Tag: health care

From a “Primary Source”

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From a “Primary Source”!

Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care.

—

In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care’s dysfunctional delivery system.

—

The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value.

Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern.

In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system—now with many more participants. This will make an eventual solution even more difficult. Ultimately, our capacity to innovate and develop new therapies would suffer most of all.

— Dr. Jeffery S. Flier, dean of Harvard Medical School, The Wall Street Journal – Health ‘Reform’ Gets a Failing Grade

(Emphasis is mine.) I will be referring back to this post at a later date.

Reality Bites

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Reader Bilgeman thought this was important enough to email to me. He was right:

Health Care Speechwriter for Edwards, Obama & Clinton Without Insurance Now

For the first time in my life, I am without health insurance and it is a terrible feeling.

In the past, I paid attention to the health care debate as a speechwriter who prepared speeches, talking points, op-eds, and debate prep material on the topic at different times for John Edwards, Barack Obama, Hillary Clinton and others. Now, I’m paying attention because I’m a citizen up the creek without a paddle.

Throughout my life, I have been very lucky because my insurance has always been there whenever I had a crisis. When my 10-speed hit a patch of leftover winter sand, and I went flying into a telephone pole, it covered the x-rays and stitches and concussion diagnosis. When a half a ton of sheet rock fell on me, my insurance paid for the cast on my foot. When my depression kicked in and I was hospitalized and painting ceramic pieces in art therapy to boost my self-esteem (sheesh), it made sure that when I got home my medical bills didn’t make me reach for a razor. And when there were growths in my uterus, it covered that medical procedure and every regular check-up, lab test, broken bone, sports injury, and antibiotic prescription in between.

Since I care more about my country than my personal pride, here’s how I lost my insurance: I moved. That’s right, I moved from Washington, D.C., back to Massachusetts, a state with universal health care.

In D.C., I had a policy with a national company, an HMO, and surprisingly I was very happy with it. I had a fantastic primary care doctor at Georgetown University Hospital. As a self-employed writer, my premium was $225 a month, plus $10 for a dental discount.

In Massachusetts, the cost for a similar plan is around $550, give or take a few dollars. My risk factors haven’t changed. I didn’t stop writing and become a stunt double. I don’t smoke. I drink a little and every once in a while a little more than I should. I have a Newfoundland dog. I am only 41. There has been no change in the way I live my life except my zip code — to a state with universal health care.

Massachusetts has enacted many of the necessary reforms being talked about in Washington. There is a mandate for all residents to get insurance, a law to prevent insurance companies from denying coverage because of a pre-existing condition, an automatic enrollment requirement, and insurance companies are no longer allowed to cap coverage or drop people when they get sick because they forgot to include a sprained ankle back in 1989 on their application.

Even if the economy was strong and I was working more, I still couldn’t afford my premium.

READ. THE. WHOLE. THING.

Remember, kids: insuring everyone will bring costs down!

And fine her $950 for not having health insurance!! (It’s cheaper than $550/month!.)

For the record, my portion of the health insurance that covers me and my wife is a bit over $400/mo., and my employer picks up the rest. I’d love the opportunity to pay only $225/mo. for the whole thing, myself, and carry it with me no matter where I live or who I work for. But the current insurance laws prohibit that.

Reality bites, doesn’t it? That is, unless you’ve mastered the ability to deny it. (Our chocolate ration is about to be increased!)

I Guess I’m Not… HUMAN

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Normally I don’t comment over at Markadelphia’s blog. He does enough of that here, but yesterday I couldn’t resist. Read his very short post, Yep.

I was the first to comment:

Great! Let him and his organization provide that coverage, and let’s see how long he and his organization stay in business.

Health care is not a RIGHT.

There were, of course, responses to that, but here’s the one I’m going to respond to with an Überpost:

blk said…

From the preamble to the Constitution:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

A basic education is a right in this country. It wasn’t always. Most people would agree that protection by the fire and the police departments is a right. It wasn’t always that way.

Why isn’t health care a right? What else would promote the general Welfare of our population than ensuring that everyone has a long and healthy life? What could be more Just than making sure that every child, worker and elderly person can see a doctor when they’re sick?

National health care would promote domestic Tranquility by giving everyone peace of mind, knowing that if their kid comes down with some awful disease they can get treatment. If you have cancer, the emergency room just ain’t gonna cut it.

To enjoy the Blessings of Liberty you have to be alive. Many people die in this country because they don’t have health care.

We are a rich country. As we’ve become wealthier and as technology and science have advanced the notion of what is a right has changed. Now that we can afford them, education, police and fire protection are rights. The way health care costs are exploding, we are going to go bankrupt. We have to change the way the system works to reign in costs. By covering everyone we can make it cheaper for each person. When everyone is covered and everyone is paying, we’ll finally have the leverage we need to prevent the explosive rise in costs.

That will mean squeezing out unnecessary middlemen who get between you and your doctor. The most expensive and least useful middlemen are insurance industry execs. By eliminating them we can squeeze literally billions of dollars from health care overhead (health care company execs pull in salaries, bonuses and options in the range of tens of millions, to hundreds of millions to a billion dollars).

Where to begin? Why, at the beginning!

A basic education is a right in this country. It wasn’t always.

No, indeed it was not. Back when I started this blog, one of the very first posts I published was an essay entitled What is a “Right”? That essay has, over the years, drawn a lot of commentary and inspired a six-part exchange with a professor of mathematics on just that very topic. (Check the left sidebar if you want to read the whole discussion. I recommend it.) The original essay was written to win me a year’s membership at AR15.com, and that contest required that I limit myself to, I think, 800 words, but the core point of the essay was this:

A “right” is what the majority of a society believes it is.

