Wolf On Death Panels

Dr. Milton Wolf has a new OpEd in the Washington Times, "Lies, damn lies and death panels".

In particular, he makes a powerful point about the new government policy of "encouraging" end-of-life counseling:

...[T]here is nothing certainly inappropriate about discussing end-of-life care with patients so long as the patient and their family can maintain complete trust that their doctor is providing caring -- and this is crucial -- uncoerced advice. Quite the contrary, it absolutely should be done, but it's a far too important part of the doctor-patient relationship to permit the government to determine how and when. These difficult decisions are undermined unless they are made freely by the patient and his or her family...

Not only have I, as a physician, counseled many families in these trying end-of-life times - a heart-rending and life-changing experience for all of us involved -- but I learned firsthand of their importance when my father, himself a physician, made his own wishes known to us in the final months of his life. If ever a family's decision should be held sacred from the government, this is it.

(Read the full text of "Lies, damn lies and death panels".)

Once the government starts specifying which medical options are "reasonable" or "effective", it undermines physicians' ability to be honest advocates for their patients and instead turns them into agents of their government paymasters.

The end result: Bureaucrats then determines whether patients live -- or die. But just don't call them "death panels".

Criminalizing Patients and Doctors

In the 12/24/2010 Daily Beast, Shikha Dalmia describes how ObamaCare will criminalize both patients and doctors.

In particular, if physicians render "unnecessary" or "ineffective" care to Medicare patients, they could be punished for committing Medicare fraud. Of course, the government gets to decide what counts as "ineffective". Patients may not have heard much about "comparative effectiveness research" -- but they soon will.

With respect to Medicare patients the government is in effect saying, "We won't tell you how to practice medicine -- we don't presume to interfere with your professional judgment. But by the way, if you treat patients in a way we don't approve of, you'll be punished."

(Read the full text of "Obamacare Criminalizes Medicine".)

ObamaCare must go.

Effects of ObamaCare

How have insurers responded to new ObamaCare rules? This list discusses the various rate increases and coverage drops across the country.

Read more at, "Hurtling to Single-Payer: A Reference Guide to ObamaCare's Trail of Destruction".

Of course, government official keep insisting that we can't blame ObamaCare for these rising costs.

Is your state next?

(Via WolfFiles.)

New Rules For 2011

Paul Gessing explains that, "ObamaCare hits my health care (and maybe yours) starting Jan. 1".

In other words, more government controls over how you can spend your own money for your own benefit.

Price Controls and Life Controls

The New York Times published a couple of interesting stories lately on government plans for health insurers and for you:

"Health Insurers to Be Required to Justify Rate Increases Over 10 Percent" (12/21/2010)

"Obama Returns to End-of-Life Plan That Caused Stir" (122/25/2010)

In other words, the government will tell insurance companies how much they will be allowed to charge for their services.

And they will "encourage" doctors to help patients plan for their deaths.

My prediction: Over time, this will inevitably lead to government "encouraging" doctors to help patients decide that certain treatments to extend their lives are too expensive and not worth considering. The government will hijack the the trust patients currently place in their physicians to be their honest advocates and instead use financial incentives to have physicians promote the government's preferred end-of-life spending priorities.

But just don't call them "death panels"!

Unless ObamaCare is repealed, expect to see more such price controls and life controls.

(Links via ReasonPharm and Instapundit.)

Holiday Break

Because of the Christmas holiday, I'll be taking a short blogging break. Regular posting will resume next week.

Merry Christmas, everyone!

Quick Links: Turner, Ralston, Fraser

In the 12/21/2010 Washington Examiner, Grace-Marie Turner explains why "Obamacare is a government takeover".

In the 12/17/2010 Orange County Register, Richard Ralston discusses the FDA Avastin ruling at "Political mugging of a valuable drug".

The Fraser Institute has published, "Waiting Your Turn: Wait Times for Health Care in Canada 2010 Report". A couple of excerpts:

The total waiting time between referral from a general practitioner and delivery of elective treatment by a specialist, averaged across all 12 specialties and 10 provinces surveyed, has risen from 16.1 weeks in 2009 to 18.2 weeks in 2010.

Canadians wait nearly 3 weeks longer than what physicians believe is "reasonable" for elective treatment after an appointment with a specialist.

Full Fraser Institute report (PDF version) here.

Catron: Obamacare and the Broccoli Mandate

David Catron has a new OpEd in AmSpec, "Obamacare and the Broccoli Mandate".

