Friday, August 29, 2008

Remember Maine?

Before Massachusetts implemented their "universal" health care plan, the state of Maine had attempted a plan to guarantee coverage for all the uninsured, called Dirigo.

Now, unhappy Maine residents are protesting yet another tax hike to fund their system, especially after the program was sold to Maine residents as not requiring any new taxes. Nor did the program do much to reduce the problem of the uninsured, as the article notes:
Dirigo Care has cost the state's taxpayers nearly $164 million in the four years since its inception. Although its intended purpose was to insure 128,000 people who had no health coverage, only 4 percent of that total, or just over 5,000 individuals, have been successfully removed from the rolls of the uninsured and into the state program, according to figures from the Maine Heritage Policy Center.
In 2007, the New York Times described Dirigo as "faltering".

In June 2008, others are using the words "boondoggle" and "failure":
DirigoChoice costs taxpayers $2,977 per enrollee per year just for the premium subsidy, excluding Dirigo Health Agency administrative costs.

As of April 2008, there were 12,637 individuals covered by DirigoChoice, less than 1 percent of the state’s population.

Only 31 percent of DirigoChoice enrollees -- 3,917 -- were previously uninsured for at least 12 months prior to enrollment. That is only 3.2 percent of the state’s uninsured population.

The marginal cost to state taxpayers is $9,603 to subsidize the coverage for one previously uninsured person through DirigoChoice.

Maine’s uninsured rate from 2003 to 2006, the latest year available, is virtually unchanged – 128,000 uninsured in 2003, 115,000 in 2004, 132,000 in 2005, 122,000 in 2006.

The Dirigo Health Agency’s administrative costs were $3.7 million in calendar year 2007.

Because of financial difficulties, DirigoChoice was closed to new enrollees on Sept. 1, 2007.

The 1.8 percent health care claims tax, which was included in the tax increase package approved by the Legislature, will cost individuals about $78 and families about $210 a year in higher health care premiums.

Without the $57 to $72 million tax increase, DirigoChoice enrollment is projected to drop by 4,000 individuals. Even with the tax increase, DirigoChoice enrollment still is projected to drop by 1,000 people.

The Dirigo Health experience has cost Maine taxpayers more than $100 million since 2005.

Dirigo Health was supposed to make health insurance more affordable and provide coverage for most of Maine’s uninsured. In fact, it has done neither.
This is the predictable result of government-guaranteed health care.

Thursday, August 28, 2008

Today's Myth: Healthcare Is Free in Canada, Germany, England, France

Here are some useful facts from This is the ninth myth listed on their page:
Myth: Healthcare Is Free in Canada, Germany, England, France

Fact: People in other health care systems often pay more than Americans do, sometimes in the form of taxes. And they may also incur high costs if they need a drug that is not covered by their health system or want to see a specialist.

In the US, a family of four with an employer-based PPO will have around $15,609 total this year in health care costs. Of this amount, $9442 will be paid by the employer and the employee will contribute $3,492 in premiums and $2,675 on copays, etc. [1] That's about 6 percent of average family income. [2]

In Canada, while the percentage of taxes used to provide health care varies, it is estimated that 22% of taxes collected went to the health system in 2004.[3] Several provinces, including Quebec, Ontario, Alberta, and British Columbia, also charge additional premiums.[4] Canadians also may spend money to receive private treatment for procedures or drugs that are not covered by the government system.

Citizens of the UK pay 11 percent of each pound they make in weekly income between £100 - £670 for the NHS, plus an addition 1 percent of income over £670 a week.[5] Though the copay for drugs is low, many drugs are not covered, often because they not considered cost efficient. And anyone who uses their own money to buy powerful but expensive drugs not paid for by the NHS finds him or herself shut out of the NHS for having gone outside the system.

In Germany, coverage from a public sickness fund currently can range significantly in cost, from around 12.2 to 16.7 percent of income, with the employee paying a bit under half. As of fall 2008, premiums are to be standardized from the federal level and health care experts anticipate that they will be set around 15.5 percent.[6] Private patients can generally expect to pay more than they would in the public system.

