Coyote Blog

Via Arnold Kling, Maggie Mahar writes:

Some citizens of the Commonwealth don't even want to pay for their own
health care insurance. Under the plan, everyone in Massachusetts is
required to buy insurance (or pay a penalty), with the state providing
a 100% subsidy for those who earn less than 150% of the poverty level.
Those receiving the full subsidy are enthusiastic. The state had hoped
to sign up 57,000 uninsured and they've over-shot their target: 76,200
of Massachusetts' poorest citizens have enrolled.

At the other end of the spectrum, the program isn't doing as well.
Uninsured citizens earning more than 300% of the poverty level are
expected to buy their own insurance. Here, the state hoped that 228,000
of its uninsured citizens would sign up. So far, just 15,000 have
enrolled.  Apparently, they've done the math and decided that it would
be cheaper to pay the penalty.  But their premiums are needed to keep
the program going.  If more in this group don't sign up, it is not at
all clear how the state will be  able to continue subsidizing the poor.

All of this adds up to "people without health insurance are so because it is not worth the price."  If they get it free, fine, they will use it like crazy, but they won't pay for it.  So I should for them?

I have argued on numerous occasions that government-funded health care is a Trojan Horse for detailed regulation of how we treat our bodies.  The Economist Blog has a great post on this topic:

Why exactly is obesity a public health issue? Well, when,
by force of law, you externalise responsibility for providing a good,
such as health care, then the effects of all individual choices that
affect the cost of providing that good for the individual are thereby
transformed from internal to external effects. If you, like
Mr Dubois, are in the grip of the blithe assumption that reducing
negative externalities by raising the cost of the behaviour that causes
them is simply what government does, then obviously my gluttony and sloth are public problems. Because public policy made them public problems! So, obviously,
it's up to the government to fiddle with prices to manipulate our
behavior in order to minimise its impact on the tax-financed national
budget.

This sort of thing drives me crazy because it's just so
thoughtlessly arbitrary -- intellectual empty calories. Why
specifically a tax on junk food? Yes, one
of the causes of obesity is "the consumption of too many calories."
Another is the failure to burn the calories one consumes. So why not
levy huge fines on people for not showing up at "voluntary"
government-funded yogalates classes? Or if people are consuming too
many calories, then just put a tax on calories. Why tax some calories
but not others? You can get fat eating steak, too. Maybe a national
"cap and trade" system of calorie credits would do the trick. Hey, do
you know who's healthy? Mormons are. Maybe the government should
provide giant tax credits for being Mormon. Or perhaps it would be
easier if the national health care system could just deny services for
ailments it judged to be obesity-related.  You could even decide not to
have a national health care system at all and allow insurance premiums to reflect the actuarial risk of individual behavior! But that would be crazy. 

Hat tip to TJIC, who has more.  I think this would be a great anti-universal-coverage T-shirt:

Ironically, this shirt is produced by the National Organization of Women, who are strong government health care supporters.  Go figure.

The NY Times outdid itself last week with a truly awful article on dentistry.  They started with just one fact:

Previously unreleased figures from the Centers for Disease Control and Prevention
show that in 2003 and 2004, the most recent years with data available,
27 percent of children and 29 percent of adults had cavities going
untreated. The level of untreated decay was the highest since the late
1980s and significantly higher than that found in a survey from 1999 to
2002.

They then apply the patented NY Times class-based story-generation model to assume a cause for this rise that is not supported by the study itself:

But many poor and lower-middle-class families do not receive adequate
care, in part because most dentists want customers who can pay cash or
have private insurance, and they do not accept Medicaid
patients. As a result, publicly supported dental clinics have
months-long waiting lists even for people who need major surgery for
decayed teeth. At the pediatric clinic managed by the state-supported University of Florida dental school, for example, low-income children must wait six months for surgery.

So is the rise in untreated dental problems concentrated in the poor?  Well, they don't say, and there is not data for that in the study, but that does not prevent the NY Times from just assuming it to be so.  In fact, the article itself contradicts this premise, by noting that the problem is not limited to the poor:

The lack of dental care is not restricted to the poor and their
children, the data shows. Experts on oral health say about 100 million
Americans "” including many adults who work and have incomes well above
the poverty line "” are without access to care.

By the way, how did they figure a 100 million don't have "access"?  I don't know, but the figure is suspiciously close to this one:

With dentists' fees rising far faster than inflation and more than 100 million people lacking dental insurance...

Anyone want to bet that the NY Times just made its usual logical fallacy of equating lack of insurance with lack of access?  And by the way, dental insurance is a HORRIBLE investment.  I have priced it many times myself and for a normal family, it is much cheaper to just pay the dental bills, particularly since there are not that many things in your mouth that can go wrong that will be bankrupting.  Trying to push everyone to dental insurance is a terrible idea.  Every time there is a dental procedure in our family, it turns out there are several options for fixing it at different prices.  We actually have the incentive to ask for these alternatives and make trade offs.  What do you think would happen if we had insurnace?

In fact, I can think of a LOT of reasons why people don't go to the dentist as often as they should.  One reason is that no one like the dentist.  Another is people's busy schedules.  And certainly rising costs are a factor -- As I mentioned before, our family makes very different decisions about treatment options than we used to with a fat corporate dental plan.  Which is as it should be. 

By the way, note the screaming socialism here:

The dental profession's critics "” who include public health experts,
some physicians and even some dental school professors "” say that too
many dentists are focused more on money than medicine.