As he notes, the issues run much deeper than health care. Instead, the key issue is freedom -- specifically, should the government be able to deprive you of your freedom to act on your own best judgment and instead force you to do what it thinks is "best" for you?:

...[T]he Obama administration... presumably believes that the commerce clause gives the federal government the authority to regulate virtually every decision we make in our day-to-day lives. Indeed, the belief that Washington can -- and should -- supervise us as if we were a nation of children is the core tenet of their nanny-state political philosophy.

This is the belief system that prompted First Lady Michelle Obama to say, as her husband signed a law that will regulate what children eat during summer vacations and what can be sold in school vending machines, that child nutrition is something "We can't just leave... up to the parents." Without the "help" of the federal government, some mother might fail to force broccoli on her kids.

Likewise, we "can't just leave it up" to the patients to decide for themselves if they should buy health insurance. Indeed, according to the Obama administration, there is something sinister in the very suggestion that we must allow them to do so.

In other words, "We're from the government, we're here to help you -- And if you don't let us, we'll punish you."

Fortunately, more and more Americans aren't buying it. A recent Rasmussen poll shows, "For First Time Ever, Most Voters Think Health Care Repeal Likely".

Let's hope our new Congress and our judges take heed.

What Every Medical Student Should Remember About Randomized Clinical Trials

Classic story by Dr. E. E. Peacock, Jr.:

One day when I was a junior medical student, a very important Boston surgeon visited the school and delivered a great treatise on a large number of patients who had undergone successful operations for vascular reconstruction. At the end of the lecture, a young student at the back of the room timidly asked, "Do you have any controls?"

Well, the great surgeon drew himself up to his full height, hit the desk, and said, "Do you mean did I not operate on half the patients?"

The hall grew very quiet then. The voice at the back of the room very hesitantly replied, "Yes, that's what I had in mind."

Then the visitor's fist really came down as he thundered, "Of course not. That would have doomed half of them to their death."

God, it was quiet then, and one could scarcely hear the small voice ask, "Which half?"

Dr. E. E. Peacock, Jr., University of Arizona College of Medicine; quoted in Medical World News (September 1, 1972), p. 45, as quoted in Tufte's 1974 book Data Analysis for Politics and Policy.)

(Quote via Raw Meat, found via Marginal Revolution.)

Flirting With Unintended Consequences in Massachusetts

The December 18, 2010 Boston Globe illustrates yet another unintended consequence of mandatory insurance benefits in Massachusetts, this time involving flirtatious models wearing short skirts and blue wigs (!)

Here's an excerpt from, "Surge in marrow testing probed":

The state’s largest health insurers began noticing at least a year ago that UMass Memorial Medical Center was submitting an extraordinary number of expensive claims for bone marrow testing and charging higher rates than other providers.

But it was not until this week that one reason for the surge in claims became clear: The Worcester hospital hired models who wore short skirts, high heels, and sometimes sported neon blue wigs to recruit bone marrow donors at malls in Massachusetts and New Hampshire, Red Sox and Patriots games, and flower shows.

The article continues:

The situation is a window into how costs can spiral in the health care system, and the unintended consequences that can occur, when insurers are required to pay for a particular service, even a worthy one.

In the last decade, Massachusetts, New Hampshire, and Rhode Island became the only states where legislators mandated insurers pay for bone marrow testing.

(Read the full text of "Surge in marrow testing probed". The issue is also covered in this December 16, 2010 New York Times story "Flirty Models Were Hired in Bid to Find Bone Marrow".)

This should come as no surprise to journalists. Whenever the government compels insurance companies to pay for a specific service, it creates a natural incentive for others to artificially inflate both the price and the demand for that service. The only unusual aspect about this case was how blatant the manipulation was, which was what allowed the hospital to get caught more easily.

Otherwise, the high costs incurred by the hospital of hiring these attractive young models would have been quietly passed along to the insurance companies, then eventually to Massachusetts residents forced to purchase mandatory insurance (or to the taxpayers).

What we don't know yet is how many more similar-but-stealthier examples of this are still happening with respect to other medical services in Massachusetts? Or how much of this will happen in the other 49 states under ObamaCare?

(Link via @Bettina702.)

Cuba Banned Michael Moore Film "Sicko"?

According to the December 17, 2010 Guardian, Cuba banned the Michael Moore film "Sicko" because it falsely portrayed their socialized health system as better than it really was.

