Medical Alert: Women and Thigh Fractures

[This post isn't on health care policy, but rather personal health care. Feel free to forward it to anyone else who might be interested. -- PSH]

Last week I attended a medical conference which included an update on the radiology of skeletal and orthopedic disease.

Although most of the lectures were intended for health professionals, there was one lecture which included information that would be of interest to the general public because it involved the common condition known as osteoporosis.

After women undergo menopause, many of them start losing bone mineral at a significant rate -- enough that they are at increased risk of developing fractures of the hip, spine, and other bones from relatively minor trauma. This condition of abnormal low bone density is known as "osteoporosis". In particular, hip fractures can be devastating to older women, and can often result in permanent disability or premature death.

In the past, women with osteoporosis (but who had not yet developed a fracture) were often treated with hormone replacement therapy in order to reduce their risk of these fractures. (Hormone replacement therapy was also widely used to alleviate the uncomfortable "hot flashes" associated with menopause). But because recent research has shown that these hormones can also increase the risks of certain cancers of the female reproductive system, this is no longer commonly done.

Instead, starting 4-5 years ago, many primary care physicians started treating such women with a different set of drugs designed to help protect and restore bone mineral density. One commonly prescribed family of drugs is known as bisphosphonates, and some examples include Fosamax, Boniva, and Actonel. These drugs have proven effective in halting (or even reversing) the mineral loss, and have also reduced the risk of these potentially devastating hip fractures.

However, in recent years there have been reports that these drugs can also paradoxically increase the risk of a certain type of upper thigh fracture (known as "subtrochanteric proximal femur fractures"). Although physicians and scientists don't fully understand the cause, it appears that women who have been on these drugs for a few years start developing tiny stress fractures in the upper femur bone (below the level of the hip joint), which gradually increase in size. Eventually, a certain percentage of these turn into complete fractures, and often the triggering event might be a relatively minor fall or bump.

This has only been recognized in the past year or so, as more women reach the point where they've been on these drugs for the (apparent) requisite time of 4-5 years.

So if you are a post-menopausal woman who has been diagnosed with either "low bone density" or "osteoporosis", and you are currently taking one of these drugs, then you need to be on the lookout for any new pain in the upper thigh region. This could be an early warning sign of a developing stress fracture.

Here is an example of an early stress fracture in the right femur (thigh) bone:



Here is an example of a late (completed) fracture:



(Both images are from "Subtrochanteric Femoral Insufficiency Fracture in Woman on Bisphosphonate Therapy for Glucocorticoid-Induced Osteoporosis", Lisabeth A. Bush, M.D., and Felix S. Chew, M.D., Radiology Case Reports, January 1, 2009.)

Your physician can then order various radiology tests (x-ray, MRI, or nuclear medicine bone scan) to see if you are developing a stress fracture. These can often affect both sides, even if you only feel the pain on one side. If you have one of these fractures, then your doctor can recommend the appropriate treatment.

For the time being, the benefits of these drugs are still felt to outweigh the potential drawbacks. Hence, physicians are not currently recommending that women who are taking them should discontinue them. And a lot more effort is being focused on this problem, now that doctors and scientists have become aware of it. The exact guidelines as to who should (or should not) be on these medications will undoubtedly undergo refinement as the research develops. As usual, if you have specific concerns, you should discuss them with their own personal physician.

Summary:

If you are taking a bisphosphonate drug such as Fosamax, Actonel, or Boniva, and you start experiencing upper thigh pain, get it checked out immediately. It could be an early stress fracture, which needs to be detected and treated before it becomes a complete fracture. This is especially important for women who are athletically active (e.g., running, tennis, etc.)

Even if you personally don't take these drugs, it's very likely you will know someone in your family or circle of friends who does.

(Obligatory disclaimer for any lawyers out there: This should not be construed as personal medical advice. If you have any questions about your specific situation, please consult your personal physician.)

Additional References:

"Subtrochanteric Femoral Insufficiency Fracture in Woman on Bisphosphonate Therapy for Glucocorticoid-Induced Osteoporosis"

"Atraumatic Bilateral Femur Fracture in Long-Term Bisphosphonate Use"

"Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate"

"More on Atypical Fractures of the Femoral Diaphysis"

Wikipedia entry on bisphosphonates

39 Fallacies About Health Care

Richard Ralston of Americans For Free Choice in Medicine has posted a collection of "Thirty-Nine Fallacies About Health Care".

See how many you can spot in the next news article you read about health care "reform"!

Ralston's Roar

The September 1, 2009 World Tribune published another OpEd by Richard Ralston of Americans for Free Choice in Medicine. His piece is entitled, "Roar from a Heartland awakened by looming government health care". Here's the opening:

Nearly a century ago, the Federal Reserve Board was created to eliminate the supposed economic problems of a free market. A century of inflation, recessions, one or two depressions, huge expansion in government debt, and wild swings in unemployment tells us the system may not be working.

Now, after forty years of expansive spending by Medicare and Medicaid -- uncontrolled and without funding -- we are told that what we need is the creation of Fannie Med to take over what remains of private health care. People are starting to get suspicious...

(Read the full text of "Roar from a Heartland awakened by looming government health care".)

A Doctor's Plan for Legal Industry Reform

The September 3, 2009 Wall Street Journal presented this great tongue-in-cheek proposal by Dr. Richard Rafal, "A Doctor's Plan for Legal Industry Reform".

Some excerpts:

* Legal "DRGs." Each potential legal situation will be assigned a relative value, and charges limited to this amount. Program participation and acceptance of this amount is mandatory, regardless of the number of hours spent on the matter. Government schedules of flat fees for each service, analogous to medicine's Diagnosis Related Groups (DRGs), will be issued. For example, any divorce will have a set fee of, say, $1,000, regardless of its simplicity or complexity. This will eliminate shady hourly billing. Niggling fees such as $2 per page photocopied or faxed would disappear. Who else nickels-and-dimes you while at the same time charging hundreds of dollars per hour? I'm surprised lawyers don't tack shipping and handling onto their bills.

* Ration legal care. One may need to wait months to consult an attorney. Despite a perceived legal need, physician review panels or government bureaucrats may deem advice unnecessary. Possibly one may not get representation before court dates or deadlines. But that' s tough: What do you want for "free"?

* Discourage/eliminate specialization. Legal specialists with extra training and experience charge more money, contributing to increased costs of legal care, making it unaffordable for many. This reform will guarantee a selection of mediocre, unmotivated attorneys but should help slow rising legal costs. Big shot under indictment? Classified National Archives documents down your pants? Sitting president defending against impeachment? Have FBI agents found $90,000 in your freezer? Too bad. Under reform you too may have to go to the government legal shop for advice.

* Collect data about the supply of and demand for attorneys. Create a commission to study the diversity and geographic distribution of attorneys, with power to stipulate and enforce corrective actions to right imbalances. The more bureaucracy the better. One can never have too many eyes watching these sleazy sneaks.

Read the full text of "A Doctor's Plan for Legal Industry Reform".

(Via Instapundit.)

How's That Massachusetts Plan Working Out?

In the August 27, 2009 Detroit News, Michael Cannon gives us the most recent update from Massachusetts. It's not a pretty picture.

Here are some excerpts from, "Massachusetts' Obama-like reforms increase health costs, wait times":

In the three years since Massachusetts enacted its individual mandate, providers successfully lobbied to require 16 specific types of coverage under the mandate: prescription drugs, preventive care, diabetes self-management, drug-abuse treatment, early intervention for autism, hospice care, hormone replacement therapy, non-in-vitro fertility services, orthotics, prosthetics, telemedicine, testicular cancer, lay midwives, nurses, nurse practitioners and pediatric specialists.

The Massachusetts Legislature is considering more than 70 additional requirements.

...As goes choice, so goes quality. Statistics on waiting times for specialist care in Massachusetts read like a dispatch from Canada. In 2004, Boston already had the longest waits among metropolitan areas. By 2009, waits had generally shortened in other metro areas (average wait: less than three weeks) but lengthened in Boston (average wait: seven weeks), according to the Merritt Hawkins survey.

...Nevertheless, those costs are appearing in higher taxes and health insurance premiums. State officials have raised taxes on tobacco, hospitals, insurers and employers, as well as eliminated coverage for many legal immigrants just to scrape up their 20 percent share of the cost. They are also showing the nation where ObamaCare would ultimately lead: government-imposed rationing.

