FreeMarketHealthCare

The big government pediatrician now in charge of Medicare

2010-08-24T19:46:00.001-07:00

Berwick avoided senate scrutiny

President Obama used the recess appointment process to appoint Dr. Donald Berwick to head up our government health care systems – Medicare and Medicaid. Presidents in the past have used this constitutional provision. Usually, it is used when the president wants to get his first choice appointed and knows he faces a hostile senate, a senate that would reject the appointment.

The constitution allows recess appointments when Congress is not available to consider giving its consent. In this case, however, it is apparent that President Obama did not want Berwick to face public scrutiny.

Berwick, a pediatrician had a short clinical resume. As a kids’ doc, he has probably never had to deal with the Medicare mess that he now leads. Chances are that he has had at least limited experience with the low reimbursements Medicaid pays to doctors.

Berwick is outspoken and controversial. His more infamous quotes have flown across the newswires and the Internet. Berwick’s praise of England’s National Health Service is particularly troublesome. While he does not favor the NHS’ long wait lines for critical health services and elective surgeries, he like the NHS and “value-based” medicine.

Imagine a hostile U.S. Senator asking, “So Dr. Berwick, are you saying that perhaps here in the United States we should withhold care from a senior citizen if Medicare thinks it is too expensive? If the person would probably die within a short time anyway?”

Pres. Obama knew better not to lay Berwick, the controversial quote-maker, open to that kind of questioning.

My favorite Berwickian quote:

For the past several weeks, I have been using one particular Berwick quote, because I think it sums up the Obama administration’s view of health care management. “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.” [Emphasis Added]

Berwick here lays bare his bias: Mortals cannot manage their own health care. Only leaders have enough savvy to tell we commoners how to care for ourselves. Government, he implies, is the proper authority to control medical caregivers. The quote speaks volumes about Berwick’s attitude toward Health Savings Accounts (HSA) and consumer-directed health care. It appears that in his view, mere mortals could not possibly make health care consumerism work. Yet, consumerism is the one shining star in pre-Obama health care reform that has both reduced spending trends, and helped individuals maintain good health.

Berwick prefers that health “experts” along with academics, researchers, and government leaders lay out what is medically preferable. President Obama appointed him, ergo, Obama believes government is the best arbitrator of individual health care.

At the same time, however, there is a remnant of truth in this Berwick quote. Health care is complicated and difficult for individuals to manage. The complexity of health insurance and the provision of medical care is why Americans seeking advice consult with non-government, private experts rather than government bureaucrats.

Doctors, nurses, pharmacists, therapists, patient advocates, professional insurance agents, insurance company claims specialists, social workers, and a host of other highly trained individuals help health care consumers navigate through medical complexity – with bureaucrats on the sideline.

Berwick implies that the army of private professionals already assisting individuals is not capable of doing what government “leaders” do. Government, Berwick implies, is providing the leadership that we demand, and without which we would certainly waste our health and money. We “need” government as our shepherd as we ponder the health care we think we need. Do not be dismayed, however, because our new health care leaders will make we get the care when they believe we need it, and in the manner they prescribe. “That’s what leaders do.”

Imagine Dr. Berwick trying to explain this to a U.S. Senate panel.

Individual insurance across state lines. Some thoughts to ponder.

2010-07-24T11:27:00.000-07:00

In a truly free market for health insurance, crossing state lines to purchase the best possible insurance product makes a lot of sense. That’s why so many smart, well-studied conservatives support it.

Competition is the key to holding down prices.

But I caution you on this, and not because I oppose it, but because there are serious downsides that must be addressed. Let me mention three:

First. The issue of individual state mandates, and how that translates into better pricing. Minnesota ranks second in the country with insurance mandates – 67 of them (RI is first at 70).

If you purchase an Iowa insurance product that might only have 55 mandates (I do not have the real number in front of me), which state’s mandates will prevail? If Minnesota’s, then a good deal of the competitive nature of the plan is gone. If Iowa, it begs the question of how will Minnesotans get their fertility treatments paid (for instance).

Or, a regional pact can be negotiated that allows at least limited competition within the region, with identical mandates (whose will prevail, and would Linda Berglin or Tom Huntley allow this?).

Second. The issue of networks. As you doctors painfully know, the insurance companies can play hardball on network negotiations in part because there are so few competing in Minnesota. On the other hand, doctors are loathe to sign contracts with more networks. How will non-Minnesota insurance companies overcome the inability to create workable networks?

Networks can be rented, of course, but what advantage would one company have over another? If all have the same mandates, and all, but a few have the same networks and contracts, I fail to see the advantage.

Third. Many who favor cross state lines sales do so because they do not support employer-based health insurance. The assumption is that individuals will be better able to shop for their own plan if freed up to do so, in a market of many plan choices.

Setting aside the issue of the individual mandate, and if we can overcome the issue of state mandates and networks to design competitive products, there are still serious considerations in unraveling the employer-based insurance system.

Today, depending on whose numbers one uses, some 140-150 million Americans receive private health insurance through employers (more than the entire Russian population, by the way). If our goal is to achieve near universal coverage, this gets us halfway there.

Let us assume that Congress eliminates the tax deduction for employers to provide health insurance. And let us assume that in so doing, Congress transfers that deductibility to individuals. Would 150 million Americans continue to receive their insurance from private markets?

The presumption is that employers would simply pay their workers the difference. That is, instead of spending $12,000 on insurance, they would spend $12,000 on payroll. The tax implications for the employer are nearly neutral, save for the extra payroll taxes generated by increased wages and salaries. An option would be paying an additional $10,000 and consider the payroll taxes part of the total compensation, but again, these are business expenses that will be allowable as deductions, and not subject to taxation.

Will the outcome, then, be increased pressure on tax revenues from the neutrality of the employer tax deductibility, and the increased deductibility of insurance premiums? If so, what will Congress tax to replace this lost revenue?