"Most
dentists consider themselves to be in the business of dentistry rather
than the practice of dentistry," said Dr. David A. Nash, a professor of
pediatric dentistry at the University of Kentucky. "I'm a cynic about my profession, but the data are there. It's embarrassing."

I wonder.  Does Dr. Nash accept a salary for being a professor?  Then I guess he is focused more on the business of education than the practice of educating.

Oh, and by the way, how is socialism in dentistry working out?

In a survey of 5,000 people in the UK, six percent claimed that
they had done DIY dentistry, including yanking their own teeth and
fixing cracked crowns with glue. Apparently they resorted to such self
treatment because they couldn't get in to see a National Health Service
dentist "¦

One respondent in Lancashire, northern England, claimed to
have extracted 14 of their own teeth with a pair of pliers. In
Liverpool, one of those collecting data for the survey interviewed
three people who had pulled out their own teeth in one morning.

"I took most of my teeth out in the shed with pliers. I have one to go," another respondent wrote.

For years I had some kind of corporate health plan.  When I started my own business, I bought a Blue Cross plan that roughly mirrored the corporate health plan I used to have -- very low deductible, lots of coverage.  And it had very high premiums. 

So I finally got serious and went out and did something 99% of Americans never do or never have to do:  I went out and really researched my health care options.  And what I found was that to raise our family's deductible from $500 a year to $2000 a year would save me over $3000 a year in premiums.  In fact, if I switched plans, I would get just as high of a maximum payout and I would get a better gaurantee on future pricing and a commitment never to drop my coverage from a large, well-rated insurance company.

There's an old joke about an economist and another fellow walking down the street.  There was a $10 bill laying on the ground, but the economist just walked right past it.  The other fellow said "what are you doing, you just passed up $10."  And the economist replied "It can't be a real $10 bill, because in an efficient market someone would have already picked it up."

That was my reaction to my health care options.  I asked my broker, "you mean that if I increase my deductible $1500 I can save $3000 a year?  Even in a worst case year I am better off, and in a healthy year I am MUCH better off."  He replied "Yep."  I asked, "But why doesn't everyone do this?"  He just shrugged.  As my Harvard investment management professor used to say, as he wrote up a market situation on the chalkboard to begin each class, either this is an opportunity, of there is something we don't understand.  As I have gained more experience with my new health plan, I have become convinced it is the former.

McQ over at Q&O has a great post on insurance vs. insulation.  I won't quote it all, but it is well worth your read.  Towards the end, he quotes John Stoessel on my particular conundrum:

But people are so conditioned to expect others to pay their medical
bills that they hate high deductibles: They feel ripped off if they
must pay a thousand dollars before the insurance company starts paying.

But high deductibles may be the key to lowering costs and putting you in charge of your health care.

I am absolutely convinced that the best possible step for US health care is to expose more users to the market and price-value trade offs, while providing high-deductible insurance that shelters people from bankrupting unusual events.  More here, here, and here.

For a while, I have been trying to highlight that the real problem with health care is that consumers who receive the service do not have any incentive to shop for the best price or to make trade offs on marginal procedures based on price.  The only people who have any incentive to shop are 1) people without insurance and 2) people with high deductibles (like me).  Politicians are trying to eliminate the former group, even if they don't want insurance, and programs like Romney's in Massachusetts actually ban high deductible insurance.

Now, Obama is worried about anti-trust:

The consequences of lax enforcement for consumers are clear. Take
health care, for example. There have been over 400 health care mergers
in the last 10 years. The American Medical Association reports that 95%
of insurance markets in the United States are now highly concentrated
and the number of insurers has fallen by just under 20% since 2000.
These changes were supposed to make the industry more efficient, but
instead premiums have skyrocketed, increasing over 87 percent over the
past six years. As president, I will direct my administration to
reinvigorate antitrust enforcement. It will step up review of merger
activity and take effective action to stop or restructure those mergers
that are likely to harm consumer welfare, while quickly clearing those
that do not.

How can these mergers harm consumers when consumers don't shop for the service and don't care about price in the first place?  Candidates like Obama and Clinton are threatening to create single payer systems that use monopsony power combined presumably with the coercive power of government to hammer suppliers.  Is it any wonder that they are joining together to try to gain some sort of bargaining position for themselves?  In the context of what Obama wants to do with health care buying, this can be thought of more as unionizing than merging.

By the way, does anyone else note the irony of Obama, who wants to create a single supplier for health care (the US Government) lamenting concentration in the health care field?

Via Q&O:

Again, the grand claim of such a system is it will be more efficient
and less costly. Nary a one of the systems in existence today that I've
read about has lived up to the "efficiency" claim, if access and
waiting times are a measure of efficiency. Every one of them seems to
suffer from lack of access.

Secondly, the "less costly" claim
seems to be accomplished by limiting access and limiting treatment. A
rigid structure with prescribed treatments which disallow deviation.
Imagine the sort of cancer treatment forced on the Japanese attempted
here. Now imagine it with any other chronic disease you can name.

What's the premise at work in a system like that?

Commenting
on the WSJ article, Craig Cantoni, a columnist in Scottsdale, Ariz.,
writes: "Like nationalized health care in other countries, the Japanese
system is based on the premise that the state owns your body."
Therefore, "the state can dictate what medical care can be withheld
from you, either by policy or by making you wait so long for care that
you die in the mean time."

