Saturday, June 30, 2007

More LTE's in Colorado Papers

The June 22, 2007 Boulder Daily Camera published the following LTE by Richard Watts:
Health care is not a right

In her letter titled "Heartless view of medical care," Deborah Hayes claims that "everyone has a right" to health care and food (Open Forum, June 15). Hayes' claim implies a "right" to force others to pay for one's food or health care — but there is no such right. The rights to life, liberty and the pursuit of happiness are not rights to force someone else to do something or to take money from another.

I have a right to satisfy my own need for food by buying a meal with money I've earned. But I have no right to feed myself by snatching your food or money, nor any right for government to force you to buy me a meal. In the same way, my right to my life implies that I have the right to take care of my health by my own effort. It does not imply a right to force you to pay for my health care (or clothing or anything else).

Furthermore, declaring a "right to health care" does not result in good quality medical care for everyone. It means only a "right" to wait in line for substandard treatment rationed by bureaucrats, as people do in Canada and Tennessee.

For more on why government enforced "universal health care" (socialized medicine) is both immoral and impractical, visit

Richard Watts, Hayden
The June 28, 2007 Rocky Mountain News printed the following LTE by Gina Liggett:
Health care is not a 'right'; it's a need

Many Americans claim we need government intervention to reform the unaffordable and inaccessible health care system because "health care is a right."

The system certainly is a mess, but health care is not a "right" -- it is a need, like food and shelter. A "right" is not simply possessing what we need for survival regardless of who provides it; it means the freedom to obtain what we need without force. For example, I should be free to buy soup from whoever offers the best quality for the price. But it would be a violation of my neighbor's rights to get a law passed making him pay for my soup.

In the same way, a person should be free to purchase health care based on his or her health concerns, but it is not that person's right to give the bill to taxpayers.

The 208 Commission on Health Care Reform will present a final plan to the Colorado legislature later this year. So far, the four runner-up proposals recommend greatly increased government control of health care access and funding. This means that Coloradans may get some kind of health care, they just won't have the right to obtain it as they individually see fit. Only a free market can provide that right.

Gina M. Liggett, Denver
The June 17, 2007 Pueblo Chieftain also printed this LTE by Gina Liggett:
Health panel stacked deck

The four initial proposals selected by the Commission on Health Care Reform recommend greatly increased governmental control of health care in Colorado.

Few people would argue against the commission's sound "guiding principles" for improving the health status of Coloradoans (i.e., the plan must provide high quality care, be financially viable and emphasize prevention.)

But the biggest surprise is that the commission's 11 evaluation criteria require that the proposals offer only government-oriented methods for reforming health care. Free-market proposals didn't have a chance.

For example, the only way a proposal received a high score on the criterion of "access" was to "increase Medicaid provider participation and serve geographically underserved areas."

On the criterion of "coverage," a high-scoring proposal must "require purchase of coverage and subsidize coverage and ensure availability of coverage" or "provide direct coverage to all . . . through a single-payer system."

These mandates built into the evaluation criteria and, thereby, into the selected proposals dictate the who, what, when, where and how. This disqualified any free-market-oriented solutions.

I only wonder why the commission bothered to solicit various proposals in the first place? They already had designed their first choice, and it's called "socialized medicine for Colorado."

Gina M. Liggett, RN
The June 27, 2007 Denver Post printed the following LTE by Martin Buchanan:
Health care for all: whose responsibility is it?

Re: "Health care and social responsibility," June 20 letter to the editor.

Letter-writer Will Pirkey suggests that we all have a "social responsibility" and a "moral and social obligation" to provide medical care for "every American." I have no such moral obligation. The 300-pound man eating two double cheeseburgers at McDonald's will have to pay for his own health care without my forced contribution. The alcoholics lining up at the liquor store on Santa Fe every morning will have to deal with their liver cancer without my money.

Mr. Pirkey suggests I have an obligation to help a "single mother working two part-time jobs at minimum wage" pay for her kids' health care. Instead, that young woman should think twice before having children she cannot afford to support, without a father to help support them.

Welfare-state politicians' approach has been to use government to interfere with the health care system and make health care much more expensive than it would be in a free market. Any sort of universal entitlement to health care will lead to either much higher taxes, government bankruptcy, or health care that is severely rationed and controlled by government.

Martin L. Buchanan, Denver

Friday, June 29, 2007

Hypocrisy About Private Medicine in Canada

How do you become the most vilified physician in Canada? Become an advocate for private medical care, like Dr. Brian Day, the incoming president of the Canadian Medical Association. Because of his views, he is known by his opponents as "Dr. Profit" and the "Darth Vader of health care".

In a recent speech, he also pointed out the hypocrisy of a number of high-ranking Canadian politicians such as New Democrat Leader Jack Layton who have availed themselves of private medical care, even as they "have railed against the evils of private medical clinics".
Former prime ministers Paul Martin, Jean Chrétien and Joe Clark have also been treated at private medical clinics, Day told the annual meeting of the Canadian Science Writers' Association.

And he says union leader Buzz Hargrove, president of the Canadian Autoworkers, proved a master at "queue jumping" when he got in for an MRI within 24 hours of injuring his leg.
(Via Dr. David Solsberg.)

Thursday, June 28, 2007

Health Care Debate in Fort Collins

The Northern Colorado Business Report summarized a recent debate in Fort Collins on between an advocate of single-payer socialized medicine (Cory Carroll, M.D.) and an opponent of socialized medicine (State Senator Shawn Mitchell). Here are some excerpts of Sen. Mitchell's views:
Mitchell said other industrialized countries that have adopted national health care or single-payer systems don't offer the same level of health care as the American system offers, and that's what most Americans want.

"Access to a waiting list is not access to health care," he said. "If you have a serious health-care problem, you're twice as likely to die in a socialized system."

...Mitchell said national health-care systems tend to restrict access to care, which helps keep their per-capita costs down. "Who's going to make the decision that you're getting too much treatment and it has to stop?" he said.

Wednesday, June 27, 2007

What's Right With Colorado Health Care

Ari Armstrong points out that there that health care climate in Colorado is better than commonly reported in the mainstream media. And he cautions us against a rush to impose massive government "reforms" that merely make the problem worse. Here are some excerpts:
"What's right with Colorado health care"

True, there are some real problems with medicine and health insurance in America; problems that can be solved through greater liberty. Yet, despite the problems, nearly everyone has ready access to the best medicine in the world.

