Coyote Blog

Government health care initiatives are not about cheaper or better care.  They are about control, and increased power for government officials.

First, via Carpe Diem:

The state is trying to shut down a New York City doctor's ambitious plan to treat uninsured patients for around $1,000 a year. Dr. John Muney (pictured above) offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs. His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.

"I'm trying to help uninsured people here," he said.But his plan landed him in the crosshairs of the state Insurance Department, which ordered him to drop his fixed-rate plan - which it claims is equivalent to an insurance policy. Muney insists it is not insurance because it doesn't cover anything that he can't do in his offices, like complicated surgery. He points out his offices do not operate 24/7 so they can't function like emergency rooms. The state believes his plan runs afoul of the law because it promises to cover unplanned procedures - like treating a sudden ear infection - under a fixed rate. That's something only a licensed insurance company can do.

"I'm not doing an insurance business," he said. "I'm just providing my services at my place during certain hours." "If they leave me alone, I can serve thousands of patients," he said.

Expect similar efforts by Wal-Mart and CVS to run afoul of the government soon, under some pretext.   Massachusetts debated for over a year before allowing just two licenses for this type of clinic.   I have already observed lefty bloggers turning their nose up at this trend, and sense they are scrounging around for some kind of meme or message to consolidate around to oppose this kind of care.  Because having people find private solutions to their problems is the last thing they want to see.  (Seriously - is this the goofiest indictment of the US medical system you have ever seen? How deep are we reaching here?)
Anyway, should you think I am exaggerating, I will leave you with this story I saw on Radley Balko's site:

The five plaintiffs, who now include former House Majority leader Dick Armey, are challenging a policy of the Department of Health and Human Services (DHHS) that denies Social Security benefits to anybody who refuses to enroll in Medicare.

Read that again: As the policy now stands, if you want to pay for your own health care rather than let taxpayers finance it through Medicare, government will not let you receive the Social Security benefits for which you have spent a lifetime paying taxes.
Note that nobody is trying to avoid contributing to Medicare. The plaintiffs merely want to decline the tax-funded benefits for which they already have paid. None of them want the bureaucracy, the governmental intrusions into their privacy, and the rationing of care they believe Medicare entails - so they volunteer to let taxpayers off the hook by providing their own health care coverage.

But DHHS won't let them. Or at least not if they want to receive Social Security benefits. Forfeit Medicare, says DHHS, and you must also forfeit Social Security even if you've paid for it for half a century.

OK, maybe not all, but there is really one critical issue at the heart of almost all the issues in health care.  It drives whatever cost problems might exist in the system, drives many of the quality problems, and is a source of much of the current dissatisfaction (at least from the middle class) with the current health care system.

For every proposal, you should make sure you understand 1) Who is choosing the amount and quality of the care and 2) who is paying the bills and is therefore trying to pay attention to the cost of care.

What the hell does that have to do with anything, Coyote?  What are you getting at?  Well, perhaps I can begin my explanation by talking about something, practically anything, other than health care.

Take purchasing a car.  When I need a new car, who determines what car I end up with?   Why, I do.  And who pays for the car and shops around for a price that makes sense in the context of the perceived value of the car?  Why, I do again.  The person who uses the car, the person who chooses the type and quality of the car, and the person who pays for the car are all the same person.

This clever procurement model of integrating the payer, the shopper, and the user all into a single individual is one we use for, well, just about every product and service we buy.  Milk, Internet service, DVD's, house painting, airline tickets -- all the same model.

OK, lets consider a model that does not work this way.  Let's say someone just rear-ended your car and, miracle of miracles, they actually have a good, solid insurance policy that owes you for your car repairs.  In this case, you will be consuming the repair services, and have the incentive to find the absolute best, cost-no-object body shop you can find to do the best, most fabulous job fixing your car, because someone else (ie the insurance company) is paying.  The insurance company has a different incentive.  They want to get off with as small a loss as possible, to protect their profitability as well as keeping prices low for future policy-holders.  They are going to want you car fixed cheap, particularly since you are probably not even their customer.  They are going to try to deliver the minimum.

No surprisingly, people tend to get ticked off in these situations, as they grind against the opposing incentives of the insurance company.  It's one reason that the insurance field is highly regulated (because nowadays people complain to their Congressman whenever they get irritated).  It's also a measure of how ineffective regulation is in really managing this friction, since despite zillions of government rules people still get pissed off.  The reason is that there is simply no good solution.   Both parties want a solution at the extreme end of a cost-value scale, neither have much of an incentive to compromise, and neither will be happy with a solution in the middle of these extreme incentives, and no amount of government fiddling with the tradeoff point is going to change this.

