Free Markets, Free People

Health Care

Health Care: It Is Getting Hostile Out There

An interesting video here – you could entitle it “What The Hell Is The Rush?!”

It is Arlen Specter at a healthcare townhall meeting being given whatfor when he says that they have to rush on the health care bill. Also speaking is Secretary of Health and Human Services Kathleen Sebelius. It would be hard to characterize the crowd as “warm and welcoming”.

The one thing I think politicans will hear almost universally is the public demands they read and understand the bill they’re voting on – not their staffers. And until they do and can discuss it rationally and actually bring it to the floor and debate it – giving debate all the time it needs – they don’t want them voting on it.

Now, that’s not to say that some of those making this demand don’t want to see health care reform passed as a result. But I think even they understand that there is no crisis and their is no rush to pass such legislation quickly. That’s a self-imposed political desire – passing it quickly – because Democrats understand that not doing so risks getting nothing passed at all.

We’ll see if politicians heed this message or, when they head back into the atmosphere prevalent inside the beltway, again fall into line with party leadership and try to rush this turkey through.

If the video is any indication, doing so could end up being a very big electoral mistake.

~McQ

Six months and counting: Team Obama looks pretty pitiful at this point

I have not posted much lately. Busy. Very busy. I don’t see how McQ does it. He’s a machine.

But I have been paying attention, and I must say Obama is as amusing during his first six months as I had hoped, and maybe more. Here’s a brief summary of where he’s at as far as I’m concerned, categorized into various types of success and failures on the political front.

Continue reading

Dodd, Cancer and Health Care “Reform” – Be Careful What You Wish For

First let me wish Sen. Chris Dodd a full recovery from the prostate surgery he will undergo soon to remove the cancer he’s been found to have.

But with all things personal, politicians try to turn them into “teachable moments” that support what they’re trying to do. And Dodd is no exception.

“I wanted to let you know that I’ve been diagnosed with an early stage of prostate cancer,” Dodd wrote. “Luckily, a routine test allowed my doctor to catch it at a very early stage, and my prognosis is excellent – we expect a full and speedy recovery. I want to assure you that I am feeling fine.”

“After the Senate adjourns at the end of next week, I’ll have surgery to remove the cancer,” Dodd wrote. “After a week or two of recuperation, I expect to be right back to work. After all, as a member of Congress, I have great health insurance. I was able to get screened, seek the opinions of highly skilled doctors, consider all the available options, and choose the treatment that was right for me.”

He added, in a reference to his current work to pass healthcare legislation, “I know you’ll agree that every American deserves the same ability. We have healthcare legislation to pass – and an election to win. And I can’t thank you enough for your support.”

The implication, of course, is that without universal health care or universal health insurance, detection and survival rates must be lower than they could be.

But a quick check of systems with universal care and insurance doesn’t at all back up the implication:

Survival was significantly higher in the United States for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%), and this “probably represents differences in the timeliness of diagnosis,” they comment. That in turn stems from the more intensive screening for cancer carried out in the United States, where a reported 70% of women aged 50 to 70 years have undergone a mammogram in the past 2 years, one-third of people have had sigmoidoscopy or colonoscopy in the past 5 years, and more than 80% of men aged 65 years or more have had a prostate-specific antigen (PSA) test. In fact, it is this PSA testing that probably accounts for the very high survival from prostate cancer seen in the United States, the authors comment.

99.3% survival rate on prostate cancer in the US vs. 77.5% among the “universals”. How can that be, given Dodd’s indication that he’s just among the lucky ones? How in the world can the US, with such a badly broken system manage to save all but 0.7% of the prostate cancer patients, while the exemplar of universal care – Europe – loses 22.5% of theirs?

The PSA? It is a blood test. It is a test routinely run in the US when people have bloodwork done. And look at the testing for breast and colon cancer – isn’t that “preventive medicine”? So why aren’t the Europeans running all of these tests?

Good question. My guess would be cost. Here’s the result:

The age-adjusted 5-year survival rates for all cancers combined [Europe] was 47.3% for men and 55.8% for women, which is significantly lower than the estimates of 66.3% for men and 62.9% for women from the US Surveillance, Epidemiology, and End Results (SEER) program ( P < .001).

The point? Don’t buy into this “the system is broken” rhetoric in which politicians claim to have a better way of providing health care. My guess is a significant portion of Europeans diagnosed with various cancers would much rather be treated here than there.

~McQ

[HT: Carly B.]

