Patient Power

SCHIP director: SCHIP lacks “actual evidence of the benefits for children”

July 9th, 2008 by Brian T. Schwartz

Via Michael Cannon at Cato-at-Liberty:

Like other advocates for children’s health, I have an almost religious conviction that the State Children’s Health Insurance Program (SCHIP) is effective public policy. … Although I have no empirical evidence to support the assertion that SCHIP is a beneficial and effective way to invest in children’s health, I worked to expand the program. … The lack of actual evidence of the benefits for children is simply damning to the program.

— Mitch Roob, Director, Indiana Family and Social Services Administration

Mr. Roob wrote this in a letter published in the July/August issue health policy journal Health Affairs. Here are some more excerpts:

I was not able to base this expansion on empirical evidence because there is none. In the past decade, a study has never been conducted to determine whether SCHIP actually improves the overall health and well-being of children. In Health Affairs in 2007, Genevieve Kenney and colleagues (Mar/Apr 07) stated, “The evidence on the effect of SCHIP on children’s health and function is mixed.” The lack of actual evidence of the benefits for children is simply damning to the program.

There is a large body of research on the positive effects that health insurance coverage has on the overall health and well-being of adults, and it is past time for the same effort to be placed on children’s health. Public policy-makers need more than just a conviction that SCHIP works and is worthy of public investment. We need facts.

I admire Mr. Roob for his honesty and courage.  Michael Cannon’s comments are precious:

Wow.  I mean, wow. 

I see three possible outcomes.  One, all that cognitive dissonance causes Roob’s head to explode.  Two, the Church hierarchy dispatches its goons to burn this heretic at the stake for noticing that their god has no clothes.  Three, the Left decides “to hell with it,” admits that it has a religion, and files for tax-exempt status.

This brings to mind philosopher Mike Huemer’s article, Why People Are Irrational About Politics. 

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Posted in Medicaid/Medicare/SCHIP | tags: SCHIP, Statism
1 Comment »

Equality and health care

July 8th, 2008 by Brian T. Schwartz

Socialist politician Aneurin Bevan, father of Britain’s National Health Service (NHS), has stated that “everyone should be treated alike in the matter of medical care” and that “the essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged.”  This is a common sentiment behind the push for politically-controlled government-run health care.  But do such systems achieve this goal?

A physician wrote to Paul Hsieh at the FIRM blog:

In order to ration funds the radiology department closed the MR scanner at 5 pm even for emergencies. One evening however I was paged interpret an emergent MRI. A member of parliament had developed acute back pain and we fired up the MRI scanner and performed the study. He happened to be the head of the NDP (New Democratic Party). The NDP is the socialist party and evolved from the CCF party. The CCF party was founded by Tommy Douglas, the original creator of Medicare!

Dr. Hsieh also cites a National Post article with the following lead:

When his five-year-old daughter’s bone scan revealed a tumour that might be cancerous, the man who is now president of the Canadian Medical Association decided to jump the queue. …

He admits he himself used the system when he needed knee surgery, jumping a long queue to get the procedure done within a week by a surgeon who was also his friend.

It’s not realistic, Dr. Day believes, to expect people not to use their connections to jump the queue when their own or their family’s health is at stake.

The Guardian reports that in England,

Generally speaking, the poorer you are, and the more socially deprived your area, the worse your care and access to it is likely to be.

For more, see 20 Myths of Single-Payer Health Insurance (Myth 2).

(via FIRM)

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Posted in morality, myths & fallacies | tags: fairness
1 Comment »

“Union employees don’t pay health insurance premiums”

July 7th, 2008 by Brian T. Schwartz

An article from the Rocky Mountain News last week suggests why unions support employer-sponsored insurance:

Qwest Communications and its largest union start new contract talks Tuesday, negotiations especially critical given the upcoming Democratic National Convention in Denver.  … The Communications Workers of America represents roughly 21,000 employees, or about 55 percent of Qwest’s work force. … Currently, union employees don’t pay health insurance premiums, but they do have co-pays and other costs, such as shared premiums for family members.

I suspect that union officials negotiated this arrangment with Qwest, and that their ability to do this gives employees more incentive to join the union.  Employer-sponsored insurance exists largly because the tax code makes it tax exempt, so it’s likely that unions support this policy as a method of increasing their negotiating power and attractiveness to employees.  If unions had their way, I wonder if they’d push for a tax policy that favors employer-sponsored auto-insurance, too.

