You might have read the story about the Socialist Alarm Clock. A friend who wishes to remain anonymous sent his libertarian version and asked me to post it (cross-posted at Division of Labour and The Beacon):
“This morning I was awoken by my alarm clock built by the ingenuity of millions of individuals all working for their own gain, but whose efforts were coordinated by the prices for labor and materials and finished goods provided by the free market. I then took a shower in the clean water provided by the shower head, pipes, and sanitation facilities whose construction also involved the efforts of thousands of people acting in their independent interest. After that, I turned on the TV to The Weather Channel, whose owners include one of the largest multi-national corporations and private equity companies, to see the week’s forecast presented in a clear, informative (and even entertaining) manner. I watched this while eating breakfast of General Mills’ inspected food and taking drugs whose strong brand name gives me confidence in its safety.
At the time which millions of people coordinate their activities to take advantage of each other’s knowledge and skills, I leave for work. I get into my Japanese-designed, Mexican-supplied, Michigan-assembled automobile and set out to work on the roads built by construction contracting companies and named after corrupt politicians, possibly stopping to purchase additional fuel that was shipped from the Middle East by an oil company at a per gallon cost many times lower than the price of having a letter delivered across the street by the government monopoly that loses millions of dollars each year. To make the purchase there is no need to leave the pump; I am able to slide a piece of plastic into a small slot and get credit extended to me by a bank who has never met me in person. On the way out the door, I put out the Fed-Ex envelope containing the documents I need to arrive across the country tomorrow morning and drop the kids off at the public school which is attended by only the best students, thanks to the high home prices in the area.
After work, I drive my Japanese-Latino-Midwestern car back home, to a house which has not burned down in my absence because of materials developed in the research and development departments of hundreds of corporations and which has not been plundered of all is valuables thanks to the lock on the door and a sign advertising the security company whose services I employ. My piece of mind was not interrupted by the thought of these events anyway, as I have both fire and homeowners insurance through privately held insurance company.
I then log on to the internet to watch and listen to artists who don’t appeal to a broad enough audience to make it onto one of the few channels that a government monopoly allows to be broadcast. I then log onto the democraticunderground.com to post about how DEREGULATING the medical industry is BAD because low-cost, quality health care can never be provided by greedy, self-interested people.”
by the Night Writer
Mitch made a reference to “this year’s model”, which reminded me of Elvis Costello’s “I Don’t Want to Go to Chelsea”, which reminded me of how little I expect of a British-style health system.
Capital punishment, she’s this year model –
They call her Natasha when she looks like Elsie
I don’t want to go to Chelsea
Oh no it does not move me
Even though I’ve seen the movie
I don’t want to check your pulse
I don’t want nobody else
I don’t want to go to Chelsea
Everybody’s got new orders
Be a nice girl and kiss the warders
Now the teacher is away
All the kids begin to play
Men come screaming, dressed in white coats
Shake you very gently by the throat
One’s named Gus, one’s named Alfie
I don’t want to go to Chelsea
Oh no it does not move me
Even though I’ve seen the movie
I don’t want to check your pulse
I don’t want nobody else
I don’t want to go to Chelsea
by the Night Writer
Congressional and other townhall defenders of the nationalized healthcare proposals — collectively lumped as “Obamacare” — are quick to deny that rationing of healthcare is intrinsic in the proposals, or that the old and the very young are at risk from a sliding scale prioritizing who receives care. While no politician is likely to put his or her name on such a specific plan, in practice the implementation of such a bill will be up to the political appointees and advisors who will create the regulations that set the directives and protocols. People such as Dr. Ezekiel Emanuel, health adviser to President Barack Obama, health-policy adviser at the Office of Management and Budget, member of the Federal Council on Comparative Effectiveness Research and brother of WH Chief of Staff Rahm Emanuel.
In an opinion piece in today’s Wall Street Journal, Betsy McCaughey describes Dr. Emanuel as President Obama’s Health Rationer-in-Chief and, rather than putting words into the good doctor’s mouth, uses his own copious writings (with citations) to demonstrate his disdain for the bothersome Hippocratic Oath and his stated views on properly prioritizing care for those of most use to the “polity”:
True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care: “Medical school education and post graduate education emphasize thoroughness,” he writes. “This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath’s admonition to ‘use my power to help the sick to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of cost or effect on others.”
… the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: “Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.” (Hastings Center Report, November-December, 1996)
So, “Citizen”, as long as you are lucid, or still have a chance to contribute, you’ve got a chance. Start drooling, however, and the tax dollars you’ve paid in over the years might get your sheets changed on a regular basis. (Say, I wonder if one’s active – but politically incorrect – participation in public deliberations could be judged by government experts as a form of dementia?) But never fear, Dr. Emanuel wants to save the maximum number of lives, as long as they’re the right lives…
In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a “complete lives system” for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. “One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.
“However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear.” In fact, Dr. Emanuel makes a clear choice: “When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated …
Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: “Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.”
The youngest are also put at the back of the line: “Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . .
Oh those poor, under-capitalized infants. Actually, that reminds me of a case in Great Britain I once wrote about: Charlotte’s Web: When the State Decides if Your Baby Shall Live or Die.