To cope with the cost of its reforms, Massachusetts created a legislative commission that has recommended moving the entire market to a single, Canadian-style payment system that would encourage doctors and hospitals to ration care.

(Read the full text of "Massachusetts' Obama-like reforms increase health costs, wait times".)

The trends I discussed a year ago in my article "Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America" (The Objective Standard, Fall 2008), are unfortunately accelerating. Yet this is the precisely the model that many are proposing that we adopt at the national level.

Will America learn from the Massachusetts Mistake?

Health Care Reform Means More Power For The IRS

The September 2, 2009 DC Examiner warns that, "Health care reform means more power for the IRS". Here's an excerpt:

...Under the various proposals now on the table, the IRS would become the main agency for determining who has an "acceptable" health insurance plan; for finding and punishing those who don't have such a plan; for subsidizing individual health insurance costs through the issuance of a tax credits; and for enforcing the rules on those who attempt to opt out, abuse, or game the system. A substantial portion of H.R. 3200, the House health care bill, is devoted to amending the Internal Revenue Code of 1986 in order to give the IRS the authority to perform these new duties.

The Democrats' plan would require all Americans to have "acceptable" insurance coverage (the legislation includes long and complex definitions of "acceptable") and would designate the IRS as the agency charged with enforcing that requirement. On your yearly 1040 tax return, you would be required to attest that you have "acceptable" coverage. Of course, you might be lying, or simply confused about whether or not you are covered, so the IRS would need a way to check your claim for accuracy. Under current plans, insurers would be required to submit to the IRS something like the 1099 form in which taxpayers report outside income. The IRS would then check the information it receives from the insurers against what you have submitted on your tax form.

If it all matches up, you're fine. If it doesn't, you will hear from the IRS. And if you don't have "acceptable" coverage, you will be subject to substantial fines — fines that will be administered by the IRS.

Under some versions of health reform now circulating on Capitol Hill, the IRS would also be intimately involved in how you pay for insurance. Everyone would be required to buy coverage. The millions of Americans who can't afford it would receive a subsidy to pay for it. Under the version of the plan currently under negotiation in the Senate Finance Committee, that subsidy would come through the IRS in the form of a refundable tax credit. Under the House plan, the subsidy would come directly from the Health Choices Administration.

In either scenario, the IRS would be the key to making the system work.

In other words, health care "reform" would mean massive new intrusions into Americans' personal and financial lives.

Government promises of "universal" health care are anything but free. Instead, we'll all pay a massive price in the form of loss of personal freedom. Nor can the government actually guarantee health care. The only thing they can guarantee is rationing and waiting lists, as we've already seen in Canada, the UK, and Massachusetts.

To paraphrase Benjamin Franklin, "Those who would give up essential liberty for temporary health care deserve neither..."

Hannah Krening's Letter To Congress

Our friend Hannah Krening recently sent this message to her federal representative Mike Coffman and GOP Chairman Michael Steele (in response to this PJTV interview, I think). Diana and I really like it, so I'm posting it with her permission. She writes:

As a taxpayer, breast cancer survivor and one whose first husband lost a long battle with cancer, I want to say that the current proposed "reform" of health care adds up to one thing for me: I hope I never have a life-threatening condition again if any proposal to further involve government in my health care becomes reality. And I hope that nobody I love has to be subjected to the rationing, waiting and other debilitating results of what they evidently believe are the best of intentions.

I know you are against HR 3200. But I fear you may compromise on some important principles as you fight against it. Please hear me out.

Bringing more government involvement into health care "reform" is not a solution. It is a recipe for disaster. Only by reducing government involvement in health care will we get the kind of justice that will bring about the best care for all at the best possible price.

Republicans who hint at "tweaking" the current ideas or "slowing down" their implementation are no better; the premise of government involvement and what the current web of regulations and mandates has already caused is the issue we must all face now to prevent untold and unnecessary suffering down the road. So above all, PLEASE do not be one of the many Republicans willing to compromise principles with those who profit by your abdication of them!

We must remember that health care is not and cannot be free: the skills of doctors, researchers and technology companies must be fairly compensated. The alternative is slavery: of the few taxpayers who will foot the huge bills and of the competent providers of health care goods and services, who will ultimately leave the field in order not to be enslaved by it.

Another area that needs to be understood better is the concept of insurance, which is properly for catastrophe, spreading out the risk of situations that would ruin us financially. The history and cause of the current state of health insurance has root causes that include (surprise!) government taxation laws and regulations. HSAs and high deductible insurance will be the first to disappear if the "reformers" get their way.

People accuse those who speak for me of making up lies about the bill. However, quotes of the actual text reveal the actual results this bill will create. For example, see http://www.classicalideals.com/HealthCareBill8-2009.htm.

As you consider your input on Republican policy, I hope you will avail yourself of some excellent information on the principles needed to fight the current proposals for the best results, go to http://www.WeStandFirm.org. In addition, people like John Mackey of Whole Foods have started to offer real solutions, not just criticisms of HR 3200. These ideas need to be a part of the discussion.

This is not regulation on some dispensable part of our lives. This concerns everyone's survival, to some degree; nobody will be untouched by the outcome of this process. We have a lot to lose.

Thank you, Hannah!

If you agree, please feel free to send it to your own representatives in Washington with a note saying that you agree with it.

(Cross-posted from NoodleFood.)

No Level Playing Field For Public Option

The August 27, 2009 DC Examiner explains the "Four reasons there's no level playing field for the public option".

Key points include:

(1) Reimbursement of Providers
(2) A start-up infusion of cash
(3) State Premium Taxes
(4) Coverage Requirements

A government plan that competes against private companies in such an unfair fashion is no better than a Mafia-run grocery store that uses arson and beatings to "out-compete" honest storekeepers.

Hsieh OpEd: "The Free Market Is Not Another Form of Rationing"

PajamasMedia has just published my latest OpEd on health care:
"The Free Market Is Not Another Form of Rationing"

Here is the introduction:

As the health care debate rages, many conservatives have correctly argued that government-run "universal care" will lead to medical rationing. To control costs, the socialized health systems of Canada and Great Britain routinely restrict patients' access to expensive services. A Canadian with a possible brain tumor might wait months for his government-approved MRI scan, whereas an American can receive one within days.

Liberals will typically counter that a free market is just "another form of rationing" -- but by price rather than government decree. It is unjust, they say, that patients with money (or good insurance) can receive MRI scans whereas those without money cannot. Hence, they contend, the government must intervene to guarantee a supposedly fair distribution of medical services.

Too often, conservatives then concede this moral high ground to the liberals and defend the free market on purely economic grounds -- e.g., a free market would lower costs for everyone. This is a serious mistake. Supporters of the free market should not allow opponents to characterize the marketplace as a form of rationing, let alone an unjust one. Instead, supporters should defend the free market as morally just because it respects individual rights...

(Full text of "The Free Market Is Not Another Form of Rationing".)

Some commentors have stated that this argument of rationing is just "linguistic". I disagree, and in fact that's the key point of my piece.

It's similar to the fallacy some people commit when they claim that newspapers choosing to publish some pieces and not others is "just another form of censorship". That's completely wrong. Their uncoerced choice to publish one piece over another is the exercise of the right to free speech. In contrast, it would be censorship if the government told the newspaper which pieces they could not publish (or were required to publish).

Similarly, it's a serious category error to equate uncoerced exchanges in a free market with rationing. Rationing inherently involves compulsion, which is the exact opposite of the free market. The market is how we exercise our rights, and rationing is wrong precisely because violates those rights. (Thanks to Tom Stone for this analogy.)

I'd like to thank Craig Biddle for his comments on an earlier version of this piece. Diana, Ari Armstrong and I have also had several discussions on this subject, and Ari has written a series of blog posts on this topic.

The brief Ayn Rand quote comes from:
Ayn Rand, Letters of Ayn Rand, “Letter to Bill Mullendore,” (New York: Dutton, 1995), p.322.

Update: Thank you, Glenn Reynolds, for the Instalanche!

Tanner Debunks Another Obama Claim

In the August 26, 2009 Orange County Register, Michael Tanner debunks President Obama's frequent claim of "If you like your private health insurance plan, you can keep your plan. Period."

Here's an excerpt from Tanner's piece, "Like your health plan? Read this":

No, Mr. President. No you can't.

To go straight to the chapter and verse: under Section 59(B)(a) of HR3200, the bill making its way through the House, and Section 151 of the bill that passed out of a Senate committee, every American would be required to buy health insurance.

