Canada's Backup Health System Is Montana

Blogger Don Surber writes about the recent birth of the Canadian Jepp quadruplets -- in Montana:

...[F]our identical Jepp sisters were born in Great Falls, Mont., instead of Calgary this weekend. The Canadian parents flew 325 miles to get to an American hospital.

Can you imagine being about to go into labor for four births, and then flying 325 miles to get to the hospital in another country? Incredible. Michelle Lang, Calgary Herald, reported:

Their mother, Calgarian Karen Jepp, was transferred to Benefis Hospital in Montana last week when she began showing signs of going into labour, and no Canadian hospital had enough neonatal intensive-care beds for all four babies.

...It's not like Great Falls, Mont., is a teeming metropolis. With 56,215 people, it is slightly larger than Charleston, W.Va. Calgary has more than a million people. This is like being demoted from the Milwaukee Brewers to the Charleston Alley Cats. (OK, they changed the team’s name to West Virginia Power.)

There is a difference between health care and health insurance. In capitalistic America, the concentration is on health. In socialistic Canada, the emphasis is on paying the bills. The story ended with how much the American hospital charged. Looks like a quarter-million bucks for a 5-day stay. Given that it was the quadruple birth of 2-pound babies two months premature, I’d say it was a bargain.

This is not to piss all over Canada. Nice nation. Great people. I’m sure most Canadians like their health system. Just remember, though, that Canada's backup system is in Montana. Americans spend 15% of their income on health care. That's why Great Falls has enough neo-natal units to handle quadruple births -- and a "universal health" nation doesn't.

After all, they didn't fly Mrs. Jepp to Cuba, did they?

(Via Instapundit.)

More Problems With The Massachusetts Plan

MSNBC reports on still more problems with the much-touted Massachusetts "universal health care plan", which seeks to cover everyone using a mixture of mandates:

The state has already backed off of "universal." About 160,000 uninsured people in the state have incomes that are too high to qualify for subsidized health insurance — but too low to afford the lowest-cost unsubsidized plans. About 60,000 of these working poor won't face a penalty for not getting insurance, but the 100,000 others are in a bind.

"What I'm starting to see," [single mother Maureen] Linehan said, "is the people have to pay for their health care, and now they can't afford to pay their rent."

Because the state is attempting to cover all patients with a government-run system divorced from market incentives, it achieves neither universal coverage, nor cost savings. One might as well attempt to eliminate homelessness by passing a law requiring that all people rent a government-owned apartment.

(Via HealthCareBS.)

Where is the Justice in Single-Payer Plans?

I don't understand the appeal of single-payer proposals to so many otherwise reasonable people. Is it the alleged simplicity? But the plans generally add layers of commissions, agencies, boards and other bureaucrats. The certainty of scheduled payments and prices? The apparent control? But most plans -- as in Canada, England, Tennessee, Vermont and Hawaii border on bankrupting the governments. So what is it? I don't know. But, here in Colorado there were six proposals from different parties advocating a single-payer system to the 208 Commission, including one of the four finalists.

For the uninitiated, a single-payer health plan means that the government -- or a quasi-government agency -- purchases or provides all of the health care within an area or for a population. Medicare is one kind of single-payer plan. England and Canada have another. The plans are financed through taxes (sometimes called assessments) from individuals, employers or on goods and services. There are two basic variations -- 1) where the plan proposes to provide almost unlimited health care benefits at a very low cost (based on the rationale that administrative costs and "evil, outrageous profits" are eliminated); or 2) a tiered plan where the government provides basic services of some benefits, and individuals may purchase more extensive coverage from the greedy, profit-driven insurance companies.

In Colorado, four of these plans propose to offer dental, vision, mental health, rehabilitation and alternative treatments, in addition to the usual medical, surgical and hospital care. Of course, while the patients get unlimited care of every kind and dimension, the doctors are treated with less respect than most fast food workers. (I mean no disrespect for fast food workers or their employers, but that industry is well-known as an excellent entry level into the workforce.) In almost any fast food store, workers will get a raise of their hourly wage based on their experience, attitude, aptitude and skills. So, at any one time, two people working together side by side may well be earning different hourly wages. Both are competent, but one may have two years experience, while another has only worked for six months, one is eager to do and learn while the other is content to just do her job, one has an acquired sensitivity for making perfect burgers while the other makes good burgers -- but they're just not quite up to perfect. Under single-payer logic, both would always and forever make exactly the same amount of money for frying the same number of burgers on any particular shift. They both might get more or both might get less, but would make the same as each other.

Under single-payer plans. all doctors performing a particular procedure or treatment will receive the same fee -- regardless of whether one has just gotten his medical license or has been practicing for 20 years, or whether one surgeon is an artist with real aptitude and flair while another is competent but perfunctory or mechanical. It is the service or treatment or procedure that is what determines the pay scale and not the doctor. Of course, this is exactly what happens with Medicare and Medicaid right now -- and is one reason many doctors opt out of those programs.

Of course, under a true single-payer system -- one that encompasses everyone in a geographical area, doctors can't opt out and continue their profession. So, they quit. And why not? How much joy can a doctor receive from learning new techniques, advocating for his patients, making innovations in her practice when other doctors who do less get paid the same? What kind of justice is that? Why should excellent, wonderful doctors want to practice in a state where they receive no acknowledgment or payment for their excellence, and instead are treated no differently than the barely competent doctor who does the same number of examinations, treatments or procedures?

French Health Care?

David Catron makes the following interesting observations:

French Health Care for the US? Merci, non.

The advocates of socialized medicine, their claims for Canadian health care having been repeatedly exposed as wildly inaccurate, are now promoting a new single-payer paradise: France.

He then proceeds to debunk the myths of the supposed paradise of the French system.

Ralph Shnelvar on Government Commissions

The August 14, 2007 Boulder Daily Camera printed an OpEd by Ralph Shnelvar criticizing some biased methodologies of government commissions. It includes the following analysis of the 208 Commission:

...Another strategy is to charter a commission, but to a) formulate the rules so that a certain conclusion must be reached, and b) pack the commission with your cronies. This is the strategy that was used in Colorado to charter the so-called 208 Commission, which is foreordained to recommend vastly expanded government participation in the healthcare sector.

Unlike most other perfunctory commissions, the foregone recommendations that the 208 Commission will present will do severe damage to Colorado. Let me draw an analogy. Imagine that the year is 1900, and the government is interested in flying people between the Americas and Europe. A Regional Transatlantic Development commission is chartered to investigate "Lighter-than-air craft capable of transatlantic crossings."

It is, of course, packed with representatives of balloon manufacturers, the people least qualified to come up with innovative solutions. You immediately see the problem. Airplanes are left out of any possible solution recommended by the RTD. Of course, RTD will recommend further public funding into dirigibles and blimps, and will state that these are the only feasible solutions to getting people to Europe by air. The next step would be to mandate that only lighter-than-air devices are legal, since they are the only ones deemed to be safe.

It has been my experience in politics over the last few years that this technique of blindsiding the voters by eliminating options early on has become far more prevalent. I've now seen this done over and over again, so that the outcome is guaranteed before any real debate is possible.

...At the state level, the constraints placed on the 208 Commission are such that only massive government intervention that will cause health care rationing, and lower quality for everyone is a possible outcome. The free market solution is completely impossible under 208's mandate. It is, of course, only a free market solution that can truly expand health care opportunities for all Coloradans.

Brian Schwartz LTE in Rocky Mountain News

The August 13, 2007 Rocky Mountain News printed the following LTE by Brian Schwartz:

Free markets key to affordable health care

The Blue Ribbon Commission on Health Care Reform has some nerve. Its favorite plans involve funding government programs by taxing you when purchasing snacks, alcohol and cigarettes ("Healthy living may pay off/Sin taxes could fund statewide medical coverage," Aug. 1).

Yet, as shown by FAIR, my proposal at the commission's Web site, such meddling in our private choices has crippled health-care markets.

First, because the tax code deeply discounts employer-paid insurance, you're essentially stuck with your employer's comprehensive plans. These discourage doctors from competing on price and service. As a captive customer, insurers can afford to mistreat you. Changing insurers requires your finding another job or paying taxes on dollars spent on an individual plan.

Second, mandated insurance benefits significantly increase premium costs, hence making it a crime to purchase affordable insurance. Further, ineffective Medicare and Medicaid programs drive up insurance costs.

Instead of further eroding our freedom, the commission should repeal legislation that prevents free markets from delivering affordable, quality health care.

Brian T. Schwartz, Boulder

Lin Zinser Letter in Rocky Mountain News

The August 7, 2007 online edition of the Rocky Mountain News posted the following letter from Lin Zinser:

Bill Scanlon's August 1 article, "Healthy Living May Pay Off," left out important facts about the plans.

