If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their own practice.
Dr. Parkinson relates his experience with an allergy specialist who he paid directly, rather than with insurance. He compares his treatment with what the specialist would have done had he been paid through Dr. Parkinson’s (the patient’s) insurance.
Michael Tanner reviews a few of Barack Obama’s promises about the health control legislation (HR 3590) in a New York Post article:
“The bill doesn’t come close to giving “everybody” access to coverage.”
“Even further from reality is the president’s continued insistence that the new law is ‘reducing costs.’”
“Anyone who thinks that their insurance premiums will be going down in the foreseeable future is going to be disappointed.”
“Obama seems to have dropped one of his claims: the promise that if you have health insurance you like, you can keep it. Apparently, not even he could keep that one up with a straight face.”
Jane Norton is seeking the Republican Party’s nomination to run for U.S. Senate this Fall. The Denver Post’s eidtorial board interviewed her in July. Here’s the published section on health care:
Q: What about health care spending? What would you do there?
A: My first agenda . . . would be to repeal Obamacare. A $2.5 trillion proposal, the more and more we see what it does, the more onerous it is on our small businesses. We could pass substantive health care reform right now that would get at the goal of bringing the cost of health care down. You have to look at the drivers of health care costs. One of them is defensive medicine. So there’s a line or two [in the bill] but nothing substantive about tort reform so what we’ve done in Colorado was to put caps back on non-economic damages. We know that’s one of the drivers and that helps. So tort reform.
Tax liability. One of the fastest-growing areas if we have any job growth is with individuals who are setting out on their own. We need tax equity so that a person who purchases health care has the same tax benefit as somebody who purchases it in a group. Portability, so if you changed jobs you could take your health plan with you. The ability to purchase across state lines is another important one that I believe would bring the cost of health care down. If you inject choice and competition into the marketplace and don’t have so many market distortions, you can actually bring the cost down.
Comments: She’s right about ObamaCare (HR 3590). Be careful about defensive medicine, and she’s right about the tax treatment of insurance and buying insurance across state lines. Though she should not conflate “health care” with “health insurance” as she does above, as they are quite different.
Surprise, a tax-funded health insurance program encourages employers to stop offering their employees coverage. More people become dependent on a government program for health insurance, which then results in a constituency that supports the program. Government dependency grows again, and politicians gain more power over our lives. The Boston Globereports:
The relentlessly rising cost of health insurance is prompting some small Massachusetts companies to drop coverage for their workers and encourage them to sign up for state-subsidized care instead, a trend that, some analysts say, could eventuallyweigh heavily on the state’s already-stressed budget.
…
Come 2014, when the bulk of the federal health care law goes into effect, the penalties for small companies that do not provide health insurance coverage will be less onerous than those in Massachusetts. That could tempt more small companies to opt out nationally, sending more workers to the public rolls — if health care costs can’t be restrained, some analysts said.
“Struggling business don’t necessarily feel the need to offer coverage to attract workers,’’ said Kaiser’s Levitt.
Massachusetts has not decided whether to adopt the federal rules for small businesses.
The federal law does not impose any penalty on companies with fewer than 50 employees that do not offer coverage, whereas in Massachusetts, employers with more than the equivalent of 11 full-time employees face fines for not offering a health plan and contributing at least 20 percent toward that coverage. But for companies with more than 50 workers, the federal law comes down a lot harder than does the state law.
Scratch a health care “reformer” and you’re likely to find a health care exploiter. As ObamaCare’s provisions and taxes begin and resistance builds through lawsuits and state-level measures, it’s important to see the exploitative motives driving increased political control of your medical care. Health control advocates won’t stop with ObamaCare (HR 3590). “Once we kick through this door, there’ll be more legislation to follow,” said House Speaker Nancy Pelosi.
Whether health control supporters demand that all policies include certain benefits or that everyone must buy government-approved insurance or something like “Medicare for all,” the policies don’t follow from the alleged justifications for them. But they do follow from one motive: charity at gunpoint. That is, forcing you to finance other people’s medical care. This is exploitation. It’s about time freedom advocates reclaim this term often misused by the left, as so-called health care “reform” is a clear case of exploitation.