In France, employees contribute only to 0.75% of their salaries towards medical care, but also pay a 7.5 percent General Social Contribution, the majority of which is earmarked for the health system. This base coverage reimburses people for the majority of costs for doctors visits and for a portion of the costs of medications.[7] On top of the government coverage, almost all French residents have supplementary coverage from a mutuelle, costing approximately 2.5 percent of salary.[8]


[1] "Average 2008 Employee Out-of-Pocket Costs for Family Health Care to Increase 10.5%, According to Milliman Index," Medical News Today, 16 May 2008,

[2] Kevin Sack, "Clinton Details Premium Cap in Health Plan," The New York Times, 28 March 2008.

[3] Jay Lehr, "Canadian Health Care is No Model for US: Claims That Canada's Single-Payer Health System Is More Efficient or More Compassionate than Ours Are Just Plain Untrue," Health Care News, 1 June 2004, available at

[4] OECD, "Taxing Wages 2006/2007: Special Feature: Tax Reforms and Tax Burdens," (2008).

[5] OECD, "Taxing Wages 2006/2007: Special Feature: Tax Reforms and Tax Burdens," (2008).

[6] "Beiträge können kräftig steigen," Süddeutsche Zeitung, 7 January 2008,

[7] David G. Green, Ben Irvine and Ben Cackett, "Health Care in France," Civitas, (2005),

[8] David G. Green, Ben Irvine and Ben Cackett, "Health Care in France," Civitas, (2005),
As always, these sorts of economic facts are tremendously helpful in reinforcing the underlying moral point that health care is not a right. Health care is a commodity that must be created by the thought and work of a rational mind. There is no such thing as a "right" to something that must be produced by another.

When a government attempts to guarantee health care as a "right", it can only do so by violating the actual rights of doctors and other health care providers, who are forced to provide that service on the government's terms and for the government's prices, rather than on their own terms in a free market.

The results we see in Europe and Canada are the result of this idea put into practice.

Wednesday, August 27, 2008

Can Concierge Medicine Solve Our Medical Malpractice Crisis?

Dr. Steve Knope explains that switching to a concierge medicine practice cut his malpractice rates by a whopping 55%. His insurance company gave him the following reasons that they were willing to offer him such a low rate:
1) The fact that patients are willing to pay you directly for your services means that you have a good reputation in the community. We know that lousy doctors cannot sustain a concierge practice.

2) Concierge practices are smaller than traditional practices. By sheer number, the risk of lawsuits is smaller. You have several hundred patients as opposed to several thousand.

3) You have more time to spend with each patient. You are less hurried. You are able to be more meticulous and pay greater attention to detail. This lowers your risk of human error.

4) Though you are capable of making a mistake, you actually have a relationship with your patients. You know them personally. You spend a great deal of time trying to do the right thing for them. Even if you make a mistake, your patients will be more likely to forgive you for human error.

5) Finally, we have looked at over 200 practice years of concierge physicians. To date, we have been unable to identify a single judgment against a concierge physician.
This is yet another example where a free market approach benefits both doctors and patients. I recommend reading his entire blog post.

Tuesday, August 26, 2008

Ten Steps to Better Health Care

Americans for Free Choice in Medicine has a nice set of practical guidelines for navigating through the American health care system entitled "Ten Steps to Better Health Care".

I've listed the main points, but I recommend reading the whole thing because the essay elaborates on each point in greater depth:
1. Think About Your Health
2. Think About How You Use Health Care
3. Know the Doctor
4. Know How the Doctor Is Paid
5. Study the Health Plan
6. Know How the Health Plan Is Paid
7. Save Money
8. Ask for Cash Discounts
9. Recognize That Health Care Is Not a Right
10. Be Personally Responsible for Your Health Care
Update: The link seems to be broken. If I find a working link, I'll repost this.

Monday, August 25, 2008

Baker on Private Medical Care In Canada

A Canadian reader pointed me towards this defense of private medical care in Canada from an LTE in the August 23, 2008 National Post:
Private surgical centres are an essential relief valve for our overburdened public health care system. To see how, let's follow the case of 82-year-old Mrs. Green from Vancouver. She needs knee surgery and has been on an orthopaedic surgeon's waitlist for over two years. In our rationed health care system, her surgeon is "allowed" only six hours of operating room time per week, and he has 129 people on his list ahead of Mrs. Green.