OK, but in this example, at the end of the day, it is just a car, and probably this is a once-in-a-lifetime event.  What if we replace "car" with "baby daughter" or "grandmother" or "your life?"  Now, as Bill Murray says, the kidding around is pretty much over.  It is a recipe for an incendiary disaster.  Which is exactly what we have in health care.

If we take these three roles - user, service quality specifyer, and payer/price shopper - there are very few places in medicine today where these three roles are united.  Further, despite the fact that the vast majority of the problems in US health care are demonstrably from this role separation, none of the plans currently being considered by Obama or Congress unify these three parties.

With my high deductible medical policy, I am actually one of the few middle/upper class folks who actually shops for health care.  And I can tell I am in the minority by the reaction I get from doctors and medical services companies, that look at me like I am from Mars when I ask for detailed pricing, or when I order less than the full and complete battery of potential tests and services based on my own judgment and price/value trade offs.  Folks in the medical profession are used to people saying "whatever, the insurance company is paying for it."

We all know the straights that the auto industry is in, but can you imagine how bad their price and product would be if everyone had some sort of policy that purchased just about any car they wanted for them whenever they wanted it?  What do you think would happen to the prices at your grocery store or at BestBuy if the proprietors of those stores knew, absolutely knew, that you were not even going to look at a price tag before you bought what you wanted?  So why do we expect anything but inflated pricing in the health care field?

Devon Harrick via Carpe Diem writes

The market for medical care does not work like other markets. Providers typically do not disclose prices prior to treatment because they do not compete for patients based on price. Payments are usually not made by patients themselves but by third parties "” employers, insurance companies or government (only 12% of medical costs are paid directly by patients, see chart [below]). And the amounts paid are not really market-clearing prices; they are "reimbursement" rates negotiated with bureaucratic institutions and networks. Furthermore, when providers do not compete on price, they usually do not compete on quality either. In fact, in a very real sense, doctors and hospitals are not competing for patients at all "” at least not in the way normal businesses compete in markets.

The author above has an interesting analysis.  The one exception to the separation of roles in medicine is cosmetic surgery.  Not covered except in special circumstances by most insurance, cosmetic surgery is something the individual must pay for and thus has a tendency to shop for.  The results in prices are clear.

This pricing differential is all the more compelling because itis probably opposite what most people would initially assume.  As cosmetic surgery tends to be a luxury good, one might expect it to have the higher-than-average inflation rate that many luxury goods have had over the past 10 years.

The flip side of the pricing situation is the incredible dissatisfaction that seems to permeate health care customers.  Because the users aren't paying the bills, health care providers have little incentive to provide good service, as even with bad service the value they provide will be able to exceed the user's price of zero, or close to zero.

But, like with the body shop in the collision, someone is indeed paying the bills.  And that someone faces a choice -- either let customers run amuck and buy absolutely as much health care as they want, or try to ration or restrain the care users receive in some way.  So, when Joe and Mary want the 9th sonogram performed just to make sure their fetus is still doing great, the insurance balks at the cost as unnecessary.  The insurance company is upset, because they feel like Joe, Mary, and their doctor are milking the insurance for unnecessary procedures.  Joe and Mary get upset, because they feel like the heartless insurance company doesn't care about their little darling baby.  Everyone calls their Congressman to tell him or her that they are unhappy and could the government please intervene to make them happier.

And so we get to current health care proposals.  Folks have, rightly, come to the conclusion that a system where the user benefits from the service and decides how much and of what quality should be consumed, while someone else pays, is not sustainable.  However, in response, no one in power is suggesting we end the split.  Instead, they are suggesting that the role of service determination and payment/price-shopping be performed by the government.  We as a consumer will just have to trust that the government will make this price-value tradeoff somehow close to how we would make it for ourselves.

But of course, this is absolutely freaking impossible.  First and foremost is the problem that the government can only choose one policy for everyone embodying a single point on the trade off curve.  But we have 300 million people with 300 million different preference functions.  No one is going to be happy.  Second, the government is a terrible shopper.  We all know this to be true.  So why do we think they are going to suddenly become wizards when it comes to health care?  Third, the government is a terrible administrator.  As a monopoly provider, they simply don't have the inventive to be either responsive of cost-effective.  Again, we all know this to be true, so why are we so willing to hope that things will suddenly change for health care?

The only thing that makes any sense at all to me is to try to give the user of health care some financial incentive to participate in the price value tradeoff and shopping process.  I know that I have simultaneously saved a ton of money as well as substantially increased my health care shopping IQ since our family adopted a high-deductible health insurance policy.  Incredibly, however, this is one solution that absolutely is off the table -- for example, the first step Massachusetts took in their single payer system was making it illegal for consumers to buy the kind of high-deductible insurance I have.  Illegal!

