Taxation without representation. That was one of the sparks that ignited the American Revolutionary War. The American Colonists were tired of being taxed by a government in which they had no representation. King George and the British Parliament were not necessarily out to get the American colonists. But the Americans did not have elected representatives to speak for their interests or protect their rights and for this reason they sought independence.
In the final days of the health care reform bill, millions of Americans are no longer represented in the House or Senate. All illusions of bipartisanship have been thrown aside as Democrats have seized control of the bill and excluded Republicans and the states and districts they represent from the discussion. Unless a posturing moderate like Olympia Snowe votes in favor of the bill, not a single Republican voter will have been represented in health care reform.
Health care reform was supposed to be a great collaborative process. President Obama and the House and Senate Democrats promised involvement from both major political parties and all parts of the health care industry. Everyone would be involved in developing a solid and comprehensive health care reform. Yet, in the final hours, not just Republicans have been excluded. Health care providers and insurers, those who had the most to offer in drafting the bill, find themselves on the outside looking in on health care reform.
In the early days of the debate, many doctors showed lukewarm support of the proposed ideas despite the loss of independence they were likely to suffer. Doctors did have two major priorities for health care reform: medical malpractice tort reform and updating of the antiquated SGR formula that determines physician reimbursement for Medicare Part B. Sure, reform health care, many said. While you're at it, just make sure that we get paid for our work and don't have our earnings stripped by the judicial system.
Not only will the final version of the bill introduce a new nightmare of bureaucracy and host of middle men, but medical tort reform and updating of the SGR will not be included. They never even made it out of committee.
The health insurance industry is the industry that will most be affected by the legislation. It had even less involvement in any collaboration process. From the beginning of the debate, insurance companies were branded by the President and Democrats as crooks. Democrats said the health insurance industry was ripping off Americans, pocketing hard-earned money while denying claims. They needed to be taken over. America swallowed the bait, despite reports showing narrow profit margins by the industry. With the final legislation, the government takes over the health insurance industry.
How can the rights and interests of physicians, insurers, and conservatives in general be represented if they have no part in the legislative process? What sort of bill is written when the legislature does not represent its constituents? We're about to find out. Using the bill that came out of the house, we can make a pretty good guess. The bill is designed to insure all Americans. It helps pay for those who can't afford insurance and criminalizes those who don't want to buy it. It is estimated to cost $894 billion over the next 10 years. Here's who will pay for it:
1) The bulk of this sum will come from the wealthy- individuals who make over $500,000 a year or families who make over $1,000,000. These individuals will have an additional 5.4% tax added to their already considerable 35% federal income tax.
2) Also footing the bill are doctors and hospitals who will be reimbursed even less for Medicare and Medicaid.
3) An honorable mention goes to the insurance companies, whose contributions are not being figured into the $894 billion, but whose cooperation allows the price tag for the bill to be as low as it is. They will be offering special low-priced premiums to all of America while the Legislature holds them at gunpoint. How long these premiums can be maintained before the industry goes bankrupt remains a question.
4) Consideration is currently also being given to those who are already insured with expensive comprehensive plans. Although it may not make sense to the general public why patients with health insurance would be taxed in order to provide health insurance to patients, Democrats are currently working it into the bill.
The Democrats have put together a health care reform bill that does not represent anyone in the health care industry, that threatens to bankrupt health insurers, and that is currently supported by less than half of America. This is the sort of representation they have provided. Instead of thoughtfully voting on a well-crafted collaborative bill, they will try to push through a half-baked, unread 1000+ page piece of legislation this weekend.
I realize that this is not the first time one party has overrun the legislature and left others in the dust. However, Democrats have pitted Americans against each other in a game of winners and losers that is contrary to American Philosophy and rights of representation fought for in the Revolution. Instead of protecting rights or even implementing a more efficient process, they simply take from one group to give to another. They would create prosperity through robbery. They try to stabilize the economy through a smash and grab operation.
Taxation without representation. It is one of the sparks that ignited the Revolutionary War. It is the reason why America is no longer governed by ruling bodies in Great Britain. Taxation without representation is the reason this legislation has been so hard to push through. It is also why Democrats are likely to find themselves out of majority power in the very near future.
Rusty Scalpel
Showing posts with label Free Market Physician. Show all posts
Showing posts with label Free Market Physician. Show all posts
Saturday, January 16, 2010
Saturday, July 4, 2009
Price Controls, Medical Shortage, and Apples
In the face of rising health care prices, price control may appear a reasonable means to keep health care accessible to the masses. If health care is becoming too expensive, why not lock in prices to a rate that will insure that everyone gets the care that they need? To answer the question, let's apply it to a field that appears much more simple and economically fundamental. Let's apply it to apple selling.
Suppose that a late frost killed the blossoms of the apple trees of North America. By late summer, the shortage really starts to show as prices triple what they were in previous years. We understand why prices are high because we remember the supply and demand curves taught us in high school economics courses. The curves really work in the real world. Apple supply has fallen and demand has remained the same. There is a relative shortage of apples and price goes up.
Let's suppose the Secretary of Agriculture declares an apple state of emergency and appeals to Congress for help. The poor who depend on apples for survival are going hungry. The rich who can afford high prices are hording apples for themselves. Congress must recognize that a disaster is at hand and take stringent measures. Congress responds to the national crisis by establishing price controls in the apple industry. By law, apples can not sell above a given price. Problem solved and constituents appeased.
We, with our rudimentary understanding of supply and demand, can anticipate what effect the new law will have on the apple shortage. The past high price of apples had ensured that they stayed stocked in supermarkets. They were available so that those who really needed them got them. As Congress stomps down the price, consumers rush to stores to buy apples. The precious few apples are squandered on ordinary uses. The produce section of grocery stores are emptied and there are no more apples to replace those sold. The prices that kept apples available are now gone and we have a real shortage on our hands.
Empty shelves are evidence enough that demand for apples is greater than available supply. In a free economy, this would push up the price of apples and encourage suppliers to produce more of them. But in our economy, Congress has set the price of apples. It cannot rise. Suppliers had very few to sell in the first place and selling at an artificially low price, they cannot make up their losses and many of them go out of business.
What's more, Congress did not realize that the international trading partners of the United States were shipping apples to our apple-starved country even as the price control was being passed. They had seen the high prices and realized that they could make a profit by selling their apples here. Had those apples arrived, supply would have increased to meet demand and the prices of apples would have fallen. However, when news got out that had Congress passed the price control bill, those apple-laden ships turned around and returned to their own countries without selling a single apple. With price controls in place, it was no longer worth it to sell their apples here.
After the first year of price controls, many apple growers are unable to stay in the market. They leave the business and further decreased the available supply. Those still in the market still face the price control. They are unable to invest in their apple crop as they would other years because they know they will have to sell low. They try to cut production costs to make up for their low selling price. They skimp on fertilizers and pesticides. As a result, it is a crop of puny, wormy apples that hit stores that summer.
It is plain to see that without price controls, the apple market would have soon recovered. The high prices would have rationed the use of apples to the most important uses. The prices would have helped apple growers survive a hard year to be able to grow in the next. The high prices would have ensured that quality apples continue to be grown (with a variety of lower-quality apples available at lower prices). What's more, the high prices would have attracted additional suppliers who would have ended the shortage of supply and brought down the price.
The lessons learned from price controls in the apple market apply to all free markets, even the supposedly impossible-to-understand medical market. As with all other goods and services, the price of health care is determined by the balance of supply and demand. If supply is high compared to demand, prices drop to increase demand for the product. If supply is is low relative to demand, high prices ensue which dictate a natural rationing of the the product. It is reserved for the most urgent purposes and a true shortage never occurs.
Just as in the apple business, the imposition of price controls in the medical market will cause an increase in demand. Artificial low prices will ensure that available medical care is "used up" instead of being reserved for the most important purposes. Here a real shortage will occur (think of the stories of 7 month waits to use an MRI in Canada).
Just like in the apple business, the imposition of price controls will decrease available supply. It will make the delivery of health care services financially unattractive, if not impossible for many providers. They will drop out of business and the shortage will worsen. Remaining available services will drop in quality. What's more, medical providers who would otherwise be willing to come to the rescue for financial motives will no longer have any incentive to do so. The care they would provide and the resulting price relief will never come.
It is interesting to note that government programs that provide "free care" to patients have many of the same effects as price controls. They lead to unbridled consumption of available health care resources by enrolled patients. Reimbursement for these services is a price control- reimbursement rates are set by Congress. These artificially low prices discourage medical care suppliers from providing services and further aggravate the medical "shortage." I would be fascinated to see a study demonstrating how much of the "high" price of health care for privately-paying citizens can be directly attributed to federal aid programs.
We live in a time of rising prices and decreased medical availability. Our legislators may be tempted to consider price-control as a means to improve access to medical care. But we know that price controls will cause true shortages. A free economy regulates itself, increasing supply to meet demand to ensure access to care by all paying customers. The solution to high prices is high prices.
Rusty Scalpel
Suppose that a late frost killed the blossoms of the apple trees of North America. By late summer, the shortage really starts to show as prices triple what they were in previous years. We understand why prices are high because we remember the supply and demand curves taught us in high school economics courses. The curves really work in the real world. Apple supply has fallen and demand has remained the same. There is a relative shortage of apples and price goes up.
Let's suppose the Secretary of Agriculture declares an apple state of emergency and appeals to Congress for help. The poor who depend on apples for survival are going hungry. The rich who can afford high prices are hording apples for themselves. Congress must recognize that a disaster is at hand and take stringent measures. Congress responds to the national crisis by establishing price controls in the apple industry. By law, apples can not sell above a given price. Problem solved and constituents appeased.
We, with our rudimentary understanding of supply and demand, can anticipate what effect the new law will have on the apple shortage. The past high price of apples had ensured that they stayed stocked in supermarkets. They were available so that those who really needed them got them. As Congress stomps down the price, consumers rush to stores to buy apples. The precious few apples are squandered on ordinary uses. The produce section of grocery stores are emptied and there are no more apples to replace those sold. The prices that kept apples available are now gone and we have a real shortage on our hands.
Empty shelves are evidence enough that demand for apples is greater than available supply. In a free economy, this would push up the price of apples and encourage suppliers to produce more of them. But in our economy, Congress has set the price of apples. It cannot rise. Suppliers had very few to sell in the first place and selling at an artificially low price, they cannot make up their losses and many of them go out of business.
What's more, Congress did not realize that the international trading partners of the United States were shipping apples to our apple-starved country even as the price control was being passed. They had seen the high prices and realized that they could make a profit by selling their apples here. Had those apples arrived, supply would have increased to meet demand and the prices of apples would have fallen. However, when news got out that had Congress passed the price control bill, those apple-laden ships turned around and returned to their own countries without selling a single apple. With price controls in place, it was no longer worth it to sell their apples here.
After the first year of price controls, many apple growers are unable to stay in the market. They leave the business and further decreased the available supply. Those still in the market still face the price control. They are unable to invest in their apple crop as they would other years because they know they will have to sell low. They try to cut production costs to make up for their low selling price. They skimp on fertilizers and pesticides. As a result, it is a crop of puny, wormy apples that hit stores that summer.
It is plain to see that without price controls, the apple market would have soon recovered. The high prices would have rationed the use of apples to the most important uses. The prices would have helped apple growers survive a hard year to be able to grow in the next. The high prices would have ensured that quality apples continue to be grown (with a variety of lower-quality apples available at lower prices). What's more, the high prices would have attracted additional suppliers who would have ended the shortage of supply and brought down the price.
The lessons learned from price controls in the apple market apply to all free markets, even the supposedly impossible-to-understand medical market. As with all other goods and services, the price of health care is determined by the balance of supply and demand. If supply is high compared to demand, prices drop to increase demand for the product. If supply is is low relative to demand, high prices ensue which dictate a natural rationing of the the product. It is reserved for the most urgent purposes and a true shortage never occurs.
Just as in the apple business, the imposition of price controls in the medical market will cause an increase in demand. Artificial low prices will ensure that available medical care is "used up" instead of being reserved for the most important purposes. Here a real shortage will occur (think of the stories of 7 month waits to use an MRI in Canada).
Just like in the apple business, the imposition of price controls will decrease available supply. It will make the delivery of health care services financially unattractive, if not impossible for many providers. They will drop out of business and the shortage will worsen. Remaining available services will drop in quality. What's more, medical providers who would otherwise be willing to come to the rescue for financial motives will no longer have any incentive to do so. The care they would provide and the resulting price relief will never come.
It is interesting to note that government programs that provide "free care" to patients have many of the same effects as price controls. They lead to unbridled consumption of available health care resources by enrolled patients. Reimbursement for these services is a price control- reimbursement rates are set by Congress. These artificially low prices discourage medical care suppliers from providing services and further aggravate the medical "shortage." I would be fascinated to see a study demonstrating how much of the "high" price of health care for privately-paying citizens can be directly attributed to federal aid programs.
