Saturday, October 27, 2007

Can you believe a fat preacher?

Lecturing and writing on the virtues of free market health care, while personally clinging to a traditional HMO-style health plan, is a lot like the preacher preaching moderation. Isn’t it?

Nothing is more obviously disconcerting than watching a size 54 preacher pound the pulpit while shouting, “And these excesses will damn you to hell, people!” Well, I say, “What’s good for the pew-sitters is good for the pulpit-pounder.

So it is with agents, academics, providers, payers, lobbyists, lecturers and speakers who tread throughout America, selling, describing, desiring, designing, leveraging, and talking about consumer-driven health care. If you believe it, live it, I say.

Rosanne (my wife) and I own a $5,650 deductible plan with an HSA that will be fully funded by the end of the year, and into which we have had to dip twice so far. Our only regret is that we do not have a $10,000 deductible plan with the consummate HSA feature still available. The fact is, however, that we would still own a high deductible health plan, because we not only talk and write about it, we believe it.

We believe in consumer-driven health care because we believe in the superiority of free markets, and even more so, the superiority of liberty. My passion for this issue stems from belief, not from recognizing that I can gain something from the current debate over health reform.

Recently, for instance, I learned something disturbing about a major conservative think tank that advocates for free market health care. Essentially, none of them “walk the talk,” but instead, cling to their low-deductible plans, and by their actions, endorsing the entitlement mentality – it’s hard to pay attention to what they write.

When a fat preacher tells me to lose weight, the only weight lost is when I leave his church.

Perhaps the first thing we should do when confronted by a health reformer is ask the question, “What kind of health plan do you have?” At least we’d know whether to consider leaving the church, or just be skeptical of their conviction.

What do you think? How do you feel about this?

Thursday, August 16, 2007

Sick people are the problem, apparently

Jon Herring writes in the eNewsletter "Early to Rise" (Tuesday, August 14, 2007) about the U.S. health care system (www.earlytorise.com). The bizarre movie, “Sicko,” prompted Herring’s piece. He praises Moore for illustrating what’s wrong with the U.S. health care system, but disagrees with Moore’s solution. Moore, of course, wants more government care, while shutting down a market-based system.

Herring, however, goes on to repeat yet another tired mantra: He says that what’s wrong with the health care system is that it’s geared to treating sickness. Well, as my children used to say, “duh!”

Herring, quite properly and effectively stresses good health as the best antidote to what ails the health care system. In this, he joins the other billions of people on the planet who have common sense. If all of us took better care of ourselves, we will need less medical treatment, fewer prescription medicines, and perhaps, will avoid artificial organs and other medical devices. No one can fault him for that logic: Its just lacks scope.

Imagine yourself after a lifetime of good diet, vigorous exercise, low stress, and a lot of rest, lying in a hospital dying of nothing. Everyone dies. Everyone dies from something (two incontrovertible laws). And accidents happen, as do communicable diseases. People get sick. People suffer.

The U.S. health care system exists for these specific purposes: to reduce pain and suffering, and to extend human life. In its truest sense, then, its purpose for existing is to treat sick and hurting people.

Herring, and others like him, want a health care system that cares for healthy people, investing more heavily in preventive medicine. Preventive medicine is cheap to provide, except when it discovers a previously-hidden chronic illness, or a benign fatty tumor that results in surgery. Then it can lead to pricy, life-saving treatments.

We can all advocate for good health. We can even shape up our own bodies. We can buy all the preventive health care services imaginable. But in the real world, we still need a health care system to treat sick people, and treating sick people costs a lot of money - a lot more than not treating healthy people.

One last point about Jon Herring’s harangue: He writes, “But don’t expect changes in this broken system. The drug companies like it just fine the way it is…” Beware the salesman who must blame others in order to sell his products, as does Jon Herring. It's just plain dumb to accuse pharmaceutical companies of wanting people to be sick. That's like blaming gas stations for selling gas to people with empty gas tanks.

The fact is that if we are to force the health care system to change in positive ways, it will take the combined efforts of millions of Americans engaging in the purchase of health care services. It would also help immensely if those millions of health care consumers lost weight, quit smoking, drank less, ate healthier, and walked every day.