I have argued for a while that one of the undiscussed problems with nationalized or universal health care is that by socializing the costs of individual lifestyle decisions (e.g. eating, drinking, smoking, wearing a bike helmet, etc) it creates a strong financial incentive for the government to micro-manage individual behavior.  I call this the health care trojan horse for fascism (other posts here).

Q&O has a good post, quoting from Paul Hsieh, on this very topic.

Here's how I understood freedom and liberty worked:

Of course healthy diet and exercise are good. But these are issues of personal "“ not government "“ responsibility. So long as they don't harm others, adults should have the right to eat and drink what they wish "“ and the corresponding responsibility to enjoy (or suffer) the consequences of their choices. Anyone who makes poor lifestyle choices should pay the price himself or rely on voluntary charity, not demand that the government pay for his choices.

Does anyone have a particular argument with that?

In fact, if you believe in freedom and liberty, there really isn't another choice, is there?

But here's what's being offered as the alternative:

Government attempts to regulate individual lifestyles are based on the claim that they must limit medical costs that would otherwise be a burden on "society." But this issue can arise only in "universal healthcare" systems where taxpayers must pay for everyone's medical expenses.

The article has a lot of good examples that follow.  Mr. Hsieh's op-ed is here.

As a side note, I was watching the movie "The Golden Compass"  the other day.  The author and the original book are quite critical of religion, at least of the organized kind, and the evil fascist entity against which the protagonists fight is a world-controlling church.  The movie actually purged most of the religion criticism (or at least made it more subtle) and made the bad buys more generically totalitarian, but hangover criticism of the book stuck to the movie as well.

It was not really a particularly good (or bad) movie, but it had one set of lines spoken by the Nicole Kidman character that I couldn't believe came out of Hollywood.  The protagonist, Lyra, asks Kidman about the contradiction between Kidman's unwillingness to let anyone tell her what to do and the rule-making and absolute obedience that her organization demands of all citizens.    I need to go back and watch the movie to get it exactly right (of course, no one on the movie sites found it memorable enough to post).  But it was something like "Only a few of us are capable of making good decisions for ourselves.  We few have to make decisions for everyone else.  It is really for their own good."  It was really a brilliant summary of the modern political mentality, and slipped through I think only because people in Hollywood took it as a criticism of the religious right, not recognizing it as an equally damning indictment of the left.  (if anyone has the exact quote or a link, please post.  It was on the dirigeable fairly early in the movie, I think).

Update: OK, the Golden Compass lines I wanted start about the 3:00 minute mark in this video [thanks to commenter for showing how to link to a specific point in a YouTube video].  Here is how I transcribed it:

Kidman (Mrs. Coulter):  The Magesterium [the world-girdling totalitarian organization] is what people need, to keep things working, by telling people what to do.

Lyra:  But you told the master that you do whatever you please

Kidman:  That's right, clever girl.  Well, some people know what's best for them, and some people don't.  Besides, they don't tell people what to do in a mean and petty way, they tell them in a kindly way, to keep them out of danger.

Its really hilarious to read through reviews, as I have trying to find this quote.  Apparently (though I missed it at the time) it became a left-right debate about the movie.  The hilarious part is all the left-leaning blogs criticising the right for not seeing how well the shoe fits, without for a second considering that this is a perfect recitation of their end game as well.

Again, about 3:00 into the below:

Yuck.

Kevin Drum is glad the Democrats are ready to body-slam the health insurance companies, and is rooting them on:

It means the health insurance industry is scared that we might actually do something in 2009 and they want to be seen as something other than completely obstructionist. That means only one thing: they've shown fear, and now it's time to bore in for the kill and gut them like trouts. Let's get to it.

Because everyone knows that most of the costs of healthcare reform can be paid for by ripping the excess profits out of the health insurance business like a liver from a fish.  Just to remind everyone, these are net profit margins reported by Google Finance for 3Q2008 of the largest health care providers and insurers:

Cigna: 3.50%
United Health Group: 4.56%
Aetna: 3.64%
WellCare:  4.08%
Amerigroup: 3.51%
Humana 2.56%
WellPoint: 5.49%

I am having a blast at the Change.gov transition site for Obama, now that I have satisfied myself it is not a fake.  Those who doubt that Obama has super-human powers should read this, from the Obama site:

The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors and plans to implement the plan. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year.

If you don't have health insurance, you will have a choice of new, affordable health insurance options.

Wow - so now you can go out purchase any care you want - any tests, any procedures, whatever - and no one is going to tell you no.  Everything is paid for.  You have a blank check to go spend.  And, by granting you an infinite supply of care, your cost is going to go down.  Obama is really superman, because no one else in history has figured out how to invert the supply curve or make 2x cost less than x.

You see, it's all about insurers' margins.  If we can just cut down on those fat margins, everyone can have full health care and a pony for less money.  You doctors who are worried about health care, you will have it better too:

Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.