...Seventy-seven percent of Coloradans polled said they receive good or excellent quality of health care, according to polling data from Hill Research Consultants reviewed at a March 28 meeting of Colorado's Blue Ribbon Commission for Healthcare Reform (also known as the "208 Commission" after its authorizing legislation. A representative of the Denver Metro Chamber of Commerce presented the information).

Coloradans are even more enthusiastic about the health care they receive than are people elsewhere in the nation, according to a comparison to Gallup statistics, by a margin of 77 percent to 65 percent.

However, while most people are happy with their own health care, they're concerned about medical care "as a whole." The polling data reveal that 60 percent of Coloradans think the quality of health care in Colorado "as a whole" is good or excellent. Only 33 percent think that health care "coverage" in the "state as a whole" is good or excellent. Part of the drop probably has something to do with all the political preachers of health care doom and gloom.

...No, it's not time to page Dr. Pangloss -- we do not live in the best of all possible worlds. But serious reforms do not begin with the opposite presumption that American medicine is in ruins and must be subjected to wholesale, government-controlled reform. Medicine is in reasonable health and can be improved by greater doses of the American values of individual rights, liberty, and freedom of choice.

Tuesday, June 26, 2007

More Reviews of "SiCKO"

David Hogberg has reviewed "SiCKO", including what he likes, as well as what's contradictory, deceptive or downright shameful.

Forbes also reviews "SiCKO", and dicusses numerous factual and philosophical problems:
The Cuba example is the most naïve. It doesn't seem to cross Moore's mind that when you confiscate a nation's private property, that yes, you can provide free dental care for public relations purposes.

...Moore is right that our system is messed up. But that may be due to it being a contorted free market system, with limited competition and little consumerism.

All that is too subtle for Moore, who seems convinced from the start that the only solution is a government takeover. That’s a scary thought. Do you want your doctors to treat you like you get treated at the Department of Motor Vehicles or in airport security lines? Or maybe we should let bad nurses work forever, like a unionized public school teacher. We now enjoy the latest medical device or drug, but will there be much more R&D in the future if a blockbuster pill can't command a blockbuster price?

Monday, June 25, 2007

NY Times on "SiCKO" and Cuba

Michael Moore's new film "SiCKO" uses Cuba as a foil against which to compare American health care. But how good are things in Cuba? According to this May 27, 2007 New York Times article, the Moore movie only tells part of the story:
Having practiced medicine in both Cuba and the United States, Dr. Cordova has an unusual perspective for comparison.

"Actually there are three systems," Dr. Cordova said, because Cuba has two: one is for party officials and foreigners like those Mr. Moore brought to Havana. "It is as good as this one here, with all the resources, the best doctors, the best medicines, and nobody pays a cent," he said.

But for the 11 million ordinary Cubans, hospitals are often ill equipped and patients "have to bring their own food, soap, sheets -- they have to bring everything." And up to 20,000 Cuban doctors may be working in Venezuela, creating a shortage in Cuba.

...Until he had to have emergency surgery last year, Fidel Castro -- who turned 80 this year -- was considered a model of vibrant long life in Cuba. But it was only last week that he acknowledged in an open letter that his initial surgery by Cuban doctors had been botched. He did not confirm, however, that a specialist had been flown in from Spain last December to help set things right.

Friday, June 22, 2007

Richard Watts' LTE: "Health care is not a right"

Richard Watts' recent LTE was just printed in the June 21, 2007 Grand Junction Free Press:
Health care is not a right

In his column titled "Universal health care's time has come," E. Michael Ervin tries to interpret the inalienable rights to life, liberty and the pursuit of happiness to mean that there is an inalienable right to health care -- i.e. a "right" to force others to provide health care to support one's life. But one's right to life is an individual right to one's own life — not a right to any part of someone else's life.

Health care is not a right, but a need, like food. I have no right to forcibly take your food to support my life, nor for government to force you to buy me a meal. Those actions would violate your moral rights to your own life, your liberty, your property and pursuit of your own happiness. I have the right to support my life by my own effort. But I have no "right" to force you to support my life by taking the products of your efforts.

Ervin confuses needs with rights, but they are not the same. There is no such thing as a right to violate another's rights. Government-enforced "universal health care" (socialized medicine) is immoral. For more on why health care is not a right, visit

Richard Watts

J.R. Heathcote LTE to Grand Junction Free Press

J.R. Heathcote of Grand Junction has replied to two recent columns favoring socialized medicine by Dr. Michael Pramenko and E. Michael Ervin in this LTE in the June 18, 2007 Grand Junction Free Press:
Giving more money to feds isn't the answer

So Dr. Pramenko and E. Michael Ervin want to reform health care in this country. While I've read many a tome on the subject by these two gentlemen they have yet to address some nagging questions. Specifically, how much is this "reform" going to cost the taxpayers and who will run such a program? In Mr. Ervin's case I would think he would gladly allow his beloved and omnipotent federal government to manage such "reform" and would willingly allow that same federal government to raise his taxes accordingly. Which begs the question, how much are you willing to have your taxes raised? Ten percent, 25 percent or even 50 percent to have "reformed" health care?

As for the federal government managing such a system, one needs to look no further than Medicare and the record of mismanagement, waste, and outright fraud that has been allowed to be perpetrated over the years with very little in the way of accountability to the very same taxpayers who would fund the same health care "reform" that Pramenko and Ervin advocate. Yet these guys want us to send even more money to Washington D.C. in the fervent hopes the feds get it right this time!? Really?


J.R. Heathcote
Grand Junction

Thursday, June 21, 2007

Why Are Health Care Costs Rising?

Devon Herrick PhD, of the National Center for Policy Analysis, covers this important question in his recent testimony to the House Education & Labor Subcommittee on Health, Employment, Labor and Pensions.

He makes the point that the rapid and unsustainable rise in costs is taking place in the government-run sectors of medicine, such as Medicare. In contrast, in the sectors of medicine that are closest to a true free market, such as cosmetic surgery and LASIK surgery, prices are going down at the same time that the procedures are becoming better and more technologically sophisticated -- which is the normal trend in every other sector of the market.