Of course, the “20-year-old that might live another 60 years” would then be 80-years-old, assuming he didn’t lose his ability to participate in public discourse when he was 70 and the national health service didn’t decide to write-off it’s “investment” at that point. And let’s not overlook this contribution to the public discourse from Dr. Emanuel:
Dr. Emanuel’s assessment of American medical care is summed up in a Nov. 23, 2008, Washington Post op-ed he co-authored: “The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed nations on virtually every health statistic you can name.”
This is untrue, though sadly it’s parroted at town-hall meetings across the country. Moreover, it’s an odd factual error coming from an oncologist. According to an August 2009 report from the National Bureau of Economic Research, patients diagnosed with cancer in the U.S. have a better chance of surviving the disease than anywhere else. The World Health Organization also rates the U.S. No. 1 out of 191 countries for responsiveness to the needs and choices of the individual patient. That attention to the individual is imperiled by Dr. Emanuel’s views.
There’s a lot more so read the whole thing, especially if you want to have the direct quotes and citations handy.
by the Night Writer
Tuesday I spent a chunk of the day down in Rochester at the Mayo Clinic (actually, St. Mary’s Hospital, part of the Mayo complex) while my father’s brother was undergoing an aortic-valve replacement, the same operation my father had in 2005.
It was my first visit to the Mayo campus and the time spent waiting with my aunt and cousins for word on the results of the operation allowed me to ruminate on being in one of the foremost medical centers in the world, the current debate on healthcare “reform” and, of course, on family ties.
One, I’ve never been in a hospital as pleasant as Mayo-St. Mary’s, at least in the parts where I went. The halls were quiet, the waiting room was comfortable, we even had free wi-fi … and nowhere did I encounter that institutional, disinfectant smell that had been such a part of my life a couple of years ago. Even parking was easy; I pulled into an underground lot in front of the hospital, took the elevator to the lobby and a second elevator to the fifth floor and walked to the family waiting room as easily as going to my office. Actually, it was even easier because I didn’t have to go through two security doors, nor did I dodge gurneys and masked orderlies in the halls, or have to work my way around the vortex of a nurses station as I commonly did when my father had his valve replacement or later when he was fighting lymphoma. He had had great care from one of the top guys in the business with his heart surgery at Barnes Hospital in St. Louis, but we were never entirely confident that he was getting the best or most appropriate treatment with his cancer, first at the regional hospital and later in St. Louis. Now, however, I was at the Mayo and my uncle was getting first class care in a setting where we were being treated as customers, almost as if my uncle was someone rich and important like the sheiks that fly into Rochester and the Mayo for their care.
My uncle is important to us, but maybe not so much to the rest of the world, however. He’s a retired rural mail carrier and, hence, a retired federal employee so he has great insurance that apparently covers him traveling 550 miles to get his surgery at the Mayo. Even though he’s well into his 70s and had triple-bypass surgery several years ago after a heart-attack, he didn’t have to go in front of a review board to determine if his quality of life was justified.
To tell you the truth, I have strong but mixed emotions about the healthcare debate that is raging in the U.S. right now (as regular readers already know). I believe very strongly that our current system desperately needs reform, but I believe even more strongly that the plans that are being proposed – in one form of single-payer, nationalized health insurance or another – is the exact opposite way that we should be going. I feel that the chances are good that this will be turned away (this time, anyway) but I’m discouraged that the result will be status quo, which is still unacceptable, and that there will be no stomach left for the good fight to bring about real, market-based reform. Neither the current system or “Obamacare” would affect my uncle: his union and federal coverage would likely still be affect under “Obamacare”, just as it is now. Whether I and other non-federal, non-union folks should be so fortunate is another matter that’s part of the debate.
As I sat with this part of my extended family there was talk of the “Stewart Curse”: my grandfather had died after a series of heart attacks, my father’s oldest brother had died of a heart attack, both of his other brothers had had heart attacks, and there were now two valve replacements in the family history. In addition, my younger brother will need a similar operation, likely in the next two years, and one of my cousins has already had two stents put in. I’m not too concerned for myself, as the risk factors aren’t present in me: my blood pressure is low, my “bad” cholesterol is very low and my “good” cholesterol is, well, “good” and we know my valves are in fine shape, thanks to a little scare a few years back that turned out to be nothing (except a confirmation of market principles). I do have a bit of stress in my life, but I also have resources for dealing with this.
It should be noted that the Mayo is doing very well under the present system, but it is a credible (if so far largely ignored by the administration) voice for reforming this system. In fact, they have long-since used their experience to make a series of proposals on how to go about doing this, including bringing the market incentives back into the insurance equation — not as a way to increase profits, but to improve healthy outcomes. Right now the only way a health plan or a hospital can improve its bottom line is to “save” money by denying care; a nationalized program would further degrade the system into a lowest-common-denominator approach that rations care. In a fair system, such as the Mayo advocates, where insurers and providers compete for the public’s dollars and confidence (the real “public option” in my opinion) there are rewards for innovation, successful outcomes and a culture of excellence. I hope we all live to see it.
(P.S. My uncle came through his surgery in fine fashion, complete with a new aortic valve that is an advanced hybrid that wasn’t available just four years ago when my father had his surgery. Let’s hear it for progress and innovation — and great skill!)
by the Night Writer
From an article in The Scotsman:
THE cost of Scotland’s flagship free elderly care policy will soar more than threefold to £813 million a year by 2031, a new report has revealed.