As I’ve written before, employer-sponsored insurance offers few choices in plans, locks people to their jobs, and reduces insurer’s incentive to please customers because of the job lock.

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Posted in insurance, tax code, HSAs | tags: employer-sponsored insurance, unions
No Comments »

Jefferson, rights, and health care

July 4th, 2008 by Brian T. Schwartz

In honor of Independence Day, it is appropriate for today’s post to concern the primary author of the Declaration of Independence, Thomas Jefferson.  After all, Patient Power is the health care blog of the Independence Institute.

Via a web search, one of the first pages I found was from RightToHealthCare.org, which attempts to use a quote by Jefferson to support their claim that health care is (surprise) a right:

“If we’re going to have a successful democratic society, we have to have a well educated and healthy citizenry”. — Thomas Jefferson [allegedly]

In this straightforward way Thomas Jefferson expressed the theme that underlies most of the arguments in this pamphlet and did so very early in our nation’s history. … We argued that the Right to Education is a legitimate model for the Right to Health Care. We have also provided some background about the historical opposition to both the Right to Education and, now, the Right to Health Care and wrote about the broad education and struggle that would be necessary to get the Right to Health Care widely acknowledged - to make it a right which we could all demand and protect.

For sake of argument, I’ll entertain the notion that Jefferson actually wrote or said the above quote.  I could not find the phrase healthy citizenry in the electronic texts hosted by The University of Virginia’s Jefferson Digital Archive.  Nor could I find the words healthy and educated close together.  Google wasn’t much help, either.

But what if we implemented the “right” to health care in the same way government enforces the alleged “right” to education?  Does this mean being healthy would be compulsory, as government-approved education is?  After all, Jefferson says the citizenry must be “healthy” for a “successful democratic society.” 

Read the rest of this entry »

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Posted in morality | tags: rights
No Comments »

Overtreated with Medicare

July 3rd, 2008 by Brian T. Schwartz

According to the OECD, patients in the United States pay only 13% of their medical expenses out of pocket (as of 2005).  This is equal to the United Kingdom, and less than Canada, both of which have (nominally) single-payer health care.  The consequence of patients spending so little for their own health care is that our health “insurance” is really insulation.  Consquently, patients over-consume by spending too much of other people’s money on ineffective medical care.

Case in point, the New Mexico Business Weekly reports:

The “Dartmouth Atlas of Health Care 2008,” a study released in April by the Dartmouth Institute for Health Policy & Clinical Practice, has shown dramatic regional differences in Medicare spending on chronically ill patients. The study went on to conclude that higher spending, more specialists and more days in the hospital do not mean better outcomes or better ongoing primary care.

The study found that patients with serious conditions who are treated aggressively for their illnesses don’t live longer or enjoy a better quality of life than those who receive more conservative treatment.

In an earlier publication, Dartmouth researchers found that

a large component of Medicare expenditures — $26 billion in 1996 dollars, or nearly 20 percent of total Medicare expenditures — appears to provide no benefit in terms of survival, nor is it likely that this extra spending improves the quality of life.

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Posted in Medicaid/Medicare/SCHIP, physicians & medical quality | tags: Medicare, Overtreated
No Comments »

Employer mandate in Colorado

July 2nd, 2008 by Brian T. Schwartz

The Denver Post reported last week that the United Food and Commercial Workers Local 7 is pushing a ballot initiative (currently “Ballot Proposal 92“) that would make criminals out of any Colorado company for not buying their employers insurance.  Companies employing fewer than twenty people are exempt.^*

The Union calls it the initiative ”Employee Responsibility for Health Insurance.” I’d call it

• a self-serving attempt to give unions more bargaining power
• an intolerant and authoritarian attempt to make criminals out of people who fail to do what you want them to do by threatening them with government punishment
• a violation of the rights of employers to run their business according to their own best judgement
• a naive and economically illiterate proposal that ignores the unintended consequences of government controls over our choices.

Remember that employer-sponsored insurance locks people to their jobs and offers patients few choices of plans.   The tax code that subsidizes employer-sponsored insurance is also responsible for insurance companies having little incentive to please patients, and for “insurance” acting like prepaid health care, which encourages over-consumption and discourages providers from competing on price.

