North Coast Online

American Health Care

Some perspective on American health care.

Last week, the British Medical Journal ran the triumphant headline "US comes last in international comparison on health care", based on a survey by the US-based Commonwealth Fund. However, the notorious anti-American bias of this publication actually buried the real shock, which was that:

The United Kingdom was ranked first overall, scoring highest on quality, efficiency, and equity.

The other countries in the list are Australia, Canada, Germany and New Zealand. It is crucial to remember that studies like this (using highly aggregated data) tend to compare apples with pears. For example, key health data like infant deaths and live births are recorded differently with the US counting extremely low-weight infants as live births. This led to false accusations on poor US standards regarding infant mortality.

The editors of The Australian Private Doctor recently provided some revealing figures, confirming that socialized NHS style systems ration services not by price but by waiting times:

While only about 5 per cent of Americans have a wait of more than four months for surgery, the figure for Australians, New Zealanders, Canadians and Britons ranges from 23 per cent to 36 percent.

The American system is more expensive because it delivers premium healthcare with high cost technology and pharmaceuticals, as well as super-specialist physicians and treatments. Most of those are rarely elsewhere available. The US also pays for the bulk of clinical research and is pivotal to medical innovation.

Much is made of the 40 million uninsured in the US, but they should really be labelled free-riders – they obtain health care on an emergency basis and others pay (roughly $1000 per year). Even more important, thanks to a range of State and Federal programmes for low-income individuals and families, "The per capita spending rate (on health care) for individuals is the same for those above and below the poverty line."

We have to be careful that in an effort to improve access to health care we don't ruin the really good parts.

Michael Moore -- Dumbing Down Ignorance One Film At A Time

The Instapundit on Michael Moore's evidently autobiographical film, Sicko.

MICHAEL MOORE:  The less you know, the more you like his films!  And vice versa, apparently:

Michael Moore received a standing -- and sustained -- ovation following the screening of his latest documentary, Sicko, at the Cannes Film Festival Saturday. But some critics suggested that in censuring the U.S. health system, Moore was overly generous in his praise of other countries'. At a news conference, Canadian journalists harangued Moore for, as Toronto Star film critic Peter Howell wrote, making "it seem as if Canada's socialized medicine is flawless and that Canadians are satisfied with the status quo." Apparently taken aback by the assault from the Canadian journalists, Moore said, "You Canadians! You used to be so funny! ... You gave us all our best comedians. When did you turn so dark?"

I don't know, maybe  three years on a waiting list for hemorrhoid surgery will do that to you . . . .

But you miss the point, Instapundit.  In Canada, everyone has to wait three years for hemorrhoid surgery (in Cuba it's no doubt much longer.)  But that's the beauty of it to Moore.  Rich people are reduced to scratching their behinds in agony just like the poor.  In fact, if there were ever a better description of socialism, I haven't seen it.

Save The Hospitals

Hints today that the hospital closings required by the Berger Commission may be negotiable.  Those recommendations were a fitting close to the once-promising, but finally-disastrous George Pataki administration.  They assumed that New York health care is already a government-run system that can be dictated from Albany.

While it is perilously close to that "ideal", we're not quite there yet and we consumers of health care should have a say in what hospital we choose just as much as we determine which supermarkets succeed.   Sadly, to me, nothing was mentioned about Millard Fillmore Gates Circle.   The thought of its closing, forcing city residents to compete for attention with even bigger crowds at Buffalo General scares the crap out of me.

If the Berger recommendations are carried out, we'll have witnessed the first evidence of what government-run health care will look like.

Health Care Hypocrites

Wal-Mart's critics often complain that by not providing health care benefits to all its employees, it's unfairly shifting its costs for those left uncovered to us -- the taxpayers.  But now that Wal-Mart's CEO has spoken out in favor of nationalized health care, I'm not hearing what I'd have expected.

After all, now it's proposing that the taxpayers support all of its employees.  Why no outcry?

Competition Would Be Good For Our Health

We all want lower health care costs and a private company is willing to build what amounts to a stand-alone emergency room in the Northtowns.  The Amherst IDA granted them $200,000 in tax breaks but has "reconsidered."

Amherst Industrial Development Agency board members changed their minds Friday on granting tax breaks for a proposed urgent care facility on Niagara Falls Boulevard.

The board, by a 4-0 vote with one abstention, rescinded the nearly $200,000 in tax breaks that it granted last month to Exigence LLC to build a 6,000-square-foot urgent care facility at 2099 Niagara Falls Blvd.

Concerns about the project’s impact on Millard Fillmore Suburban Hospital, which is tripling the size of its emergency room, along with questions about how it might affect a possible transformation of DeGraff Memorial Hospital in North Tonawanda into an urgent care facility prompted the IDA to reconsider its approval last week.

Another urgent care facility would spur competition, lead to faster emergency room service and actually allow people to compare prices.  Those generally leads to lower consumer costs.  Remember when Buffalo was the 2nd most expensive city in the country to fly to?  The NFTA attracted competition and local airline prices plummeted. 

It's a simple concept. But when it comes to health care, rational thinking goes out the window. 

I hope it gets built despite the IDA's decision.  We need more health care options around here -- not fewer.  That's why the state's decision to close Millard Fillmore Gates Circle and St Joseph are so preposterous.   There's a race around here for our health care dollars and it can only lead to better service; but New York State and its development agencies see competition as something to be avoided and discouraged.

It makes no sense.

Worse Than The Illness

Yes, it is broken, but, please, let's keep her out of the repair shop. 

"Step away from the tools, ma'am."

Between The Sheets

You might think I'd praise a government agency that was watching its expenses, but, um, not in this case.

Cleaners at an NHS hospital with a poor record on superbugs have been told to turn over dirty sheets instead of using fresh ones between patients to save money.