A dramatic growth in the number of pensioners over the next three decades will send costs, put at £256 million in 2006, spiralling, Lord Sutherland’s report shows. And the author warns that Scotland must wake up to the huge impact the country’s rapidly changing age profile will have on public finances and services.
Free personal and nursing care was introduced to a fanfare in 2002. It has been hailed as one of the biggest achievements of Scotland’s devolved government, and is the envy of many south of the Border. But the independent review, commissioned by the Scottish Government last summer, reveals the price that such a popular policy will have in years to come.
The report says the bill will far exceed initial predictions – costing hundreds of millions of pounds more – due to the number of elderly people rising more rapidly than was expected.
Lord Sutherland insists the policy, which has attracted widespread political and public support, will be “affordable” in years to come.
The number of over-65s is expected to rise from 837,000 in 2006 to 1.36 million by 2031.
Read the whole thing. Note, however, that no mention is made that it is likely that the number of taxpayers available will also be decreasing as these costs are increasing.
Katherine Kersten has just visited Scotland and wrote today on some of her impressions of the Nanny State.
Actually, I don’t think that that was what the AARP set out to poll, but the stereotype of Baby Boomers as shallow and self-absorbed couldn’t help but be burnished by an article I saw in a daily news bulletin put out by the A.M. Best company. This article (subscription required) covered a press release from AARP describing the overwhelming support among voters for national health care coverage:
Most Baby Boomer-Era Voters Support Universal Health Insurance, AARP Poll Says
WASHINGTON October 10 (BestWire) — Most voters say they are likely to vote for candidates who express support for the concept of national health-care coverage, according to a poll of 1,500 likely voters commissioned by AARP.
More than three-quarters of likely voters — 77% — said they are “very likely” (41%) or “somewhat likely” (36%) to vote for a candidate who supports a plan for national health-care coverage, the seniors’ lobbying group said. Nearly eight in 10 of all of those polled — 78% — said the federal government should ensure that everyone has health insurance. Sixty-one percent strongly agreed.
David Sloane, AARP’s director of government relations, said the polling data show that most baby boomer-era voters are reacting to health insurance becoming less affordable and less accessible. “The voter anxiety reflected in this poll is the result of a system that is inefficient, at the mercy of uncontrollable costs, and is leaving tens of millions of people without health insurance,” Sloane said.
… (snip) …
AARP’s poll surveyed likely voters age 42 and older, finding that nearly all (93%) are registered to vote, and that an overwhelming majority (86%) say they plan to vote next month. Fifty-six percent said they “always” vote, and 31% said they “nearly always” vote. Older voters show up at the polls more consistently than younger ones, according to the poll data, with 65% of those older than 60 saying that they always vote, compared with 50% of those aged 51-60 and 44% of those aged 42-50.
More than half of those surveyed said they are “very interested” in this year’s election. Yet as of Oct. 2, only 47% said they had given “quite a lot of thought” to their choice of candidate. Many remain undecided about both House (60%) and Senate (50%) races.
When asked about health insurance, older voters were more likely than younger ones to vote for a candidate who supports national health insurance. Forty-three percent of those aged 61 and older said they would vote for such a candidate, compared with 46% for those aged 51-60 and 32% of those aged 42-50. More younger voters, those aged 42-50, said they would be “somewhat likely” to vote for a candidate supporting national health care. Only small minorities said they would be “not very likely” to vote for candidates who support such a plan, with 9% of those aged 42-50, 6% of those 51-60, and 9% of those older than 61 agreeing.
I’ll leave it to more experienced poll-busters (Mitch, David, King?) to dig into this, but I have to seriously wonder what kind of sampling went into selecting these 1500 likely voters, and just what questions were asked (and how they were worded). This information wasn’t offered in the original AARP press release, but I’m speculating it was along the lines of “Would you rather use your own hard-earned assets to pay for your healthcare when you’re older or would you like an ice-cream sundae with whip cream and a cherry?” Hmmm, tough choice. Ice cream?
Of course, just about everyone likes ice cream, but the reality of a single-payer, national health insurance system is more like sour cream, neither of which are that good for you. It hasn’t worked in Cuba (unless you’re Fidel Castro, in which case you can apparently live forever), and in Great Britain and Canada it may even kill you, as I posted a couple of weeks ago. Sure, these programs always sound “fair”, especially if you don’t realize how much you’re paying for it (which is the reason our current flawed and counter-intuitive health system has managed to keep tottering forward). The Boomers, most of whom are beginning to realize they’ve underfunded for their dreams of golden retirement (at least they’ve got a killer sound-system and the big-screen plasma tv) are looking for another answer. The problem is they’re only being given a choice between two systems, one just slightly less imperfect than the other. They’re ready to jump at the “something for nothing” deal because that’s what they’ve come to expect as their due, but just wait until they need that hip replacement and have to wait more than a year to get it — or even find out that the government has decided that they’re too old or incapacitated to justify spending any more of its resources on them. This is not a generation that reacts well to being denied.
