Posts tagged with: medicine

Blog author: mvandermaas
Wednesday, April 30, 2008
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Continuing with my posts highlighting just how wonderful things will be here in the United States when the government finally does its job and takes over the healthcare sector of the economy, I’d like to bring your attention once again to the fabulous success story that is the Canadian health care system:

Last year, the Canadian government issued a series of reports to address the outcry over long wait times for critical tests, procedures and surgeries. Over a two year period:
• Wait times for knee replacements dropped from 440 to 307 days.
• Wait times for hip replacements dropped from 351 to 257 days.
• Wait times for cataract surgeries dropped from 311 to 183 days.
• Wait times for MRIs dropped from 120 to 105 days.
• Wait times for CT scans dropped from 81 to 62 days.
• Wait times for bypass surgeries dropped from 49 to 48 days.

Sure, you might have to wait a couple of months for that lifesaving bypass surgery. But remember: it’s free!

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.

I thought this was an interesting bit at the intersection of morality and economics. An insurance brokerage firm, K&B Underwriters, is sponsoring a physicians’ survey designed to determine whether doctors who work within a “culture of life” framework (e.g., eschewing abortion) are less prone to malpractice suits than those who don’t. The company’s hypothesis is that pro-life physicians are indeed “safer” in this way, with the implication that pro-life medical practices could be one criterion taken into account when calculating malpractice insurance. It’s a controversial claim, to be sure, but an intriguing approach—and the results so far seem to be supporting the hypothesis.

You can read more about the initiative—and complete the survey, if applicable—here.

HT: Deal Hudson’s “The Window” column.

With all this talk of health care reform this year, I couldn’t help but do some digging into the real aspects of the proposals. Ranging from the completely disruptive universal medical care plan from California Governor Arnold Schwarzenegger to the socialist-like plan from Senator Ted Kennedy (D-MA) in the 110th congress, health care is big on the agenda for 2007. I am afraid that if the policies proposed by Schwarzenegger and Kennedy are passed, future generations will witness a detrimental effect on our economy. Kennedy’s home state of Massachusetts, being the first state to provide universal health care to its citizens, has already seen negative aspects in regards to business and job creation.

These arguments for universal health care come disguised in many forms, but all contribute negatively to the economy. The idea of making health care affordable and available to citizens is an excellent idea, however, Governor Schwarzenegger’s and Senator Kennedy’s ideas are the wrong way to go.

Forcing employers to provide health care and penalizing them for not providing coverage is not the right direction to head.

The state of Massachusetts employs a combination of subsidies and penalties to make insurance more affordable and to force people to buy it. The law requires employers with 11 or more full-time employees to offer health coverage or be subject to a $295 fee for each employee, as well as face being billed for services their uninsured employees get.

Because of this policy, employees are going to lose other benefits and suffer pay cuts, or even be fired. The cost of medical insurance is extremely high. The real solution rests in not forcing employers to provide coverage, but to make insurance more affordable.

The answer lies in eliminating all of the fraudulent law suits filed every day by money-hungry lawyers who are completely destroying the medical system. As lawyers sue doctors, malpractice insurance premiums increase. The number of personal injury litigations has steadily increased at a rate of 12% since 1975.

Jury Verdict Research, a database of plaintiff and defense verdicts, says awards in medical liability cases increased 43 percent in 1999, from $700,000 to $1,000,000. Jury awards in medical malpractice claims jumped 43 percent in one year—from $700,000 in 1999 to $1 million in 2000. Juries are compensating plaintiffs more generously than in the past. From 1994 to 2000, Jury Verdict Research found that more than half of medical malpractice jury awards were for $500,000 or more.

Seeing the direct correlation between health care cost and the cost of medical malpractice insurance for doctors (driven up by law suits), the root of the problem is obvious. This must be attacked before anything else. If Senator Kennedy and Governor Schwarzenegger want to see real progress, their plans must be disregarded and tort abuse must be solved first. There are various other aspects to their plans that are also misinformed and misdirected, but I’ll save that for another time.

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.

Jim Aune, blogger-in-chief at The Blogora, complained yesterday about his health care treatment. He says, “I have been in constant pain for 36 hours. I actually used a cane to go to the office yesterday for some meetings. The problem? I have a trapped nerve in my abdomen from a double hernia repair a year ago. I got shot up with steroids about 3 weeks ago, and that worked for about 5 days, but I still can’t walk without a ripping sensation (as if my right leg were being separated from my side).”

That sounds horrible. He continues: “I’m about to go see the doctor again today (he’s a nice guy, as family practice doctors usually are, as the anesthesiologist at the pain clinic), so I decided to read up on the Internets about this condition. Now, a little learning, especially online, is a dangerous thing, but it appears that entrapped nerves have gone from happening in 1% of hernia repair patients to closer to 40%, and the speculation is that the new use of plastic mesh is a possible cause.”