Dialing It Down On Health Care

Charles Krauthammer nails it today in an editorial in the Washington Post (and not just because he and I agree that something called “health care reform” is going to pass):

Yes, Obama’s aura has diminished, in part because of overweening overexposure. But by year’s end he will emerge with something he can call health-care reform. The Democrats in Congress will pass it because they must. Otherwise, they’ll have slain their own savior in his first year in office.

That’s party politics (which we’ve come to learn from both parties, usually means putting the party first and the country second). They are not going to be responsible for killing the presidency of a Democrat. But they’re also not going to pass anything like what they started out to pass.

So what will it be?

But that bill will look nothing like the massive reform Obama originally intended. The beginning of the retreat was signaled by Obama’s curious reference — made five times — to “health-insurance reform” during his July 22 news conference.

Thus the beginning of the campaign to demonize the insurance companies as “the villains”. And it is going to be a long and loud campaign until the “something” is passed.

Result?

Reforming the health-care system is dead. Cause of death? Blunt trauma administered not by Republicans, not even by Blue Dog Democrats, but by the green eyeshades at the Congressional Budget Office.

Krauthammer have a slight disagreement on this. Not that the CBO is the primary entity that put a lance through the heart of “health-care system” reform – and that is what Obama referenced repeatedly and, when you talk about type of care and changing the behavior of doctors, is obviously more than “insurance reform”.

Our disagreement stems from my belief that health-care system reformation isn’t at all dead, it’s just delayed. One things the Democrats are adept at is incrementalism. They’ve worked diligently for decades to expand relatively modest programs into huge, wasteful bureaucratic monstrosities that hand out money – at least that which finally works its way through the bureaucracy – like a political party handing out “walking around money”.

This, unfortunately will be no different. And even more unfortunately something on which the Democrats can begin their incremental construction will be law by this fall.

~McQ

Demonization Time – Dems Target Insurance Companies

Why?  To take the heat off of them and to counter the Republican message about “government run health care”.

The message in the memo, though, won’t fit on a bumper sticker:

“Remove the insurance companies from between you and your doctor— capping what they can force you to pay in out of pocket expenses, co-pays and deductibles, and giving you the peace of mind you will be covered for the care you need, if get sick, or if you change or lose your job.”

Or, “replace the insurance companies with the government which is sure to do a much better job”.

Ye gods.

And the brains behind this message?

House Speaker Nancy Pelosi (D-Calif.) brought out the new message in an exchange with reporters in the Capitol, when she said, “They are the villains in this.”

Ah demonization – one of Pelosi’s favorite tactics. Apparently she didn’t learn much when she did it to the CIA.

~McQ

The Shape Of Things To Come

A short little blurb in the WSJ:

The medical costs of treating obesity-related diseases may have soared as high as $147 billion in 2008, the Centers for Disease Control and Prevention said Monday, as its new director set a fresh tone in favor of more aggressively attacking obesity.

Fresh my rear end. The only thing “fresh” about it is another bureaucrat discovering a “fresh” new area in which to intrude.  A little reading between the lines is required.

Note the name of the agency. Is it a stretch, given what we’ve seen lately, to imagine this agency recommending that obesity be classified as a “disease”?

Why else would the director of the CDC even address the issue?

Of course once it has been declared a disease, all sorts of “prevention” can be legislated – for your own good, of course. And to “cut medical costs”.

The cost of treating obesity doubled over a decade, signaling the rising prevalence of excess weight and the toll it is taking on the health-care system. The medical costs of obesity were estimated to be $74 billion in 1998, according to a study by federal government researchers and RTI International, a nonprofit research institute in Research Triangle Park, N.C.

Hmmm can taxes on food – sugary drinks, high calorie foods, etc – be far behind? Right now that may be a little more difficult and problematic because the government doesn’t have control of health care in this country. But, with that in the offiing, I think the new director of the CDC is just anticipating this “fresh” direction once said legislation is expelled from the bowels of Congress.

Just keeping you up to date.

~McQ

Maxine Waters – Political Rocket Scientist

I ran across this today and got a good chuckle:

Liberal frustration started to boil over in the House on Tuesday as negotiations over healthcare reform with centrist Blue Dog Democrats dragged into a second week.

The delay prompted Rep. Maxine Waters (D-Calif.) to lash out at the Blue Dogs as hypocritical and even hint that more liberal Democrats might challenge them in primaries.

Apparently Ms. Waters doesn’t quite understand why they’re called “Blue Dogs”:

Asked if she would recruit more liberal candidates to run against Blue Dogs, Waters said, “That’s normally not done.”