Here's an excerpt from his testimony:
Fostering Competition. When providers compete for business, the market fosters competition. In competitive markets, producers seek to reduce costs and to offer products that meet customer demands. However, instead of a competitive national market for health insurance, we operate under a patchwork of 50 different sets of state regulations. Since each state insurance market is protected from interstate competition, legislators often require insurers to cover services that drive up premiums. For example, about one-fourth of states mandate benefit packages that cover acupuncture and marriage counseling. More than half require coverage for social workers and 60 percent for contraceptives. Seven states require coverage for hairpieces and nine, hearing aids. Needless to say, these mandates drive up the cost of providing health insurance, often making it prohibitively expensive for an insurer licensed in one state to do business in another state. As a result, consumers have little choice among plans. In many localities, only one insurance product is available, so the consumer is forced to buy an overpriced product, or forgo insurance altogether.

Fostering Innovation. When patients directly control their health care dollars, not only do prices go down, medical providers begin to offer innovative services to meet the demand of empowered patients. Telephone consultations, walk-in retail clinics, electronic medical records, and personalized care are among the innovative services provided by doctors. These new physician services tend to have two characteristics: (a) they offer patients greater convenience and (b) they step outside normal reimbursement channels. Furthermore, many of these innovations (such as electronic medical records) dramatically improve the delivery of quality health care.
Read the whole thing.

Wednesday, June 20, 2007

Brian Schwartz in the Media

The June 19, 2007 Denver Post has published the following LTE from Brian Schwartz (halfway down the page):
"Universal" health care

Re: "Patient, take care of thyself," June 14 Pius Kamau column.

Surgeon Pius Kamau admirably explains that "each man and woman should be responsible for their own health." Yet, the "universal health care" he advocates as "ideal" erodes this responsibility.

"Universal" health care is a deceptive euphemism for government- controlled medicine. By forcing providers and patients to abide by its prices and rules, government treats doctors like vending machines and adult patients like dependent children. The only thing "universal" about government-run health care is poor quality, low access, and long waiting times. By restricting choice and freedom, authority-driven health care makes government the parent responsible for the health of infantilized adults.

Contrast this with consumer-directed health care, which combines a low-premium, high-deductible insurance policy with a tax-deductible Health Savings Account. Patients self-insure with money invested in HSAs until reaching the deductible, after which the policy's coverage applies.

Free-market medicine and voluntary charities promote personal responsibility and accessible quality care.

Brian T. Schwartz, Boulder
Brian's June 17 interview on the John Andrews radio show is available for download in MP3 format here.

Tuesday, June 19, 2007

Gina Liggett LTE's Around the State

Gina Liggett's recent LTE has appeared in the June 13, 2007 Grand Junction Daily Sentinel as well as the June 14 Carbondale Valley Sentinel:
Need vs. right

Many Americans claim we need government intervention to reform the unaffordable and inaccessible health care system because "health care is a right." The system certainly is a mess, but health care is not a "right" -- it is a "need," like food and shelter.

A "right" is not simply possessing what we need for survival, regardless of who provides it; it means the free­dom to obtain what we need without force.

For example, I should be free to buy soup from whomever offers the best quality for the price; but it would be a violation of my neighbor’s rights to get a law passed making him pay for my soup.

In the same way, a person should be free to purchase health care based on his or her health concerns, but it is not that person’s right to give the bill to taxpayers.

The 208 Commission on Health Care Reform will present a final plan to the Colorado Legislature later this year. So far, the four runner- up pro­posals recommend greatly increased government control of health care ac­cess and funding. This means that Coloradans may get some kind of health care, they just won’t have the right to obtain it as they individually see fit.

Only a free market can provide that right.

Sincerely, Gina M. Liggett, RN, MPH Denver

"Business Week" Debate on Health Care

Business Week has featured two opposing columns on "universal health care", with the "Pro" side given by Katherine Swartz of the Harvard School of Public Health and the "Con" side given by Onkar Ghate of the Ayn Rand Institute.

Here's Onkar Ghate's column:
No Right to "Free" Health Care

The cause of the U.S. health-care mess is governmental interference. The solution, therefore, is not more governmental control, whether via nationalized medical insurance or a government takeover of medicine.

Health insurance costs so much today because the government, on the premise that there exists a "right" to health care at someone else's expense, has promised Americans a free lunch. When a person can consume medical services without needing to consider how to pay for them -- Medicare, Medicaid, or the individual's employer will foot the bill -- demand skyrockets. The $2,000 elective liver test he or she would have forgone in favor of a better place to live suddenly becomes a necessity when its cost seems to add up to $0.

As the expense of providing "free" health care erupts accordingly, the government tries to control costs by clamping down on the providers of health care. A massive net of regulations descends on doctors, nurses, insurers, and drug companies. As more of their endeavors are rendered unprofitable, drug companies produce fewer drugs, and insurers limit their policies or exit the industry.

Doctors and nurses, now buried in paperwork and faced with the endless, unjust task of appeasing government regulators, find their love for their work dissipating. They cut their hours or leave the profession. Many young people decide never to enter those fields in the first place.

What happens when demand skyrockets and supply is restricted? The price of medicine explodes. What was once to serve as a free lunch for everyone becomes lunch for no one.

The solution? Remove all controls. Recognize each citizen's right and responsibility to pay for his or her own health care, and return to insurers the entrepreneurial freedom to come up with innovative products.

True freedom would bring health care into the reach of the average U.S. citizen again -- just as it has done for other goods and services, such as computers, cell phones, and food.

Monday, June 18, 2007

Hawaii: Trouble In Paradise

The Commonwealth Fund praises Hawaii as a model of how a state can implement "universal health care". However, they are committing the common fallacy of confusing "health insurance" with "health care", according to this story from the 6/17/2007 Honolulu Star Bulletin:
"Doctor Shortage Belies Top Ranking"

Many islanders can't find a doctor, especially on the neighbor islands and in rural Oahu areas, despite the state's top ranking nationally for access to health care, says the Hawaii Medical Association, a local physicians association.

A Commonwealth Fund survey said Hawaii has the best access to health care in the country, primarily because of a high number of residents with health insurance. But the study didn't consider availability of doctors, Hawaii Medical Association members say.

"If we don't have doctors available to see them, what good does insurance do you?" said HMA President Linda Rasmussen, a Kailua orthopedic surgeon. High malpractice premiums and low insurance reimbursements have created a "state of crisis" in Hawaii with physician shortages limiting access to health care, she said.