Okay, I’ll admit that that’s an unfair and extreme characterization of a generation that I find myself in (although at the tail end). What really gets me upset, however, is the proposition that if what we currently have doesn’t work then there’s only one other option. We shouldn’t have to keep propping up this misbegotten and artifical system we currently have, but we definitely don’t need to switch to an even more oppressive and inefficient model (especially when it’s been proven not to work). What we need is a market-driven healthcare system that takes the purchasing power out of the hands of third-party payers or the government and into the hands of the consumer, allowing us to buy healthcare the way we buy groceries or auto insurance.
Will it be easy? No. Will it be painful? Yes. Has this generation ever taken the path that wasn’t easy or that offered pain? Anecdotally, the evidence doesn’t look very good. There’s a lot to be unlearned, and special interest to be overcome, but we’ve got a chance to bite the bullet and do it — and leave a lasting legacy (instead of a curse) for those that come after us.
Along these lines, Policy Guy recommends a book, The Cure: How Capitalism Can Save American Health Care.
If you think healthcare is expensive now, just wait until it is free.
— P.J. O’Rourke
That quote appears in my blog header this week because I’ve been keeping an eye on the Single-Payer Health Bill passed a couple of weeks ago by the California legislature and forwarded to Governor Arnold Schwarzenegger. The Terminator vetoed the bill yesterday but, like his namesake, you can expect that “it will be back.”
The bill would have outlawed all private health insurance in California in favor of a state-run, single-payer system that essentially mirrors the socialized programs of countries such as Canada and Great Britain (two links) and, in the words of Gov. Schwarzenegger, “would require an extraordinary redirection of public and private funding by creating a vast new bureaucracy to take over health insurance and medical care for Californians — a serious and expensive mistake.”
Proponents of the bill say it would actually save the state $8 billion a year in administrative costs, while private health insurance interests released a report that shows that that amount is overstated by $3.5 to $5 billion and that these administrative functions are the industry’s primary defense against fraud and abuse. The private insurers are naturally going to respond strongly to these claims, but even their counter-argument suggests that there may still be as much as $3 billion in administrative costs that could be attacked. Nevertheless, the idea that a state-run bureaucracy with no competive pressure will do a better job of ferreting out abuse and redundancies is counter-intuitive, just as the idea of a “single-payer” is a misnomer since the costs are ultimately extracted from all California tax-payers.
Both sides can readily marshall all kinds of statistics and sound-bites to support their positions. If we only had these to go by, it could be a challenge to try to peer into the future to see what the ultimate impact might be. Fortunately, we don’t have to go by expert opinion or suppositions, we can see the results and unintended consequences such as poor quality care, long waiting lists for necessary surgery and an ever-expanding bureaucracy. The problems in Canada – extolled by some for its artificially reduced drug prices – have become so severe that the New York Times recently reported that an average of one private (and therefore illegal) health clinic per week is opening in our socialized neighbor to the north. The clinics are opening in response to demand from citizens willing to pay out of their own pockets to get needed surgery to improve the quality of their lives. As the head of one of these new clinics stated, “This is a country where a dog can get a hip replacement in under a week and in which a human can wait two or three years.”
I’ve written before (such as in the links in the third paragraph above) that this situation ultimately leads to the government making decisions on who should live and die by rationing or even denying care based on its assessment of costs and quality-of-life issues. There’s also evidence, however, that this isn’t the only way socialized medicine can kill you. Amy Ridenour recently noted that “under socialized medicine, public officials administer a single budget and usually ration care among a population whose sole choice is to take whatever therapies the state monopoly provides” and that “politically driven health care jeopardizes patients’ lives,” citing:
- Breast cancer is fatal to 25 percent of its American victims. In Great Britain and New Zealand, both socialized-medicine havens, breast cancer kills 46 percent of women it strikes.
- Prostate cancer proves fatal to 19 percent of its American sufferers. In single-payer Canada, the National Center for Policy Analysis reports, this ailment kills 25 percent of such men and eradicates 57 percent of their British counterparts.
- After major surgery, a 2003 British study found, 2.5 percent of American patients died in the hospital versus nearly 10 percent of similar Britons. Seriously ill U.S. hospital patients die at one-seventh the pace of those in the U.K.
- “In usual circumstances, people over age 75 should not be accepted” for treatment of end-state renal failure, according to New Zealand’s official guidelines. Unfortunately, for older Kiwis, government controls kidney dialysis.
- According to a Populus survey, 98 percent of Britons want to reduce the time between diagnosis and treatment.
- Emily Morely, 57, of Meath Park, Saskatchewan, discovered that cancer had invaded her liver, lungs, pancreas and spine. She also learned she had to wait at least three months to see an oncologist. In Canada, where private medicine is illegal, this could have meant death. However, Mrs. Morely saw a doctor after one month — once her children alerted Canada’s legislature and mounted an international publicity campaign.
- James Tyndale, 54, of Cambridge, England, wanted Velcade to stop his bone-marrow cancer. However, the government’s so-called “postcode lottery” supplied this drug to some cities, but not Cambridge. The British health service finally relented after complaints from the Tories’ shadow health secretary, MP Andrew Lansley.
- Edward Atkinson, 75, of Norfolk, England, was deleted from a government hospital’s hip-replacement-surgery waiting list after he mailed graphic anti-abortion literature to hospital employees. “We exercised our right to decline treatment to him for anything other than life-threatening conditions,” said administrator Ruth May. She claimed her employees objected to Mr. Atkinson’s materials. Despite a member of Parliament’s pleas, Mr. Atkinson still awaits surgery.