All these years you thought malpractice insurance costs were high because of huge malpractice court settlements that usually bore little relationship to true malpractice, well, you were wrong.  Its because of the insurers and their margins.  We don't have to reform malpractice tort law (which is just as well since tort lawyers were so generous with donations to our campaign), we just have to get insurers to stop overcharging doctors.

To give you an idea of the absolutely huge amount of savings that can be extracted by just pounding on the insurers to give more coverage for less money, let's take a look at those outsized margins they are making.  These are net profit margins reported by Google Finance for 3Q2008 of the largest health care providers and insurers:

Cigna: 3.50%
United Health Group: 4.56%
Aetna: 3.64%
WellCare:  4.08%
Amerigroup: 3.51%
Humana 2.56%
WellPoint: 5.49%

Freaking robber barons!  Look at those outsized margins.  No wonder we have a health care crisis.  By cutting these guys margins in half, Obama expects to reduce the price of health care by 1-2%, which should be more than enough to pay for large increases in services and 30-50% price cuts.

Update: Oh, its magic.  That explains it.

Update #2: OK, the page has come down, as have most all the pages that had any kind of policy detail or promises in them.  I wish I had screen shots, but I can say everything above was cut and pasted directly form the web site.  Could I make that stuff up?  Too bad, there probably were another 10 blog posts in there somewhere.

I have written on a number of occasions that I thought it odd that the left (and women's groups in particular) don't see a contradiction between their support for government health care and their long-held abortion beliefs that people should be free of government coercion when it comes to decisions about their body and their health.  These views certainly don't seem compatible in England:

A cancer charity has today published research that shows doctors are keeping
  cancer patients in the dark about new treatments that could extend their lives.

Myeloma UK, which conducted the research, said a quarter of myeloma
  specialists questioned in a survey admitted hiding the facts about
  treatments that may be difficult to obtain on the NHS.

The main reason given was to avoid distressing or confusing patients.

Myeloma is a bone marrow cancer that affects around 3,800 people each year in
  the UK. Of these, 2,600 are likely to die from the disease.

I thought this was pretty apt:

The Left's approach to health-care cost containment is to give more
health coverage to more people with more ailments, all the while making
everyone pay less.

This kind of thinking should be familiar to the Arizona legislature, since they went into special session to close a $2 billion budget shortfall and ended up actually increasing spending!

If I had to name the one single biggest problem in US healthcare, it would be this:

"Twenty years ago, when I was in training, nobody really dealt with
economics," says Stephen Hufford, an oncologist in San Francisco. The
prevailing thinking, he says, was: "Cost should never be an issue in
someone's care."

In a survey of 167 cancer doctors reported last year in the Journal of
Clinical Oncology, 42% said they regularly raised the issue of costs
when discussing treatment options with patients.

Which means that even today, 58% of oncologists did not raise cost or price issues with various treatment options, despite practicing in perhaps the most costly of medical fields.  What planet are we living on, here?  Can you imagine a survey in which 58% of car dealers refused to raise the issue of cost in a new car sale?   Or 58% of real estate brokers saying they never mentioned the prices of houses when discussing them with clients? 

This represents a process failure in the health care system on two levels.  First, not having any single person in the decision-making process making cost-benefit trade-offs is a recipe for disaster.   Insured customers will consume as much as they can when price is off the table.  Many folks in the health care debate recognize this.

But there is a second problem.  Even when there is a single entity making these trade-offs, it is almost never the patient.  Most "reformers" on both the left and the right want to place this decision-making authority in government bureaucrats, in insurance companies, in Congress, in doctors -- any place but in the individual patient herself.   This particular article discusses the role of doctors in this process:

Many health-policy experts say it's high time for American doctors to
start considering costs when assessing treatment options. In 2007, the
cost of cancer care alone reached an estimated $89 billion in the U.S.,
up from $72 billion in 2004, according to the American Cancer Society
using data from the National Institutes of Health....

The study, conducted
by Deborah Schrag, an oncologist at the Dana Farber Cancer Institute in
Boston, found that 23% of oncologists said costs influence their
treatment decisions, and 16% said they omit discussion of very
expensive treatments when they know the cost will place great strain on
patients' resources.

This misses the mark.  Doctors should be ready to inform patients of their options, but at the end of the day we need a system where the patient is making these tradeoffs.  Note the absolute, nearly criminal arrogance of doctors who don't suggest the best treatment regime because the cost might stress out the patients.  How does the doctor know what financial resources the person might be able to bring to bear?

Postscript:  In an adjoining article, the WSJ has an article on the wacky way the French government makes these cost-benefit trade offs in health care:

Since 1860, when Napoleon III appropriated this
ancient Roman spa at the foot of the Alps for his empire, the National
Baths of Aix-les-Bains have been a symbol of France's cushy health-care
system.

