyers and suppliers both agreed to the transaction at X price, so X price was fair for both."   

But we can't do this with drug prices.  The reason we can't determine whether individuals are getting a good value is that, as I wrote at length in this post, our health care system is not structured in a way where individuals make cost-benefit tradeoffs for themselves.  Our employer's insurance company, via their coverage policies, or the US Government, via its rule-making and tort law, make these trade-offs for us.  Some drugs you might never pay for yourself, but you take because your insurance company pays for them.  Some drugs (e.g. Vioxx) you might dearly love to take, but the American litigation mess effectively precludes your access to it.  My suspicion is that, given the value I put on my life, prices for many US drugs are still a bargain for me, but who knows what trade-offs other people would make in a free society?  At the end of the day, we don't know what the real market price for pharmaceuticals is.  All we can say with confidence is that whatever price the government "negotiates," it will most likely be wrong.

Posted on January 15, 2007 at 10:44 AM | Permalink | Comments (6)

Who Is Paying For This Lunch

Michael Cannon at Cato has an analysis of who will be paying for California's health care free lunch.  If the answer is "not-Californians" and if there is no such thing as a free lunch, guess who?  (Hint: Check mirror).

Posted on January 15, 2007 at 12:21 AM | Permalink | Comments (0)

Our Bodies, Ourselves

Perhaps the central touchstone of the women's movement has been the ownership and decision-making for one's own body, starting of course with the freedom to choose an abortion, but extending into a number of other health and sex-related issues. 

What amazes me, though, is how quickly all this is chucked out the window when it comes to having the government take over health care.  Because many of the exact same people who have campaigned for the primacy of a person's decision-making for their own body are also strong supporters of government funded universal health care.  And I can't think of anything less compatible with individual decision-making for one's own body than having the government run health care. 

The demands for universal health care general come from two complaints:

  1. Health care is too expensive and is more than I can afford
  2. Health care quality is low.  In this category, by far the most common complaint is that "my insurance won't pay for X procedure that I want, or Y level of care, etc."

Neither is a surprising complaint, given how our health care system is currently set up, and both are highly related to one another.  The key problem in the US health care system is that, unlike just about any other product or service you and I purchase, the typical individual is not presented with a cost-quality tradeoff.   Since most of us have a fixed price insurance plan, we couldn't care less how much anything costs, and in fact, like an all-you-can-eat buffet, our incentive is to use as much as possible. 

This puts the insurance companies in the odd position of having to make cost-quality tradeoffs for us, via their coverage and treatment rules.  But when they try to cut costs by narrowing or limiting certain treatments, consumers tend to get the government involved to remove these limitations.  They either do this though legislation (many states now have onerous requirements on what procedures insurance companies must pay for in that state) or through litigation (the threat of lawsuits pushing doctors into expensive defensive medicine, asking that every conceivable test be conducted).  In other words, people take their dissatisfaction with #2 above to the government, who acts, pushing up costs and making problem #1 worse.

Until we find ourselves in a Strossian post-scarcity world, someone is going to have to make this cost-quality tradeoff for our health care.  Even if it is never discussed, this is the most important design factor in any health care system.  There are only three choices:

  • Individuals make these choices for themselves, paying for their health care and making their own decisions about whether certain procedures are "worth it".  - OR -
  • Insurance companies make these choices for us.  (I am not sure this is even a choice any more, as government micro-management seems to be pushing this de facto into the next choice). - OR -
  • The government makes these choices for everyone

So, folks that are pushing for government-funded universal health care are in fact saying "I want the government to take over decision-making for my body."  Yuk!  Where are the feminists when we need them?