That’s the pragmatist in me coming out. What people believe is a “right” they will agitate for and defend against encroachment. Conversely, if they don’t believe, they won’t defend. Is universal education really a “Right”? Philosophically, no, it’s not, but we’ve had it hammered into us for so long the majority believes it is. They believe that it is the job of the government to educate our children to the point that many parents no longer take any responsibility for that education on themselves, and don’t pay any attention to what their children learn (or don’t) while those children spend six to eight hours a day under the control (or not) of our public education system.

I’ll come back to that.

Most people would agree that protection by the fire and the police departments is a right. It wasn’t always that way.

Obviously I’m not “most people.” I know better. I’ve lived where residents had to pay a local private fire company to get them to come to their homes if there was a fire. If they chose not to pay, the firefighters could choose not to come. Or if they did, the homeowner would get a big damned bill for their appearance afterward that would represent a lot more than a few years of subscription to their services. If the homeowner chose not to pay that bill, they’d be taken to court.

Does that sound like a “right”?

I also understand that I have no “right” to police protection. That happens to be just one of many reasons I’m an activist for the right to arms. As I said, I’m a pragmatist. I try to deal with the way the world works rather than how people think it ought to be. And given your assertion that police protection is a “right,” you ought to read both pieces of that essay. You might be surprised.

Why isn’t health care a right? What else would promote the general Welfare of our population than ensuring that everyone has a long and healthy life? What could be more Just than making sure that every child, worker and elderly person can see a doctor when they’re sick?

Let’s take these one at a time, because they’re not a set. This is a textbook example of argumentum ad consequentiam – the proposition that belief in X will lead to good consequences, therefore X is good.

Why isn’t health care a right? For the same reason having a fire engine show up at your door in the event of a fire isn’t a right – it demands that someone else do something for you. One thing I try to do with this blog is make sure that if someone can say something better than I can, I let them. Let me quote Dr. Pat Santy, a psychologist and MD on the topic:

Let me be clear. I don’t believe that people have a “right” to health care; because, what advocating such a “right” basically means is that you believe you have a “right” to my mind; you have a “right” to my professional competence; i.e., you have a “right” to enslave me.

In that six-part series on ‘What is a “Right”?’, I concluded that there is only one fundamental right, and all others are corollaries of it, but one defining factor is that YOUR rights end when they require DEMANDING something of another. That’s the idealist in me.

And I’m able to tell the difference between idealism and pragmatism.

What else would promote the general Welfare of our population than ensuring that everyone has a long and healthy life? Excuse me? Everyone? What do you do with the chronically ill? The disabled? The terminally ill? Define “long” and “healthy.” Who gets to be the arbiter of what is and what isn’t a “long and healthy life”? You? Or some bureaucrat? You’re postulating a utopian outcome as achievable fact when it is obviously fantasy.

What you’re doing is appealing to emotion: “Wouldn’t it be wonderful…” Why yes, it would. But back to reality. Life doesn’t work that way, Sparky. Some people get roses, some get fertilizer. Wishing it weren’t so won’t make it not so. If you are incapable of dealing with what is, you shouldn’t be advocating change.

What could be more Just than making sure that every child, worker and elderly person can see a doctor when they’re sick? And they can’t? This is Argumentum ad Misericordiam – the appeal to pity. Let me quote the author of the blog Bloodletting, an up-and-coming doctor now doing his residency training, from a post he wrote in 2004 back when Bush was pushing for expanded Medicare drug prescription entitlements. Fisking Nancy Pelosi’s response to a Bush speech:

HEALTH CARE AND MEDICARE PRESCRIPTION DRUGS
Third, our “opportunity society” is built on the belief that affordable, available health care is not a luxury, but a basic foundation of a truly compassionate society. [OK, now we are going to get into the real nitty-gritty about the difference between “want” and “need.” Healthcare is denied to nobody. NOBODY. Nobody is denied a ferrari, either, but most people do not want to spend the money on one.]

This is from a man in the system, providing that care – what Markadelphia calls “a primary source.” And let’s stop playing semantic games. What you’re advocating is universal health care insurance – the method of paying for health care. If health care is a right, why should anyone have to pay? What we’re debating about here is the level of that care and its cost. I’ll come back to this, too.

Next up, National health care would promote domestic Tranquility by giving everyone peace of mind, knowing that if their kid comes down with some awful disease they can get treatment. If you have cancer, the emergency room just ain’t gonna cut it. I’m tempted, but let’s wait until I come back to the “level of care” question.

To enjoy the Blessings of Liberty you have to be alive. Many people die in this country because they don’t have health care. No, they may die because they don’t have sufficient or sometimes competent health care, but health care is available. If you’re deathly ill and call 911, an ambulance will come, an EMT will examine you, you will be transported to a hospital, and (assuming you live long enough) you will get looked at by a doctor, and probably admitted somewhere. Might be a crappy hospital, might not be enough to save you, but it’s a lot more than our Founders got when they wrote the Constitution you quoted.

Now to the meat of it.