Each plan creates new state bureaucracies, anticipates increased federal health care subsidies to Colorado, and call for new and/or increased taxes.

Moreover, these plans assume that government's role is to ensure that each individual has a doctor (a medical home) and that the patient is forced to seek medical care from that doctor as controlled by the plan.

Many today, even with insurance, choose not to go to doctors until they are so ill they end up in hospitals. The answer is force?

These plans assume that people cannot be informed about healthy lifestyles and alternatives. They assume that people must be forced to limit consumption of junk food, coffee, alcohol, or cigarettes -- or pay higher taxes. These taxes are intended to limit a person’s ability to make her own decisions about what is healthy, proper and good for her in the context of her life.

Civilization began when people used reason rather than force in human transactions. The mark of a developed civilization is the extent to which people are free and are not compelled -- by a king, the Gestapo, a Mafioso, a gang, or a nanny-state -- against their own values and choices. These plans assume government force is the only answer, and they are uncivilized and wrong.

Lin Zinser, Arvada

Republicans and Health Care

FIRM is a non-partisan organization, and hence we are not supporters of either political party, nor any particular political candidate. And although Rudolph Guiliani makes some pretty good points in this recent opinion piece in the August 3, 2007 Boston Globe, others have taken issue with his statement that, "Most Republicans believe in expanding individual choice and decision-making."

In particular, the FreeMarketCure.com weblog notes:

Let's see: When the GOP was in charge of the Senate and the Oval Office, it passed COBRA and EMTALA, two major expansions of government regulation into health care. When the GOP controlled both house of Congress, it passed HIPAA, another big expansion of government regulation into health care, plus a new government health insurance program, the State Children's Health Insurance Program (SCHIP). Now, Republicans like Orrin Hatch and Chuck Grassley are leading the charge for a big SCHIP expansion. Finally, Republican Senator Pete Domenici is pushing for a nationwide "mental health parity" benefit mandate, one that President Bush says he will sign if it passes.

"Most" Republicans believe in believe in expanding individual choice? Heck, I'd settle for half.

Although individual Republicans may vary, I don't see any principled opposition to socialized medicine coming from them as a party. For instance, I agree with the ideas expressed by former Colorado State Senator Mark Hillman in this piece. On the other hand, the health care proposals of high-profile Republicans such as Mitt Romney and Arnold Schwarzenegger are as bad as any that have come from Democrats such as Hillary Clinton or Barack Obama.

Mark Hillman OpEd on Health Care

The August 7, 2007 edition of the Denver Post printed the following OpEd by former Colorado State Senator Mark Hillman. Here are some excerpts:

Rights do not burden others
By Mark Hillman

When we consider drastically altering our expectations of government, we risk undermining the principles on which our country was founded and proving Ronald Reagan's maxim: "Freedom is never more than one generation away from extinction."

Every expansion of government entitlements masquerading as rights - like a "right to health care" - is a dangerous step along this path, no matter how well-intentioned.

...Authentic rights can be enjoyed without permission from anyone else. Freedom of speech or religion or the right to keep and bear arms impose no cost on others or government. Only when competing rights collide must one freedom yield. In these circumstances, the Founders concluded that the proper balance ought to be drawn by the people whom government serves.

However, there is no right to be free from annoyance or irritation. That the mere exercise of our rights bothers someone else is an inevitable consequence of freedom.

Freedom also demands that we refrain from interfering in others' enjoyment of their inalienable rights. Freedom encompasses not simply the opportunity to make choices but the responsibility for those choices. Just because one choice seems wiser or safer doesn't justify using the force of government to require everyone to make the same choice. Likewise, government shouldn't protect those who make irresponsible choices from the consequences of their actions or, worse yet, make someone else bear the cost.

Entitlements, on the other hand, always impose a cost and always interfere with someone else's fundamental freedoms....

...[H]istory has but one example of a country founded on individual freedom. Despite its shortcomings and injustices, America remains a beacon to oppressed people around the world.

...Our vision for the future should emulate the Founders of that freedom - not the empty promises and repressive systems that so many around the world are dying to escape.

Mark Hillman (www.markhillman.com) is a wheat farmer and former state senator.

(Note: I am neither a Republican nor a Democrat, but I agree with Hillman's views on rights. In my opinion, the gradual expansion of entitlements by disguising them as "rights" is one of the biggest threats to the American political system.)

Russell Shurts Opinion Piece in Rocky Mountain News

The August 7, 2007 Rocky Mountain News published the following opinion piece from Russell Shurts:

Socialized medicine another gang operation

By Russell W. Shurts

Let's say your friendly neighborhood gang on successive nights threw rocks through your window, and then on the third day sent a rather menacing member of the gang to your door to offer you the opportunity to buy protection from further intrusions. Would you call what was being offered 'protection,' in the proper sense of that word?

Let's say your friendly neighborhood gang on successive nights threw rocks through your window, and then on the third day sent a rather menacing member of the gang to your door to offer you the opportunity to buy protection from further intrusions. Would you call what was being offered 'protection,' in the proper sense of that word?

Well, for nearly half a century the government has been throwing legalized 'rocks' through your health care system, and today after thoroughly wrecking it their unsavory representatives are offering you 'protection.' In 1965 the same type of people advocating further government intervention in medicine now were successful in convincing Americans to give the government control over all health care provided for those who are indigent or over 65. Prior to the introduction of Medicare and Medicaid in that year, health care spending never exceeded 6% of annual gross domestic product. Today it is 16% and rising. It is not difficult to understand when you make a valuable service 'free,' the demand for that service will rise. When the demand for anything valuable increases, its price inevitably increases, or at least it does if there is any kind of a free market available to trade for it in.

And that's where the government 'protection' comes in; the only way the unsavory representatives know how to lower prices is to mandate them by government force, i.e. to do away with the free market. Unfortunately, as we have seen time and time and time again, reality is not to be denied; not by wishing, not by magic wands and most certainly not by government mandate.

Since the introduction of socialist programs over 100 years ago, we have seen the same pattern repeated over and over and over again. Whatever service or good is either made the property of the state or put under the control of the state immediately becomes a scarce service or good. Remember the endless waiting lines in the Soviet Union? Well, they are being played out right now in the doctor's offices and emergency rooms in every country and state that has put the control of medicine under the government thumb.

There is a word that properly describes what is being offered here: extortion. Your government, however, is not as honorable as your friendly neighborhood gang; because if you buy this kind of 'protection' you will not get more and cheaper health care. You will only get far less effective health care, if you get any at all.

Russell W. Shurts, Centennial

Dr. Kevin Pho on Medicare

Dr. Kevin Pho, who runs the outstanding KevinMD.com blog, has written the following OpEd on Medicare cuts and the impact on doctors. Here are some excerpts:

Medical practices today essentially function as small businesses. Physicians are responsible for expenses like rent, payroll, employee health insurance and malpractice insurance. These costs are expected to increase 20 percent in the next nine years. During this same time, physician Medicare payments are faced with cuts of 40 percent. Already, some practices lose money every time a Medicare patient is seen. Some may find the link between medicine and money distasteful, but the hard truth is that it is impossible to practice medicine in a business model that is headed for financial disaster.

At a time when baby boomers are approaching the age of 65, some physicians attuned to this economic reality have simply stopped accepting Medicare patients. According to a recent survey by the American Medical Association, 60 percent reported that they would have to limit the number of new Medicare patients they treat due to next year's cut. Half would reduce their staff. Fourteen percent would "completely get out of patient care." Some seniors are already faced with calling 20 to 30 providers in the desperate hope that someone will accept Medicare.

As David Catron points out:

...[F]or Medicare patients, there is already a shortage of primary care physicians. For all of you out there clamoring for "single-payer health care," this shortage is a taste of what you will face under such a system.

Medicare is, for all intents and purposes, "single-payer for seniors." Indeed, "Medicare for all" is the battle cry of many single-payer advocates. Well, the system they want for everyone is already vitiating the care of seniors.

Advocates of government-run health care often admonish us not to conflate "single-payer health care" with socialized medicine. For the patient who cannot find a primary care doctor, this is a distinction without a difference.

Brian Schwartz OpEd in Denver Post

The August 5, 2007 Denver Post printed the following excellent OpEd by Brian Schwartz, PhD:

Don't model state reforms on Medicaid
How should Colorado lawmakers fix a broken system?
By Brian T. Schwartz

Colorado's Blue Ribbon Commission for Healthcare Reform recently selected four proposals for further analysis and eventual legislative review. The so-called 208 Commission's goals include improving access, encouraging personal responsibility, and supporting a "financially viable, sustainable and fair" system. Yet, these proposals preserve or expand Medicaid, which fails to meet these goals.