Wouldn’t you just love it if your government decided you were too old — or too politically incorrect — to receive life-saving or life-enhancing care?
My mistake: the bill that Gov. Schwarzenegger vetoed yesterday was a “Wal-Mart” bill similar to the one vetoed by Chicago Mayor Daly earlier this week. Arnold has not officially vetoed the single-payer bill yet, but has written a published op-ed piece in the San Diego Union-Tribune where he stated that he would veto it. He has until September 30 to terminate it.
Last April I posted on the story of Charlotte Wyatt, the British infant whose doctors had gone to court to get a “Do Not Resuscitate” order — over the objections of her parents. The doctors’ petition was granted, and to me it as an example of a socialist state demonstrating that it does indeed believe that it owns the children and is also the final arbiter of what constitutes “quality of life.” There is now more to report on this story and on some interesting developments closer to home.
In Charlotte’s case she is now nearly two and a half years old, despite her doctors’ original opinion that she wouldn’t live but a few months, and their later predictions that she wouldn’t survive each of the many challenges she encountered. (She was born at 26 weeks gestation and today her parents readily acknowledge that she has significant developmental issues; their issue all along is that their daughter has the same right to life as a healthier baby.) The judge’s order was never overturned, but it was lifted by the judge last fall when Charlotte’s improving health made it unnecessary. Charlotte’s parents were able to bring her home for an unsupervised visit last Christmas, and earlier this month the hospital indicated that she might soon be released for good. Now, however, she has caught a cold or picked up an infection in the hospital that has become serious and again the judge has instituted the DNR order.
But little ones cannot keep off infections forever, especially in a hospital and in wintertime, and she caught a cold which quickly began to hamper her breathing. In a normal case when your baby is ill the hospital will step up efforts to help. But Charlotte is special, and instead doctors submitted an emergency application to the judge to get permission not to treat her. Yesturday Justice Hedley concurred with them, reversing his previous order. Apparently the baby was on a “downward rather than an upward trend” and therefore not worth saving.
Never mind the vast improvements she had made, the way she had always made stunning recoveries after each of her illnesses, how she had proven the doctors wrong each time. Never mind that she had shown herself a fighter, and with all the strength in her little body was battling for her chance at life.
After all, she was Charlotte, and Charlotte… Charlotte might always be a disabled child. She might never be quite normal, and her joys might never be quite the same as ours. Disabled people aren’t like the rest of us, and when they are sick…they have to be allowed to die.
What has our grand world come to when we can do this, and still walk the streets without shame? How can we pretend we are innocent of a great crime? –for are indeed guilty to if we do not protest. And the measure of a society is in how it treats her most defenseless.
Or if you are a child with special needs, is it only if you can manage to never be ill, never show weakness, always be impoving that you will be considered worth having around? When it comes to the difficult times, will your life never be worth fighting for?
As in April, from this distance I can offer no perspective on Charlotte’s overall health, medical prospects or quality of life. I stand shoulder-to-shoulder with her parents, however, in saying that her level of care should be up to them and not to the state.
The state’s argument, of course, is that it’s paying the bills and therefore has the right to decide how and when care is appropriated. This position is coincidentally highlighted by this story from the New York Times reporting that an average of one private (and therefore illegal) health clinic per week is opening in our socialized neighbor to the north, Canada. The clinics are opening in response to demand from citizens willing to pay out of their own pockets to get needed surgery to improve the quality of their lives. As the head of one of these new clinics stated, “This is a country where a dog can get a hip replacement in under a week and in which a human can wait two or three years.”
The article also notes that Canada is the only industrialized nation to outlaw privately purchased medical care. The new clinics are encouraged, however, by a Canadian Supreme Court ruling last year that a Quebec provincial ban on private health insurance was unconstitutional when people are suffering and even dying on waiting lists. I suppose if you’re one of those people on a list it’s probably a good thing for you that drugs are so cheap.
But that’s still not the whole story as far as this post is concerned. As Amy Ridenour notes, here’s what one of the leading lights of our own “reality-based community”, Sen. Ted Kennedy, had to say in a speech last year:
…I propose that, as a 40th birthday [of Medicare] gift to the American people, we expand Medicare over the next decade to cover every citizen from birth to the end of life …
… I call this approach Medicare for all, because it will free all Americans from the fear of crippling medical expenses and enable them to seek the best possible care when illness strikes …
… Right-wing forces will unleash false attack ads, ranting against socialized medicine and government-run health care … Today we are immunized against such attacks by the obvious success of Medicare. It is long past time to extend that success to all…
(You can read Kennedy’s entire speech here, but doing so will make you glad you can still buy aspirin over the counter.)
Amy goes on to note that this “successful” plan is currently underfunded for future obligations by $29.7 trillion — more than seven times that of Social Security, and that the system as currently constructed will go broke in 2020, 21 years ahead of Social Security.
We’ve seen what this system leads to in the UK and in Canada, and what is already happening here. And if mental capacity should become a standard for determining whether someone should be resuscitated or not then Sen. Kennedy should look at Charlotte Wyatt and feel humbled … and very, very concerned.