We see all sorts of bloviation
by the left about attacks on our liberty. Yet, for the most part, they
are supportive of the most insidious attack on our liberty you can
imagine with their call for some form of universal health care system
here. And make no mistake, all of the leading Presidential candidates
are talking about an eventual government-run system despite their
obvious spin.

I've said something similar for years.  As one example, I have pointed out that the National Organization of Women's strong support for national health care just demonstrates their utter intellectual bankruptcy, as I wrote here:

What this article really shows is that by going with a single-payer
government system, each of us would be ceding the decisions about our
health care, our bodies, and even lifestyle to the government.  So
surely women's groups, who were at the forefront of fighting against
government intrusion into our decisions about our bodies, is out there
leading the fight against government health care.  WRONG!
Their privacy arguments stand out today as sham libertarian arguments
that applied only narrowly to abortion.  It's clear that as long as
they can get full access to abortion, women's groups are A-OK with
government intrusion into people's decisions about their bodies.

Don't miss their web site, which has sales offers for "Keep your laws of my body" T-shirts right next to appeals to "demand health care for all now."

I will admit I don't even know who Essent Healthcare is.  I don't know if they do a good job or a bad job.  I do know that there is a blogger dedicated to sounding the alarm about Essent.  But there are such gadflies for nearly every major corporation.  But in this case Essent is making the classic PR mistake of trying to silence a blogger by taking expensive-to-defend-against legal action against the blogger.  Specifically, Essent is trying to force the blogger's ISP to reveal the identity of the blogger and his confidential informants, many of whom are employees of Essent likely to face retaliation (more here).

I made the point that this kind of thing always backfires, as publicity tied to such suits and the inevitable backlash from bloggers tends to greatly expand the audience of these small bloggers from a few people who are already disgruntled with the target company to a much wider and more damaging audience.

Case in point:  Look who is suddenly the #1 & #2 Google search return for "problems at essent healthcare."  Neither site was in the top 100 a few days ago.

I have written on a number of occasions that the real problem in American health care is the insulation between the person who receives the services and the true cost of the services.  Other than a few folks like me with high deductible policies, there is no incentive to shop around and no incentive to eschew certain avoidable and high cost procedures.

Marc Cooper complained that he went to the hospital for a day and it ended up costing the insurance company over $100,000.  His take-away form this is that the government needs to step in.  My take-away was different:

Did he ask for a price estimate in advance? Did he ask, as most of
us do with all of our large purchases, for a written estimate or
quotation? Did he get such estimates from two or three competitors? Did
he shop around?

Of course not! Because in a system where someone else is paying the
bills, we have no incentive to shop around. So providers have no
incentive to compete on price or to worry about productivity and cost
control.

Sure, this looks like a rip-off.  But if you went in to buy a car,
concerned only with the quality of the
car, and never asked the price and then got a bill for $100,000 a few
weeks later, would you be surprised?  Would anyone give you sympathy if
you complained you paid $100,000 for the car but admitted you never
asked what the price was?

So I was very pleased to see this from John Stossel:

America's health-care problem is not that some people lack insurance, it is that 250 million Americans do have it.

You have to understand something right from the start. We Americans
got hooked on health insurance because the government did the insurance
companies a favor during World War II. Wartime wage controls prohibited
cash raises, so employers started giving noncash benefits like health
insurance to attract workers. The tax code helped this along by
treating employer-based health insurance more favorably than coverage
you buy yourself. And state governments have made things worse by
mandating coverage many people would never buy for themselves.

Competition also pushed companies to offer ever-more attractive
policies, such as first-dollar coverage for routine ailments like ear
infections and colds, and coverage for things that are not even
illnesses, like pregnancy. We came to expect insurance to cover
everything.

He concludes:

Imagine if your car
insurance covered oil changes and gasoline. You wouldn't care how much
gas you used, and you wouldn't care what it cost. Mechanics would sell
you $100 oil changes. Prices would skyrocket.

That's how it works in health care. Patients don't ask how much a
test or treatment will cost. They ask if their insurance covers it.
They don't compare prices from different doctors and hospitals. (Prices
do vary.) Why should they? They're not paying. (Although they do in
hidden, indirect ways.)

From Kevin Drum:

Marc Cooper spends 20 hours in the hospital and tells his story here.  Price of stay without insurance: $116, 749.  Price with insurance: $4,730.  Only in America, folks.

He's not very clear if this was an emergency situation -- like, did he have a heart attack and get rushed to the hospital in an ambulance -- or an important but non-emergency situation.  I will assume the latter by the tone of Marc Cooper's detailed post.

If so, then my first comment is, indeed only in America would he have gotten this procedure without waiting twelve weeks or without traveling to, say, America to get it done more expeditiously,

Second, I wonder:  Did he ask for a price estimate in advance? Did he ask, as most of
us do with all of our large purchases, for a written estimate or
quotation? Did he get such estimates from two or three competitors? Did
he shop around?

Of course not! Because in a system where someone else is paying the
bills, we have no incentive to shop around. So providers have no
incentive to compete on price or to worry about productivity and cost
control.

Sure, this looks like a rip-off.  But if you went in to buy a car, concerned only with the quality of the
car, and never asked the price and then got a bill for $100,000 a few
weeks later, would you be surprised?  Would anyone give you sympathy if you complained you paid $100,000 for the car but admitted you never asked what the price was?

