Coyote Blog

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.

Every food service operation has some problems matching supply with demand, but strikes me as staggering incompetence (via a reader):

Hospitals are throwing away as much as half of their food, NHS figures show.

Close
to 13 million meals were thrown away last year, with 33 hospitals
dumping more than a quarter of their food, including two that discarded
more than was eaten.

Meanwhile, almost 140,000 patients left hospital malnourished, double the figure a decade ago.

Last year, Ivan Lewis, the health minister, admitted that many elderly
people were in effect being starved in hospitals. He said that some
were given a single scoop of mashed potato as a meal, while others were
"tortured" with trays of food placed beyond their reach and no help
with eating.

Maybe the last bit shows that the Brits are enshrining the same "duty to die" that is being discussed in Canada.

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.

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 floored by the number of progressives who embrace all kinds of wacky non-scientific health theories.  These are the same folks who criticize creationists as being anti-scientific.  I am not a creationist, but I might be able to embrace it faster than I could, say, the insanity that is homeopathic medicine**. 

Unfortunately, these are the same folks who will likely make up the backbone of the socialized medicine bureaucracy when and if the US finally decides to hand health care over to a consortium of the Post Office and Walther Reed.  So here is a preview of what we will get:

Tom and Donna (not their real names) are professional
shamen. They teach classes in shamanism at a "foundation", where you
can learn "soul retrieval healing", help the dead "continue their
journey into the Hereafter", and investigate "the Fairy Kingdom". These
soul retrievers and Fairy Kingdom investigators also work for the NHS "”
where, according to Tom's foundation profile, they "use complementary
therapies to help those with mental health difficulties". Shaman
therapies are not the only unorthodox treatments for which the NHS will
gladly pay.

Taxpayers are also subsidising Emotional
Freedom Technique (EFT) "therapy", in which, according to one NHS
trust, "subtle energies" are reordered via "tapping with the fingertips
to stimulate certain meridian energy points while the client is "˜tuned
in' to the problem". "¦If EFT doesn't do the job, an NHS foot massage
might help. Reflexologists believe that each part of the foot maps to a
different organ, and that massaging a particular point can treat that
organ. Medical doctors think it's absurd. "¦Most depressing of all for
the rational taxpayer is the NHS Directory for Alternative and
Complementary Medicine, which aims to promote "dowsers", "flower
therapists" and "crystal healers". We've just learnt that some
hospitals are removing every third light bulb to save money, and that
nurses are being paid half the minimum wage "” or being asked to work
for nothing "” at others. That's how bad the financial crisis has
become. Meanwhile, the National Health Service is employing shaman
fairy enthusiasts as psychological counsellors, enthusiastically
providing treatments invented by "an ordained minister and a personal
performance coach" who thinks tapping your body can cure diabetes,
promoting dowsers and crystal healers and spending vast amounts on
therapies that can't be scientifically supported.

Just as with the Walther Reed mess, the left wants to write off this stuff as just bad management, as an exception.  But unfortunately, this is the rule for government management.  It always goes bad.  Mismatched incentives + lack of individual choice + strong unionized bureaucracy most concerned with its own job security + impossibly complex information flows = mess.  Always.  I get very tired of the excuse, as I wrote here, that "if only we were in charge, everything would work great." 

Throughout these years, libertarians like myself argued that there
were at least three problems with all of this technocratic statism:

• You don't have the right to make decisions for other people.
  Period.  No matter how high-minded and idealistic you want to portray
  it, at the end of the day you are proposing to use force to coerce
  another man into doing your will.  You may stop them from using force
  or fraud against others, but an adult may make decisions for
  themselves, even if they are bad.  I am reminded of a great line from
  the HBO show Deadwood, "Can you let me go to hell the way I want to?"

• You can't make better decisions for other people, even if you
  are smarter, because every person has different wants, needs, values,
  etc., and thus make trade-offs differently.  Tedy Bruschi of the
  Patriots is willing to take post-stroke risks by playing pro football again I would never take, but that doesn't mean its a incorrect decision for him.

• Technocratic idealists ALWAYS lose control of the game.  It may
  feel good at first when the trains start running on time, but the
  technocrats are soon swept away by the thugs, and the patina of
  idealism is swept away, and only fascism is left.  Interestingly, the
  technocrats always cry "our only mistake was letting those other guys
  take control".  No, the mistake was accepting the right to use force on
  another man.  Everything after that was inevitable.

Everyone has had a turn running the place (except libertarians, I might observe) and everyone has screwed things up.