In desperation, she contacts us. Two weeks later, Mrs. Green gets her new knee, in Quebec. Her surgeon there, Dr. Jones, operates at a public hospital but has used up all of his allotted time in the public system. But happily, he also operates in a private Quebec surgical centre every week, after completing his time "quota" in the public hospital. The extra money he earns for this work keeps him from moving to the United States.

When Mrs. Green travelled to Quebec for her new knee, Mrs. Brown moved up one slot on the public waitlist and will get her surgery a week earlier.

To summarize, by being able to operate in a private surgical centre as well as a public hospital, Dr. Jones has the incentive to stay in Canada, Mrs. Green has cut her wait time down to two weeks from 51 and Mrs. Brown will get her surgery in the public system one week sooner.

What part of this scenario do the apologists for our Canadian public health care system not understand?

Rick Baker, Timely Medical Alternatives Inc., Vancouver.
(The LTE was in response to this article in which the head of the Canadian Medical Association advocated a "mixed" public-private system.)

Here's more information about Rick Baker's service. Were it not for the small amount of private medicine permitted in Canada, things would be much worse for Canadian citizens, who would otherwise be forced to rely on the state-run medical system for their care.

It's eerily reminiscent of the small private farms in the former USSR which only occupied 3% of the land compared to the state-run collective farms, but produced over 25% of the crops.

Friday, August 22, 2008

Good Stuff On

Due to external obligations, posting may be light for a few days. Fortunately, Dr. Brian Schwartz (PhD) at PatientPower has some good stuff. For instance:

Are the uninsured really "free riders", or is that just a myth?

Does the current perverse system insurance drive marriage choices?

(I've heard of "job lock", but "spouse lock" takes this to a whole new level!...)

Wednesday, August 20, 2008

Hsieh LTE in Denver Post

The August 18, 2008 Denver Post published my LTE opposing single-payer health care. I was responding to an earlier pro-single payer letter by Kristin Hannum of the group Health Care for All Colorado.

Here's my letter:
Re: "Guaranteed health care is best for America," Aug. 13 letter to the editor.

Kristen Hannum's letter propagates the myth that government-run socialized medical systems can actually "guarantee" health care.

The British government has just told patients the exact opposite when it stated that the National Health Service should deny life-saving care if it is too expensive.

Whenever governments attempt to "guarantee" health care, they must also control it. Canada and England save money through rationing and wait lists. Rather than being "guaranteed," government-run health care becomes a privilege dispensed at the discretion of bureaucrats. Do we really want this sort of system?

Paul Hsieh, Sedalia
Given that Senator Barack Obama has now spoken positively about "single payer" systems, it's especially important to let Americans know why they should oppose this idea.

Tuesday, August 19, 2008

Government "Guaranteed" Care -- Unless It's Too Expensive

Supporters of "universal health care" like to argue that under a government-run system, health care will be "guaranteed".

Unfortunately, the facts of reality show the exact opposite. Recently, the British government has ruled that its National Health Service should deny medical care if the cost is too high:

Patients 'should not expect NHS to save their life if it costs too much'

The NHS should not always attempt to save someone's life if the cost is too much, the medical regulator has ruled...

[T]he regulator says: "There is a powerful human impulse, known as the 'rule of rescue', to attempt to help an identifiable person whose life is in danger, no matter how much it costs. When there are limited resources for healthcare, applying the 'rule of rescue' may mean that other people will not be able to have the care or treatment they need...
This is of course, classic rationing.

In reality, government "guaranteed" health care means that health care is dispensed at the government's discretion, rather than on the basis of what a patient and his physician decide is best.

Do we really want that kind of system for America?

Monday, August 18, 2008

Halderman and Stossel on Life Expectancy Statistics

Dr. Linda Halderman tackles another frequently asked question about nationalized health care:
Q: If socialized medicine is so bad, why do people in countries with government or single-payer healthcare live longer?
Here are excerpts from her answer:
A: Life expectancy in the U.S. compared with that of other countries is often cited to condemn the American healthcare system; the uninsured are dying from lack of health insurance and treatment, it is argued, while countries with universal coverage live longer as the result of their healthcare systems.

But is life expectancy primarily dependent on having health insurance? Is access to healthcare services the main determinant of longevity?


Motor vehicle fatalities are the leading cause of death for Americans aged 1-29. Driving under the influence of alcohol is the most common factor in fatal crashes. For every reported death related to a motor vehicle crash, it is estimated that thirteen individuals are injured severely enough to require hospitalization.