And do employees benefit?  In their book Healthy Competition, Michael Cannon and Michael Tanner argue that they do not:

The drawbacks of employer mandates outweigh any benefits.  The amount of compensation each worker receives is a function of her productivity.  Mandating an increase in a worker’s compensation (through the provision of health insurance) increases the employer’s operating costs, but does nothing to increase the worker’s productivity.  Employers therefore must find ways to offset the added costs imposed by the mandate.  Their options includeraising prices (which is unlikely in a competitive market), lowering wages, reducing wage increases, reducing health benefits (e.g., drug coverage, retiree health benefits) reducing other benefits (e.g., pensions), instituting layoff, initiating automation, reducing hiring, hiring ineligible workers, out-sourcing, and refusing to comply with the law.  Noncompliance with Hawaii’s mandate has been significant.

Instead of perpetuating our foolish employer-based system, unions should support policies that empower workers rather than themselves.  For example, see here.

Read the rest of this entry »

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Posted in Colorado, insurance, tax code, HSAs, regulation | tags: employer mandate, employer-sponsored insurance, unions
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Dehumanizing doctors

July 1st, 2008 by Brian T. Schwartz

Problem: Doctors may stop seeing Medicare patients because the reimbursement rates are so low.

The solution?  At least one blog commenter wants to make Medicare the only game in town so doctors either put up or shut up. 

Bloomberg News reports:

James King, a doctor in Selmer, Tenn., doesn’t take new Medicare patients. More physicians may do the same if Congress can’t find a way to block a scheduled cut in Medicare fees that begins Tuesday, he said.

With physician reimbursements set to drop 10 percent, doctors will begin evaluating whether to stay in Medicare, said King, 53, president of the American Academy of Family Physicians. He stopped accepting new Medicare patients last year when cuts were last considered.

And from U.S. News and World Report:

Read the rest of this entry »

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Posted in Medicaid/Medicare/SCHIP, morality, physicians & medical quality | tags: Medicare
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Overtreated with unnecessary CT scans

June 30th, 2008 by Brian T. Schwartz

The New York Times reports on how expensive CT scans for heart disease are often unneccessary, and relates one case where the patient probably did not need the scan:  The doctor “said the scan would be valuable anyway because it might reassure him. And his insurance would cover the cost.”  

I understand the motivation to want reassurance.  But that’s a lot easier to ask for when insurance covers it, so it appears free to the patient, or prepaid through his insurance premiums.   Yet, our tax system subsidizes insurance, so we are more likely to buy policies that resemble prepaid medical care that insulates us from the true costs of wanting reassurance.

Read the rest of this entry »

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Posted in insurance, tax code, HSAs | tags: Overtreated
3 Comments »

Operation Walk Denver

June 27th, 2008 by Brian T. Schwartz

Last week the Denver Post published an opinion piece about the charitible organization, Operation Walk Denver:

Operation Walk Denver is an all-volunteer team of surgeons, anesthesiologists, nurses, physical therapists and other staff who surrender a week of vacation to cross time zones and language barriers, helping those crippled by bone and joint disease.

It’s not hard to imagine a charitable organization like this that operates primarily in the United States or even within Colorado.   Yet, Medicaid and other government charities unfairly compete with such voluntary charities, as donors (taxpayers) go to jail for not donating.  A tax credit for such donations would help level the playing field, which I write about here.

Given that physicians voluntarily donate their time and abilities to assist those in need, I can imagine that some of them would find “the right to health care” offensive — as if someone’s need entitles them to the time and skills physicians invested several hard years of their lives to acquire.

Posted in Colorado, charity |
No Comments »

When government controls health care, it controls you

June 26th, 2008 by Brian T. Schwartz

Richard Ralston, director of Americans for Free Choice in Medicine, makes this point in a recent article.  An exerpt:

Would a complete government monopoly in medicine create a system in which politicians care primarily about you? Or about their spoils system? Would your disease be politically correct and place you first in the line for rationed medical care? Or last? Or would newly powerful national medical unions always be first in line? As in Great Britain, would you be denied treatment for some conditions because you smoke, are too old [example, example] or too fat? We had better think that through, because once the government has taken from “the mouths of labor the bread it has earned” to pay for such a system, it won’t care.

Case in point, in addition to to the links above:

• In April, the Telegraph reported that “Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives.”
• From the New York Times earlier this month: “Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups.”
  …”Those exceeding government limits … steered toward further re-education.”

(Via FIRM)

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Posted in Policy - National | tags: choice, rights
No Comments »