More of a concern than transferring insurance cost to wage cost is the most simple of questions: Without an employer mandate, why do we believe employers would pay the insurance savings in increased wages? This is a dangerous assumption that could leave individuals with reduced net income, and leave more on the bottom line for employers. Unfortunately, those now-liberated employees might also forgo health insurance because of the negative impact of employers not transferring those costs – unless Congress forces them to do it (and that raises numerous other issues). Hence the uninsured rate could spike higher, driving us closer to single payer or some other such scheme.

I would suggest there are other considerations, but will not dwell on them here. They do, however, include the right of employers to control their own businesses, the need for employers to retain and attract good employees, and other such issues.

Lastly, let me repeat. I am not for or against the idea of purchasing individual health insurance across state lines, but I believe these serious issues need to be fully vetted before this idea can win wide spread support.

CNN interviews whiners about health care reform

2010-04-09T13:08:00.000-07:00

Today, someone sent me to a CNN webpage that reported on four individuals -- Karen Scheuerman, Mary Pitman, Douglas Wolk, and Lita Epstein -- that are pleased as pink about Obamacare. Go and look for yourself and then come back to this blog, because I am going ask the questions below that CNN, apparently, failed to ask.

Go here: http://money.cnn.com/galleries/2010/news/1004/gallery.health_care_real_people/index.html

For Karen Scheuerman – How much money have you saved because you pay premium for a $10,000 plan, versus first dollar coverage? It certainly should be enough to pay for necessary preventive services. What preventive services are you unable to afford, given how much you are saving?

Do you sincerely believe that a health insurance plan offered through a Health Insurance Exchange will save you money? Based on what data? And those subsidies you expect to receive, are they free? I mean, does someone else have to pay them so you can pay less? I note that you are in some kind of financial advisory business. Will you be advising your clients that getting on the dole is a wise strategy?

Mary Pitman – I see that you are willing to pay for preventive care, but not for catastrophic coverage. What part of “insurance” do you fail to understand? Insurance is all about getting help for unexpected occurances, not preventive care (well, in a normal insurance market, anyways).

And you suggest the ER is the only choice for uninsured people? Are you sure, or does your town lack Community Health Centers?

Apparently you believe picking pockets is okay, as long as it is someone else’s pocket you pick. Do I have that right?

Why do you care, by the way, that people (prior to Obamacare) with health insurance have to pay more, since you are not presently insured?

You suggest that everybody will get cheaper health care. That is an interesting theory, but I expect you will be very disappointed as health care cost continues to rise faster than CPI.

Lastly, I see that you are a healthy person, and you understand that getting healthy people into the pool is important. Why, then, haven't you jumped into the pool yet? Or are you just waiting until someone else helps to pay your premium?

Douglas Wolk – Let’s see. You are young and healthy, and apparently, you only need flu shots (I would ask you who told you that, but it would take me off course). If you only need flu shots and help for an occasional snotty nose, that might even work in one of those foreign countries (as long as you can find a family doctor willing to take your case).

Imagine, you have to pay a whopping $500 a month to insure three people. How much do you think is fair? Then I see that you prefer not to abide by the insurance contract you willingly signed that tells you up front not everything you want is covered. Let me ask you this: When you go to a restaurant and pay the menu price of a hamburger, do you get angry if the owner denies you prime rib?

About that single payer thing: As a writer you need to do more research. And are you really anxious to live in a country where the government could employ “mechanisms” to keep costs down? I wonder how that would work?

Lita Epstein – You are 57 and self-employed. Your $700 a month insurance increased to $1,200 at age 56. I am 62, self-employed, and the insurance my wife and I own just increased to $689 a month. What gives? Aha. You probably have richer coverage than I do, instead of the common sense insurance that I own.

I see you have a health plan of sorts. Looks to me like a plan that costs you more than you will ever actually spend on health care, since it is virtually useless for any catastrophic procedures.

You Four: Listen up now. Aren’t you glad that in the United States there are filthy rich people, people that make more than $200,000 year – really filthy rich – who are willing to give you some of their money? What a country.

Cars are not people - Welcome to finite value

2010-03-27T08:16:00.000-07:00

Auto Insurance Mandate is a False Argument
Humans are not autos

You’ve likely heard it. “If the government can mandate auto insurance, then why do you say it cannot mandate health insurance?”

There are at least four major differences (and be sure to read number 4, because it is the most critical):

First: The FEDERAL government does not mandate auto insurance. States mandate it. And three states have chosen not to do so. Auto insurance, like health insurance, is a state issue.

Second: The mandate for ownership of auto insurance only covers what the driver might do to someone else. It is liability insurance, not collision, comprehensive, glass, or preventive maintenance. To be like the new FEDERAL health insurance law, auto insurance would have to cover routine maintenance, parts replacements, and just about everything else.

Third: Even though 47 states mandate auto insurance coverage, the average uninsured rate, according to the Congressional Budget Office, is 14.6 percent. (Actually, I believe that estimate is very low, considering that in California and Texas, it exceeds 25 percent.) The uninsured rate in our mostly voluntary health insurance system has held steady at about 15.5 percent or so for a decade.

Four: Auto collision insurance is somewhat like catastrophic health insurance in that it will pay to fix damage from an accident. But it never pays more than the value of the car (there is no limitless benefit).

If an 85-year old man wraps his $3,500 car around a tree, and the car suffers $4,000 in damages, the insurance company pays the old guy $3,500. The auto has a finite value.

If that 85-year old man breaks his bones, and if health insurance worked like auto insurance, the insurance company would give the man three choices: 1) the fair market value of his life in cash, 2) enough money to pay for hospice care until he dies, or 3) pay for assisted suicide.