So this is a dead-obvious outcome from the health care system we
have, where no one has the incentive to shop. By the way, I have a high-deductible policy which causes me to
shop around, because costs come out of my own pocket. I ask questions
like, is that extra CT scan really necessary?

It's incredible to me that given this situation, the solution for
this blog's author and most of his readers is not "we should find a way
to have individuals experience both the cost and benefits of care,
because only they can make these tradeoffs for themselves and shop
around for better options" but is instead "lets just turn it over to
the government, since they do such a good job with Iraq and the mail
and our schools."

Finally, I would point out that the author is making some wild assumptions about an insurance statement he probably does not understand (I say that with confidence since no one understands health insurance statements).  His assumption that the walk-in poor would have had to pay $100,000 for the procedure or would have been left to die are demonstrably untrue, since there is just not that much evidence that either outcome is occuring with any regularity.  That is why health care socialization supporters always talk about the number of people uninsured, which is almost irrelevant, instead of the number of people who don't get care, which is a much much smaller, almost vanishingly small number.

Reader Robert Hammond, who always sends me good stuff, pointed out this article from the Evening Standard about proposed new health care rules in England.  Frequent readers will know that I have long argued that nationalized or single-payer health care is a Trojan Horse for fascism (and much more here) in the form of micro-management of individual decisions.  If your personal choices that in the past only put yourself at risk now cost other taxpayers money, then those other taxpayers are going to try to redirect your choices.

Failing to follow a healthy lifestyle could lead to free NHS treatment being denied under the Tory plans. 

Patients would be handed "NHS Health Miles Cards" allowing them to earn
reward points for losing weight, giving up smoking, receiving
immunisations or attending regular health screenings.

Like a
supermarket loyalty card, the points could be redeemed as discounts on
gym membership and fresh fruit and vegetables, or even give priority
for other public services - such as jumping the queue for council
housing.

But heavy smokers, the obese and binge drinkers who
were a drain on the NHS could be denied some routine treatments such as
hip replacements until they cleaned up their act.

Those who
abused the system - by calling an ambulance when a trip to the GP would
be sufficient, or telephoning out of hours with needless queries -
could also be penalised.

The report calls for a greater
emphasis on the "citizen's responsibility" to be healthy and says no
one should expect taxpayers to fund their unhealthy lifestyles.

Here is the real problem:  This is absolutely logical.  There is nothing at all incorrect about the last statement for example.  This is not an abuse or an excess.  This is a completely predictable result of single-payer health care.  Any single-payer is going to have these incentives, but when the single-payer is the government, they not only have the incentives but the full coercive power to do something about it.  I am exhausted with the statist defense against such outcomes that "well, its just the particular individuals in charge -- if we could get the right guys in there, it would work great."  No.  The right guys are never in there, despite technocrats' big dreams, in part because the incentives in place turn even the right guys into the wrong guys. 

One of the reasons we spend so much on health care today is because most of us can do so without any personal financial cost.  Few of us (I am an exception, with a very high deductible policy) actually have to make cost-benefit trade offs in each of our health care purchases like we do in contrast for ... absolutely everything else we buy except health care.   The results are predictable.  We get pissed off when our insurance company denies coverage on some procedure or cost, we is part of the base-level of discontent that health care "reformers" draw on.  But it is stunning to me that people who have discontent with their current insurer feel like things will be better with the government!

Hey, this sounds like a women's issue!

What this article really shows is that by going with a single-payer government system, each of us would be ceding the decisions about our health care, our bodies, and even lifestyle to the government.  So surely women's groups, who were at the forefront of fighting against government intrusion into our decisions about our bodies, is out there leading the fight against government health care.  WRONG!  Their privacy arguments stand out today as sham libertarian arguments that applied only narrowly to abortion.  It's clear that as long as they can get full access to abortion, women's groups are A-OK with government intrusion into people's decisions about their bodies.

So please, dedicated feminists are urged to comment.  How do I relate this T-shirt from the NOW web store:

With this button from the NOW home page:

And a bit of text from their site:

People need and deserve universal, continuous,
and accessible health coverage that is provided by a single payer and
does not require full-time employment and a beneficent employer.
Learn more with our action toolkit....

With the recent release of Michael Moore's new movie, "SiCKO", and the
introduction in Congress of a bill to provide health insurance to all
U.S. residents, the movement for universal single-payer health
insurance is gaining momentum. This toolkit is provided to help you
take action on this important issue....

Health care is a right, not a privilege.

I am always absolutely amazed when advocates of some form of national or single-payer health care argue that such a system would be more efficient.  For example, Kevin Drum argued:

A few days ago, during an email exchange with a
friend, I mentioned that I don't usually tout cost savings as a big
argument in favor of universal healthcare. It's true that a national
healthcare plan would almost certainly save money compared to our
current Rube Goldberg system, but I suspect the savings would be
modest. Rather, the real advantages of national healthcare are related
to things like access (getting everyone covered), efficiency (cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies), choice
(allowing people to choose and keep a family doctor instead of being
jerked around everytime their employer decides to switch health
providers), and social justice (providing decent, hassle-free healthcare for the poor).