And not just any insurance: to qualify, a plan would have to meet certain government-defined standards. For example, under Section 122(b) of the House bill, all plans must cover hospitalization; outpatient hospital and clinic services; services by physicians and other health professionals, as well as supplies and equipment incidental to their services; prescription drugs, rehabilitation services, mental health and substance-abuse treatment; preventive services (to be determined by the Centers for Disease Control and Prevention and the United States Preventive Services Task Force); and maternity, well-baby, and well-child care, as well as dental, vision, and hearing services for children under age 21.

But that's not all. Section 1239(b) of the bill also establishes a federal Health Benefits Advisory Committee, headed by the U.S. surgeon general, which will have the power to develop additional minimum benefit requirements. There is no limit to how extensive those future required benefits may be.

If your current health insurance doesn't meet all those requirements, you won't be immediately forced to drop your current insurance for a government-specified plan. But you would be required to switch if you lose your current insurance or “if significant changes are made to the existing health insurance plan.”

More critically, for the 70 percent of us who get our insurance through work, those plans would all have to satisfy the government's benefit requirements within five years.

More likely, your employer will simply find that the increased cost and administrative burden is not worth it, and will dump you into the government-run "public option."

Tanner also describes more ways in which government policies would destroy current insurance plans, concluding:

Any way you look at it, under the bills currently before Congress, millions of Americans will be forced out of their current health insurance plan, even if they are happy with it. Period.

The government doesn't want you to decide what kind of insurance you can have. Instead, they'll decide for you.

Americans need to decide if they want this kind of government.

Armstrongs Debunk More Myths

The August 31, 2009 Grand Junction Free Press has published the latest OpEd by Linn and Ari Armstrong:

"Debunking Health Care Reform Myths"

Myths they discuss include:

Myth No. 1: Opponents of Obamacare are the ones creating myths.
Myth No. 2: Opponents of Obamacare are "anti-health care reform."
Myth No. 3: Opponents of Obamacare are criminals, thugs and mobs.
Myth No. 4: We need Obamacare to give everybody health care.

Feel free to circulate their article as far and wide as possible!

Evan Madianos, Twitter Machine

Fellow radiologist Dr. Evan Madianos has been posting all sorts of excellent links on his Twitter feed, RadsDocDancer.

If you're interested in intellectual ammunition to further the fight for free market health care reform, you should subscribe to his feed.

Proto Magazine: Hsieh on Obesity

Proto magazine is a quarterly biomedical and health magazine published by the Massachusetts General Hospital, which is one of the premier teaching hospitals for Harvard Medical School.

One of their "Policy Watch" articles in the Summer 2009 issue was entitled "The Future of Obesity?" The topic was what sorts of government programs (if any) should be imposed to stop the obesity epidemic. They interviewed eight people, most of whom were in favor of some sort of government-run "public service campaign" and/or new regulations to fight obesity along the same lines as the anti-tobacco campaign of the 1990s.

The author Charles Slack got my name through Craig Biddle (editor of The Objective Standard) and he was good enough to interview me as one of the eight "experts" specifically to provide a pro-freedom perspective on obesity regulations

My quote from "The Future of Obesity?" appears on page 2:

DON'T TREAD ON THE RIGHT TO BE FAT

In a free society, the individual has the right to make diet and lifestyle choices—and the responsibility to enjoy or suffer the consequences.

The government should not try to solve the obesity problem by coercing consumer behavior or by restricting the freedom of businesses to advertise their products. Some argue that such controls are justified because people who develop obesity-related illnesses will be treated at taxpayer expense. But the sole legitimate function of government is to protect individual rights, not violate them. Just because government currently violates individual rights by forcing citizens to pay for others’ health care does not justify further violations in the form of telling Americans what we may or may not eat. Two wrongs don’t make a right.

Those who become ill as a result of their poor choices should pay the price themselves or rely on voluntary charity rather than be supported by taxpayer dollars.

--Paul Hsieh, a physician in Denver, is a co-founder of Freedom and Individual Rights in Medicine, a nonprofit group that promotes personal liberty and free markets in health care.

This mirrors one of my themes from my earlier Christian Science Monitor piece, "Universal Healthcare and the Waistline Police".

Thanks, Craig, for helping to arrange this interview!

Armstrong On Rationing - Parts 3 and 4

Ari Armstrong has posted the final two parts of his series on rationing.

Part 3: "The Harm of Conflating Price Distribution with Rationing"
Part 4: "Politically-Controlled Insurance and Rationing"

Single Payer - The Musical

Today's video: "One -- Single Payer System"



(Via Rand Simberg.)

Ramirez Cartoons

Pulitzer Prize winning cartoonist Michael Ramirez has penned some excellent cartoons on the health care debate.

Hsieh LTE on Health Statistics

The August 29, 2009 Denver Post has just published my LTE responding to some bad health care statistics they cited 3 days earlier in their article, "Fact Check on Health Care".

Here's my LTE:

Health care statistics

Life expectancy and infant mortality statistics are notoriously poor measures of the quality of a nation's health care system. For instance, more Americans are killed in car accidents and homicide than in Canada and Europe. According to ABC News, if one adjusts for these fatal injuries, then U.S. life expectancy is actually higher than in nearly every other industrialized nation.

International comparisons of infant mortality rates are similarly suspect. The U.S. counts any premature infant born with a heartbeat as a live birth even if it survives only a few hours. Many European countries count such children as "stillborn" if they weigh less than 1 pound even if they show a heartbeat. Japan doesn’t count such infants as "live births" unless they survive for more than 24 hours.

Flawed statistics make a poor basis for public policy.

Paul Hsieh, M.D., Sedalia
The writer is co-founder of Freedom and Individual Rights in Medicine.

For more information on life expectancy claim, see this column by ABC News reporter John Stossel, "Why the U.S. Ranks Low on WHO's Health-Care Study".

For more information on infant mortality statistics, see this column by former NIH director and former Red Cross president Dr. Bernadine Healy, "Behind the Baby Count".

Armstrong On Rationing - Part 2

Ari Armstrong's second piece on the nature of rationing is now up:

"Rationing II: The Definition and Application of Rationing"

Sloan Compares Canada and the US

In the August 26, 2009 Grand Junction Free Press, former Canadian resident Kelly Sloan compares the health care systems of Canada and the US.

Here are some excerpts from, "Why the U.S. can't afford Canadian-style health care":

When Tommy Douglas, architect of Canada's government-run health care system, (and head of North America's first socialist government) nursed his pet project to fruition in the early 1960s, he envisioned a medical utopia, where contented citizens, freed from the ravages of market forces, heartless insurance companies, and greedy doctors (sound familiar?) would receive timely, quality medical care on demand, provided by an army of cheery yet determined practitioners whose only concern in the world was to advance the general welfare of their fellow man. Paradise in a lab coat.

Some 40 years later, the reality bears little semblance to the idealistic vision of Kiefer Sutherland's grandpa. Skyrocketing costs, crippling tax rates, chronic doctor shortages, months-long waits for routine tests, (years for many specialized services), and oftentimes outright denial of procedures are the norm. Governments, desperate to control costs and prevent a total collapse of the system, are continuously de-listing previously covered procedures, and seeking new taxes or even, (heaven forbid) user fees.

As a Canadian, I can testify to the elongated waits for tests that often result in additional and more costly treatment, when you do finally get around to being treated. Those who can afford it flock south for their medical care.

So what went wrong?...

Sloan also offers some positive recommendations to improve the current American system:

This is not to say that improvements can't be made. America has been in the business of improving things since its inception more than 200 years ago. Few would deny there are costs associated with the system that can be controlled. Tort reform (it is somewhat ironic that under President Obama's plan, the only segment of the health care industry who would not be making great financial sacrifices are the trial lawyers), addressing the issue of portability, easing mandates on insurance companies, and Health Savings Accounts would all go a long way toward creating real competition, lowering costs, and helping solve the problem of dropped coverage associated with job loss and pre-existing conditions, as individuals took ownership of their insurance. Many of these common sense reforms were, incidentally, voted down by previous Congresses, which included then-senator Obama in the "nay" column.

These would be excellent steps in the right direction -- and would constitute real reform.

(Read the full text of "Why the U.S. can't afford Canadian-style health care".)

Armstrong on Rationing

Ari Armstrong has started a four-part series analyzing the concept of "rationing" and how it applies to the health care debate.

Part 1: "Price Distribution Is Not Rationing"

McNulty on the British NHS

Aeon McNulty gives an in-country perspective on the failing British National Health Service.