We are a rich country. Well, I’d say we were a rich country, but not any more. You are aware of the thing called “the national debt”? As of Monday the Treasury reports that our national debt was $11,919,879,121,739.54. That’s $11.9 trillion dollars. That’s the total of what the government has spent in excess of its income and not paid off. Per the CIA World Factbook the 2008 US GDP – defined as “the sum value of all goods and services produced in the country valued at prices prevailing in the United States” – was $14.26 trillion. On Sept. 30, 2008 (end of the 2008 fiscal year) the national debt was $10,024,724,896,912.49. According to this site, the total federal income in 2008 through taxes, fees, etc. was $2.524 trillion, or a mere 17.7% of GDP, and each and every year our federal government spends several hundred billion dollars more than it takes in – thus making the national debt ever larger.

Are we a “wealthy nation” or are we a debtor nation, living on money we don’t have? Could you run your household that way? Can you spend, each and every year, more money than you earn, borrowing to make up the difference? EVERY year? Do you owe more than five times your annual income to creditors?

As we’ve become wealthier and as technology and science have advanced the notion of what is a right has changed. That’s the only thing you’ve said that I agree with without reservation. We certainly have “advanced the notion,” but that doesn’t change the reality. As we’ve changed the notion of what is a right, we’ve spent ourselves into the poor house. “Entitlement” spending – and “health care” is just an expansion of entitlement spending – makes up about 45% of the federal budget now. (PDF)

Now that we can afford them, education, police and fire protection are rights. Really? Police protection isn’t a right. The courts say so. Fire protection isn’t a right. Education isn’t a right either, but I will agree that the majority certainly believes that it is.

But can we still “afford” it? I invite you to read The George Orwell Daycare Center. Pack a lunch.

The way health care costs are exploding, we are going to go bankrupt. Regardless of what health care costs do, we are going bankrupt. All you have to do is look at the numbers to see that.

We have to change the way the system works to reign in costs. Who’s this “we”? You want the government to do it, no? An army of bureaucrats appointed by our elected officials. Lots of GSA employees with great benefit packages, administering health care claims or monitoring those evil health insurance companies to ensure no one (especially Uncle Sugar) gets ripped off?

By covering everyone we can make it cheaper for each person. Really? Show me the data. Then explain, using small words, why a healthy 25 year old should be made to pay for the dialysis of an 86 year old (s)he has never met and will never meet? Explain to me how making that healthy 25 year old pay will make it cheaper for him/her.

When everyone is covered and everyone is paying, we’ll finally have the leverage we need to prevent the explosive rise in costs. Again, really? Everyone? So you’re going to make the poor pay too? I thought the deal was to cover everybody including those who can’t pay. Who picks up their tab? I’ve heard various numbers bandied about, but we’ll use 47 million, since that seems to be a popular number. You honestly are going to tell me that adding 47 million people to the health care system is going to make it work better? That it’s going to reduce costs? How long does it take for you to get an appointment with your regular doctor, and when you go, how long do you spend in that doctor’s actual presence? You’re playing in fantasy-land again. It sounds wonderful, but it doesn’t pass the smell test.

That will mean squeezing out unnecessary middlemen who get between you and your doctor. And here we go. Who decides who is “unnecessary”? And won’t this add to unemployment? Why do those “unnecessary middlemen” exist in the first place? How about this example: What if lawyers had to bill like doctors do? (Stolen without shame from Dr. Westby G. Fisher, MD.)

Beginning July 1, 2010, under the Legal Billing Obfuscation Act of 2009, lawyers will receive their payments for services rendered after approval by a central US government Payment Distribution Authority (USPDA). To receive payment from the Authority plaintiff and defendant complaints must be coded and filed electronically using the International Classification of Legal Complaints, 10th edition (ICLD-10), copyright © 2009, American Bar Association and Legal Proceeding Terminology (LPT) codes, copyright © 2009 American Bar Association. The full publication of each of these codes will be available in print March 1st 2010 and in electronic form on DVD in July 2011.

To familiarize lawyers with the new coding scheme requested by the USPDA, a small sample for the complaint of “Spilling” is shown below:

  • Spilling 200
    • Spilling, Water – 210
      • Spilling, Water, Hot – 211
        • with blisters 211.1
        • without blisters 211
      • Spilling, Water, Warm – 212
      • Spilling, Water, Cold – 213

      . . .

  • Spilling, Coffee – 240.1
    • Spilling, Coffee, Hot – 240.11
        • Spilling, Coffee, Hot, With Cream only – 240.12

        • with blisters – 240.121
        • without blisters 240.122
      • Spilling, Coffee, Hot, With Regular Milk only – 240.13
      • Spilling, Coffee, Hot, With 2% milk only – 240.14
      • Spilling, Coffee, Hot, With Skim Milk – 240.15
      • Spilling, Coffee, Hot, With Soy milk only 240.16
      • Spilling, Coffee, Hot, With Sugar only – 240.17

        • Spilling, Coffee, Hot, With Artificial Sweetner (of any type, including, but not limited to Nutrasweet, Splenda, Sweet ‘n Low) – 240.18

    • Spilling, Coffee, Hot, With Cream and Sugar 240.16

      • . . .

Pairing of improper complaint codes with legal proceeding codes will result in non-payment. “Up-coding” of legal proceedings shall constitute grounds for prosecution with some additional fines imposed by the IRS, as determined by the Office of Health and Human Services. For instance, pairing a legal complaint of “Spilling, Coffee, Hot, with blisters” to and of those of Divorce, same gender, living apart, male (or female) (shown below) will result in non-payment.

  • Divorce: 100-199
    • Between husband and wife 100.1
    • Between same gender couple, living together, male, 100.011
    • Between same gender couple, living together, female, 100.012
    • Between same gender couple, living apart, male, 100.021
    • Between same gender couple, living apart, female, 100.022

      • . . .