In the United Kingdom, the value of human life is determined by a formula. For the most ill patients and the elderly, health care regulators decide the value of human life in Quality Adjusted Life Years. If there is not enough economic value in the “repair” of a human life, plans are made to help them adjust to death. In the United States, Oregon demonstrated this principle with 64-year old Barbara Wagner.

Wagner contracted cancer. She wanted to continue to live, and indeed, if she lived in any state other than Oregon, the health system would have given her that chance. Wagner’s doctor prescribed Tarceva, a new chemotherapy drug regimen. Wagner, however, received her health coverage from the Oregon Health Plan – a government health plan. Because of its global budget, Oregon officials notified Wagner that they would not pay for her chemotherapy, but they would pay for either hospice care or an assisted suicide.

Dr. Walter Shaffer, a spokesman for Oregon’s Division of Medical Assistance Programs, explained the realities of the Oregon Health Plan. “We can’t cover everything for everyone. Taxpayer dollars are limited for publicly funded programs. We try to come up with policies that provide the most good for the most people.” Oregon’s health care managers decide, in the end, who will gain relief from pain and suffering, and who will die.

Despite strong bipartisan opposition, President Obama signed the “Patient Protection and Affordability Act” on March 23, 2010. The bill authorizes federal government approved health plans, and will help 68 percent of Americans to receive some form of federal tax subsidy to purchase overly expensive health insurance. Accepting a government subsidy means they will be governed by federal health plan guidelines. Barbara Wagner, were she alive, would tell you what this means.

Health insurance is not auto insurance: So you get the picture. Auto insurance deals with predictable, finite cost. It is a state issue, not a federal issue. And when the cost of the insured item exceeds its finite value, it is cashed out. Why would auto insurance companies cap payments at the value of the auto, and not offer limitless coverage, preventive care, reimbursements for worn out engines and transmissions? Because no one could afford it.

With the stroke of his pen, President Obama has invited you into the world of finite human value.

Health reform’s hidden costs - Placing states and citizens at a huge risk - Attacking the American Spirit

2009-12-17T11:27:00.000-08:00

Governors across the country have begun screaming at Congress, “Hold on a minute. Time out on this health care reform thing.”

Truth has begun to set in, that as a result of federal health care reform, every state faces a plethora of unfunded mandates that will drown them in dilemmas and red ink. Once it passes (or, if) the hidden costs of federal health reform will immediately become clearer. As a result, states and local governments will increasingly find it impossible to fund their most vital services – education, police, fire, water, energy, roads and bridges.

Governors have warned for years that the cost of Medicaid threatens their state budgets. They had hoped Congress would fix the problem, not exacerbate it. Congress, instead, has been showing it is deaf to governors and to citizens.

But the increased billions to be spent on Medicaid is just the tip of the iceberg.

This is a partial list of the increased cost and loss of state revenue faced by states, and their residents. I am certain you can add many thoughts to these.

1. By raising Medicaid eligibility to 133 percent of the Federal Poverty Level, millions more Americans will qualify for the program. The federal government will pay this cost for a period of time, but eventually, states will be forced to spend more on Medicaid, not less. Nebraska Gov. Dave Heineman says this will cost his state $2.5 billion. Other governors are making the same case.

2. Every current state-level health care and insurance statute, rule, and regulation will have to undergo scrutiny to ensure it complies with new federal law. When changes are required, they will be subject to statutorily-required bureaucratic and legislative review at a cost that the best economists could never predict. This effort will take bureaucrats away from their assigned tasks, meaning current programs will suffer; or states will hire more bureaucrats to fulfill their mission.

3. While everything is under review and being rewritten, state programs will be in limbo. Federal law will require states to conform to new mandates for which there will be no guidelines. States will spin their bureaucratic wheels while trying to conform to vapor regulations, and face the potential of lost federal revenue for non-compliance.

4. Today, even before adding millions more to the Medicaid roles, 40 percent of practicing physicians refuse to accept Medicaid patients. This results from low Medicaid reimbursements (and yet, even at this, Medicaid bleeds money from states’ Medicaid program cost). So much for access to health care. States will be forced to step in, but no one knows how or the cost of solving this unintended result.

5. Attorneys, accountants, and benefit consultants will make a fortune as they advise employers on the overwhelming changes – and penalties – associated with new federal law. Employers will be forced to divert funds to compliance, even if they choose to drop the health insurance benefit. (Depending on which version of reform that might pass, employers could be faced with new mandated insurance benefit costs.) Productive capital, that otherwise would be invested in expansion and increased employment, would be spent on compliance. This will cost state and federal treasuries billions of dollars in lost tax revenue.

6. Individuals, faced with the mandate to purchase insurance, will be forced to divert income from self-initiated purchases to insurance premiums. The reduction in purchasing power will further depress the moribund economy, and ripple out to the economy’s edges. Some experts predict that individual health insurance premium cost will double in the next 10 years as a result of federal reform. That money must be diverted from other spending, savings, or debt reduction.

7. States would lose tax revenue, as the increased cost of health care would reduce business profits and individual net income. Sales and income tax revenues would plunge, as more money is diverted to federally-mandated health insurance cost.

8. The cost of apprehending and prosecuting violators of the insurance mandate would add billions to the IRS’ enforcement budget, as well as expanding the cost of federal law enforcement and federal courts. This will rob necessary programs of their revenues, and will drive taxes upward. Every dollar spent on taxes will be diverted from the productive economy.

Perhaps the most serious unknown cost of federal health care oversight is the loss of what we used to call the American Spirit. This is the idea that individuals are free to pursue their own destinies, with government kept as far-removed from daily lives as possible. The American Spirit celebrates life, rather than regulates it. The American Spirit is a spirit of individualism and even nonconformance, not communalism and compliance.

The hidden costs of federal health care reform are incalculable, not too mention incomprehensible. This is a bad idea that grows worse each day. Now that leftwing activists are realizing it, too, it’s time for a pause…a long pause.