I don't think any of these are true.  For example, let's take access.  Yes, everyone in a universal health care system would have a piece of paper that says they have health care, and the left seems really focused on that piece of paper.  But that paper has about as much value as my piece of paper that says I own a hundred shares of Enron.  Because someone has to redeem that piece of paper and actually provide the care, and there is the rub, is it not?  Canadian David Gratzer writes (vis Q&O):

My book's thesis was simple: to contain rising
costs, government-run health-care systems invariably restrict the
health-care supply. Thus, at a time when Canada's population was aging
and needed more care, not less, cost-crunching bureaucrats had reduced
the size of medical school classes, shuttered hospitals, and capped
physician fees, resulting in hundreds of thousands of patients waiting
for needed treatment"”patients who suffered and, in some cases, died
from the delays....

Nor were the problems I identified unique to
Canada"”they characterized all government-run health-care systems.
Consider the recent British controversy over a cancer patient who tried
to get an appointment with a specialist, only to have it canceled"”48
times. More than 1 million Britons must wait for some type of care,
with 200,000 in line for longer than six months. A while back, I toured
a public hospital in Washington, D.C., with Tim Evans, a senior fellow
at the Centre for the New Europe. The hospital was dark and dingy, but
Evans observed that it was cleaner than anything in his native England.
In France, the supply of doctors is so limited that during an August
2003 heat wave"”when many doctors were on vacation and hospitals were
stretched beyond capacity"”15,000 elderly citizens died. Across Europe,
state-of-the-art drugs aren't available. And so on.

I had forgotten about the heat wave.  Could you imagine backwards old America having 15,000 people die when the temperature got into the 90's?

As to efficiency, which Drum defines as "cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies," does anyone really ascribe these characteristics to the government?  Really?  Even European health care bureaucrats would not agree with this statement:

This privatizing trend is reaching Europe, too.
Britain's government-run health care dates back to the 1940s. Yet the
Labour Party"”which originally created the National Health Service and
used to bristle at the suggestion of private medicine, dismissing it as
"Americanization""”now openly favors privatization. Sir William Wells, a
senior British health official, recently said: "The big trouble with a
state monopoly is that it builds in massive inefficiencies and
inward-looking culture."

I won't get much into the last two, except to say that we actually have a ton of health care choice in the US today, far more than any other country.  And even if we did not, what does doctor choice mean if the best people are driven away from being doctors, as they are in socialized medicine.  And social justice?  Well, the poor get care in the US, the key is the "hassle-free" in his statement.  Would you immediately assume that a government-run service is going to involve less hassle than a private service?  Have you renewed your drivers license lately?  It may well be that the poorest 10% have such an awful health care experience that they will see things better.  But almost assuredly the other 90% are going to be worse off.

Remember this -- Universal health care is NOT a system in which the majority of us who are satisfied with our care can keep our current system, while the poor get a better one.  It is a system where all of us are thrown out of our current system and given the same care the poor get.  It is roughly equivalent to a Great Society housing program in which not just the homeless get housing, but everyone in the country are forced to give up their current house and live in public housing.

Postscript:  There is great improvement to be had in the health care system.  It revolves, though, around making the payer for health care the same person who receives the service, as it is for every other product and service we buy in this country.  We already have too much single-payer.  We need multi-payer.  I won't go there today, but I explained here.

Another Thought: A huge pillar of the women's movement was that the government should not make decisions for a woman and her body (e.g. by banning abortion).   All well and good.  But I have never understood how this was consistent with support, say, for the FDA, which tells women exactly what they can and can't put in their body.  And now women's groups are all for universal health care, where government will make all the medical decisions about what procedures one can and can't have, and when.  Consistency please?

James Christopher via Kurt Loder via Cattalarchy:

After marveling at Moore's rosy view of the British health care system
in "Sicko," Christopher wrote, "What he hasn't done is lie in a
corridor all night at the Royal Free [Hospital] watching his severed
toe disintegrate in a plastic cup of melted ice.  I have."

The whole review is worth reading.  Many folks seem to think Michael Moore is brilliant until he makes a film about something with which they are actually familiar.  Which, come to think of it, encapsulates my entire view of the media, not just Michael Moore, as well.  Nothing will reduce your confidence in the media more than reading an article on a topic about which you have intimate knowledge.

Michael Canon has proposed for principles of an anti-universal health care coverage club:

1. Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
2. To
   achieve "universal coverage" would require either having the government
   provide health insurance to everyone or forcing everyone to buy it.  Government provision is undesirable, because government does a poor job of improving quality or efficiency.  Forcing
   people to get insurance would lead to a worse health-care system for
   everyone, because it would necessitate so much more government
   intervention.
3. In a free country, people should have the right to refuse health insurance.
4. If governments must subsidize those who cannot afford medical care,
   they should be free to experiment with different types of subsidies
   (cash, vouchers, insurance, public clinics & hospitals,
   uncompensated care payments, etc.) and tax exemptions, rather than be
   forced by a policy of "universal coverage" to subsidize people via
   "insurance."

You know I'm in;  after all, I am the one that has said that "universal coverage is as if, in the Great Society public housing programs, everyone in the country, not just the poor, had been required to tear down their current houses and enter monolithic public housing structures."

However, I would have added a fifth principle:  Health care decision-making and tradeoffs amongst cost, quality, and
content of care should belong to the individual, except when an
individual delegates this decision in some way by his own choice (say
by joining a very structured HMO program).

I wrote about the joys of actually shopping for health care under a high-deductible policy here and here.  Michael Canon also has a new post on shopping and HSA's here.