Berwick’s view of rationing is, in fact, the opposite of [Paul] Ryan’s. The latter believes it should be driven by the informed decisions of consumers in a free market, while our new CMS head has summed up his contempt for the intelligence of patients as follows: “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”
The hidden premise here is that if doctors, patients, and insurers are free to contract with each other as they please, they won’t do what Donald Berwick wants. To authoritarians like Berwick, we’re all pawns to be used by the “leaders.” As economist Frederic Bastiat wrote in The Law (1850):
Socialists look upon people as raw material to be formed into social combinations. This is so true that, if by chance, the socialists have any doubts about the success of these combinations, they will demand that a small portion of mankind be set aside to experiment upon.
Berwick’s comment also reveals ignorance about how free markets work. No single person, or group of “leaders” knows how to configure a health care system. They do not even know how to manufacture a simple wooden pencil. See Leonard Read’s classic I Pencil. Or watch Milton Friedman explain:
Berwick praised the heavy-handed rationing methods of Britain’s National Institute for Health and Clinical Excellence (NICE) and said, “The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open.”…
Before Obama picked him to be our new Medicare czar, Berwick was the chief executive officer of an outfit he founded called the Institute for Health Care Improvement (IHI). IHI bills itself as a nonprofit charity, but it seems to do an awful lot of work on behalf of for-profit entities. As CEO of this enterprise, Dr. Berwick earned a cool $2.3 million in 2008. But, more to the point, IHI will provide him with private health care coverage during his declining years: “The Institute created a postretirement health benefit plan for its chief executive officer (CEO). It provides the CEO and his spouse medical insurance from retirement until death.”
In other words, Dr. Berwick has made sure that he and his wife will never be subjected to the tender mercies of Medicare, the health care program for seniors over which he now has control. Thus, even after he has implemented rationing programs modeled after those of NICE, he won’t have to worry about his wife suffering for lack of drugs deemed too pricey by some obscure comparative effectiveness calculation.
The arrogance of government officials like Berwick is astounding in a two-fold way.
First, they believe they are qualified to set draconian rules over the lives of the citizenry, because we are unable to make such decisions for ourselves. The typical excuse given is that it’s for our own good or for some nebulous “common good”.
But by exempting themselves from their own rules, they recognize (at some level) that these rules are actually bad for the individuals involved — but they don’t care.
Paul mentions environmentalists who jetset around the globe advocates of gun control who have bodyguards or exempt themselves from gun bans. Read more here. To add to Paul’s examples, there are the politicians, like president Obama, who support the government school monopoly but send their kids to private schools.
Will Anthem act like a slumlord health insurer if the CO Division of Insurance forbids them from increasing rates? The Denver Post reports that Colorado authorities are still deliberating about whether to permit Anthem to increase premiums. It’s taken as a given that government officials have a right to interfere with what should be private transactions in this way. My guess is that forcing Anthem to keep premiums down will encourage them to skimp on customer service, their network, and other expenses. That is, they’ll act like insurance slumlords, just as landlords respond to rent control.
Recent advances in biotechnology have allowed private companies to offer affordable genetic testing directly to consumers, to help them determine their risks of developing problems such as diabetes, heart disease, and various forms of cancer. In response, the U.S. government has told these companies that their tests must be approved by FDA regulators before they can be sold because, in the government’s words, “consumers may make medical decisions in reliance on this information.”
These restrictions thus represent a new level of government paternalism over the citizenry. In the name of “protecting” us, the government seeks to prevent willing consumers from learning medically useful information about their own bodies that could tell them which diseases they may develop — and help them make important treatment, prevention, and lifestyle decisions.
Last month, Apple released its new iPhone, a faster and more powerful version of its ever popular computer-phone. It’s a remarkable device - particularly remarkable given that its machine ancestors were large and expensive, often filling whole buildings yet able to crunch fewer numbers than your average “app”. But, thanks to careful government planning and strict regulations, the computer industry has evolved at an extraordinary pace, from multi-ton mainframe to cool, hand-held gadget.
Except, of course, the smartphone revolution has been unguided by the hand of government planners. There is no central committee to steer consumers towards good hand-held devices and away from bad knock-offs. And that, in a nutshell, is the problem with President Obama’s appointment of Dr. Donald Berwick, a Harvard pediatrician and health-policy expert, to run the Centers for Medicaid and Medicare Services. To Dr. Berwick, there are two worlds: one in which brilliant intellects like - say - Dr. Berwick turn chaos into order, and our current health care system, where blind chaos rules.