Thursday, August 9, 2007

Single Payer and Nurse Shortages

Nurses are pitching universal health care. By that, they mean that we should move toward a single payer health care system. They want this because they believe there is a nurse shortage: About this, they are right, and it will get worse, especially with government run health systems.

Now I know that rank and file union nurses are smart people. They have to be to make it through all that training. Of course, all smart people are ignorant about some things, like politics and economics. That’s why they rely on their union leaders to make good decisions for them. So I excuse the rank and file from my criticism here.

The U.S. spends about 16 percent of its Gross Domestic Product (GDP) on health care. A good deal of that goes to health professionals, like physicians and nurses. By contrast, Canada spends about 10 percent of its GDP on health care.

Of that 16 percent, 45 percent is paid by government programs, and 55 percent by private insurance, and out of pocket payments. Or, it could be stated this way: About 7.2 percent of GDP is spent by governments to provide health care services (for 25 percent of the population), while 8.8 percent is spent by private insurance companies and people paying out of pocket.

Very few Americans feel undertaxed. Government health care is paid from tax revenue. In most Canadian provinces, health care spending already reaches 47 percent of all provincial tax revenue; plus the national government tosses in billions more.

If the U.S. decided to move to a government-run, universal health care system, the dollars available through tax resources would be less than are available today. That is, unless governments are prepared to raise tax rates by astronomical margins, or cut other vital programs to the bones – like bridge repair, for instance.

The end result of government-run, single payer health care is this: There will be fewer nurses than today, not more. Unless government health managers decide to dump physicians and replace them with less expensive nurses to deliver health care, and that, my friends, is not a step in the right direction.

Nurses, of all people, should be pushing to reduce the government’s role in health care (and I didn’t even touch on the low, low reimbursement rates they now receive, the rates that make it less possible to employ more nurses).

Nurses, work on your skills. Carve out a niche in an emerging, free market health care system.

Monday, August 6, 2007

Why ask the president to solve health care's problems?

Several months ago, in an article about the U.S. health care “crisis,” The Economist asked the question, “…what is President Bush going to do about it.” My immediate response was, “Why is it even his business?”
Providing and paying for health care ought to be a local and personal issue, not one in which the federal government plays a central role. It is the idea that the federal government had to solve health care crises that got us into this mess.
That, however, is not the thrust of this message. Rather, it has to do with the questions surrounding health care. Should our focus be to:
  1. Reduce overall health care spending? And if so, is that in real dollars, or a percentage of GDP, or both?
  2. Or is this about reducing per capita health care spending in wealthy states, while increasing it in less wealthy states? Or cities? Or neighborhoods?
  3. Increase access to all health care services for everyone? Or about reducing services for some, so that others can have what they now lack?
  4. Reduce the rate of those without health insurance to zero? Or those without someone else paying for their health care to zero?

Whichever question moves to the top of the list will leave the others unresolved. For instance, if our overall goal is to reduce health care spending, while maintaining access for everyone to quality health services on an equal basis (sounds like single-payer to me), then we will not accomplish any of those goals.
If we squeeze provider reimbursements believing it will reduce spending, it will also reduce the supply of providers. Many will quit.
If we open the floodgates so that everyone can have everything, it will send health care spending through the roof.
Try taking services away from Hollywood, California and give them to Hayward, Wisconsin.
I believe that the best way to get a handle on this is not to look to Washington, D.C., but look to Washington Street, Lane, Avenue, Blvd., Way, Court, or on any other street where health consumers live. Put them in charge of their own lives. They are up to it.
The president has far more important issues to tackle than where I get my next blood test, who pays for it.