Colorado's Medicaid spending has almost doubled since 1997, eats up 20 percent of your state taxes, and increases prescription drug prices. The National Association of State Budget Officers reports that "increases in Medicaid costs will far outstrip the growth in state revenues into the future." But why should state-level administrators be frugal? For each dollar state taxes compel you to donate, the feds pitch in another by taxing someone else.

One of the four proposals being considered recommends that Medicaid switch from its current "fee-for-service" model - where taxpayers pay doctors at government-set rates - to HMO-style managed care. However, a National Bureau of Economic Research study concluded that switching from "fee-for-service to managed care was associated with a substantial increase in government spending but no observable improvement in health outcomes."

Medicaid and managed care are not insurance, but prepaid health care. Tiny or non-existent copayments and deductibles discourage prudent spending. Medicaid patients spend someone else's money, so providers need not reduce costs. Because the federal tax exemption for employer-paid premiums has transformed insurance into prepaid health care, the privately insured do the same. This tax policy makes medical costs skyrocket.

Medicaid recipients also have poor access to medical care. Doctors are five times more likely to refuse seeing new Medicaid patients than privately insured patients, who also have greater access to physicians after ER visits. Increasing reimbursement rates won't induce many doctors to see Medicaid patients; more than two-thirds of doctors reported being overwhelmed by Medicaid's billing requirements, paperwork, and delays in payment.

Medicaid erodes personal responsibility. Many recipients avoid higher-paying jobs and saving money because such admirable behavior disqualifies them from benefits. Hence, Medicaid keeps those it "aids" helpless, on their backs and dependent on government.

Medicaid is a bully. It unfairly competes with private insurers and private charities, crowds them out of the market, and hence forces some to depend on government for inferior health care. Harvard's George Borjas found that Medicaid cutbacks have significantly increased immigrant enrollment in employer-sponsored insurance. And USA Today reports that "many workers choose Medicaid over insurance offered by their employers."

One state proposal advocates significantly expanding Medicaid eligibility. This would further crowd out insurers and subject yet more Coloradans to Medicaid. The "single-payer" proposal advocates squashing private insurance entirely - forcing us all to depend on government for health care. A scary thought, given Medicaid's track record. If Medicaid is as good as its defenders claim, why not let it compete fairly with insurance companies and voluntary charities for customers and donations?

An alternative to Medicaid is consumer-directed health care, which combines low-premium, high-deductible policies with tax-deductible Health Savings Accounts (HSAs). Patients spend their own HSA funds until reaching their deductible, after which the policy's coverage applies. With savings from lower premiums, employers often contribute to employee HSAs, which employees own even after changing jobs. Further promoting consumer choice and affordable insurance entails eliminating laws mandating minimum benefits; these laws criminalize the sale of economical insurance policies. Empowering consumers provides quality, affordability and portability.

Patients spending their own money on medical care empowers them to consume wisely, take personal responsibility for their health, and gives doctors incentives to satisfy patients instead of bureaucracies. The RAND Health Insurance Experiment found that patients with the equivalent of consumer-directed plans spent 30 percent less than those with prepaid plans - with negligible effect on their health.

Consumer-driven health care is not foreign to Medicaid. Cash & Counseling programs have high participant satisfaction and Colorado's Consumer-Directed Attendant Support operated 21 percent under budget in its first two years.

Medicaid fails to meet the 208 Commission's criteria for cost, quality, access, personal responsibility, and fairness. The Colorado legislature should choose consumer-directed over authority-directed health care. Health care is too important to be left to government.

Brian Schwartz is an optical engineer in Boulder. This article was adapted from his proposal to Colorado's Blue Ribbon Commission on Healthcare Reform, called FAIR: Free-Markets, Affordability, and Individual Rights. The proposal is available at WhoOwnsYou.org.

Walter Williams on Socialized Medicine

Economist Walter Williams explain why he would much rather trust the marketplace rather than the government to deliver good health care. Here are some excerpts:

"Health Care: Government vs. Private"

... Do we want the government employees who run the troubled Walter Reed Army Medical Center to be in charge of our entire health care system? Or, would you like the people who deliver our mail to also deliver health care services? How would you like the people who run the motor vehicles department, the government education system, foreign intelligence and other government agencies to also run our health care system? After all, they are not motivated by the quest for profits, and that might mean they're truly wonderful, selfless, caring people.

As for me, I'd choose profit-driven people to provide my health care services, people with motives like those who deliver goods to my supermarket, deliver my overnight mail, produce my computer and software programs, assemble my car and produce a host of other goods and services that I use.

... Our health care system is hampered by government intervention, and the solution is not more government intervention but less. The tax treatment of health insurance, where premiums are deducted from employees' pre-tax income, explains why so many of us rely on our employers to select and pay for health insurance. Since there is a third-party payer, we have little incentive to shop around and wisely use health services.

There are "guaranteed issue" laws that require insurance companies to sell health insurance to any person seeking it. So why not wait until you're sick before purchasing insurance? Guaranteed issue laws make about as much sense as if you left your house uninsured until you had a fire, and then purchased insurance to cover the damage. Guaranteed issue laws raise insurance premiums for all. Then there are government price controls, such as the reimbursement schemes for Medicaid. As a result, an increasing number of doctors are unwilling to treat Medicaid patients.

Here's the full article. (Via Health Care BS.)

Hsieh and Hayden LTE's in Denver Post

The July 31, 2007 Denver Post printed the following LTE's by myself and Richard Hayden:

Re: "Uninsured grow as hospital costs soar," July 27 news story.

The real culprit behind rising medical costs is government interference in medicine. In the sectors of medicine where there is the least government regulation, such as cosmetic surgery and LASIK, we see a continual decrease in prices and improvement in quality. This is the normal pattern of a free market, and something we take for granted in the rest of the economy. Just ask anyone who's bought a DVD player recently.

Instead of more government regulation of medicine, we need less. Free-market plans, such as health savings accounts combined with high-deductible catastrophic insurance, preserve the patient's right to spend his money as he sees fit, and have been proven to cut costs while preserving high-quality medical care.

Free-market medicine is the only genuine cure for rising health costs.

Paul Hsieh, M.D., Sedalia


Re: "Child health care funding is vital," July 22 editorial.

Your editorial claims that the State Children's Health Insurance Program (SCHIP) should be expanded. It indicates that President Bush supports renewing SCHIP but not expanding it, and that Sen. Ken Salazar claims that SCHIP is a moral obligation. But SCHIP, like all entitlement programs, forces some to subsidize the expenses of others.

Each parent has the moral responsibility to care for the health of his or her own children, and parents need to evaluate their decision to have kids based on their ability to finance appropriate care. It is morally wrong to force anyone to subsidize the expenses of someone else's children, whether for health care or any other cost.

Anyone who wishes to help those who cannot afford medical care should do so voluntarily through private charity, not by trying to use the force of government to extort money from others. The funding of SCHIP should be neither renewed nor expanded. Instead, this immoral program should be abolished.

Richard Watts, Hayden

Gina Liggett LTE to Colorado Confidential

The July 21, 2007 edition of Colorado Confidential printed the following LTE by Gina Liggett:

Dear Editor,

Many Americans claim we need government intervention to reform the unaffordable and inaccessible health care system because "health care is a right." The system certainly is a mess, but health care is not a "right" -- it is a "need", like food and shelter. A "right" is not simply possessing what we need for survival regardless of who provides it; it means the freedom to obtain what we need without force. For example, I should be free to buy soup from whomever offers the best quality for the price; but it would be a violation of my neighbor's rights to get a law passed making him pay for my soup. In the same way, a person should be free to purchase health care based on his or her health concerns, but it is not that person's right to give the bill to taxpayers.

The 208 Commission on Health Care Reform will present a final plan to the Colorado Legislature later this year. So far, the 4 runner-up proposals recommend greatly increased government control of health care access and funding. This means that Coloradoans may get some kind of health care, they just won't have the right to obtain it as they individually see fit. Only a free market can provide that right. For more information, visit www.westandfirm.org.

Sincerely,

Gina M. Liggett, RN, MPH
Denver, CO

208 Commission Rejects Free-Market Proposal

Writer Ari Armstrong documents in detail the fact that the 208 Commission is interested only in proposals that will cause massive increase in government interference in medicine in Colorado, under the guise of "universal coverage".

His article covers both the details under which the only free-market health care proposal ("FAIR: Free-markets, Affordability, & Individual Rights," by Brian T. Schwartz, Ph.D) was rejected.

He also covers the praise they've heaped upon the single payer proposal and all the other variants of socialized medicine that they've selected for their final four proposals.

Read the whole thing.