See also, 21st Century British Healthcare.
“Hello, this is ABC Cardiology. How may I help you?”
“Yeah, I’m looking to have a little work done, and I’m calling around to find out what it costs to see one of your doctors and have a couple of tests?”
“What kind of tests?”
“Oh, you know, EKG, stress test, enzyme test, whatever it is you folks do to figure out if something’s wrong with the old ticker.”
“Um, I don’t know what that costs. Let me transfer you.”
“Hello, Coding Department.”
“Yeah, could you please tell me how much a visit with one of your cardiologists costs, and what kind of tests I might expect and how much they cost?”
“Well, I’m not sure I can tell you…”
“Look, it’s like this. I’m thinking it might be a good idea to have someone take a look at me, but I have a high deductible health plan so that means I’m paying for most, if not all, of any visit out of my own pocket and I’m just calling around trying to get some prices for a comparison.”
“Well, let’s see…a consultation is $334 to $432, depending on the amount of time spent.”
“Yow! Is there anyone in town who charges less?”
“No, that’s pretty much the standard Usual, Customary and Reasonable cost accepted by the health plans.”
“So, uh, do you have any coupons or specials this week?”
The above is a composite of the discussions I’ve had recently as I try to follow up after my ultimately innocuous visit to the ER recently. I’m taking this approach for two reasons.
The second reason is that I have more than a passing familiarity with the U.S. healthcare industry as a result of my job and I believe the current third-party payer model, like that found in your employee benefits, is the fundamental reason for the virtually uncontrolled costs of our current environment. The only efficient way to control costs and provide greater access to all consumers is to return to a direct pay of health insurance that puts the individual or family back in charge of determining how the money gets spent – just like they do for everything else that is bought and sold in this country from deodorant to houses. As King or Phil would say, “markets work.”
The approach my wife and opted for is a step in this direction because, in exchange for monthly premiums a couple hundred dollars less than the HMO plan, we’re responsible for the first few thousand dollars or so of our care before the insurance kicks in (a tax-deferred HSA is an important part of this program because this is where you can accumulate and hold the funds to cover your out-of-pocket costs). Theoretically this means I can “shop” for the healthcare that fits my needs and/or budget, just as I might shop for an oil change or new home entertainment system.
The problem is that the U.S. healthcare system is still so indoctrinated into the third-party format that it is hard to bring market forces to bear individually as my vignette above illustrates. It is not presently set up to compete on price, and the suggestion that doctors or clinics might have to do so is greeted by the same slack-jawed incredulity that certain Minnesota judges have expressed now that they actually have to campaign for positions. The world is changing and the healthcare system – and the judges – will learn to adjust.
Some might argue that, as inefficient as our current system might be, it has allowed some very high-tech, life-saving technology to be created and that introducing price competition might diminish this. It seems to me, however, that price competition hasn’t kept the computer industry from leaping ahead with ever-faster, ever-smaller computers and accessories such as iPods, or slowed the development of market-driven, market-demanded goods such as high definition televisions or computer game consoles with more computational power than the Apollo spacecraft.
Switching to a direct-pay health insurance model will be dramatically different than what we’ve become used to over the last 70 years. That doesn’t mean it will be unfamiliar though.
To better illustrate, in an amusing way, how downright stupid and impractical our current model is I highly recommend you read this article from Joseph Bast at the Heartland Institute, entitled “What Hunger Insurance Could Teach Us About Health Insurance.” Here’s an excerpt:
To understand what lies at the heart of the failure of our current health-care financing system, imagine, if you can, what the world would be like if we tried to buy food the same way we buy health-care services.
You could go to work tomorrow morning and hear your boss tell you the following: The company has decided to offer a new benefit: hunger insurance. The company will purchase a hunger insurance policy for you that covers about 95 percent of your food costs whenever you enter a grocery store or restaurant, and a smaller share of the miscellaneous snacks and condiments you purchase from street vendors and the corner drugstore. To pay for the new benefit, the company will withhold some of your pay—about $100 a week or so.
Effect on Consumers
What effect would hunger insurance have on you, a consumer of food? If you’re like me, you will probably start to eat more . . . and eat better, more expensive foods. Why eat hamburger when you can have tenderloin? Why settle for beer when the finest wines cost you just as little? Why eat at McDonald’s when you can eat, for nearly the same price, at Chez Paul?
If there were such a thing as hunger insurance, some of us would stop checking prices before we ordered food, just as we don’t check prices when we ask for medical treatment. Some of us would order fancy and expensive foods that we wouldn’t order if we really had to balance the price against the improved taste . . . just as we order unnecessary and expensive tests to get just a little more peace of mind.
And if there were hunger insurance, some of us would overeat until we were so round and fat that our health was endangered, just as we see millions of people in America asking for and receiving unnecessary surgery and medication that actually endangers their health.
Effect on Providers
What effect would hunger insurance have on the providers of food? Put yourself in the shoes of a grocery store manager. You would start stocking more caviar and less Cheese Whiz, wouldn’t you? Rather than lose customers to fancier (and more expensive) establishments, you would carpet your aisles, hang chandeliers in the lobbies, and have distinguished-looking fellows with white gloves push people’s carts down the aisles!