Here are few excerpts from, "The Long Shadow of the National Health Service":

...There are countless reports, articles, essays and books that will give you all the statistics, anecdotes and arguments you could possibly want (please see the links at the end of this article). I don’t want to debate figures here; plenty of misinformation is swirling around on both sides of the political divide and I see no value wading in to fight over the shifting minutiae. I’m interested in exploring the underpinning ideas.

...The primary reason, however, that the NHS has a death-grip on the psyche of our nation is tied to its founding beliefs. It is no coincidence that the NHS was sold to the British public during wartime. In a country conditioned by emergency measures, nationalised industries and rationing the idea of an egalitarian "free" health service, based on need not ability to pay, struck a powerful chord. No-one would be left behind; everyone would be treated the same; we were all in it together.

The wartime spirit is palpable in NHS hospitals even today. Nowhere else in 21st Century British life do you feel this atmosphere. The staff seem to be constantly fighting a losing battle. As a patient you're a supplicant, not a customer, pathetically grateful for what you receive. You’re just one of the many faceless victims waiting to be treated. Waiting, for everything, is a matter of course. Queueing, filling in forms, being moved by harassed looking nurses, more waiting. But you mustn’t grumble; stiff upper-lip and all that.

The consequence of this is clear:

...People often assume that removing financial incentives encourages virtue and will somehow simplify the decision making process, but resources are limited and the need for medical care is infinite. If money is taken out of the equation other, less direct, constraints become necessary and the remaining incentives are twisted. Long waiting times, mushrooming administrative bureaucracy, rationing of care and lack of transparency are not simply a matter of insufficient funding; they’re inescapable components of this type of system.

Here’s an example. You come in for a check-up and your doctor notices a minor discrepancy. It's probably nothing but to eliminate all doubt she needs to order an expensive test. If you were paying for your healthcare, or had control over your insurance, she could explain the situation candidly and leave the decision up to you. You would need to balance the small risk against the expense, or -- depending on the nature of the potential problem -- a change in your lifestyle. You might even shop around for a cheaper kind of test; it's your money after all. But if your doctor is required to give you free treatment the situation changes drastically. She must now consider the fact that if she tells you the whole truth you will naturally demand the test. It doesn't matter to you how much it costs or how tiny the risk; you’re not paying for it. Your doctor, however, has to think about the hospital targets, the other patients waiting for tests and, if you're elderly, the effectiveness of continuing treatment considering your age.

As far as I can tell, most doctors maintain their integrity. They're honest with their patients and zealously fight their corner against the hospital managers. But what kind of system sets up a clash between the interests of the patient and the doctor? What kind of system punishes virtue?

I highly recommend reading the full essay.

McNulty's essay echoes this warning from British MP Daniel Hannan that America should not follow Great Britain down the road towards socialized medicine:



Let's hope enough Americans are listening.

Goldhill: How American Health Care Killed My Father

The September 2009 Atlantic carried the following piece by David Goldhill, "How American Health Care Killed My Father".

He makes many excellent observations. Although I don't fully agree with all of his proposed solutions, his article is well worth reading. Here are a few excerpts:

...Like every grieving family member, I looked for someone to blame for my father's death. But my dad’s doctors weren't incompetent -- on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing -- without exception, his nurses were dedicated and compassionate. Nor from financial limitations -- he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.

Indeed, I suspect that our collective search for villains -- for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care -- from doctors to insurers to pharmaceutical companies -- work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create.

In particular, he describes in detail the following major points:

* Health Care Isn't Health (Or Happiness)
* Health Insurance Isn't Health Care
* The Moral-Hazard Economy
* There's No One Else to Pay the Bill
* The Government Is Not Good at Cost Reduction
* Our Favored Hospitals
* You Are Not the Customer
* The Strange Beast of Health-Care Technology
* The Limits of "Comprehensive" Health-care Reform

(Read the full text of "How American Health Care Killed My Father".)

Most of his proposed changes are free market reforms or would be happen naturally in a free market. (I disagree with some of his ideas, such as requiring everyone to own a Health Savings Account. But I agree with repealing legal obstacles to purchasing HSAs and catastrophic-only insurance plans.)

And most importantly, he's willing to challenge the idea that "reform" is synonymous with government-run "universal coverage", especially given that he identifies himself as a Democrat. More politicians need to hear this message.

Peck Praises Mackey

Blogger Tim Peck penned the following eloquent response to John Mackey's proposed free market health care reforms.

Here is an extended excerpt from Peck's letter:

...I too believe that the government must reverse its inappropriate manipulation of the health care industry and turn to free market solutions to repair the problems that prior government intervention has created.

I believe that the government's only proper role is the protection of individual rights. Interference by the government in the health care and insurance industries violates individual rights by forcing unwilling participants to pay for a predatory collective, by pressing physicians and other independent professionals into involuntary servitude for the sake of some mysterious, shape-shifting and ultimately illusory "common good," and by dictating the terms upon which an insurer can operate. This regulatory interference causes the rising cost of health care and diminishing access to the quality and innovation that only the profit-motive can supply.

The "public option" and "single-payer" health care proposals being advanced by disinterested power-seeking central planners in Washington would mean a government bureaucracy interfering in the private relationships between doctors and their patients. It is a subversion of the individual's right to contract. It is a subversion of the right to use one's judgment to act in one's own best interest without interference. It is a subversion of the right of doctors, nurses and insurers to voluntarily offer products and services to satisfied health care consumers for their mutual benefit.

...As philosopher Ayn Rand urged throughout her life, political and economic freedom are requirements of life. Statism serves to undermine those ends while capitalism serves to further them. Capitalism is not right because it works, it works because it is right.

TIM PECK
ASHEVILLE NC

(Read the full text of Peck's reply to Whole Foods.)

More Americans like Peck speaking out to defend the principle of individual rights. And more politicians are starting to listen.

Lewis: Suppose Car Insurance Was Considered to Be a 'Right'

Duke University professor John Lewis has written another powerful OpEd using an analogy between car insurance and health insurance.

Here's his piece, "Suppose Car Insurance Was Considered to Be a 'Right'":

The major impetus behind the Democratic health care plans is not economic -- it is moral. The claim that health care is a moral right has motivated enormous government coercions against the medical industry for nearly fifty years. But this moral claim has blinded people to the fact that huge price increases have necessarily followed the growth of the coercions. To understand why, it is instructive to consider what would happen if car insurance were considered to be a "right" and the right was enforced by the government.

After the purchase of a home and the ordeal of major surgery, a car is most people's biggest financial risk. One mistake -- or one bad driver -- can harm dozens of people. We need insurance, so why should it not be considered a right?

Car insurance is provided by companies that manage their investments in order to absorb financial losses. If insurance is considered to be a "right," then someone must be forced to provide it: either the companies directly, or the citizens through coercive taxation. Either way, the new "right" will be taken by physical force, that is wielded by the state against those who are bound, by law, to provide it.

To enforce this new "right," the government must take money from some people and give it to others, without regard for the actual risk they pose. As huge amounts of money are pumped into insurance markets, demand increases, and prices rise. Government officials blame the companies, so they pass more controls, thus squeezing the supply. Prices rise further -- the law of supply and demand cannot be thwarted.

People want to be protected from greedy repair shops and auto manufacturers. So the companies undergo a ten-year approval process costing millions of dollars for new products. As lawsuits mount, courts enforce claims of strict liability against the companies -- who pass the costs on. Price rises accelerate.

As people get used to a "right" to car insurance, they demand more coverage. Oil changes, brake jobs, torn seats and new tires become insurance matters. If insurance is a "right," then no one should be deprived of these goods because he cannot pay for them. Every visit to the repair shop -- big or small, routine or emergency -- now involves an insurance claim. Prices escalate.

Male drivers under 25 pay more because they are statistically higher risks—but they resent this inequality. So they assert their "right" to insurance at the same price as older, wiser drivers. Companies spread the costs out across the board -- and as good drivers face higher premiums, they demand more coverage. Prices shoot up further.

By this point, no one asks what a repair job will actually cost -- they ask only about their "co-pay." Customers have little incentive to keep costs down. Why bother to change the oil, if the insurance will give you a new engine?

As regulations increase, critics castigate companies who are unwilling to cover pre-existing conditions, such as a fender dented before the car was insured. As paperwork increases, repair shops that once had four mechanics and one secretary now have five secretaries, who spend their days filing claims. Prices rise further -- until car insurance becomes a crushing burden.