Housekeeping staff at Good Hope Hospital in Sutton Coldfield, have been asked to re-use sheets and pillowcases wherever possible to cut a £500,000 laundry bill.

Posters in the hospital's linen cupboards and on doors into the A&E department remind workers that each item costs 0.275 pence to wash.

Why not just wrap each patient in plastic and skip the whole problem?

Imagine That Buffalo's Hospitals Were Run Like Buffalo's Schools

We'd like to think that if health care were brought under the fair and protective umbrella of the government, that we'd keep what we have now (arguably the best health care in the world) but that the underprivileged would be allowed in out of the rain with us.   It's just that it hasn't worked out like that where it's been tried.

Last night (Easter Monday Public Holiday) at 10:00 we noticed one of our elderly cats couldn't stand up, rang the vets who cheerfully opened up the surgery and by half past the poor old Moppet was being examined by the vet in spotless surroundings. Sadly she had a thrombosis and we had to have her put to sleep as that seemed to be the kindest choice of the options we were given. We brought her home by 11:00
Over in another part of town my eldest son was stricken by severe abdominal pain down on the lower right side. The doctor was rung at 10:00 but of course was unavailable, at 11:30 his mother was still waiting to see if she was to be allowed to take him to hospital that night to be examined.

Says it all about health care doesn't it.

It's all quite fair, of course, but everyone makes do with a lot less.

H.T. to the Adam Smith Institute.

Tell Me How It Would Work

One of the biggest problems in debating with advocates of single-payer health care plans is their lack of details -- in short, how much will it cost?  They're usually quite certain that cutting out insurance company profits and eliminating duplication of services will pay for it, but I'm never convinced that they know what they're talking about.  Arnold Kling agrees.

Jonathan Cohn writes,

French universal health insurance works an awful lot like Medicare does in this country. And that's the great irony of how screwy the debate over health care has become in this country. Conservatives always talk about expanding choice, yet when it comes to the choices Americans prize most -- choice of doctor and hospital -- government-run health care actually delivers that choice better than private health insurance.

Last year, I scaled up the French population to our level, and then created the following table of medical expenditures:

Country	Health Care Spending $ billions
France*	900
U.S.--Medicare	300
U.S.--non-Medicare	1600

*with 300 million people

If Medicare were a country, it would already be way over the top in terms of health care spending. If we were to keep Medicare as it is and then introduce the French level of total spending then we would have to cut spending on the non-Medicare population by roughly 67 percent. Is that what Cohn is talking about? I doubt it. But I can never figure out what single-payer advocates are talking about, because they so often evade the basic issues of how it is supposed to operate.

I really want the advocates of single-payer health care to get into specifics about spending, taxes, methods for compensating health care providers, and all of the other mechanics that need to be worked out if the government is going to take over health care finance. It is irresponsible to just blithely say, "It works in Europe, so it can work here."

Me, too.

Nothing To See Here, Folks. Just Move Along

It may be just dumb luck, but America's (semi) private health care system doesn't seem to suffer from these increasingly common "superbug" outbreaks.  Oh look, they're happening in Canada, too.

'Single Payer Dreaming'

Panda Bear, M.D.

Potemkin Health Care

Before the United States can have anything approaching the obvious perfection of European-style universal health care, our people are going to have to learn some good manners.  While I am a fierce patriot and love America before all other countries, I cannot help but to admire the urbanity and the insouciance with which Europeans obligingly die before they can become a burden to their nanny states. 

In truth, I am ashamed to report that where Americans, in a typically boorish fashion, will insist on hundreds of thousands of dollars of medical care to preserve their shameless lives beyond the point where it would be convenient for society, in Europe not only are many procedures and medications unavailable to patients over a certain age but some of those elegant continentals have even hit on the money-saving idea of offering a couple of hundred guilders worth of euthanasia drugs to politely eliminate those who might otherwise become a burden.

The problem with offering universal access to health care, which should be obvious to anyone with good manners, is that there is an almost inexhaustible demand for it.  Maybe you, oh loyal and patient reader, don’t think about this as you are no doubt a veritable Hector or Andromache, in the prime of your life and about to conquer the medical world, but the old and the infirm, with stunning bad manners, do want their hips replaced, their coronary arteries vigorously scrubbed, and their expensive sojourns in the intensive care unit.  Sadly, there is no end to their demands as they clamour for more and more precious health care, grimly hanging on just for spite until at around 90, eighty if we’re lucky, their bad manners finally catch up to them like their mothers from the turn of the last century said they would.

It’s shameful.  The demand may be inexhaustible but the supply cannot possible keep pace.  Certainly not now where, with typical American insensivity, we structure our society around merit and allocate services to those who earn them and certainly not under a single payer system where there is no restraint on demand whatsoever…except that it is to be hoped we learn some European style-good manners.

There's more -- read the whole thing.

Hat tip to Division of Labor

Can You Say "Disconnect?"

Let's get this straight.  We face the closure of Millard Fillmore Gates Circle Hospital because we have too many unused hospital beds in Buffalo.  Two miles away, Erie County Medical Center is preparing to build a $91.7 million heart center largely with taxpayer money.

If we had a truly private health care system, I'd say build away and let the customers decide if we need it nor not.   But closing here under state orders and building there with state money illustrates just what a mess we're in.

Making The Employer Pay, And Pay, And . . .

Coyote Blog highlights the degree to which politicians are forcing health care expenses onto business.  The owner of Netflix illustrates.

So, here I am, having risked absolutely everything I own, having gone without salary for three years, and I am now being told that if I hire somebody, and he gets married in Vegas while drunk, then gets a divorce the next day, I’ve got to cover the bimbo into the next decade? (Feel free to add in the gender-reversed variation of that, as well - I’m equally appalled that I might have to pay for an employee’s ex-husband’s meds)....