...Supporters of government-provided healthcare often attribute longevity to healthcare access without considering the impact of other factors. Healthcare access in the U.S. has less of an impact on mortality statistics than trauma.
She also discusses obesity, smoking and crime, concluding:
As you can see, comparing life expectancy in countries where government foots the insurance bill to our system here is like equating apples and oranges. Conditions relating to obesity, tobacco use, alcohol, and violence make America unique. Adopting a national health insurance model will not necessarily lead to a longer life.
ABC News reporter John Stossel makes a similar point in this article:
Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.

Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.
Using international life expectancy statistics as a justification for a government takeover of medicine is misleading and dangerous. Fortunately, some doctors and reporters know better.

Saturday, August 16, 2008

Pueblo Chieftain Against Single-Payer

The August 10, 2008 Pueblo Chieftain published the following good editorial against single-payer health care:
Love story

The recent 40th anniversary of Medicare was observed in Pueblo by several doctors calling for a single-payer health insurance program for all U.S. residents.

Single-payer is a euphemism for government-controlled health care. If you are enamored of the Postal Service, you will simply love health care directed by bureaucrats in Washington, D.C.

The fact that Medicare already limits the payment for much of America's health care should tell the medicos something. It's that, when a finite number of tax dollars are going to pay for health care, there will be rationing.

One only needs to look north of the border, where health care is a government-run enterprise. People with serious ailments often must wait for months to get the treatment they need, and some die waiting. Canadians who can afford it often travel south to the United States to get the care they need when they need it.

The same can be said of government-run health care in Great Britain. The English may wait for care while keeping a stiff upper lip, but this ain't the United Kingdom. Ironically, less than a week after American "Medicare for all" was being touted, the Government Accountability Office reported that about 10 per cent of Medicare dollars for medical equipment such as wheelchairs are going to fictitious sellers. The government has been aware of these shenanigans for at least three years, but the bureaucracy has been slow to shore things up.

People say they want health care that's the highest quality, available to all and inexpensive. It's axiomatic that you can have any combination of two, but not all three.

Which one do the single-payer advocates want to do away with?

Friday, August 15, 2008

The Ethics of Concierge Medicine

Dr. Steven Knope addresses some of the common myths about concierge medicine. In particular, he tackles the following four misconceptions:
Myth # 1: The only ethical way to save our medical system is to create a universal health care system managed by the government and abandon private medicine.

Myth #2: Concierge Medicine doctors only see wealthy patients, abandoning the poor and middle class.

Myth #3: Health care is a right! People should not have to pay for their healthcare.

Myth #4: Concierge doctors are only concerned with money. There is no reason that they cannot care for complex patients with multiple medical problems in an eight-minute office visit.
I recommend reading the whole thing, because Dr. Knope provides a positive moral defense of his profession.

Concierge medicine is a natural consequence of the free market, where physicians and patients can voluntarily negotiate using their rational judgment according to their mutual interest. Patients receive quality care for a fair price, and physicians are able to practice good medicine according to their professional conscience. Both sides win as a result.

Thursday, August 14, 2008

Tales From Canada

One Canadian resident pointed out to me that socialist policies may seem successful in the short term due to the initial looting of taxpayers, but this is not sustainable in the long run. Economic reality then sets in, with the inevitable shortages and rationing.

Here's a slightly edited version of his e-mail, quoted with his permission:
...When Canada's Health Care System was nationalized, I predicted, to any who would listen, that in 15 years its initial flush of great service would decline from 'lack of funds' (1985). That is exactly what happened, but health care professionals took dozens of steps to mask or hide that effect. E.g., for the last decade, in the hospital where [a family member] works, an entire ward of ~25 beds has been used for storage, while patients lie on gurneys in the hallways. It is closed because the government will not provide enough funds for nurses to man it. Many staff in the hospital are unaware of this closed ward, even as they walk past it every day. Patients on those gurneys who die of heart failure or stroke, while awaiting for surgery, are not listed as having died from "waiting".