But she added: “There may be people out there listening and observing all of this who may get motivated based on what they’re seeing and throw their hat into the ring.”

Yeah, well, unless they too are “Blue Dogs” its unlikely they’ll be able to take a conservative district. And the present BDs know that if they’re a party to a liberal government program being stood up on their watch and with their support they’re not long for DC either.

But I’m sure Republicans would love to see a more liberal type take on a BD and help spend their war chest in the primary effort. It would only make the mid-terms a little brighter for the GOP in those districts.

~McQ

Health Care Blast From The Past – Hayek Has His Say

Here’s a post I did in January of 2007. It is very appropriate now that the health care reform business is well afoot.

So here’s ” Friedrich Hayek on Universal Health Care“, January 2, 2007:

As the 110th Congress prepares to convene and the run for the ’08 presidential nominations begins in earnest, we’re seeing far more appeals from the left, both from politicians, bloggers and opinion makers to address the supposed “health care problem”.

The appeals range from governmentally run universal health care to single-payer (again government) health insurance. The reasons given are also varied from the emotional “for the children” rhetoric favored by some to the technical “it would be more efficient and less costly” sobriquet.

Reading through Friedrich Hayek’s monumental “The Constitution of Liberty” again over the holidays, I revisited his discussion of the topic. And, willing to risk boring you out of you skull I thought I’d share it with you. Fair warning: Long post follows.

One of the most important thoughts he has on the subject gets to the crux of designing a system which would supposedly provide equal care to all. Health care cannot really be quantified and thereby presents peculiar problems which must be understood:

“They result from the fact that the problem of “need” cannot be treated as though it were the same for all who satisfy certain objective criteria, such as age: each case of need raises problems of urgency and importance which have to be balanced against the cost of meeting it, problems which must be decided either by the individual or for him by somebody else.”

And therein lies the great dilemma and the greatest threat to liberty. Because in a state run scheme it is the latter which will, indeed must, prevail.

He approaches the topic of health insurance and “free health care” by saying:

“But there are strong arguments against a single scheme of state insurance; and there seems to be an overwhelming case against free health service for all. From what we have seen of such schemes, it is probable that their inexpediency will become evident in the countries that have adopted them, although political circumstances make it unlikely that they can ever be abandoned, not that they have been adopted. One of the strongest arguments against them is, indeed, that their introduction is the kind of politically irrevocable measure that will have to be continued, whether it proves a mistake or not.”

That line is one of the most important points about this entire debate and one of the major reasons that many, especially among libertarians and fiscal and small government conservatives, resist the implementation of such a plan. Witness Medicare, Medicaid and Social Security. Once it is in place there is no turning back even if it is an outrageous mistake.

Fine, you say, but other than resisting it, to this point, because it may turn into an expensive and inefficient debacle, what can you offer to at least lend credence to an argument against such a system?

Fair question. And for that, I offer Hayek’s argument, an argument that is well reasoned, not emotional, and provides some unique insights.

He begins his critique by pointing out that the case for free health service is based on two fundamental misconceptions:

“They are, first, the belief that medical needs are usually of an objectively ascertainable character and as such that they can and ought to be fully met in every case without regard to economic considerations, and, second, that this is economically possible because an improved medical service normally results in a restoration of economic effectiveness or earning power and so pays for itself.”

But, as he argues, both miss the mark because they mistake the nature of the problem involved in decisions concerning “the preservation of health and life”:

“There is no objective standard for judging how much care and effort are required in a particular case; also, as medicine advances, it becomes more and more clear that there is no limit to the amount that might profitably be spent in order to do all that is objectively possible.”

Now make sure you’re clear on his point here. He’s not claiming it is profitable (or rational) to spend what is necessary to do all that is objectively possible. He’s arguing that if you agree that even marginal improvement, no matter how small, is “good” (“no objective standard”) then there is no limit as to how much you can spend for marginal improvement. Without an objective standard for making judgments as to how much care and effort are enough care and effort, the want is infinite.