The 220-215 Health Reform Vote - What's Next?

2009-11-09T08:19:00.000-08:00

Everyone will have an opinion about the November 7 vote in the US House. Mine looks ahead to the remaining hurdles. Take heart. This is a long way from finished.

Senate and Conference Committee

HR 3962, passed by an embarrassingly slim five-vote margin, now moves to the U.S. Senate. Many national talking heads and elected officials are saying it is already dead there. We shall see. Frankly, I never believed the Democrats could pass it out of the House, given the rancor over abortion, immigration, resistance from seniors and the like.

The AARP may have sacrificed its future by backing this bill. The same is true of the American Medical Association. These groups are facing incredible hostility from their own members.

Let’s assume, however, that the Senate actually passes a bill. Its version, and that of the House, must be identical in every aspect. This includes the words, the provisions, the organization, even the punctuation. Given the mood of the Senate, if they pass anything, it will be significantly different from the House version.

If the Senate passes a bill, it will be sent to a conference committee. The conference committee includes members of the House and Senate. If the conference committee can somehow pass a bill out, it still faces immense opposition.

The conference committee reconciled bill is sent back to the House and Senate for consideration. Imagine if the conference committee bill retains abortion coverage. Or does not contain the government option. Imagine that the employer mandate falls off the table in the conference report, or strong immigration verification language is added. Conference committees often report out bills that look very little like that which Congress had already passed.

The next step is a House and a Senate vote. No amendments are allowed. They must vote it up or down. Will Pelosi be able to hold onto 218 votes? Will Reid be able to get a conference bill passed?

Bottom line. You must redouble your pressure on the U.S. Senate. Your groups must come out swinging. Your neighbors, co-workers, and friends must be alerted. There is no time to waste.

This may seem self-serving, but now is the time to load up with FACTS: Not Fiction booklets, and give them to everyone you know. Here’s the link: http://tinyurl.com/yex2eab

Never, never, ever give up.

Demonizing insurance companies

2009-08-12T07:11:00.002-07:00

President Obama and Congress changed their strategy in the last several days. They no longer campaign for health care reform, it is now health insurance reform. (Sidebar: Obama rightfully rails at the out of control cost of Medicare and Medicaid as threats to the national economy, but sees as his priority, reforming the private health insurance market. Strange logic.)

Health insurance policies are contracts. Contracts are supposed to be enforced by governments.

Health insurance policies are, to my understanding, filed with and approved by government agencies.

Health insurance policies are subject to the political gamesmanship of state legislatures and are, therefore, politically-negotiated and approved contracts.

Health insurance companies must collect enough premium to pay the bills of those with whom it contracts (people who own the insurance policies) and the physicians, hospitals, and other providers whose services are used by those people who own insurance contracts. If they do not collect enough premium, they will go out of business. Yes, they must also cover their administrative expenses, but only at levels allowed by the laws passed by elected officials.

Health insurance is held hostage to some extent by economic forces, of course, but within the constraints allowed by the political process (in the case of health insurance, usually driven by ideological populism and the cancerous desire to be re-elected rather than pass good laws).

Since health insurance is, by this logic, already controlled by the political process, and since our tax dollars already support in part or whole, health care services for 103 million people, plus government employees, why has Obama and Congress made the insurance companies public enemy number one? I believe they should admit they have met the enemy, and the enemy stares them in the face each morning.

A health care system driven by politics, rather than economics and individual moral responsibility, will always need demons – and the insurance companies are catching it.

Governments should establish the basis of an enforceable contract, and then enforce them, not demonize them.

Venture capitalism and health care

2009-08-10T06:09:00.001-07:00

Just a rambling thought, but wish for responses from you learned folks.

Venture capitalism is under attack from zealous Congressional and SEC pinheads who believe they can best manage individual lives and money. See the WSJ today. Why should we care?

The Bio-Pump, the world’s largest selling hear assist blood pump, was developed with high risk investment money. This little device has saved millions of lives. Its inventors, Dr. Harold Kletshcka and Edson Rafferty, created this device to save lives. Never once did they consult with insurance companies to make sure it would be a covered benefit, nor did they seek permission from the federal government to build it. On the contrary, FDC laws regarding medical devices that went into effect in 1976 impacted its progress, and a false SEC lawsuit in the early 1970s nearly drove them out of business. (See To Change the Heart of Man – www.tochangetheheartofman.com).

Now here is my question. Should venture capitalists invest only in new medical devices that they predetermine will be covered by health insurance, or that they predetermine the federal government will approve? And should new laws regulating venture capitalists require that they prove beforehand that their chances of earning a ROI are without risk, or at least low risk? And if all this happened, would it serve to advance the efficacy and value of health care or defeat it?

As you evaluate health care reform, you must, must look at the threads running through all new policies that are under consideration. The impact of further centralization of all aspects of commerce, whether directly related to health care or not, will prove deadly in the long run.

Our moral obligation re: health care

2009-03-18T09:02:00.000-07:00

A national health reform leader made the argument to me today that we have a moral obligation to provide health care to all Americans. I asked him to define “all” Americans to clarify his position, and am awaiting his answer.

1. Do we have a moral obligation to provide health care to all Americans?
2. Do we have a moral obligation to provide all forms of health care to all Americans, or do some people have the right to use services not financially available to others?
3. Is there a place at which the public's (i.e. government's) moral obligation ends, and government must decide to cease offering it?

Perhaps you might say it depends on what the meaning of “we” is. Is “we” all U.S. residents or just those here legally - or just citizens?

And if we have this obligation, should this care be delivered and/or paid for by governments, private insurances, charities, and/or personal service?

This is a tough question. How it is answered will have a profound impact on health care reform.