Similarly, emergency-ward wait times have been increasing. I used to hear of people waiting as much as twelve hours, but recently spoke to a man in who had to wait 36 hours while in considerable pain (a new record for my mental tracking of wait times). Meanwhile, an architecturally stunning new cancer wing has been built with private funds provided by local construction magnate... Outside there are gardens and statues of ordinary looking people 'leaving the building'. A sign tells us they are "Survivors". The wing has received a great deal of positive media attention and garners lots of oohs and aahs, but elsewhere there are still ~25 beds unavailable for other patients.

The hospital president is good friends with [a local politician]. When that friend became the province's Minister of Health the president was very excited that, with a little "schmoozing" (his word) he would now be able to get money for the hospital. Yes, that's how it's done!
More American politicians should learn what medical care is really like in Canada, before advocating a similar system for the US:

Wednesday, August 13, 2008

Schwartz Vs. Krugman on Universal Health Care

Dr. Brian Schwartz, health care blogger for the Independence Institute, takes on the latest New York Times opinion piece by Paul Krugman singing the praises of government-run "single-payer" health care. Here are a few excerpts from Dr. Schwartz's piece:

If citizens of these other wealthy countries have guaranteed care, can Dr. Krugman explain to me to following instances of people in these countries not getting needed medical care:

  • The British National Post reports on “How the NHS is letting my father die - by a top hospital consultant.”
  • The Globe and Mail reports that “More than 100 Canadian women with high-risk pregnancies have been sent to United States hospitals over the past year – in what a doctors’ group attributes to the lack of a national birthing plan.”
  • The Canadian Medical Association Journal reports that in one year, 71 Ontario patients died while waiting for coronary bypass surgery and over one hundred more became “medically unfit for surgery.”
  • The Canadian Broadcasting Corporation reports that “109 people had a heart attack or suffered heart failure while on the waiting list. Fifty of those patients died.”
  • The Globe and Mail also reported that “More than 400 Canadians in the full throes of a heart attack or other cardiac emergency have been sent to the United States because no hospital can provide the lifesaving care they require here.”
  • A Daily Telegraph headline reads: “Sufferers pull out teeth due to lack of dentists.” “Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives,” reports another article.

(Read the whole piece here.)

My own thoughts: This is the consequence of "universal health care".

Whenever the government attempts to guarantee a good or service such as health care, it must also control it. The inevitable end result of attempting to make health care a "right" is this sort of rationing and waiting lists. Far from being a "right", government health care then becomes a privilege dispensed at the discretion of bureaucrats who control those lists. Ask any Canadian who has waited 8 months for his knee MRI scan, while the son of a well-connected politician jumps to the front of the line.

The flawed premise behind "universal health care" is regarding health care as a "right". Health care is a need, but not a "right", and that's a critical difference. A right is a freedom of action, such as the right to free speech or right to contract. It is not an unearned automatic claim on the goods or services produced by another person -- that's just state-sanctioned theft or slavery. Just because my neighbor is hungry, it doesn't give him the right to take a can of soup from my pantry.

Rights only impose negative obligations on others -- for instance, my right to free speech only means that someone else (my neighbor or the government) can't stop me. If someone chooses to leave me alone, then he hasn't violated my rights.

In contrast, the various entitlements (such as an alleged "right" to health care) imposes a positive obligation to provide something to someone (e.g., an appendectomy). One of the biggest problems with modern-day America is the proliferation of positive "entitlements" which are mistakenly called "rights".

Any alleged "right" to health care can only be implemented by violating the actual rights of doctors and other health care providers. This is why "universal health care" is such a grossly immoral policy, and should be opposed as such.

(Via MedPolitics.)

Tuesday, August 12, 2008

Zinser Interview on "Politics Cafe"

FIRM's executive director, Lin Zinser, was interviewed on August 11, 2008, by Mark Belcher on "Politics Cafe", a popular internet talk radio talk.

The MP3 audiofile for her interview can be found here.

Manion LTE on Mandated Insurance

The August 11, 2008 Denver Post printed the following good LTE criticizing mandatory health insurance:
More government mandates for health care?

When part of a building is on fire, panic has been known to drive a crowd directly into the fire.

Such is Froma Harrop's call for even more government interference in the health care industry.

She likes the insurance mandate in Mitt Romney's Massachusetts health plan:
"Everyone must get coverage. Those who don't, pay a penalty. The uninsured holdouts tend to be young, male and in good to excellent health. They figure that if something goes wrong, they can report to the emergency room where they'll get free care. Such people are called 'free riders.'"
The problem is real, but what is the cause? Why do people get free emergency room care? It's because of existing government mandates!