On a recent morning, Jacqueline Surmont and her
husband, Guy, a 77-year-old retired construction worker, headed for
their daily mud wrap. The spa's rheumatism cures, thermal baths and
13-minute deep-tissue massage all are covered by France's national
health-insurance system. Transportation and lodging are, too....

"For many people, it's like a free holiday," says Ms. Surmont, who says
all her mud wraps and massages were properly prescribed by a doctor to
soothe her ailing back. "Some patients go shopping in the afternoon.
They're hardly in pain."

Wonderful.  This kind of BS is virtually inevitable in state-run systems.  I think one can already imagine a US health care system where taxpayers foot the fill for groovy treatments loved by the dippy left, from acupuncture to aromatherapy to homeopathy, while cancer patients are denied drugs and people have to wait months or years for elective surgery.

By the way, we get this in the "goes without saying" file from a state-run spa employee facing cutbacks:

"Of course we went on strike," said Martine Claret, a 52-year-old
physiotherapist who has worked at the spa since 1979 and doubles as a
union representative.

Via Michael Tanner:

• Slightly less than half of Massachusetts' uninsured population
  actually complied with the mandate. True, the number of people without
  health insurance was reduced from 13% of the state's population to 7%,
  but when the bill was passed, advocates promised that "all Massachusetts citizens will have health insurance."  Perhaps it depends on your definition of "all."
• Most of those who are signing up are low-income individuals, whose
  coverage is fully or partially subsidized, proving once again that if
  you give something away for free people will take it. It certainly
  appears that it is the expensive and generous Massachusetts subsidies
  (up to 300% of the poverty level), not the unprecedented individual
  mandate that is responsible for much of the increased coverage.
• Adverse selection remains a big problem, with the young and healthy
  failing to comply with the mandate. The state refused to change its
  community rating laws which drive up the cost of insurance for young,
  healthy individuals. Not surprisingly, they don't find this a good deal.
• The program is far exceeding its projected costs, with at least a 33% budget overrun in its first year.
• The program has increased demand for health care services without
  increasing the supply of providers. As a result, patients are having
  trouble finding providers and waiting lists (Canada here we come) are
  beginning to develop.

The stories keep coming about using health concerns as the thin edge of the fascism wedge.  This time via Hit and Run:

Sheridan Communications and Technology Middle School
eighth-grader Michael Sheridan was suspended from school for three
days, barred from attending an honors student dinner and stripped of
his title of class vice president.

     His offense?

     He bought a bag of Skittles.

The punishment was meted out because the New Haven school
system banned candy sales and fundraisers in 2003 as part of the
districtwide school wellness policy.

In fact, this school has outlawed an financial transactions whatsoever between students:

Turner had repeatedly warned students that she would
not allow any candy to be sold in schools, nor did she want money
changing hands in school, said Sullivan-DeCarlo.

This one comes via a reader, and is from Belgium:

Two sets
of parents in Belgium were recently handed five month prison terms for failing
to vaccinate their children against polio. Each parent was also fined 4,100
euros ($8,000)....

"Nobody
has the right to unfettered liberty, and people do not have a right to endanger
their kids," said John Harris, a professor of bioethics at the
University
of Manchester.

"The
parents in this case do not have any rights they can appeal to. They have
obligations they are not fulfilling."

Next in my series about the health care Trojan Horse for fascism, comes this story via Q&O in Canada  (McQ gives as good a definition of any of the Trojan Horse: "once government has control over your health care, it will use all
sorts of justifications and excuses to exert more and more control over
your life as a result.")

For 60 years or more, libertarians and conservatives have been arguing
that government programs intended to promote the public welfare
inevitably end by restricting freedom more and more: as the state does
more for you, it finds itself doing ever more to you. Who
would dare challenge that premise now, in the face of Judge James
Blacklock's decision? The man made no secret of the chief pretext for
his ruling. Motorcycle riders who don't wear helmets are more costly to the medicare system; therefore, in the name of reducing those costs, the government is free to require the wearing of helmets,
even if that conflicts with a fundamental Charter right and interferes
with the most personal and intimate sort of decision-making conceivable.

I have chided women's groups for the inconsistency of supporting choice and freedom from government coercion when it comes to decisions about their bodies, but at the same time lobbying for universal government health care.  If after my previous posts you still fail to see the inherent contradiction, try this story:

A Winnipeg case currently winding its way to its grim conclusion pits
the children of Samuel Golubchuk against doctors at the Salvation Army
Grace General Hospital. According to the pleadings, Golubchuk's doctors
informed his children that their 84-year-old father is "in the process
of dying" and that they intended to hasten the process by removing his
ventilation, and if that proved insufficient to kill him quickly, to
also remove his feeding tube. In the event that the patient showed
discomfort during these procedures, the chief of the hospital's ICU
unit stated in his affidavit that he would administer morphine.