Beyond just ceding to the government decisions such as whether its really worth it for dad to get his new hip joint, there is another chilling factor, which I have written about a number of times.  Government health care will act as a Trojan Horse for nanny fascism.  Because, you see, if the government is paying to fix your body, then you can't be trusted to do whatever you want with your body.  By paying for your health care, the government has acquired an ownership interest in your body.  You want that Wendy's cheeseburger?  Sorry, but the government can't allow that if it is paying for your health care.  Likewise, it is not going to allow your kid to play dodge ball at all or to play soccer without a helmet -- can't afford to fix all those broken bones.   And no swing sets or monkey bars either!

Already, when its only affects us as individuals, the government is poking its nose into micro-managing our lives.  Just think what will happen when the government has a financial incentive, in the form of health care costs, to do so!  Eek! In fact, it is already happening:

People who are grossly overweight, who smoke heavily or drink excessively could be denied surgery or drugs following a decision by a Government agency yesterday.  The National Institute for Health and Clinical Excellence (Nice) which advises on the clinical and cost effectiveness of treatments for the NHS, said that in some cases the "self-inflicted" nature of an illness should be taken into account.

Or here in the US:

New York City is at the forefront of this new public health movement. In January, city health officials began requiring that medical testing labs report the results of blood sugar tests for all the city's diabetics directly to the health department. This is first time that any government has begun tracking people who have a chronic disease. The New York City Department of Health will analyze the data to identify those patients who are not adequately controlling their diabetes. They will then receive letters or phone calls urging them to be more vigilant about their medications, have more frequent checkups, or change their diet....

So what could be wrong with merely monitoring and reminding people to take better care of themselves?  New York City Health Commissioner Thomas Friedan has made it clear that it won't necessarily end there. If nagging is not sufficient to reduce the health consequences of the disease, other steps will be taken. Friedan argues that "modifications of the physical environment to promote physical activity, or of the food environment to address obesity, are essential for chronic disease prevention and control." Friedan envisions regulations for chronic disease control including "local requirements on food pricing, advertising, content, and labeling; regulations to facilitate physical activity, including point-of-service reminders at elevators and safe, accessible stairwells; tobacco and alcohol taxation and advertising and sales restrictions; and regulations to ensure a minimal level of clinical preventive services."

Read that last paragraph.  That's just the starting point for where the government will go when it starts paying for all our health care.

Postscript:   This is a very hard topic to discuss with people, because they are so ingrained with the way the market is set up today.  When I started working for myself, I told my wife that we needed a high-deductible medical plan, to protect us from a health disaster, but we would just self-pay for dental costs.  "What?"  She said.  "You can't pay for your own dental - you need insurance.  We can't go without insurance.  That's all you hear on TV, the problem of not having insurance.  We'll be one of those people!"  I patiently explained that it was almost impossible for us to face a dental problem that would bankrupt us, and that for any conceivable level of dental care, it was cheaper to just pay the bills than get dental insurance.  Eventually, she relented.

We have been paying our own dental bills for years now, and have saved thousands vs. the quotes I got for insurance.  The other day we had an issue that perfectly highlights why 3rd party payer systems cause problems.  My wife chipped a tooth.  She was presented with two choices:  To file it down for nominal cost, or to do a major repair which would cost $500.  She asked me my advice on which to do, and I said "its your mouth.  You know what else we might use $500.  You make the tradeoff."  I am not even sure what decision she made.  It is simply impossible to make this kind of decision for someone else.  Everyone will make it differently.  A government-payer system would only have two options:  1)  don't allow anyone to get the expensive fix or 2)  force taxpayers to pay for everyone to get the expensive fix.  Both solutions are wrong.  Such is the problem with all single-payer systems.

 

Posted on January 15, 2007 at 12:02 AM | Permalink | Comments (3)

Another Bail Out of "Big Rust Belt"

For the lack of a better term, I will call large, old-line union dominated companies "Big Rust Belt."  These are companies that tend to have strong unions and that have compensation packages most new companies eschew (e.g. defined benefit rather than defined contribution pensions).  These companies tend to be experienced rent-seekers, and usually are beneficiaries of protectionist practices.  I generally lump the big 3 auto makers (and much of their supply chain) and integrated steel manufacturers in this description.  Other industries, like traditional airlines (e.g. United but not Southwest) also fit in this description.