He continues:

“Moreover, it is also not true that, in our individual valuation, all that might yet be done to secure health and life has absolute priority over other needs. As in all other decisions in which we have to deal not with certainties but with probabilities and chances. We constantly take risks and decide on the basis of economic considerations whether a particular precaution is worthwhile, i.e., by balancing the risk against other needs. Even the richest man will normally not do all that medical knowledge makes possible to preserve his health, perhaps because other concerns compete for his time and energy. Somebody must always decide whether an additional effort and additional outlay of resources are called for. The real issue is whether the individual concerned is to have a say and be able, by an additional sacrifice, to get more attention or whether this decision is to be made for him by somebody else. Though we all dislike the fact that we have to balance immaterial values like health and life against material advantages and wish that the choice were unnecessary, we all do have to make the choice because of facts we cannot alter.”

The fundamental issue he confronts here is the right of individual choice and the attack on that right which programs such as “free health care” pose. In essence individual choice is, at some point, overruled by collective choice. As Hayek implies in his discussion of “objective standards” and the real lack of them in judgments of how much care and effort are required in a particular case, those sorts of standards must be part and parcel to any “free health service”. Infinite need/want meets finite fiscal and physical resources in such a system, and consequently some method of defining the limits of “health care” within those fiscal and physical constraints must, of necessity, be made. Individual choice then is reduced to those standards and the freedom to pursue “additional sacrifice” in terms of spending more on your health is removed from your array of choices.

Even when such “objective determinably standards” are outlined, they prove not to be well considered or, as Hayek says, have any “relation to reality:”

“The conception that there is a an objectively determinable standard of medical services which can and ought to be provided for all, a conception which underlies the Beveridge scheme and the whole British National Health Service, has no relation to reality. In a field that is undergoing as rapid change as medicine is today, it can, at most, be the bad average standard of service that can be provided equally for all. But since in every progressive field what is objectively possible to provide for all depends on what has already been provided for some, the effect of making it too expensive foremost to get better than average service, must, before long, be that this average will be lower than it otherwise would be.”

Why the US continues to be the gold-standard for the most progressive and best medical care available instead of the British National Health Service is to be found in that paragraph. When their health is involved, people will rarely, if ever, chose the “bad average standard of service” over one which provides them the opportunity to access the best and most progressive. Health care, as provided by any universal scheme can, at best, only offer that “bad average standard of service”.

Hayek then addresses another part of the base misconceptions he identifies above:

“The problems raised by a free health service are made even more difficult by the fact that the progress of medicine tends to increase its efforts not mainly toward restoring working capacity but toward the alleviation of suffering and the prolongation of life; these, of course, cannot be justified on economic but only on humanitarian grounds. Yet, while the task of combating the serious diseases which befall and disable some in manhood is a relatively limited one, the task of slowing down the chronic process which must bring about the ultimate decay of us all is unlimited. The latter presents a problem which can, under no conceivable condition, be solved by an unlimited provision of medical facilities and which therefore must continue to present a painful choice between competing aims. Under a system of state medicine this choice will have to be imposed by authority upon individuals. It may seem harsh, but it is probably in the interest of all that under a free system those with full earning capacity should often be rapidly cured of temporary and not dangerous disablement at the expense of some neglect of the aged and mortally ill. Where systems of state medicine operate, we generally find that those who could be promptly restored to full activity have to wait for long periods because all the hospital facilities are taken up by the people who will never again contribute to the needs of the rest.”

Or who are presently too young to contribute.

What Hayek says, without saying it, is even in a system of “free health service”, there must and will be a system of rationing. Of course one of the main objections to our present system is we ration health care by price. But it doesn’t matter as the nature of health care, unlimited need meets limited means, requires it in every scenario imaginable short of a magic solution of some sort.

If we deal just in the economics of such a system, that which makes the most sense is to give priority of treatment to those who can recover quickly and contribute. That wouldn’t be the retired and children. Or stay at home moms. And those, usually, are the ones first identified as needing this sort of a system. But they are the very reason such systems fail to deliver on the promises made.

Hayek hints that such a system has an outside chance of working if it focuses on “restoring working capacity” and not much else. If and when it becomes focused on the “alleviation of suffering and the prolongation of life”, economic justification is impossible because the need/want for that is unlimited.

Such a system that gives priority to restoring those able to work productively would give further priority to treatment of the immediate problem and not necessarily the treatment of the chronic problem, if there is one – not if it wished to remain economically viable.

Thus far then, with such a system we’re reduced to a “bad average standard of service” which will, in some way, be rationed and in which individual choice will be abridged.

