Thursday, July 31, 2008

Ms. Think on Paying Doctors

Lawyer-blogger Ms. Think has another medically-related post out, "Pay Doctors, Don't Enslave Them".

She cites a NY Times article about dermatologists responding to natural economic incentives, and concludes:
...[I]t gives me hope that we're getting to the day when people accept the fact that if you want to voluntarily entice a human being to provide you with a service, you have to pay them for it. When that day comes, I'll feel more secure that when I need a doctor, I'll be able to find one who's willing to do business with me.

There's no solution to this problem if you're a universal health care statist -- except open advocacy of enslaving doctors. There are only two ways to get dermatologists to stop preferential treatment of cosmetics patients -- you're either going to pay them more to treat sick patients or you're going to punish them for treating cosmetics patients. If you're for universal health care, you can't openly advocate anything that will make the system more expensive to taxpayers. If you force insurers to pay more, you'll have to let them raise premiums or you'll have spend more tax dollars subsidizing dermatology. That's a no-no. So all you're left with is: an open call to punish dermatologists who preferentially treat cosmetic patients. Which will lead to an exodus from dermatology that could only be stopped by somehow forcing doctors to become and remain dermatologists.

Which will show people just exactly why restricting doctors' freedom must inevitably lead to decreased access to medical care.
Thank you, Paula!

Wednesday, July 30, 2008

The Price of RomneyCare

The July 29, 2008 Wall Street Journal has published a good OpEd criticizing the cost overruns of the Massachusetts "universal" health care plan. Here are a few excerpts:
As this public option gets overwhelmed, budget gaskets are blowing everywhere. Mr. Patrick had already bumped up this year's spending to $869 million, $144 million over its original estimate. Liberals duly noted that these tax hikes are necessary because enrollment in Commonwealth Care is much higher than anticipated. But of course more people will have coverage if government gives it to them for free. The problem is that someone has to pay for it.

Thus the extra tab of $129 million, which may need to go higher because it relies on uncertain federal funds from Medicaid. For now, Mr. Patrick wants one-time (yeah, right) charges of $33 million on insurers and $28 million on providers, plus some shuffling of state funds. The balance comes from an estimated $33 million boost in the state's "pay or play" tax: If businesses don't offer "fair and reasonable" insurance to their employees, they get hit.

...The main reason people are uninsured is because coverage is too expensive. Massachusetts didn't have many options for reforming the way health dollars are laundered in the third-party payment system created by the federal tax code. But it could have helped make insurance cheaper by reforming its private market before defaulting to public programs.
Their economic analysis is on target. It's also important to recognize that these problems arise from government interference in the free market. Patients, providers, and insurers are not allowed to negotiate voluntarily in the free market for their mutual benefit, but instead must do so under constraints designed to somehow guarantee health care for everyone. These adverse economic results are a consequence of this basic violation of their right to contract.

Tuesday, July 29, 2008

Stossel Documentary: Sick In America

The TV special on health care policy, "Sick in America" by ABC news reporter John Stossel is now available on YouTube. He adopts a generally pro-free market perspective, a nice counterpoint to the usual pro-"universal care" slant that one routinely sees in the popular press. The documentary appears in 6 parts:

Part 1/6:

Part 2/6:

Part 3/6:

Part 4/6:

Part 5/6:

Part 6/6:

(Via PatientPower.)

Monday, July 28, 2008

Schroeder on the Wyden Plan

During the past week, four different people (including supporters and opponents) have drawn my attention to the "universal health care" plan proposed by Oregon Senator Ron Wyden, known as the "Healthy Americans Act".

I haven't spent much time looking into the details, but at first glance it appears to include many of the same elements that have made the Massachusetts plan such a disaster, including an individual insurance mandate, subsidies for people making up to 4 times the federal poverty level (FPL), additional restrictions on what sorts of products insurance companies must and must not sell, a "connector"-type agency to match customers to sellers, etc.

Pediatric cardiologist Dr. James Schroeder sent me the following insightful analysis, which I am quoting with his permission. (Segments in bold are my emphasis.):
Sounds like Romney-care gone national, with all the right buzzwords (choice, affordable, meaningful, etc). I especially like the phrase, "For starters, every American will have the power to choose - and will be required to choose - a comprehensive health insurance plan." So reminiscent of Hillary Clinton's 'we want you all to participate voluntarily, but if you don't volunteer we are prepared to make you participate' philosophy!!