So we are to solve the problems caused by one government mandate with another government mandate? Where will it all end?

We are fast approaching the point where every aspect of life will be either mandatory or prohibited.

Clarence Manion, Lyons
For more information on why mandatory insurance has failed in Massachusetts, the home state of Mitt Romney, see our collection of links here.

Monday, August 11, 2008

Massachusetts Dental Pain

Massachusetts blogger Paula Hall dissects the latest problem with Massachusetts' universal health care -- lack of dental care -- in her latest blog post, "A Pocket Full of Insurance and no Dental Care to Buy".

Here are some excerpts she's highlighted from the following article in the August 7, 2008 Boston Globe. Again, it highlights the fact that "coverage" is not the same as actual care:
Dental benefits widen, waiting lines grow

Two years into the state's bold healthcare experiment, its early success in expanding dental coverage may be threatened by a shortage of dentists willing to treat newly insured patients.

...Dentists say the state's reimbursement rate for adults covers only about half their costs, and they also cite payment delays and burdensome paperwork.

...The Massachusetts Dental Society has been urging members to join, saying it is the responsible thing to do. But it's been slow going.

...Michael Wasserman, a Pittsfield dentist who treats some subsidized patients [stated,] "I think if a dentist is going to treat these patients he or she should not be forced to lose money."
Dr. Wasserman is exactly right and the Massachusetts Dental Society is exactly wrong here. It is wrong for the state dental society to claim that their member dentists have a moral responsibility to work at a loss. No has the right to demand that one person commit professional or economic suicide for the sake of another.

Currently dentists can still remain financially viable because they are not forced to accept everyone covered by the state plan, but can voluntarily choose how many of the government-covered patients they will accept. In essence, the private sector patients are continuing to subsidize the government patients.

But if the socialists have their way, private insurance is outlawed, and the government pays all dental bills (i.e., "single payer"), what will happen? How many dentists will continue to practice if they have to work at a loss?

At the economic level, the big mistake is conflating "coverage" with actual health care. David Hogberg explains the danger of this fallacy at, "'Health care,' more or less".

At the philosophical level, the underlying problem is the premise that dental care is a "right". If idea is fully and consistently implemented, this essentially turns dentists into slaves of the state. Massachusetts hasn't gotten there yet, but it is moving in the wrong direction. We shall see how far Massachusetts dentists are willing to go along with this idea before they rebel.

Friday, August 8, 2008

Two Medicare Anecdotes

I recently read the following e-mail about Medicare from a US medical student, which I am quoting with his permission:
My grandparents just this past week were told by their personal physician of 20 years (a close friend at that) that he was leaving his private practice to be a hospitalist for the same pay at half the hours, simply sacrificing his freedom in setting his own schedule. He did this because because the cost (both in time and effort) of practicing on his own was too great. When asked by my grandparents who he would recommend they seek out as their new doctor, he said he knew of no one taking on new Medicare patients in their town of over 100k.

I see this as leaving us as future physicians at a crossroads... go into private practice and spend a good deal of our time dealing with bureaucracy, but having a level of autonomy in treating our patient's as we see fit, or being an employee of hospital subject to the rules and regulations of administrators separated from actual patient care.

One possible solution to those of us interested in having the freedom and autonomy of private practice is exemplified by a [location deleted] general surgeon I had the pleasure of playing golf with a few months back. He had decided to stop treating Medicare patients which were 40% of his patient base, but accounted for 13% of his total income. By doing this, he was able to close his office one day a week (playing more golf he noted), saving the salary/wages/overhead that running a private practice office entails. In the end, he said he made slightly more money b/c he was able to eliminate the expenses required to treat these patients.
There are some politicians who wish to nationalize health care along the lines of "Medicare For All", on the grounds that Medicare has been such a huge success. Of course, this is a myth that has been rebutted numerous times.

But stories like this should give those politicians pause, since Medicare clearly penalizes doctors for treating patients. The recently described RAC bureaucratic nightmare is just one small example of this. If nationalized health care is imposed in this country, I anticipate many doctors will simply reduce their hours, retire early or quit medicine altogether to go into other fields.