By this point, the very idea that insurance should be used for catastrophic losses—not routine maintenance -- has been lost. A chorus of calls for "reform" demands more government coercion to enforce the "right." Anyone who suggests reducing the controls is shouted down by those who blame the "free market" for rising costs. By this point, most people have forgotten what a free market is -- or that they had no "right" to insurance before someone else produced it -- or that there was a time when insurance was not so costly.

This is fiction, of course -- but it directly mirrors what has happened in health care. After World War II, companies began to offer employee health insurance because government controls forbid them from paying higher wages. Twenty years later, the "Great Society" lavished billions on programs -- and as prices rose, regulation against the producers multiplied. HMOs and a host of other schemes were tried.

Now, bucking under the weight of economic distortions and regulations, the law of supply and demand is wreaking vengeance on those least able to pay. Medicare and Social Security are approaching insolvency, insurance companies are forbidden from selling across state lines or from offering innovative health savings accounts, and the solution offered is—even more programs, with a price tag so large that it that cannot be grasped by the human mind.

To expand government programs is not "reform." It is an extension of sixty years of government interventions. The government now controls nearly fifty percent of all health care dollars -- paid for by skyrocketing prices, taxes and borrowing. The correlation with history, and with the law of supply and demand, is precise and inescapable.

The primary cause of medical price increases is the government coercions. But the cause of the coercions is the idea that health care is a right. Until we understand that nothing is a "right" if others must be forced to provide it, we will continue to swallow the same poison, and we will reap even worse consequences in the future.


John David Lewis (website) is a Visiting Professor of Political Science, Duke University. He has been a Senior Research Scholar in History and Classics at the Social Philosophy and Policy Center, and an Anthem Fellow. He is a contributing writer for Capitalism Magazine, and a Consulting Editor for The Objective Standard.

(Full text here at CapMag.com.)

Health Insurers Are Not Your Friend

In the August 14, 2009 DC Examiner, Tim Carney reminds us that health insurance companies are not necessarily friends of the free market.

Here's an excerpt:

Dear conservatives:

Health insurance companies are not your friends. Keep opposing a new government-run insurer, a single-payer plan, and new regulations on the HMOs. But grant that Speaker of the House Nancy Pelosi is correct on this: Insurance companies are villains.

Insurance companies lobby for big-government regulations, subsidies, mandates, and tax-code distortions that funnel them money, keep out competition, and stultify innovation. These policies preserve the employer-based health-care system that mocks the idea of free-market competition. Then they cry "unfair competition" when government threatens to encroach on their government-protected monopolies.

But they're not just lobbying against a government option. Today, health insurers are lobbying to force you and me to buy their product or face a tax hike (the individual mandate).

They are lobbying to force entrepreneurs to buy insurance for employees (the employer mandate). They are lobbying for more subsidies paid for by us taxpayers. In short, they are lobbying against regular people and against the free market...

(Read the full text of "Down With The Health Insurers".)

Carney makes an important point. Too often, insurance companies are advocates of more statist regulation (not less), as I argued in my piece, "Health Insurance Industry Sells Its Soul to the Devil".

Hence, it's important to defend the principle that insurance companies and patients have the right to contract in a free market without government interference, while simultaneously opposing any attempts by insurers to lobby for more government regulations that would violate that same right.

(Link to Carney OpEd via Brian Schwartz.)

Health Care Debate Shifting Onto Moral Grounds

The August 20, 2009 New York Times reported that President Obama is trying to make the argument that we have a "moral obligation" to provide universal health care.

This is good news for free market reform advocates.

The President and his political allies know that they are losing the economic arguments, so they are now trying to shift the argument to the moral plane. But this happens to be our strength. Most Americans want to "do the right thing", but they are sometimes mistaken as to what that right thing is. Fortunately, more and more people are raising the point that universal health care is wrong because there is no such thing as a "right" to health care.

Here are a few recent OpEds along these lines

Mike Rosen, "No 'Right' To Health Care"
Denver Post, August 13, 2009

John Lewis, "Health Care: Why Call It a 'Right'?"
Huffington Post, August 12, 2009

John Mackey, "The Whole Foods Alternative to ObamaCare"
Wall Street Journal, August 11, 2009

Theodore Dalrymple, "Is There a 'Right' to Health Care?"
Wall Street Journal, July 28, 2009

Wendy Milling, "Lest We've Forgotten, Health Care Is Not a Right"
RealClearMarkets, June 23, 2009

In my opinion, the best-formulated arguments are from John Lewis and Wendy Milling. But all of these writers are trying to steer the debate in the right direction -- to the level of morality and rights. And their arguments are resonating with ordinary Americans.

This means that Americans are receptive to a discussion of these issues at the fundamental philosophy. At some level, they recognize that this fight is not merely about a particular economic program, but about the future direction of America.

The best essay I've ever read along these lines is Dr. Leonard Peikoff's classic article entitled, "Health Care is Not a Right", available at the FIRM website.

(This is the 2007 version by Leonard Peikoff updated with the assistance of Lin Zinser. For printing, I recommend the PDF version, but for sending as an e-mail link there's also an HTML version. The Ayn Rand Center website also has a nice PDF version suitable for printing.)

As Dr. Peikoff noted:

...Most people who oppose socialized medicine do so on the grounds that it is moral and well-intentioned, but impractical; i.e., it is a noble idea -- which just somehow does not work. I do not agree that socialized medicine is moral and well-intentioned, but impractical. Of course, it is impractical -- it does not work -- but I hold that it is impractical because it is immoral.

This is not a case of noble in theory but a failure in practice; it is a case of vicious in theory and therefore a disaster in practice.

I want to focus on the moral issue at stake. So long as people believe that socialized medicine is a noble plan, there is no way to fight it. You cannot stop a noble plan -- not if it really is noble. The only way you can defeat it is to unmask it -- to show that it is the very opposite of noble. Then at least you have a fighting chance...

Last week, a local doctor called me up to tell me that he had started surfing the FIRM website, read Dr. Peikoff's essay, and thought it was the best analysis he had ever seen on this issue, precisely because it cut to the heart of the debate.

We are at a crucial point in the battle of the ideas. According to pollsters and pundits, ObamaCare is in political jeopardy -- but it is not dead yet. The American people know that there is something deeply wrong with the idea, and they are starting to understand why. We can help them by providing the proper moral arguments they need to counter the faux moral arguments now being advanced by the White House.

Hence, please feel free to circulate the above links to any friends, family, or elected officials who might be interested. You can also print out copies to distribute at Tea Parties, Town Hall meetings, etc.

We have the right ideas and the right tools. Now we just have be willing to use them.

Schwartz on Employer Mandates

The August 21, 2009 Denver Daily News published Brian Schwartz's critique of employer mandates. Here's an excerpt:

...The problem, not the solution

Government's favoring employer-sponsored insurance is the problem, not the solution. When your employer buys your insurance, it's a non-taxable corporate expense. Employers save by "paying" you with insurance instead of higher wages.

This tax policy coddles insurance companies. They need only please your employer, not you. Most employers offer just one or two plans. Want more choices? If you prefer one of the many plans available at eHealthInsurance.com, you face a stiff tax penalty. Or try changing jobs. Insurers know you're essentially stuck with your employer's plan, so why should they please you?

Tax-discounted insurance has turned insurance into prepaid health care. If car insurance worked this way, it would cover predictable expenses like oil changes and replacement tires. You wouldn't price compare or consider whether services were really necessary. Rather, you'd ask if "it's covered." Costs would soar. This has happened with medical care.

The tax bias for employer-sponsored insurance punishes those who incur medical conditions and then lose their job. A pre-existing condition can make them uninsurable.

(Read full text of "Not a Health Care Remedy".)

As Schwartz and others have noted, we need real change, not just further entrenching bad government policies which locks people into their jobs, stifles economic growth, and violates individual rights.

How about trying a free market?

Ingemarson Defends Individual Rights

More and more people are daring to challenge the statists' view that there is a "right" to health care.

For example, Mike Rosen's piece in the August 13, 2009 Denver Post, "No "right" to health care" created a stir.

One of best supportive responses was this LTE from Anders Ingemarson, printed in the August 19, 2009 edition of the Denver Post (7th one down):

Bravo, Mike Rosen, for identifying the fundamental, moral health care issue -- there is no right to health care.