The biggest bamboozlement is the comment that the employer tax break for health care insurance "costs" the government 200 billion dollars! So instead of giving individuals a comparable tax break, they propose taking that tax break away from everybody, and funding the subsidized portion of the program with that imaginary money. Sounds like a cost shift and a new tax to me, whether it ends up being mandated onto the worker or onto the employer, somebody is going to have to chip in that money.

The other typical stuff about increased efficiency because it's the government, and decreased utilization because the worker is paying the premium, and subsidizing up to 400% FPL is not surprising. The advocates of socialized medicine have learned the vocabulary of the market without applying any of the principles. This type of plan is the health care reform equivalent of a stealth bomber, because it is sneaky and it is going to bomb, for sure. Unfortunately, it seems like a substantial number of Republicans are prepared to go along with it because it sounds good superficially. Of course, in 2-3 years, when the cost overruns kick in and the government has to step in for "cost-containment" purposes, it will be too late, we will be smack in the middle of nationalized health care.
I believe Dr. Schroeder's analysis is completely on target. This sort of plan appeals to conservatives because it preserves the veneer of a "marketplace" while introducing still more government controls. Then when it fails (as it inevitably will), people will blame the failure on the "market" and say, "See, free market reforms don't work -- now we need to go to a fully government-run medical system."

Hence, it is critical that supporters of genuine free market reforms oppose this "stealth" socialism masquerading as market reforms.

Friday, July 25, 2008

Bokor on the Houston Meeting

In response to accounts of the recent Houston meeting on nationalized health care, Sylvia Bokor has sent the following strong letter to the Houston Chronicle:
Re the congressional hearing on H.R. 676, "The United States National Health Insurance Act," held in Houston on July 18, 2008.

A "congressional hearing" is meant to find out what citizens think about a given subject. But the July 18 meeting was no hearing. It was a carefully orchestrated power-play presided over by Congresswoman Sheila Jackson Lee and Congressman John Conyers, Jr., to force socialized medicine down citizens' throats.

From all reports the meeting was held in a manner faithful to dictators and their ilk the world over: The politicians showed up an hour and half late (a tactic designed to reduce attendance by tiring people's patience and driving them away), dominated the podium with interminable talk outlining their point of view (designed to present an appearance of unstoppable force), and refused to take questions from the floor (designed to squash all opposition).

The comic relief was provided by Mr. Conyers who claimed that "This issue isn't about ideas or theories or philosophy or idealism. It's about providing healthcare." Given what's revealed by this statement, one can only conclude that for Congressman Conyers the term "learned" is an oxymoron.

When healthcare does not deal with ideas, theories, philosophy or idealism, it can only deal with "practice" -- the practice of non-thinking, uneducated, brain-dead zombies who will stick a knife into you without an idea, theory, philosophy or ideal to guide their action. That's what socialize medicine boils down to. No wonder those speakers described themselves as "bleeding heart liberals." That organ, too, is no longer viable, having been bled out.

There is no legal penalty against egregious lack of knowledge, but one might hope that there would be punishment for elected officials, such as Conyers and Lee who treated their constituents with such unpardonably arrogant disdain. One might hope they will be booted out of office ASAP.

Sylvia Bokor
Albuquerque, NM

Thursday, July 24, 2008

Concierge Medicine

Government insurance programs such as Medicare devalue the services of primary care physicians relative to specialists, as many physicians such as have noted. As a result, it is entirely natural that some of the more entrepreneurial primary care doctors are switching into the field known as "concierge medicine":
Concierge medicine is an appealing option for some primary-care doctors who want to break free from the assembly-line method of patient care that they say they are forced to adopt.

Primary-care doctors say this limited practice is appealing for many reasons. They cite the drumbeat of threatened pay cuts from government programs such as Medicare and the red tape and restrictions of private insurance companies. Other factors include the rising cost of malpractice insurance and the expense of hiring assistants and office managers who must push paperwork.