We live in a time of rising prices and decreased medical availability. Our legislators may be tempted to consider price-control as a means to improve access to medical care. But we know that price controls will cause true shortages. A free economy regulates itself, increasing supply to meet demand to ensure access to care by all paying customers. The solution to high prices is high prices.
Rusty Scalpel
Monday, May 18, 2009
Review of Mitt Romney's "The Answer is Unleashing Markets- Not Governments"
What is Mitt Thinking?
I believe I have a pretty good feel for Mitt Romney. I share his conservative philosophies. I think I understand his cultural and religious background. But my understanding for who Mitt is does not necessarily translate into an understanding of what Mitt does.
Take the op-ed piece that we're about to critique. Mitt Romney wrote this interesting piece on health care policy that appeared in the May 18 edition of Newsweek. In it he promotes aspects of the Massachusetts Health Care Reform law of 2006 that he helped enact as governor. His views in this editorial may be influential in providing congressional Republicans the backbone for the compromise on health care reform that they will make with Democrats this summer. But why does Mitt, a self-proclaimed free market guy, make the recommendations that he does? For example, why does Mitt claim to support a mandate that every person must be insured? (The first point in his essay.)
Mitt proposes tax penalties for those who by state standards can afford insurance, but do not buy it. That's the sort of argument that should be coming from the managed-market guys, not the free-market guys. The managed-market guys would claim that forcing everyone into the market, especially the healthy and deliberately-uninsured young adults, will bring more people into the insurance pool and bring down the price of premiums for everyone. We would expect Mitt to argue that mandating the use of a certain commodity runs counter to market principles and counter to freedom in general. Obligatory purchase of commodities negates the free in free market.
It turns out that the historical Mitt, the Mitt we think we know, would agree with us. The plan that he proposed as governor of Massachusetts had no individual mandate attached. The state was struggling with free-riders showing up at the emergency room without health insurance and leaving the state with the bill. Mitt proposed that state residents without insurance post a $10,000 bond to cover unpaid hospital bills. Mitt opposed the individual insurance mandate. It was the democratic legislature pushed the compulsory individual insurance mandate.
Why then, is the mandate the first point of his health care proposals? Why not a plan that directly addresses the issues of free-riders at the emergency room or on bankruptcy law instead of a direct attack on the market? In fairness, we point out that the Massachusetts individual mandate was softened with provisions allowing the purchase of catastrophic coverage and Health Savings Accounts to fulfill state requirements. But should we have to have health insurance to be law-abiding Americans? Does Mitt really believe in mandatory health insurance (history says no), or is this just political expediency?
Mitt's plan would use funds once dedicated to the payment of emergency room bills to the payment for health insurance for the Massachusetts's needy and projects huge state savings with the change. Whether this change is financially advantageous for the state in the long run remains to be seen. We have to be wary of any state-provided service. It seems human nature, even for Americans, to like all things "free" and politicians love to win votes with the promises of increased government services. Mitt cites the original Medicaid bill, which was supposed to cost $500 million, but now costs $500 billion to operate. I think we can safely assume that the overall cost of his state-purchased health insurance policies will similarly balloon.
The rest of the essay is more what we would expect from Mitt. He proposed increasing the portability of health insurance, touted the effectiveness of co-insurance plans, supported increasing patient information about cost and quality of care, and recommended reform of Medicaid and Medicare. Very importantly, he states that any health care reform should occur on a state, not a national, level.
So, what are we to think overall of Mitt's proposed plans? Regardless of objections we may have, his proposals are going to be much more conservative and market-oriented than anything that comes out of Congress this summer. And as the Heritage Foundation pointed out, the mandates in Mitt's plan are less problematic than they appear.
And yet, as freedom loving Americans, we should be able to expect something more from conservative leadership. As the editorial title states: the answer is unleashing markets, not government. I believe I speak for true conservatives and freedom-lovers when I say I believe the state has no business whatsoever providing health care for its citizens. Ideal health care reform removes government from health care. Ideal health care reform removes restrictions on the market. Innovation becomes legally possible, the patient is empowered as a consumer, prices are driven down and accessibility increases. The ideal reforms removes tax burdens on Americans and allows them to care for and rely on each other instead of picking their pockets and forcing reliance on Uncle Sam.
These are the principles that should be promoted by conservative leadership. Compromise happens after we champion the ideal. I worry that Mitt may be rejecting the ideal and his past principles in order to embody the compromise. I like Mitt, so I hope I am wrong. Conservatives everywhere are being tempted and taunted to embrace this new moderate Republicanism with which McCain lost the election. I hope that Mitt and other conservative leaders hold to their principles and continue in honorable service promoting the ideal.
Rusty Scalpel
I believe I have a pretty good feel for Mitt Romney. I share his conservative philosophies. I think I understand his cultural and religious background. But my understanding for who Mitt is does not necessarily translate into an understanding of what Mitt does.
Take the op-ed piece that we're about to critique. Mitt Romney wrote this interesting piece on health care policy that appeared in the May 18 edition of Newsweek. In it he promotes aspects of the Massachusetts Health Care Reform law of 2006 that he helped enact as governor. His views in this editorial may be influential in providing congressional Republicans the backbone for the compromise on health care reform that they will make with Democrats this summer. But why does Mitt, a self-proclaimed free market guy, make the recommendations that he does? For example, why does Mitt claim to support a mandate that every person must be insured? (The first point in his essay.)
Mitt proposes tax penalties for those who by state standards can afford insurance, but do not buy it. That's the sort of argument that should be coming from the managed-market guys, not the free-market guys. The managed-market guys would claim that forcing everyone into the market, especially the healthy and deliberately-uninsured young adults, will bring more people into the insurance pool and bring down the price of premiums for everyone. We would expect Mitt to argue that mandating the use of a certain commodity runs counter to market principles and counter to freedom in general. Obligatory purchase of commodities negates the free in free market.
It turns out that the historical Mitt, the Mitt we think we know, would agree with us. The plan that he proposed as governor of Massachusetts had no individual mandate attached. The state was struggling with free-riders showing up at the emergency room without health insurance and leaving the state with the bill. Mitt proposed that state residents without insurance post a $10,000 bond to cover unpaid hospital bills. Mitt opposed the individual insurance mandate. It was the democratic legislature pushed the compulsory individual insurance mandate.
Why then, is the mandate the first point of his health care proposals? Why not a plan that directly addresses the issues of free-riders at the emergency room or on bankruptcy law instead of a direct attack on the market? In fairness, we point out that the Massachusetts individual mandate was softened with provisions allowing the purchase of catastrophic coverage and Health Savings Accounts to fulfill state requirements. But should we have to have health insurance to be law-abiding Americans? Does Mitt really believe in mandatory health insurance (history says no), or is this just political expediency?
Mitt's plan would use funds once dedicated to the payment of emergency room bills to the payment for health insurance for the Massachusetts's needy and projects huge state savings with the change. Whether this change is financially advantageous for the state in the long run remains to be seen. We have to be wary of any state-provided service. It seems human nature, even for Americans, to like all things "free" and politicians love to win votes with the promises of increased government services. Mitt cites the original Medicaid bill, which was supposed to cost $500 million, but now costs $500 billion to operate. I think we can safely assume that the overall cost of his state-purchased health insurance policies will similarly balloon.
The rest of the essay is more what we would expect from Mitt. He proposed increasing the portability of health insurance, touted the effectiveness of co-insurance plans, supported increasing patient information about cost and quality of care, and recommended reform of Medicaid and Medicare. Very importantly, he states that any health care reform should occur on a state, not a national, level.
So, what are we to think overall of Mitt's proposed plans? Regardless of objections we may have, his proposals are going to be much more conservative and market-oriented than anything that comes out of Congress this summer. And as the Heritage Foundation pointed out, the mandates in Mitt's plan are less problematic than they appear.
And yet, as freedom loving Americans, we should be able to expect something more from conservative leadership. As the editorial title states: the answer is unleashing markets, not government. I believe I speak for true conservatives and freedom-lovers when I say I believe the state has no business whatsoever providing health care for its citizens. Ideal health care reform removes government from health care. Ideal health care reform removes restrictions on the market. Innovation becomes legally possible, the patient is empowered as a consumer, prices are driven down and accessibility increases. The ideal reforms removes tax burdens on Americans and allows them to care for and rely on each other instead of picking their pockets and forcing reliance on Uncle Sam.
These are the principles that should be promoted by conservative leadership. Compromise happens after we champion the ideal. I worry that Mitt may be rejecting the ideal and his past principles in order to embody the compromise. I like Mitt, so I hope I am wrong. Conservatives everywhere are being tempted and taunted to embrace this new moderate Republicanism with which McCain lost the election. I hope that Mitt and other conservative leaders hold to their principles and continue in honorable service promoting the ideal.
Rusty Scalpel
Monday, April 27, 2009
Andrew Lloyd Webber and Ayn Rand on Mob Politics and Targetted Taxation
We live in a time of world-wide economic difficulty, a time when everyone is cutting spending, tightening their belts and budgets, and preparing for some lean times. That is, everyone except for the world governments. They, some some reason, have ballooning budgets and unchecked ambition for expansion. (President Obama promised 3% of the national GDP for development of science technologies today. He forgets that social security and other national obligations of debt already eclipse the GLOBAL gross domestic product.) So where is the funding for these programs to come from, with money so scarce among the citizenry? For politicians who have won office on the vote of the poor, the answer comes easily: tax the wealthy.
But what happens when a majority of voters chooses to strip the rights of the few? What happens when we begin to single out members of society to carry a country's financial burdens? Can a country sustain itself with such policies? Can we escape a recession with such legislative looting?
Andrew Lloyd Webber, the British broadway behemoth, spoke out today against a new 50% income tax on in an editorial in the London Daily Mail. Great Britain has upped their 40% income tax with a 50% income tax on anyone earning over 150,000 pounds. Here's what he had to say:
"The opinion polls have uttered. The country loves the new 50 per cent top rate of income tax. Soak the rich. Smash the bankers. So Government spin doctors are in second heaven...
The next few years are going to be horrendous in the UK. The last thing we need is a Somali pirate-style raid on the few wealth creators who still dare to navigate Britain's gale-force waters...
I write this article because I fear the inevitable exodus of the talent that can dig us out of the hole we find ourselves in. It is inevitable, given that other countries are bidding for entrepreneurs. The Government must modify its proposals...
So I ask the Government to reconsider what it is doing. More than ever before we need to keep high-flying professionals in the UK. We can't, as we have done in the past, dump on them through penal personal taxation."
Andrew Lloyd Webber's points out that not only is such taxation unfair, it is ineffective. Industry leaders and highly-trained professionals, or "High-flyers" as he put it, are not going to stay in a country where they are enslaved. They will take their talents and the jobs and revenue they would generate elsewhere. Individuals who would generously "take one for the team" when done voluntarily may not feel so generous if they feel they are being robbed at gunpoint. They can afford plane tickets and they will leave.
His point is eloquently reinforced by an email titled "Who is John Galt?" sent to me today:
"We all hear about the need to protect patients' so-called "right" to health care. But we don't hear about protecting the rights of the doctors or the doctor-patient relationship. This issue is eloquently summarized by Dr. Thomas Hendricks, one of the characters in Ayn Rand's novel, Atlas Shrugged:
'Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything--except the desires of the doctors. Men considered only the "welfare" of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only "to serve." . . . I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind--yet what is it that they expect to depend on, when they lie on an operating table under my hands?'
We need to protect the rights of doctors and patients to trade on a free market to mutual benefit. Otherwise we will see more and more doctors silently shrugging off the burdens of being controlled by collectivists."
We've seen historically what happens when a nation tries to enslave portions of its population. The population rebels, especially when the population is already a motivated and hard-working demographic. Look at the American Revolution. When Britain tried to impose taxation without proper representation on its hard-working entrepreunerial colonists, those colonists rebelled. Great Britain lost the incredible wealth and talent that developed from this continent by its targetted taxations. This sort of rebellion and exodus is likely to occur in any democracy where a majority mob vote determines to strip the rights of the minority.
Not only is targetted taxation a formula for economic failure, but it is a sign of a failing democracy. A democracy is a meaningless institution without guranteed rights. When rights are eroded for any portion of population, they are eroded for all. Those who find themselves in power with the majority in one moment are liable to find themselves isolated and enslaved as a minority in the next moment. We cannot expect the good favor of the Creator, or durability as a republic if we trample those rights that we once held to be God-given.
Rusty Scalpel
But what happens when a majority of voters chooses to strip the rights of the few? What happens when we begin to single out members of society to carry a country's financial burdens? Can a country sustain itself with such policies? Can we escape a recession with such legislative looting?
Andrew Lloyd Webber, the British broadway behemoth, spoke out today against a new 50% income tax on in an editorial in the London Daily Mail. Great Britain has upped their 40% income tax with a 50% income tax on anyone earning over 150,000 pounds. Here's what he had to say:
"The opinion polls have uttered. The country loves the new 50 per cent top rate of income tax. Soak the rich. Smash the bankers. So Government spin doctors are in second heaven...