From the article:

Cuba banned Michael Moore's 2007 documentary, Sicko, because it painted such a "mythically" favourable picture of Cuba's healthcare system that the authorities feared it could lead to a "popular backlash", according to US diplomats in Havana.

The revelation, contained in a confidential US embassy cable released by WikiLeaks , is surprising, given that the film attempted to discredit the US healthcare system by highlighting what it claimed was the excellence of the Cuban system.

But the memo reveals that when the film was shown to a group of Cuban doctors, some became so "disturbed at the blatant misrepresentation of healthcare in Cuba that they left the room".

Castro's government apparently went on to ban the film because, the leaked cable claims, it "knows the film is a myth and does not want to risk a popular backlash by showing to Cubans facilities that are clearly not available to the vast majority of them."

(Read the full text of "WikiLeaks: Cuba banned Sicko for depicting 'mythical' healthcare system".)

I don't condone the actions of Wikileaks in releasing secret US diplomatic documents.

But the irony in this particular case was simply too perfect.

Update: Michael Moore is disputing this story.

Hmm, who should we trust here: US government officials or Michael Moore? Unfortunately, neither have a great track record with respect to unassailable honesty!...

Hsieh PJM OpEd: "Beware Counterfeit 'Responsibility'"

PajamasMedia has published my latest OpEd, "Beware Counterfeit 'Responsibility'":

My theme is that the Obama Administration's version of "individual responsibility" (also shared by many Republicans) is a counterfeit version of the concept aimed masking its drive to subvert genuine responsibility and freedom.

Here is the opening:

The ObamaCare individual insurance mandate met its first courtroom defeat when Judge Henry Hudson ruled it unconstitutional in Commonwealth of Virginia v. Sebelius. But while the legal battle is likely to smolder on for years until it reaches the U.S. Supreme Court, the rhetorical battle is heating up in the court of public opinion.

In particular, the Obama administration is attempting to defend the individual mandate as a matter of "individual responsibility." If Americans allow them to get away with this counterfeit notion of "responsibility," it will jeopardize the freedoms that make genuine individual responsibility possible...

(Read the full text of "Beware Counterfeit 'Responsibility'".)

Domestic Medical Tourism

As health costs continue to rise, some entrepreneurial doctors and patients are taking advantage of domestic medical tourism for elective procedures. From the article:

Employers who fund their workers' health coverage are also eager to contain mounting medical costs, Stephano says. They may offer a range of inducements to persuade a patient to have a more affordable procedure, she says.

A $100,000 heart bypass could be had for as little as $32,000 at hospitals working with a facilitator (according to figures provided by BridgeHealth).

Bob Ihrie, senior vice president for employee rewards and services at Lowe's Companies Inc., led a group of five large employers who negotiated special rates with the highly respected Cleveland Clinic to perform heart, back/spine and knee/hip surgeries. While the other companies have not yet announced their plans, Lowe's has already sent 16 employees to Cleveland for surgery since the program launched on April 1, with 14 others scheduled for procedures or awaiting approval.

(Read the full text of "Healthcare: Pay Less, Travel Less".)

As with overseas medical tourism, patients can shop around for quality care at heavily-discounted prices. And one advantage of domestic (as opposed to foreign) medical tourism is that US malpractice laws still apply -- thus giving patients legal recourse if something goes wrong.

This isn't a complete solution to the problems raised by ObamaCare. But it may help in the short-to-medium turn until our politicians finally repeal that law.

For other strategies patients can adopt in the meantime, see "How to Protect Yourself Against ObamaCare" from the Summer 2010 issue of The Objective Standard.

(Article link via J.G.)

Quick Links: Forbes, Florida, and II

Forbes recently published two pieces on ObamaCare:

"The Irresponsible Individual Mandate" by Yaron Brook and Don Watkins of the Ayn Rand Center for Individual Rights.

"Don't Tweak ObamaCare; Repeal It" by Dr. Scott Atlas. (Dr. Atlas is both a senior fellow at the Hoover Institute as well as a professor of radiology at Stanford. I used Dr. Atlas' excellent neuroradiology textbook during my residency.)

HealthCareLawsuits.org discusses the next big legal challenge to ObamaCare happening today in a Florida court.

Brian Schwartz of PatientPower links to this audio from the Independence Institute (aka "II"), "Kopel & Natelson discuss Virginia v. Sebelius".