Michael Canon has proposed for principles of an anti-universal health care coverage club:

1. Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
2. To
   achieve "universal coverage" would require either having the government
   provide health insurance to everyone or forcing everyone to buy it.  Government provision is undesirable, because government does a poor job of improving quality or efficiency.  Forcing
   people to get insurance would lead to a worse health-care system for
   everyone, because it would necessitate so much more government
   intervention.
3. In a free country, people should have the right to refuse health insurance.
4. If governments must subsidize those who cannot afford medical care,
   they should be free to experiment with different types of subsidies
   (cash, vouchers, insurance, public clinics & hospitals,
   uncompensated care payments, etc.) and tax exemptions, rather than be
   forced by a policy of "universal coverage" to subsidize people via
   "insurance."

You know I'm in;  after all, I am the one that has said that "universal coverage is as if, in the Great Society public housing programs, everyone in the country, not just the poor, had been required to tear down their current houses and enter monolithic public housing structures."

However, I would have added a fifth principle:  Health care decision-making and tradeoffs amongst cost, quality, and
content of care should belong to the individual, except when an
individual delegates this decision in some way by his own choice (say
by joining a very structured HMO program).

I wrote about the joys of actually shopping for health care under a high-deductible policy here and here.  Michael Canon also has a new post on shopping and HSA's here.

Apparently, HMO's only have a 15% approval rate with Americans.  People don't like the waits, and the institutional service, but, more than anything, they don't like someone in the HMO back office rationing their care based on pre-set formulas about what care or test is appropriate in each given situation.

All well and good.  However, if this is so, then why does the idea of universal government health care appeal to so many people?  Because if universal health care turns out as well as it possibly could, then the best we could expect is that it will resemble... current HMO's.  And unfortunately, it will probably be worse.  Because today, the guy in the HMO back office who is setting up the allowed care formulas knows that if he cuts things back too far, you will go to another competitor.  No such threat or incentive will exist for the government bureaucrat, who will be setting the formulas based on stupid mindless rules and interst-group pressures and absolutely no concern about your satisfaction.

As I wrote in a previous post, state-run health care tends to act as a Trojan Horse for increased government micro-management of our lives by giving the government a financial interest in our health and risk-related decision-making.  A reader sends along this article demonstrating this effect yet again:

An attempt to revive famous TV adverts
from the 1950s that encouraged people to "Go To Work On An Egg"
have been blocked by regulators on health grounds.

The British Egg Information Service (BEIS) had wanted to
bring back the adverts featuring comedian Tony Hancock to mark
the 50th anniversary of the British Lion mark.

But the Broadcasting Advertising Clearance Centre (BACC)
said the famous commercials could not be repeated because
eating eggs every day went against the policy of encouraging
people to eat a varied diet.

"The concept of eating eggs every day for breakfast goes
against what is now the generally accepted advice of a varied
diet and we therefore could not approve the ads for broadcast,"
a BACC spokesman told the BBC.

PS-  Readers who send me stuff - let me know if I can use your name when you email me the post.  When I sit down to blog in short bursts, I am happy to give specific credit but I am always unsure whether to use your real names or not.

The USAToday published a front-page story today arguing that a health care "crisis" looks a lot like Houston, Texas.  I would argue, from their descriptions, that a health care "crisis" looks exactly like state-run medicine.

Ijeoma Onye awoke one day last month short of
breath, her head pounding. Her daughter, Ebere Hawkins, drove her 45
minutes from Katy, Texas, to Ben Taub General Hospital, where people
without health insurance pay little or nothing for treatment.

Onye, 62, waited four hours to be seen. Still,
going to the emergency room was faster than getting an appointment. For
that, "you have to wait months," Hawkins says....

The huge number of uninsured residents here means that health officials
must make tough decisions every day about who gets treated and when.
"Does this mean rationing? You bet it does," says Kenneth Mattox, chief
of staff at Ben Taub, the Houston area's pre-eminent trauma care
facility.

The article goes on and on like this.  The problem is delays and queuing in facilities that provide free care.   And the difference between this and state-run health care is what exactly?  When a product or service is free, people will tend to over-consume the supply, with rationing taking place via queuing rather than price.  This is how every state-run supply system works, from food in the Soviet Union to health care in Canada.  And by the way, exactly how upset should I be about people receiving an extraordinarily valuable and costly service for free but having to wait a while to get it?

This article is actually a great rebuttal of the inherent message in
the health care debate that "uninsured" means "denied health care."  In
fact, it is clear that even in the spot USAToday picked out as the worst in
the country, the uninsured are in fact getting health care.  It is tedious with long waits, but there are no examples in the long article of people going without.  Yes some people consume less than they might if it was free and convenient, but that is just the rationing at work.  Anyone who says that rationing goes away in a state-run system is bald-faced lying to you.

Remember that national health care does not eliminate queuing and waits for the poor -- it just institutionalizes these waits for the rest of us.   Universal Health Care is equivalent to a Great Society housing program where everyone, rich and poor, have to give up their house and move into a crappy public apartment block.

Postscript: By the way, I am sympathetic to certain hospital administrators who have a "crisis" on their hands because the mass of uninsured show up in their emergency rooms.  That, however, is a problem manageable far short of government-run health care.  They want to blame diversions of critical patients away from over-crowded emergency rooms on the "uninsured" but it is really a function of their own faulty triage.