The next few years are going to be horrendous in the UK. The last thing we need is a Somali pirate-style raid on the few wealth creators who still dare to navigate Britain's gale-force waters...
I write this article because I fear the inevitable exodus of the talent that can dig us out of the hole we find ourselves in. It is inevitable, given that other countries are bidding for entrepreneurs. The Government must modify its proposals...
So I ask the Government to reconsider what it is doing. More than ever before we need to keep high-flying professionals in the UK. We can't, as we have done in the past, dump on them through penal personal taxation."
Andrew Lloyd Webber's points out that not only is such taxation unfair, it is ineffective. Industry leaders and highly-trained professionals, or "High-flyers" as he put it, are not going to stay in a country where they are enslaved. They will take their talents and the jobs and revenue they would generate elsewhere. Individuals who would generously "take one for the team" when done voluntarily may not feel so generous if they feel they are being robbed at gunpoint. They can afford plane tickets and they will leave.
His point is eloquently reinforced by an email titled "Who is John Galt?" sent to me today:
"We all hear about the need to protect patients' so-called "right" to health care. But we don't hear about protecting the rights of the doctors or the doctor-patient relationship. This issue is eloquently summarized by Dr. Thomas Hendricks, one of the characters in Ayn Rand's novel, Atlas Shrugged:
'Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything--except the desires of the doctors. Men considered only the "welfare" of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only "to serve." . . . I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind--yet what is it that they expect to depend on, when they lie on an operating table under my hands?'
We need to protect the rights of doctors and patients to trade on a free market to mutual benefit. Otherwise we will see more and more doctors silently shrugging off the burdens of being controlled by collectivists."
We've seen historically what happens when a nation tries to enslave portions of its population. The population rebels, especially when the population is already a motivated and hard-working demographic. Look at the American Revolution. When Britain tried to impose taxation without proper representation on its hard-working entrepreunerial colonists, those colonists rebelled. Great Britain lost the incredible wealth and talent that developed from this continent by its targetted taxations. This sort of rebellion and exodus is likely to occur in any democracy where a majority mob vote determines to strip the rights of the minority.
Not only is targetted taxation a formula for economic failure, but it is a sign of a failing democracy. A democracy is a meaningless institution without guranteed rights. When rights are eroded for any portion of population, they are eroded for all. Those who find themselves in power with the majority in one moment are liable to find themselves isolated and enslaved as a minority in the next moment. We cannot expect the good favor of the Creator, or durability as a republic if we trample those rights that we once held to be God-given.
Rusty Scalpel
Friday, April 24, 2009
Helping Patients Take Charge of Their Health (Part II)
Might God help them get better?
Helping patients make life-saving changes can be a challenge. Many of the behaviors that contribute to the development of preventable illness are habitual and some are even addictive. Last week we talked about using money as a motivating factor to help patients to take responsibility for their health. We showed how a fee-for-service system and a personal assumption of medical costs might help diabetes patients to better control their disease. But we acknowledge that even patients who are resolved to make major lifestyle changes may fail to do so. Changes, even the major changes that survival often requires, are often difficult to pull off.
A couple of weeks ago I attended a meeting where visiting physicians talked about their past histories of drug abuse. They talked about how they, even with their understanding of medicine and the body, became desperately addicted to various drugs. They knew the effects of what they were doing. They saw the havoc the drugs were wreaking on their professional lives and on their families, but they would not quit.
One physician told about his addiction to prescription painkillers. At night he would return to the the hospital he worked at and rummage through the garbage and sharps containers looking for old needles and syringes that might have residues of the painkillers he was addicted to. He would collect these residues little by little until he would have enough to take a hit of the drug. Another physician told of a crack house in Detroit that he often visited. He had a credit card with a $100,000 line of credit. Seeing his affluence and his dependence on the drug, the crack house opened a room just for him to stay in during his frequent visits.
But a couple things happened to these physicians to help them turn their lives around. First, they hit rock bottom and realized they had to change. Second, they found God.
The physicians described the desperation they felt when they realized that their lives were out of control. They were losing everything that was dear to them. They realized they had to change and made the decision to change. They told us about the support they received from professional organizations and the Twelve Step Program. The physicians then related, boldly and unabashedly, that only through the help of God were they able to break free from their addictions. Without Him, they would have been lost. Every single day, they told us, they thank Him for helping them escape and remain free from the drugs that once dominated them.
Let's return to our patients who struggle with habits that impact their health and shorten their lives. As physicians we counsel, we educate, we set goals and do everything in our power to help these patients change life habits. But our experience demonstrates that most patients will not change their behavior. Have we come to believe that change is impossible? Are our patients helpless? Are they irreversibly locked in habits of smoking, drinking, over-eating, drugs, inactivity, and damaging sexual practices?
Most physicians and patients believe in God. Do physicians believe that God can help patients overcome their habits? More importantly, do patients believe in a God that would help them change their lives?
As physicians we use all sorts of tools to try to help our patients to change unhealthy habits. Have we tried applying the patient's own faith to the problem? To the patient that is sincerely but unsuccessfully trying to quit smoking, we might ask, "Do you believe that God will help you have the strength to stop smoking?" How powerful it will be if we can follow their affirmative response with, "I know He will."
Change is hard to make, but it is not impossible. We are not treating animals who have no control of their destiny, but Man. He can choose to change. If our patients need help in making change, why not tap into the resource of their faith to help them clinch that change? If our patients believe in a God who watches after the life of each sparrow and cares for the lilies of the field, then perhaps he will help them control their diabetes or quit smoking.
Rusty Scalpel
Helping patients make life-saving changes can be a challenge. Many of the behaviors that contribute to the development of preventable illness are habitual and some are even addictive. Last week we talked about using money as a motivating factor to help patients to take responsibility for their health. We showed how a fee-for-service system and a personal assumption of medical costs might help diabetes patients to better control their disease. But we acknowledge that even patients who are resolved to make major lifestyle changes may fail to do so. Changes, even the major changes that survival often requires, are often difficult to pull off.
A couple of weeks ago I attended a meeting where visiting physicians talked about their past histories of drug abuse. They talked about how they, even with their understanding of medicine and the body, became desperately addicted to various drugs. They knew the effects of what they were doing. They saw the havoc the drugs were wreaking on their professional lives and on their families, but they would not quit.
One physician told about his addiction to prescription painkillers. At night he would return to the the hospital he worked at and rummage through the garbage and sharps containers looking for old needles and syringes that might have residues of the painkillers he was addicted to. He would collect these residues little by little until he would have enough to take a hit of the drug. Another physician told of a crack house in Detroit that he often visited. He had a credit card with a $100,000 line of credit. Seeing his affluence and his dependence on the drug, the crack house opened a room just for him to stay in during his frequent visits.
But a couple things happened to these physicians to help them turn their lives around. First, they hit rock bottom and realized they had to change. Second, they found God.
The physicians described the desperation they felt when they realized that their lives were out of control. They were losing everything that was dear to them. They realized they had to change and made the decision to change. They told us about the support they received from professional organizations and the Twelve Step Program. The physicians then related, boldly and unabashedly, that only through the help of God were they able to break free from their addictions. Without Him, they would have been lost. Every single day, they told us, they thank Him for helping them escape and remain free from the drugs that once dominated them.
Let's return to our patients who struggle with habits that impact their health and shorten their lives. As physicians we counsel, we educate, we set goals and do everything in our power to help these patients change life habits. But our experience demonstrates that most patients will not change their behavior. Have we come to believe that change is impossible? Are our patients helpless? Are they irreversibly locked in habits of smoking, drinking, over-eating, drugs, inactivity, and damaging sexual practices?
Most physicians and patients believe in God. Do physicians believe that God can help patients overcome their habits? More importantly, do patients believe in a God that would help them change their lives?
As physicians we use all sorts of tools to try to help our patients to change unhealthy habits. Have we tried applying the patient's own faith to the problem? To the patient that is sincerely but unsuccessfully trying to quit smoking, we might ask, "Do you believe that God will help you have the strength to stop smoking?" How powerful it will be if we can follow their affirmative response with, "I know He will."
Change is hard to make, but it is not impossible. We are not treating animals who have no control of their destiny, but Man. He can choose to change. If our patients need help in making change, why not tap into the resource of their faith to help them clinch that change? If our patients believe in a God who watches after the life of each sparrow and cares for the lilies of the field, then perhaps he will help them control their diabetes or quit smoking.
Rusty Scalpel
Friday, April 17, 2009
Helping Patients Take Charge of Their Health (Part I)
Making Money a Motivating Factor
Americans spend hundreds of billions of dollars a year treating preventable illnesses. The sums of money spent on these illnesses are even more breathtaking when we realize that it is money that does not have to be spent. For example, in 2007 Americans spent $116 billion on medical expenses related to diabetes, according to the American Diabetes Association. The average diabetic spends $6649 a year just on diabetes. The numbers force us to ask: what must we do to prevent this preventable disease?
In this post, I'll use diabetes as a case study for all other preventable diseases. When speaking of preventable diabetes, I am referring to most Type II diabetes mellitus. Although it has genetic components, the onset of this type of diabetes is generally brought on by an unhealthy lifestyle. The landmark Diabetes Prevention Program study showed that type II diabetes could be prevented or delayed by diet and exercise in 58% of cases (compared to placebo). This effect was seen in all individuals regardless of race, sex and class. In short, type II diabetes can be prevented in most patients by diet and exercise.
The American physician struggles to help patients prevent and treat diabetes. The first-line treatment for diabetes is exercise and diet. Doctors tell this to their patients. Yet deep in his or her heart, the doctor knows that the patient probably will not change their lifestyle. They will return to the next visit with the same blood glucose level and without having exercised or dieted. The doctor will be left with only pharmacological and surgical means for treating a disease that the patient should be able to treat on his or her own. So instead of pounds being dropped, medications are prescribed and gastric bypasses are performed.
One reason that patients may be unmotivated is that we have attempted to remove money as a motivating factor in our health care system. We want everyone to get the care they need, regardless of their ability to pay. We try to create a health care system where money is not the object, but in so doing we may be harming our patients.
Consider the Medicaid patient who knows that diabetes is shortening their life and ruining their lifestyle, but is unmotivated to personally address their diabetes. Free visits to the clinic and daily insulin shots are much easier than a massive overhaul of diet and daily exercise. Instead of getting healthy, the disease progresses and the taxpayer shoulders the bills. Patients with comprehensive health insurance may likewise put off taking care of their health. If they stay on their current policy, their premiums will not radically change and the disease may not hit their pocketbooks too hard.
But imagine the patient that is directly confronted with the cost of their poor health in every visit and with every prescription. In every medical bill these patients have a concrete, immediate reason to take diabetes into their own hands. As stated above, diabetes will cost the average patient $6649 a year on top of their other medical expenses. These self-paying patients are immediately aware of this cost and will look for ways to reduce it.
The thoughtful doctor could talk finances with a self-paying patient and encourage health lifestyle with a conversation something like this:
"Bob, you know that I'm concerned about your weight, your blood pressure, and your glucose levels. Unless we get these under control, it's not a question of if you'll get diabetes, but when you'll get diabetes. But if we can get your weight and these other things under control, you're going to be healthy for years.
Now I know that work and family keep you busy and you don't feel you have time to take care of yourself. But think of it this way. If you get diabetes, it is going to cost you about $7000 a year to treat. Now that's a lot of money. If we can start preventing the disease now, that's money in your pocket. If we work out the numbers, taking a 30-minute daily walk may save you $20 a day. Earning forty bucks an hour to take care of yourself- that's not bad."
I don't know about you, but if I were Bob, I might start jogging. I could think of a lot better uses for $7000 a year than insulin shots. Seven thousand dollars a year- now that's motivation.
Some might say that having patients to pay for their own care is cruel or unfair. But look at the scenario above- paying his own bill just made Bob healthier. We must pay for our own care. Any other system cannot last- such socialism truly is only a contrivance. When the reality of our personal responsibility for our health is realized (perhaps accompanied with some lessons from the school of hard knocks), we will see the epidemic of preventable disease disappear along with its accompanying epidemic of apathy.
Preventable diseases are prevented when patients are made responsible for their own health. As doctors, we're really missing out on one of our best tools to help patients truly be healthy if we don't make money a motivating factor. As Americans and as children of God, we're not meant to be coddled. When given the responsibility, we take care of ourselves. When entrusted to the system, we all get gastric bypasses.
Rusty Scalpel
Americans spend hundreds of billions of dollars a year treating preventable illnesses. The sums of money spent on these illnesses are even more breathtaking when we realize that it is money that does not have to be spent. For example, in 2007 Americans spent $116 billion on medical expenses related to diabetes, according to the American Diabetes Association. The average diabetic spends $6649 a year just on diabetes. The numbers force us to ask: what must we do to prevent this preventable disease?