Valid code pairings for spillage include Accident codes (0010-0059), Assault codes (4400-4499), or Battery codes (5500-5599) provided documentation supports the requests for payment.

You’re talking about adding another layer of government oversight to a system already buried under paperwork. You won’t be “squeezing out unnecessary middlemen,” you’ll be replacing them with government drones. Yet you think that will make the system more efficient?

What planet do you live on, because it isn’t mine.

And, finally: The most expensive and least useful middlemen are insurance industry execs. By eliminating them we can squeeze literally billions of dollars from health care overhead (health care company execs pull in salaries, bonuses and options in the range of tens of millions, to hundreds of millions to a billion dollars). Ah, yes: Argumentum ad Invidiam, the appeal to envy.

Total health care expenditures in fiscal year 2009 are estimated to reach $2.5 trillion, according to the National Coalition on Health Care. (Edit: Did, in fact, reach $2.6 trillion in 2009 according to this site.) According to Crooks and Liars, the compensation of the top 10 highest-paid insurance company CEOs totals out to $85,429,970. Assuming the top 100 insurance company executive’s compensation is ten times that amount, you’re still looking at less than a billion dollars total. Hell, lets assume that the top 1,000 is 100 times that amount, you’re looking at $8,542,997,000 You’re talking about cutting – at most – 0.3% of total expenditures, even if you don’t include what the government employees that replace them will cost.

Whoopee-fucking-doo.

Halving total health care expenditures would increase that savings to a whopping 0.6%! Be still my beating heart! But by G*d those greedy fucking fat-cat executives won’t have three vacation homes!

You believe that everyone should have a right to health care. How noble of you! Another example of self-congratulations as a basis for social policy. You asked, What could be more Just than making sure that every child, worker and elderly person can see a doctor when they’re sick? You’re concerned about Justice? OK, here are some questions for you: How much health care is “Just”? Who decides, and on what basis? Is it “Just” that someone who can afford to pay gets more care than someone who would be dependent on government provided insurance alone? Or do we “level the playing field” and require everyone to accept the same level of care? Would that be “Just”? Or should everyone get every single bit of care that modern medical science can provide? What would that do to the costs you’re so concerned about?

Here’s the deal, from my perspective. The government does only two things well: nothing, and overreact. (Thank Congressman Adam Putnam for that pithy observation.) You want the federal government, which took in only $2.54 trillion last year, to expand by another $2.5 trillion, and you expect me to believe that it will do better than what we have now. You honestly expect me to believe that the federal government, currently responsible for the administration of Public Education, Social Security, Medicare and Medicaid, will run America’s health insurance system better?

Go ahead, pull my other leg. And read today’s Quote of the Day.

Don’t deny that what you are advocating is the doubling of the amount of money flowing through Washington D.C. You hold up Education, Policing, and Fire Protection as equivalent “rights” yet all those are all paid for through taxation. You claim that the U.S. is a “rich nation,” yet you ignore the fact that at our current level of national debt, every man, woman, and child in the country is on the hook for over $39,000 to pay off that debt – far more, in fact, since we’re doing it on time and paying interest.

Do you have a spare $39k laying around? I don’t know about you, but my VISA card limit is pretty far below that, and I don’t think I could float a loan for it, either. And if 47 million people can’t pay for health insurance, how many can pay their portion of the national debt?

You’ve interpreted the Preamble of the Constitution to require the federal government to do a lot of different things. You’re hardly alone. FDR put forth the idea of an Economic Bill of Rights that I’m sure you’d love, but have you read the rest of the original document? It’s quite short. As P.J. O’Rourke put it,

The U.S. Constitution is less than a quarter the length of the owner’s manual for a 1998 Toyota Camry, and yet it has managed to keep 300 million of the world’s most unruly, passionate and energetic people safe, prosperous and free.

That document spells out, with brevity and clarity, how the federal government is arranged, how it is to be staffed, and what the powers of each branch are and are not. As you’ve noted, the public’s perception of what are and aren’t “rights” has certainly changed over the years, and I put the blame – yes, blame – on our education system. The founding documents of our nation were based on the idea of limiting how much government could do, both for us and to us, yet we’ve been taught for decades that it’s the job of government to take care of us, that only government is big enough to do certain jobs, that we’re not qualified to do things for ourselves. In fact, we should be actively discouraged from doing so.

Alexis de Toqueville wrote long ago, “The American Republic will endure until the day Congress discovers that it can bribe the public with the public’s money.” Congress discovered that little trick some time back, and the bill is now coming due.

And that’s brought us to where we are today, $14-plus trillion in the hole and digging ever faster. Yet you and millions like you want us to redouble our digging in the name of “Social Justice!”

No, health care is not a right. Fire protection is not a right. Police protection is not a right. And pretty damned soon if we don’t get our shit in one sock and our heads on straight with the nose in front, just living is going to become damned difficult because Reality won’t be ignored forever.

And I guess I’m just not human for realizing and articulating that fact.

(Ah, well, only 3,500 words or so in this one. I may be losing my touch.)

UPDATE: Marko writes on the specifics of why health care is not a right. It is, typical of Marko, crystal clear and precise.

Abandonment or Ass-Covering?

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Abandonment or Ass-Covering?

Sailorcurt links to a fascinating op-ed at CBS that proclaims as its headline:

The Health Care Cost Saving Myth
Dan McLaughlin: There Will Be No Cost Savings. There’s No Sense In Pretending Otherwise.