A Canadian Doctor Describes How Socialized Medicine Doesn't Work

Dr. David Gratzer explains what's wrong with socialized medicine in Canada, Sweden, and Great Britain. Here are some excerpts from this excellent article in the July 26 Investors Business Daily. (Items in bold are my emphasis.):

I was once a believer in socialized medicine. As a Canadian, I had soaked up the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people.

My health care prejudices crumbled on the way to a medical school class. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute.

Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care.

...Government researchers now note that more than 1.5 million Ontarians (or 12% of that province's population) can't find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who'd get a doctor's appointment.

These problems are not unique to Canada -- they characterize all government-run health care systems.

Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled -- 48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. In France, the supply of doctors is so limited that during an August 2003 heat wave -- when many doctors were on vacation and hospitals were stretched beyond capacity -- 15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren't available. And so on.

...One often-heard argument, voiced by the New York Times' Paul Krugman and others, is that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use and cultural values. It pains me as a doctor to say this, but health care is just one factor in health.

Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall or a car accident. Such factors aren't academic -- homicide rates in the U.S. are much higher than in other countries.

In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don't die in car crashes or homicides outlive people in any other Western country.

And if we measure a health care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50%; the European rate is just 35%. Esophageal carcinoma: 12% in the U.S., 6% in Europe. The survival rate for prostate cancer is 81.2% here, yet 61.7% in France and down to 44.3% in England -- a striking variation.

Like many critics of American health care, though, Krugman argues that the costs are just too high: health care spending in Canada and Britain, he notes, is a small fraction of what Americans pay. Again, the picture isn't quite as clear as he suggests. Because the U.S. is so much wealthier than other countries, it isn't unreasonable for it to spend more on health care. Take America's high spending on research and development. M.D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.

Dr. Gratzer summarizes his position with this point:

...In the coming years, with health expenses spiraling up, it will be easy for some to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like-minded politicians could take off the shelf, dust off and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.

But such initiatives would push the U.S. further down the path to a government-run system and make things much, much worse. True, government bureaucrats would be able to cut costs -- but only by shrinking access to health care, as in Canada, and engendering a Canadian-style nightmare of overflowing emergency rooms and yearlong waits for treatment.

America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home -- in the other four-fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.

Read the whole thing.

Problems with Wisconsin's Socialized Medicine Scheme

The proposed Wisconsin universal coverage plan is going to be hugely expensive, and can only lead to rationing. Here are some excerpts from the July 24, 2007 Wall Street Journal analysis:

...Democrats who run the Wisconsin Senate have dropped the Washington pretense of incremental health-care reform and moved directly to passing a plan to insure every resident under the age of 65 in the state. And, wow, is "free" health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker.

Employees and businesses would pay for the plan by sharing the cost of a new 14.5% employment tax on wages. Wisconsin businesses would have to compete with out-of-state businesses and foreign rivals while shouldering a 29.8% combined federal-state payroll tax, nearly double the 15.3% payroll tax paid by non-Wisconsin firms for Social Security and Medicare combined.

This employment tax is on top of the $1 billion grab bag of other levies that Democratic Governor Jim Doyle proposed and the tax-happy Senate has also approved, including a $1.25 a pack increase in the cigarette tax, a 10% hike in the corporate tax, and new fees on cars, trucks, hospitals, real estate transactions, oil companies and dry cleaners. In all, the tax burden in the Badger State could rise to 20% of family income, which is slightly more than the average federal tax burden. "At least federal taxes pay for an Army and Navy," quips R.J. Pirlot of the Wisconsin Manufacturers and Commerce business lobby.

...The plan is also openly hostile to market incentives that contain costs. Private companies are making modest progress in sweating out health-care inflation by making patients more cost-conscious through increased copayments, health savings accounts, and incentives for wellness. The Wisconsin program moves in the opposite direction: It reduces out-of-pocket copayments, bars money-saving HSA plans, and increases the number of mandated medical services covered under the plan.

So where will savings come from? Where they always do in any government plan: Rationing via price controls and, as costs rise, waiting periods and coverage restrictions. This is Michael Moore's medical dream state.

(Via KevinMD.)

More Problems in Mass. Utopia

As many have warned, coverage does not equal access. In other words, just because politicians encourage or mandate third-party payment for routine medical care, doesn't mean that patients will be able to actually see a doctor. Just ask patients in Canada or England, where patients routinely wait for needed services. (Those duped by Michael Moore's claims to the contrary should read John Goodman's corrective.)

Now The Wall Street Journal brings us the latest problems from Massachusetts, where everybody (well, not quite everybody, it turns out) is "covered" by political force. Tamar Lewis is 24 years old. "Earlier this month, she signed up for state-subsidized insurance under a new Massachusetts law that aspires to universal coverage. The plan costs her $80 a month. But it takes a lot more than an insurance card to see a doctor in this state. On the day Ms. Lewis signed up, she said she called more than two dozen primary-care doctors approved by her insurer looking for a checkup. All of them turned her away. Her experience stands to be common among the 550,000 people whom Massachusetts hopes to rescue from the ranks of the uninsured. They will be seeking care in a state with a 'critical shortage' of primary-care physicians, according to a study by the Massachusetts Medical Society released yesterday, which found that 49% of internists aren't accepting new patients. Boston's top three teaching hospitals say that 95% of their 270 doctors in general practice have halted enrollment. For those residents who can get an appointment with their primary-care doctor, the average wait is more than seven weeks, according to the medical society, a 57% leap from last year's survey."

Yet various Colorado "reformers" continue to look to Massachusetts as a model.

What such "reformers" refuse to do is examine the actual causes of skyrocketing health costs. In brief, federal tax distortions entrenched high-cost, non-portable, employer-paid insurance. Federal politicians created Medicaid and Medicare, which now underpay doctors and push costs onto others. Then federal and state governments subjected insurance to a host of controls that further drive up prices. Political meddling resulted in insurance that a significant minority of Americans cannot afford. So, obviously, "reformers" argue, the solution is more political meddling. I'm sure there's a five-year plan to fix the newly created problems.

Health Care "Reforms" To Avoid

John Goodman explains why lawmakers should avoid these false "solutions" to the health care issue. Examples include:

Entitlement Creep
1. Do not turn a tax subsidy for health care into an entitlement.

Coverage, Benefit Mandates
2. Avoid mandated insurance coverage and mandated benefits.

Perverse Incentives
3. Don't create perverse incentives for health plans.

Crowding Out
4. Don't encourage people to forgo private coverage by expanding public coverage.

Click through for more information.

Gina Liggett LTE in Northern CO Business Report

The Northern Colorado Business Report recently printed the following LTE by Gina Liggett:

Free health care?!

I'm hoping the title to Michael Moore's sequel to "Sicko" will be "Just Kidding."

He and many Americans, including Dr. Carroll at your HealthCare Summit (June 26), are in collective denial about the disaster that single-payer health care would bring: the infamous waiting lists for tests and treatment found with the Canadian system, soaring costs of Medicare/Medicaid and TennCare, rationing of treatments for more serious and costly diseases like cancer, and bureaucrats influencing medical decision-making that should only take place confidentially between a patient and a physician.

Is nobody shocked that Washington politicians model one such single-payer proposal (HB-686) on the soon-to-be-bankrupt Medicare? Does anyone care that Moore's advocacy of greater regulation of the pharmaceutical industry would only further stifle innovation at a time when we need it most to cure such devastating diseases as Alzheimer's, Parkinson's and diabetes?

The 208 Commission on Health Care Reform will present a final plan to the Colorado legislature later this year. So far, the four runner-up proposals recommend greatly increased government control of health-care access and funding.

As a nurse who takes care of patients with many serious and chronic diseases, I can assure you that if you think our health care system is so bad now - despite the tremendous advances in life-saving and life-enhancing treatments - it will crash and burn under statewide or nationwide socialized medicine.

Gina Liggett, RN
Denver
westandfirm.org

The Myth of Medical Bankruptcies

One of the arguments cited by advocates of socialized medicine is that the high costs associated with the current system of medical care drive too many uninsured patients into personal bankruptcy.

Recently, Todd Zywicki, Professor of Law at George Mason University School of Law, testified to the US Congress that this was not the case. A copy of his July 17, 2007 testimony to the United States House of Representatives Committee on the Judiciary, Subcommittee on Commercial and Administrative Law is available here (MS Word document). Some of his key points are as follows:

"There is No Evidence That There Has Been An Increase in the Frequency or Severity of Job Loss or Income Interruption as a Result of Health Problems"

"There is Little Evidence That Medical Debt Is a Major Causal Factor in Bankruptcy Filings"

"[T]here is no evidence that lack of medical insurance is a major causal factor in bankruptcy filings."

Each point substantiated with the appropriate evidence and citations.

(Via HealthCareBS and Volokh.)

