Sunday, August 30, 2009
Friday, August 28, 2009
Limiting health care’s availability by the criterion of personal wealth rightly offends our sense of the dignity of the individual. Are the lives of the poor not of the same intrinsic value of those of the wealthy? To be fair, it is rare in the United States that poverty alone prevents the uninsured poor from receiving lifesaving intervention in a healthcare crisis. A poor man having a heart attack is not turned away from the emergency room, nor is the poor woman in labor sent away to have her baby at home. (I am not arguing that such enormities never occur, but the fact that such occurrences remain scandalous and newsworthy is a testament to their rarity.) Yet it is equally undeniable that the poor get a lesser share of the preventive care that can maintain health or of the quotidian care for the less dramatic challenges to their health.[snip]All modern societies ration health care. A wise society considers the options and chooses a method of doing so which best conforms to its values and capabilities. Thus we come to the terrible question we would so very much like to avoid: How shall we ration health care? How shall we explicitly ration it? So noxious a question is this, so offensive in its tacit assumptions and implications, that most politicians and wishful thinkers will deny that we need to address it at all. They will argue that the fundamental problem is one of distribution, not one of unmeetable demand. They will argue, with more enthusiasm than evidence, that an emphasis on preventive care would substantially reduce aggregate demand. Some will say we must reduce the role of government; others will argue that we should augment it. If only we will adopt their plan—they’ll say—waste, fraud, and abuse will be abolished. There will be chicken—or at least chicken soup—in every pot, and a vaccine in every arm. People love honesty, but they hate the truth. To frankly acknowledge and address the ineluctable reality of healthcare rationing is not merely to touch the proverbial third rail of American politics; it is to lie across the tracks in front of the onrushing train.
Come, let us speak of unpleasant things. How is health care to be rationed? Who gets the short end of the stick?[snip]On its face, one might think that the question of medical necessity is best answered by the physician who is actually taking care of the patient, rather than one who has never met him and is basing his decisions on a limited amount of information. But that will not do. That thought is one of the many illusory ways of denying the inevitability of rationing. To have the providers determine medical necessity is to have no limits at all on expenditures for health care, since all providers at all times believe (or at least claim) that the service they are providing is medically necessary. To have the providers be the arbiters of medical necessity is to abjure rationing altogether. The insurance company that does that will be very popular—very briefly. Then it will either go bankrupt in short order, or sharply adjust its premiums upward to have its income match its hemorrhaging outflow. If premiums rise enough, people will not buy the insurance. The result will quickly be the most generous insurance policy that nobody can afford.[snip]As Congress and the people consider restructuring the American healthcare system, they must keep in mind that rationing health care may not be undeniable, but it is unavoidable. To claim that Congress will devise a new federal healthcare plan that will not involve rationing is like claiming that it will invent a triangle that doesn’t have three sides. Currently, within the private sector of health care, we have a large number of private insurance companies vying for the business of their customers. They ration health care on the basis of evidence-based medical necessity. The Obama health plan, the details of which are still being worked out, will also ration health care. The alternative to that is an accelerated escalation of aggregate healthcare costs. But the single-payer system to which Obama’s plan will lead will have no competitor and no pressing financial incentive to please its customers. No competitor for the single payer means no alternative for the patient. We can reasonably expect that a single-payer system of rationing will be largely implicit rather than explicit, and governed as much by cost and political considerations as by medical evidence. Such a system would likely combine the fiscal responsibility of the Postal Service, the customer friendliness of the Bureau of Motor Vehicles, and the smooth efficiency of the Immigration and Naturalization Service.
Many experts oppose the whole concept of a greater role for consumers in our health-care system. They worry that patients lack the necessary knowledge to be good consumers, that unscrupulous providers will take advantage of them, that they will overspend on low-benefit treatments and under-spend on high-benefit preventive care, and that such waste will leave some patients unable to afford highly beneficial care.
Thursday, August 27, 2009
Wednesday, August 26, 2009
If you read one thing on the health care reform debate, read Jeffrey Gordon's post at KevinMD on the economics of health care. He outlines in succinct form the dilemma of delivering a complex but necessary product to a population that varies in it's ability to understand and pay for this product.
In economics, a public good is a good that is non-rivaled and non-excludable. This means, respectively, that consumption of the good by one individual does not reduce availability of the good for consumption by others; and that no one can be effectively excluded from using the good. In the real world, there may be no such thing as an absolutely non-rivaled and non-excludable good; but economists think that some goods approximate the concept closely enough for the analysis to be economically useful.
By definition “public goods” are not well distributed by market mechanisms. Americans are very accepting of some public goods, i.e. police and fire departments, national military forces, the GPS system, water distribution and sewage treatment plants, education, radio frequencies and the internet. Looked at from an economic and a public policy perspective, health services are the epitome of a “public good.” This is what is meant by the phrase “Health Care is A Human Right!” Hospitals, ambulance systems, mosquito control, TB control, restaurant inspections, sanitation, and vaccines are all good examples.
When a person gets sick he or she functions poorly as a consumer. Often there is no opportunity to investigate or shop around for quality, never mind price. A seriously ill person has no price sensitivity - care is needed now and many patients will face even bankruptcy to get needed care in spite of looming bills. Even the most intelligent and computer literate sick patients are often seriously deficient in relevant knowledge both of disease states and who is well qualified to treat them.
Under our insurance system, the patient is rarely the consumer. Most purchasing decisions are made by a doctor acting as the patient’s surrogate. While one can discover a price for one item or service, it is totally impossible to have any sense of the ultimate charges for any significant package of medical services, so it is impossible to price shop even when there is time.