..."If I have a patient who needs a total joint (replacement) and has an abnormal EKG (electrocardiogram) and needs to see a cardiologist, it's almost three months to get an appointment before he gets cleared," she said.

"If a person calls when they're 50 for a colonoscopy, they're almost 51 before they get in."

..."People are frustrated," said HMA Executive Director Paula Arcena. "They have insurance coverage but they can't find doctors." The neighbor islands and rural Oahu are affected the worst, especially in specialty and trauma care, she said.
David Hogberg of the National Center for Public Policy Research makes a similar point in his recent article, "'Health care,' more or less".

(Via KevinMD.)

Friday, June 15, 2007

Devon Herrick to Speak at 208 Commission on 6/19/2007

Update: Devon Herrick is scheduled to speak and answer questions from 12:15-1:30 p.m. on 6/19/2007 (not 1:00 pm to 2:15 pm as originally posted).


Devon Herrick PhD, a health care economist at the National Center for Policy Analysis, will be speaking to the 208 Commission on Tuesday June 19, 2007. He is a prominent advocate of market-based health care systems, and some of his recent articles include:

"New Hillary care plan contains same old ailments"

"Why Are Health Costs Rising?"

"Canadians Wait Longer for Medical Care"

"The Uninsured: Few Americans Truly Lack Access to Health Coverage"

"Is There a Crisis of the Uninsured?"

"Eliminate Costly Insurance Regulations"

I do hope that the Commission gives his ideas the consideration they deserve.

The meeting will be at:

Englewood City Center
1000 Englewood Parkway
2nd Floor, Community Room
Englewood, CO 80110

(Update: Dr. Herrick is currently scheduled to speak from 12:15-1:30 p.m., not 1:00 pm to 2:15 as originally posted.)

Thursday, June 14, 2007

The Difference Between "Health Care" and "Health Insurance"

David Hogberg of the National Center for Public Policy Research explains that we should not confuse the two. In a recent article in the Washington Times, he writes:
Health care is the products and services used for the prevention, treatment and management of illness. Health insurance, on the other hand, is a way of paying for health care. Specifically, it is an agreement whereby the insurer pays for the health care costs of the insured.

Believing health care and health insurance are the same thing easily leads to some mistaken, if not dangerous, notions. It leads to the beliefs that (1) universal health care and universal health insurance are the same; and (2) that if a nation has universal health insurance, where the government pays for every citizen's health care, that nation will have universal health care, where citizens will have ready access to health care whenever they need it. As the experience of other nations shows, however, universal health insurance often leads to very restricted access to health care.
He shows how attempts in Canada, Sweden, and the UK to provide "universal coverage" merely led to rationing and waiting lists, to the detriment of patients. He concludes:
It is important to note, however, that all these people had health insurance -- that is, their governments would pay for their health care. What they did not have was ready access to treatment. As the Canadian Supreme Court said upon ruling a ban on private health care as unconstitutional, "access to a waiting list is not access to health care."

As the debate over the future of the U.S. health-care system proceeds, it is important that we -- and especially lawmakers who will craft health policy -- understand the very real difference between health care and health insurance. It is vital we realize universal health insurance is not the same as universal health care. Universal health insurance provided by the government leads to rationing of health care that has adverse impacts on health, including death. Thus, we should be highly skeptical of politicians promising to improve our health care system with universal health insurance.
The whole essay is worth reading.

Wednesday, June 13, 2007

Problems with Individual Mandates in Massachusetts

Two of the four plans under consideration by the 208 Commission include individual insurance mandates - i.e., individuals are forced to purchase health insurance, with the terms of the insurance set by the government. As this June 11, 2007 article from the New York Times observes, Massachusetts is having a hard time enforcing such mandates in their attempt at "universal coverage". Here are a few excerpts:
"Mandatory Coverage Is Easier Said Than Done"

...Requiring people who can afford health insurance to buy it -- the same way that car owners must buy auto insurance -- appeals to those who believe that mandatory coverage is fairer than asking everyone else, directly or indirectly, to pick up the health care costs of those who choose not to buy it.

...But the state [Massachusetts] is discovering that making health insurance mandatory is easier said than done. It has spent the past year dealing with questions about how much basic coverage people need, and how much they can be expected to pay.

A mandate is critical, however, to helping the state achieve near-universal coverage,...

...Nevertheless, forcing people to buy coverage can be difficult, especially when some people do not think they need it.
Many residents dislike the mandates because the state is simultaneously forcing insurers to provide a generous benefits package, which may be more extravagant (and therefore more expensive) than they would otherwise voluntarily purchase with their own money:
"If you make everyone buy a Cadillac, you're going to have more people who can't afford it," said Devon M. Herrick, a senior fellow at the National Center for Policy Analysis, a nonprofit research group in Dallas that favors market-oriented solutions.
Mandates are wrong because they entail government forcing people to spend their own money in the way that the bureaucrats prefer, rather than allowing individuals to use their rational judgment to decide what's in their own best interest. It's no surprise that individuals chafe under mandates.

In contrast, a system of Health Savings Accounts (HSA's) coupled with high-deductible, low-cost catastrophic insurance (such as featured in this recent Business Week article) takes the exact opposite approach. Such systems allow citizens to decide for themselves how best to spend their health care dollars. They respect individual rights and encourage individual responsibility, because they allow people to exercise their independent judgment to decide what's best for themselves. As one would expect, such free-market based systems result in higher quality patient care for lower prices.

Tuesday, June 12, 2007

Armstrongs' Column on Socialized Medicine

On June 11, 2007, the Grand Junction Free Press published the following article by columnists Linn and Ari Armstrong:

Health socializers ignore benefits of liberty, harms of controls

Advocates of socialized, government-controlled medicine argue U.S. medicine is too expensive and unresponsive to patients and more-socialized medicine in other countries is better.

However, U.S. medicine is too expensive and unresponsive precisely because it is already mostly controlled by politicians and bureaucrats. Nevertheless, the U.S. system is better to the degree it remains free. There's a reason Canadians come to the United States for medical care, and not the other way around.

The socializers ignore the evidence and arguments in favor of restoring liberty in medicine. They seize upon any superficial, out-of-context "advantage" of more-socialized systems even as they ignore or downplay the systemic, life-threatening problems of government-controlled medicine.