It is not so different from questions about our moral obligation to provide food, shelter, and clothing for everyone. We already provide food stamps, WIC, Section 8 housing, vouchers for necessities, at taxpayer expense. It is likely that during the 1960s, we asked and answered the moral question that yes, every American has a right to these essentials, even if it cost taxpayers some of their livelihood.
Help me think this through.

Mortgage Bailouts and Health Reform

2008-09-25T06:56:00.001-07:00

What does the mortgage crisis have to do with the future of health care reform? Plenty.
Stan J. Liebowitz, economics professor at the University of Texas at Dallas, tracked the intervention of the federal government into mortgage lending during the past 20 years. Boiling it down: In the name of home ownership, economic laws were suspended so that people without assets could buy houses. Should we be surprised when they cannot pay for them, and when they are foreclosed upon?

Now economists insist that free markets cannot adequately serve the lending industry, and that is why the federal government must step in to rescue it.

The commonality with health care reform is twofold:

1. The federal government, since at least 1965, has continuously ratcheted up its involvement in the payment and delivery of health care. States have either stayed a step ahead of the feds, or followed closely behind. Government has nearly destroyed the health care market economy.

2. The same logic used to justify a federal bailout of mortgage lenders and the banking industry will be used to reform health care. We have been told for decades that health care cannot operate in a free market environment. When it fails to meet governments’ goals for it, our vaunted U.S. health system, so the politicos will claim, need to be rescued by the government.

The big difference is that we have time to do something about health reform. An army of health insurance agents can dispatch itself to work overtime to convert the insurance market to consumer-directed health plans.

Only by bringing consumer (aka voter) pressure on Washington, D.C. and state capitals will the United States be able to avoid a national health plan. I am convinced that without such a movement, the march to socialized medicine will reach the tipping point by 2012-2014.

Please, don’t let this happen.

The uninsured in America

2008-09-01T16:22:00.000-07:00

We're not doing so bad after all.

The U.S. Census Bureau has lit the fuse for the next battle in health care reform. The uninsured rate and numbers have dwindled, and that is good news. Why they dwindled might seem not so good.

Allegedly, now only 45.7 million of us are without insurance (or as our detractors say, "are without health care); about 15.3 percent of the current population. The drop is attributed to more people enrolling onto government health plans (more than 300,000 in Massachusetts along, thanks to the Connector).

On the other hand, this means that more than 255 million Americans are covered under a health plan.

Stick with me on this: At 255 million (the number of Americans with a health plan) it would make a country the third largest in the world, next to China and India. That we have the resources and systems in place to insure so many people (more than eight times the population of Canada) is a great accomplishment.

202 million Americans get their insurance through an employer, a number that held steady. The rate (just under 60 percent) is lower, but that is not so dismal news. After all, we have been fighting a difficult economy. I think it is a strong indicator of the important people place on group insurance.

Of the remaining folks without insurance, no more than 15 million, or five percent, are chronically uninsured. Those aged 18-34 comprised 54 percent of the uninsured, and that produces an interesting and vitally important issue.

The drive toward "universal health care" is a misnomer. The honest term is "mandatory universal health care," meaning forcing everyone by law to purchase health insurance. Now think about this.

If more than half of the uninsured are aged younger than 35, and we use the law to force them to buy health insurance, what does this mean? It means that we want young, healthy people to underwrite the cost of older people - of us Baby Boomers. Once again, the Baby Boomers want to be bailed out by someone else.

The other fascinating uninsured statistic is that of the new immigrants, who still make up 33 percent of the uninsured. Well over half of the uninsured, and many in this category, qualify for government health care, but refuse to sign up.

There are many reasons to reform U.S. health care, but the uninsured rate is not one of them. Don't let anyone get away with that myth any longer.

Harry and Louise have mellowed

2008-08-19T09:13:00.000-07:00

Harry and Louise are back.

Remember them? They were trotted out during the height of HillaryCare in the 1990s. People who believed that Mrs. Clinton’s purpose was to move us to government-run health care used the ads to stop her in her tracks.

Harry and Louise appear to have mellowed.

You can see it for yourself at http://www.harryandlouisereturn.com/. This is the newest ad, and it is meant to throw resolution of health care into the lap of the next president.

From where I sit, asking the politicians to solve the health care dilemma is a prescription for problems. Every time they step in to help, it gets more complicated and expensive.

The ad, however, takes no explicit sides. But since it prominently mentions access to care and affordability of health insurance, it tries to set the debate.

These are real problems, and they need real solutions. The political arena is the worst place to get this done, although it obviously cannot be ignored.

Political leaders use health care reform to gain votes. Those who are serious, like Mrs. Clinton, are the ones who will advance their government solutions based on the appearance of a groundswell of support.

The answer to what ails U.S. health care lies primarily in two areas: We must become healthier. We must become involved in paying for, and therefore knowing about, the cost of care.

Politicians are building the case to tell us how to live, what to eat, where to go, and what to do. That runs contrary to traditional U.S. culture. Maybe Americans have become passive enough to accept top down directives. What do you think?

Clearly, most top down health reform points toward mandatory coverage, forcing more people to pay more to do more and will end up costing more. For certain, politicians cannot solve the spending problem by managing spending.

Why health care costs so much

2008-08-18T13:00:00.000-07:00

Greg Dattilo and I are writing a new book. Our working title is “Why health care costs so much.”

I had a practical example on July 31.

Early that afternoon I suffered chest pains. (Since them, I have been calling them chest “aches.”) At the time, all I knew is that they did not stop. Feeling pains in the chest and the accompanying pressure is disconcerting, to say the least.

I called my doctor, planning to go to the clinic. They gave me to a triage nurse.
The triage nurse demanded I call the paramedics. She told my wife absolutely not to drive me to the ER. I felt stupid, because the pains (ache) were higher up in the chest. I had no other symptoms of a heart attack. But she insisted.