In this post, I'll use diabetes as a case study for all other preventable diseases. When speaking of preventable diabetes, I am referring to most Type II diabetes mellitus. Although it has genetic components, the onset of this type of diabetes is generally brought on by an unhealthy lifestyle. The landmark Diabetes Prevention Program study showed that type II diabetes could be prevented or delayed by diet and exercise in 58% of cases (compared to placebo). This effect was seen in all individuals regardless of race, sex and class. In short, type II diabetes can be prevented in most patients by diet and exercise.
The American physician struggles to help patients prevent and treat diabetes. The first-line treatment for diabetes is exercise and diet. Doctors tell this to their patients. Yet deep in his or her heart, the doctor knows that the patient probably will not change their lifestyle. They will return to the next visit with the same blood glucose level and without having exercised or dieted. The doctor will be left with only pharmacological and surgical means for treating a disease that the patient should be able to treat on his or her own. So instead of pounds being dropped, medications are prescribed and gastric bypasses are performed.
One reason that patients may be unmotivated is that we have attempted to remove money as a motivating factor in our health care system. We want everyone to get the care they need, regardless of their ability to pay. We try to create a health care system where money is not the object, but in so doing we may be harming our patients.
Consider the Medicaid patient who knows that diabetes is shortening their life and ruining their lifestyle, but is unmotivated to personally address their diabetes. Free visits to the clinic and daily insulin shots are much easier than a massive overhaul of diet and daily exercise. Instead of getting healthy, the disease progresses and the taxpayer shoulders the bills. Patients with comprehensive health insurance may likewise put off taking care of their health. If they stay on their current policy, their premiums will not radically change and the disease may not hit their pocketbooks too hard.
But imagine the patient that is directly confronted with the cost of their poor health in every visit and with every prescription. In every medical bill these patients have a concrete, immediate reason to take diabetes into their own hands. As stated above, diabetes will cost the average patient $6649 a year on top of their other medical expenses. These self-paying patients are immediately aware of this cost and will look for ways to reduce it.
The thoughtful doctor could talk finances with a self-paying patient and encourage health lifestyle with a conversation something like this:
"Bob, you know that I'm concerned about your weight, your blood pressure, and your glucose levels. Unless we get these under control, it's not a question of if you'll get diabetes, but when you'll get diabetes. But if we can get your weight and these other things under control, you're going to be healthy for years.
Now I know that work and family keep you busy and you don't feel you have time to take care of yourself. But think of it this way. If you get diabetes, it is going to cost you about $7000 a year to treat. Now that's a lot of money. If we can start preventing the disease now, that's money in your pocket. If we work out the numbers, taking a 30-minute daily walk may save you $20 a day. Earning forty bucks an hour to take care of yourself- that's not bad."
I don't know about you, but if I were Bob, I might start jogging. I could think of a lot better uses for $7000 a year than insulin shots. Seven thousand dollars a year- now that's motivation.
Some might say that having patients to pay for their own care is cruel or unfair. But look at the scenario above- paying his own bill just made Bob healthier. We must pay for our own care. Any other system cannot last- such socialism truly is only a contrivance. When the reality of our personal responsibility for our health is realized (perhaps accompanied with some lessons from the school of hard knocks), we will see the epidemic of preventable disease disappear along with its accompanying epidemic of apathy.
Preventable diseases are prevented when patients are made responsible for their own health. As doctors, we're really missing out on one of our best tools to help patients truly be healthy if we don't make money a motivating factor. As Americans and as children of God, we're not meant to be coddled. When given the responsibility, we take care of ourselves. When entrusted to the system, we all get gastric bypasses.
Rusty Scalpel
Tuesday, March 31, 2009
Those Who Pay the Bills Run the Business
Several news stories and political developments drive home an important point in health care delivery: Money is power. The person who pays the bills runs the business.
Take for example the dwindling autonomy of businesses and industries that accepted government aid over the last couple of months. 1) The Obama Administration forced CEO Rick Wagoner out of GM after rejecting GM's restructuring plans. The Obama Administration paid to keep GM alive and now runs GM. 2) Recently, the House tried to hammer AIG, another bailout recipient, and passed a 90% tax on AIG's executive bonuses. The federal government owns AIG. It's freedom as a business only extends as far as good favor from the government. 3) Now Barney Frank is pushing a bill that would establish government control of the salaries of all businesses that received bailout funds. If the government pays the bills, they run the business.
Health care providers need to decide who they want calling the shots at their own clinics: do they want government-directed care, insurance company-directed care, or patient-directed care? That will be determined by who they allow to pay the bills.
I believe that most physicians truly believe that patients should be their own health care executives. They should have the final say on all medical decisions. Physicians and other health care workers are contracted to the patient to provide services under the patient's direction. Patients can hire and fire physicians at will. That is the ideal in medicine- the patient is in charge.
Experience and reason show that the responsibility of physicians to patients extends only to the degree that patients pay their own bills. The patient remains the health care executive only as long as they pay the medical bills. As soon as they delegate that responsibility of paying, they are no longer in charge of their care.
Patients' and doctors' experience with health insurance companies supports this idea. When clinics begin working with insurance companies, the whole nature of the practice changes. The insurance company is now making the calls. They determine treatment regimens- declaring some treatments acceptable and ruling others out despite patient wishes. They mandate diagnostics, both requiring redundant screenings and denying more expensive essential diagnostics. They even require additional staff hiring at the clinic, requiring the hiring of billing personnel exclusively for correspondence with the insurance company. Insurance-paid medical care is not patient-driven medical care. Many patients are okay with this- they've contracted insurance companies to manage their care. Insurance pays the bills and insurance runs the business.
What about when the government pays the bills for health care? It seems that the federal government has demonstrated a light touch in the cases of Medicare and Medicaid. Here the government is paying the bills, but they have allowed remarkable autonomy to patients and thus practitioners. Thus the common claim: Medicaid is the best health insurance! However, the reality that government-paid health care is government-controlled health care is present in each health care regulation or bill that rolls through the legislature.
Take for example the conscience-clause regulations that President Obama is about to overturn. Which health care providers do conscience-clause laws and regulations actually effect? Only those who receive federal funding through programs including Medicare and Medicaid. For another example, consider the health care legislation that was buried in the February stimulus package. The legislation establishes a National Coordinator of Health Information Technology with potential powers to establish and enforce a national standard of care. What health care providers will be responsible to this Coordinator? As far as I can see in the bill, only "government-sponsored" health care programs (pp 470) and recipients of Medicare, Medicaid, and state children's health insurance programs (pp 481) are currently marked for integration into the HIT program. When the government pays the bills, government runs the business.
If patients want to control their health care, they must pay the bills. If health care providers want patient-driven health care, they must establish practices where patients pay the bills. As government control increases in the health care industry, the best way to maintain autonomy over a practice may be to refuse third-party funding, especially government funding. Cash-only practices may become the only venue where patients remain health care executives and the doctor-patient relationship is preserved.
The federal government is trying to work up a steam push through government-run health care. They don't call it that, in fact many will sell the package as patient-run or patient-centered health care. But those who pay the bills run the business. You can bet that the same House, Senate, and White House that had so much to say about AIG and GM will have plenty to say about health care. Patient control over health care will be as remote as my control of the House of Representatives. After a few unanswered letters to the legislature, they will be left powerless and blogging.
Rusty Scalpel
Take for example the dwindling autonomy of businesses and industries that accepted government aid over the last couple of months. 1) The Obama Administration forced CEO Rick Wagoner out of GM after rejecting GM's restructuring plans. The Obama Administration paid to keep GM alive and now runs GM. 2) Recently, the House tried to hammer AIG, another bailout recipient, and passed a 90% tax on AIG's executive bonuses. The federal government owns AIG. It's freedom as a business only extends as far as good favor from the government. 3) Now Barney Frank is pushing a bill that would establish government control of the salaries of all businesses that received bailout funds. If the government pays the bills, they run the business.
Health care providers need to decide who they want calling the shots at their own clinics: do they want government-directed care, insurance company-directed care, or patient-directed care? That will be determined by who they allow to pay the bills.
I believe that most physicians truly believe that patients should be their own health care executives. They should have the final say on all medical decisions. Physicians and other health care workers are contracted to the patient to provide services under the patient's direction. Patients can hire and fire physicians at will. That is the ideal in medicine- the patient is in charge.
Experience and reason show that the responsibility of physicians to patients extends only to the degree that patients pay their own bills. The patient remains the health care executive only as long as they pay the medical bills. As soon as they delegate that responsibility of paying, they are no longer in charge of their care.
Patients' and doctors' experience with health insurance companies supports this idea. When clinics begin working with insurance companies, the whole nature of the practice changes. The insurance company is now making the calls. They determine treatment regimens- declaring some treatments acceptable and ruling others out despite patient wishes. They mandate diagnostics, both requiring redundant screenings and denying more expensive essential diagnostics. They even require additional staff hiring at the clinic, requiring the hiring of billing personnel exclusively for correspondence with the insurance company. Insurance-paid medical care is not patient-driven medical care. Many patients are okay with this- they've contracted insurance companies to manage their care. Insurance pays the bills and insurance runs the business.
What about when the government pays the bills for health care? It seems that the federal government has demonstrated a light touch in the cases of Medicare and Medicaid. Here the government is paying the bills, but they have allowed remarkable autonomy to patients and thus practitioners. Thus the common claim: Medicaid is the best health insurance! However, the reality that government-paid health care is government-controlled health care is present in each health care regulation or bill that rolls through the legislature.
Take for example the conscience-clause regulations that President Obama is about to overturn. Which health care providers do conscience-clause laws and regulations actually effect? Only those who receive federal funding through programs including Medicare and Medicaid. For another example, consider the health care legislation that was buried in the February stimulus package. The legislation establishes a National Coordinator of Health Information Technology with potential powers to establish and enforce a national standard of care. What health care providers will be responsible to this Coordinator? As far as I can see in the bill, only "government-sponsored" health care programs (pp 470) and recipients of Medicare, Medicaid, and state children's health insurance programs (pp 481) are currently marked for integration into the HIT program. When the government pays the bills, government runs the business.
If patients want to control their health care, they must pay the bills. If health care providers want patient-driven health care, they must establish practices where patients pay the bills. As government control increases in the health care industry, the best way to maintain autonomy over a practice may be to refuse third-party funding, especially government funding. Cash-only practices may become the only venue where patients remain health care executives and the doctor-patient relationship is preserved.
The federal government is trying to work up a steam push through government-run health care. They don't call it that, in fact many will sell the package as patient-run or patient-centered health care. But those who pay the bills run the business. You can bet that the same House, Senate, and White House that had so much to say about AIG and GM will have plenty to say about health care. Patient control over health care will be as remote as my control of the House of Representatives. After a few unanswered letters to the legislature, they will be left powerless and blogging.
Rusty Scalpel
Friday, February 20, 2009
Government Struggles to Grasp Economic Reality
The nation is struggling to understand true economics. We have a presidential administration, legislature, and news media bent on changing our economy into a controlled economy. And yet, they hesitate to pull the trigger, despite their monopoly of power. The plain truth of economics and freedom is hitting hard, and it's hard to ignore.
I've got a collection of economic-related news stories that I would like to highlight. Many of them are stories that you may have already read, especially if you are a news junkie like myself. I don't have much to say about them, other than they demonstrate the gap in between reality and the ideologies and programs that our elected officials and media are trying to push. Some of them may show a glimmer of hope that our newly elected officials may actually be learning something about economics while in office.
1. Wall Street flips at the suggestion of bank nationalization. Stocks plummeted Friday morning at the suggestion that the government may take over failing banks. What is interesting was the White House response. They attempt to reassure, insisting that they never had any plans to nationalize. Is the administration becoming aware that their policies of change to the nation's economic structure may not be plausible?
2. Wholesale inflation takes a leap. It went up 0.8% last month. The story says economists had only expected a 0.2% jump. Those must have been the economists who approved of the last stimulus package as well. Perhaps flooding the economy with freshly-printed and borrowed money does not make the country any wealthier.
3. The Chicago Tea Party. CNBC's Rick Santelli is an internet sensation in his spirited criticisms of the White House mortgage relief bill. The relief bill rewards bad behavior, Santelli says. "How many of you people want to pay for your neighbor's mortgage that has an extra bathroom and can't pay their bills?" he asks. The floor of traders behind him burst a unanimous boo. Santelli looks into the camera, asks if President Obama is listening and...
4. The White House responds. The very next day the White House already feels compelled to respond directly to criticisms in the cable morning news report. "Santelli doesn't know what he's talking about," the spokesman says. Maybe so, but the attention attracted by the tirade of a lower-profile newsman shows that the White House at least found his comments very compelling. It seems that White House response to media criticisms are usually limited to the big dogs- the Rush Limbaugh's, the New York Times- the big media outlets. The fact that they so immediately respond to Santelli is remarkable.