Business shouldn't have to pay for our health care and neither should the government.  We should each be responsible just as we are for feeding ourselves.  Yeah, it's expensive but so's food, buying cars, houses, wide-screen TV's and cellphones.   If government didn't keep finding patsies to buy it for us under threat of ruin, we'd suck it up and take care of the matter ourselves.

Not As Bad As We Thought?

The U.S. Census Bureau has admitted to a flaw in its estimates of Americans who, at one time or another, were without health insurance.

WASHINGTON — The government's estimate of the number of people in the U.S. without health insurance fell by nearly 2 million Friday, but not because anyone got health coverage.

The Census Bureau said it had been overstating the number of people without health insurance since 1995. The agency blamed the inflated numbers on a computer programming error.

The agency reissued figures for 2004 and 2005 on Friday. It plans to issue new numbers for every affected year in August, when the 2006 numbers are scheduled for release.

Now, this is a relatively small decrease from the original estimate -- roughly 4.35% -- but expect many stories in the next few days worrying that we'll think the problem is now solved.  Michael Cannon illustrates.

It is important that we not over-react to these numbers. The worst thing we could do would be to stop panicking about the uninsured. A lot of interest groups have spent a lot of money and misused a lot of data to convince the public that this mostly healthy bunch of people are America’s #1 health care problem. If we were to go off-message now, then Barack, Hillary, Mitt, Arnold, and all the other Chicken Littles we’ve created . . . well, they might get horribly confused.

National health care will swallow up a lot of money to protect a lot of people (most of us) who never get very sick.  Seems rather a waste, doesn't it.  It's kind of like making people who don't own cars buy driver's insurance.

It's So Simple, Only He Could Have Thought Of It

New Mexico Governor Bill Richardson (one-time major-league baseball draft pick) made a splash at the Dems' Las Vegas health-care caucus by promising universal health care without tax increases.

New Mexico Governor Richardson says he could provide universal health care in the first year of his presidency without raising taxes.

Richardson says his plan would include a tax credit for low-income people who need coverage and prevention strategies such as a nationwide smoking ban like the one he signed in New Mexico.

Richardson made the comments Saturday at an event focused on health care in Las Vegas, Nevada.

Fellow Democratic presidential candidate John Edwards said Saturday that he could provide health care for everyone in the US at the cost of raising taxes.

Richardson says he would pay for his plan in part by ending the war in Iraq and shifting the military spending to human needs—an idea that won loud applause.

Let's review,  he would implement a nationwide smoking ban and shift military expenditures from the Iraq War to health care.  In other words he'll give us freedom from worry by eliminating our freedom.  I think that would make the perfect campaign slogan.

A Mistake Of EPIC Proportions

A lot of people probably think I'm opposed to government-sponsored or government-provided health care because I'm quite mean and have no compassion for the poor.  But my opposition is really due to cock-ups like this one.

Basic economics dictate that businesses selling their products for less than they cost will ultimately go out of business.

Astonishingly, that is precisely the kind of business strategy Gov. Eliot L. Spitzer’s proposed budget asks the state’s pharmacies to pursue.

The governor’s plan fails to reimburse pharmacies for the actual costs they incur to dispense medication through Medicare and the state’s Elderly Pharmaceutical Insurance Coverage (EPIC) program, threatening their ability to continue providing critical community- based health care services.

While politicians may indeed be sincere in their desire to see everyone provided with health care, they are also subject to competing demands for our money from the schools, infrastructure needs and their own districts' pet projects. Governor Spitzer is no different.   He's robbing health care to pay education.

By cutting the reimbursement rate to pharmacies for EPIC customers he will claim that he's cutting health care costs for New Yorkers, but he isn't. Government can control prices by simply legislating them, but government can't control costs.   And it will cost many pharmacies more to fill a prescription than the state will pay them.

Wal-Mart (and I do applaud them) can charge $4 for a generic prescription because it's so huge that the loss will be made up for when its pharmacy customers do some other shopping in the store.  The Governor's proposal won't hurt Wal-Mart one bit and it shouldn't.  But the small, independent pharmacy on the East Side can't sell prescriptions for that price and survive.

But I have a feeling that the same people who protest Wal-Mart because it kills small businesses won't utter a peep when the state government kills small businesses.   If government's going to pay for prescriptions, then it must do as it does with Food Stamps and reimburse the pharmacy the full asking price. 

It will cost the taxpayers more money but at least then we'll know what we're arguing about, and can stop pretending that government can reduce health care costs when all it's really doing is shifting the costs onto the very people that provide us with our care and very well driving them out of business in the process.

America's Infant Mortality Rate

Don Boudreaux addresses America's high infant mortality rates which are sometimes used as a justification for implementing some form of national health care.  Boudreaux, however, cites an article in the Economist which suggests that American health care is so advanced that we've raised the bar on infant mortality -- babies who once wouldn't have been born at all now stand a chance of birth -- and death.

Read the whole thing.

We're From The Government And We're Here To Help

If you're pushing for government-run health care, go here for a preview of what it would be like.

Blame Canada

You can favor universal health coverage without slavishly promoting the Canadian system.

Passing The Health Care Buck

States Running Out Of Health Dollars For Poor Kids

Some states are warning that hundreds of thousands of poor children could lose their health insurance if Congress doesn't act soon to come through with more money for the program.

The situation is most severe in Georgia, where officials plan to stop enrolling kids in the state's PeachCare program starting March 11 because of a $131 million shortage.

The problem is that many states have nearly used up their annual federal subsidy for child health care, and it is not even midway through the fiscal year — a situation some are blaming on the formula by which the money is doled out by Washington. Congress has been unwilling so far to deliver more money.

The uncertainty is making it difficult for some states to draw up their new budgets, because they do not know how much they will ultimately get from Washington.

In the meantime, states are scrambling to protect youngsters.

If protecting the children's health is so important, then why aren't the states raising their taxes?  Why is it so important that the federal government pay for it, state taxpayers and federal taxpayers are all the same people?