At the ER, two EKGs, blood work, and a chest X-ray indicated that whatever I had, it was not my heart. Yet, the ER doctor suggested I say overnight in the hospital and get a stress test.

I went home. Five days later, I had the stress test, but my insurance agent told me I had already spent all my deductible. I had the nuclear stress test, by the way.

The great news: My heart is 100 percent. The not so great news: I still have the achy chest, but it is far less of a problem. Tomorrow, the endoscopy. I told my doctors to look up helicobacter pylori (check it out at www.helico.com). We may be on to something here.

Why do we spend so much on health care? To date, I am guessing we’ve spent $5,000-$6,000 on this incident, although I have only seen the $1,600 charge for the paramedics. And there is more to come.

On July 31, there is no question I needed to see a doctor. Maybe even in the ER. Maybe.

My story, however, does indicate in a small way why health care costs so much.
Defensive medicine played a role. If the triage nurse had agreed with me, and I had suffered a heart attack on the way to the clinic, she fears getting sued. If the ER doctor had not offered the chance for me to be admitted, and I suffered a heart attack at home, he fears being sued (he admitted to me that the number one reason ER doctors get sued are chest pain issues).

Okay. They were all doing their job, and did it professionally. I get it. But I also realize that I spent at least $4,500 that accomplished only two things; it gave me peace of mind about my heart and it ate up my deductible.

So, of course, that means I am now considering other medical irritations that just might need treatment this year, instead of next. I admit it. I am just as human as the other 304 million Americans. The deductible has been met. What is your next question?

Oh, did I mention, I have a high deductible health plan and an HSA. And am I ever glad I have the HSA! And a good heart.

Obesity weighs down emergency costs

2008-08-10T13:13:00.000-07:00

There is near unanimous agreement that obesity drives health spending higher. We understand this regarding diabetes, heart disease, blood pressure and other diseases.

I was struck by this additional cost that certainly never before crossed my mind. It is an indicator of how interrelated are the hidden costs of health care, and why it is so hard to get the health system under control.

The paragraphs below are lifted from “How To Purchase A Power Cot,” a sales brochure from MonsterMedic, a manufactuer of equipment used by Emergency Medical Technicians on ambulances.

Consider the additional cost for workers’ compensation insurance, heavier duty equipment, lost days to injury, short and long term disability insurance, not to mention pain and suffering of the medic.

“It is widely known that patients in the U.S. on average are getting heavier. Some experts estimate that about two-thirds of American adults are overweight or obese; 3.8 million people are over 300 pounds, over 400,000 carry 400 pounds or more.

“Obesity creates more medical risk factors and consequently, more emergency calls. A heavier patient creates a hardship for the EMT as the amount of weight to lift is more, the risk of cot tipping is higher, and the loss of control of the cot is more prevalent. Of course, this affects the safe transfer of the patient.

“It also presents a risk to the EMT. More weight to lift creates more physical strain on the EMT, especially to their back, shoulders, and knees. The highest percentage of the EMT back injuries occur when they need to bend down over the patient to raise them from the ground. Another common accident is when the EMT has to react unexpectedly to a cot that has become out of control.

“It’s not difficult to connect the dots.

“As patients become bigger, the EMTs face more physical challenges when transporting them. A look at current statistics point out that ambulance cart tipping is increasing and EMT back injuries are on the rise.

“As the general population changes, we must adjust the way we serve them.”

Now that is an understatement.

"EMR, call home"

2008-06-12T07:30:00.000-07:00

Can electronic medical records (EMR) save us?

Technology has done marvelous things to better human life. It seems only normal, then, that we would turn to electronic medical records (technology) to help solve our health care spending problems.

Eventually, we might even get there. I sure hope so, but it will take a while – maybe a decade, or two.

Dr. Richard Reece has been reporting on the business of health care for more than 40 years. He informs me that today, about 10 percent of hospitals and a like number of doctors are using electronic medical records. That is a good start.

But there is a huge pushback by doctors, because it is expensive, time-consuming, and is viewed as adding very little to their ability to practice medicine. Before doctors commit thousands of dollars to convert their office and patient records to such a system, they will have to see its medical benefits, or a great deal of savings in streamlined record-keeping.

A second issue, seldom addressed, is that the emerging EMR systems speak but one language – the language of their own kind. That is, they do not speak to other EMR systems operated by other doctors and hospitals. Over time, this should be able to be resolved, but to find the common language and/or the translator that acts as a go-between will be costly, and in itself, create errors and misinformation.

Dr. Reece points out, too, that doctors in one specialty often need to know different information than doctors in another specialty. What is vitally important to the podiatrist, and about which he or she would take pains to record, is of very little interest to the pediatrician (who has his or her own specific needs for patient history).

I don’t write this as a doom-and-gloom commentary, but a realistic one. Reece said, “Someday, I suppose someone will come up with an algorithm to tie all this together,” but it may take 20 years to get there.

In the meantime, the most pressing need is to change patient behavior, in the way they take care of themselves, and how they spend their own health dollars. We cannot hope that technology will offset bad personal decisions.

Health care spending to decline?

2008-05-09T06:49:00.000-07:00

Congressional hand-wringers warn us that unless we accede to more government control over health care, spending will go through the roof. They warn that the United States cannot afford to spend 16 percent of GDP on health care, and that this will spiral to 25 percent, unless we let them mange our health care economy.

Never mind that no one really knows how much health care we can afford, nor how the market will react when we hit that magic, but unknown ratio. What we all can agree upon is that a good deal of health care dollars are spent unwisely: Maybe that is changing.

One reason Americans spend so much on health care is that we can. Our total health spending eclipses the GDP of most every other nation. We are a wealthy people; and as our net spendable income increases, so does our spending on health care, only geometrically. The more net income we have, the more we spend on our own health.