A case in point is a May 15 study from the Commonwealth Fund. While the organization publishes some useful raw data, it favors socialized medicine and filters its findings accordingly.

The Commonwealth Fund's "overview" of its study stated, "Compared with five other nations -- Australia, Canada, Germany, New Zealand, the United Kingdom -- the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: Quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage."

Various Commonwealth Fund data contradict the group's political stance. In an October, 2000, paper, the Commonwealth Fund reveals that, compared with the other countries mentioned, the U.S. has the lowest mortality rate per incidence for prostate cancer, breast cancer, and AIDS. The United States has the best five-year survival rate for breast cancer. But the 2007 study omits such hard data.

In a 2005 article for the Cato Institute, John Goodman cites other evidence as well, writing, "Delays in Britain for colon cancer treatment are so long that 20 percent of the cases considered curable at time of diagnosis are incurable by the time of treatment. During one 12-month period in Ontario, Canada, 71 patients died waiting for coronary bypass surgery while 121 patients were removed from the list because they had become too sick to undergo surgery with a reasonable chance of survival."

The 2007 Commonwealth Fund study does admit: "In other countries, like the U.K and Canada, patients have little to no (direct) financial burden, but experience long wait times for ... specialized services." So, while patients don't pay directly for services with their money (but instead indirectly through taxes), they pay with their time and, in some cases, with their lives.

Commonwealth Fund President Karen Davis, listed as the lead author of the study, told Reuters, "We focus primarily on measures that are sensitive to medical care making a difference — infant mortality and healthy lives at age 60." However, that is a completely inappropriate basis for comparison.

Last year, David Hogberg wrote an article for The National Center for Public Policy Research titled, "Don't Fall Prey to Propaganda: Life Expectancy and Infant Mortality are Unreliable Measures for Comparing the U.S. Health Care System to Others."

Lifestyle choices such as diet have a much greater influence on longevity and old-age health. In a second study also released in May, titled "Multinational Comparisons of Health Systems Data, 2006," the Commonwealth Fund showed the United States tops the list for obesity, which is linked to various diseases. While 30.6 percent of people in the United States are obese, according to the study, only 23 percent of people in the United Kingdom are obese, and the percent drops to 12.9 percent for Germany.

The same study shows that, while the United States suffers the most "years of life lost" from (lifestyle-related) circulatory diseases and diabetes, the U.K. leads in deaths from heart attacks. Why? According to a 2006 Commonwealth Fund study, the United States has nearly 1.7 times as many Magnetic Resonance Imaging units as the U.K. has per capita, more than twice as many Computer Tomography scanners, more than 30 times as many cardiac catheterization procedures, more than four times as many coronary angioplasty interventions, and more than three times as many coronary bypass procedures. Even though fewer British are obese, more die from heart attacks because of worse medical service.

With respect to infant mortality, Dr. Bernadine Healy pointed out last year in U.S. News & World Report, "It's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths." So U.S. infant mortality figures are inflated precisely because of the heroic efforts of U.S. doctors to save the lives of more infants.

Advocates of government-controlled medicine twist the data to serve their political aims. Those seriously interested in what we can do to contain costs, improve quality, and increase liberty in medicine in the U.S. should turn to the resources provided by Freedom and Individual Rights in Medicine at and Brian T. Schwartz, Ph.D., at

Monday, June 11, 2007

Problems with Sweden's Single-Payer System

Sweden is often romanticized by Americans as a model for socialist ideas done correctly. So how does their government-run single-payer system work out in actual practice?

According to this new study by David Hogberg, Ph.D. of the National Center for Public Policy Research, not too well. Like any such system, they control costs by waiting lists and rationing. Here are some excerpts from his paper. (Items in bold are my emphasis):

"Sweden's Single-Payer Health System Provides a Warning to Other Nations", by David Hogberg, Ph.D.

Görann Persson had to wait eight months during 2003 and 2004 for a hip replacement operation. Persson was not considered to be a very pleasant person to begin with, and he became even grumpier due to the pain he endured while waiting for his operation. As a result, Persson walked with a limp, reportedly used strong pain medication and had to reduce his workload.

What made Persson unique was not his wait for hip surgery. Despite the government promise that no one should have to wait more than three months for surgery, 60 percent of hip replacement patients waited longer than three months in 2003 (see Figure 2). Rather, Persson stood out because he was Prime Minister of Sweden at the time. Persson could surely have used his position in the government to gain access to private care, essentially jumping the waiting list. Yet Persson stated that he planned on waiting for his surgery like everyone else.

Whether Prime Minister Persson did this out of benevolent motives is an open question. His party, the Social Democrats, have used the phrase "equal access to health care" to attack the center-right parties on the issue of health care for many years. Persson would have greatly undermined the effectiveness of that attack had he jumped the waiting list.

...While rationing may permit the government to save on costs and thereby restrain health care budgets, putting patients on waiting lists is not cost-free. One study that examined over 1,400 Swedes on a waiting list for cataract surgery found that 5.2 million kronas were spent on hospital stays and home health care for patients waiting for surgery. That was the equivalent of what it would have cost to give 800 patients cataract surgery.

A recent study that examined over 5,800 Swedish patients on a wait list for heart surgery found that the long wait has consequences far worse than pain, anxiety or monetary cost. In this study, the median wait time was found to be 55 days. While on the waiting list, 77 patients died. The authors' statistical analysis led them to conclude that the "risk of death increases significantly with waiting time." Another study found a mean wait time of 55 days for heart surgery in Sweden and a similar rate of mortality for those on the waiting list. Finally, a study in the Swedish medical journal Lakartidningen found that reducing waiting times reduced the heart surgery mortality rate from seven percent to just under three percent.

Sweden is one of several nations whose practices offer proof that single-payer health care systems lead to the proliferation of waiting lists. It also shows that waiting lists have adverse and sometimes tragic consequences for patients.


While Sweden is a first world country, its health care system - at least in regards to access - is closer to the third world. Because the health care system is heavily-funded and operated by the government, the system is plagued with waiting lists for surgery. Those waiting lists increase patients' anxiety, pain and risk of death.

Sweden's health care system offers two lessons for the policymakers of the United States. The first is that a single-payer system is not the answer to the problems faced as Americans. Sweden's system does not hold down costs and results in rationing of care. The second lesson is that market-oriented reforms must permit the market to work. Specifically, government should not protect health care providers that fail to provide patients with a quality service from going out of business.