All The Health Care You Want

Thomas Sowell reminds us why prices matter.

Nothing is easier for any government than to impose price controls. Governments have been doing that for thousands of years. What governments cannot control are the underlying realities expressed through prices.

What does the history of thousands of years of price controls tell us?

The first thing undermined or destroyed is self-rationing. When you pay the full price of going to a doctor, you go there when you have a broken leg but not when you have the sniffles or a minor skin rash. When the government makes health care “affordable,” you go there for sniffles and a minor skin rash.

The underlying reality has not changed, however. The doctor’s time is still limited, and the time that you take up with your sniffles or skin rash is time that somebody else with a broken leg — or perhaps cancer — has to wait to get an appointment.

Government-run health-care systems in countries around the world have longer waits — sometimes months — to get medical attention. In other words, the rationing goes on, but more haphazardly, because prices do not force people to ration themselves according to the seriousness of their problem.

People who want the government to take over health insurance look only at the potential benefit:  everyone would have insurance.  But they refuse to examine the downside which is that our health care system would be swamped.  Not only by the addition of the previously-uninsured but by the fact that we would all consume as much care as we could get. 

It's no different than if we were able to go to the supermarket without having to pay.  The shelves would soon be empty. Once the system has been nationalized, health care will have to be rationed if we're to keep it from collapsing.  That's never mentioned by the advocates and if it were, the huge numbers of people who support it would probably have a change of heart.

Why Close Those Hospitals?

Lawrence Southwick, Jr. wrote a superb op-ed for today's Buffalo News about the state's recommended hospital closures.  I want to draw attention to it in the hopes that some of you who might have missed it will see it now.

The commission proposes to reduce competition by merging Erie County Medical Center and Kaleida Health System. It also proposes to reduce the number of providers of particular services, making the surviving providers monopolies. Suppose Ford, General Motors and Toyota merged. Would this reduce car prices?

What is the criterion for these closures? It is to reduce "excess" capacity. Maybe we should get rid of Rite-Aid, Eckerd, CVS and pharmacies in grocery stores. After all, Walgreens and WalMart could handle the load and the others are "excess" capacity.

The real problem is that government is much too involved in health care. If there were a free market in health care, the efficient number of hospitals and other health care facilities would exist. Some less efficient than others would go bankrupt. Others would prosper by providing good service at a reasonable price.

Government can provide a useful service by giving the consumers information about how hospitals and physicians perform on particular types of cases. The customers would do the rest by buying those services that meet their needs and budgets.

Please read the whole thing.

Clump Of Cells Survives

It gets harder and harder to justify abortion with no questions asked, doesn't it?

Bigots!

Anti-discrimination laws eventually come full circle.  Women in southern Sweden will no longer be able to choose a gynecologist based on sex.

Women in southern Sweden will in the future not be able to choose the sex of their gynaecologist. Allowing them to choose discriminates against male gynaecologists, it has been ruled.

The new practice has been introduced by clinics in the counties of Skåne, Halland, Blekinge and Kronoberg. Gynaecological patients in those areas will now be assigned a doctor of either sex, Helsingborgs Dagblad reports

Well, not all women will have their choices limited.

Exceptions will be made in some cases, such as for women who come from parts of the world with 'patriarchal traditions' or for the victims of sexual assaults, the paper reported. These women could insist on a female gynaecologist.

Women with less specific reasons for wanting a female gynaecologists may be turned down.

Ain't government health care great?  Who are we to decide?  The "common good" will make a decision for us.

We Don't Need No Stinkin' Private Property

I certainly hope that St. Joseph Hospital's appeal to remain open succeeds -- and that if it does, Millard Fillmore Gates Circle can follow its example. The key issue.

"This was the state government telling a private institution to close, and not for quality reasons or issues of profitability," McDonald said

I suppose though that, given the huge amounts of state aid given to the hospital and earned through Medicare and Medicaid patients, the courts could just come right back and claim that by its dependence on taxpayer money it's subject to taxpayer oversight.  Of course, no modern hospital really has a choice.

The federal and state governments now account for almost 60% of health care payments.  And there are no doubt substantial penalties for those who wouldn't accept patients whose insurance is government-sponsored.  So they've got us where they like us -- over their knee. Such is life when you let the government have control over your affairs.  Imagine how cool it'll be if the Dems get their way and the government's in charge of the whole thing.

The Health Care Debate. Chapter 24,839

Doug Turner editorializes in favor of nationalized health insurance today, though he uses the euphemism "single-payer" to describe it.  The immediate inspiration for his piece was President Bush's State of the Union  proposal to change the taxable status of health insurance.  A proposal Turner dismisses as, get this, "ideological."

Think of it as the domestic policy twin of President Bush's indirect reference in his 2003 State of the Union message to yellow cake uranium.

Four years ago, Bush's infamous 16-word warning that Saddam Hussein shopped in Africa for materials for a nuclear bomb helped Bush launch the Iraq War.

Last Tuesday night, with no more hard facts and less interest in the welfare of worried citizens, Bush told Congress and the nation that he has a plan to expand health coverage to the uninsured.

Right, no discernible political agenda there, Doug.

Turner goes on to round up the usual suspect statistics that get trotted out whenever and wherever proponents of nationalized health-care gather in its name:  46 million uninsured and higher health care expenditures in the U.S. than in Canada.  But in the end, the argument over how to improve our health care system does come down to ideology.

And this is demonstrated just as much by the Democrats' refusal to consider any reforms that don't involve government as it is by any Republican insistence on the opposite.  Now, if you believe the recent media coverage, you'd have to get the impression that the momentum is on the side of the nationalizers.  But little of substance can happen until they can convince the 80% of Americans who do have good insurance coverage that dramatic change will benefit them.