Golubchuk
is an Orthodox Jew, as are his children. The latter have adamantly
opposed his removal from the ventilator and feeding tube, on the
grounds that Jewish law expressly forbids any action designed to
shorten life, and that if their father could express his wishes, he
would oppose the doctors acting to deliberately terminate his life.

In
response, the director of the ICU informed Golubchuk's children that
neither their father's wishes nor their own are relevant, and he would
do whatever he decided was appropriate. Bill Olson, counsel for the ICU
director, told the Canadian Broadcasting Company that physicians have
the sole right to make decisions about treatment "” even if it goes
against a patient's religious beliefs "” and that "there is no right to
a continuation of treatment."...

The claim of absolute physician discretion to withdraw life-support
advanced by the Canadian doctors would spell the end of any patient
autonomy over end-of-life decisions. So-called living wills, which are
recognized in many American states, and which allow a person to specify
in advance who should make such decisions in the event of their
incapacity, would be rendered nugatory.

I find the discussion of the "duty to die" to save the state money especially chilling.  This story is also in the save vein.

The looming federal government takeover of health care as proposed by most of the major presidential candidates will be far worse than anything we have seen yet from government programs.  Take this example:  In the 1960's, the federal government embarked on massive housing projects for the poor.  In the end, most of these projects became squalid failures.

With the government housing fiasco, only the poor had to live in these awful facilities.  The rest of us had to pay for them, but could continue to live in our own private homes.

Government health care will be different.  Under most of the plans being proposed, we all are going to be forced to participate.  Using the previous analogy, we all are going to have to give up our current homes and go live in government housing, or least the health care equivalent of these projects.

Think I am exaggerating?

One such case was Debbie Hirst's. Her breast cancer had metastasized, and the health service would not provide her with Avastin,
a drug that is widely used in the United States and Europe to keep such
cancers at bay. So, with her oncologist's support, she decided last
year to try to pay the $120,000 cost herself, while continuing with the
rest of her publicly financed treatment.

By December, she had
raised $20,000 and was preparing to sell her house to raise more. But
then the government, which had tacitly allowed such arrangements
before, put its foot down. Mrs. Hirst heard the news from her doctor.
"He looked at me and said: "˜I'm so sorry, Debbie. I've had my wrists
slapped from the people upstairs, and I can no longer offer you that
service,' " Mrs. Hirst said in an interview...

Officials said that allowing Mrs. Hirst and others like her to pay
for extra drugs to supplement government care would violate the
philosophy of the health service by giving richer patients an unfair
advantage over poorer ones.

Patients "cannot, in one episode
of treatment, be treated on the N.H.S. and then allowed, as part of the
same episode and the same treatment, to pay money for more drugs," the
health secretary, Alan Johnson, told Parliament.

Here is the poll question I would still love to see asked:

Would you support a system of
government-run universal health care that guaranteed health care
access for all Americans, but would result in you personally getting
inferior care than you get today in terms of longer wait times, more
limited doctor choices, and with a higher probabilities of the
government denying you certain procedures or medicines you have
access to today.

I was going back through my archives and I found a health care poll question I suggested about a year ago that I would still love to see asked.  I believe it accurately reflects the reality that most middle class Americans face with various universal health care plans:

Would you support a system of
government-run universal health care that guaranteed health care
access for all Americans, but would result in you personally getting
inferior care than you get today in terms of longer wait times, more
limited doctor choices, and with a higher probabilities of the
government denying you certain procedures or medicines you have
access to today.

I have said a number of times that health care is not like failed Great Society housing programs.  In those housing programs, only the poor got crappy government housing -- the rest of us kept what we had.  Universal health care is different, because it will effectively be like forcing everyone to move into the housing projects.

I saw these two posts one after the other on Q&O.  One is about Chavez's food regulations in Venezuela, the other is about a government health care plan in California.  One is about government takeover of a critical industry, price controls, supply rationing, and demonizing large private corporations, and the other is about the same thing, but in Venezuela.  Since Chavez is further along with his program, we might see how things are working out for him:

Venezuela's top food company has accused troops of illegally seizing
more than 500 tonnes of food from its trucks as part of President Hugo
Chavez's campaign to stem shortages.

The leftist Chavez this
week created a state food distributor and loosened some price controls,
seeking to end months of shortages for staples like milk and eggs that
have caused long lines and upset his supporters in the OPEC nation.

The
highly publicised campaign has also included government crackdowns on
accused smuggling, with the military seizing 1,600 tonnes of food and
sending 1,200 troops to the border with Colombia....

He also threatened to expropriate companies selling food above regulated prices.

"Anyone
who is distributing food ... and is speculating, we must intervene and
we must expropriate (the business) and put it in the hands of the state
and the communities," Chavez said during the inauguration of a new
state-run market in Caracas.