True health care reform protects the fundamental right of patients, doctors and insurance companies to voluntarily exchange products and services in the marketplace without government intervention. Such reform must focus on repealing existing laws and programs, not creating new ones. Repeal laws preventing insurance companies from offering policies with selective coverage and individuals from choosing such policies. Repeal laws making health insurance premiums tax-deductible for corporations but not for individuals. Repeal laws forcing doctors to take on excessive amounts of malpractice insurance to protect themselves against lawsuits. And yes, eventually repeal Medicare and Medicaid.

In health care, as in life in general, the moral is the practical; true health care reform will result in an abundance of health care options for people of all means.

Anders Ingemarson, Denver

Thank you, Anders!

Remember Maine (Part 2)?

Last year, we noticed that Maine's universal health care plan was failing.

Today's (August 21, 2009) Wall Street Journal reports that Maine's troubles are worsening.

Apparently, the combination of a "public plan" (called DirigoChoice), strict regulations on insurers specifying who they must accept, and subsidies for low-income patients seems not to be working. Yet this is precisely what's being proposed at the national level!

An excerpt from their piece, "No Maine Miracle Cure":

...Then the state created a "public option" known as DirigoChoice. (Dirigo is the state motto, meaning "I Lead.") This plan would compete with private plans such as Blue Cross. To entice lower income Mainers to enroll, it offered taxpayer-subsidized premiums. The plan's original funding source was $50 million of federal stimulus money the state got in 2003. Over time, the plan was to be "paid for by savings in the health-care system." This is precisely the promise of ObamaCare. Maine saved by squeezing payments to hospitals and physicians.

The program flew off track fast. At its peak in 2006, only about 15,000 people had enrolled in the DirigoChoice program. That number has dropped to below 10,000, according to the state's own reporting. About two-thirds of those who enrolled already had insurance, which they dropped in favor of the public option and its subsidies. Instead of 128,000 uninsured in the program today, the actual number is just 3,400. Despite the giant expansions in Maine's Medicaid program and the new, subsidized public choice option, the number of uninsured in the state today is only slightly lower that in 2004 when the program began.

...This problem was exacerbated because since the early 1990s Maine has required insurers to adhere to community rating and guaranteed issue, which requires that insurers cover anyone who applies, regardless of their health condition and at a uniform premium. These rules—which are in the Obama plan—have relentlessly driven up insurance costs in Maine, especially for healthy people.

The Maine Heritage Policy Center, which has tracked the plan closely, points out that largely because of these insurance rules, a healthy male in Maine who is 30 and single pays a monthly premium of $762 in the individual market; next door in New Hampshire he pays $222 a month. The Granite State doesn't have community rating and guaranteed issue.

The WSJ concludes:

...Unlike the federal government, Maine has a balanced budget requirement. So out of fiscal necessity, the state has now capped the enrollment in the program and allowed no new entrants. Now there is a waiting list. DirigoChoice has become yet another expensive, failed experiment in government-run health care, alongside similar fiascoes in Massachusetts and Tennessee.

Waiting lists, skyrocketing costs, and a failure to actually guarantee "access" -- who could have predicted that these would be the results of government intervention in health care and health insurance?

Balko on Whole Foods

Radley Balko really takes the anti-Whole Foods protestors to school.

Just read the whole thing.

The Contradictions of ObamaCare

The August 20, 2009 Wall Street Journal observes that President Obama seems to be sending contradictory messages about his proposed health care "reform".

First, regarding the overall need for change:

[The President] likes to start off explaining our catastrophe of a health system. "What is truly scary--what is truly risky--is if we do nothing," he said in Portsmouth, New Hampshire. We can't "keep the system the way it is right now," he continued, while his critics are "people who want to keep things the way they are."

However, his supporters also want to keep things the way they are. "I keep on saying this but somehow folks aren't listening," Mr. Obama proclaimed in Grand Junction, Colorado. "If you like your health-care plan, you keep your health-care plan. Nobody is going to force you to leave your health-care plan. If you like your doctor, you keep seeing your doctor. I don't want government bureaucrats meddling in your health care."

With respect to deciding what care you can receive:

Mr. Obama couldn't be more opposed to "some government takeover," as he put it in Belgrade, Montana. In New Hampshire, he added that people were wrong to worry "that somehow some government bureaucrat out there will be saying, well, you can't have this test or you can't have this procedure because some bean-counter decides that this is not a good way to use our health-care dollars."

So no bureaucrats, no bean-counters. Mr. Obama merely wants to create "a panel of experts, health experts, doctors, who can provide guidelines to doctors and patients about what procedures work best in what situations, and find ways to reduce, for example, the number of tests that people take" (New Hampshire, again).

And on Medicare:

"The only thing I would point is, is that Medicare is a government program that works really well for our seniors," he noted in Colorado. After all, as he said in New Hampshire, "If we're able to get something right like Medicare, then there should be a little more confidence that maybe the government can have a role—not the dominant role, but a role—in making sure the people are treated fairly when it comes to insurance."

The government didn't get Medicare right, though: Just ask the President. The entitlement is "going broke" (Colorado) and "unsustainable" and "running out of money" (New Hampshire). And it's "in deep trouble if we don't do something, because as you said, money doesn't grow on trees" (Montana).

Looks like we elected two Presidents for the price of one!

(Full text of "ObamaCare's Contradictions")

How Free Health Care Got So Expensive

Steven Malanga explains "How Free Health Care Got So Expensive".

Here is an excerpt:

... [A] public option won't restore sanity to the health insurance market. What will, is getting get rid of the rules, mandates and tax exemptions that treat health insurance different from other coverages.

Consider auto insurance, which is typically required of us by states, and home insurance, which mortgage lenders demand. Both give us protection from financial ruin at more reasonable prices than health insurance because our options are greater and the scope of the coverage narrower. When we buy home insurance we are essentially purchasing security against a catastrophic event that could cost us our investment in our home and possibly ruin us financially. We don't expect this insurance to cover everything that goes wrong on the property. Instead, we accept that we will pay out of our own pockets the tradesmen who come and install our new water heater, fix our electrical short-circuits and repave our driveway. Many of us haven't gotten a health care bill in years equal to what we paid the plumber for his last visit because the cost of a home insurance policy that covered every leak and crumbling piece of pavement would be prohibitive.

There are significant other ways that government mandates treat health insurance differently, at great cost to all of us. Consider this scenario: You don't have home insurance and a big storm comes through and knocks over a tree into your roof. You can't just phone up an insurer, buy coverage and then submit a claim, even if you face financial ruin by not having the coverage. But that's more or less what you can do in health insurance under so-called guaranteed issue rules, in which someone who hasn't purchased insurance and gets sick can't be turned down for coverage. Needless to say, states that have guaranteed issued, like New Jersey and New York, have the highest health insurance premiums in the country because healthy people know they can run the risk of not buying insurance until they get sick. Insanely, the health reform package now on the table in Washington would create a federal version of guaranteed issue.

In auto insurance, some states have given us our own private version of tort reform to keep premium prices low. In these states, a driver can opt out of the litigation lottery when he purchases auto insurance by promising not to sue for pain and suffering if he's hit and injured by another driver. By doing this a policy holder can save hundreds of dollars a year on premiums. And yet for some reason the same option, that is, allowing us to buy a health insurance policy where we agree not to sue a health provider for pain and suffering if a treatment goes wrong, is not available, even though I imagine the cost savings would be enormous.

Government regulators also require us to buy so much more health insurance. In auto coverage, for instance, states will generally mandate that we have certain minimum coverage to compensate anyone we may crash into, but otherwise regulators will leave us alone to decide which options (towing, collision) we want to buy. By contrast, states will require buyers of individual and small group health policies to load up on mandatory coverage, including options that many people don't want to pay for, like fertility treatments. Politicians will often claim that they demand these coverages because they are looking out for our own good, but that's a difficult case to make persuasively when mandates help make insurance unaffordable for many people.

Read the whole thing.

Government regulations and bad tax laws have turned health insurance from protection against unlikely-but-expensive events into inefficient pre-paid health plans.

We don't need yet more government regulations. Instead we should scrap the ones we already have and move towards a free market.

Stoddard On Mandates

William Stoddard sparks a heated discussion on mandatory health insurance at Megan McArdle's Atlantic blog.

Here's the letter from him that she is quoting:

I'm not sure I'm in any of the four groups of uninsured people you identify. I'm 59 years old, self-employed, and uninsured... because I can't afford to pay for even catastrophic coverage. I have a touchy gall bladder; I haven't had an attack in several years, but it's a pre-existing condition, so it raises my premiums, which are painfully high anyway for a man my age. I've been self-employed since 2002, when my former corporate job was outsourced. Does that fit any of your categories?