That's the tiny bit that Hillary ignored when she proposed her now-famous reforms in the nineties.  The Dems have no doubt learned from that disaster, but they still can't justify their approach with much more than an appeal to our guilt over the supposed plight of the less fortunate.  That's an increasingly hard-sell especially for New York residents who are very conscious of the excellent Medicaid coverage that our poor already receive at our expense.

Once, when there were no schools for the vast majority of Americans, it wasn't hard to set up a government-funded one.  And when all but a tiny elite had no means of supporting themselves once they could no longer work, Social Security was widely supported.  Nationalized health care comes at a different time with different conditions.  Americans are famously guilt-free when it comes to keeping what we've worked hard to earn for ourselves.

Intelligent Health Care Debate

Brad Delong sums up both sides of the health care issue.

Neither prescription [the left's or the right's] will be very effective as a remedy to cost drivers like these. Our irresistible force is our belief that health care should not be rationed by price. Our immovable object is the unwillingness of American taxpayers to be turned into an IV drip bag for the health sector that the health sector itself controls. What happens when these meet is a crisis, which cannot be averted no matter whether we adopt the right-wing prescription, adopt the left-wing prescription, or muddle through.

Is there a magic bullet to reduce these chronic-diseases-of-aging-life-style-driven sources of secularly rising health care costs? I can see only one chance: the nanny state. Lectures every half hour, on every TV channel, by the surgeon general and the assembled celebrities of America, telling us to: lose weight, exercise more, don't smoke, don't drink to excess, watch your fats, watch your sugars, eat your vegetables, et cetera--remember that you are an East African Plains Ape that did not evolve to live in a world where fats and carbohydrates were abundant and smoke damaging to your lungs was laced with nicotine.

There's a lot more (all of with which I do not agree,) but please, read the whole thing.

Never Enough For Some

The anti-Wal Mart-crowd exposed themselves (so to speak) with their silence after the company began selling generic prescription drugs for $4 a couple months ago.  This isn't at all what they'd been hoping for.  After all, this one marketing move stands to save American consumers millions, if not hundreds of million of dollars on health care costs.  You'd be forgiven if you'd thought that some congratulations might have been extended Wal-Mart's way.

But you haven't heard it, have you?  The media dutifully reported the news, but but then shut up and the Wal-Mart detractors have only stepped up their criticisms.  You see, reducing the cost of health care is not at all what this gang is after, what they want is nationalized health care -- socialism. 

And when their poster child for corporate greed called their bluff, they weren't happy at all.

You'd think we all could see this, but evidently not.  Wal-Mart's now in the position of trying to explain it to us.  How pitiful that we've sunk so low.

Duh, What Do I Do Now, Doc?

Kevin Drum calls out Arnold Kling for his beliefs in free market health care.

Arnold Kling, who thinks the healthcare biz need less insurance and more free market capitalism in order to drive down costs and force people to buy only the care they need. I doubt it. More likely it would result in what I saw today: medical offices becoming more like Turkish bazaars (or used car dealerships), filled with distraught patients trying to decide whether they can afford a crown today or if they should wait and run the risk of needing a root canal later. No thanks.

Kling responds:

To which I plead: Guilty!

Just today, I saved money on a drug prescription, thanks to the Turkish Bazaar. What happened was that my doctor had prescribed a patented antibiotic. I asked if this was medically necessary relative to just using a common generic. He explained the difference, we agreed that it was minor, and we went with the generic. It cost 95 percent less. If only Medicare had that kind of negotiating power!

A lot of the justification for nationalized health care (or single-payer if you prefer the euphemism) is that we're just all too stupid to purchase our treatments sensibly. It will occasionally be the case that we depend on our doctor (in leftist parlance: the primary care physician) to advise, us.  But I think we're as capable of managing our health as we are of managing our diet, our education and our children's upbringing.

Or am I just a wild-eyed optimist?

All You Can Eat Health Care Buffet

Russ Nelson, New York State's premier econoblogger, describes our health care problem in the most succinct terms I've read yet.

Health care in the USA is completely broken. Health care is a difficult problem, to be sure, but I think it's clear that we're currently solving it very badly. Two problems with health care: One is that people expect everyone to have the same health care as a rich person, even if they're not rich themselves. Another is that health care, not being exposed to the discipline of the market, is very expensive. If everyone gets the same health care as a rich person, then there is no pressure to create more frugal health care.

"But Craig (and Russ,)" you ask, "how can you differentiate between the poor and the rich with something so basic as health care?"  Easy, a lot of health care spending in the U.S. isn't necessary.  If trips to the doctor are free (or nearly so) then people will go to the doctor with minor ailments.  The news is full of stories of Medicaid recipients who summon ambulances for stomach aches and visit emergency rooms for the flu.

Those cost a lot of money.

I'll happily grant the "rich" the privilege of such foolishness but it's not too much to ask the poor to pay as much attention to their health as they do to their diet.  Food Stamps don't buy many jumbo shrimp, so sensible Food Stamp recipients don't waste their rationed allotment on them.  By the same token, were their government-provided health care a little more limited, they might think twice before wasting it on minor ailments.

Even publicly-subsidised housing doesn't equal a home in Spaulding Lake, and with only a few exceptions, no one thinks it should.  Government housing provides shelter, but usually without the lakes and we've got to get used to the idea that subsidised health care doesn't merit an open wallet.  We're not talking about cancer treatment or heart surgery here, even we Conservatives can justify those.

But the idea that the poor are so stupid and irresponsible that we dare not impose any limits on them is self-defeating.  When we encourage them at any cost to seek health care, as we are now, we're making the problem worse.  Read the whole thing.   

Not Good For What Ails You

The United Hospital Fund has put forth a plan for universal health insurance in New York State that will probably be heralded as a great "beginning step."  WNED radio is touting it as some bold, new idea but it's really just the same package that Massachusetts adopted last year and consists of three main parts:

• Expand Medicaid
• Make health-insurance compulsory
• Tax the crap out of businesses that don't provide health care for their employees

In other words, it's another big expensive government program.  Now, I'm not altogether opposed to making health care coverage mandatory, that cat's already out of the bag with car insurance, but expanding the very Medicaid system that's already credited (even by the Dems) with draining local  economies doesn't sound too sensible on its face.