Karen Libby LTE on "Universal Care"

The July 17, 2007 Denver Post published the following LTE by Karen Libby:

The health care debate in the wake of "Sicko"

It's a shame that Michael Moore's latest movie, "Sicko," didn't also explore what is "sick" about two widely touted government-managed health care systems: those of Canada and Britain.

In Canada, someone needing a CAT scan faces a three-month waiting list. It is worse for MRI screening, and if one is of a certain age, they are denied these widely used diagnostic tools. Many people in Canada are unable to find a primary-care doctor because so many Canadian doctors have left the profession or have left Canada to practice in the U.S.

Our health care system is indeed in need of an overhaul, but not by turning over medical care to the government, which cannot even issue passports in a timely fashion. Our representatives in Washington are set for life, as far as medical insurance goes. Moreover, well-heeled citizens who can afford it will always have access to private health care. Passing a single-payer universal health care bill will only create a two-tier system in our country and will not benefit those of us who will be stuck with higher taxes (yes, we will still be paying for our health care) and who cannot afford to foot the bill for private health insurance without an employer's supplement.

Even with its flaws, Americans still enjoy superior health care. There needs to be a safety net for the uninsured, and astronomical medical costs need to be brought under control. These issues are what our lawmakers should be addressing, not dumping a system that can be fixed in favor of a massive bureaucratic mess.

Karen Libby, Denver

Diana Hsieh LTE on Single Payer Systems

The July 17, 2007 Rocky Mountain News published the following LTE by Diana Hsieh:

Free-market medicine is the answer

At a weekend rally in Denver, filmmaker Michael Moore advocated the total government takeover of medicine with heartbreaking tales of peoples' medical disasters ("Filmmaker Moore presides at Colorado health care rally," June 25). He neglected to mention that "single-payer" socialized medicine makes medical disasters routine because of inevitable rationing of care.

In Canada, patients are forced to wait weeks and months for diagnostic tests, appointments with specialists, and treatment as their deadly cancer cells multiply.

In Britain, most National Health Service kidney patients over the age of 55 are allowed to die rather than offered dialysis. As usual, the working poor suffer the most: They are unable to afford treatment outside the government system they’ve already bought with taxes.

The only reliable protection against medical disasters is a genuinely free market in medicine. Only when medicine is freed of burdensome government regulations, mandates and entitlements will patients be able to pay for their own routine health care and purchase affordable catastrophic insurance. That's the reform Colorado needs.

Diana Hsieh, Sedalia

Rocky White Wants More Bureaucratic Medicine

Ari Armstrong has written a strong critique of the single-payer plan advocated by Rocky White.

John Stossel Interviews Michael Moore

ABC journalist John Stossel has interviewed Michael Moore in preparation for an upcoming segment of the television show 20/20. Stossel makes some good points, including the fact that what we currently have is not a free market in health care:

America's medical system has problems, but profit is the least of it. Government mandates, overregulation and a tax code that pushes employer-paid health insurance prevent the free market from performing its efficient miracles. Six out of seven health-care dollars are spent by third parties. That kills the market. Patients rarely shop around, and doctors rarely compete on price or service.

...The U.S. mail manages to deliver his dad's checks, but compare its performance to FedEx or UPS. The Post Office said it wasn't possible to deliver packages overnight.

I want FedEx health care: innovation, new cancer treatments, hip replacements and pain relief. We get that from private-sector competition, not government lethargy.

In-Store Health Clinics

The July 5, 2007 Rocky Mountain News had a good OpEd favoring in-store health clinics. Here are some excerpts:

Experts who study health-care finance agree that a significant way to contain costs would be to encourage more patients who aren't suffering acute or life-threatening ailments to visit facilities that provide routine care and not occupy scarce and expensive emergency-room beds.

An ER visit to treat strep throat on average costs $329, the Rocky's Joyzelle Davis found, more than three times the cost of a trip to an urgent-care center; doctors' offices routinely charge at least $100 for such a visit.

Enter in-store health clinics, now opening at retail pharmacies and department stores. Over the past couple of years, hundreds of these clinics have sprung up across the country and thousands more are in the works. They're staffed by nurse practitioners or physician's assistants, accept patients without appointments and can write prescriptions, treat infections and perform a host of other routine procedures. Many are open seven days a week.

Physicians are available on-call if a patient requires more-extensive care and needs to be sent to a doctor's office or emergency room.

You'd hope the American Medical Association would support the concept, but you'd be wrong. The medical association claims the clinics are not safe alternatives for many patients, because they provide only limited services. It also worries that a clinic located, say, in a Walgreens might push patients to buy their prescriptions at that store rather than at another pharmacy.

...What's really going on here is protectionism, pure and simple. The association would deny patients this convenient, cost-saving alternative rather than surrender turf to innovative rivals.

The professionals who staff in-store clinics are doing nothing illegal, and they're providing patients with a service they value - affordable health care with hours that fit their desires.

On July 12 and July 13, 2007, the Rocky Mountain News printed two responses. One was from me, supporting their position and one was from Dr. Jeremy Lazarus of the AMA opposing their position.

Here is my response:

In-store health clinics

As a physician, I wholeheartedly agree with the RMN position favoring in-store health clinics ("The Cheaper Option", July 5, 2007), and I disagree with the AMA position against them. If a nurse practitioner or a physician’s assistant in a clinic is offering an honest service for a good price, and the patients find that acceptable, then nobody should interfere with their right to trade according to their best rational judgment.

Such in-store clinics are especially good at providing affordable quality health care to those without insurance and those with Health Savings Accounts, as noted by Grace-Marie Turner in the 5/14/2007 Wall Street Journal.

If the AMA truly wants what's best for patients, it should support such free-market medicine, rather than oppose it.

For more information on free market medicine, go to http://www.WeStandFIRM.org.

Paul Hsieh, MD of Sedalia

Here is Dr. Lazarus' response:

Health clinics need physician oversight

The American Medical Association is committed to ensuring that all patients have access to high quality health care, which is why we support the safe and responsible operation of in-store health clinics.

The AMA understands and appreciates that innovative and alternative strategies may be needed to ensure all patients get the health care services they need in a timely fashion. However, we do not agree with the Rocky's July 5 editorial ("The cheaper option/AMA should stop looking down nose at in-store health clinics"). We do not accept that in-store health clinics should be held to a lesser standard than the local physician's office down the street. The AMA has put forth principles these clinics should comply with to ensure patient safety, and continuity of care when necessary.

These principles include reasonable measures such as making sure these clinics establish appropriate sanitation and hygienic guidelines; protocols to ensure appropriate physician oversight; and advanced communication with patients to ensure patients know the qualifications of the health professional providing their care.

The AMA was founded 160 years ago to promote the highest standards of medical care in this country. History shows that patient care and medical practice have benefited from these efforts. The AMA remains committed to promoting these high standards of care whether it's delivered at your doctor’s office or at an in-store clinic.

Dr. Jeremy A. Lazarus of Greenwood Village is a board member of the American Medical Association.

Today's Cartoon

(Via FreeMarketCure.)

Francis Miller Questions the 208 Commission Process

In this July 8, 2007 OpEd in the Rocky Mountain News, Francis Miller raises some troubling questions about the objectivity of the 208 Commission's process in selecting health care reform proposals:

Promoting socialized medicine

I am increasingly concerned that the Denver dailies are assisting in a not too subtle attempt to shape public opinion to be receptive to schemes being concocted by Colorado's 208 Blue Ribbon Commission on Health Care. Initiated by a governor and a legislature that are both clueless as to how to solve the health care problem, this commission has deftly created a situation whereby two obviously unacceptable proposals are being put up against two proposals which would essentially mandate the uninsured buy health care insurance. This is classic railroading when you are forced to pick from options that have been selected to lead to a preordained outcome. Is there any question in your mind that this Commission is going to call for some kind of mandated insurance similiar to Massachusetts and California?

As an aside, an article on July 1, 2007 in the NY Times by Pam Belluck, noted that Massachusetts, (with a population of nearly 6.5 million people) has, since 2006, been able to get only 130,000 people into their new scheme, and that required the insurance be free or subsidized. The rest of the uninsured in the state have said, thanks, but no thanks.

This whole endeavor is a not so veiled attempt to solve the State's rising Medicaid cost crisis and the hospital's and doctor's collections problems by putting as many people as they can herd into a corral and force them to buy insurance. The problem is that federal ERISA plans in the state are not going to participate and you can bet that PERA and other governmental employee organizations are not going to touch this skunk with a ten foot pole. If the State unwittingly destroys the individual and small group health insurance market they will create a highly regressive system with many unintended consequences.