The trend underscores the fact that the role of primary-care practitioner is a less appealing option for young doctors who see more lucrative career paths in specialized areas of medicine such as dermatology or plastic surgery.
Both the patients and doctors benefit from this option. Physicians are able to spend more time with their patients and practice their craft according to their best medical conscience, for reasonable reimbursement. Patients get the benefit of improved quality care for a fair price. Both parties benefit from the exchange, because in essence it represents a shift towards a partially free market.

It is only partially free because patients and doctors must still work within various regulations such as FDA rules, government licensing requirements, etc. But even so, the benefits are significant. Just imagine the benefits we could see in a fully free market! (Via W. Perry.)

Wednesday, July 23, 2008

Hsieh LTE in USA Today

The July 23, 2008 edition of USA Today has printed my LTE critical of mandatory insurance:
Reform health care

Paul Hsieh, M.D., Co-founder, Freedom and Individual Rights in Medicine - Sedalia, Colo.

Mandatory insurance does not solve our underlying health care problem, which is government interference in the free market. This approach has already been tried in Massachusetts and has led to long waits, skyrocketing costs and frustrated patients ("Individual health policies leave many in the lurch," Cover story, News, Thursday).

Instead of government-imposed "universal health care," America needs free market health reforms -- reforms such as eliminating mandatory insurance benefits, repealing laws that forbid purchasing health insurance across state lines, and allowing individuals to use health savings accounts for routine expenses and low cost, catastrophic-only insurance for major expenses.

Such reforms would respect individual rights, allow patients to choose from the best offerings from all 50 states, lower costs and make health insurance available to many who currently cannot afford it.

Tuesday, July 22, 2008

Socialists in Houston

Leading leftist Congressmen tried to stage a "town hall" meeting in Houston to claim support for socialized medicine. Fortunately, blogger Gus Van Horn was able to report on what really happened.

Thank you, Gus, for shining a bright light onto this effort to destroy health care in America.

Monday, July 21, 2008

Medicare's "Free Market" Facade

The website has posted Yaron Brook's 7/19/2008 OpEd on Medicare:
Medicare's "Free Market" Facade
By Ayn Rand Institute: Yaron Brook (07/19/08)

Irvine, CA--Some Republicans are bemoaning the passage of a new law they say undermines allegedly free-market elements of Medicare--in particular, Medicare Advantage, a program which gives seniors the option of receiving their government-financed care through private health plans. They claim that such "free market" elements are crucial to controlling the spiraling costs that are plaguing Medicare.

"The view that programs like Medicare Advantage have anything to do with free markets is a delusion," said Yaron Brook, executive director of the Ayn Rand Institute. "On a free market, each individual is responsible for his own--and only his own--health care. But Medicare Advantage is essentially no different from traditional Medicare: it forces some Americans to bankroll the health-care needs of other Americans. The inevitable result is our current health-care crisis.

"If the government guarantees health care to people, costs have to skyrocket. When someone else is footing the bill for health-care costs, consumers demand medical services without having to consider their real price. The artificially inflated demand this creates sends expenditures soaring out of control. It is irrelevant whether the government finances this spending spree directly, as it does with traditional Medicare, or indirectly, as with Medicare Advantage. In the end, the results are the same.

"The only way to fix the problems caused by government interference in medicine is to eliminate government interference in medicine--not to have some mishmash of government controls and market elements. By returning to a truly free system where each individual is responsible for his own health-care costs, we would unleash the power of capitalism in the medical industry, leading ultimately to high quality, affordable medical care for Americans. Let's start looking at ways to phase out government interference in medicine."

Yaron Brook is president and executive director of the Ayn Rand Institute.

Copyright ©2008 Ayn Rand® Institute. All rights reserved.

Friday, July 18, 2008

Commonwealth Fund At It Again

The Commonwealth Fund has issued another report critical of American health care, as part of its continuing push for government-run "universal care".

But given that their past reports have been rebutted by multiple analysts, including John Graham, Grace-Marie Turner, and John Goodman, is there any reason to believe them this time?

Thursday, July 17, 2008

More On Massachusetts Mandates Mess

As more policy analysts review the results of the Massachusetts health plan, they are coming to recognize the numerous problems caused by individual mandates.