Suppose, then, that certain economic developments decreased net spendable income. What if, for instance, gasoline, along with all other petroleum-based products, doubled in price? What if the cost of food increased 25 or 50 percent? Would we have more or less disposable income?

Given the increases in the everyday cost of living, it follows that most of us will have fewer discretionary dollars for plastic surgery, elective dentistry, health spas, chiropractic services, alternative (and often pricey) medicines or even name brand pharmaceuticals. When I say “most of us” I mean, of course, those of us who have some kind of connection with the first-dollar cost of health care.

On the other hand, those who receive health care from the government, and those with rich health plans, may just keep on spending like gluttons at an all-you-can-eat buffet. What better reason do we free market people need than to convince people that now is the time to go on a health insurance diet – that less is more, and HSAs along with high deductible health plans are the best option.

To have more discretionary income means spending less on those products and services that have lower cost options; another key selling point for high deductible health plans.

Overall, though, I think we might be in for a slowdown in national health spending. Politicians will ignore this, however, and continue to force increasing management burdens on providers, while strapping the public systems with an ever-increasing number of subsidized insured residents.

What do you think?

The Minnesota 17% uninsured crisis

2008-04-29T07:23:00.000-07:00

You are reading this because the headline got your attention. You think you know that Minnesota does not have a 17% uninsured rate. In fact, you know that Minnesotans without health insurance, according to a 2007 Minnesota Department of Health, amounts to about 7.2 percent of the population.

So what’s with this 17% thing?

Minnesota law mandates that everyone who drives a car must have auto insurance. We have an auto insurance crisis in Minnesota, with somewhere near 17% driving without insurance. This far exceeds the state’s health uninsurance rate.

Car insurance is mandated by law. Health insurance is voluntary (for now). And yet, the health uninsurance rate is far below the auto uninsurance rate.

While pointing these facts out during a presentation several weeks ago, I think I found the real answer. Please, no one tell the politicians what I am about to suggest.

Employer-based insurance

A disclaimer is required. What I am about to say is written with my tongue planted firmly in my cheek, but I am saying it for a profound purpose:

What if governments allowed employers to provide auto insurance for their employees, and then gave employers the right to deduct that insurance expense? If auto insurance was a regular employer benefit, would the rate of uninsurance still be at 17%? Or would it be more like, say, 7.2%?

While I am not suggesting that auto insurance be made an employee benefit, I am saying this, and I hope, saying it clearly: One of the key reasons that our uninsurance rate in Minnesota is only at 7.2% is because employers provide health insurance.

Let me say it another way: If employers did not provide health insurance, our health insurance uninsured rate would probably be at 17%, or more, even if the state mandated it.

Let’s be clear about this idea that individual health insurance is the best way to go: It may be, but it carries with it the very real potential of driving up the uninsurance rate. With or without a legislative mandate requiring the purchase of health insurance, there is no doubt whatsoever that uninsurance rates would climb.

I share this because of my political crystal ball. Those who prefer a government-managed, single-payer system seize on the uninsurance rate to justify it. Why would any sane, market-oriented person want to give them more ammunition for their argument?

The best answer is to maintain choice. Let employers decide, as they do now, whether to provide group insurance and in what form they will or will not provide it. That is a free market.

"Unaffordable co-pays"

2008-04-24T08:30:00.000-07:00

Recently, I ate lunch with a group of Michigan health insurance agents. Earlier that morning, they had endured my talk, “Arming Agents for Health Care Reform.”

Table talk turned to the plausibility of employees choosing high deductible health plans (HDHPs) over traditional HMO or PPO (networked) health plans.

Then the talk turned to unions, and their contracted health plan designs.

“So the UAW fought the automakers over a $5.00 co-pay,” I said, “saying they feared it would grow to $20.00.” I shook my head in disbelief.

“I’ve got groups with $2.00 co-pays!” one agent said, referring to a public school teachers’ group she serviced. “Try talking to them about HDHPs, HSAs and anything that costs them out of pocket.” Actually, I would like to, but that’s another story.

Going to a Tigers’ game

The teacher and her electrician husband drive two hours to Detroit for a Tigers’ ball game. They hand the parking attendant $15, and walk to the park, handing the ticket-taker a pair of $35 seats.

They have a great time. The Tigers even win.

He drinks three beers at $7.00 each; she sticks with diet Cokes at $5.50 each. They eat three hot dogs each, at $5.00, and share an order of nachos with cheese - $7.00.
After the game, they walk down the street, and pop into a restaurant for a leisurely dinner, spending $49.50, plus a tip.

On the way home, the wife begins feeling faint, turns pale, and throws up (thankfully, she had saved the plastic souvenir Coke cup). Her stomach starts cramping up, and she feels rotten. Since it came on fast, they pull off at the first sign saying “hospital” and head to an emergency room.

“Okay,” the admission’s clerk says to the husband, while his wife lay in an ER bed, “all I need is your $50 co-pay, and we’re set.”

“I thought it was $25,” he protests.

“It is, but only in a hospital in your insurance plans’ network,” she explains.

“Hey, this is about my wife’s health!” he exclaims. “I don’t get it. Why should we have to pay anything?” He launches into a rant about greedy insurance companies and selfish employers as he reaches for his credit card.

“This is just unfair, and who can afford it anyway?”

Indeed.

Health care and police forces

2008-04-19T08:28:00.000-07:00

Recently, a socialist argued that great countries have learned they must assign certain duties to governments, and among these is the responsibility to administer and pay for health care. The socialist argued that after all, governments already use national schemes to provide many basic services, and named armies and police forces as examples: Why not also administer health care?

He could have mentioned that governments also build and manage the interstate highway system, waterways, forests, water purification, and any number of other such entities. (Of course, there is that inconvenient fact of a bridge falling down last August 1 in Minneapolis.) Whether it is best for us to have assigned these duties to governments is an argument for another time. I prefer to unpack the idea of police forces for our socialist friends to ponder.