Recent editorials by members of the Commission are little-by-little revealing their socialistic philosophical core and their nearly complete lack of understanding of market-based economics. To say that the market has failed is to ignore the role government has played over the past 30 years in meddling in the health care market. You would have to go way back to before the 1970s to find any semblance of a functioning health care market. This is tantamount to the federal government polluting Rocky Flats and then proclaiming that nature doesn't work any more. We are on a path to socialize the remainder of 16%, soon to be 20%, of the US economy. If the hospitals and doctors think that forcing the uninsured to buy health insurance is not one more step toward having their fees and practices regulated by a government bureaucracy they are mistaken. Global warming has less of a chance of melting the glaciers than the creeping vine of liberal Democratic socialism has of turning the medical profession into proxy employees of the government. You reap what you sow guys!!!

Fran Miller has been a management consultant for 25 years and he has a graduate degree in health policy from the University of Colorado’s Graduate School of Public Affairs. Miller is the past president of the Colorado Business Coalition for Health, a two term member of the Colorado Legislature’s Interim Committee on Health Care. He was appointed by governors Richard Lamm and Roy Romer to two terms as vice chairman of the Colorado Health Data Commission. He is presently writing a book on health care in the 21st century.

Gina Liggett on the "Right" to Health Care

In response to Rep. Claire Levy's July 1 OpEd in which she asserts, "We must begin with the premise that health care is a basic right", the July 6, 2007 Denver Post printed the following response from Gina Liggett:

"The bureaucrats are coming, the bureaucrats are coming," I cried out after reading your columns on health care. All the writers have legitimate concerns about the problems with health care. All erroneously blame the free market. All advocate socialized medicine. Dr. Pius Kamau says, "How long can we go on ... without thinking of our overall responsibility to every American" for the health care he's often not compensated for.

Gabriel Kaplan says that "regulation and government involvement are the most effective and efficient means" of fixing the health care system; yet the very problems he describes are a direct result of government dominance in the health care system.

Rep. Claire Levy blames problems such as the huge cost of "insurance company overhead" on "employer-based health insurance" and says we should "spend according to a comprehensive plan" - presumably one of those 208 Commission proposals that recommend increased governmental control of the health care marketplace.

Health care is most definitely not a right. A right is not forcing citizens to pay for goods and services enjoyed by someone else. A right is not a mortgage on the life of a physician. Only a free market honors the rights of the consumer and the provider.

Socialized medicine is immoral, it is impractical, and health care will deteriorate if the government completes its takeover of the health care system.

Gina Liggett, RN, Denver

LTE's by John Mueller and Richard Watts

The July 6, 2007 Rocky Mountain News printed the following LTE from John Mueller:

Despite Moore, United States has best health care

Until I read reviews of it, I thought Michael Moore's latest film, Sicko, was an autobiography. But then, leave it to Moore to twist the subject of his so-called documentaries to suit his own left-leaning views.

Exactly where does Moore think that all the life-saving medicines and great doctors are coming from? Not from Europe or other countries, but from the United States.
We lead the world in cancer and AIDS research. We have the ability to send our doctors overseas through Doctors Without Borders and the much-maligned U.S. military. What more can we as a nation do?

My beloved wife of 25 years is getting much needed medicine from a couple of major companies at no charge and I will always be beholden to them for helping her. To have Moore say that any system other than ours is better is an outright lie.

John A. Mueller, Northglenn

The July 7, 2007 Rocky Mountain News printed the following LTE from Richard Watts:

Health care

In the June 29 Speakout titled "On the road to health-care reform", two members of the 208 Commission on Health Care Reform attempt to gloss over the concerns about the commission’s activities.

They state, "We selected four very different plans to analyze". There are some differences. But what the commissioners don't mention is what all four plans have in common -- they chose only proposals which call for a massive increase in government interference. None of the four plans respect the individual's right to make his or her own health and financial decisions, despite the commissioners' ridiculous assertion that "One emphasizes choice and the enabling of market forces".

On the 208 Commission's chosen menu of coercive measures are forcing every individual in Colorado to buy health insurance, forcing employers to buy health insurance for employees, enormously expanding Medicaid and forcing every person in Colorado into a state-run health care system. The commissioners make their selections sound less coercive than they are, stating that one plan "imposes no coverage requirements on businesses or individuals". They don't mention that this is the plan for the enormous expansion of Medicaid.

Forcing Coloradans into a government-run medical program because some people are uninsured would be just as wrong as forcing everyone to live in a government-run housing project because some people are homeless.

To learn more about how socialized medicine wipes out your choices, and to learn about the free market remedy, visit www.WeStandFIRM.org

Richard Watts, Hayden

Single Payer In The USA

We already have a single-payer system in place in the USA, and it works terribly. It's called the Indian Health Service. Dr. Bernadine Healy, former director of the National Institutes of Health and former CEO of the American Red Cross tells more:

The shame of a nation

...The health of American Indian tribes became the government's responsibility long ago, through treaties and other covenants signed in exchange for hundreds of millions of acres of tribal land. After generations of neglect, in 1955 the Indian Health Service took over, creating an independent, single-payer, government-funded system. After half a century, there have been small improvements, but the large picture, as described in "Broken Promises," the U.S. Commission on Civil Rights' July draft report evaluating the Native American healthcare system, remains bleak.

The health status of the more than 2.5 million tribal members is worse than that of any other U.S. minority or majority group. Native Americans have a life expectancy of 71, roughly 5 years less than all others. They face higher maternal and infant mortality rates and are many times more likely to die from tuberculosis, diabetes, and alcoholism. During flu season, they die far more often. Indian teenagers kill themselves at a higher rate. The rate of kidney failure from diabetes is staggering; heart disease is rising. Native American cancer patients have the poorest survival rates of any group.

The Indian Health Service is everyone's worst nightmare of what government healthcare would look like. The system is riddled with crumbling facilities, mindless regulations, ancient equipment, and far too few nurses, doctors, pharmacists, and dentists. Long waits choke clinics and emergency rooms. Patients have to fight to see specialists. Everything is rationed -- eyeglasses, dental visits, gallbladder operations, kidney dialysis, CT scans, basic psychiatric services. Almost half of "urban Indians" who have moved off the reservation to cities, usually in search of economic betterment, have no medical care because they are too far from a reservation and have little access to private insurance. Although the government's trust responsibilities extend to this group of about 1 million Native Americans, they have been largely abandoned by the health agency created in their name.

Although the article is from September 2004, it is still relevant today.

Via KevinMD, who also notes:

And spare me the argument that it's underfunded. What makes anyone think that a single-payer system applied nationally will be given the appropriate dollars? This is the government we're talking about.

Insurance Mandates

Insurance mandates in Delaware can increase the cost of insurance by as much as 30%.

Gina Liggett letter to Rep. Levy

Gina Liggett writes:

Rep. Claire Levy (state house district 13) wrote an article in "Perspectives" (Denver Post, July 1) in which she said "health care is a right" and that we need "a comprehensive plan." I've written her this letter in response. I also sent yet another LTE to the Denver Post about this and the other articles by Gabriel Kaplan and Dr. Kamau in which they too advocate government takeover of health care. If you'd like to send Rep. Levy a letter, her email address is: claire.levy.house@state.co.us

Here is Gina's response:

Dear Representative Levy,

I read your recent Denver Post article on health care reform with much interest. In one respect, I agree that our health care system is indeed broken, as you pointed out in your examples (the thousands of uninsured, high costs of care burdening businesses and families, and wasteful administrative expenses.)

But I profoundly disagree with the most compelling sentence in your article: "We must begin with the premise that health care is a basic right." Health care is most definitely NOT a right.

A right is a moral concept that defines an individual's freedom of action in society. Our most fundamental rights to our own lives, liberty, property and the pursuit of happiness mean that in order for us to survive as rational beings in society, we must retain the right to think, to act according to our own judgment, to create and keep what is needed for survival and to live for our own purpose without sacrificing the rights of other individuals. Thus, it is proper that we outlaw the actions of a criminal who wants to "pursue happiness" by stealing purses to support his methamphetamine habit.

In terms of health care, it is one of our many needs, but it is not a right. It is not a right to force citizens to pay for the health care of others. It is not a right to mandate that I purchase some health plan whether I want it or not. It is not a right that a physician must accept a certain payment that he or she has not consented to. These would actually violate the individual rights of consumers and providers.

But an insurance company who offers to sell me a health insurance plan that I want and can afford violates nobody's rights. It is a trade between members of society each according to his own judgement and benefit. It is a completely moral exchange. In a word, it is what free market capitalism is. Only a free market honors the rights of the consumer and the provider.

What you advocate, however, as a solution to the health care mess is a "comprehensive plan"--presumably one of the 208 Commission's runner-up proposals that recommend greatly-increased government control of health care. (And I was shocked to discover that the criteria the 208 Commission used to initially evaluate all proposals required only specified government-oriented methods for reforming health care! Any free-market proposal couldn't possibly have had a chance.)