Update: Michael Moore will soon argue that its better in Cuba.  Hah! That is funny.  If people really want to believe this, then it is another reason is is way past time to open up our relations to Cuba, so people can see for themselves what a lying sack of poop this filmmaker is.

For quite a while, I have been arguing that universal health care is a Trojan horse for freedom-robbing government interventions into our personal habits (and micro-habits).  Suddenly activities that used to be personal choices that affected only ourselves (e.g. unhealthy diet) become public interest questions affecting government-funded health care costs.

Jonah Goldberg, via Ronald Bailey, seems to agree:

The British government recently unveiled
plans for a massive crackdown on "excessive drinking," particularly
among the middle class. It will include all of the familiar tactics of
public health officials: dire new warnings on wine bottles,
public-awareness campaigns, scolding from men and women in lab coats...

Britain
still subscribes to a system where health care is for the most part
socialized. When the bureaucrat-priesthood of the National Health
Service decides that a certain behavior is unacceptable, the
consequences potentially involve more than scolding. For example, in
2005, Britain's health service started refusing certain surgeries for
fat people. An official behind the decision conceded that one of the
considerations was cost. Fat people would benefit from the surgery
less, and so they deserved it less. As Tony Harrison, a British
health-care expert, explained to the Toronto Sun at the time, "Rationing is a reality when funding is limited."

But
it's impossible to distinguish such cost-cutting judgments from moral
ones. The reasoning is obvious: Fat people, smokers and "” soon "”
drinkers deserve less health care because they bring their problems on
themselves. In short, they deserve it. This is a perfectly logical
perspective, and if I were in charge of everybody's health care, I
would probably resort to similar logic.

But I'm not in charge
of everybody's health care. Nor should anyone else be. In a free-market
system, bad behavior will still have high costs personally and
financially, but those costs are more likely to borne by you and you
alone. The more you socialize the costs of personal liberty, the more
license you give others to regulate it.

Universal health care,
once again all the rage in the United States, is an invitation for
scolds to become nannies. I think many Brits understand this all too
well, which is one reason why they want to fight the scolds here and
now.

I like his term "socializing the costs of personal liberty."  Its a good description of much of what is wrong with government today.

While it may have been unintentional, a quote in New York magazine helps make the point I have been trying to make about universal health care (HT: John Scalzi)

"With universal [health care], you'd get the same kind of
mediocre shittiness that you'd get in all other kinds of standardized
approaches. But for millions of people, that would be a big upgrade."

Americans are unbelievably charitable people, to the extent that they will put up with a lot of taxation and even losses of freedoms through government coercion to help people out.

However, in nearly every other case of government-coerced charity, the main effect is "just" an increase in taxes.  Lyndon Johnson wants to embark on a futile attempt to try to provide public housing to the poor?  Our taxes go up, a lot of really bad housing is built, but at least my housing did not get any worse.  Ditto food programs -- the poor might get some moldy cheese from a warehouse, but my food did not get worse.  Ditto welfare.  Ditto social security, unemployment insurance,and work programs. 

But health care is different.  The author above is probably correct that some crappy level of terribly run state health care will probably be an improvement for some of the poor.  But what is different about many of the health care proposals on the table is that everyone, not just the poor will get this same crappy level of treatment.  It would be like a public housing program where everyone's house is torn down and every single person must move into public housing.  That is universal state-run health care.  Ten percent of America gets pulled up, 90% of America gets pulled down, possibly way down. 

I don't think most Americans really know what they are signing up for.  Which is why it is so important for health care socialists to have people like Michael Moore running around trying to convince the middle class they will be getting better health care.  Because there is almost no possibility of this being true, and health care proposals will never pass if people realize it.

More here.

I missed this article the first time around, but Arnold Kling makes a point that I have been trying to make coherently for a long time:  The biggest problem in health care is not under-insurance or efficiency or drug company profits.  The biggest problem is the insulation of the consumer from health care prices.

For health care providers, insulation is a bonanza. Because
consumers are not spending their own money, they accept doctors'
recommendations for services without questioning them and without
concern for cost. Faced with an insured patient, a health care provider
is like a restaurant catering to convention-goers with unlimited
expense accounts. The customer will gladly take the most high-end
recommendation and not worry about the price.

Consumers are
happy as well. Insulation relieves the patient of the stress of making
decisions about treatment. The patient also does not have to worry
about shopping around for the best price.

The problem with
insulation is that it is not a sustainable form of health care finance.
Individuals, employers, and government are all under stress.

Health care plans on the table basically put decision making for a) making price comparisons and b) deciding if a given procedure is worth the price -- in one of two people's hands:

• The individual being cared for or
• The government

That's it.  Its one or the other.  The current system of "nobody" is not sustainable.  To the extent that people have grief about their employer or their insurer, it is usually because the insurer is trying to make these decisions (someone has to) and the individual is resentful that the insurer is not making decisions the way the individual might like.  In this context, it is nuts that many people see the solution not as "let individuals take over this decision" but as "let the government do it."  I'm sure that will turn out well.

By the way, I have been with a high deductible policy for a while now, and the medical care shopping process is a real eye-opener.  I really highly recommend it -- not only am I managing the costs but I am learning more about the care itself.  For those of you who don't want to price compare,  Michael Cannon of Cato makes the very good point that everyone does not have to price shop - only a few people need to for all of us to get the benefit.  I never even look at the price of toilet paper, but I know it is probably a good price because there are folks out there who DO compare.