We can all agree that health care costs too much in the U.S. and we should be working to bring those costs down.  There are ways to do that:  let New Yorkers buy insurance from other states, cut down the number of state-mandated coverages that apply to relatively few people, make health care costs tax-deductible and eliminate outrageous malpractice awards.

This plan addresses none of those as far as I can tell, it simply puts the financial burden for a broken system on already over-taxed working citizens and the businesses that employ them -- but that's par for New York.  The very  idea that a state losing people for lack of jobs and business would now add yet another financial burden -- no matter how well-intentioned -- to its dwindling band of survivors strikes me as a cure worse than the illness. 

Conflicting Reports

There's a disconnect somewhere.

Mercy Hospital has been unable to adequately assume double duty since Our Lady of Victory Hospital closed. Go to the emergency room; patients are in beds in the hallways. How sanitary is that? Family members are pressed against the bed as staff attempt to navigate through the congestion due to insufficient space. Wait times are far too long. Forget privacy! How will remaining hospitals be able to adequately meet the needs of all the people now serviced by the targeted facilities?

If there are so many vacant beds, why do people needing inpatient admission languish in emergency rooms because no beds are available? On six occasions in the past year, I experienced single-digit and double-digit waiting times with my husband, who was confined to a narrow, uncomfortable ER gurney because no hospital bed was readily available.

I'm quite surprised to hear that conditions at Mercy are this dire, though I'm not sure at all what "single-digit and double-digit" waiting times actually mean.  But I'll take the writer's word for it for the moment.  No none, however, is disputing the statistic that 50% of Buffalo hospital beds lie vacant on average either. 

If, in truth, Mercy Hospital is so severely over-burdened, it would sure seem to me that the Catholic Health System would be directing more of its customers to the evidently under-used St Joseph which sits just 5 or 6 miles away.   Or maybe this editorial is just crap. 

How Dare They Charge So Little, Must-Not-Be-Allowed

The evil Wal-Mart planned on bringing its $4 generic drug plan to California but has changed its mind.  The reason?  Why, California strictly regulates "competition" and Wal-Mart's price is just too low.

The $4 generic drug plan at Wal-Mart Stores Inc. has arrived in California with dozens of drugs priced at $9.

The world's largest retailer said Friday that 55 different drugs will be sold for $9 in California and eight other states to conform with "loss leader" statutes.

The drugs include a wide range of antibiotics, heart pills, diabetes drugs and anti-inflammatory medicines.

The reason for the $9 price: The California code forbids anyone from selling something below cost "for the purpose of injuring competitors or destroying competition."

That all makes sense if, of course, you're really more interested in government control of health care than you are in a reduction of prices.

Health Care Workers Face The Reality Of A Shrinking State

There have been some positive noises out of Albany today regarding the recommendations to close nine New York State hospitals and drastically reorganize quite a few more.  I'll believe it when I see it, but the news is encouraging.  For the last ten years, New York has tried to use health care taxes as a job-creation program and sooner or later it was destined to fail.

New York's done so well that they've actually created more health care jobs than the market can bear.  It would be most refreshing to find out that even the Democrats (though in New York the Republicans hands are pretty dirty, too) admitted that the attempt to create an economy on tax payments was nothing but a giant Ponzi scheme.

All of which should remind us, in the end, of who will have to pay the price for our bloated health care industry, the health care workers.  Thousands of them stand to lose their jobs through this reorganization and that's a shame.  For years now, every article on career prospects and every expert survey on the job outlook has touted health care as the profession to enter.

In a desperate bid to stay in New York, many people have retrained as nurses and radiology technicians.  A recent Buffalo News article suggested that if you want your kids to stay in Western New York, you should steer them into health care.  And the City of Buffalo, itself, has been fed the line that our economic future lies in the provision of health care.

This commission study is an unwelcome but probably healthy dose of reality.  There was no feasible way that the health care industry could continue to grow as it has.  Not only is Buffalo's population shrinking but advances in pharmaceuticals and technology are making hospital stays less necessary and much shorter. Those trends will likely only grow.

So, I feel very sorry for those Western New Yorkers who believed the experts' and the politicians' foolish predictions.  Like the steelworkers and machinists before them, many of Buffalo's best-trained and hardest-working will now have to follow I-95 south to cities that are growing and need them.  Education spending's next on the chopping block (maybe not this year, but it has to happen,) teachers won't be far behind.

Living in a shrinking city in a dying state's a real bitch. First your church closes, then your neighborhood dies and finally you lose your hospital.  I sure wish we'd start to do more of what it will take to grow again.  Hint: subsidising the arts won't do it, we need serious tax cuts.

Nine Hospitals Recommended For Closure

Beside Millard Fillmore Gates Circle and St. Joseph's Hospital, Pataki's commission has recommended the closure of seven others across the state.

The nine hospitals slated for closure are, in Manhattan, St. Vincent's Midtown Hospital and Cabrini Medical Center; Victory Memorial Hospital in Brooklyn; New York Westchester Square Medical Center in the Bronx; the Parkway Hospital in Queens; Millard Fillmore Gates Circle Hospital in Buffalo; Bellevue Woman's Hospital in the Albany capital region; Community Hospital at Dobbs Ferry in Westchester County, and St. Joseph Hospital in Cheektowaga, according to the source.

You might expect that the Governor will sign off on the recommendations.  But by the time our health-care-union-funded legislature gets through with it, we'll be lucky if we don't end up with a couple of "sorely-needed" new hospitals. 

This fight will make last year's struggle to avoid military base closings pale in comparison.