Your article and those of Dr. Pius Kamau and Mr. Gabriel Kaplan have one central thing in common: they all advocate socialized medicine, despite the historical fact that government dominance of health care is the root cause of the problems you and the editorialists describe.

If what you want in a health care system is affordability, accessibility, innovation in service, ever-improving quality, breakthroughs in treatment for our most intractable diseases, and freedom of choice, then you have to advocate for sweeping free-market-based reforms of the health care system.

On the other hand, you should push for government-run health care if you want waiting lists, a dramatic drop in quality, uncontainable costs, limited options for care, rationing of services, and stifling of innovation in treatments and diagnosis. I can guarantee that's what we'll get. And liberty is what we'll lose.

Sincerely,
Gina M. Liggett, RN
www.WeStandFirm.org

High Deductible Health Plans and ER Visits

A recent paper in the Journal of the American Medical Association studied the effect of so-called "high deductible" health plans on patients' use of the emergency room. These plans are often part of the combination of HSA's (health savings accounts) and catastrophic insurance (with high deductible), favored by many free market advocates. The first component covers routine small medical expenses, whereas the second component covers the rare-but-expensive medical disasters.

The JAMA paper showed that patients with the high deductible plans used the ER less, primarily by not going there for low-to-medium severity conditions. There was no evidence of adverse effect on overall health, and no evidence of patients failing to go to the ER for the high-severity (serious) problems that really needed the full services of an ER.

In other words, when people are given the choice of how to spend their own health care dollars, they do so responsibly and prudently. Given that uncompensated emergency care is often cited as a major cause of rising health costs, free market measures that reduce this amount without adversely affecting patient outcome (while encouraging individual responsibility) are to be applauded.

In contrast, some health care reform plans limit out-of-pocket spending and deductibles to small amounts, in the $100-$500 range. They claim that this will save money because "people won't have to go to the ER". If the JAMA paper is true, this will have the exact opposite effect.

The full paper is only available to subscribers, but here is the abstract. A popular press version of the story is available here.

More Harsh Critiques of "SiCKO"

Kurt Loder of MTV wrote the following:

'Sicko': Heavily Doctored
Is Michael Moore's prescription worse than the disease?

...Unfortunately, Moore is also a con man of a very brazen sort, and never more so than in this film. His cherry-picked facts, manipulative interviews (with lingering close-ups of distraught people breaking down in tears) and blithe assertions (how does he know 18,000* people will die this year because they have no health insurance?) are so stacked that you can feel his whole argument sliding sideways as the picture unspools. The American health-care system is in urgent need of reform, no question. Some 47 million people are uninsured (although many are only temporarily so, being either in-between jobs or young enough not to feel a pressing need to buy health insurance). There are a number of proposals as to what might be done to correct this situation. Moore has no use for any of them, save one.

As a proud socialist, the director appears to feel that there are few problems in life that can't be solved by government regulation (that would be the same government that's already given us the U.S. Postal Service and the Department of Motor Vehicles). In the case of health care, though, Americans have never been keen on socialized medicine.

Read the whole thing.

Grace-Marie Turner of the Galen Institute has this to say in the July 4 Pasadena Star-News:

'Sicko' serves up health care lies

...Moore also ignores the limits, restrictions on access, and rationing of care in single-payer health care systems in Canada, the U.K., and elsewhere. In Canada, for example, more than 800,000 people are on waiting lists for surgery and other medical treatment, with some forced to wait months or even years for the care they need.

The promise of universal health coverage doesn't always translate to timely medical care, especially for those with serious medical problems. A Canadian citizen who needed hip replacement surgery was condemned to spending many months in pain waiting for the state to get around to treating him. Unwilling to wait, he sued his provincial government because he was denied the right to buy private insurance to pay for prompt surgery.

...One of Moore's core arguments in "Sicko" is that profit in the health sector is evil and that we should rid our health care system of private "for-profit" physician practices, hospitals and suppliers. He and other single-payer advocates are convinced that a generous and benevolent government would put doctors and hospitals back in charge of decisions.

Why, then, are doctors and hospitals today forced to follow more than 110,000 pages of rules and regulations in our Medicare program serving

42 million seniors? Imagine the libraries that would be filled with the rules to run a system for 300 million!

In our own government-run health care systems - Medicare, Medicaid, and the VA - government micromanagement and price controls are the norm. Government makes decisions about what will be covered, under what circumstances and for whom, and how much doctors and hospitals will be paid for their services. And government seldom gets it right - overpaying for some and underpaying for others, but also inducing over-consumption of health care.

Moore's new film certainly makes for compelling viewing. The problem is that it also makes for an incomplete picture of what socialized medicine is really like.

After all, it would've been impossible to fit all the Britons and Canadians languishing on waiting lists into a neat, two-hour movie.

In a separate piece in the June 29, 2007 Baltimore Sun, Grace-Marie Turner also asks:

If Michael Moore's waistline ever puts him in the hospital for heart surgery, it will be interesting to see where he goes for medical care -- the Mayo Clinic, or Cuba?

English Health Care Behind the Curve

The BBC reports that the British National Health Service has been studying a new computerized test for detecting cervical cancer in women which is more accurate than standard Pap smears. This is certainly good news for the women of Great Britain.

What the article doesn't mention is that this ThinPrep technology has already been in use in the US for quite some time. The Denver-based pathology group Metropath helped develop this technology and has been using it for the past 4 years.

It's not new; just new to the UK.

(Via Katherine Konopka.)

Proper Government Functions

The Colorado Springs Gazette printed the letter on healthcare I sent them last week:

TAKING CHARGE
People, not government, responsible for health

Marcy Morrison, the sole El Paso County representative on Colorado’s 2008 Commission for Health Care Reform, claims that her goal is to insure as many people as possible (“Morrison works to insure more Coloradans,” Metro, June 25). That’s morally wrong. The government should not attempt to enforce universal medical coverage, nor universal healthy diets, nor universal fashionable haircuts. The only proper function of government is to protect our rights.

In medicine, that means protecting the rights of health care providers, insurers and patients to contract for the services they deem in their best interest, free from government regulations, mandates and entitlements.

Only then can people act as responsible adults, rather than as wards of the nanny state.

Diana Hsieh
Sedalia

Brian Schwartz LTE in Rocky Mountain News

The July 2, 2007 edition of the Rocky Mountain News printed the following LTE by Brian Schwartz:

Health insurance

George Swan (Speakout, June 15) erroneously equates medical "coverage" with actual medical care. "Access to a waiting list is not access to health care," wrote Canadian Chief Justice McLachlin when striking down legislation banning private insurance. As David Hogberg documents in "Health Care, more or less," patients in Canada, England, and Sweden die or become incurable while waiting months for treatment -- despite having "coverage."

You should have as much choice in health insurance as in car insurance. But tax policy deeply discounts employer-provided insurance, so you're stuck with your employer's plans. Insurers are unresponsive to your dissatisfaction, as they know you must quit your job to change providers. A "single-payer" system is worse; with government as a monopolistic insurer, you must move out of state to change providers.

Prescribing "single payer" is like feeding Twinkies to a patient with a heart condition. Let free-markets work by eliminating poisonous laws.

Brian Schwartz, Ph.D., Boulder, CO

Happy July 4!

As we work to preserve our individual rights in medicine, I'd like to take a little time to honor those men in 1776 who fought for their rights and founded this great country of ours. It is because of them that we enjoy the unparalleled benefits of freedom and prosperity. America leads the way in medical innovation because of their ideas and their courage.

So to those brave men who put it all on the line against the most powerful empire in the world, and swore to each other to pledge "our Lives, our Fortunes and our sacred Honor", I thank you!

LTE From Steve Schweitzberger

The June 30, 2007 Rocky Mountain News published the following LTE by Steve Schweitzberger. Here are some excerpts:

...I have repeatedly heard Moore use the analogy that fire protection, provided as a socialized necessity, is an example of how medicine should also be socialized. No report about that analogy has brought attention to the fact that most homeowners carry private fire insurance. Although a "fire department" will try to save life and property, and prevent a fire from spreading to the next house, they do not provide compensation for losses.

...If Michael Moore has a toothache, it is not my responsibility to pay for his dentistry. If it were, then I would have the right to tell him not to eat sweets. I don't want that kind of government-paid medical policy. Do you?

Steve Schweitzberger, Littleton CO

Massachusetts: More Stick Than Carrot

The July 1, 2007 New York Times has an update on the attempt of Massachusetts to guarantee universal health care for all residents, "Massachusetts Universal Care Plan Faces Hurdles". One of the most chilling lines in the piece comes from Governor Deval Patrick who said:

"Ultimately we are going to have to explain to people that this is an obligation, that it is not optional."