Last point, and privacy advocates should zero in on this:

“There are so many serious problems raised by the nationalization of medicine that we cannot mention even all of the more important ones. But there is one the gravity of which the public has scarcely yet perceived and which is likely to be of the greatest importance. This is the inevitable transformation of doctors, who have been members of a free profession primarily responsible to their patients, into paid servants of the state, officials who are necessarily subject instruction by authority and who must be released from the duty of secrecy so far as authority is concerned. The most dangerous aspect of the new development may well prove to be that, at a time when the increase in medical knowledge tends to confer more and more power over the minds of men to those who possess it, they should be made dependent on a unified organization under a single direction and be guided by the same reasons of state that generally govern policy. A system that gives the indispensable helper of the individual, who is at the same time an agent of the state, an insight into the other’s most intimate concerns and creates conditions in which he must reveal this knowledge to a superior and use it for the purposes determined by authority opens frightening prospects. The manner in which state medicine has been used in Russia as an instrument of industrial discipline gives us a foretaste of the uses to which such a system can be put.”

Now scoff if you wish, but that is the inherent risk any such system has because of its very nature. Such access to information is ripe for abuse, and, as Hayek notes, the fundamental change in the relationship of the doctor to the patient in this scheme makes such a risk of abuse more likely instead of less. The authority in this process is no longer the patient for whom the doctor used to work, but the entity which instructs the doctor on what he can or can’t do and pays him for the service. And the authority which makes such decisions must and will have access to all the information necessary to make them. What was once privileged information shared between doctor and patient would become shared information within the bureaucracy with possible potential abusive uses of which Hayek reminds us. Some may see those abuses as far fetched. I see their potential as a logical result of the system. One of the arguments we constantly make about corruption in the Congress is that the problem is systemic. It comes from the very nature of the institution its structure. This system is of similar construct and cannot help, at some time, becoming corrupt. Such corruption would most likely see the information within its databases used for purposes other than the treatment of patients.

An example? How hard do you suppose it would be to sort all the new mothers out of the population and offer them a choice of limited future service or complying with a government mandate that they see a doctor regularly? Some might argue that’s actually good. Ok, how about obese people? Alcoholics? Drug users?

Oh, wait, couldn’t the list of drug users be used for other purposes?

Yes. And so could a lot of other lists.

While all the lure of “free” health care sounds wonderful, especially to those who may not have access to health care at the moment, it is an emotional appeal which ignores the huge down-side such a program imposes on a society. No one argues that the system we have is perfect, and it certainly isn’t the least expensive, but, it appears it is the most responsive and provides access for most to the best and most innovative medicine available. There are some obvious things which could be done to improve it (remove health insurance from the realm of the employer, for one). But given the power of Hayek’s arguments, it should be a little more clear that putting our health care into the hands of the government is not one of them.

~McQ

The Health Care “I Told You So” Post

When your political opposition is self-destructing (even while in the majority and in control of the legislative and executive branches), most political observers would advise stepping back and allowing them to do so.

But not the Republicans. They’re going to be the “significant other” that gives this president a win on his signature issue and help him maintain both his momentum and the viability of the rest of his agenda.

The “I told you so” part of this is, as I (and many others) have said, Democrats will eventually pass something they can call “health care reform” and save the viability of Obama’s presidency. What you didn’t figure is the Republicans would be both complicit and key to that:

Sen. Olympia Snowe (R-Maine) confirmed that the three Republicans and three Democrats negotiating the Senate Finance bill are moving away from a broad-based mandate that would force employers to offer insurance. The senators instead are leaning toward a “free rider” provision that requires employers to pay for employees who receive coverage through Medicaid or who receive new government subsidies to purchase insurance through an exchange.

Snowe stressed the committee hasn’t reached a final agreement on any of the key provisions but said, “There is not a broad-based employer mandate. … There are approximately 170 million Americans that receive coverage through employers. That is a significant percentage of the population. We don’t want to undermine that or create a perverse incentive where employers drop the coverage because their employees could potentially get subsidies through the exchange.”

On the nonprofit insurance cooperative, Snowe also said no final decisions have been reached, but “it is safe to say it is probably one that will remain in the final document.”

This is what everyone who talks about it means when they say that Republicans “talk the talk but don’t walk the walk”. Here is a group, and I’d bet there are more that will sign on, who are involved in one of the biggest expansions of government undertaken since the “New Deal”. And when November of next year rolls around, this is the party that is going to want you to believe they are all for less government, less spending and less government intrusion.

And they’ll have this to point to as proof. [/sarc]

The reason the GOP is a shrinking party isn’t because it is the party of the Southern white male. It’s because no believes their nonsense any longer.  Sometimes being the party of “no” is the right thing to do.

[Welcome RCP readers]

~McQ