Holy $hit! Honesty in the MSM! The piece continues with flawless logic:

One of the central selling points used by President Obama to push the Democrats’ health care plan is the notion that a comprehensive overhaul of the health care system will reduce costs. But costs to who, and how? Let’s step back a minute and try to figure out how Obama’s cost-cutting argument could possibly be so.

First, a quick reminder of two reasons why cost-cutting is such an important selling point.

Number one, the core of what the Democratic base, in particular, wants from health care “reform” is universal coverage. You often hear statistics thrown around about there being 30 or 35 or, last I heard, 47 million people without health insurance, and the implication that these people are receiving zero or negligible healthcare. Debunking those statistics and assumptions is itself a cottage industry, but let’s leave that aside for the moment, because the fact of the matter is that in a country of 300 million people, when you strip out the people who (1) already have health insurance and expect to continue having it, (2) don’t especially want to buy health insurance, (3) are only briefly without health insurance and not worried about it, or (4) don’t or can’t vote, what you end up with is a very small slice of the electorate that would benefit from getting health insurance they currently lack or fear lacking. Now, voters don’t only vote their own self-interests on any issue – but the fewer people who benefit directly from legislation, the harder it is to drum up public support for a bill that may threaten the self-interest of others. So, it becomes politically necessary, if the bill is to be as sweeping and ambitious as most of the versions circulated have been, to sell it to the public on the basis of some argument above and beyond insuring the uninsured. That’s doubly so because if your goal was solely to insure the uninsured, much of what is in the various bills would be unnecessary.

(My emphasis.)

So we’ve established that the purpose cannot be to “insure the uninsured.” Onward!

Second, specific to the issue of saving money for the federal government, the Obama Administration and the Democrats have already severely tried the electorate’s appetite for massive expansions of federal spending, especially deficit spending. The explosion of new spending, most notably the pork-laden “stimulus” bill, makes prior complaints about spending under Bush look like complaints about the deck chairs on the Titanic and flatly contradicts Obama’s read-my-lips pledge during two of last October’s debates that his proposals would result in a net reduction of federal spending. The voters have noticed that they’re not getting anything resembling what they were promised. Thus, Obama has repeatedly pledged, with the same assurance as his campaign pledge on spending, that the health care bill would be “deficit neutral.” The Congressional Budget Office, typically a liberal redoubt, has repeatedly thrown cold water on the claim that any of the proposals on the table would be deficit-neutral. Clearly, to get there, cost savings would need to be found somewhere to completely offset outlays.

How’s that gonna work?

Damned fine question! And remarkable admissions for an MSM outlet to publish! (I guess they figure no one really reads anymore.)

Let’s review the options. The Democrats’ main argument is that restructuring the entire health care sector will reduce the nation’s total (public and private) outlay for health care. When you boil it down, though, there are only three variables you can cut: reduce the amount of medical care provided; reduce what providers of medical care earn for their products and services; and reduce intermediary costs. All are problematic.

I. Less Medical Care

AKA: “Rationing.”

The most obvious way to cut spending on medical care is to buy less of it. That’s at the crux of the public’s worry about “death panels” cutting off care, about rationing; it’s why so many of the people showing up agitated at town halls are senior citizens worried about getting less medical care.

The “death panel” phrase was shorthand, of course, but it neatly captured the core of the problem: government already rations care, albeit not very efficienctly, in programs like Medicare and Medicaid (see, e.g., here – then again, the failure to do more rationing explains those programs’ exploding, budget-busting costs) and the end-of-life consulting procedures criticized by Palin and subsequently dropped by chastened Democrats are not the only way in which government incentives could or would be brought to bear on physicians to push patients from consuming health care to preparing for death or assisted suicide. More here, among many other places. But you don’t have to be looking at the end-stage to see that any plan premised upon cost-cutting by reducing the amount of care provided would, well, reduce the amount of care provided. And if the costs being cut are taxpayer costs, the power to do so would end up being vested in some sort of governmental entity, likely a panel of government-appointed “experts,” as Mickey Kaus notes was alluded to by President Obama himself back in April:

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

LEONHARDT: So how do you – how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance.

Mark Steyn had a fascinating example of such rationing in a National Review piece last week. In it he illustrated the difference between health “care” and medical treatment. And yesterday I pointed to a piece by Maj. Chuck Zeigenfuss illustrating that “death panels” are completely unnecessary, so long as you have the right forms handy.

One argument advanced by proponents of the various plans is that costs would be reduced by providing more care, because preventative care would prevent more expensive care from being needed. Even leaving aside the grim fact of human mortality (i.e., preventing heart disease at one age can just leave you to die slowly of cancer or suffer prolonged dementia later), Charles Krauthammer notes that studies in reputable medical journals have concluded that the need to offer preventative care to so many people to make sure you catch health problems early means that more widespread preventative care is more, not less expensive:

Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.

Another illustration of the adage that “For every problem there is a solution which is simple, obvious, and wrong.”

And usually government-mandated.

That’s a hypothetical case. What’s the real-life actuality? In Obamaworld, as explained by the president in his Tuesday town hall, if we pour money into primary care for diabetics instead of giving surgeons “$30,000, $40,000, $50,000″ for a later amputation – a whopper that misrepresents the surgeon’s fee by a factor of at least 30 – “that will save us money.” Back on Earth, a rigorous study in the journal Circulation found that for cardiovascular diseases and diabetes, “if all the recommended prevention activities were applied with 100 percent success,” the prevention would cost almost 10 times as much as the savings, increasing the country’s total medical bill by 162 percent. That’s because prevention applied to large populations is very expensive, as shown by another report Elmendorf cites, a definitive review in the New England Journal of Medicine of hundreds of studies that found that more than 80 percent of preventive measures added to medical costs.