Wolf: Mr. President, Tear Down This Law

In the 12/15/2010 Washington Times, Dr. Milton Wolf offers some good advice to the President, "Mr. President, tear down this law".

From the OpEd:

...[I]t was the individual mandate to purchase insurance that was determined to exceed the letter and spirit of the Constitution. But this ruling threatens the entire edifice of Obamacare because that mandate is the central linchpin of the Affordable Care Act. In the simplest of terms, the goodies Obamacare promises depend on the money brought in by compelling young, healthy Americans to purchase more insurance than they need. It's a clever version of redistribution, but it's not immune from this one simple reality: no money, no goodies.

Dr. Wolf then goes on to explain how the combination of requiring insurers to take all comers regardless of pre-existing conditions but without the mandate will make private insurance quickly unaffordable. Many patients will "game" the system and only purchase insurance when they become ill.

Or as Amanda Teresi once explained, "It would be the equivalent of not having any car insurance, hitting a tree, and then calling Geico and saying you want to sign up. It doesn't make sense."

Dr. Wolf advises the President:

Be bold. Lead the charge to repeal Obamacare. I know this is against every instinct you have, but look where your instincts have gotten you. This is your chance to hit that reset button.

This is excellent advice from the good doctor. Whether the President listens is a separate matter altogether...

(Read the full text of "Mr. President, tear down this law".)

Quick Links: Orient, Cowen, Siegel

Dr. Jane Orient of AAPS explains, "What Healthcare Reform “Comparative Effectiveness Research” Means to You".

In the 12/11/2010 New York Times, Tyler Cowen notes, "Following the Money, Doctors Ration Care"

In the 12/10/2010 New York Post, Dr. Marc Siegel discusses the "Flight of the MDs" from ObamaCare.

Some Hudson Ruling Reactions

Now that Judge Hudson has ruled the ObamaCare individual mandate to be unconstitutional, what does that mean and what's next? Here are some helpful reactions and analyses:

"A Noxious Commandment", Randy Barnett, New York Times.

"Highlights From the Ruling", and a more detailed analysis, "ObamaCare Loses in Court", Wall Street Journal.

"Key points in Virginia v. Seblius", David Kopel, Volokh Conspiracy.

"Initial Thoughts on the Virginia Health Care Ruling", Jonathan Adler, Volokh Conspiracy.

"Health Care Law Individual Mandate Unconstitutional", Doug Mataconis, Outside the Beltway.

Breaking News: ObamaCare Ruled Unconstitutional

This is obviously a fast-breaking story.

From AP, "Federal judge in Va. strikes down health care law".

You can read the full ruling by Judge Hudson here in PDF format (mirrored here) or here on Scribd.com.

Law professor William A. Jacobson also quotes from Hudson's ruling:

However, the bill embraces far more than health care reform. It is laden with provisions and riders patently extraneous to health care -- over 400 in all.... [at p. 38]

This will almost certainly now go to the US Supreme Court.

Severability Update

At the Volokh Conspiracy law blog, Randy Barnett notes, "White House Concedes Individual Mandate is Not Severable".

If so, this could make today's expected court ruling on ObamaCare very interesting, as Thomas Lifson notes in, "Court to rule on ObamaCare constitutionality Monday" (American Thinker, 12/10/2010).

Today's Wall Street Journal has a nice background piece, "Federal Judge to Rule on Health Law's Constitutionality".

If you missed it earlier, David Catron covered some important background information in his 12/7/2010 article, "Of Severability and Sins of Omission".

The Avastin Travesty

At today's PajamasMedia, Thomas Bowden of the Ayn Rand Center for Individual Rights discusses "The Avastin Travesty".

In particular he describes why the flawed view of a "right" to health care leads to insoluble problems of rationing and cost control in this Pajamas Media piece. The collectivist approach to health policy necessarily harms individual patients in the end. Read the full text.

(For more on this topic, see my related PajamasMedia piece, "Avastin and Your Life".)

Why Health Care Costs Are Still Rising

Devon Herrick at NCPA discusses, "Why Health Costs Are Still Rising".

The short answer:

A primary reason why health care costs are soaring is that most of the time when people enter the medical marketplace, they are spending someone else's money. When patients pay their own medical bills, they are conservative consumers.

In particular, Herrick notes that our current third-party payor system results in:

* For every $1 worth of hospital care consumed, the patient pays only about three cents out of pocket, on the average; 97 cents is paid by a third party.