If the House of Representatives proposal passes, I expect that my premiums will be right at the legal maximum of 12% where subsidies kick in... assuming that my income doesn't rise past the threshold where a single man is ineligible for help! It averages around $40K, so 12% is $400 a month. I know I can't afford to pay that; I used to pay that much for Blue Cross, and it left me under chronic financial stress. So I'm planning to pay the penalties; 2.5% is $1K a year, which will hurt me, but it won't completely wipe me out. On the other hand, I can't see how it's supposed to help me maintain my health.

But I'll tell you, I supported Obama over both McCain and Clinton partly because he opposed mandates. Now he hasn't said a word to stop them. I don't know if I could bring myself to vote for a Republican, but if the Democrats inflict this financial injury on me, they can forget about my ever voting for another Democrat. I didn't know if Obama was trustworthy; now I know.

Later in the comment thread, Stoddard elaborates on his views:

In response to Mr. Thacker's question, John McCain's proposals on health care were the single thing that most strongly tempted me to vote for him; they are very close to what I would prefer... though not as close as John Mackey's proposals in the August 11 Wall Street Journal. I was deterred from supporting McCain by cultural issues, and centrally by his endorsement of the Republican Party's intolerable orthodoxy on abortion. Obama's position on mandates was just enough to make him a marginally lesser evil.

If Obama were maintaining his position... which he could do easily, by announcing that he will veto any bill that includes mandates... then whatever proposal Congress came up with, if it cost too much, I could remain uninsured and at least not be made worse off. Mandates take that protection away from me; they allow Congress, or some administrator, to decide what I am supposed to be able to afford, and require me to comply. And without mandates, if a lot of people choose not to sign up, Congress will get the message that their proposals aren't working; with mandates, people who send them that message faces fines. Their willingness to resort to compulsion does not inspire confidence in their ability to devise something that people would willingly choose.

And I'm not in the category where large numbers of people will be hurt. The Democratic proposals will really damage many people in their twenties, by forcing them to spend large amounts of money on insurance for the sake of lowering costs for people my age. All income redistribution strikes me as ethically dubious, but income redistribution from the young and poor to the old and nonpoor seems hard to justify in terms of the values the Democratic Party claims to support. What they actually support seems to be forcing 45 million Americans to become customers of the health insurance industry, whether they can afford it or not... the same industry that has completely failed to control health care costs.

Stoddard is asking the sorts of questions that many Americans are asking.

It will be very interesting to see how our political leaders respond...

Don't Drink The Co-Op Kool-Aid

The August 18, 2009 Investor's Business Daily explains why we should not be fooled by the new rhetoric of "insurance co-ops". Instead, that's just the old "public plan" in a new guise.

More information here from Michael Tanner:

The health care "co-op" approach now embraced by the Obama administration will still give the federal government control over one-sixth of the U.S. economy, with a government-appointed board, taxpayer funding, and with bureaucrats setting premiums, benefits, and operating rules.

Plus, it won't be a true co-op, like rural electrical co-ops or your local health-food store -- owned and controlled by its workers and the people who use its services. Under the government plan, the members wouldn't choose its officers -- the president would.

The real issue has never been the "public option" on its own. The issue is whether the government will take over the U.S. health care system, controlling many of our most important, personal, and private decisions. Even without a public option, the bills in Congress would make Americans pay higher taxes and higher premiums, while government bureaucrats determine what insurance benefits they must have and, ultimately, what care they can receive.

Crumbling Canadian Health Care

The August 16, 2009 Canadian Press reports that Canadian doctors are issuing dire warnings about the state of that country's health care system:

The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it.

Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country - who will gather in Saskatoon on Sunday for their annual meeting - recognize that changes must be made.

"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.

Americans should not wish to emulate this failing system.

Canadian Mark Wickens posted the following insightful observation in response to the related story, "Canadian doctors open to private health care":

Your headline got my hopes up, but what's being discussed is not the kind of fundamental change that's needed. Patients and doctors need to be allowed to obtain and offer services without the interference of government. That someone must wait months for services that they are willing to buy and which would be offered if government didn't outlaw it in the name of "equity" is wrong. That this state of affairs is allowed to persist in the life-and-death field of medicine is outrageous.

The Truth About Health Insurance

The August 12, 2009 Wall Street Journal points out that a few states already have some of the same new rules on health insurance that President Obama would impose on the country as a whole, in their piece "The Truth About Health Insurance".

And what has been the result?

...[O]nly five states--Maine, Massachusetts, New Jersey, New York and Vermont--have Mr. Obama's proposal for "guaranteed issue" on the books today. New Hampshire and Kentucky repealed such laws after finding that they soon had an even smaller individual insurance market as companies fled the state.

Another proposed reform known as "community rating" imposes uniform premiums regardless of health condition. This also blows up the individual insurance market, by making it far more expensive for young, healthy or low-risk consumers to join pools--if they join at all. And if the healthy don't join risk pools, then premiums go up for everyone and insurers have little choice but to reduce their risk by refusing to cover those who have a high chance of getting sick, such as people with a history of cancer. This is why 35 states today impose no limits whatsoever on how much insurers can vary premiums and six states allow wide variation among consumers.

New York, New Jersey and Massachusetts have both community rating and guaranteed issue. And, no surprise, they have the three most expensive individual insurance markets among all 50 states, with premiums roughly two to three times higher than the rest of the country. In 2007, the average annual premium in New Jersey was $5,326 for singles and in New York $12,254 for a family, versus the national average of $2,613 and $5,799, respectively. ObamaCare would impose New York-type rates nationwide.

The WSJ concludes:

ObamaCare would impose on all 50 states rules that have already proven to be failures in numerous states. Because these mandates would raise the cost of insurance, ObamaCare would then turn around and subsidize individuals to buy the insurance that the politicians made more expensive. Only in government could such irrationality be sold as "reform."

Will our politicians learn from their mistakes? Or will they repeat them?

Schwartz: Bennet Should Oppose Health “Reform”

The August 10, 2009 Denver Business Journal published Brian Schwartz's latest LTE entitled "Michael Bennet should oppose Democrat health 'reform'":

Senator Michael Bennet says that "health care reform must shift control from insurance companies to doctors, nurses and their patients." If so, he should oppose the Democrats' so-called health care "reform." Insurance companies have too much control because politicians have handed it to them through tax laws that give preferential treatment to employer-provided insurance.

This punishes employees who buy insurance directly instead of settling for their employer's insurance options. Hence, insurers cater to employers instead of patients. The Democrats' proposals to mandate employer-provided insurance won't solve this problem, but merely entrench it.

Worse yet, tax-discounted insurance has skewed demand in favor of excess insurance to cover routine and predictable expenses. If car insurance similarly covered oil changes and new tires, customers wouldn't compare prices--they'd only ask if "it's covered." Demand and prices would soar, and insurers would wield too much power.

Senator Bennet should support ending a biased tax policy that that favors employer-controlled insurance over patient-controlled insurance.

(PDF scan of the print version.)

The Whole Foods Alternative to ObamaCare

The August 11, 2009 Wall Street Journal recently published an OpEd by whole Foods CEO John Mackey, proposing some genuine free market alternatives to government-run "universal health care".

In his piece, "The Whole Foods Alternative to ObamaCare", Mackey makes several good recommendation including:

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs)

• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.

• Repeal all state laws which prevent insurance companies from competing across state lines.

• Repeal government mandates regarding what insurance companies must cover.

• Make costs transparent so that consumers understand what health-care treatments cost.

(Read the whole thing.)

Although I have a few very minor quibbles, I think he is basically on the right track.

Whole Foods is taking a lot of heat for its views.

Hence, I thought I'd give them my moral support. Here's a copy of an e-mail I sent their customer service department (and posted to their discussion forum):

Dear Whole Foods,

My wife and I have been customers of Whole Foods for many years now, here in the Denver metro area.

We were delighted to read CEO John Mackey's excellent piece in the Wall Street Journal proposing genuine free market health care reforms rather than the usual heavy-handed top-down government-mandated "solutions", which is all we're hearing lately.

In particular, I applaud his recognition of the fact that there is no "right" to health care. This is the fundamental moral issue underlying the health care policy debate. Any attempt by the government to guarantee a false "right" to health care must necessary violate the actual individual rights of patients, providers, and taxpayers. Hence, I'm glad that Mr. Mackey is proposing solutions that will lower health costs for Americans while respecting our individual rights.