Thursday, August 2, 2007

Mississippi River Bridge Collapse

This is an unusual post to a health care blog, but I wanted to share it with you. I can say that the response of the health care provider community is amazing, and a great testiment to the high quality of U.S. health care.
The I35W bridge is about 10 miles west of our home, just on the west of the U of MN campus. The Humphrey Metrodome, where the Twins play, is about 4 blocks west of the freeway. It is likely that some of those cars were on the way to the Twins-Kansas City Royals game.
But here’s my story.
My sons, Dan and Dave (and his wife Alicia) had a softball doubleheader tonight. The first game was to start at 6:15, on the ballfields at 20th Ave and 2nd Street, roughly three blocks from I35W on the west, and two blocks south of the Mississippi River.
I arrived at the ballfield at 6:05, and walked across the field. About the time I got to the ballfield where the boys would be playing, I heard the first sirens. And there were many sirens. Son David came about five minutes later. All I knew was that something big was going on, but felt it could have been police chasing someone, as squad cars drove past the ballfields on my left and right, and to the west of me, they were parking at the foot of a bridge that leads north, parallel to I35W.
Then I saw black smoke in the NW, and fire trucks started to appear. And more cop cars. One of the ball players called his brother, and that’s when we knew the bridge had collapsed, but we knew nothing else.
Dan came about 6:20, and he had crossed the bridge that parallels I35W. He saw the bridge down in the water, but had no details. I tried to call people to see what they knew, but cell phone traffic stalled out. Around 7:10 I walked two blocks north to the river and could see one of the spans laying at a 45 degree angle down into the river. I walked west and looked north and could see another span hanging down from the north, into the river. But I still had no idea that so much of the bridge had collapsed flat into the water.
I finally left the ballfields after 8 p.m. and listened to radio reports. Still, it wasn’t until I got home at 9:20, after picking my wife up from work, just how devastating this was.
Okay. My irony, and evidence of God working to protect me and my family: When I checked directions to the ballfield, I saw that I could take I94, to Riverside and so forth, or I could I35W and exit, and so forth. I chose I94. There is absolutely no question that I would have been on that bridge, or very near to it (within 5 minutes one way or the other, or on it) when it collapsed.
My writing partner, Greg Dattilo, had left my office just past 5 p.m. He drove across that span around 5:30 p.m.
Of course, we will hear many stories like this. This morning we learned that a family friend lost her daughter in this tragedy. Joy Blackhawk’s youngest, Julia. We do not know details.
Now we watch and see.
This ranks right up there with Hurricane Camille (we lived in Gulfport, MS when it hit), and the Twin Towers.
We have checked with our own family members, and everyone seems to be accounted for.

Tuesday, July 31, 2007

Politicized health care, the real illness

“You know,” I said to Greg Dattilo as we walked toward the Minnesota State Capitol building, “this is what is really wrong with health care.”


“What do you mean?” he asked.


“Well, we’re going to a legislative meeting where politicians are going to decide the future of our health care system. That’s what I mean.” The Minnesota Health Care Access Commission, chaired by two liberal politicians, was about to hear testimony. Well, it was really about to hear what it wanted to hear to justify further polarization of health care.


When Congress passed Medicare and Medicaid in 1965, it subjected health care to the pressures of elective politics.


Politicians love a void, because they step in and fill it. It’s really a vicious circle. They “solve” a problem and create new ones that they get to solve.


For instance, in 1960, 4.5 million elderly Americans had no health insurance (though they did have health care). In fact, about 22% of Americans went without health insurance, but no one went without health care.


Congress created Medicare and Medicaid and health care spending went through the roof. Congress stepped in to solve the crisis and created HMOs. Double-digit spending ensued. All across America, legislators got into the act, and someone invented the uninsured statistic to prove that politicians needed to do even more.


That bothersome uninsured rate, by the way, has held pretty much steady during the last many years, but it is The Big Crisis of Today which only politicians can solve. Hence, a Health Care Access Commission must meet and decide the fate of our health care system.
Micro-managing health care is a politician’s dream. Tens of billions of dollars are at stake, and interest groups pay big money to get a politician’s ear. The sheet power of even an average state legislator is magnified through their vote on the floor of the house or senate, or better yet (for them), in committee.


What I am looking for are politicians who want to consumerize health care, placing the power of shaping our system into the hands of We the People (what a novel idea; free people making their own decisions about how to live). It takes a Big Man or Big Woman to give up so much power voluntarily, and this is what is really wrong with U.S. health care.


Pollsters tell us that US health care sits atop election year political issues, but not in the way it should. Rather than ask government to back away, American’s misunderstanding of the role of government and politics begs politicians to do more.


Those who have watched health care reform for decades believe that Americans do not have the stomach for government-run health care. Were this true, we would expect a backlash among voters during the next five years, as Congress, a new president, legislators, and governors – politicians – work to solve our current crisis. I worry about this, because I see that few people understand how dangerous and unhealthy such a system will be. What follows after the imposition of a government health care system? Decades more of politicians deciding our health care future.


Politics is what is really wrong with US health care.