Don't You Dare Close "My" Hospital

In just one day, the letters in Everybody's Column show just how hard it will be to reduce our hospital space in Buffalo.

Closing best trauma center will not benefit patients

Closing St Joseph would be a mistake

ECMC teaches University students must stay open

Everyone in Buffalo has his or her "favorite" hospital.  I remember, for example, how wonderful the staff at St Joseph were to my father as he was dying.  I've been admitted twice, myself, in the last four years to Gates Circle, and during each visit there I was treated far beyond my expectations.  The nurses were caring and efficient, the doctors concerned and the technology state-of-the-art. I'd hate to see either go.

We witnessed the outcry a couple years ago when it looked as if Children's would close.  It was eventually spared, and I fear many Buffalonians will expect the same for their favorite.  But somehow we'll have to follow through this time.

Everyone agrees that health care costs must be brought under control and closing several of these huge hospitals with their 50% occupancy rates and their duplication of expensive services is one way to begin.  In the end, we customers will have to go along with whatever decision is made, and I trust that health care will be as good if not better than what we have now.

At some point, though, politics will begin to figure in; and that's where it will get really ugly.  After all, the health care unions comprise the most powerful lobby in New York State.  And I can't imagine that any closings of the planned magnitude will take place without their support.

The state has pledged over $1 billion to aid in the mothballing of as many as three hospitals here.  I can't begin to imagine how much we'll have to cough up to get the unions' agreement.  In the end, I fear, it may be cheaper to just leave everything the way it is.  I can just imagine those SEIU ads on WBEN now.   

Government Health Care -- Kinda' Like The Public Schools Except That If It Doesn't Work, You Die Tonight

The Democrats control Congress and Eliot Spitzer runs New York.  Government-sponsored health care is sure to be a topic of discussion in the next couple years.  Jane Galt lays down the challenges to its implementation.

Here's a taste.

1) It cannot provide less, or less rapid, coverage than the typical American policy does now. Over three quarters of Americans are happy as clams with their health care now; to the extent that they support national health care, it is because they fear losing what they have. Nationalisers, therefore, cannot sell a programme by guaranteeing them that they will lose some of what they have now. Horror stories aside, most Americans, despite their copays, have much more lavish coverage than that available elsewhere, with unfettered access to their doctors, semiprivate hospital rooms, expensive machines around every corner, and so forth. In what other country would my eighty-eight year old grandmother have had her hip replaced two weeks after the doctor decided it was time? That two weeks being the period needed for my mother to arrange her schedule so she could take care of Mom. That is the baseline of care, not whatever is currently on offer in France, no matter how fond the French may be of their system. Countries with national systems set them up a long time ago, when the median voter had no insurance at all, so whatever crap the government gave you was an improvement.

She lists three more, read the whole thing.

Competition For Thee But Not For Me

Business's worst enemy is business -- other businesses.  In a climate where politicians are all too eager to gain power through the regulation of private industry, it's unfortunately a natural response that businesspeople will fight back.  Unfortunately, they tend not to reject the principle that government should keep its mitts off of business, they just want government to keep its mitts off of them.

The Buffalo News' revealing look at UnitedHealth Group on Oct. 22 raises some serious concerns about this company and what Western New Yorkers might expect when it enters the local market.

UnitedHealth's ongoing stock-options scandal and federal ethics probe that led to the recent resignation of the company's CEO, among others, have been well documented, overshadowing to a large degree its blistering battles and lawsuits with physicians and hospitals throughout the United States. From New York to Denver and many points in between, UnitedHealth is involved in contentious negotiations with providers, negatively impacting millions of its members.

Michael Cropp, M.D., is president and CEO of Independent Health.

Mr. Cropp doesn't like the fact that there's some new competition in town.  If there's anything New York needs, it's some competition in health care provision.  By all means, let the investigations continue -- they're only accusations.  But don't let a comfy, local "non-profit" CEO talk us out of letting another insurance carrier in.

We expect, no -- we demand, competition in gasoline sales, food sales and auto sales. Why would health insurance be any different?  It ain't.  The entry of United Health into the Buffalo market will likely drive down (slightly) the cost of health care insurance. 

Wegmans Joins The Fray

Wegmans will join Wal-Mart, Target, Meijers and a growing number of retailers in cutting the prices on generic drugs.

Wegmans Food Markets Inc., an upscale supermarket chain with 71 stores in five states, said Tuesday its pharmacies will begin selling almost 100 generic prescription drugs at a sharp discount.

The drug program - which includes almost 200 generic drugs when counting different strengths of the same medications - covers a variety of cardiac, thyroid, anti-depressant and other drugs that, beginning Thursday, will sell for $11.99 for a 90-day supply. Previously, some drugs on its list sold for twice as much or more, Wegmans said.

Good deal!  Wal-Mart started the trend and it's the best sign to date that the problem of spiraling health care costs willl ultimately be solved by the private market -- if the government will only let it.  For Wal-Mart it was an absolutely brilliant move.  Its detractors have always ignored the benefits to consumers of low prices but this prescription drug policy has knocked them off their game.

Once again, competition in a free economy is benefiting consumers.  Now, I'm sure the union-led opposition to "big-box" retailers will eventually regain its footing, but people lined up to get $4 blood pressure medication may not be listening too closely -- nor should they.

For Profit Health Care: A Good Thing

Here's an op-ed from today's Buffalo News about the entry of a major national health care insurer into the Buffalo market.  Upshot:  competition is good.

Miracle

In South Africa a sleeping pill is instead waking comatose patients.

[UPDATE:] I should mention that these are not comatose but patients in a persistent vegetative state.

Like It Or Lump It

Did you know that it's illegal for most Canadians to purchase private health insurance?  One Calgary man has decided to challenge that.

Calgarian Bill Murray is challenging the law forbidding residents from purchasing private health insurance after he was denied the opportunity to receive a Birmingham hip replacement.