Yep, sounds about the same.  Fortunately, people in the West can still travel across borders to get health care when government rationed and price-controlled services are not available, as many Canadians and British do. So in the US, when we implement all these same steps, we'll be able to travel to..., travel to...  Where will we be able to go?

Well, I can't blame this bit of command and control on Mitt Romney, but it is still a great example of politicians doing exactly the opposite of what is needed to making US health care even more convenient and affordable.

In-store health care services offer cheap primary care, ease the
burden on emergency rooms, and help people who can't afford health
insurance"“or who have insurance but can't find a decent primary care
physician. They also boast stratospheric customer satisfaction ratings. 

So why is idiot Boston Mayor Thoma Menino against them?  Because they're driven by profit!

The decision by the state Public Health Council,
"jeopardizes patient safety," Menino said in a written statement.
"Limited service medical clinics run by merchants in for-profit
corporations will seriously compromise quality of care and hygiene.
Allowing retailers to make money off of sick people is wrong."

This is as opposed to doctors in hospitals, who everyone one knows don't make any money off of sick people.  Seriously, who in their right mind could possibly oppose a free market solution to cleaning out these non-life-threatening type cases from hospital emergency rooms?

I just don't understand the enthusiastic support for Mitt Romney and his description as an heir to the Reagan legacy.  In particular, he claims to single-handedly have implemented HillaryCare in Massachusetts, the program that was arguably responsible for sweeping the Republicans into Congress in 1994.  My sense is that Hillary in the intervening years has moved on to an even more socialist plan, but everything I see in the Romney plan looks very much like Hillary's original proposal. 

The plan is command and control at every turn -- for example, I am a huge believer in high deductible health insurance.  My family has saved a ton with it, and it shifts health insurance to be more like, you know, insurance -- meaning it covers catstrophic, bankrupting problems but not day to day expenses.  Well, this sort of very reasonable plan, which has the added benefit of bringing some price competition to medicine because people like me now care about prices, was made illegal in Massachusetts by Romney and Company.  Romney strikes me as just another 1970's-style big government Nixonian Republican, like nearly every other Republican in the race this time around.

Previous posts on Romney's plan here and here and here.

Kevin Drum observes that yet another study has put to rest the theory that Thimerosal, a preservative that used to be put in some childhood vaccines, causes autism:

However, despite the equivocal (at best) scientific evidence linking
thimerosal to autism, conspiracy theories abounded and the issue deeply
split the autism community. Firm evidence in one direction or the
other, though, had to wait until now. Thimerosal was ordered removed
from most childhood vaccines in 1999, and by the early 2000s children
had stopped receiving virtually all thimerosal-based vaccines. If
autism rates then decreased, it would be good evidence that thimerosal
really had been to blame.

But that didn't happen. Interim studies have shown no decrease in
autism rates, and a study released today puts the nail in the coffin of
the thimerosal story. It tracks children born in California and
includes enough years of data to show pretty definitively that autism
diagnoses continued to rise even after thimerosal was removed

I thought it was time to move on from this theory years ago, but Drum says that it continues to be carried forward by parents desperate to find an explanation for their child's autism.  I guess I am a bit more cynical, for I would argue that this bad science of Thimerosal has been carried forward, just like the bad science of breast implant caused immune deficiencies, by trial lawyers desperate for another easy extortion target.  And, just as medical studies did not stop lawyers from pressing forward implant lawsuits, I am sure the Thimerosal lawsuits are not going to go away either.

More on state-run health care as a Trojan horse for fascism, this time from France:

Writing in the left-wing Liberation newspaper, sociologist Henri Pierre
Jeudy suggested the ban marked "the end of an era" for France -- and a
danger for personal freedoms.

"Public health costs are being used to justify an ever more
coercive control over our private lives," he said, with France's yen
for smoky cafes now cast as "an unhealthy mistake".

My other posts on the same topic here.

In about the hundredth post in this series, yet another example of government health care costs being used to micro-regulate even the smallest personal lifestyle decisions:

The city that banned plastic grocery bags and styrofoam take-out
containers has found a new cause: your favorite soft drink. San
Francisco may impose a new fee on those big retail stores that sell
them. The purpose is to curb the obesity problem among kids and adults.
Such fee or tax would be the first in the nation.

 

San Francisco says the obesity problem is costing the city too
much money in health care costs. Studies have linked obesity to
diabetes and heart disease.

"One third of all of our new
on-set diabetics are type 2 because of obesity and this is in children
now," says Robert Lustig, M.D., Endocrinologist, UCSF.