Whatever else can be said for more preventative care, it is likely to offer no great cost savings.

Quite the opposite, in fact. (“Obamaworld”? “Back on Earth”? I like this guy!)

Why is it that this is so obvious to the people who actually look, but denied by those who so strongly urge rapid passage of “health care reform” legislation?

Don’t you wonder?

Moreover, reducing the total amount of care provided contradicts one of the central premises of the entire project, which is that it will result in providing more care to tens of millions of people not presently receiving it. As Bob Hahn notes, if this is the case, it won’t just drive up costs but will create shortages:

If we added 47 million more people to the health care system, there would be lines. We wouldn’t even know how to send 47 million more people to McDonald’s without causing lines.

Around the blogosphere, this kind of observation is usually noted with a resounding DUH!

I’m unfamiliar with the details, but apparently there is some provision in Obama’s plan that expands the number of doctors, nurses, hospital beds, etc., to instantly accommodate 47 million more people. It usually takes eight to ten years to school a new doctor, so whatever the Democrats are doing here is a major advance.

The Democrats can’t have it both ways. One way or another, they either need to sell the public on the idea of sharply curtailing the amount of medical care provided, or stop claiming cost savings that can only come from less care.

(*ahem*) DUH!

II. Medical Care For Less Cost

The issue of shortages brings us to the problem with the second option: rather than reducing the amount of care provided, reduce the amount paid to the people who provide it: doctors, nurses, and pharmaceutical and medical device companies. Certainly on the Left there is a fair amount of sentiment for making it less profitable to provide care. But there is really no getting around the basics of supply and demand: if we make it less profitable to become a doctor, we will end up with fewer doctors. If we skimp on salaries for nurses, home health aides, and less-skilled care providers (e.g., people who work in nursing homes), we will exacerbate the existing shortage of nurses and other providers, which is likely to become more acute in years to come as the population ages. And if labor responds to financial incentives, capital is even more sensitive: slash the profit margins of drug companies and medical device manufacturers, and inevitably there will be less investor capital for those companies and less coming out of the pipeline in terms of drugs and devices that save or improve lives. The net effect will be the same as rationing care directly: cost savings will come only by reducing the quantity and quality of medical care.

But that’s back here on Earth. In Obamaworld . . .

III. Cutting Out The Middleman

With open advocacy of government rationing of care largely politically infeasible and reducing the profitability of health care providers economically impractical, the debate logically falls upon the middlemen, mainly insurance companies. Pretty much everybody hates insurance companies, whose business model by nature involves collecting more money than they lay out. And there’s empirical data to support the idea that we’re spending proportionally more of our health care dollars on insurance, rather than care, than we used to spend. To shift the discussion away from rationing care, Democrats are desperately trying to paint the insurers as somehow siphoning off more money to enrich themselves than they “should,” an effort that’s now leading to an especially vindictive crackdown by panicked Congressional liberals:

House Democrats are probing the nation’s 52 largest insurance companies for lavish spending, demanding reams of compensation data and schedules of retreats and conferences.

Setting a deadline of Sept. 14, the letters demand extensive documents for an examination of “executive compensation and other business practices in the health insurance industry.”

The main idea here, other than simply intimidating the insurers, is to try to sell the Democrats’ plan on the theory that the insurers are artificially inflating their overhead. The fact that they have to subpoena 52 companies suggests that this will not be as easy a case to make as in the case of a monopoly industry…and of course, a monopoly is the preferred solution of Democratic policymakers, elected officials and even Democratic base voters who essentially see the long-term goal as using a “public option” to plant the seeds for replacing this patchwork of private companies with a single-payer system of government monopoly insurance.

Which I covered here. They deny, deny, deny when in front of the general public, but when surrounded by the like-minded, they have no problem declaring the actual end-game being pursued. (Damned YouTube.)

But let’s unpack here a little further the elements of the expense of a middleman. First of all, there’s the question of why have insurance at all. Most of us pay for other life essentials – food, clothing, shelter, transportation – directly, rather than buying, say, grocery insurance to make sure that an insurance company or government agency will give us groceries every week on terms acceptable to the insurer plus a premium. Now, unless you are seriously wealthy, insurance against truly catastrophic health care costs makes economic sense, so that the pool of the insured absorbs the individual occurrences of massive spikes in one person’s health care costs. But pretty much all the proposals on the table go far beyond purely catastrophic coverage.

This is a point I think that gets overlooked far too much. I don’t have an insurance policy that pays for oil changes or new tires on my truck. I don’t have an insurance policy that pays for replacing my worn-out clothes and shoes. But I have an insurance policy that pays for annual checkups at my doctor and my dentist. Why?

The entire rationale of the Democrats’ proposal is to get more people to buy insurance or have it bought for them than is currently the case, thus increasing the proportion of our health care that is paid for through intermediaries rather than directly. That’s true of people who currently buy no insurance and get little or no care, or pay for it out of pocket; it’s true as well of people who currently get their care from emergency rooms. That’s exactly the opposite direction of where you want to be moving if cutting intermediary costs is your goal.

Especially if the intermediary is a government bureaucracy.