From Michael Cannon at Cato:

There's a lesson here for those who want to cover the uninsured: focus on the incentives facing the 250 million Americans who have
health insurance, not on the estimated 45 million who don't. If the
federal government stopped encouraging people with health insurance to
be less careful consumers, then coverage would be more affordable, the
number of people without coverage would shrink, and the quality of care
would improve.

My family just switched to a high deductible policy, and its amazing how much our behavior has changed.  We question doctors now -- do we really need that?  We had to take my son in for a CT scan on his head (he got hit by a line drive at the hot corner the other day) and we actually asked the price before we scheduled an appointment.  When was the last time you asked the price of any medical procedure or visit?

PS- The son is fine, but half his face looks like its been inflated with a high-pressure pump.

After the post below, several have written to ask about the procedure itself.  My dad wrote with details, which I believe are from Science magazine:

The drug for treating macular degenerations is ranibizumab, sold under the brand name "lucentis" by genetech, its developer and manufacturer.

It is "a monoclonal antibody - made by using biotech methods, from genetically engineered bacteria that attacks a protein responsible for the leading cause of blindness in seniors.  In clinical trials with Lucentis, the eyesight of about 95 per cent of AMD patients either improved or stopped getting worse."

Lucentis was created by tweaking the molecular structure of another, older drug Avastin, which itself was originally approved for colorectal cancer but now has been approved for certain kinds of lung cancer, and has been submitted to Food and Drug Administration to be used against breast cancer and possible kidney cancer as well.

The editors of Science magazine, the widely respected journal of the American Association for the Advancement of Science, selected ten "breakthrough" discoveries of the year last December.  No. 6 on the list was the results of the clinical trial results for Lucentis.

PS:  My son and I often joke that they have run out of car names.  With a name like ranibizumab, they seem to have run out of drug names too.  I can must see the ad campaign:  "With a name like ranibizumab, it's got to be good."

The good news is that they have, for the first time, a treatment for macular degeneration.  My mom got her first treatment yesterday.

The bad news is that it involves getting a hypodermic needle stuck in your eyeball for a direct injection of the drug.

Eeeek.  Didn't want to think about that any more today, so I thought I would dump that image on you guys.

Update:  For those interested, I have an updated post on the details of the new drug.  I joked about the procedure, but in fact it is a god-send, and my mom says that the needle thing is a lot worse in anticipation than in reality.  Those with this same problem should definitely look into it.

From the owner of Smartflix:

So, here I am, having risked absolutely everything I own, having gone
with out salary for three years, and I am now being told that if I hire
somebody, and he gets married in Vegas while drunk, then gets a divorce
the next day, I've got to cover the bimbo into the next decade? (Feel
free to add in the gender-reversed variation of that, as well - I'm
equally apalled that I might have to pay for an employee's ex-husband's
meds)....

It is a testament to the American character that even when we are
this tightly bound by the chains of the State, we, as a people, still
start new businesses.

That, or maybe it's a testament to our stupidity.

From Kevin Drum, who I consider one of the smarter folks on the left (but not this time):

A few days ago, during an email exchange with a
friend, I mentioned that I don't usually tout cost savings as a big
argument in favor of universal healthcare. It's true that a national
healthcare plan would almost certainly save money compared to our
current Rube Goldberg system, but I suspect the savings would be
modest. Rather, the real advantages of national healthcare are related
to things like access (getting everyone covered), efficiency (cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies), choice
(allowing people to choose and keep a family doctor instead of being
jerked around everytime their employer decides to switch health
providers), and social justice (providing decent, hassle-free healthcare for the poor).

Name one industry the government has taken over in a monopolistic fashion and subsequently increased efficiency or individual choice?  Anyone?  Buehler?  In fact, I am not sure I can name one government program that even provides the poor with decent, hassle-free services. 

Lets take the most ubiquitous government monopoly, that on K-12 education. 

• Efficiency?  My kid's for-profit secular private school has a administrator to student ratio of at least 1:15.  How many assistant principals does your public school have?  Many public schools are approaching 1 administrator for every 1 teacher.
• Choice?  That's a laugh.  The government and its unions fight choice in education tooth and nail.  In fact, in the context of education, Drum and others have effectively argued that choice is the enemy of his last point, social justice, so it is absurd to argue that government monopolistic health care will optimize both.  Yes, people may be frustrated their insurance company does not cover X procedure, but this will only get worse when the government is making the choices for us.  Oh, and by the way, about the evils of those employers running our health plans?  They do so only because of WWII wage controls and decades of federal tax policy that have provided them strong incentive to do so. 
• Decent, hassle-free service?  Ask a concerned black family in an inner-city school how good their kid's government-provided education is.  In fact, I will bet that most inner city parents get healthcare of better quality today despite the admittedly Rube Goldberg system we have (courtesy of years of silly government interventions) than the quality of education they receive from the government education monopoly.  After all, most of them walk out of the hospital today with their life, while many of their kids are walking out of worthless government schools with no life.

As to the claim that national health care would "almost certainly save money," that is hard to argue with for this reason:  The government, once in charge of health care choices, can simply start denying procedures and care ("rationing").  This is in fact how costs are managed in most socialist medical systems.  So while this statement is technically true, it would be very hard for anyone to really believe that for the same quality and quantity of care, the government could do it cheaper.