5. Bill Clinton gets some blame for the economic downturn because of his... "free-wheeling capitalism." It's funny that of all the Clinton's Administration acts that would be blamed, Time targets free-wheeling capitalism. That definitely was not the hallmark of the Clinton Administration. Much more pertinent and logical to point at would be the growth of Fannie Mae and the Community Reinvestment Act passed during Clinton's tenure. The attacks on capitalism continue from surprising sources as...
6. Alan Greenspan supports bank nationalization. We've come full circle now and perhaps see part of the reason why we have executive and legislative branches that are attacking capitalism and American freedom at will. Have American conservatives and patriots forgotten the principles this nation stands on? Economic freedom is not a get-rich-quick scheme. Capitalism is not just another economic system along with socialism, communism, etc. It is not to be swapped out for one of the others because of an economic recession. Capitalism is the state of the economy in a state of freedom. As evidenced in the news, it also happens to be the only system under which mankind will find ever prosperity.
Rusty Scalpel
I've got a collection of economic-related news stories that I would like to highlight. Many of them are stories that you may have already read, especially if you are a news junkie like myself. I don't have much to say about them, other than they demonstrate the gap in between reality and the ideologies and programs that our elected officials and media are trying to push. Some of them may show a glimmer of hope that our newly elected officials may actually be learning something about economics while in office.
1. Wall Street flips at the suggestion of bank nationalization. Stocks plummeted Friday morning at the suggestion that the government may take over failing banks. What is interesting was the White House response. They attempt to reassure, insisting that they never had any plans to nationalize. Is the administration becoming aware that their policies of change to the nation's economic structure may not be plausible?
2. Wholesale inflation takes a leap. It went up 0.8% last month. The story says economists had only expected a 0.2% jump. Those must have been the economists who approved of the last stimulus package as well. Perhaps flooding the economy with freshly-printed and borrowed money does not make the country any wealthier.
3. The Chicago Tea Party. CNBC's Rick Santelli is an internet sensation in his spirited criticisms of the White House mortgage relief bill. The relief bill rewards bad behavior, Santelli says. "How many of you people want to pay for your neighbor's mortgage that has an extra bathroom and can't pay their bills?" he asks. The floor of traders behind him burst a unanimous boo. Santelli looks into the camera, asks if President Obama is listening and...
4. The White House responds. The very next day the White House already feels compelled to respond directly to criticisms in the cable morning news report. "Santelli doesn't know what he's talking about," the spokesman says. Maybe so, but the attention attracted by the tirade of a lower-profile newsman shows that the White House at least found his comments very compelling. It seems that White House response to media criticisms are usually limited to the big dogs- the Rush Limbaugh's, the New York Times- the big media outlets. The fact that they so immediately respond to Santelli is remarkable.
5. Bill Clinton gets some blame for the economic downturn because of his... "free-wheeling capitalism." It's funny that of all the Clinton's Administration acts that would be blamed, Time targets free-wheeling capitalism. That definitely was not the hallmark of the Clinton Administration. Much more pertinent and logical to point at would be the growth of Fannie Mae and the Community Reinvestment Act passed during Clinton's tenure. The attacks on capitalism continue from surprising sources as...
6. Alan Greenspan supports bank nationalization. We've come full circle now and perhaps see part of the reason why we have executive and legislative branches that are attacking capitalism and American freedom at will. Have American conservatives and patriots forgotten the principles this nation stands on? Economic freedom is not a get-rich-quick scheme. Capitalism is not just another economic system along with socialism, communism, etc. It is not to be swapped out for one of the others because of an economic recession. Capitalism is the state of the economy in a state of freedom. As evidenced in the news, it also happens to be the only system under which mankind will find ever prosperity.
Rusty Scalpel
Tuesday, February 10, 2009
Step One of Government Health Care Takeover Hidden In Stimulus Package
Here's the followup on today's earlier post on Bloomberg's piece about hidden health care legislation in the stimulus package. I'm afraid we're a bit behind on this one. My searches today showed that the other bloggers have been talking about it for weeks- we took notice only after Rush and Drudge brought it to national attention yesterday. My only excuse is that the stimulus bill was so depressing that we never looked at it. Maybe that was their strategy all along.
There is a lot of discussion about the hidden health care policy in the bill and I'm not sure how accurate it all has been. I've gone to the bill itself to try to make sure that my description of the health care inclusions in the bill are accurate. I'll also point out that the following discussion is not the only reason to oppose the bill. In principle the whole thing stinks. These are just some of the especially low points. Under the guise of a anything-is-justified-because-the-sky-is-falling stimulus package we usher in the beginning of the Obama socialized medicine era.
The bill establishes a National Coordinator for Health Information Technology. His purpose is to oversee the development of a federal electronic health care system (pp 441). Included among his duties the director ‘‘(2) improves health care quality, reduces medical errors, reduces health disparities, and advances the delivery of patient-centered medical care; ... (4) provides appropriate information to help guide medical decisions at the time and place of care;... (9) promotes prevention of chronic diseases; (10) promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved outcomes in health care services; and (11) improves efforts to reduce health disparities." (pp 442).
Isn't that fantastic? We now will have a government officer, probably to be reverently referred to as Mr. (or Ms.) Coordinator, that will make health care better. He will lovingly "guide medical decisions at the time and place of care." He will promote prevention of chronic disease. He will promote a more effective market place- isn't that great, the federal government will step in to help the market be more of a market! He will help improve health disparity. If we're lucky, he may even turn back death.
‘The National Coordinator shall, in consultation with other appropriate Federal agencies... update the Federal Health IT Strategic Plan... to include specific objectives, milestones, and metrics with respect to... the utilization of an electronic health record for each person in the United States by 2014." (pp 445)
The National Coordinator will appoint the HIT committee (Health Information Technologies Committee) composed of "providers, ancillary healthcare workers, consumers, purchasers, health plans, technology vendors, researchers, relevant Federal agencies, and individuals with technical expertise on health care quality, privacy and security, and on the electronic exchange and use of health information." (pp. 457)
This committee will advise the Coordinator on how to best achieve his stated mission of stepping in to help the market be a safer and more federally-approved market, help doctors make good decisions, etc. Perhaps this group will make the Coordinator's decisions bipartisan if he can't get bipartisan support from democratically elected officials.
The biggest question I have is whether health care practitioners will be forced to use the electronic medical system. Will they will be forced to follow The Coordinator and the People's Committee's recommendations on appropriate medical decisions, having a "more fair" market, spreading the wealth, etc?
I couldn't find a clear answer to that question. The bill talks about paying practitioners to use the electronic system, but those provisions were found under the headings of Indian Health Services and Medicare. However, the following slightly menacing statement is found at least twice in the bill: "The Secretary shall seek to improve the use of electronic health records and health care quality over time by requiring more stringent measures of meaningful use..." (pp 518, pp 541)
I sincerely believe that a national medical database is not a bad idea. It is an idea that deserves discussion. But it's not getting that discussion. It's being ramrodded down senators' throats by President Obama. He tells them we're in a national crisis. Don't think about it- just vote yes.
But this database, and especially the powers attached to the Coordinator, are a big deal. They take up over 100 pages of the 680 page stimulus package. This is Phase One of Obama's Change for socialized medicine. Why is it buried in the stimulus bill? Is the Democratic Force for Change afraid America wouldn't support it in open discussion?
Rusty Scalpel
There is a lot of discussion about the hidden health care policy in the bill and I'm not sure how accurate it all has been. I've gone to the bill itself to try to make sure that my description of the health care inclusions in the bill are accurate. I'll also point out that the following discussion is not the only reason to oppose the bill. In principle the whole thing stinks. These are just some of the especially low points. Under the guise of a anything-is-justified-because-the-sky-is-falling stimulus package we usher in the beginning of the Obama socialized medicine era.
The bill establishes a National Coordinator for Health Information Technology. His purpose is to oversee the development of a federal electronic health care system (pp 441). Included among his duties the director ‘‘(2) improves health care quality, reduces medical errors, reduces health disparities, and advances the delivery of patient-centered medical care; ... (4) provides appropriate information to help guide medical decisions at the time and place of care;... (9) promotes prevention of chronic diseases; (10) promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved outcomes in health care services; and (11) improves efforts to reduce health disparities." (pp 442).
Isn't that fantastic? We now will have a government officer, probably to be reverently referred to as Mr. (or Ms.) Coordinator, that will make health care better. He will lovingly "guide medical decisions at the time and place of care." He will promote prevention of chronic disease. He will promote a more effective market place- isn't that great, the federal government will step in to help the market be more of a market! He will help improve health disparity. If we're lucky, he may even turn back death.
‘The National Coordinator shall, in consultation with other appropriate Federal agencies... update the Federal Health IT Strategic Plan... to include specific objectives, milestones, and metrics with respect to... the utilization of an electronic health record for each person in the United States by 2014." (pp 445)
The National Coordinator will appoint the HIT committee (Health Information Technologies Committee) composed of "providers, ancillary healthcare workers, consumers, purchasers, health plans, technology vendors, researchers, relevant Federal agencies, and individuals with technical expertise on health care quality, privacy and security, and on the electronic exchange and use of health information." (pp. 457)
This committee will advise the Coordinator on how to best achieve his stated mission of stepping in to help the market be a safer and more federally-approved market, help doctors make good decisions, etc. Perhaps this group will make the Coordinator's decisions bipartisan if he can't get bipartisan support from democratically elected officials.
The biggest question I have is whether health care practitioners will be forced to use the electronic medical system. Will they will be forced to follow The Coordinator and the People's Committee's recommendations on appropriate medical decisions, having a "more fair" market, spreading the wealth, etc?
I couldn't find a clear answer to that question. The bill talks about paying practitioners to use the electronic system, but those provisions were found under the headings of Indian Health Services and Medicare. However, the following slightly menacing statement is found at least twice in the bill: "The Secretary shall seek to improve the use of electronic health records and health care quality over time by requiring more stringent measures of meaningful use..." (pp 518, pp 541)
I sincerely believe that a national medical database is not a bad idea. It is an idea that deserves discussion. But it's not getting that discussion. It's being ramrodded down senators' throats by President Obama. He tells them we're in a national crisis. Don't think about it- just vote yes.
But this database, and especially the powers attached to the Coordinator, are a big deal. They take up over 100 pages of the 680 page stimulus package. This is Phase One of Obama's Change for socialized medicine. Why is it buried in the stimulus bill? Is the Democratic Force for Change afraid America wouldn't support it in open discussion?
Rusty Scalpel
Friday, February 6, 2009
Wal-Mart President on Medical Market
How Would Wal-Mart Do Health Care?
All along we've argued the the "problem" with American health care is its high price. We've seen Wal-Mart have significant impact on the retail market, offering goods at prices significantly lower than their competitors and bringing these goods into the budgets of their customers. How would the Wal-Mart model work for health care?
We're going to have the opportunity to find out. Wal-Mart, like other retailers, has been introducing in-store clinics. I'm unsure about how many are now in operation, but 400 were announced in 2007. Some sources say there will be over 2000 in the next four years.
These clinics treat common medical problems for $40-65 a visit depending on clinic location and the health malady. In addition to the cheap office visit, Wal-Mart pharmacies have begun a $4 prescription plan. An impressive survey of medications are available for $4 for a 30-day supply or $10 for a 90-day supply.
Wal-Mart and its clinics certainly have critics, but it seems to us at FMP that these in-store clinics truly address the greatest need of American health care- the need for affordable care. The Wal-Mart mission of "saving people money so they can live better" certainly applies to health care.
Here are some extractions from speeches by former Wal-Mart President Lee Scott at the World Health Care Congress in 2007 and at the National Retail Federation last month on Wal-Mart's clinics and on the role of the market in health care.
"The private sector can make a difference," he said. "I believe American businesses can lead and we should."
"We think the clinics will be a great opportunity for our business. But most importantly, they are going to provide something our customers and communities desperately need -- affordable access at the local level to quality health care," Scott said. "We believe we can deliver effective and efficient health care at the local level."
"Within days of announcing our $4 program, countless other discounters, drug stores and supermarkets dropped their prices on generic prescriptions," Scott said. "That has surely saved our health-care system millions of more dollars. So let there be no doubt that the private sector can lead."
All along we've argued the the "problem" with American health care is its high price. We've seen Wal-Mart have significant impact on the retail market, offering goods at prices significantly lower than their competitors and bringing these goods into the budgets of their customers. How would the Wal-Mart model work for health care?
We're going to have the opportunity to find out. Wal-Mart, like other retailers, has been introducing in-store clinics. I'm unsure about how many are now in operation, but 400 were announced in 2007. Some sources say there will be over 2000 in the next four years.
These clinics treat common medical problems for $40-65 a visit depending on clinic location and the health malady. In addition to the cheap office visit, Wal-Mart pharmacies have begun a $4 prescription plan. An impressive survey of medications are available for $4 for a 30-day supply or $10 for a 90-day supply.