Already over the past several years, Big Rust Belt has been getting bailouts of their defined-benefit pension plans.  Going forward, Big Rust Belt is looking for the government to bail them out of their health care obligations as well.  Big Rust Belt began offering health benefits as part of their compensation packages in WWII, when government wage freezes made it difficult to compete for labor, and offering health benefits was a way to evade the wage laws.  Health benefits grew in popularity at a time when it seemed reasonable that your employer might still be alive and employing you forty years from now, and because Congress and the IRS made these plans tax-preferred over cash compensation.  Short-sited corporate executives began offering retirement health care in labor negotiations as a way to reduce cash wage increases, on the theory that cash wages hurt the bottom line now while retiree benefits hit the bottom line, well, on someone else's watch.

Now these health benefits are an albatross around these corporations' collective necks.  Not only are they bankrupting them, but smaller companies who were not so dumb as to make these promises to their employees are out-competing them. 

So Big Rust Belt wants at least three things:

  • It wants the government to force its smaller competitors to have to offer the same health insurance it was dumb enough to promise.
  • It wants the government to take on a portion of its medical obligations, particularly for retirees
  • It wants to government to by law limit the procedures it has to pay for (i.e. ration care), something they have been unable to do in their union negotiations.

And, surprise surprise, given that Big Rust Belt is even better at rent-seeking than it is in running its core businesses, state and federal governments look ready to deliver on all of these.  Each of these is a feature of the governator's new plan, and all are features of various Hillarycare models discussed by Democrats in Congress.  So no one should be surprised when GM CEO Robert Lutz says:

he expects the new Democratic-controlled Congress will be more understanding on health care issues

"More understanding" means "more ready to bail Lutz and GM out of there business problems."  And remember that for Big Rust Belt, universal health care does not mean "great, now everyone can have health care";  it means "great, now we don't have to bother competing with any companies who are smarter about how they have compensated their employees."

Update:  More Big Rust Belt rent-seeking here.

Posted on January 9, 2007 at 11:14 AM | Permalink | Comments (0)

The Obesity Non-Epidemic

It seems of late that obesity is the new sky-is-falling health care issue I see in papers all the time.  One of the easiest ways to create a "trend" is to steadily change the standards**, which is in fact what has been happening with obesity in the US.  Every year or two, government officials or whoever does this stuff expand the range of weights that constitute "obese".  By doing this, even if the average weights are not changing (and I don't know if they are or are not) you can create a trend in increasing obesity just from changing the standards.  In fact, I argued here:

By the way, I am willing to make a bet with anyone that no where near 40% of our healthcare charges in Arizona are due to obesity.  I am positive some advocate made up this number, or created it using some ridiculously broad assumptions, and it has now been swallowed by the credulous and scientifically-illiterate press. 

Sandy Szwarc who runs the new Junkfood Science blog, writes of a similar effect in hospital statistics.

The HCUP report is not actually reporting hospital stays of obese people. It is a tally of the numbers of times “obesity” was checked off on the billing codes on the hospital records. These codes are currently known as ICD-9 codes, taken from the International Classification of Diseases, Ninth Revision. This is an enormous, complicated and continually changing system which gives a number to every disease and medical procedure, and currently has about 12,000 codes. The medical literature is filled with documentations of their inaccuracies in reflecting actual patient disease rates. But over recent years, healthcare providers are being increasingly educated on using these codes in order to receive reimbursements ... including coding for obesity. The weight loss and bariatric industry has been especially intense in marketing the usage of the obesity code, in particular.     

Not surprisingly, more providers are.    

So that 112% increase in hospitalizations for “obesity”since 1996 actually reflects increased usage of the coding, but whether or not it means there are actually more obese patients is arguable. But with the heightened stringency and surveillance by third party payers in compelling providers to accurately note ICD-9 codes in order to receive reimbursements, the current figures are certainly more complete than in past years.