It seems that Aune somehow associates John Stossel with his problem. “Enter the biggest jackass on television: John Stossel of 20/20, who believes that the market solves all problems, and that any government intervention in that frictionless market creates no end of bad ‘unintended consequences.'”

What is Aune’s argument against Stossel? After citing a Daily Kos item, Aune contends, “markets are wonderful things, but they only work in cases of ‘symmetric information.’ That is,they work efficiently when both parties to an exchange have nearly similar information.” (Last night’s episode of ER dealt with a very similar issue).

Markets only work in cases of symmetric information. Is this true? Or is the opposite true? Hayek’s observations about the nature of diffuse and unequal information are the basis for his arguments against the practicality of state intervention. As Steven D. Levitt and Stephen J. Dubner put it in their book Freakonomics, “We accept as a verity of capitalism that someone (usually an expert) knows more than someone else (usually a consumer).” Medical care isn’t the only example of information asymmetry, of course. Typical ones include car sales, or especially car repair, but they can apply in any instance where there is particular expertise involved.

Levitt and Dubner go on, “But information assymetries everywhere have in fact been mortally wounded by the Internet.” Now it is true that in practice, as in Aune’s experience, there are all kinds of limits on the potential for the Internet to even out information. It takes time, access, and a certain amount of patience to educate oneself about certain medical conditions, for example. Thus Levitt and Dubner go on to admit, “The Internet, powerful as it is, has hardly slain the beast that is information asymmetry.”

Aune later asserts, “markets do not work efficiently when information is asymmetric.” Maybe they don’t work as efficiently as they might otherwise, but they still seem to work, and perhaps better than any other option available to us. And there are methods for the sharing of information and such that does not necessitate government involvement (independent ratings, consumer reviews, and the like).

It’s not clear what Aune’s solution is (if there is one in his complaint), but I take it that Aune is arguing at least implicitly that the government needs to be the entity that solves the problem of information asymmetry. Would he rather have no choices, even the limited ones he is inadequately informed about, and instead have the government decide for him? Why don’t we just make doctors government employees? Then they can enforce the course of treatment they deem best.

Blog author: jballor
Wednesday, September 13, 2006
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Two pieces on Christianity Today’s website this week are worthy of comment. The first, “Despair Not,” reminds us that “there is something worse than misery and death.” The author Stephen L. Carter interacts with C.S. Lewis’ famous book, The Screwtape Letters, to show that “the terrible tragedies that befall the world work to Satan’s benefit only if we despair. Suffering, as Screwtape reminds his nephew, often strengthens faith. Better to keep people alive, he says, long enough for faith to be worn away. The death of a believer is the last thing the Devil wants.”

Dietrich Bonhoeffer criticized the impetus to deny the value of suffering in this life. In his Ethics he wrote of modern nihilism and Western godlessness:

The loss of past and future leaves life vacillating between the most brutish enjoyment of the moment and adventurous risk taking. Every inner development, every process of slow maturing in personal and vocational life, is abruptly broken off. There is no personal destiny and therefore no personal dignity. Serious tensions, inwardly necessary times of waiting, are not endured. This is evident in the domain of work as well as in erotic life. Lasting pain is more feared than death. The value of suffering as the forming of life through the threat of death is disregarded, even ridiculed. The alternatives are health or death. What is quiet, lasting, and essential is discarded as worthless.

The other CT piece is a book review by David Fisher of Reclaiming the Body: Christians and the Faithful Use of Modern Medicine. The book’s authors argue that “modern medicine… emphasizes the autonomy of the individual and holds up the supreme end of bodily perfection. These goals are not only unattainable, but more importantly, are inconsistent with the Christian faith. The book points out the dangers of society’s worship of and allegiance to medicine for its perceived ability to defeat or forestall death. While our Christian beliefs should protect us from this deification of medicine, the authors remind us that we often fall into the same trap.”

Indeed, the authority and influence of medicine on our lives and behavior can be seen as a kind of scientism, in which science, in this case in the form of medicine, takes on “a priestly ethos — by suggesting that it is the singular mediator of knowledge, or at least of whatever knowledge has real value, and should therefore enjoy a commensurate authority. If it could get the public to believe this, its power would vastly increase.” Authors Joel Shuman and Brian Volck issue “a call to transformed Christian living, one that emphasizes the importance of viewing medicine through the lens of the larger community of the body of Christ.”

With respect to the worship of health and life in and of itself, or “vitalism,” Bonhoeffer says,

Vitalism ends inevitably in nihilism, in the destruction of all that is natural. In the strict sense, life as such is a nothing, an abyss, a ruin. It is movement without end, without goal, movement into nothingness. It does not rest until it has everything into this annihilating movement. This vitalism is found in both individual and communal life. It arises from the false absolutizing of an insight that is essentially correct, that life, both individual and communal, is not only a means to an end but also and end in itself.

One important and indeed hopeful way to talk about death as an end, in addition to death as a means to an end, or “our entrance into eternal life,” is in this way: as “an end to our sinning.”