And in the existing health care market, Democrats (with the help of big-government Republicans) have been driving up costs for the past two decades by piling on mandates and “patients’ bill of rights” legislation that ever increases the number of procedures that the insurers have to be involved in. The Medicare prescription drug plan likewise expanded the scope of health care products and services paid for through a public intermediary rather than directly by consumers. And of course, subsidizing preventative care that may be presently paid for out of pocket does the same. So, not only are the Democrats proposing to have more people use health care intermediaries (public or private), but their proposals will inevitably continue the trend towards having more types of health care paid for through intermediaries.

But of course! If this legislation passes the competition to “give away” more and more medical “entitlements” will be dizzying! It will be, as the population ages, the easiest way to buy votes!

Well, say Democrats, we will use more intermediaries, but we’ll be much more efficient in doing so, because the public plans won’t have a profit motive and expensive executives. Which is true. But it’s also true that government programs, even ones that start out fairly simple, tend only to grow and expand over time and grow less efficient as their competition is eliminated and the political power of those who draw salaries and contracts from them grows. Will unionized government workforces necessarily be less expensive than non-unionized private insurer workforces? History doesn’t suggest so.

History rather insists on the exact opposite. As Daniel Hannan explained, the British National Health Service is currently the third largest employer in the world, after the Chinese Red Army and the Indian National Railway system. China and India each have populations that top 1 billion. The UK has a population on the order of 60 million.

And 1.4 million of them work for the NHS, with over half being administrators (paper-pushers, bean-counters, etc.) rather than doctors, nurses, or other care-givers.

Extrapolate that out to a population of 300 million, and you get about seven million American Health Service workers.

And there’s no reason to believe that wouldn’t become the case here.

As one National Review reader posed the question:

If we can cut a half-trillion dollars from Medicare and Medicaid to pay for health insurance reform but if, as looks to be the case, healthcare reform won’t pass, why not just cut a half-trillion dollars from Medicare and Medicaid anyway?

The fact that it hasn’t happened and won’t happen should remind us that replacing a competitive private marketplace with a colossal, Washington-run bureaucracy is a bad bet to produce savings. The conservative answer in this situation is not to throw out the entire existing system on the hope that things will work out better than they ever have before.

Or: Let’s NOT “Do it again, only HARDER!“

The elephant in the waiting room is the other big cost driver of intermediaries besides the scope of coverage and the cost of having shareholders and executives: lawsuits. Precise figures are again a subject of intense dispute, but a goodly chunk of what drives the amount of `unnecessary’ care provided, the cost of providing services and the cost of intermediaries is the need to protect against and pay for the cost of medical malpractice and denial of coverage litigation. None of the Democratic proposals, however, seek to make any practical inroads against this source of costs. Replacing a private system with a public one could arguably do so if the trial bar is effectively precluded from bringing against the government many of the kinds of lawsuits now used against private insurers

You mean like in this case?

– but aren’t liberals in favor of keeping those kinds of suits viable? And how likely is it that in the long run they won’t provide other mechanisms to keep one of their vital constituencies in business?

“Vital constituencies” indeed. How many members of Congress are lawyers, again?

We have pretty much exhausted the options for cost-cutting: less care (at a steep political price, at the cost of giving frightening power to the government, and at odds with the goal of providing care where none is now given); less money to caregivers, which would amount to the same thing; less use of intermediaries (which is likewise contrary to the whole thrust of the project); or less cost in using intermediaries (which is impractical and unlikely to pan out).

There will be no cost savings. There’s no sense in pretending otherwise.

And since when has lawmaking had anything to do with making sense? It’s about buying VOTES. It’s about GETTING RE-ELECTED.

And it’s about EXPANDING GOVERNMENT POWER. Period.

My question at the moment is: does this piece represent a shift away from the Obamafellatio we’ve come to know and loathe from the MSM, or is it just an aberrant “covering our asses” piece that the powers-that-be can point to in the future as evidence of their “fair and balanced” coverage of the health-care debate?

I know where I’d place my bet.

Well, Now We Know Where the Terminators Will Come From

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And it ain’t Sunnyvale, California.

Remember the Cyberdyne Systems T-800?


It looks like it started out life as an exoskeleton designed to assist human beings:


Exoskeletons Are on the March

Cyberdyne is shipping nearly 100 more exoskeletons this fall

17 August 2009—An army of exoskeletons is coming. And according to their inventor, Professor Yoshiyuki Sankai of the University of Tsukuba, in Japan, they’re making a difference in the lives of disabled people.

Speaking at the International Conference on Intelligent Robotic Technology and Business, held earlier this month in Taipei, Taiwan, Sankai proudly described how the robotic exoskeleton suit HAL (short for Hybrid Assistive Limb), helped a 46-year-old man whose left leg was withered by polio when he was 11 months old.

HAL reads electric signals at the surface of the skin that are generated by the muscle beneath and then uses them to guide the movement of robotic limbs strapped to a person’s real limbs, thereby multiplying their strength.

The polio patient’s withered left leg generated extremely weak bioelectric signals at first, and the robotic limb remained unmoved. Ten days later, with HAL’s assistance, the patient moved his left leg based on his own intention. “He cried,” says Sankai.

Sankai suspects that in the past 45 years, the patient’s brain had rarely generated the signals needed to move his left leg. After the patient used HAL, the levels of signals strengthened and became detectable. Sankai says that similar phenomena were observed when applying the HAL suit to patients with spinal cord injuries. Starting in late April, his team began measuring bioelectric signals in polio and stroke patients before and after using HAL. They hope to record data over a period of 8 to 12 months. An analysis of how the brain adapts to HAL will be taken into account to improve the exoskeleton’s operation, says Sankai.