Wal-Mart and its clinics certainly have critics, but it seems to us at FMP that these in-store clinics truly address the greatest need of American health care- the need for affordable care. The Wal-Mart mission of "saving people money so they can live better" certainly applies to health care.
Here are some extractions from speeches by former Wal-Mart President Lee Scott at the World Health Care Congress in 2007 and at the National Retail Federation last month on Wal-Mart's clinics and on the role of the market in health care.
"The private sector can make a difference," he said. "I believe American businesses can lead and we should."
"We think the clinics will be a great opportunity for our business. But most importantly, they are going to provide something our customers and communities desperately need -- affordable access at the local level to quality health care," Scott said. "We believe we can deliver effective and efficient health care at the local level."
"Within days of announcing our $4 program, countless other discounters, drug stores and supermarkets dropped their prices on generic prescriptions," Scott said. "That has surely saved our health-care system millions of more dollars. So let there be no doubt that the private sector can lead."
"As businesses, we have a responsibility to society. We also have an extraordinary opportunity. Let me be clear about this point … there is no conflict between delivering value to shareholders and helping solve bigger societal problems. In fact … they can build on each other when developed, aligned and executed right.
At Wal-Mart, we do not really see it as philanthropy or CSR or the Triple Bottom Line. All of those approaches have merit and can have an impact. But what we are talking about is different.
We believe you can bring together the bottom line on a balance sheet … with social and environmental bottom lines. Societal responsibilities and how we fulfill them can align and strengthen the business. When you do that, things really start to take hold, build momentum and make a much bigger difference. We have seen this at Wal-Mart when we have put together the “Save Money” and “Live Better” parts of our mission … and applied them to big challenges like the cost of prescription drugs. And I believe this can apply to all of us.
The principles are very simple. Does how you want to contribute to larger societal issues work with your business model – so it will last during the both good and bad economic times? Does it fit with your mission and culture – so that all parts of your company are engaged, energized and contributing? Does it offer the opportunity to leverage your unique strengths – so you can scale your efforts and make a unique, powerful and meaningful difference? And we can make a special contribution as retailers."
Rusty Scalpel
Friday, January 30, 2009
Recovery of the Medical Market
American health care is in trouble. America's dependence on third-party payers and courtrooms to determine medical practice and price has placed us on the short path to health care bankruptcy. The simple doctor-patient relationship, a system where the patient pays for physician services and where the physician is responsible to the patient for services rendered must be reestablished. Our current path leads to economic failure, socialism, and a loss of American freedoms extending far beyond the realm of health care. True principles of economics must be applied to revolutionize medical field. We must recover the medical market.
We've been asked what it will take to return to this simple medical market. Here are FMP's keys to the return of the medical market and the return of health care availability and affordability to all Americans.
1) The return of the market must take place by market forces. We will return to the market because it is a system that works and sells itself. There may be laws abridging freedom and market forces that need be amended. Legislators can be won over for this purpose, but no fake economics of tax incentives or federal subsidies should drive the return to a medical market. Functional, profit-earning, fee-for-service clinics should attract customers and patients not because these consumers have subsidized health savings accounts, but because these clinics offer prices and services superior to that of their competitors.
2) The market will return as America escapes the standard of care. We've spoken of this in the past. The standard of care should rest in the hands of patients, not doctors. Patients should hold doctors responsible to their personal standard of care and deny them their business if they do not perform to that standard of care. The current high price of health care can be partly attributed to doctors treating patients by generalized, expensive, and self-serving standards of care that are established by courtrooms. These standards serve to protect the doctor and not necessarily serve patients. Patients are not and should not be responsible to the standard of care, but should only pay for health care that meets their personal standards.
It is worth suggesting that this independence from the standard of care will allow patients to seek non-traditional health care. It is quite possible that many, many consumers would choose the lower prices and competent services of nurse practitioners and physicians assistants if the states were to allow these practitioners due practice rights. It is also quite probable that this injection of medical supply into the market would significantly reduce the price of health care. That's food for thought.
3) The market will return when doctors realize they can escape the medical rat race. Doctors need to discover that they can determine for themselves the scope of their practice. They can escape from the bureaucratic crush of insurance company and government regulation. They can set their own hours and call schedules. For each doctor who wants his or her life and profession back, there are loads of patients who want affordable health care. Doctors just need to step out from the safety of government and insurance reimbursement to meet these patients and strike up a contract where each party gets what they want.
4) The market will return with idealism, sacrifice, and foresight. Once our medical revolution has begun and the medical market returns, the profiteers and followers of the Invisible Hand will get on board. But the path to medical freedom may require physicians who act because they see the oncoming waves of socialism, godlessness, and the loss of American freedom. It requires physicians who see the future and personally strive to change that future. It requires physicians who let integrity and the welfare of their patients dictate their actions. It requires physicians who are willing to ennoble mankind, educate him, and make him the master of his own destiny and health. May we be and inspire others to be such physicians.
Rusty Scalpel
We've been asked what it will take to return to this simple medical market. Here are FMP's keys to the return of the medical market and the return of health care availability and affordability to all Americans.
1) The return of the market must take place by market forces. We will return to the market because it is a system that works and sells itself. There may be laws abridging freedom and market forces that need be amended. Legislators can be won over for this purpose, but no fake economics of tax incentives or federal subsidies should drive the return to a medical market. Functional, profit-earning, fee-for-service clinics should attract customers and patients not because these consumers have subsidized health savings accounts, but because these clinics offer prices and services superior to that of their competitors.
2) The market will return as America escapes the standard of care. We've spoken of this in the past. The standard of care should rest in the hands of patients, not doctors. Patients should hold doctors responsible to their personal standard of care and deny them their business if they do not perform to that standard of care. The current high price of health care can be partly attributed to doctors treating patients by generalized, expensive, and self-serving standards of care that are established by courtrooms. These standards serve to protect the doctor and not necessarily serve patients. Patients are not and should not be responsible to the standard of care, but should only pay for health care that meets their personal standards.
It is worth suggesting that this independence from the standard of care will allow patients to seek non-traditional health care. It is quite possible that many, many consumers would choose the lower prices and competent services of nurse practitioners and physicians assistants if the states were to allow these practitioners due practice rights. It is also quite probable that this injection of medical supply into the market would significantly reduce the price of health care. That's food for thought.
3) The market will return when doctors realize they can escape the medical rat race. Doctors need to discover that they can determine for themselves the scope of their practice. They can escape from the bureaucratic crush of insurance company and government regulation. They can set their own hours and call schedules. For each doctor who wants his or her life and profession back, there are loads of patients who want affordable health care. Doctors just need to step out from the safety of government and insurance reimbursement to meet these patients and strike up a contract where each party gets what they want.
4) The market will return with idealism, sacrifice, and foresight. Once our medical revolution has begun and the medical market returns, the profiteers and followers of the Invisible Hand will get on board. But the path to medical freedom may require physicians who act because they see the oncoming waves of socialism, godlessness, and the loss of American freedom. It requires physicians who see the future and personally strive to change that future. It requires physicians who let integrity and the welfare of their patients dictate their actions. It requires physicians who are willing to ennoble mankind, educate him, and make him the master of his own destiny and health. May we be and inspire others to be such physicians.
Rusty Scalpel
Friday, January 9, 2009
The Economic Burden of Standard of Care
During our life experience we sometimes make startling discoveries about the institutions and devices that we trust to protect us and benefit us. We discover that some inventions of man, usually without malice by those who implemented them, are hurting us and limiting our progression. Such discovery is normal in the medical field. We regularly discontinue medications and treatments that we discover are doing our patients harm. But sometimes we are surprised and don't know what to do with the truth when it is presented to us.
I believe that our current concept and application of standard of care is one of these long-trusted devices is harming patients. I believe that it must be reconsidered and discarded.
Standard of care consists of the care that experts would consider to be best practice. The standard of care guides physicians as they make treatment plans for their patients. The purpose for having a standard of care is to prevent patients from being mistreated by negligent or malicious medical practitioners. If a court establishes that a physician caused damage by not following a standard care, that physician can be convicted of malpractice. Despite its protecting purpose, I believe that standard of care has contributed to patients' ultimate harm. It has made and continues to make health care inaccessible to them.
To prove this point, let's look at it from an economic standpoint. We've discussed supply and demand in the past. The price of any commodity is a function of the relationship between supply and demand. When demand for commodity increases with regard to supply, the commodity becomes scarce and costs more. When demand decreases with regard to supply, the commodity becomes less scarce and costs less. Now let's examine a scenario to see how standard of care effects the relationship between supply and demand.
Let's assume that American family practitioners read in the New England Journal of Medicine that extensive meta analysis of multiple studies proves that medication XYZ is hands-down the best treatment for ear infection. Within a short time, the data is almost universally accepted by family practitioners and a new standard of care has been established. Medication XYZ is a relatively new product and significantly more expensive than older antibiotics, but a course of XYZ is now the standard of care for ear infection.
Now when the doctor sees patients with ear infections, he prescribes XYZ. It is the standard or care. The medications he used formerly are not less effective than they were. But, if he practices something other than the standard of care he will expose himself to malpractice suits if those treatments fail. In this scenario, what has standard of care done to the price of health care?
First of all, the price of treating ear infections has gone up because the medication used is more expensive. Patients paying cash will feel that cost immediately. Patients on insurance may not immediately feel the change, but they notice it when their insurance premium goes up the following year. Those receiving government assistance may not recognize the change, but everyone's taxes will go up because of it.
Doctor's dedication to the new product will have some effect on the relationship between supply and demand as well. Because doctors are now universally using the XYZ, demand rises dramatically with regard to supply. Scarcity will increase and prices will go up. And so the cost of treating an ear infection has gone up for two reasons: first, because the new standard of care calls for the use of a more expensive medication and second, because the standard of care has created a demand for the product that has driven up its price.
The above scenario characterizes a complex process, but accurately summarizes what may be the leading cause for the rising cost of health care over the last thirty years. Standard of care, a device meant to protect patients from negligence and malice, has made health care unaffordable and inaccessible to them.
What must we conclude then, is it economically impossible to provide Americans with good health care? We've shown that if all doctors use the hottest new medications, the price of health care will continue escalating. Does supply and demand require that quality health care be reserved for the few?
Our problem does not lie in seeking the best health care. It lies in dictating “the best health care” and then force feeding it to Americans. “Best care” cannot be dictated to doctors. Doctors cannot dictate it to patients. Doctors should exert themselves to stay abreast of the latest studies and the best data. They should be held responsible if they do not provide truthful and complete information to their patients. Patients will choose from doctor recommendations a treatment plan that that suits their needs and their budget. They will determine the best care.
I believe that the current concept of standard of care is harmful, both to America as a whole and to patients as individuals. I believe that it does not protect patients, but makes health care inaccessible to them. Consensus of best practice as seen in standard of care has gone too far in bridling physicians and their patients. Freedom must be maintained in all fields, especially health care. As we jettison obstacles to this freedom, American health care, the very best health care in the world, will become accessible to all American citizens.
Rusty Scalpel
I believe that our current concept and application of standard of care is one of these long-trusted devices is harming patients. I believe that it must be reconsidered and discarded.
Standard of care consists of the care that experts would consider to be best practice. The standard of care guides physicians as they make treatment plans for their patients. The purpose for having a standard of care is to prevent patients from being mistreated by negligent or malicious medical practitioners. If a court establishes that a physician caused damage by not following a standard care, that physician can be convicted of malpractice. Despite its protecting purpose, I believe that standard of care has contributed to patients' ultimate harm. It has made and continues to make health care inaccessible to them.
To prove this point, let's look at it from an economic standpoint. We've discussed supply and demand in the past. The price of any commodity is a function of the relationship between supply and demand. When demand for commodity increases with regard to supply, the commodity becomes scarce and costs more. When demand decreases with regard to supply, the commodity becomes less scarce and costs less. Now let's examine a scenario to see how standard of care effects the relationship between supply and demand.
Let's assume that American family practitioners read in the New England Journal of Medicine that extensive meta analysis of multiple studies proves that medication XYZ is hands-down the best treatment for ear infection. Within a short time, the data is almost universally accepted by family practitioners and a new standard of care has been established. Medication XYZ is a relatively new product and significantly more expensive than older antibiotics, but a course of XYZ is now the standard of care for ear infection.
Now when the doctor sees patients with ear infections, he prescribes XYZ. It is the standard or care. The medications he used formerly are not less effective than they were. But, if he practices something other than the standard of care he will expose himself to malpractice suits if those treatments fail. In this scenario, what has standard of care done to the price of health care?
First of all, the price of treating ear infections has gone up because the medication used is more expensive. Patients paying cash will feel that cost immediately. Patients on insurance may not immediately feel the change, but they notice it when their insurance premium goes up the following year. Those receiving government assistance may not recognize the change, but everyone's taxes will go up because of it.