Nor is this simply a matter of throwing more money at Medicare. If more money is thrown at it, costs will skyrocket out of control. Conversely, if costs are kept down by government controls, it will necessarily result in rationing. This is a consequence of a system in which the state attempts to guarantee health care. Such systems are doomed to fail, because they run contrary to normal free market mechanisms.

In contrast, the free market consistently delivers goods and services in a fashion where prices decline and quality goes up with time -- the exact opposite as we see with Medicare and other government-run health care. Note that we never hear of rationing with computers or cellphones.

The last thing this country needs is "Medicare For All"; instead we need the only moral and practical solution -- free market health care and health insurance for all.

Thursday, August 7, 2008

Government-Run Hospitals in the UK...

... are infested with vermin:
...Vermin were found in wards, clinics and even operating theatres. A patients' group said the situation was revolting.

..."If these hospitals were restaurants they would be closed down and out of business."
Don't you feel better about "universal health care"?

(Via Instapundit.)

Wednesday, August 6, 2008

Putting Doctors on the Medicare RAC

Dr. Evan Madianos has alerted me to the next possible Medicare cost-containing measure -- the Recovery Audit Contractor or RAC. Basically, these are people who are given the task of finding overpayments from Medicare to doctors, and was initially implemented in 2005 as a pilot program in three states (California, Florida, and New York), then later expanded in 2007 to include three more states (Massachusetts, South Carolina, and Arizona).

According to this article:
Because the contractors were paid in part based on how many overpayments they found, they were soon referred to as "bounty hunters," a moniker that still persists.

Physicians in California and Florida complained that the contractors used questionable tactics. They say the RACs made medical necessity determinations based on written Medicare coverage guidelines without the input of a single physician. Contractors reviewed claims that Medicare carriers already had adjudicated, misinterpreted coding statutes and went on fishing expeditions by demanding scores of records at a time. For the most part, CMS [Centers for Medicare & Medicaid Services] officials were powerless to review the RACs' work unless a doctor lodged an official appeal.
The article also describes in detail the "Kafka-esque" nightmare of Dr. Jeffrey E. Kaufman, a urologist accused of overbilling for drugs. Only after he spent "countless hours of unpaid work" submitting numerous records and appeals, did he finally clear his good name of the accusations of financial impropriety.

Many physicians don't even bother to dispute the charges but instead just pay the penalty, because "the cost to the practice of retrieving the corresponding record and forwarding the information could be 10 times that amount" of the requested fine.

As this program is implemented nationwide, I expect we'll see large numbers of RAC "bounty hunters" making money by alleging real or imagined billing errors by physicians who are caught in a maze of increasingly-complex Medicare regulations that no one can be reasonably expected to follow.

This will then spawn a new set of RAC consultants who will (for a price of course) tell physicians how to keep clear of the RAC "bounty hunters". As one such consultant promises:
What you'll learn:

* What RAC-stricken physicians and clinics are dealing with now.
* 3 Must-do steps to prepare for RAC audits -- as well as OIG and Medicare contractor visits.
* Can I -- and should I -- appeal RAC decisions? Here's what the experts say.
* Future concerns: projecting problem area identification and the expansion of external audits.
* What types of facilities and specialties RACs are targeting next.
In turn, this will spawn new laws to close the "loopholes" allegedly being "exploited" by "greedy" physicians trying to cheat the government, etc., etc.

The end result will be that the bureaucrats and parasites who create no actual value will make out like bandits, while the producers (i.e., the physicians) get sucked dry.

When doctors are obliged to pay the salaries of their own destroyers, this takes us dangerously close to the nightmare scenario depicted in the classic novel, Atlas Shrugged.

(Of course some doctors have decided to opt of the Medicare altogether and adopt alternative practice models, such as concierge medicine. If Medicare continues to create disincentives for physicians, I expect this trend will accelerate, just as the large numbers of Baby Boomers hit retirement -- in which case things are going to get very interesting very quickly...)

Tuesday, August 5, 2008

Infant Mortality

Dr. Linda Halderman tackles this frequently asked question:
If socialized medicine is so bad, why are infant mortality rates higher in the U.S. than in other developed nations with government or single-payer health care?
In particular, she discusses some of the reasons that these comparisons showing the alleged superiority of single-payer care are misleading. Here are a few excerpts:
...According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.