This country was founded on principles of freedom and individual liberty. I'm glad that CEO Mackey recognizes and respects that fact. As a result, my wife and I are delighted to continue to give our business to Whole Foods and we will encourage our friends and colleagues to do so as well.

Sincerely,

Paul Hsieh, MD
Freedom and Individual Rights in Medicine (FIRM)
http://www.WeStandFIRM.org

My wife also sent them this letter:

Dear Whole Foods --

I have been a regular shopper at Whole Foods for the past year, but now I have more to appreciate about your stores than your fine nuts, hearty meats, and pungent cheeses. I salute CEO John Mackey for his op-ed proposing free market health care reforms.

I am particularly grateful for Mr. Mackey's clear statement that health care is a need not a right. Too often, people think that their want creates an obligation on the part of others to satisfy it. In fact, a person is responsible for satisfying his own needs and wants in life. His rights to life, liberty, and the pursuit of happiness enable him to do that: they allow him the freedom to act in pursuit of his own goals without forcible interference from others. They do not allow him to rob and plunder his neighbors. If that is permitted by law, the results are exactly as Ayn Rand portrayed in "Atlas Shrugged."

I realize that many Whole Foods shoppers support socialized medicine, so I particularly appreciate Mr. Mackey's willingness to speak out on this issue. Such courage is rare in America today.

Thank you!

Diana Hsieh (Ph.D, Philosophy, CU Boulder)
Sedalia, Colorado

In times like this, the courage of men such as John Mackey should be praised and rewarded.

Armstrong On Rationing and ObamaCare

The August 14, 2009 Colorado Springs Gazette printed Ari Armstrong's OpEd, "Rationing Inherent In Obamacare".

Here is the introduction:

The health reform debate has heated up mainly over rationing. On August 6, Mike Sola of Michigan confronted Rep. John Dingell. As Sola’s son watched from a wheelchair, Sola charged, "Under the Obama health care plan which you support, this man would be given no care whatsoever because he is a cerebral palsy handicapped person."

That same day in Longmont, a cancer survivor told a crowd, "I've had a total of 11 surgeries. Do you think that Obama's health care would have paid for that?” When the crowd answered "no," he said, “Exactly. But I’m still alive today."

A July 29 rally in Colorado Springs featured a sign calling Obamacare "a death sentence for seniors."

Obama glibly brushes off criticism as "misinformation" as his supporters attack critics as un-American thugs and mobs. Yet rationing under Obama's proposal is inevitable. The only question is how rationing would play out...

(Read the full text of "Rationing Inherent In Obamacare".)

Because of government policies, the British and Canadians currently endure long waits for advanced medical care (such as MRI scans) that most Americans would find outrageous.

Americans are starting to wake up to the fact that ObamaCare would be dangerous to their health. Let's hope the politicians start realizing that as well...

Dalmia: The Myth Of Free Market Health Care In America

In the July 29, 2009 Forbes Shikla Dalmia reminds us that the US health care system is far from a free market. Instead, it's much closer to the European systems than many recognize, and that's why we're in such trouble.

Here's an excerpt:

...The fact of the matter is that America's health care system is like a free market in the same way that Madonna is like a virgin--i.e. in fiction only. If anything, the U.S. system has many more similarities than differences with France and Germany.

Hence, it's wrong to blame the free market for our current problems:

...The point is that there is no health care model, whether privately or publicly financed, that can offer unlimited access to medical services while containing costs. Ultimately, such a model arrives at a cross roads where it has to either limit access in an arbitrary way, or face uncontrolled cost increases. France and Germany, which are mostly publicly funded, are increasingly marching down the first road. America, which is half publicly and half privately funded, has so far taken the second path. Should America offer even more people such unlimited access through universal coverage, it too will end up rationing care or facing national bankruptcy.

The only sustainable system that avoids this Hobson's choice is one that is based on a genuine free market in which there is some connection between what patients pay for coverage and the services they receive. That is emphatically not what America or any Western country has today. Looking to these countries for solutions as Obama and other advocates of universal health coverage are doing will lead to false diagnoses and false cures.

(Read the full text of, "The Myth Of Free Market Health Care In America".)

Quote Of The Day

Health care economics in a nutshell:

Health care in the US is covered by three main systems -- Medicare, medicaid, and private insurance.

Two of these systems are bankrupt, and will be unable to make payments beyond [2017].

The third is solvent, and can make all of its payments for the foreseeable future.

Barack Obama's plan is to take the one system meeting its obligations and fold it into the two systems that are bankrupt.

(Via InsureBlog and Ace of Spades)

Svorny: A Victory For Special Interests

The August 6, 2009 Investors Business Daily carried a good editorial by professor Shirley Svorny warning that special interest groups are salivating at the opportunity to feed at the trough of government-run health care.

This will be done in the guise of the government deciding on an appropriate basic package of care that all Americans are (somehow) "entitled" to receive.

Here are some excerpts:

Government Care: A Victory For Special Interests

...Put the federal government in charge of deciding what is appropriate care, and special-interest groups will fight long and hard for a place on the list.

Politics, not patient needs or the need for increased access to care, will determine which procedures are covered.

Evidence of political influence in health care abounds, mostly at the state level, because that is where health care has been regulated. Increasing regulatory power at the federal level will bring out lobbyists' big guns, as any win is much bigger than it is at the state level.

If you want to see how corrupt government oversight can get and how it can work to produce outcomes that raise costs and reduce access, look to the various states.

At the state level, special-interest influence can be seen in regulations that limit the entry of medical professionals with unnecessary education requirements, define what medical professionals are allowed to do (scope-of-practice turf wars pit groups against one another fighting for legislative support), dictate benefits that health insurance must cover whether consumers want them or not, tie the hands of providers with rules like nurse-patient ratios, and restrict health maintenance organizations from being able to channel patients to physicians who agree to lower prices and other cost-saving behaviors.

These public policies are all the result of politicians yielding to pressures from special-interest groups. In each case, the result is that providers cannot experiment with cost-efficient methods of care. Health care is costly because state governments require it, even when there is absolutely no evidence to support the restrictions imposed on providers.

...As consumers, we would be foolish to support legislation that shifts more power to special interests by increasing federal oversight and regulation of the health care industry. We should be moving to limit state regulation instead of expanding the regulatory power at the federal level.

(Read the full text of "Government Care: A Victory For Special Interests".)

Sadly, physicians groups such as the American Medical Association are some of the guiltiest players of this game.

Physicians groups, hospitals, insurers, and politicians should be championing the rights of individuals to seek health care from willing providers on terms they find mutually acceptable -- not making it harder (or impossible) for patients to exercise that right.

John Lewis Quoted On Limbaugh

On his August 12, 2009 radio show, Rush Limbaugh read extended sections of John Lewis' analysis of the Democrats' Health Care Bill HR3200.

Here's a transcript of Limbaugh's program segment:
"A Duke Professor Explains What the Health Care Bill Actually Says"

Here's the link to Dr. Lewis' full analysis of HR3200.

If John Lewis' ideas reach enough people, he might have just saved our country...

France Fights Universal Care's High Cost

France is often touted as a shining example of how governments can provide universal health care in a cost-effective manner. Hence, as the flaws in Canada and England become more apparent to Americans, many on the political left are pointing to France as the model to emulate.

But the August 7, 2009 Wall Street Journal tells a different story. Here are a few excerpts from their aritcle, "France Fights Universal Care's High Cost":

...France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.

One key problem is that the system is founded on socialist premises:

...French taxpayers fund a state health insurer, Assurance Maladie, proportionally to their income, and patients get treatment even if they can't pay for it.

In other words, following the Marxist principle of, "From each according to his ability, to each according to his need".

The inevitable result:

...[S]ervice cuts -- such as the closure of a maternity ward near Ms. Cuccarolo's home -- are prompting complaints from patients, doctors and nurses that care is being rationed. That concern echos worries among some Americans that the U.S. changes could lead to rationing.

The American Pilgrims learned the error of the socialist approach the hard way in 1623 with respect to food production.

Let's hope today's Americans don't have to relearn the same lesson the hard way with respect to health care.

Health Rationing in Oregon

The Independence Institute has a new video on how health care is rationed in Oregon, and how the priorities are driven by special interest groups:



Will this be the future of America under ObamaCare?