Doctor's dedication to the new product will have some effect on the relationship between supply and demand as well. Because doctors are now universally using the XYZ, demand rises dramatically with regard to supply. Scarcity will increase and prices will go up. And so the cost of treating an ear infection has gone up for two reasons: first, because the new standard of care calls for the use of a more expensive medication and second, because the standard of care has created a demand for the product that has driven up its price.
The above scenario characterizes a complex process, but accurately summarizes what may be the leading cause for the rising cost of health care over the last thirty years. Standard of care, a device meant to protect patients from negligence and malice, has made health care unaffordable and inaccessible to them.
What must we conclude then, is it economically impossible to provide Americans with good health care? We've shown that if all doctors use the hottest new medications, the price of health care will continue escalating. Does supply and demand require that quality health care be reserved for the few?
Our problem does not lie in seeking the best health care. It lies in dictating “the best health care” and then force feeding it to Americans. “Best care” cannot be dictated to doctors. Doctors cannot dictate it to patients. Doctors should exert themselves to stay abreast of the latest studies and the best data. They should be held responsible if they do not provide truthful and complete information to their patients. Patients will choose from doctor recommendations a treatment plan that that suits their needs and their budget. They will determine the best care.
I believe that the current concept of standard of care is harmful, both to America as a whole and to patients as individuals. I believe that it does not protect patients, but makes health care inaccessible to them. Consensus of best practice as seen in standard of care has gone too far in bridling physicians and their patients. Freedom must be maintained in all fields, especially health care. As we jettison obstacles to this freedom, American health care, the very best health care in the world, will become accessible to all American citizens.
Rusty Scalpel
Wednesday, January 7, 2009
The Third-Order Approach to Solve Hunger, Poverty, and Healthcare
There are many different ways we can approach the problems in the world. Many of the approaches can be classified as good, better, or best. Like many, I want to make the world a better place which has led me to ponder the Chinese proverb: “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” Giving a man food because he is hungry a first-order approach to a problem. It’s simple a simple one-variable equation: if someone is hungry, give them food – problem solved. The third-order approach may be less intuitive and even more complex because it involves asking “Why are they hungry?” or even “Why I am not hungry?” Instead of one variable there are three variables that have to be met which allows the third-order approach to solve the problem and prevent it from recurring.
The third-order approach requires three essential components: a republican form of government, rule of law, and economic freedom. A classic example of a country that overcame poverty by following these components is Hong Kong. In the 1950s Hong Kong looked like most struggling third world countries. Today it boasts of an average annual income above European countries such as Great Britain and Italy. Hong Kong has a land area of roughly 400 square miles with no natural resources to sustain it’s population of 7 million people. Yet its citizens maintain a high standard of living.
We can look at Hong Kong and also at the United States of America as an example of prosperity and freedom. Our founding fathers established the framework for this country to become the richest country in the world. They understood the importance of a limited government and rule of law. In their wisdom they decentralized power and gave us a republic which provided economic freedom, the framework for the “American Dream.”
On the other hand we can look at countries who have centrally planned economies and limited economic freedom. Countries such as India and Sierra Leone have centrally planned economies, yet despite extensive government intervention they have some of the highest rates of poverty in the world. It is counterintuitive to think that government leaders, albeit experts in their fields, can cause such poor outcomes. Milton Friedman once commented on having government officials directing an economy by saying “There is nothing that does so much harm as good intentions.”
Several years ago I had the opportunity to live in the Dominican Republic and was able to see the influence of these principles at work. Like many Latin American governments there is corruption there, but the government is improving and foreign investors are noticing. The government has certain places called “Free Trade Zones” where foreign companies can build clothing factories and take advantage of the cheap labor with limited tariffs. These factories give people work and allow their children to have a better future. The economic pie is not fixed but grows because the universal law of comparative advantage prevails.
So how should one respond to issues such as severe poverty, hunger, and healthcare? I would suggest that it comes down to education, education, and more education. An individual must educate him or herself first and then educate others. Ayn Rand’s philosophy holds that historical trends are the inescapable product of philosophy. Fighting for the victory of ideas can defeat widely held ideologies that threaten liberty, private property rights, economic and individual freedom.
The major battlegrounds in this fight are the very places where students learn ideas that shape their lives such as high schools and universities. There are many organizations that are trying to spearhead a cultural renaissance and reverse trends of anti-freedom and anti-individualism such as the Mises Institute, the Cato Institute, the John Birch Society, etc. Learning from these institution can give an individual the tools necessary to promote the third-order approach.
As mentioned before there are many approaches to solve the problems in the world. The first-order approach is very satisfying for everyone involved, but it is not sustainable and does not address the underlying cause of the problem. The third-order approach, although more difficult to measure, is the best approach. It is incumbent for everyone to learn about these ideas and promote them, whether it be through financial contributions to these organizations or through educating other individuals. I am not suggesting we neglect the needs of people today in order to promote ideas we hope they will grasp tomorrow. By the same token we should not be distracted by doing something good or something better, when we can be working towards the best solution which solves the problem and prevents it from happening.
Cato
Friday, October 24, 2008
If Elected President, I Will...
Free Market Physician's guide to solving the "Health Care Problem"
Of course we recognize that the fix that health care needs is not within the constitutional powers of the president of the United States. Any comprehensive plan that a presidential candidate offers is probably going to throw a wrench in the economy and is possibly unconstitutional as well.
What we offer is the hard, but true, solution to the health care problem. It's hard because it is not just an executive or legislative fix. Our congressmen are not going to pass a bill that makes health care affordable and available for everyone. No, the solution is to be found in the market and it requires politicians to do the thing that is most difficult for them- to untie our hands and stay out of the way.
And just to be clear, let's specify what the Health Care Problem really is. It is high prices due to a lack of supply of medical care. So without further ado, here are our three recommended actions for solving the Health Care Problem.
1) Remove the legislation of discrimination that denies non-traditional providers access to the field.
Spurred on by the physicians of the American Medical and American Osteopathic Associations, many state legislatures have passed strict laws regulating the practice rights of physicians assistants and nurse practitioners. Many physicians see them as a threat to their practice and believe that an unregulated medical market is somehow an infringement on their rights as physicians. However, the right to a monopoly of the medical market does not exist.
NP's and PA's, those "masters of the mundane," have the incredible potential of filling the gap in America's primary care services. Their education is less extensive than that of DO's and MD's, it takes less time, and it costs less to receive. They have the potential to drop the floor out of the costs of primary care, offering general care at a fraction of the price charged by traditional physicians. They have the potential to work for traditionally underserved populations, opening branches of practices in new locations.
NP's and PA's cannot do everything a doctor can do. They practice within a scope defined by their education, by their licensing, and especially by the market. If they provide competent medical care at low prices, the market will be very likely to reward them.
2) Remove state regulation preventing physicians from competing against each other.
In what other market is non-competition so actively advocated and enforced as in the medical market? We now have the natural effects of these efforts- a market that is not truly a market. The deliberately-limited supply of physicians and the lack of competition between physicians creates artificially high prices in health care. The medical economy is not consumer friendly. In fact it's nearly impossible to shop around. Medical prices are hard for consumers to verify, illegal for doctors to compare, and made homogeneous by insurance companies.
But remove regulations preventing physician competition, and you will see doctors scramble to please patients. Prices will be dropped, advertised, compared, and then dropped even lower. Doctors will be forced to show ingenuity in the administration of their practices, cutting waste across the board. Now empowered, consumers will swap their comprehensive health insurance plans for catastrophic plans and personally shop for price and quality. Health care prices will drop again.
3) Take the philosophical burden of patient care and place it firmly on the patients' shoulders.
After almost a century of modern medical grind, doctors are realizing that they can no longer be responsible for our patients' health. We deeply desire to keep our patients healthy and we've gone to extraordinary means to promote that health. In our frustration, we have tried to control our patients lives. We have tried to control patients by professional authority, we have tried to control patients by barring other practitioners from the markets, we try to control patients by by lobbying state and federal legislatures to pass laws regulating behavior.
We have had success in convincing them. Patients now see us as responsible for their health as well. This fact is evident in the call schedules we keep and in the onslaught of lawsuits we face. But the burden of responsibility for patient care is one we cannot truly carry. It always was the patients' and it must return to them.
When the true responsibility for patient care is established, medical care will be revolutionized. Doctors will see a reduction in status and income, but they will also see a reduction in call hours, malpractice suits, and headaches from dealing with insurance companies. America will find itself healthier and with a more efficient and less costly medical system. This truly is the final solution for all of our national woes- personal responsibility. The sooner this responsibility is acknowledged, the sooner this nation can begin to truly resolve the problems at hand.
Rusty Scalpel
Of course we recognize that the fix that health care needs is not within the constitutional powers of the president of the United States. Any comprehensive plan that a presidential candidate offers is probably going to throw a wrench in the economy and is possibly unconstitutional as well.
What we offer is the hard, but true, solution to the health care problem. It's hard because it is not just an executive or legislative fix. Our congressmen are not going to pass a bill that makes health care affordable and available for everyone. No, the solution is to be found in the market and it requires politicians to do the thing that is most difficult for them- to untie our hands and stay out of the way.
And just to be clear, let's specify what the Health Care Problem really is. It is high prices due to a lack of supply of medical care. So without further ado, here are our three recommended actions for solving the Health Care Problem.
1) Remove the legislation of discrimination that denies non-traditional providers access to the field.
Spurred on by the physicians of the American Medical and American Osteopathic Associations, many state legislatures have passed strict laws regulating the practice rights of physicians assistants and nurse practitioners. Many physicians see them as a threat to their practice and believe that an unregulated medical market is somehow an infringement on their rights as physicians. However, the right to a monopoly of the medical market does not exist.
NP's and PA's, those "masters of the mundane," have the incredible potential of filling the gap in America's primary care services. Their education is less extensive than that of DO's and MD's, it takes less time, and it costs less to receive. They have the potential to drop the floor out of the costs of primary care, offering general care at a fraction of the price charged by traditional physicians. They have the potential to work for traditionally underserved populations, opening branches of practices in new locations.
NP's and PA's cannot do everything a doctor can do. They practice within a scope defined by their education, by their licensing, and especially by the market. If they provide competent medical care at low prices, the market will be very likely to reward them.
2) Remove state regulation preventing physicians from competing against each other.
In what other market is non-competition so actively advocated and enforced as in the medical market? We now have the natural effects of these efforts- a market that is not truly a market. The deliberately-limited supply of physicians and the lack of competition between physicians creates artificially high prices in health care. The medical economy is not consumer friendly. In fact it's nearly impossible to shop around. Medical prices are hard for consumers to verify, illegal for doctors to compare, and made homogeneous by insurance companies.
But remove regulations preventing physician competition, and you will see doctors scramble to please patients. Prices will be dropped, advertised, compared, and then dropped even lower. Doctors will be forced to show ingenuity in the administration of their practices, cutting waste across the board. Now empowered, consumers will swap their comprehensive health insurance plans for catastrophic plans and personally shop for price and quality. Health care prices will drop again.
3) Take the philosophical burden of patient care and place it firmly on the patients' shoulders.
After almost a century of modern medical grind, doctors are realizing that they can no longer be responsible for our patients' health. We deeply desire to keep our patients healthy and we've gone to extraordinary means to promote that health. In our frustration, we have tried to control our patients lives. We have tried to control patients by professional authority, we have tried to control patients by barring other practitioners from the markets, we try to control patients by by lobbying state and federal legislatures to pass laws regulating behavior.
We have had success in convincing them. Patients now see us as responsible for their health as well. This fact is evident in the call schedules we keep and in the onslaught of lawsuits we face. But the burden of responsibility for patient care is one we cannot truly carry. It always was the patients' and it must return to them.
When the true responsibility for patient care is established, medical care will be revolutionized. Doctors will see a reduction in status and income, but they will also see a reduction in call hours, malpractice suits, and headaches from dealing with insurance companies. America will find itself healthier and with a more efficient and less costly medical system. This truly is the final solution for all of our national woes- personal responsibility. The sooner this responsibility is acknowledged, the sooner this nation can begin to truly resolve the problems at hand.
Rusty Scalpel
Wednesday, October 8, 2008
A Conservative Approach to Universal Health Care
I believe that most Americans believe that all Americans should have access to health care. We believe that in times of necessity, every American should be able to receive health care despite personal economic difficulty. We can all agree that we would not have a single one of our American brothers or sisters suffer when prudent use of medical care could alleviate that suffering. In this I believe we all stand united.
The division of thought perhaps lies in how relief ought to be administered. A part of our population, often referred to as liberals, generally believe that government programs should be put into place to relieve the suffering of the medically uncared. They believe that adequate funds could be taken from the population to provide for basic medical care for the entire populace.
Another part of our population generally disagree with such government-run programs. These are those who are called conservative and the growing population of those called libertarians. There are many reasons they may oppose such programs and among those are the following:
1) They simply oppose big government. They may oppose growth of government beyond traditional constitutional bounds for constitutional reasons.
