Posts tagged with: health care

This evening, I attended a showing of Michael Moore’s movie Sicko

I wasn’t expecting much, so maybe it was easy to exceed my expectations. But I was pleasantly surprised that the movie wasn’t far more painful for me to watch. Although certainly not without its flaws, it has something to add. And the movie was well-made, humorous in places, poignant in others– effective and provocative.

Moore is quite critical of insurance companies and HMO’s– and quite complimentary of the health care systems of France, Cuba, Canada, and England. With that combination, you would expect him to be optimistic about the United States moving toward single-payer health care. But his cynicism toward our government– in particular, the often-unsavory relationship between politicians and interest groups– leads him to criticize our system (correctly in many cases) without embracing government as a practical means to his desired end.

Some examples? Early-on, he mentions that Medicare fails to cover a lot of things (although he fails to pile on by talking about the program’s extraordinary expense). And he points to the government’s selective provision of health care to the heroes of 9/11. He also notes that the government provides awesome health care for the detainees at Guantanamo. (He could have bolstered this with the observation that our troops receive health care that is largely illegal in the states– since interest groups have restricted competition from competent providers like physicians’ assistants and nurse practitioners.) Implicitly, he notes the absurdity of restricting trade in pharmaceuticals, health care services, and health insurance. In a word, he isn’t happy with the status quo, but he’s not at all optimistic that our government can or will fix the problem.

The problem with health care– from the point of an economist– is that government is too heavily involved in health care: in addition to the above examples, we could also list Medicare, Medicaid, and most notably, government’s subsidy of health care insurance (as a non-taxed form of compensation).

Because of the subsidy, ironically, those who can afford health care insurance have too much of it. First, by definition, something that is subsidized will be purchased too much (at least in terms of efficiency). Second, imagine how insurance typically operates: it covers rare, catastrophic events. In contrast, health care “insurance” covers everything from allergy shots to cancer. By way of analogy, car insurance of this type would cover everything from door dings and oil changes to severe car accidents. And what would happen to the cost of oil changes, the paperwork associated with oil changes, etc.? We’d have exactly the same sort of mess we have in health care.

With government’s current level of involvement– very far from a market-based system– one can make an argument that a single-payer plan would be an improvement over the status quo. But of course, one can also argue that a single-payer plan would be even worse. A quick look at our education system and the post office indicate that a government-run monopoly is unlikely to deliver decent quality with any kind of efficiency or without special interest politics. This seems to be Moore’s dilemma in the proverbial nutshell.

Sure, there were examples of poor analysis in the movie. For example:
-There was a strange reference to “full employment” in England (when all of Europe struggles with significantly more unemployment than us– due to various employer mandates Moore seems to appreciate);
-He repeats the common reference to U.S. infant mortality rates (vastly oversold since we treat premies different for the purposes of that statistic);
-He repeats the tired canard that schools just need more money (while they already spend more than $10K per student; how much more money do you want to inject into a government-run entity with tremendous monopoly power?); and
-His analysis of other countries seems to miss the important factor that their populations are smaller and more homogeneous than ours.

And I suppose that other viewers– perhaps most who would see Moore’s film– could see a call for bringing socialized medicine to the U.S. in Moore’s work. But a more nuanced reading of the film points to an idealistic but laudable desire that our health care system would be something better– without holding out much hope that our politicians will be able to deliver us closer to that outcome.

— Also see Dr. Don Condit’s Acton Commentary: What’s Wacko about Sicko? – Ed.

Don Surber thinks so, and it’s hard to argue his point when you see stories like this:

Sorry about the wait for that angioplasty...

Sorry about the wait for that angioplasty...


More than 400 Canadians in the full throes of a heart attack or other cardiac emergency have been sent to the United States because no hospital can provide the lifesaving care they require here.

Most of the heart patients who have been sent south since 2003 typically show up in Ontario hospitals, where they are given clot-busting drugs. If those drugs fail to open their clogged arteries, the scramble to locate angioplasty in the United States begins…

…While other provinces have sent patients out of country – British Columbia has sent 75 pregnant women or their babies to Washington State since February, 2007 – nowhere is the problem as acute as in Ontario.

At least 188 neurosurgery patients and 421 emergency cardiac patients have been sent to the United States from Ontario since the 2003-2004 fiscal year to Feb. 21 this year. Add to that 25 women with high-risk pregnancies sent south of the border in 2007.