In Japan, more than 20 sets of various HAL exoskeletons are in use at hospitals and rehabilitation centers, Sankai says. The facilities lease the robots from Sankai’s company, Cyberdyne, for about US $1700 per month on average.

“It’s worthwhile, because a suit can be used for eight patients per day,” he says, adding that the service could possibly be cheaper once the market for the exoskeletons increases.

Sankai, who is Cyberdyne’s CEO, expects to supply 80 to 90 suits in Japan in October. At the end of September, 10 sets of HAL suits will be delivered to Denmark to be used by nurses who care for elderly people. The suits should enhance the nurses’ strength, helping them to move patients.

More versions of HAL are in the works, says Sankai. Following HAL’s use by a man injured in a car wreck to climb the 4164-meter Breithorn Mountain, in Switzerland, the company decided to develop a weather-resistant outdoor exoskeleton. Sankai says the company will also be introducing a HAL with significantly smaller and lighter batteries this fall at an event in Kyoto.

Screw Terminators. I want a Mecha:

“All of these things serve to make America less American.”

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Daniel Hannan, conservative member of the European Pariament for Britain gives a speech at the Army-Navy club in August of this year. Worth your time:

Part I:

[youtube https://www.youtube.com/watch?v=v8vJYfxR14Y&hl=en&fs=1&rel=0&w=640&h=505]
Part II:

[youtube https://www.youtube.com/watch?v=b3ftNEzSjQY&hl=en&fs=1&rel=0&w=640&h=505]
Part III:

[youtube https://www.youtube.com/watch?v=fTuEaoicXlQ&hl=en&fs=1&rel=0&w=640&h=505]

Thanks, DJ.

Multiply by the Zip Code

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Via Neo-Neocon comes this fascinating piece by an actual doctor on the wonders of .gov health care, Obamacare and Me. By all means, read the entire piece, but I want to archive here the crucial portion:

I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid. For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.

Each time I was told to fax Medicaid for the approval forms, which I did. Within 48 hours the form came back to me which was sent in immediately via fax, and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye.

Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list. Get the point — rationing of care.

Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time.

Again, extreme rationing. Solution: I have a foundation here in Atlanta supported 100% by private funds which supplies all of these contact lenses for my Medicaid and illegal immigrants children for free. Again, waiting for the government would be disastrous.

—

I am a pediatric ophthalmologist and trained for 10 years post-college to become a pediatric ophthalmologist (add two years of my service in the Navy and that comes to 12 years). A neurosurgeon spends 14 years post-college, and if he or she has to do the military that would be 16 years. I am not entitled to make what a neurosurgeon makes, but the new plan calls for all physicians to make the same amount of payment. I assure you that medical students will not go into neurosurgery and we will have a tremendous shortage of neurosurgeons. Already, the top neurosurgeon at my hospital who is in good health and only 52 years old has just quit because he can’t stand working with the government anymore.

You want to know what “Single-payer Universal Health Care” would be like for those with serious illness?

Take that, and multiply by the Zip Code.

“You Don’t Trust Me?”

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Claire McCaskill asked that question of her constituents at a Town Hall meeting, insisting that a “single-payer” bill wouldn’t pass. The response was swift. I’m going to pick on Markadelphia some more, because he is such a stereotype that he lends himself to it.

We’ve been discussing the ChOsen One’s enthusiasm for rushing “Health Care Reform” through the Congress with as little delay, transparency, and discussion as possible, and just why that might be. As many here have objected (me included), it’s a plan that will lead to “single-payer” / “Socialized medicine.”

Markadelphia denies this. For example:

I don’t know for certain what system we will have. So why are you so certain that it will be a single payer system and be as bad as GB?

And:

I didn’t answer the question because the solutions that are out there don’t have the government as a single payer. What they have is the government as one option and private insurance as another.

And from his own blog:

And speaking of the single payer system, the final bill floating around DC is the United States National Health Care Act. This bill is a single payer system, similar to Canada’s health care system, that was put forth by John Conyers. Of the three bills that seek to overhaul health care in the United States, this is the one that is being taken the least seriously. Although, you wouldn’t know it by listening to hyper paranoid voices on the right.

In fact, virtually all single payer advocacy groups have been screaming at the top of their lungs that they are being excluded from the process…other than a pity meeting with Max Bachus. The fact is that this bill is never going to pass because our country, despite what the flat earthers will have you believe, is center right. Private industry will never be shut out of the process. It’s too integral to our economy and our future as a nation. This is very true when it comes to health care. I do agree that competition spurs innovation and with a single payer system, we would not have that.

And that’s why out of all three bills, I favor HR3200 out of all three. Primarily, it offers the best of both worlds and addresses the issue of how to pay for all of this. Wyden’s bill relies too heavily on the private sector and Conyers bill will, in all likelihood, break the bank. We need to strike a balance and that’s what this bill does. And this balance allows for traps and pitfalls that are going to occur along the way where the other two really don’t.

Yes, Markadelphia trusts the government to come up with a “third way” that will provide a “public option” without eliminating private insurance.

Neo-Neocon found a video I’ve been waiting for. I’ve seen all of these clips spread around, but someone took the time to compile them into a coherent whole:

[youtube https://www.youtube.com/watch?v=zZ-6ebku3_E&hl=en&fs=1&rel=0&w=640&h=505]
Why are we “so certain that it will be a single payer system and be as bad as GB?” Because they’ve told us what they’re doing. It’s not a Trojan Horse, it’s just right there!

Why should we trust them? “It is not a principled fight!” Indeed, it is not. The fact that they are confident enough to admit it publicly, proudly, should frighten you.

It does me.