When the United States chooses to reform its health care system, reform should lead to improvement. Reforming along the lines of Sweden would only make our system worse.

Sunday, June 10, 2007

Gina Liggett LTE in Boulder Daily Camera

On June 9, 2007, the Boulder Daily Camera published the following letter to the editor by Gina Liggett:

There's no 'right' to any health care

Many Americans claim we need government intervention to reform the unaffordable and inaccessible health-care system, because "health care is a right." The system certainly is a mess, but health care is not a "right." It is a "need," like food and shelter.

A "right" is not simply possessing what we need for survival regardless of who provides it; it means the freedom to obtain what we need without force. For example, I should be free to buy soup from whoever offers the best quality for the price; but it would be a violation of my neighbor's rights to get a law passed making him pay for my soup. In the same way, a person should be free to purchase health care based on his or her health concerns, but it is not that person's right to give the bill to taxpayers.

The 208 Commission on Health Care Reform will present a final plan to the Colorado Legislature later this year. So far, the four runner-up proposals recommend greatly increased government control of health care access and funding. This means that Coloradans may get some kind of health care; they just won't have the right to obtain it as they individually see fit. Only a free-market can provide that right.


Friday, June 8, 2007

Business Week article on Health Savings Accounts

Business Week has an interesting article on Health Savings Accounts (HSA's), featuring the experience of an academic health economist who decided to change his traditional coverage into a combination of HSA's and catastrophic insurance:
Health Care You Control

One family finds that health savings accounts may be the smart choice

In the name of academic research, finance professor Stephen T. Parente got his physician wife to agree, reluctantly, to make a radical change in their family's medical coverage. The health-economics specialist who teaches at the University of Minnesota's Carlson School of Management had realized he knew a lot about health savings accounts (HSAs) as a scholar. But he had no experience with them as a consumer. So two years ago he enrolled himself and his family in a high-deductible insurance plan linked to a tax-sheltered HSA for medical expenses.

... The HSA contributions are made with pretax dollars. Withdrawals are tax-free as long as the money goes toward qualified medical expenses, which include everything from acupuncture to organ transplants to quit-smoking programs. The money is usually parked in a bank-like account, and beneficiaries of the plan receive a checkbook or debit card for paying bills. It's like a flexible spending account—except that with an FSA, you forfeit what's not spent in a calendar year while unused HSA money rolls over.

The idea behind the high-deductible/HSA plans is this: Catastrophic coverage prevents serious medical illness from financially crippling an individual or family. Patients, who will now have more financial skin in the game, spend their health-care dollars more carefully, putting downward pressure on health-cost inflation. "Besides doing research in the area, I liked the idea of having more control over our medical spending..."
And he found that the theory actually worked:
So what has he learned as a consumer? Just as with his previous insurance, he doesn't worry that medical bills will cause financial ruin. Once he exhausts his $5,000 deductible, his insurance kicks in and his family is protected against disaster. In addition, he is now fully covered for preventive care to encourage sound medical habits, a relief with three children, ages 2, 5, and 10. Such services includes immunizations and well-child care, as well as annual physicals and mammograms. Some 82% of high-deductible/HSA plans follow this practice, according to the Kaiser survey.

...The tax-sheltered savings account does have an impact on his health-care spending, he says, just as his scholarly work predicted. "When the account is your money, and when you get to keep it, you do act differently," he says.

He draws an analogy between this sort of health plan and auto insurance. If there's major damage to your car, you file a claim with your insurer to defray the cost of repair. But if you just have a cracked windshield or dent in a door, chances are you'll shop around for the best deal and pay out of pocket, rather than file a claim and risk getting a premium hike next year.

The same applies to your family's health care. If someone develops a major illness, the catastrophic insurance will cover the expenses. But if your child has strep throat, you can pay for the strep test and doctor's visit from your HSA. If Parente sticks with in-network doctors and laboratories, he pays the same rates insurers pay in other university health plans.
This market-based system provides quality care at an affordable price, without the drawbacks of the current employer-based system.

Thursday, June 7, 2007

Gina Liggett e-Letter to Denver Post on 208 Commission

On June 6, 2007, the Denver Post published the following e-Letter by Gina Liggett, RN, MPH:

Free market health care reform?

The four initial proposals selected by the 208 Commission on Health Care Reform recommend greatly increased governmental control of health care in Colorado. Few people would argue against the Commission's sound "Guiding Principles" for improving the health status of Coloradoans (e.g., the plan must provide high quality care, be financially viable and emphasize prevention). But the biggest surprise is that the Commission's eleven Evaluation Criteria required that the proposals offer only specified government-oriented methods for reforming health care. Free-market proposals couldn't possibly have had a chance.

For example, the only way a proposal received a "high" score on the criterion of "Access" was to "Increase Medicaid Provider Participation AND Serve Geographically Underserved Areas." On the criterion of "Coverage," a high-scoring proposal must "Require purchase of coverage AND Subsidize coverage AND Ensure availability of coverage" OR "..provide direct coverage to all..through a single-payer system." These mandates built into the Evaluation Criteria and thereby into the selected proposals dictate the who, what, when, where and how. This disqualified any free-market-oriented solutions.

I only wonder why the Commission bothered to solicit various proposals in the first place. They had already designed their first choice, and it's called "Socialized Medicine for Colorado."

Gina M. Liggett, Denver

Richard Watts LTE on 208 Commission

On May 31, 2007, the Glenwood Springs Post-Independent published the following LTE by Richard Watts:

Don't allow the government to dictate your health care

Dear Editor,

The AP article titled, "Panel wants a consolidated plan to reform health care" notes that Blue Ribbon Commission members say they "want to issue a consolidated plan on ways the state can provide coverage for 770,000 Coloradans who lack health insurance." But it is not the proper role of government to "provide coverage," nor to ensure that everyone in Colorado has health insurance.

The commission thinks it knows best, discarding the only free market proposal (called FAIR), considering only proposals which would force more government control and regulation of health care on every person in Colorado, assuming a right to make your health decisions instead of your being allowed to decide. The 208 Commission's chairman voices concern that TABOR could require the issue to go before the voters - the commission does not want you making your health choices for yourself, and they worry you will reject their plan if you are allowed to choose.

The 208 Commission's proposals would violate your right as an individual to decide how much of your money you spend, which providers you go to and which treatments you get. Their plan would be a disaster for you, for your doctor and for Colorado.