Although Queen’s Park says it is ensuring patients receive emergency care when they need it, Progressive Conservative health critic Elizabeth Witmer says it reflects poor planning.

That is particularly the case with neurosurgery, she said, noting that four reports since 2003 have predicted a looming shortage.

“This province and the number of people going outside for care – it’s increasing in every area,” Ms. Witmer said.

“I definitely believe that it is very bad planning. …We’re simply unable to meet the demand, but we don’t even know what the demand is.”

Read that last line again: “We’re simply unable to meet the demand, but we don’t even know what the demand is.”

Well, that’s a confidence builder.

The Canadian system is supposedly one of the main models upon which the coming American health care revolution will be based. And yet this wondrous Canadian system seems to be more and more incapable of providing relatively common medical procedures to Canadian citizens, even in Canada’s most populous province. Because the system is controlled by a bureaucracy, it doesn’t respond to market pressures (goodness knows that most of the time, bureaucracies barely respond to political pressure) and in fact can’t even figure out what the market is demanding. All of this results in the Canadian government relying on the supposedly inferior US system to provide lifesaving care in many instances. No wonder 3 out of 4 Canadians live within easy driving distance of the US border.

So what happens if we decide to go down the path toward single-payer health care in the US? You’d have to be a fool to think that we could try the same thing that the Europeans and Canadians have done and get different results. No, in the long run, we’ll experience the same sorts of inefficiencies, quality and supply problems that plague the government systems, and yes, more Canadians will die, because the safety net that currently exists for the Canadian system here in the United States will be gone.

More: Check out the video after the jump… (more…)

As a person with a strong family history of cancer, this story warmed my heart. Oh wait, did I say “warmed my heart”? What I meant to say was “chilled me to the bone“:

Created 60 years ago as a cornerstone of the British welfare state, the National Health Service is devoted to the principle of free medical care for everyone. But recently it has been wrestling with a problem its founders never anticipated: how to handle patients with complex illnesses who want to pay for parts of their treatment while receiving the rest free from the health service…

…One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.

“He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview.

“I said, ‘Where does that leave me?’ He said, ‘If you pay for Avastin, you’ll have to pay for everything’ ” — in other words, for all her cancer treatment, far more than she could afford.

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones…

…in a final irony, Mrs. Hirst was told early this month that her cancer had spread and that her condition had deteriorated so much that she could have the Avastin after all — paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense.

Mrs. Hirst is pleased, but up to a point. Avastin is not a cure, but a way to extend her life, perhaps only by several months, and she has missed valuable time. “It may be too bloody late,” she said.

I’m simply thrilled that so many people are so keen on introducing this system to the United States.

It’s a shame that the marvel of government-controlled health care hasn’t been implemented in the US yet:

Seriously ill patients are being kept in ambulances outside hospitals for hours so NHS trusts do not miss Government targets.
Thousands of people a year are having to wait outside accident and emergency departments because trusts will not let them in until they can treat them within four hours, in line with a Labour pledge.

What a fool I’ve been to oppose this massive improvement in standards of care. Hat tip to The Corner for pointing this one out.

Do you care enough to help?

Via Hot Air

The mammoth Congressional expansion of SCHIP is such a bad idea, even the normally big spending President Bush vetoed the bill. I wrote a piece titled, “Abandon SCHIP: Big Government Returns,” which is now available on the Acton Website.

The political posturing concerning the program has reached a troubling level. Supporters are using using kids as props to usher in socialized medicine and government expansion. But one of the main problems with the bill is the regressive characteristic of the expanded version. Money will be transfered from poorer states and citizens to fund a permanent middle to upper-middle class entitlement. While the growing cost of health care is a serious problem, we need to find solutions that provide affordable private coverage outside of the impending bureaucratic and regulatory nightmare.

Another growing frustration is a lack of conservative leadership on explaining the consequences of expanding this program. In general it seems, in the last few years political and moral leadership on government expansion has been largely vacant. Conservatives use to fight the expansion of these programs and point out the unintended consequences of such measures. Do we really want a permanent entitlement for the well to do?

There are a number of problems with Paul Krugman’s NYT piece earlier this week, “A Socialist Plot.” Krugman compares the American educational system to its healthcare system, arguing that because Americans aren’t inclined to disparage the former as a socialist threat, we likewise shouldn’t consider universal healthcare as a “socialist plot.”