Every grocery store would offer an impressive array of products, from the very finest meat department to the best stocked liquor counter (providing state law allowed it). That the store next door has the same expensive freezers and wine cellar matters not at all: Cost, you understand, is no object. “Overinvesting in new technology,” you ask? Hey, the insurance company pays for it all! And if we don’t offer it, customers will cross the street and shop there.. You know you would.
What if you were a lousy grocery store manager who just couldn’t keep costs down and quality up? Before hunger insurance came along, you would be forced out of the market by stores managed by sharper people able to cut costs without sacrificing quality. Customers wouldn’t patronize your establishment, and you’d be out of business. But with hunger insurance, you can pass along your higher costs to the insurer, so the customer never knows how inefficient you are! So you get to stay in business despite your inefficiencies. Out of gratitude, you may even spend a little money lobbying to make sure hunger insurance is always available!
If there were such a thing as hunger insurance, the price of food would begin to soar, just as the price of health services has steadily risen faster than the price of other goods and services. Financed by hunger insurance companies, grocers and restaurateurs would sell more food and of a fancier variety than if they faced customers who paid with their own money, just as health-care practitioners today are free to overtreat and overprescribe. Food sellers would over-invest in expensive and under-utilized equipment and pass the cost along to the insurers, just as hospital administrators today buy too many MRIs and CAT scanners and pass along the expense to health insurers. And inefficient, low-quality providers of food would stay in business rather than be forced out by better competitors, just as high-cost providers of health care are tolerated in today’s health-care marketplace.
Effect on Insurers
What would happen to insurers if hunger insurance were provided? The premiums they charged at first were based on past levels of food consumption and prices. As consumption expands and prices rise, insurers have to raise their premiums again and again. The exploding number of insurance claims buries them in paperwork. The businesses that pay the insurance premiums will, of course, be outraged by all this. “Find a way to control these rising costs !” they will demand. “The rising cost of hunger insurance is making us less competitive with businesses in other countries!”
The insurers will hire an army of “managed-eating” experts who will search the grocery bags of the insured for signs of unnecessary products, just as today’s health insurers have hired experts in “managed care” to review health services utilization. People will resent this intrusion into their personal dietary habits, just as they resent the managed care experts second-guessing their health concerns. People with hunger insurance will find ingenious ways to avoid the managed-eating experts, and the eventual results will be higher, not lower spending . . . just as businesses with managed-care programs today are discovering.
Effect on the Uninsured
Some people in our imaginary world will be uninsured: They won’t have hunger insurance because their employers are too small to afford to offer this new benefit, or because they are self- employed or unemployed. Or, in their effort to control costs and make money, some hunger insurers will refuse to cover people who are high food-risks—the hoarders, the people with exceptionally delicate palates, and the bulimics. They will offer cheaper rates to others: beer-drinking football fans, people who can’t smell, and anorexics.
The uninsured will be hurt the most by hunger insurance because they will see the price of food bid up and out of reach by those lucky enough to have hunger insurance. The foods that were once plentiful and inexpensive will now be unavailable or high-priced, just as health insurance has replaced inexpensive general practitioners with expensive specialists, and inexpensive but slow-working therapies with expensive but quick surgical procedures.
Those who lack hunger insurance will be seen standing with their noses pressed to the windows of our beautifully carpeted and chandelier-lit grocery stores and restaurants, just as millions of Americans today crowd the emergency rooms of state-of-the-art hospitals whose beds are between one-third and one-quarter empty.
Effect on Elected Officials
What would happen to our elected officials if hunger insurance existed? Civil rights activists and well-meaning people without much understanding of economics would campaign against for-profit hunger insurers, denouncing them for being heartless in their discrimination against people with eating disorders. They would condemn them for profiting from the provision of something so fundamental to human life as food. “Food is a right, not a privilege,” they would say. “The high administrative costs of the hunger insurers are what is causing the problem. We should abolish private hunger insurance companies and replace them with a single provider of food.”
And since experience will have so convincingly shown that the current hunger insurance system is inefficient and unjust, our enlightened elected officials would eventually yield to the public’s demands and pass “play or pay,” forcing businesses to buy hunger insurance for all their employees, or “national hunger insurance,” where government acts as the single payer of all hunger insurance claims.
The nation will face a difficult choice: Either abandon the idea that all food should be paid for by hunger insurance, or impose draconian rationing measures, price controls, and restrictions on new investments in food processing and delivery technologies. If we can judge by what is happening today in the health-care arena, the advocates of rationing will dominate the debate.
Commissions will spring up everywhere to determine whether a carrot is more valuable to the community’s welfare than a grape, and a grape more valuable than a banana; just as commissions are being created at this very moment to decide whether capping 1,000 teeth is “worth more” than extending a person’s life for one week by kidney dialysis. The issue will be addressed as if justice and virtue, rather than economics and incentives, were at the heart of the issue.
Read the whole article for details on how this transition can take place.
(Monty Python and the Holy Grail, Scene 2)
CART MASTER: Bring out your dead!
CUSTOMER: Here’s one.
CART MASTER: Ninepence.
DEAD PERSON: I’m not dead!
CART MASTER: What?
CUSTOMER: Nothing. Here’s your ninepence.
DEAD PERSON: I’m not dead!