Kalese Hammonds of the Texas Public Policy Foundation notes the following:
In Massachusetts, the individual mandate and state subsidies have led to massive cost overruns. The newly insured have flooded doctors’ offices, creating a shortage of providers and forcing doctors to either turn down patients or put them on a waiting list.

What Massachusetts has found – and what advocates for the uninsured fail to recognize – is that health insurance does not necessarily mean access to health care. In fact, health insurance is partially responsible for the continuing decay of our health care system. Its desensitization of consumers from the cost of health care has created an environment that encourages overutilization.

As the demand for health care services has risen, so have their prices; proof that the economic principles of supply and demand do, in fact, apply to health care.
And Grace-Marie Turner of the Heartland Institute notes:
* It's easy to get people to enroll in health insurance if you make it free or nearly so to them. The great majority of those newly covered by insurance in Massachusetts are in plans completely or heavily subsidized by the taxpayer. Of the 330,000 newly enrolled in insurance, at least 232,000 are getting free or heavily subsidized coverage.

* The hard part is convincing people who don't get subsidies--and who face growing penalties for not enrolling--to buy insurance. The state government has the audacity to tell residents what they can and cannot afford to pay. For example, if your family income is $70,001, the state says you can afford to spend $550 a month, or $6,600 a year, for health insurance. If you don't buy it or get a waiver, you'll be fined. The penalty now is as much as $1,824 for a couple, and it will increase again next year.

* The plan is starting to strain the state budget as well. Gov. Deval Patrick (D) has asked for $869 million for fiscal 2009, but state authorities warn the cost will be closer to $1.1 billion--about as much as the state pays for its total public safety budget. The state also is concerned about another 30,000-40,000 people who have job-based coverage now but could be added to the subsidy rolls as well.

* Insurance costs continue to rise. The state has approved a 12 percent rate increase for health insurance for next year.

* Some safety net hospitals are threatening bankruptcy. Hospitals are still treating a large number of people without health insurance, but the payments they receive for uncompensated care have been cut as part of the reform deal.

* The state is finding its goal of universal coverage to be increasingly elusive. Several hundred thousand people are still without health insurance, and they will be the most difficult to enroll because the majority won't qualify for subsidies. They face rising health insurance costs, growing fines, or a complex waiver process.

* The shortage of primary care doctors is making it difficult in some parts of the state for people who are newly insured to find a doctor who will take new patients. One person wrote us, "Before, I was uninsured and couldn't see a doctor. Then I made the sacrifice to buy insurance, but I still can't find a doctor who will see me. So now I still don't get to see a doctor, but it's just costing me more."

* The state has a detailed list of minimum coverage standards for 2009 that many small businesses will not be able to meet. They find the richer package more expensive than they can afford to buy for their workers. What will the state do? Fine them? Relax its rules again?
These problems will not be solved simply by throwing more money at the system. Because they are a consequence of the government forbidding individuals, providers, and insurers from contracting freely, they will be inherent in any system of mandated insurance.

Tuesday, July 15, 2008

Father of Canadian Health System Says It's In "Crisis"

The June 25, 2008 edition of Investor's Business Daily has an interesting article on the father of Canadian health care, Claude Castonguay, and his current views. Here are a few excerpts:
Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits

...Back in the 1960s, Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec -- then the largest and most affluent in the country -- adopt government-administered health care, covering all citizens through tax levies.

...Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in "crisis."

"We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," says Castonguay. But now he prescribes a radical overhaul: "We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."

...What would drive a man like Castonguay to reconsider his long-held beliefs? Try a health care system so overburdened that hundreds of thousands in need of medical attention wait for care, any care; a system where people in towns like Norwalk, Ontario, participate in lotteries to win appointments with the local family doctor.

Years ago, Canadians touted their health care system as the best in the world; today, Canadian health care stands in ruinous shape.

Sick with ovarian cancer, Sylvia de Vires, an Ontario woman afflicted with a 13-inch, fluid-filled tumor weighing 40 pounds, was unable to get timely care in Canada. She crossed the American border to Pontiac, Mich., where a surgeon removed the tumor, estimating she could not have lived longer than a few weeks more.

The Canadian government pays for U.S. medical care in some circumstances, but it declined to do so in de Vires' case for a bureaucratically perfect, but inhumane, reason: She hadn't properly filled out a form. At death's door, de Vires should have done her paperwork better.