But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies -- considered "unsalvageable" outside of the U.S. and therefore never alive -- is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.

...Forty percent of all infant deaths occur in the first 24 hours of life.

In the United States, all infants who show signs of life at birth (take a breath, move voluntarily, have a heartbeat) are considered alive.

If a child in Hong Kong or Japan is born alive but dies within the first 24 hours of birth, he or she is reported as a "miscarriage" and does not affect the country’s reported infant mortality rates.
Thank you, Dr. Halderman! (Via J.Lewis.)

Monday, August 4, 2008

Bredensen on Health Care Reform

Tennesseee Governor Phil Bredensen recently made an interesting analogy in his July 31, 2008 OpEd in USA Today:
Think gas prices are high? Watch out for health care

...Imagine a trip to a grocery store. You walk up the aisles as usual, while attractive displays compete for your attention. You fill your basket, take it to the checkout, and the clerk rings it up. But you never see any price or total, and the bill is just sent to some anonymous party for payment. A box of oatmeal would cost $20 at that grocery, and that is exactly the way our health-care economy works today.

That grocery store is not going to be straightened out by tax credits for the purchase of oatmeal or by a better grocery information system. America has a wonderful and efficient economic system where competition drives innovation and value; we can and should put it to work in health care.
I believe Governor Bredensen is exactly right on this point. The perverse economic incentives of our employer-based health insurance system lead to rampant overutilization of services, because individuals don't directly experience the financial consequences of their choices as they would if they purchased a new washing machine or stereo. Then when costs run wild, the government offers various forms of rationing as a "solution" to the problem.

Note: I strongly disagree with Gov. Bredensen's proposed solution, which entails more government interference in the free market, along the lines of "Social Security or Medicare" -- hardly models of solvency. Overall, I regard his OpEd as mixed, because he recognizes that market forces are good, but unfortunately he isn't willing to take the next logical step and advocate for a free market as the proper solution.

Friday, August 1, 2008

More Commonwealth Errors Debunked

A couple of weeks ago, the Commonwealth Fund released yet another report sharply critical of US health care, claiming that we ranked 19th out of 19 Western Countries, supposedly worse than Greece, Spain, Portugal, and Italy.

Fortunately, Linda Gorman of the Independence Institute has written a devastating critique of the Commonwealth study entitled, "Commonwealth Ranking: Are We Really 19th Out of 19?". She discusses numerous methodological problems with their report, including:
Choosing Nonmedical Benchmarks
Cherry-Picking the Benchmarks
Using Questionable Benchmarks
Equating Low Spending with Efficiency
Using Questionable Measurements
Confusing "Access" with "Third-Party Insurance"
Ignoring Self-Insurance
Ignoring Assets
Applying the Commonwealth Criteria of "Underinsured" to the Medicare Population
Ignoring Rationing by Waiting
Misusing Statistics.
Each of those points is covered in greater detail.

She also discusses a number of measures in which the US has improved between 2006 and 2008, but which were not regarded as significant by the Commonwealth Fund, including:
1. Deaths per 100,000 population fell.
2. Infant mortality fell.
3. Higher percentages of adults and children received recommended preventive care.
4. Higher percentages of diabetics and hypertensive adults had better blood sugar and blood pressure control.
5. A higher percentage of hospital patients received recommended care.
6. A higher percentage of heart failure patients received written discharge instructions. (This is a process measure, whether it improves outcomes is unknown.)
7. A slightly lower percentage of patients reported medical, medication, or lab test errors.
8. A lower percentage of children were prescribed antibiotics for a sore throat without first getting a strep test.
9. A smaller percentage of short-stay nursing home residents developed pressure sores.
10. A higher percentage of patients reported that doctor-patient communication was adequate.
11. A higher percentage of adults reported that they had no cost barriers to health care access.
12. Actual to expected deaths for hospital mortality ratios fell from 101 to 82.
For those who are interested in the details, I highly recommend reading the whole thing.

As John Goodman points out, "On his way to get health care at the Cleveland Clinic, Italian Prime Minister Silvio Burlesconi probably flew over a half dozen higher ranking countries, not to mention his own. What could he possibly have been thinking? Doesn't he read Commonwealth reports?"