Terminally Ill Can Be Starved to Death, UK Court Rules
By Nicola Brent, CNSNews.com Correspondent, August 02, 2005(CNSNews.com) – An appeal court has denied a terminally ill British man the assurance that his wish not to be starved to death once he becomes incapacitated will be respected to the end.
Former mailman Leslie Burke, 45, has a progressively degenerative disease that although leaving him fully conscious, will eventually rob him of the ability to swallow and communicate.
He petitioned the High Court last year to ensure that he would not be denied food and water once he was no longer able to articulate his wishes.
CART MASTER: ‘Ere. He says he’s not dead!
CUSTOMER: Yes, he is.
DEAD PERSON: I’m not!
CART MASTER: He isn’t?
CUSTOMER: Well, he will be soon. He’s very ill.
DEAD PERSON: I’m getting better!
CUSTOMER: No, you’re not. You’ll be stone dead in a moment.
Burke won that right when judge James Munby ruled that if a patient was mentally competent — or if incapacitated, had made an advance request for treatment — then doctors were bound to provide artificial nutrition or hydration (ANH).
But last May, the General Medical Council (GMC) — the medical licensing authority — took the case to the Appeal Court, arguing that doctors had been placed “in an impossibly difficult position.”
The appeal judges have now agreed, overturning the High Court judgment and upholding GMC guidelines on how to treat incapacitated patients.
CART MASTER: Oh, I can’t take him like that. It’s against regulations.
DEAD PERSON: I don’t want to go on the cart!
CUSTOMER: Oh, don’t be such a baby.
CART MASTER: I can’t take him.
DEAD PERSON: I feel fine!
Those guidelines give doctors the final say in whether a patient should be given life-sustaining “treatment,” a term legally defined to include artificial feeding or hydration.
The latest ruling obliges doctors to provide life-prolonging treatment if a terminally ill and mentally competent patient asks for it.
However, once a patient is no longer able to express his or her wishes or is mentally incapacitated, doctors can withdraw treatment, including ANH, if they consider it to be causing suffering or “overly burdensome.”
Ultimately, the court said, a patient cannot demand treatment the doctor considers to be “adverse to the patient’s clinical needs.”
CUSTOMER: Well, do us a favour.
CART MASTER: I can’t.
CUSTOMER: Well, can you hang around a couple of minutes? He won’t be long.
CART MASTER: No, I’ve got to go to the Robinsons’. They’ve lost nine today.
CUSTOMER: Well, when’s your next round?
CART MASTER: Thursday.
DEAD PERSON: I think I’ll go for a walk.
Anti-euthanasia campaigner and author Wesley Smith told Cybercast News Service it was important Burke had taken the case to court because “it is now clear that a patient who can communicate desires cannot have food and water withdrawn.
“That is a line in the sand that is helpful.”
However, he added, the judgment had “cast aside” those who were mentally incompetent or unable to communicate their wishes — “those who bioethicists call non-persons because of incompetence or incommunicability.
“I believe that the judgment clearly implies that the lives of the competent are worth more than the lives of the incompetent since doctors can decide to end life-sustaining medical care, including ANH,” said Smith, a senior fellow at the Discovery Institute and author of Culture of Death: The Assault on Medical Ethics in America.
Burke was quoted as saying in reaction to the ruling that it held “no good news at all” for people who shared his concerns.
In the light of public health service cuts and underfunding, Burke said he was worried about “the decisions that will have to be made” by doctors in the future.
“I have come to realize that there are quite a few people who feel the same way I do,” the Yorkshire Post quoted him as saying. “Not everyone wants to be put down. Not everyone wants their life to be ended prematurely.”
CUSTOMER: You’re not fooling anyone, you know. Look. Isn’t there something you can do?
DEAD PERSON: [singing] I feel happy. I feel happy.
[Cart Master hits him in the head.]
Responding to the court’s ruling, the GMC said it should reassure patients.
The council’s guidelines made it clear “that patients should never be discriminated against on the grounds of disability,” said GMC President Prof. Graeme Catto in a statement.
“We have always said that causing patients to die from starvation and dehydration is absolutely unacceptable practice and unlawful.”
A professor of palliative medicine at Cardiff University, Baroness Ilora Finlay, supported the court ruling. “Stopping futile interventions allows natural death to occur peacefully,” she argued in a British daily newspaper. “This is not euthanasia by the back door.”
But the Disability Rights Commission (DRC) took a different view.
The commission was one of several campaigners, including right-to-life activists and patients’ groups, which had strongly supported Munby’s earlier ruling.
DRC Chairman Bert Massie expressed the group’s dismay at the Appeal Court decision, saying it did nothing to dispel the fears of many disabled people that “some doctors make negative, stereotypical assumptions about their quality of life.”
It had also “totally ignored” the rights of those who were unable to express their wishes, he added.
CUSTOMER: Ah, thanks very much.
CART MASTER: Not at all. See you on Thursday.
The Night Writer’s vote for the funniest line: “Ultimately, the court said, a patient cannot demand treatment the doctor considers to be ‘adverse to the patient’s clinical needs.'” You mean, such as, “Please don’t starve me to death?”
See also Suing to Stay on Life Support.
(Monty Python and the Holy Grail excerpt available here.)