To learn more about how government interference caused the problems we face in health care and health insurance, visit

Richard Watts

Monday, June 4, 2007

Excellent Critique of the Massachusetts Program

Sandy Szwarc, BSN, RN, CCP, has written an excellent and detailed criticism of the moves towards government-run "universal care" in Massachusetts, Minnesota, and California. Among the many excellent points she makes, this one stood out the most to me:
One misconception among consumers is that the free market system hasn't worked, so the government must step in. But we don't have a free market system with health insurance. A free market system only works if it's allowed to exist unfettered from government mandates that limit competition and allow certain companies to monopolize markets.
The whole thing is worth reading, but I'd like to highlight parts of her discussion of Massachusetts. The Massachusetts program, signed into law by Governor (and Republican presidential candidate) Mitt Romney, is one that's frequently cited by advocates of socialized medicine as a model for the US. (The items in bold are my emphasis, not hers):
"Free universal health care for everyone" sounds wonderful and seems to be the vision most repeated in media, but what would that actually look like?

...Citizens' Council on Healthcare (CCHC), a nonprofit patient and physician advocacy organization, did an analysis of the Massachusetts plan last year and made troubling conclusions about its impact for consumers. While the plan was created "to expand access to healthcare for Massachusetts residents, increase the affordability of health insurance products, and enhance accountability of our state’s health system," they found the plan would create an enormous set of new bureaucracies (no less than ten new agencies, six financial-management funds, and three new programs) to establish, oversee and enforce. There is no evidence to suggest that the government will do things cheaper, better or more efficiently.

The MA state plan essentially creates a monopoly of insurers residents can choose from. Every policy has to comply with the state's coverage mandates, and mandates always cost more money than they claim to save. There are thousands of insurance mandates that have been passed by state legislatures over recent years and behind every mandate is a special interest that will benefit by the product or service. A recent analysis by the Council for Affordable Health Insurance estimated that mandated benefits increase the cost for basic health insurance for everyone by 20% to more than 50%, depending on the state. Worse, a number of these mandates are for preventive "wellness" programs, screenings and treatments that are unsound, ineffective, costly, unproven, unwanted or potentially dangerous.

One misconception among consumers is that the free market system hasn't worked, so the government must step in. But we don't have a free market system with health insurance. A free market system only works if it's allowed to exist unfettered from government mandates that limit competition and allow certain companies to monopolize markets. The government has catered to special interests and created an insurer managed care system, which has resulted in higher premium costs and more people uninsured. Those who want affordable insurance alone, without a third-party managed care bureaucracy standing between them and their doctor, find it unavailable...

...Cost containment efforts will likely drive away healthcare providers and, as has been seen in other single-payer systems, result in shortage of providers and services; rationing of available care and resources; and long waits for tests, surgeries and treatment.

Health insurance coverage is not the same as access to care.

...Overall, Twila Brase, RN, president of CCHC, said of the plan:

[A]n intrusive and prescriptive bureaucracy will be authorized to ration health care and make decisions about who gets what health care when. Health-care decisions will be taken out of the hands of patients and doctors as the agendas of special interests, not the needs of patients, take precedence. The legislation is extremely intrusive.
To sum it up: People will have no choice but are being forced to buy the insurance plans the state dictates. But these are not health insurance plans, as might be believed or some might desire, which protect people from catastrophic health problems, this is managed care. The state is also the regulator, payer and enforcer — a recipe for conflicts of interest.
(Hat tip to MikeN.)

Saturday, June 2, 2007

My Op-Ed in the Rocky Mountain News

The Rocky Mountain News just published my op-ed opposing socialized medicine in Colorado. It was edited slightly, and this is the version that appeared in print:

Free market holds key to ensuring quality for Coloradans

By Paul Hsieh, M.D.
June 2, 2007

The Colorado Blue Ribbon Commission on Health Care Reform recently selected four health care reform proposals for eventual consideration by the Colorado legislature. Although they differ in their details, these differences are dwarfed by their fundamental similarity - they all entail a massive increase in government interference in medicine in the name of "universal coverage."

All four plans inject government force into the doctor-patient relationship. They include some combination of forcing all residents into a single health program, forcing some or all individuals and/or businesses to purchase a state-approved insurance policy, requiring insurance companies to provide new additional benefits, establishing a new bureaucracy to set payments to the doctors for services they provide, and doubling the Colorado Medicaid population.

These are just disguised forms of socialized medicine.

Similar programs already have been tried in states and other countries. They have all failed, resulting only in higher costs and lower quality patient care. The TennCare disaster - Tennessee's failed attempt at "universal coverage" - offers an important lesson for Colorado.

In the 1990s, the Tennessee government expanded the state Medicaid program to include people earning up to 300 percent of the federal poverty line, i.e., a middle-class family of four making $55,000 a year. The state also forced insurance companies to offer expensive new benefits and forced employers to either buy health insurance for their employees or else pay into a state fund for the uninsured. Many employers chose the second option, shifting their employees' health costs onto taxpayers. Because of the new regulations, many insurance companies withdrew from Tennessee, forcing more patients into the state health plan.

The Tennessee government initially offered a generous benefits package. Predictably, costs skyrocketed because patients had no incentives to spend prudently. In response, the government attempted to control costs by slashing payments to doctors and hospitals.

Hospitals closed and doctors left the state in droves. Many doctors who remained stopped seeing TennCare patients since they lost money on each one. Families with sick children often had to drive long distances to find a doctor who would see them. And they had no alternatives to TennCare because the state regulations had all but destroyed the insurance market. Ironically, TennCare ended up causing the most harm to the very people it was intended to help - the working poor and rural patients.

Nor did TennCare save money. Instead, it nearly bankrupted the state budget.

The problems of TennCare are not aberrations that can be fixed with a few minor reforms. They are inherent in any system of government medicine. Under such systems, bureaucrats and politicians decide what care individuals can receive, not doctors and patients. This has long been the case in Canada's "single-payer" socialized medical system, with its infamous waiting lists for critical medical tests and treatments. For the sake of my patients and myself, I don't want this to happen in Colorado.

Socialized medicine is not the cure for Colorado's health care problems. Forcing everyone into a government-run medical program because some people are uninsured would be just as wrong as forcing everyone to live in a government-run housing project because some people are homeless.