He ended up going out of the province and paying for the procedure out of his own pocket.

“Denying an individual medical treatment while also making it illegal to purchase health insurance is unconscionable and completely unacceptable in a free and democratic society,” said CTF federal director John Williamson.

Canada's national health system started out (as would an American version) as a kind-hearted attempt to ensure that all citizens would receive adequate health care no matter their ability to pay.  Over time though, the system hasn't been able to keep up.  Because of government budget constraints (even Canadians draw the line at higher taxes at some point,) new technology is scarce and doctors and nurses are leaving for the United States where they can make more money.

The solution has been to force people into accepting less -- even, as we see here, to the point of forbidding doctors to provide care for cash payments.  The result has certainly been an improvement in care for the very poorest but the well-off are well, worse off.  The attitude of government-medicine supporters is aptly summed up in this statement.

But Liberal health critic Laurie Blakeman said Murray wants to be subsidized for queue-jumping.

She said Murray didn’t qualify for a Birmingham hip replacement procedure under a pilot project in Alberta because of his age so he went elsewhere – and now he wants taxpayers to foot the bill.

Blakeman said introducing private health insurance will leave Albertans with less choice, rather than more choice as claimed by backers of the suit.

But she warned that if the suit is successful it will be detrimental to all Albertans.

“Our public health system will be undermined,” she said. “It will be a huge crisis.”

Doesn't that sound eerily reminiscent of the arguments in the U.S. against charter schools?  Their opponents claim that "siphoning" money away from the public schools and allowing people choice will hurt if not destroy the system.  They ignore the students whose parents have freely chosen to enroll them and whose educational results are often better than in the poor public schools they left.

It's a case of a cherished institution ahead of actually educating children.  Support for public health care can only end up the same, ignoring the health of individuals to maintain a failing system which, we'll be told, will be fixed soon -- as soon as we just give it a little more money.  In the meantime just get in line and like it.

Kalifornia On The Brink

California might be ready to make the big plunge into government health care for all.

California's Democrat-controlled Assembly has passed a universal healthcare bill that is expected to figure in Gov. Arnold Schwarzenegger's re-election bid.

The bill would eliminate private medical insurance plans and establish a statewide health insurance system for all state residents, reports The San Francisco Chronicle. The state senate is expected to approve changes to plan and send it the Republican governor, who has expressed his opposition to a single-payer plan.

The Chronicle said the governor, however, has not offered an alternative for the state's 7 million people who are uninsured. His office has said the governor would propose solutions in his State of the State address in January if he is re-elected. Republicans and insurance groups oppose the new bill, saying it will create an inefficient government bureaucracy.

Better them than us.  Actually, I wish they'd do it.  It's been said that the states are the nation's laboratories for democracy and the more-popular-than-it-should-be idea that government could run the health care system better than the markets should be studied with real-live human guinea pigs.

Bear in mind that 60% to 70% of Californians already have perfectly good private health coverage.  How will they react in five or ten years when faced with huge tax increases or the prospect of rationed care?  We can debate it all we want; it would be interesting to see how it actually worked out.

Yet Another Reason To Worry

If it wasn't bad enough that New York's spending is out of control and that the population continues to shrink, there's now more cause for worry.  Upstate's elderly aren't signing up for Medicare prescription drug benefits in large numbers!

A total of 62,589 seniors in Erie County, or about 38 percent of those enrolled in Medicare, had joined the drug plan as of April 18. That compares to rates exceeding 60 percent in parts of New York City.

The obvious conclusion is that New York City residents are savvier socialists than are their Appalachian cousins, And that has government-types concerned.

Enrollment in the new Medicare prescription drug program is lagging behind expectations in the Buffalo area and much of upstate New York, prompting federal officials to start an advertising blitz before the May 15 deadline to sign up.

Sort of a "No Senior Citizen Left Behind" I suppose. Stupid old people anyway -- makes you wonder how they managed to live as long as they have without the compassion of government to lead them toward the light.

Here's What Reform Looks Like

Wonder why our doctors are leaving -- and where they're likely going?

In the summer of 2003 the Texas Legislature enacted important medical litigation reform. A voter-approved constitutional amendment, Proposition 12, followed later that year to solidify the changes. As a result, physicians are returning to the state, particularly in underserved specialties and counties. Insurance premiums to protect against frivolous lawsuits have declined dramatically, with the state's largest carrier reporting declines up to 22% and other carriers reducing premiums by an average of 13%. The number of lawsuits filed against doctors has been cut almost in half.

Prior to the successful reform effort, personal injury lawyers had put Texas doctors on the run. According to the Texas Department of Insurance, the frequency of claims was increasing at a rate of 4.6% annually--between 1996 and 2000 alone, one out of four doctors was sued.

These surging legal and insurance bills reduced patient access to health care. Texas fell to 48th out of 50 in physician manpower. There were 152 medical doctors per 100,000 citizens, well below the U.S. average of 196. Some 158 counties had no obstetrician. Good, competent doctors were closing their doors, unable to afford the cost of insurance.

New York's trial-lawyer lobby will make sure that no limitations are ever placed on malpractice lawsuits here.  You'll remember that it took Washington's passing a law that finally negated New York's idiotic regulations that held car leasing companies liable for accidents caused by their customers.  Attempts to do it locally were thwarted by the tort-lawyers.

Now, I don't like the federal government's ever-increasing power, but it's probably the only hope we have of addressing our "growing" health care problems.  unlike other states which actually take action to fix problems themselves, New York is more and more a big overweight helpless dependent baby.

Mandatory Health Insurance

A while back the BuffaloPundit and I carried on a debate over potential solutions for the problems of health care in America.  In the end we came to a rough agreement that the Swiss model which requires all citizens (and all visitors) to purchase insurance was a good first step.  Well, the state of Massachusetts has followed our advice, sort of.