* For every $1 worth of physician services consumed, the patient pays less than 10 cents out of pocket, on the average.

* For the health care system as a whole, every time patients consume $1 in services, they pay only 12 cents out of pocket.

Herrick contrasts that with the sectors of medicine where consumers pay the bills rather than third parties, such as cosmetic surgery. He notes that in those sectors, demanding consumers seek the best value for their dollar -- and the result is that providers offer ever-improving services at lower prices.

(Read the full text of "Why Health Costs Are Still Rising".)

Suppose food were treated the same way as health care, where one paid a monthly premium to a "food co-op", then got to eat at restaurants where the coop would pay 88-97% of the bill. Hence, consumers only had to cover a "food co-pay" of 3-12%. Would most people eat frugally? Or would they eat lavishly as if they were dining from their boss' expense account?

Of course, this would be unsustainable. Under such a system, the food co-ops (or eventually the government) would quickly have to set strict limits on what foods members could purchase. The end result would be the government telling you what you could or could not eat -- on the grounds that others are paying for your meals. Americans may consider such arguments absurd in the realm of food, but the precise same arguments are currently being made in the realm of health care.

Of course third-party payors play a valuable role in providing voluntary catastrophic insurance. Such a service would be of value to many Americans and would thus naturally arise in a free market. But the current system of third-party employer-based insurance is an artifact of bad government tax policies, and would never have arisen in a true free market.

(For more details, see "Moral Health Care Vs. 'Universal Health Care'" from the Winter 2007-2008 issue of The Objective Standard.)

Prospective Vs. Retrospective Medicine

This ER physician discusses a typical "damned if you do and damned if you don't" scenario in, "Inevitable Malpractice".

As he notes, this the difference between prospective and retrospective medicine: "Doctors have to make decisions in five minutes and lawyers have 5 years to tell you why those decisions were wrong".

Although our broken tort system is not the primary contributor to rising health costs, from personal experience, I know that the amount of defensive medicine that ER doctors must practice in the form of ordering radiology tests is enormous. And given the legal climate in which they must operate, I don't blame them one bit.

(Via @DrVes and @KevinMD.)

Catron on Severability

One of the interesting aspect to the legal challenges to ObamaCare is the fact that the legislation does not contain a "severability" clause. Hence, some argue that if the courts strike down the individual mandate provision as unconstitutional, then the whole law is deemed unconstitutional. At least, that's the argument.

David Catron analyzes this issue in depth in his most recent article, "Of Severability and Sins of Omission".

In particular, he discusses:

1) Was the omission of a severability clause a screw-up or a clever Machiavellian maneuver?

2) Will it make a difference in the long run?

(Read the full text.)

We'll find out soon enough...

Quick Links: Schwartz, Catron, Eck

Brian Schwartz asks, "Should you trust the Colorado Trust?" on the cost-shift argument.

David Catron discusses, "ObamaCare vs. Kids and Seniors".

The rich and powerful always do well under socialized medicine because they have "pull".

Dr. Alieta Eck warns about, "Electronic Medical Records in the Age of Wikileaks".

Can a government that can't even guard its own classified diplomatic secrets be trusted with your personal medical data?

Tech Blogger Vs. FDA

Technology blogger James Kendrick describes how the FDA interfered with a medically necessary treatment for his blocked carotid artery:

It became apparent to me on the table that things weren’t going as the specialists anticipated. It turns out the imaging clearly demonstrated that the blockage was only 70-75 percent, and not the 80-90 percent previous imaging had indicated. That turned out to be very significant, as the FDA only allows the stents to be used in patients like me when the blockage is 80 percent or greater.

Even though the specialists felt I needed the stent to correct my problem, they were not allowed to put it in. [Emphasis mine. -- PSH] So after three hours of intense work by a great medical team, and even though I was already on the operating table ready for the full treatment, the doctors had to pull out without doing anything other than the angiogram. They faced serious sanctions by the FDA had they continued as planned with the actual correction of my medical problem.

(Read the full text of "FDA Takes Over in the OR".)

The FDA claims to be protecting patients against unscrupulous doctors and medical device makers. However, it appears that what patients really need is protection against the FDA.

(Via R.K.)

Update: Reader J.S. correctly points out that the FDA does not directly regulate the practice of medicine. However, it does set the legal climate in which uses of certain devices in certain settings are permissible (or not).