...Americans should know that one of the founding fathers of Canada's government-run health care system has turned against his own creation. If Claude Castonguay is abandoning ship, why should Americans bother climbing on board?
The author of this article, Canadian physician David Gratzer and author of The Cure: How Capitalism Can Save American Health Care, makes many excellent points.

One point that deserves further emphasis is the fact that the economic failures of the Canadian system are due to their fundamentally flawed premise -- that health care should be a "right". This point has to be explicitly challenged (and rejected) before genuine free market health care reform can take root in this country.

Monday, July 14, 2008

Paula Hall: Don't Become A Primary Care Physician

Attorney/blogger Paula Hall has written an excellent post entitled, "An Open Letter to Medical Students: Please don't become primary care physicians!!":
An Open Letter to Medical Students: Please don't become primary care physicians!!
By Paula Hall
9 July 2008

All the talk about the health care crisis is about the costs. All the solutions proposed to the health care crisis are aimed at making it more affordable.

No one ever talks about access to health care. And with good reason -- because everyone knows, in their heart of hearts, that access to health care means access to physicians, and the only way to even attempt to guarantee access to physicians is to enslave them.

What is missing is a proud and open statement by physicians that they, too, understand that guaranteed access to health care -- government socialization of health care -- means enslavement of physicians. Physicians as a group need to stand up and be proud of the decades of hard work it took for them to become a physician -- and ask everyone clamoring for universal healthcare if they can conceive any mechanism, even brute force, that can make someone learn to be a doctor.

Many doctors are leaving the profession, because the bureaucracy is crushing them, preventing them from spending time practicing, and because they aren't getting paid enough for what they do. It is a senseless and useless argument to claim that doctors are being greedy and should accept whatever low payment we healthcare-needing consumers are willing to pay. It doesn't matter. There is nothing that can be done to stop a doctor from leaving the profession. You wouldn't even want to force a doctor to stay in the profession -- ask yourself if you would be willing to operated on a surgeon who didn't want to do the operation and was only there because he was threatened. Could you possibly trust the advice of a practitioner who hated what he did? Does anyone truly believe a mind can be forced, that good judgment can be elicited at gunpoint?

The healthcare access crisis is acutest at the primary care level and for the elderly on Medicare. Primary care physicians are the gatekeepers for all the bureaucracies and bear the burden of all the regulations and requirements. (Do not go on about how HMOs and insurance companies are greedy private concerns. They are subject to thousands of laws and regulations telling them what services they may or may not offer, what things can and cannot be covered. Anyone making this objection should know that, since they are the ones lobbying for all the laws.) Primary care physicians receive the lowest compensation. And primary care physicians are the ones everyone needs, they are the ones who get to know the patients and refer them on to specialists.

People clamor for more primary care physicians while at the same time clamoring for regulations and costs that drive them out of business. And no one seems to get what is happening, or be willing to admit what is happening. But it's happening -- we're losing primary care physicians. And we're losing the doctors who treat the elderly. I'm middle-aged. By the time I am elderly, there will be few doctors available to treat me. And I am scared. I am scared that primary care physicians willing to treat the elderly will be hounded out of the profession. And I cannot blame them one bit for leaving. I am completely sympathetic to the medical student who chooses a lucrative specialty, like plastic surgery or dermatology, over primary care.

I think perhaps the most effective means to get the message to people that the only way to increase the number of doctors is to free them is: drastically to decrease the number of doctors on the explicit grounds that they are not free. So, medical students of today, I beg of you -- don't go into primary care! Let everyone know that you are avoiding primary care because it is too regulated and doesn't pay you enough. If you are a primary care physician, find a way to quit, and scream from the rooftops the reason why! Doctors and doctors-to-be, find a way to leave the primary care profession altogether, because if you try to go on strike while retaining your right to practice, the bureaucrats will use the antitrust laws to destroy you. Just leave!

And hopefully, when there are no primary care physicians in a few years, everyone will see what must be done. Only when everyone sets the doctors free, should they come back to primary care. Hopefully, this process will be quick -- so that when I am old, I will be able to find a good doctor.