** I am amazed I have not posted a rant on homeopathic medicine, but searching through my archives, I don't find anything.  If you don't know, here is the fast answer why homeopathy is silly.  Advocates of homeopathy argue that they can make certain substances more effective by diluting them, and the more they dilute them, the more effective they are.  Go to one of their web sites, and you will see dilution rations that translate into having less than one molecule of the active ingredient in a mass of water the volume of all the world's oceans.  Advocates argue that even though the molecules are gone, some sort of resonance remains.  Uhh, right.

Expect the next Democratic presidential nominee to run strongly on single-payer (ie socialized) medicine.  Vodkapundit reminds us what this is like, with the latest from England:

Hospitals across the country are imposing minimum waiting times -
delaying the treatment of thousands of patients.

After years of Government targets pushing them to cut waiting lists, staff
are now being warned against "over-performing" by treating patients too quickly.
The Sunday Telegraph has learned that at least six trusts have imposed the
minimum times.

In March, Patricia Hewitt, the Secretary of State for Health, offered her
apparent blessing for the minimum waiting times by announcing they would be
"appropriate" in some cases. Amid fears about £1.27 billion of NHS debts, she
expressed concern that some hospitals were so productive "they actually got
ahead of what the NHS could afford".
...

The Sunday Telegraph has learned of five further minimum-waiting-time
directives. In May, Staffordshire Moorlands PCT, which funds services at two
hospitals and is more than £5 million in the red, introduced a 19-week minimum
wait for in-patients and 10 weeks for out-patients. A spokesman said: "These
were the least worst cuts we could make." In March, Eastbourne Downs PCT,
expected to overspend by £7 million this year, ordered a six-month minimum wait
for non-urgent operations. Also in March, it was revealed that Medway PCT, with
a deficit of £12.4 million, brought in a nine-week wait for out-patient
appointments and 20 weeks for non-urgent operations.

Doctors are also resigning. One gynæcologist said that he spent more time
doing sudoku puzzles than treating patients because of the measures. Since
January, West Hertfordshire NHS Trust, with a deficit of £41 million, has used a
10-week minimum wait for routine GP referrals to hospital. Watford and Three
Rivers PCT, £13.2 million in the red, has introduced "demand management": no
in-patient or day case is admitted before five months.

Note that this is not a bug with single-payer systems, it is a feature.  Any 3rd party payer system has to impose some sort of artificial rationing or bankruptcy will ensue.  Would you drive more if your gasoline costs were all covered by a single-payer system, such that you did not pay directly for gas.  Would your choice of cars be affected?

Along the same lines, from Marginal Revolution comes this story of new scholarship showing the enormous spike that occurs in health care demand under third party payer (e.g. insurance) systems.

On several occasions, I have warned that government funded health care is becoming a Trojan horse for increasing government micro-management of your life.  The logic is that by paying for your health care, the government can argue it has a financial interest in your not eating fatty foods, not smoking, wearing a bike helmet, exercising, etc, decisions that would otherwise only affect the individual themself.*

For those who often accuse me of exaggerated paranoia when it comes to government intervention, check out this from the UK:

People who are grossly overweight, who smoke heavily
or drink excessively could be denied surgery or drugs following a
decision by a Government agency yesterday.  The National Institute for Health and Clinical Excellence (Nice) which
advises on the clinical and cost effectiveness of treatments for the
NHS, said that in some cases the "self-inflicted" nature of an illness
should be taken into account.

Sorry, but I told you so.  What's next?  Is an unwanted pregnancy "self-inflicted"?  How about an STD from unprotected sex?  The rulers of this process in England might argue that "Oh, we would never include those things" but technocrats in the US have seen parallel things happen as they have lost political control of their similar institutions in the US.

It gets me to wondering whether the Solomon Amendment may be the new template for government control of individual lives.  In both Universities and state governments, the Feds use the threat of withdrawal of federal funds to coerce actions (think 55 mile speed limit, title IX, military recruiting on campus) that the Constitution nominally does not see to give them authority over.  Now, there is the distinct possibility that federal funds to individuals (Social Security, Medicare, unemployment) could be used to increase federal authority and coercive micro-management at the individual level.

*Update: Yes, I do know that "themself" is probably not correct grammar.  I sometimes use they, them, themself as a grammatically frowned-upon but I think less awkward substitute for he/she, his/her, and his-or-herself when trying to be gender-neutral.  Sometimes I just use the traditional male pronoun, sometimes I use the female pronoun generically since women will complain about "he" used generically but men will not complain about "she", and sometimes I mix them up.  There is still some consensus building to do in coming up with gender neutral pronouns, though this person defends the singular "they".