It is perhaps appropriate, given the polls in Iowa, that Mike Huckabee precipitated one of the earliest posts in this series:

Mike Huckabee, the Governor of Arkansas, now
requires annual fat reports. These are sent to the parents of every
single child aged between 5 and 17; a response, he says, to "an
absolutely epidemic issue that we could not ignore" in the 1,139
schools for which he is responsible.

I
just cannot craft any reasonable theory of government where this is the
state's job.   The "obesity" crisis in this country just amazes me.
"Experts" every few years broaden the definition of who is overweight
or obese, and suddenly (surprise!) there are more people defined as
overweight.  Even presuming it is the state's job to optimize our body
weights, is it really the right approach to tell everyone they are too
fat?  Having known several people who were anorexic, including at least
one young woman who died of its complications, is it really a net
benefit to get young people more obsessed with looks and body style?
And what about the kids that are genetically programmed to be
overweight?  Does this mean that years of taunting and bullying by
their peers is not enough, that the state's governor wants to pile on
now?

It is interesting to note that governor Huckabee apparently started
this initiative after his own personal battle with weight loss:

[Huckabee] lost 110lb after being warned that his
weight, more than 280lb after a life of southern fried food, was a
death sentence. A chair even collapsed under him as he was about to
preside over a meeting of state officials in Little Rock.

We
all have friends who have lost weight or gotten into homeopathy or
became a vegan and simply cannot stop trying to convert their friends
now that they see the light.  Now we have the spectacle of elected
officials doing the same thing, but on a broader scale and with the
force of law, rather than  just mere irritation, on their side.  One
can only imagine what report cards kids would be carrying home if
Huckabee had instead had a successful experience with penis
enlargement.  What's next, negative reports for kids with bad acne?
For women whose breasts are too small?  For kids who are unattractive?

Update: I see Q&O posts on the same issue

I really wanted to make a serious point about TJIC's post on Medicare overpaying for medical devices.  However, that may be nearly impossible because the post selects "penis pumps" as the example medical device, and it is difficult to have a meaningful political dialog over penis pumps:

amount Medicare spent last year on penis pumps so that old can could stand at attention: $21 million

average price/ pump Medicare paid: $450

cost of the identical pump online: $108

Well, I will try anyway.  I am sure if someone pointed this out in the Democratic debate as a potential issue with letting the government, famed for buying $800 hammers, run our health care system, they would all have stated piously that such things would not happen under their plan.  But how?  I mean, this kind of government waste has been going on for time immemorial.  It is so closely tied to the unchangeable incentives of government managers that it could rightly be called a feature of rather than a bug in the system.

But I think I have figured it out.  This is why most socialized health care systems do not allow one to go out of system to get private care.  By banning all private care, the government eliminates all those irritating private analogs that might demonstrate they are inefficient.  So, in the example above, the government typically tackles the problem not by reducing the $450 paid by Medicare, but banning the private sales of such devices so no annoying snoop can uncover the fact that a private system could have delivered it for 1/4 the price.  Genius!

Romney-care, which looks surprisingly like v1.0 of Hillarycare, is over-budget by $135 million (and counting*) in Massachusetts.  TJIC is stunned.

* must be pronounced in that deep eastern European voice from the early James Bond films, where in the bad guy's lair the PA system kept saying "one minute, and counting."

I remember in about 1978 going on a bus tour into East Berlin through checkpoint Charlie.  It is hard to describe to my kids what a creepy experience this was.  The state-run tour was clearly run by the propaganda ministry, and they really pulled out all the stops to convince you that life was great in the East.  The interesting part is that all this propaganda failed miserably.  No matter what streets they took you down, you couldn't help but notice the stark contrast in prosperity between East and West.  East Berlin was full of buildings in 1978 that still had not been rebuilt from WWII bomb damage  (this actually might have been a plus, since much of West Berlin was rebuilt in that hideous 50's European public architecture).

The most amazing statement was when the tour guide bragged, "And over 70% of everyone in the city has running water."  It was just so clueless and pathetic, to be so out of touch that what Westerners considered a statistic indicating poverty was hailed as one they thought indicated wealth.

I was reminded of this story when I read the British NHS response to an article that over 70,000 Britons a year travel abroad for health care.  Their response was:

A Department of Health official said the number of patients seeking
treatment abroad was a tiny fraction of the 13 million treated on the
NHS each year.

Waiting times had fallen. Almost half of patients
were treated within 18 weeks of seeing a GP. Most people who had
hospital care did not contract infections.

I had exactly the same response as I did to the East Berlin tour guide.  Half within 18 weeks?!  That's PATHETIC.  Again, what we Americans know to be awful service is being bragged about as a sign of excellence. 

The really creepy part, though, is that America is the last place on Earth that people understand that a medical system can do much better than 18 weeks.  But we are likely to elect a President in the next election whose goal is to bring our system down to the level of the rest of the world.  Unfortunately, someday our grandkids may not know any better.