(Inspired by a column by Senator Tom Coburn (R-OK), appearing on the Real Clear Politics website -- and which does not go nearly far enough in making the case for doctors.)
Thank you, Paula!

Friday, July 11, 2008

Why Doctors Are Reluctant to Use E-Mail

Dr. Benjamin Brewer explains in his blog at the Wall Street Journal:
With the rest of the world hooked on electronic communication, doctors sometimes seem like the last holdouts. Most doctors I know seem unwilling or unable to make even email part of the way they practice medicine.

I think there are two main reasons. The first is that email is another stream of information on top of phone calls, faxes and electronic pages from the hospital that the typical primary care doc has to contend with every day.

The other factor is the privacy and security laws known as HIPAA that scared docs from trying something new. They got the message you could be penalized for doing communications in the wrong way, so it's easier to not go there at all.
This is yet another unfortunate "unintended consequence" of bad laws like HIPAA. They retard the adoption of technologies that could benefit patients and doctors alike.

Thursday, July 10, 2008

A Conversation With My Dentist

Just as an example of informal but effective activism, I had an interesting conversation with my dentist yesterday. I would classify him as a moderate Republican (definitely not a religious zealot) with a strong work ethic and a good American sense of life. He likes to think about issues and he takes ideas seriously, which makes him precisely the target audience I want to reach. Over the past year, he's gladly read all of the health care policy articles I've sent him.

He told me that a few days ago he was working out at the gym, and the person next to him started talking about how health care should be a universal right and that everyone in America should be entitled to receive free medical care. My dentist said that he had just recently read Dr. Richard Parker's OpEd on Senator Ted Kennedy and "universal" health care, so he got upset and expressed his disagreement politely but firmly, making a number of pretty good moral and practical arguments against "universal" health care. Other people at the gym started listening in, and after the discussion was over one of those random people said to my dentist, "You know, I had never really thought about some of those points before".

My dentist recounted the story with a slight trace of embarrassment on his face, because he knew he got a little worked up over the issue at the time. (Knowing him, I'm sure he was firm, but not obnoxious or unpleasant).

I told him that he was right to stand up for what he believed in, and that it was good for him to speak his mind when he felt passionate about an issue like this. I told him that just as it is proper for him to be passionate about his work and his family, it is also proper to be passionate about his ideas and convictions. And I said that he did a good thing in speaking out, because you never know when the right person will hear the right idea at the right time.

I think that struck a nerve in him, because he gave me a big smile and said, "Yes, you're right". Then we settled down to business, and the rest of my dental appointment was totally uneventful.

Basically, I gave him explicit moral support for standing up for a good idea, and at some level he appreciated it.

This is something we can all do with very little effort -- give our moral sanction to those who deserve it, even if they don't necessarily realize how much they want or need it. Moral sanction is a crucial component of practicing the virtue of justice.

And you never know when you may be giving the right person the courage to do the right thing at the right moment.

Wednesday, July 9, 2008

More Medicare Misery

As the Medicare political controversy heats up, two recent articles make points worth remembering.

First, the Covert Rationing blog correctly states:
The current physician reimbursement system is emblematic of what we might expect if we turned the entire healthcare system over to the government, and those who rail against such a single-payer system ought to use this example as an object lesson.
(I may disagree with some other points on that website, but I agree completely with the point quoted.)

Second, more and more physicians are looking to escape the Medicare/Medicaid system altogther:
...[M]ore and more Texas doctors are opting out of Medicare due to growing cuts in reimbursement. And the trend is not limited to Texas doctors. Primary care doctors from around the country have told ABC News that they too are either opting out of treating Medicare patients, or are preparing to do so if Congress once again OKs slashing reimbursement rates.

"Unfortunately, there are physicians that I know of in the Columbus, Ohio, area that are opting out [of Medicare]," said Dr. Mimi Ghosh, a family practice physician at the Ohio State University Medical Center. "Most physicians I know have taken a pay cut every year for years... Reimbursements are just getting worse, and more physicians are retiring early, or going to other careers [like] pharmaceuticals [or] real estate."
As the crunch gets worse, the government will be start recognizing that the current system is not sustainable in the long run, and it will faced with a choice between two fundamentally different alternatives. They could either shut down "escape valve" of the private sector altogether and force doctors to work for a government-run "universal" medical system.