She concludes by questioning whether there really is an epidemic of hospital admissions for obesity.  Remember that this is important because it is this obesity epidemic that is used as justification for nanny-state interventions like the NY trans-fat bans as well as potential tobacco-clone litigations against fast food companies. 

This report is being presented as proof that “‘obesity’ has become a major public health problem.” That was even its opening sentence. But the media’s failure to give us the full story is demonstrated in the most significant fact in the report: 94.3% of all hospitalizations made no mention of obesity!    

Fat people are not flooding into hospitals with health problems more than anyone else.   

“Obesity” is the primary diagnosis in only 0.4% of all hospitalizations and virtually all of those (95%) were for bariatric surgery! Not the result of fat people succumbing to life-threatening health problems, but a profit-making elective surgery targeting them.

My sense is that the obesity issue is the next phase of what I call the health care trojan horse (and here and here).  This is the practice of using government funded health care expenditures as an excuse to micro-regulate our eating and other personal practices.  As I said then:

When health care is paid for by public funds, politicians only need to argue that some behavior affects health, and therefore increases the state's health care costs, to justify regulating the crap out of that behavior.  Already, states have essentially nationalized the cigarette industry based on this argument.



** As an aside, a fantastic example of this game is in the movie "An Inconvenient Truth."  The filmmakers try to make the argument that global warming is making weather more volatile.  As "proof", they show the number of reported tornadoes in the US rising dramatically since the 1950's.  But here is the rub:  In the 1950's, we had no good way of detecting smaller class 1 and 2 tornadoes that we now detect using Doppler radar and the like.  This means that we do not necessarily experience more tornadoes, we just can detect more.  In fact, if you look only at larger class 3-5 tornadoes that we could detect through the whole period, the tornado frequency has NOT gone up.  I leave it to the reader to decide if the filmmakers are terrible at interpreting scientific data, or if they are disingenuous.  Neither reflects well on the rest of the film.

Posted on December 22, 2006 at 10:44 AM | Permalink | Comments (6)

More on the Health Care Trojan Horse for Fascism

Frequent readers will now that I have long warned of government-funded health care acting as a Trojan horse for micro-management of our personal lives, the logic being that if our lifestyles or behaviors make us less healthy, then the government that funds medical care may claim an interest in regulating those behaviors.  I often post examples of this phenomena, the most recent of which is here.

This installment comes via Reason, and looks at the NYC Health Commissioner Thomas Friedan's new fascism to prevent diabetes program.  I am not sure I even need to comment on the following for you to get the picture:

New York City is at the forefront of this new public health movement. In January, city health officials began requiring that medical testing labs report the results of blood sugar tests for all the city's diabetics directly to the health department. This is first time that any government has begun tracking people who have a chronic disease. The New York City Department of Health will analyze the data to identify those patients who are not adequately controlling their diabetes. They will then receive letters or phone calls urging them to be more vigilant about their medications, have more frequent checkups, or change their diet....

So what could be wrong with merely monitoring and reminding people to take better care of themselves?  New York City Health Commissioner Thomas Friedan has made it clear that it won't necessarily end there. If nagging is not sufficient to reduce the health consequences of the disease, other steps will be taken. Friedan argues that "modifications of the physical environment to promote physical activity, or of the food environment to address obesity, are essential for chronic disease prevention and control." Friedan envisions regulations for chronic disease control including "local requirements on food pricing, advertising, content, and labeling; regulations to facilitate physical activity, including point-of-service reminders at elevators and safe, accessible stairwells; tobacco and alcohol taxation and advertising and sales restrictions; and regulations to ensure a minimal level of clinical preventive services."

The NYC health department starred in a previous post for their brave attack on restaurants that give patrons too much for their money.

Posted on March 22, 2006 at 11:11 PM | Permalink | Comments (4)