Instead, Colorado should adopt free market reforms such as the FAIR Program ("Free-Markets, Affordability & Individual Rights") proposed by Brian Schwartz, Ph.D. Such programs are especially good at providing affordable quality care for the working poor and rural patients. They work precisely because they encourage individual responsibility and they respect the right of the individual to spend his health care dollar according to his best judgment.

Colorado has an opportunity to become a real innovator in health care reform. Instead of recycling failed government programs, we should set an example for the rest of the country by adopting free market solutions. Only the free market can provide Coloradans with the high-quality, affordable health care they need and deserve.

Dr. Paul S. Hsieh is a practicing physician in the southern metro area. He is a founding member of the Colorado group Freedom and Individual Rights in Medicine.

Friday, June 1, 2007

More LTE's from Richard Watts

Two letters to the editor have appeared recently in Colorado newspapers from Richard Watts.

It the May 30, 2007, edition of the Steamboat Pilot, Richard Watts wrote:
The 208 commission doesn't want you making your own health decisions

The May 22 article titled "Panel wants a consolidated plan to reform health care" speaks of the Blue Ribbon Commission's picking out four health care reform proposals for closer scrutiny. The commission is choosing to consider only proposals which recommend more government restrictions on consumers, doctors, employers and insurance companies.

On the 208 Commission's chosen menu of coercive measures are forcing individuals to buy health insurance, forcing employers to buy health insurance for employees, an enormous expansion of Medicaid and forcing every person in Colorado into a state-run health care system.

The "consolidated plan" which the 208 Commission is creating will contain some combination of these elements. That plan would destroy your choice of how much of your money you spend on health care, which providers you go to and which treatments you get. It is your right to freely make your own decisions in these matters.

But the 208 Commission thinks it knows best. The commission's chairman voices concern that TABOR could require the issue to go before the voters -- the commission does not want you making your health decisions for yourself, and they worry you will reject their plan for socialized medicine if you are allowed to choose.

To learn more about how government control of medicine wipes out your choices, and to learn about the free market remedy, visit

Richard Watts

In the May 31, 2007, edition of the Rocky Mountain News, Richard Watts wrote:
In his May 22 article "Health plans up in air," Bill Scanlon notes that the Blue Ribbon Commission’s task is "to recommend three to five plans that would improve access to health care while keeping down costs."

Only a free market can achieve this.

The commission thinks it knows best, discarding the only free market proposal (named FAIR), and recommending the very government interference that caused our present problems in health care -- more people in Medicaid, and more restrictions on consumers, doctors, and insurance companies. Colorado would then scramble to contain costs by restricting access to health care, i.e., bureaucrats would allow access only to certain approved providers, treatments, and drugs.

These recommendations won't work because they violate the rights of every person involved. You have a right as an individual to choose exactly how you spend your own health care dollars. Regulation and control by any government violates this right. But the 208 Commission thinks it knows better than you and your doctor what kind of health care is appropriate for you.

To learn more about how government interference caused the problems we face in health care and health insurance, visit

Socialism by any other name .....

I received an e-mail criticizing me for calling the various 208 programs socialist. The writer said that Chavez socialized oil companies, and Cuba socialized private companies in Cuba. He also indicated there was no way we would ever have socialized medicine in the US.

This is a modification of my response to him and why I think it is important to call these programs of government control over health insurance or medicine by the name of socialism.

Socialism is the political theory where government owns and controls the means of production. Some of those programs discussed by the 208 Commission for future medical care in this state do indeed want medicine in the hands of the government -- doing away with private hospitals and clinics -- and having only public non-profit (i.e., state-owned or quasi-state) hospitals and clinics. This is also the British model.

More common proposals would require that all residents be taxed, and the state or federal government would then dole out the money to four or five or twenty insurance companies who would then pay for the medical care. This is state-run health insurance -- control of the insurance industry -- providing certain proscribed benefits. This is more like Medicare. Economists usually refer to this as fascism -- a state where the government controls an industry, but nominal ownership is left to the individual companies. It is nominal ownership, because true ownership allows the owners to make decisions about what products or services to sell, pricing, choice of customers, etc.

Many programs would require doctors, hospitals and other providers to be paid the same price for the same services, regardless or quality, location or experience, or any other factors. Some do not allow providers to opt out or to offer services that the program doesn’t cover. This is either fascism or socialism, depending on whether there is insurance, and whether the providers are state employees. Although Medicare allows doctors to opt out, a participating doctor can’t offer uncovered services (those not provided by Medicare) at any price to a patient.

From an economic perspective, fascism differs from socialism based on ownership of the productive means. But, fundamentally, there is little, if any, difference. The fundamental nature of all of these programs is government control of medicine and health insurance. Canada, Britain, Germany, France, and Sweden are some of the most discussed medical programs. Under economic analysis, some may be fascist. But they are not referred to in that manner -- they are called socialist medical programs. Each has its own variation. Some have "private" insurance companies, some have only national health insurance or no insurance. Hospitals and clinics can be state-owned or private, quasi-state facilities. Doctors can be state employees or employees or partners in groups or clinics.

But, in all of these countries, there is no capitalist free market in medicine or health insurance. The government determines what services are provided, what is the appropriate and recommended treatment, when you can get that treatment, and what prices the doctors are paid. Fundamentally, that is Statism, and that is what is wrong with these plans. It is not simply that they are economically inefficient – that makes efficiency the standard of judgment. What is crucially, fundamentally, wrong with these plans is that they turn doctors, hospitals and patients into widgets. Individuals have little power or choice over their own careers, jobs, treatment or payment --- someone else, somewhere, in the name of the government (or its quasi-agency), makes those decisions for every doctor, hospital, insurer, patient and consumer. It is precisely because life and health are so important that these decisions should be made individually, without government being involved.

And that describes in detail, precisely, two of the plans that the 208 Commission selected. A third plan has a bit less control -- it simply would force every resident to purchase a state-approved health insurance policy. The fourth option would essentially eliminate health insurance for another 550,000 Colorado residents earning, by making them eligible for Medicaid, thus taking away any incentive for insurance companies to compete in that market because Medicaid is subsidized.

It might be more proper to call these statist or fascist programs. I have no quarrel with that although I don't think most Americans today would understand or recognize those terms. But it is important to name them government control of medicine -- in any of its forms -- socialism, fascism or statism.