Or they could admit that government-run medicine is a failure because it violates basic individual rights and free market principles, and instead work for the eventual elimination of Medicare and Medicaid and allowing the free market to work.

The first path will lead to death and misery for millions, whereas the second could bring quality affordable health care to millions who cannot currently afford it. The choice is up to us.

(Links via KevinMD.)

Tuesday, July 8, 2008

A Glimpse of the Future

The July 7, 2008 Wall Street Journal makes some interesting observations about the current political battle over Medicare:
As a virtual monopoly, Medicare uses a complex formula to set reimbursement rates for thousands of services. In short, it controls prices. That's why doctors are supposed to eat a pay cut, even though everyone knows this would prompt more doctors to stop seeing Medicare patients. But price fixing is the way that an open-ended entitlement like Medicare – which gobbled up $432 billion in 2007 – tries to control spending...

Yet Mr. Obama wants to... create a Medicare-like "public option" for everyone of any age. Democrats will fund this program generously, crowding out private coverage and maintaining the slow-roll toward a complete government takeover...

The fight over doctor fees is merely an appetizer for such a system, where competing interest groups would clash for their share of the spending pie. Highly politicized Medicare-like price controls on providers and services would spread to every health decision. The result would be rationing and declines in quality of care.
When single-payer advocates point to the supposed glories of the system in other countries, it's important to let them know that we already have an example of a broken government-run system in our own country.

The problems of Medicare are a glimpse of our future if we adopt any sort of Medicare-for-all solution. When the government stops patients and providers from contracting freely for goods and services to their mutual benefit in a free market, these bad results are inevitable.

Monday, July 7, 2008

Mandate Madness

David Catron has written a nice essay about mandate madness.

(I agree with his main point. My only comment is that in a fully free market, the "high risk pools" mentioned towards the end should not require any government funding at all but should be created and funded entirely by private parties and voluntary charities.)

Friday, July 4, 2008

Happy July 4th!

Thomas Jefferson was invited to attend a celebration in Washington DC on July 4, 1826, to commemorate the 50th anniversary of the signing of the Declaration of Independence. He had to decline due to reasons of health, but he did write the following in his last letter:
I should, indeed, with peculiar delight, have met and exchanged there congratulations personally with the small band, the remnant of that host of worthies, who joined with us on that day, in the bold and doubtful election we were to make for our country, between submission or the sword; and to have enjoyed with them the consolatory fact, that our fellow citizens, after half a century of experience and prosperity, continue to approve the choice we made.

May it be to the world, what I believe it will be, (to some parts sooner, to others later, but finally to all,) the signal of arousing men to burst the chains under which monkish ignorance and superstition had persuaded them to bind themselves, and to assume the blessings and security of self-government.

That form which we have substituted, restores the free right to the unbounded exercise of reason and freedom of opinion. All eyes are opened, or opening, to the rights of man. The general spread of the light of science has already laid open to every view the palpable truth, that the mass of mankind has not been born with saddles on their backs, nor a favored few booted and spurred, ready to ride them legitimately, by the grace of God. These are grounds of hope for others. For ourselves, let the annual return of this day forever refresh our recollections of these rights, and an undiminished devotion to them.
(Via Marginal Revolution, from last year. Regular health care blogging will resume next week.)

Wednesday, July 2, 2008

Enslaving Doctors?

Blogging may be light for the next few days, due to my schedule.

But in the meantime, I urge readers to take a look at Brian Schwartz's post on his PatientPower blog: "Dehumanizing Doctors".

In particular, he points to the following disturbing comment on another blog:
A true "universal" system does not involve private insurance or a two tier level of service that doctors can run to when they are unhappy with the "government" tier. If universal is going to work then we all have to be in the same system and have the same commitment to its success.
This is precisely the attitude Dr. Leonard Peikoff warned about when he wrote in "Health Care Is Not A Right":
To call "medical care" a right will merely enslave the doctors and thus destroy the quality of medical care in this country, as socialized medicine has done around the world, wherever it has been tried, including Canada (I was born in Canada and I know a bit about that system first hand).
The result of "universal health care" is a system in which government forces doctors to work under the government's terms and for the government's prices even if patients and doctors would both gladly choose otherwise in a free market.