For instance, the FDA might authorize the use of a device only for certain clinical trials until the FDA gives the green light for broader use. In that case, a doctor who strayed beyond the FDA restrictions might risk lawsuits or penalties from licensing/credentialing boards. Or if the physician has commercial ties with the device maker, his use contrary to FDA rules might viewed as "promotion". In either case, the physician is thwarted from using the device as he deems appropriate, even if that would be in the patient's best medical interests.

Hence, the FDA still exerts tremendous indirect effect on how innovative new devices can be used by physicians, even if it doesn't directly overrule the physician's judgment at the time of treatment.

A Day In The Life Of A Neurosurgery Resident

What does it take to become a neurosurgeon?

At KevinMD.com, one aspiring neurosurgeon wrote up a detailed description of a typical day of residency. The countless number of crucial decisions he has to make each day is staggering. I highly recommend reading the full text of his post, "A neurosurgical resident's typical day".

(My own residency in radiology was not as grueling as his, but still pretty damned busy. I saw how hard the neurosurgery residents worked at Washington University of St. Louis during their 7-year program, and I had tremendous respect for them.)

Some day, if you ever have a serious head injury (or develop a brain tumor), your life may lay in the hands of a well-trained neurosurgeon like this one, practicing according to his best independent rational judgment. Yet this the kind of person whom the government wishes to regulate via "universal health care" and "cost effectiveness guidelines". When your life is on the line, who should decide what's best for you -- your neurosurgeon or the government bureaucrat?

In Ayn Rand's classic novel Atlas Shrugged, one of the characters is physician Thomas Hendricks who put the issue into essential terms:

..."I quit when medicine was placed under State control some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I could not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward.

"I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything -- except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, but 'to serve.' That a man's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards -- never occurred to those who proposed to help the sick by making life impossible for the healthy.

"I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind -- yet what is it they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn.

"Let them discover the kind of doctors that their system will now produce. Let them discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled. It is not safe, if he is the sort of man who resents it -- and still less safe, if he is the sort who doesn't."

We have been warned.

Health Reform and the Decline of Physician Private Practice

A recent report from Merritt Hawkins discusses how ObamaCare will "will dramatically change how physicians conduct business and likely will mean the end of full-time, independent, private practitioners".

The full report can be found here (PDF version).

The report notes:

[R]esults from a national survey of 2,400 physicians, only 26% of whom said they would continue practicing the way they are in the next one to three years. The remaining 74% said they would retire, work part-time, close their practices to new patients, become employed and/or seek non-clinical jobs.

The physicians who remain in practice will increasingly be herded into large "accountable care organizations" which will require them to practice according to government "cost-effectiveness" guidelines. This trend has already been noted by the New York Times, and will accelerate in the next few years.

If you loved the "managed care" of the 1980s, including the denial of service to save money, then you'll love the new "Government Managed Care version 2.0"!

Medical Bribery in Canada and Japan

Under the system of medical rationing in Canada, some patients are resorting to very desperate measures:

A Quebec woman who claims that she paid a doctor $2,000 to expedite surgery for her cancer-stricken mother is raising questions about whether bribery is being practiced in the province's health-care system.

Vivian Green said she was doing what she had to in an effort to save her elderly mother, who had been diagnosed with pancreatic cancer after she developed a pain in her side.

"When you're desperate you don't care who you bump and how sick they are," Green told CTV News. "I was desperate."

(Read the full text of "Quebec woman claims she bribed doctor for treatment".)

Basically, the Canadian medical system puts decent people in an impossible situation where they must choose between following the rules vs. saving their own lives.

Nor is this limited to Canada. In Japan, those willing to pay appropriately large "gifts" to doctors and hospital administrators get bumped to the head of the waiting lists.

Under such socialized medicine, those who are able to "grease" the system through money or political influence will always do well. In contrast, ordinary people will lose out.

(Link via Zip and K.V.)

Update: More details at the Montreal Gazette, "Want fast care? Slip an MD some cash":

Minimum $2,000 to guarantee that a woman's doctor will be there for the birth. "And it can go up to $10,000," he added.

For general surgery, the cost runs between $5,000 to $7,000 to jump the wait list into the operating room, he said.

For Green and Marcus, the $2,000 got their mother's operation bumped up -- but not the surgeon they wanted.

(Via @debbywitt and Mark Perry.)