“The truth is that there’s no difference in principle between saying that every American child is entitled to an education and saying that every American child is entitled to adequate health care. It’s just a matter of historical accident that we think of access to free K-12 education as a basic right, but consider having the government pay children’s medical bills ‘welfare,’ with all the negative connotations that go with that term,” says Krugman.

Krugman assumes that a defense of private versus public education is indefensible. After hypothesizing about making a case for abolition of public education, he purrs to his NYT audience who have never considered any practical option besides the government administration of education, “O.K., in case you’re wondering, I haven’t lost my mind.” Clearly to even consider getting rid of public education is insane.

First, let’s make a basic distinction between government mandates and government provision. The government mandates that I have car insurance before I take my car out for a spin, but I don’t sign up with the government for that car insurance. In the same way, drawing my own analogy, government could mandate K-12 education without being the primary provider of said education.

And as far as socialists plots go, government provided education should be ranked right up there. Even social observers who are largely sympathetic to socialism see the administration of public education primarily in terms of its utility as a means of social control rather than as a means of inculcating truth. Thus says Reinhold Niebuhr: “While education is potential power, because it enables the disinherited to protect their own interests by organised and effective methods, the dominant classes have suppressed their fears about education by the thought that education could be used as a means for inculcating submissiveness.” Whether the dominant class is the bourgeois or a politburo, public education as social control is a real concern.

Kristoff concludes, “We offer free education, and don’t worry about middle-class families getting benefits they don’t need, because that’s the only way to ensure that every child gets an education — and giving every child a fair chance is the American way. And we should guarantee health care to every child, for the same reason.” Socialism, apparently, is the American way. And middle-class families that send their kids to private schools aren’t “getting benefits they don’t need,” they are paying via taxes, often dearly, for education they don’t want.

There is an analogy between health insurance, car insurance, and education. It may be that the government mandate that all Americans have health insurance (although I doubt such a policy’s prudence), and yet not become the primary provider of such health insurance. Where market forces fail, nonprofits, charities, community groups, and churches must fill the gap. BlueCross and BlueShield is a nonprofit health insurance association providing coverage for about 1/3 of the American population. If need be tax credits and other incentives could be extended to promote private financing of such initiatives.

For more on the push for socialized health care in the US, check out this week’s commentary, “What’s Wacko about Sicko.”

Blog author: jballor
Friday, March 9, 2007
By

Joe Knippenberg reflects on President Bush’s speech earlier this week about advancing social justice in the Western Hemisphere:

Bush has lots to say about encouraging what he calls “capitalism for the campesinos.” He ties this to “social justice,” by which he means, above all, “meeting basic needs” to education, health care, and housing so that people can “realize their full potential, their God-given potential.” But social justice, thus conceived, doesn’t require massively redistributive government action; rather, it requires unleashing the potential of individual initiative, sowing some seeds, and leveraging the efforts of non-governmental organizations, especially faith-based ones.

In comparison to a speech from President Kennedy in 1961, Knippenberg concludes, “If you compare GWB to JFK, you’ll see that the goals aren’t all that different, but the thought put into the methods is.”

See also today’s WSJ editorial, “Capitalism for Campesinos.” More on Bush’s visit in the context of socialism in the NYT today.

Go to this page to watch a short video highlighting the story of one man’s fight against Canada’s health system.

The film is focused on the defects of socialized medicine and so, naturally, does not deal with the serious problems existing in other systems (such as the United States). But it is an effective display of a problem that every attempt to manipulate prices encounters: how to make supply meet demand.

Transparency International is a group devoted to exposing corruption of all kinds. One of the most sickening forms of corruption in many poor countries is health care corruption. One sort of corruption is absentee-ism: medical personel bill for their services even when they aren’t at work, but are doing another job.

The increasingly large and legal market for pharmaceutical drugs is attracting criminal activity. Pharmaceuticals are high value and easily portable, and the penalty for stealing or smuggling them is far lower than for narcotics, so trade is brisk. This is especially the case in Africa where borders are porous to those prepared to pay bribes. Furthermore pharmaceutical markets are segmented internationally since companies recouping research and development costs want to charge efficient prices in vastly different settings for products with very low marginal costs. Antiretrovirals (ARVs) to treat HIV have 20-fold price differentials between western and African countries, which mean illegal but massive arbitrage possibilities exist for smugglers.

Once again, lack of virtue retards economic development.