Monday, July 30, 2007

Americans spend billions on health care

We need DogiCaid before it’s too late

My “Business Week” magazine came on Saturday. Dated August 6, 2007, the cover features a very ugly (in my opinion) dog. The dog is wearing gold bling and a diamond tiara.

“The Pet Economy” sits in huge, blocked letters next to the ugly, fancied-up dog. And herein lies a most interesting factoid.

“Americans now spend $41 billion on their pets,” says the article on page 44. We learn here that $41 billion exceeds the GDP of 78 nations.

Of that $41 billion, $9.9 billion goes to supplies and over-the-counter medical products. (The article doesn’t mention doggie generics, but maybe a Congressional committee could investigate this to cut the cost of doggie pharmaceuticals.)

Another $9.8 billion is paid to veterinarians. Outrageous sums of money like this demands federal government intervention. Clearly, doggie care has gotten out of control. We need a DogiCaid program for low income cat and dog lovers.

Actually, my real reflection about this is based on the much-repeated mantra of the government-knows-best health reformers, the one that goes, “Americans spend twice as much on health care as do other nations.”

Hey, Americans spend $41 billion on their pets! We have bigger houses. More cars. TV sets. Our grocery stores are the world’s envy.

We spend nearly $10 billion on doggie health care.

Americans spend 16 percent of U.S. GDP on health care because we can. And the wealthier we become as a nation, the more we will spend on health care. While we do not spend it wisely, and health care cost is a great concern, the fact that we spend it should not astonish anyone.

We spend $41 billion on our pets!

Saturday, July 28, 2007

What is SCHIP's goal?

Watch out. Medicare for everyone is being introduced incrementally.

Several years ago, Republicans created the State Children's Health Insurance Plan (SCHIP). They hoped it would allow low income parents to purchase or find health insurance for their children. As is too often the case, there have been unintended results.

First, it gave some employers the ability to off-load a portion of their dependent coverage for low income workers. Why have the group plan pay when the state is willing?

Second, states expanded this program for children so that some low income adults would qualify(it should now be State Children's And Adult Low Income Insurance Plan-SCHALIAIP). Great. A program for children is now a program for adults.

Third, Congress, as usual, needs to spend more on programs that grew beyond their original concept, costing billions more in tax dollars.

But even considering these issues, what strikes me is the hidden agenda.

For those who want the U.S. to embrace a government health plan run from Washington, D.C., this is the perfect subterfuge. Grace-Marie Turner recently wrote that raising the enrollment guidelines to include children in families with income up to 400 percent of the poverty level would include more than 70 percent of all children - to age 25.

This feels an awful lot like Medicare from birth to 25, and Medicare from 65 to death. I suggested this to Grace-Marie and she missed my point. She correctly stated that this is Medicaid for everyone.

But my point is simpler: Once 70 percent of children have spent all of their lives on a government health plan, why would they want anything different? They wouldn't have a clue about the benefits of a free market health system because they will have never participated. When Congressman Iama Statist introduces the Comprehensive Universal Health Insurance Plan (CUHIP), far greater than 50 percent of Americans will already be on the dole, and it will pass.

Goodbye free market health care.

Leave SCHIP at 200 percent of poverty level for now. Then find a way to dump it and replace it with a new free market plan. Please.

Thursday, July 26, 2007

They say this is killing us?

The last few days brought profound news to the health care reform movement. Sure to change everything.

First, we learned that a can of soda a day causes heart disease. This we learned as news anchors soberly warned us as we watched images of very obese people wander across the TV; most of them sucking down a soda (even diet soda) along with a Big Mac or DQ Blizzard. Right. Sodas cause heart disease.

Second, we learned that being fat is something you catch from a friend or family member. Now the Authorities That Be (ATB) claimed that just living or hanging with fatties will make you fat. Once again, there were those TV images of large people grazing at the buffet, and washing it down with a soda. But it's not their fault. It's just that they hang with the wrong people.

Third, today we learned from the ATB at Childrens' Defense Fund that health insurance deters crime. Yes, that's what they said! If we just get all the children insured, it will reduce the crime rate. Does that mean that most crimes are committed by sick kids without insurance. I'd love to see that study.

My college statistics professor's first profound statement was, "Correlation does not prove cause." Do they still teach that?