Policing, at the beginning of our nation, was not a government duty; it was a private duty. That notion fell victim to dense population centers and a sense of desire for more security. Few but the most extreme libertarians would argue against government-provided police forces, sheriffs, U.S. marshals, the FBI, and such.
Our socialist friend asserted that police forces provide a level of proof that a national, single payer health system makes plenty of sense. Since governments run this essential service that serves a common good, all services that serve a common good could or might be nationalized (or governmentized).

What do police officers do, where do they do it, and who pays their bills? Moreover, do they do it alone?

Where’s that peacekeeper while someone is burgling your home?

Police offers have sometimes been labeled peace officers; nothing could be further from the truth. While the presence of a police officer, or a squad car, might have the effect of reducing crime while there is a police presence, there are far too few police officers to actually keep the peace.

The primary duty of police officers is to come along after a crime has been committed, to search out and find the criminals, and remove them from the population. Seldom can one call a police officer before a crime is committed in order to get that officer’s protection from the crime. There are two plain reasons for this: First, one has no sure knowledge that a crime will be committed, and therefore, cannot call for a police officer in advance. And two, there are not nearly enough police officers to assign each one a peacekeeping role.

Police officers are to public order what emergency rooms and specialist physicians are to health care. They are on call and ready to help, as long as not too many crimes are committed at the same time in nearby jurisdictions. When there is an outbreak of crime, its victims must wait for hours before the squad car shows, and by then, the criminal has long since left the scene and the victim’s bloody wounds have become the concern of a local medical emergency room.

Of greater importance is the simple fact that government police forces only provide a small fraction of the peacekeeping required to maintain social order. The primary role of peacekeeper is borne by hundreds of thousands of private security workers. They guard buildings, act as bodyguards, ferry millions of dollars in armored cars, secure routes for superstars and politicians, patrol shopping malls, and keep an eye on communities. These peacekeeping guards are more like our system of private physicians that provide health care services to almost all Americans. They are outside the government system, except for the likely requirement for a license, and by such, a certain form of proof of competence.

Government-paid police forces are augmented by a vast army of private sector “police officers” who serve as the nation’s peacekeepers. To suggest that police forces are an example of a common good being met in any comprehensive fashion by governments is facetious and shortsighted; and it is untrue.

(The same argument could be extended to our justice system, relying as it does on hundreds of thousands of private legal practitioners (lawyers) to carry the primary burden of ensuring justice for their clients. Americans agreed that the government should provide a justice system, but lays very little of its duties on government agencies; rather, relying on a contract system most often the result of negotiations between armies of lawyers in private practice.)

There is one other significant characteristic of police forces to consider: They are almost all locally controlled, by small town boards, city councils, county boards, or state legislators. They are not national “single policing” organizations. Policing is a local issue.

Neither is the administration of health care a national issue; it is a local issue, and serves the needs of communities and populations that hardly resemble each other in lifestyles, ethnicities, racial compensation, traditions, wealth (or lack of it), and in untold other nuanced differences. People are different in different places, and it would be a sorry place to live that tried to force them to all live and look alike.

Thanks to the U.S.

The United States, much to the chagrin of liberals and socialists, has the world’s most powerful military force. One might argue that it is too large and too strong given the relative lack of attacks on the United States, but such an argument is extremely shortsighted and naïve. The fact that we have sustained so few attacks is testimony to our military strength; but I add this for a more important reason.

Were it not for the strength of the U.S. military, most foreign nations would be forced to spend billions more on defense, and on building their own military forces. If the United States pulled out of Iraq, Afghanistan, Germany, Japan, and all other foreign military bases, does the liberal and socialist assume that those nations would be comfortable with the void such a withdrawal would create? Such naïve thoughts seem even beyond their pale.

Suppose, however, that the U.S. drew down its military force to the handful that liberals and socialists seem to desire, thereby saving our country $300-400 billion or more each year (and spend it on health care and education). If such a thing were to happen, would Canada and Mexico feel as secure as they do today, or would they be forced to spend tens of billions to build their own military forces for the sake of security? I think the former is most likely, and if Canada built a national military force powerful enough to provide such protection, the money would have to come from its citizens, and would further strap their health system with shortages heretofore unthinkable. It is arguable, in fact, that the strength of the United States’ military helps Canada in its attempts to provide a government-run health system.

If the United States was not the home to 80 percent of the world’s pharmaceutical research, medical device research, and medical entrepreneurism, the health care systems of most foreign nations would be hard strapped to create medical innovations, much less provide necessary daily health services through their government-run plans.

For the United States is the world’s medicine cabinet, and its police force.

Can you believe a fat preacher?

2007-10-27T07:44:00.000-07:00

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?

Sick people are the problem, apparently

2007-08-16T11:56:00.000-07:00

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.

Single Payer and Nurse Shortages

2007-08-09T11:38:00.000-07:00

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.

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

2007-08-06T12:43:00.000-07:00

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:

Reduce overall health care spending? And if so, is that in real dollars, or a percentage of GDP, or both?
Or is this about reducing per capita health care spending in wealthy states, while increasing it in less wealthy states? Or cities? Or neighborhoods?
Increase access to all health care services for everyone? Or about reducing services for some, so that others can have what they now lack?
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.

Mississippi River Bridge Collapse

2007-08-02T09:40:00.001-07:00

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.

Politicized health care, the real illness

2007-07-31T07:33:00.000-07:00

“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.

Americans spend billions on health care

2007-07-30T06:19:00.001-07:00

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!

What is SCHIP's goal?

2007-07-28T11:24:00.001-07:00

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.

They say this is killing us?

2007-07-26T09:16:00.000-07:00

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?