Can we shop for electricity suppliers? or water and sewage providers? or schools? Actually, we can. People choose to upgrade their water all the time, and go to private schools, and we also buy batteries and generators for portable electric power. Under any health care reform proposal, people would be allowed to purchase more insurance as they saw fit, and they could pay for premium care if they perceived added value. None of this would change under any proposed reform bill, but safe and affordable electricity, water and public schools are considered necessary for a civilized society, and so should health care.
Read the whole thing to see what his conclusion is. Hint: the town hall screamers' teabags would explode.
"Right now, it's a little too late to get the tight ass. You get the tight ass right now, pack it in. Right now, this is a man's game. I know what I've got. I'm still waiting for it to show up."
Tuesday, August 25, 2009
Tags: health, reform, town hall, rage, right-wing, monkey washing cat, Sarah Palin, protests, mongering, conservative, monkeys!, animals, Bill O'Reilly, Nazis, media, Glenn Beck, flashbacks
|The Daily Show With Jon Stewart||Mon - Thurs 11p / 10c|
Monday, August 24, 2009
In just the latest revelatory memoir, former Homeland Security Chief Tom Ridge has come clean on all those terror alerts that were issued in the weeks before the 2004 Presidential election, and it appears these were a ploy to scare the bejesus out of the electorate in order to gain support for the President. A book excerpt via TIME:
[Attorney General John] Ashcroft strongly urged an increase in the treat level, and was supported by [Secertary of Defense Donald] Rumsfeld. There was absolutely no support for that position within our department. None. I wondered, "Is this about security or politics?" Post-election analysis demonstrated a significant increase in the president's approval rating in the days after the raising of the threat level.
"And just so it's clear: using the threat of terrorism to try to achieve political goals is, you know, what terrorists do."
Tucker Carlson -- at the height of the August, 2004, controversy triggered by Howard Dean's accusation that the Bush administration manipulated terror alerts for political gain -- labeled those who believed the alerts were being exploited for political purposes as "insane conspiracy nuts" and said: "what they really need is psychological help, obviously." Separately, Carlson said that Dean had gone "berserk" and demanded that the Kerry campaign repudiate Howard Dean for suggesting that this was the case. I've emailed Carlson and asked him:
In light of Tom Ridge's belief that this is exactly what happened -- that, as the official responsible for assessing terrorist threats, he was pressured to raise the terrorist threat alert in order to benefit Bush's re-election campaign (something he also strongly suggested in 2005 after he resigned) -- do you still believe that? Or do you merely now believe Ridge to be one of the berserk, insane conspiracy nuts in need of psychological help?
I'll post any reply I receive.
One other note is that Ridge's tell-all may have ulterior motives since he has signed on as a consultant for a security firm and also is reportedly considering a Senate campaign against Arlen Specter in 2010. Distancing himself from his role in the Bush administration may have more tangible benefits.
Saturday, August 22, 2009
President Obama is losing the debate on health care due to nutjobs on the right buying the propaganda from industry groups of "death panels" and "big gummint." But equally as insidious is the misguided demagoguery from the left that mischaracterizes Obama's stated goals of health care reform.
Now Senator Grassley (R-IA) and Rep Mike Enzi (R-WY) are calling for a super-majority of 80 Senators to pass any health care reform bill, in other words, they do not want any reform at all. Grassley also thinks that a few screamers in several town hall meetings somehow should dictate the debate. That's incredible to hear, but WTF, that's his gig.
The larger question is why the Senate Democrats even consider the opinion of the marginalized leadership of the shrinking GOP. This latest laughable request should be met with, well.... laughter. This is, after all, the same party that had Sarah "death panels" Palin slated to be #2 on the list to lead the free world.
When the Medicare Part D drug benefit passed in 2003, with all the benefits going to the pharmaceutical industry, it passed with 54 votes. The same goes for the Bush tax cuts in 2001 which passed with 58 votes. Each of these votes had a similar monetary impact on the budget as the proposed House bill on health care reform.
The President and the Congressional Democrats need to do what is best on health care and ignore the noise from the Republicans. The GOP is clearly are not voting for any bill anyway, anyhow. This is why they were voted out of office in 2006 and 2008.
Note that the total votes cast for Republican Senators-- representing a lot of tiny square states-- is 40 million and those who voted for Democrats is 82 million. Even negating the 4 Democrats who would likely support a filibuster, the total is still 79 million. The Democrats in the Senate already have a "super-majority" when taking into account ballots cast.
Friday, August 21, 2009
In a word: no. But there is a bigger question....
Thursday, August 20, 2009
Thousands of people lined up last week for free medical treatment at the Forum in Inglewood. The arena floor resembled a vast healthcare assembly line as hundreds of patients at a time were seen by dozens of doctors, dentists and optometrists.
But many others had to be turned away because of a shortage of medical professionals willing to volunteer their time and expertise.
Stan Brock, founder of Remote Area Medical, the nonprofit group that organized the Forum mega-clinic, was clearly frustrated by being unable to match the overwhelming demand for healthcare with a sufficient supply of caregivers.
If local doctors aren't willing to donate their time -- a big enough problem on its own -- why can't physicians from other states come here to do pro bono work?
So let's try this instead: As a condition of licensing, a medical professional would be required to demonstrate that he or she treats at least a tenth of patients on a pro bono basis annually.
That is, for every 10 patients that a healthcare provider sees, one would receive the same level of care as all the others but at no cost.