One small business owner said about the employer mandates:

"This is going to bring me to my knees," said Deb Maguire, who runs Liam Maguire’s Irish Pub and Restaurant in Falmouth.

Another resident spoke about the individual mandate:

Linda Impemba, 58, a marketing company employee in Wakefield, said she would remain uninsured, pay penalties, and, as soon as her ailing mother dies, will leave Massachusetts. "There's no way in heaven I can possibly survive in this state," Ms. Impemba said. "Now not only is my cost going to go up, everything's going to be raised so I can pay for the other people" to be insured.

Nor will the plan improve access to care. Instead, the article notes that the plan "will strain what is already a shortage of primary care physicians", according to Dr. David Torchiana, chief executive of the Massachusetts General Physicians Organization.

By relying on the harsh stick of government mandates rather than proven free market reforms, the Massachusetts plan will hurt both patients and doctors.

(Via Dr. David Solsberg.)

Race To The Bottom

A New York psychiatrist explains why pursuing universal health care may be politically popular, but will cut down health care quality and stifle innovation. Here are some excerpts from his essay, "First Do No Harm" (sections in bold are my emphasis):

Expressing opposition to Universal Health Care is a bit like opposing the Flag, Mom, and Apple Pie; it is generally seen as indicative of a cruel and cramped attitude toward the less fortunate. Furthermore, with the price of health insurance and health care acting as a major factor in the increasing anxiety of the middle class, such opposition is a political loser of the first order. Yet the American public is being sold a bill of goods when it comes to Universal Health Care. If [candidate X] gains the Presidency... the American Middle class is in for one of the great "bait-and-switch" scams of all time.

It is a useful approximation to consider the American health care system as a 3 tier system as follows:

Tier 1: The highest level of health care, with state of the art technology, pharmacology, and personal care, complete with continuity of care, exists for the wealthy and those who have very good insurance. This gold standard is the level of care afforded to our Senators and Congressmen and is very expensive.

Tier 1A: Available to those with good insurance, Tier 1A offers all but the very newest technology and the most expensive of new drugs. This is the level of care that most middle class Americans have been accustomed to; there are some trade-offs, especially in terms of continuity of care. As Doctors have become squeezed by pressures on reimbursement, they have aggregated into groups which decrease expenses but make it harder to obtain timely appointments with the Physician of choice. Thus far this has been a tolerable trade-off for most Americans. Of special note, when Medicare was initially introduced, it was a Tier 1A system; it no longer can be considered such.

Tier 2: Available to those with merely adequate, lower cost (though still expensive for most people) insurance, including Medicare and most managed care health plans, Tier 2 offers some assurance of timely care, very little continuity of care, increasing limits on cutting edge technology and medication, and features significant rationing via such limitations as well as via the administrative road blocks that effectively deny payments for a significant fraction of all claims.

Physicians have been "voting with their feet" for the last decade; those who can afford to have been abandoning Medicare in droves. The result is a decreased availability of Physicians and an overall diminution of quality as those Physicians who can attract a more well-to-do clientele make the difficult decision to leave the system.

...Tier 3: The lowest tier of American health care is available to anyone, including Medicaid patients, uninsured people of limited means, illegal immigrant, et al. Tier 3 offers excellent state of the art care in emergencies and merely adequate health care for non-emergencies. Those who enter this tier must be willing to tolerate long waits for appointments, crowded waiting rooms in which to spend entire days waiting for routine care, minimal choices of medication and Tier 2 level technology only in the very rarest of cases. This level of care is unacceptable to most Middle Class Americans.

...Here is the essential problem: UHC will be offered as a plan which implicitly suggests the availability of Tier 1A coverage for all. That is the only way it can be sold to the American middle class. Yet anyone who has spent any time giving even the most superficial thought to the question will recognize that any affordable UHC will be at best a Tier 2 system, like Medicare, which, have I already mentioned?, is rapidly on its way to Tier 3 status.

And the worst will the long term effects on innovation and creativity. The attacks on the drug industry, which have been mostly in the realm of public relations up till now, will certainly escalate. Rules and regulations will metastasize in order to keep costs down, thereby limiting the profits of the industry that has done more than any other to keep people healthy. As innovation stalls, chronic illnesses which should be curable in the next 5-15 years, will remain as expensive management cases rather than (initially) expensive cures. More money for more older people with chronic illnesses will lead to more intense pressure to curtail treatment for those who are deemed problematic (notice that in England, under their UHC system, those over a certain fairly young age can not get a hip replacement. In addition, the ranks of those who are refused treatment for various cancers and other expensive illnesses grows by the day.)

Furthermore, establishing a Health Insurance floor, as any UHC system must inevitably do, will encourage suppliers of Tier 1A care to edge toward Tier 3 care (since Tier 2 will be slowly disappearing.) Since Tier 1 and 1A effectively support the bulk of innovation in Medicine, this movement will further constrict the moneys available for difficult and expensive research. Even those in Tier 1 will suffer by the loss of life saving innovations.

It will all be sold as fulfilling the credo that is almost universally fed to young people in the health care system, that "Health Care is a Right, not a Privilege." Sadly, the only way to make this privilege a right is to offer almost everyone the same level of care, and that way lies disaster.

(Via KevinMD.)

The key to attacking the misguided quest for "universal health care" is to challenge the premise that health care should be a "right". As many have pointed out, there's a big difference between a "need" and a "right". All humans have needs, including the need for food, clothing, shelter, medical care. That's just part of our nature as living beings. But that does not translate into a "right", in the sense that a person can demand the automatic satisfaction of those needs as a government entitlement, regardless of personal circumstance. The only way this can be guaranteed is if the government forces others to pay for it. This is the path to tyranny.

(Disclaimer: I am neither a Democrat nor a Republican but an independent voter. The author's views on any specific political candidates do not necessarily reflect my own. Since the purpose of this post is educational, as opposed to advocating for or against a particular candidate, I've edited out his reference to a specific presidential candidate. However, I completely agree with his broader economic analysis of the inevitable "race to the bottom" that will result if this country adopts universal health care.)

Gina Liggett LTE in USA Today

The June 29, 2007 edition of USA Today printed the following LTE by Gina Liggett:

Moore in denial

Gina M. Liggett, R.N. -- Denver

I'm hoping the title of the sequel to "Sicko" will be "Just Kidding." Moore and many Americans are in denial about the disaster that single-payer health care would bring, including:

* Long waiting lists for tests and treatment.

* Soaring costs of Medicare.

* Rationing treatments for more serious and costly diseases like cancer.

* Bureaucrats influencing medical decision-making that should only take place between a patient and a physician.

Does anyone care that Moore's advocacy of greater regulation of the pharmaceutical industry would only further stifle innovation at a time when we need it most to cure such devastating diseases as Alzheimer's, Parkinson's and diabetes?

As a nurse, I take care of patients with these diseases, and if our health care system is bad now, it will crash and burn under socialized medicine.

Here's the blog version with online comments.

LTE by Russell Shurts in Rocky Mountain News

The June 29, 2007 Rocky Mountain News printed the following LTE by Russell Shurts:

'Social responsibility'

In a recent letter to the editor concerning universal health care Will Pirkey said, "Our society does not need more personal responsibility, but rather social responsibility." In fact, this theme is the essential idea behind the current all out effort being conducted by some to provide medical care for everyone through the government. Since this idea is so important to their message let's look at it in the light of reality. How would a society that practices social responsibility over personal responsibility actually work?

In his letter Mr. Pirkey used a single mom with two kids working two minimum wage jobs as an example of someone who was being ill-treated by those who practice personal responsibility over social responsibility. He believes we all should chip in to pay for or provide the medical care such a single mom needs.

When those who believe in social over personal responsibility come to me for my contribution to this poor woman's plight I will simply ask, "Why are you asking me to do anything for her? I thought you believed in social responsibility. Why don't you have society take care of her? Go ask it."

Indeed, anyone who agrees with Mr. Pirkey can't honestly ask anyone to do anything, because asking depends on each person being asked to take personal responsibility for meeting the request.

Mr. Pirkey and his brethren don’t seem to grasp that there is no 'society' per se and therefore no such thing as 'social' responsibility. Certainly there are groups of people who work together, but any such group is ultimately dependent on the actions of each individual person in the group, i.e. each individual taking personal responsibility.

What Mr. Pirkey really wants is not for the single mom and me to work together for a common purpose, but for me to provide for the single mom. He wants those who have succeeded through personal effort to provide for those who have not, and he would not be bashful about pointing the government gun at us to force us to do it.
Please remember; this is the true meaning of 'social responsibility' the next time you hear it.

Russell W. Shurts, Centennial CO