2) They see government-administered programs as ineffective. They believe that increased taxation actually results in a decrease in tax revenue. They believe that the collected funds are ineffectively administered. They believe that many government programs foster dependence on the system and prevent the development of productive citizens and progressing human beings.
3) They resent government intrusions into personal liberty. They believe that growth of the government comes at the expense of personal liberties. Government programs hit pocketbooks and limit Americans' utilization of personal funds. Government programs often lead to regulations that limit personal choice. They believe that the preservation of liberty is more important than overall economic strength and that liberty should not be sacrificed for any other goal.
4) They recognize that governmental assistance to the needy does not result in the same spiritual or moral growth as personal assistance to the needy. They see no moral progression in being taxed to help the poor. They see little patriotism in having a pocket unwillingly picked. The funds that they might otherwise dedicate to the good of their fellowmen are taken from them. In addition, the substitution of government checks for loving service and assistance from neighbors and friends considerably blunts the moral growth that could take place in those on the recipient end of charitable action. Those who believe in this way believe that there is no institutional salvation for America without the individual salvation of American citizens.
For those who share this mindset and who cherish personal freedoms, might I suggest a potent means of combating the incoming wave of American socialism. Let's use our freedoms to decrease the need for increased social programs now.
What need can there be for liberal social programs if we use our still-present freedom to alleviate the suffering of our fellow Americans? What driving force would there be behind socializing health care if all Americans had adequate access to basic primary care?
As we look beyond ourselves, we will see solutions to the "health care crisis" that require the exercise, not the sacrifice of personal liberty. How striking it would be if we could demonstrate examples of entire communities where the utilization of innovation and personal freedom lead to a complete independence from federal funding for health care. What a statement we would make if without tax impositions we achieved a society where there is no poor among us.
All Americans, compassionate conservatives and bleeding-heart liberals alike, desire the good of their fellow Americans. As conservatives, and especially as physicians, let's use our own agency to benefit our fellow men. Let us show how our to exalt our liberties and what a great loss America will suffer if these liberties are taken away.
Rusty Scalpel
The division of thought perhaps lies in how relief ought to be administered. A part of our population, often referred to as liberals, generally believe that government programs should be put into place to relieve the suffering of the medically uncared. They believe that adequate funds could be taken from the population to provide for basic medical care for the entire populace.
Another part of our population generally disagree with such government-run programs. These are those who are called conservative and the growing population of those called libertarians. There are many reasons they may oppose such programs and among those are the following:
1) They simply oppose big government. They may oppose growth of government beyond traditional constitutional bounds for constitutional reasons.
2) They see government-administered programs as ineffective. They believe that increased taxation actually results in a decrease in tax revenue. They believe that the collected funds are ineffectively administered. They believe that many government programs foster dependence on the system and prevent the development of productive citizens and progressing human beings.
3) They resent government intrusions into personal liberty. They believe that growth of the government comes at the expense of personal liberties. Government programs hit pocketbooks and limit Americans' utilization of personal funds. Government programs often lead to regulations that limit personal choice. They believe that the preservation of liberty is more important than overall economic strength and that liberty should not be sacrificed for any other goal.
4) They recognize that governmental assistance to the needy does not result in the same spiritual or moral growth as personal assistance to the needy. They see no moral progression in being taxed to help the poor. They see little patriotism in having a pocket unwillingly picked. The funds that they might otherwise dedicate to the good of their fellowmen are taken from them. In addition, the substitution of government checks for loving service and assistance from neighbors and friends considerably blunts the moral growth that could take place in those on the recipient end of charitable action. Those who believe in this way believe that there is no institutional salvation for America without the individual salvation of American citizens.
For those who share this mindset and who cherish personal freedoms, might I suggest a potent means of combating the incoming wave of American socialism. Let's use our freedoms to decrease the need for increased social programs now.
What need can there be for liberal social programs if we use our still-present freedom to alleviate the suffering of our fellow Americans? What driving force would there be behind socializing health care if all Americans had adequate access to basic primary care?
As we look beyond ourselves, we will see solutions to the "health care crisis" that require the exercise, not the sacrifice of personal liberty. How striking it would be if we could demonstrate examples of entire communities where the utilization of innovation and personal freedom lead to a complete independence from federal funding for health care. What a statement we would make if without tax impositions we achieved a society where there is no poor among us.
All Americans, compassionate conservatives and bleeding-heart liberals alike, desire the good of their fellow Americans. As conservatives, and especially as physicians, let's use our own agency to benefit our fellow men. Let us show how our to exalt our liberties and what a great loss America will suffer if these liberties are taken away.
Rusty Scalpel
Reader Recommendation: The Four Ways Money is Spent
We very much appreciate the following recommendation by one of our readers:
I saw this on C4L so I thought I would pass it on...
Milton Friedman brilliantly described the four ways that money is spent.
I saw this on C4L so I thought I would pass it on...
Milton Friedman brilliantly described the four ways that money is spent.
- The first and most common way in the private sector is people spending their own money on themselves. In this case, the buyer is interested in both quality (the best product or service that he can afford) and value (getting it at the best price) because he is both the producer of the wealth being spent and the consumer of the good or service being procured.
- The second way is when people spend their own money on others (such as gifts). Here they are still concerned about value (it's their money), but less concerned about service quality as they are not the consumer.
- The third way is spending other people's money on yourself. Think of the rich man's girlfriend who buys herself the nicest dresses in the store on his credit card without even looking at the tag. She wants quality, but value is irrelevant since she sacrifices nothing.
- The fourth way is when people spend other people's money on other people. In this case, the buyer has no rational interest in either value or quality. Government always and necessarily spends money in this fourth way. This guarantees inefficient public spending because the spenders have no vested interest in efficiently allocating those funds.
Friday, September 26, 2008
Resistance to Federal Assistance
Yesterday FMP received the following comment to the post Among These are Life, Liberty and the Pursuit of Happiness from our reliable reader, Anonymous:
How can we expect to be "free market" physicians when we don't allow those currently treating our wives and children to do the same? I know it is uncomfortable to talk about this, but by giving in to using social (programs), we are exacerbating the problem rather than solving it. We cannot use these programs now, but expect others not to use them or not accept their payment when we are the ones providing care and paying taxes. Just a thought that we all should consider.
(It is FMP's understanding that Anonymous was referring to medical students who personally may not approve of expanding medicaid and other welfare plans, but nevertheless accept aid from those programs for their families while they are in medical school. Should they utilize a program they personally disagree with?)
The comment raises an important question. As Free Market Physicians, what is our responsibility regarding national and state welfare programs that we don't approve of? In a time when we may disagree with the expansion and universal establishment of federal health care programs, should we deny ourselves federal aid that we otherwise qualify for?
As Anonymous acknowledged, the subject is indeed a little bit sensitive. But let's look at it from a market perspective.
All along we have argued that, like all other markets, the medical market is best governed by the consumer. Low prices and high quality products are achieved, not by government intrusion, but by consumers actively selecting the products that best suits them. With that understanding, let me compare our current discussion with another market movement.
There are those that believe that "Corporate America," or the big national businesses- the Walmarts of the industry, have been unethically driving local businesses and producers out of the market. They are saddened by the loss of culture and personality in small communities when the big national stores arrive. Apparently, people cannot resist the attraction of low prices. As the locals forsake their neighbors' businesses to shop at the retail outlets, local industry dies.
We free marketeers probably see nothing wrong with the situation. We may have sympathy for the local loss. But we argue that the consumer has been presented with a choice. The consumer knows best what his or her needs are and has evidently chosen lower prices because that value trumps other values. The consumer apparently values lower prices and convenience more than he or she values local industry and personality.
Let's go back to the medical market and the enticement of federal aid. In each community a medical market is available with variety of prices and services. The medical care may vary and the prices and means of paying vary. Involved in the market are such commodities such as health insurances, cash-only practices, and government-paid health care.
The decision of which of the products or programs to use is ultimately at the discretion of the consumers. That's us. This is our opportunity to choose a product based on our personal values. In my case, the values that should determine my purchase include the following:
I want my family to receive the medical care it needs.
I would like doctors who view me as an equal and who counsel, not dictate, treatment options.
I don't believe in taking anything I haven't earned.
I rely on myself, my family, and my God before I look to the government for aid.
I do not believe that paying taxes is patriotic.
I would like use my resources to help those around me- not to have those goods confiscated by the government to help those around me.
It is plain to see that my values rule out certain options on the market. Based on my values, I will choose a medical plan and product that best suits me. Other people with other values will choose the plan that best suits them. There are those whose chief value is taking care of their family, but they have no means to do so. I will not criticize their decision to accept federal aid.
In our market decisions, let us always beware of the bargain. It appears to be human nature to purchase an item marked as "on sale," even if we had no intention of buying it in the first place. Even more provocative are those things marked as "free."
The federal government is advertising "free" health care. It will be aggressively advertising it in the presidential election. Let us buy our health products and services wisely, based on our values. With consideration, I think we will find market options that suit us much better than any federal plan.
Rusty Scalpel
How can we expect to be "free market" physicians when we don't allow those currently treating our wives and children to do the same? I know it is uncomfortable to talk about this, but by giving in to using social (programs), we are exacerbating the problem rather than solving it. We cannot use these programs now, but expect others not to use them or not accept their payment when we are the ones providing care and paying taxes. Just a thought that we all should consider.
(It is FMP's understanding that Anonymous was referring to medical students who personally may not approve of expanding medicaid and other welfare plans, but nevertheless accept aid from those programs for their families while they are in medical school. Should they utilize a program they personally disagree with?)
The comment raises an important question. As Free Market Physicians, what is our responsibility regarding national and state welfare programs that we don't approve of? In a time when we may disagree with the expansion and universal establishment of federal health care programs, should we deny ourselves federal aid that we otherwise qualify for?
As Anonymous acknowledged, the subject is indeed a little bit sensitive. But let's look at it from a market perspective.
All along we have argued that, like all other markets, the medical market is best governed by the consumer. Low prices and high quality products are achieved, not by government intrusion, but by consumers actively selecting the products that best suits them. With that understanding, let me compare our current discussion with another market movement.
There are those that believe that "Corporate America," or the big national businesses- the Walmarts of the industry, have been unethically driving local businesses and producers out of the market. They are saddened by the loss of culture and personality in small communities when the big national stores arrive. Apparently, people cannot resist the attraction of low prices. As the locals forsake their neighbors' businesses to shop at the retail outlets, local industry dies.
We free marketeers probably see nothing wrong with the situation. We may have sympathy for the local loss. But we argue that the consumer has been presented with a choice. The consumer knows best what his or her needs are and has evidently chosen lower prices because that value trumps other values. The consumer apparently values lower prices and convenience more than he or she values local industry and personality.
Let's go back to the medical market and the enticement of federal aid. In each community a medical market is available with variety of prices and services. The medical care may vary and the prices and means of paying vary. Involved in the market are such commodities such as health insurances, cash-only practices, and government-paid health care.
The decision of which of the products or programs to use is ultimately at the discretion of the consumers. That's us. This is our opportunity to choose a product based on our personal values. In my case, the values that should determine my purchase include the following:
I want my family to receive the medical care it needs.
I would like doctors who view me as an equal and who counsel, not dictate, treatment options.
I don't believe in taking anything I haven't earned.
I rely on myself, my family, and my God before I look to the government for aid.
I do not believe that paying taxes is patriotic.
I would like use my resources to help those around me- not to have those goods confiscated by the government to help those around me.
It is plain to see that my values rule out certain options on the market. Based on my values, I will choose a medical plan and product that best suits me. Other people with other values will choose the plan that best suits them. There are those whose chief value is taking care of their family, but they have no means to do so. I will not criticize their decision to accept federal aid.
In our market decisions, let us always beware of the bargain. It appears to be human nature to purchase an item marked as "on sale," even if we had no intention of buying it in the first place. Even more provocative are those things marked as "free."
The federal government is advertising "free" health care. It will be aggressively advertising it in the presidential election. Let us buy our health products and services wisely, based on our values. With consideration, I think we will find market options that suit us much better than any federal plan.
Rusty Scalpel
Friday, September 12, 2008
Among These Are Life, Liberty, and the Pursuit of Happiness
We live in a time where phrases from the Constitution and Declaration of Independence are thrown around glibly to achieve personal and financial ends. A current abuse to our great founding documents is the argument for universal health care, construing it as part of our inalienable, God-given right to life.
To put it in context, this reference to the right to life is part of the rationale for breaking away from Great Britain in the Declaration of Independence:
We hold these truths to be self-evident:
That all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness; that, to secure these rights, governments are instituted among men...
We've discussed the subject in length before, but let's briefly use the Declaration to show why the increasingly-popular right to health care is not truly a right.
The “right” to heath care is not self-evident. It is a head-scratcher. There are many applications of the right to life that are self-evident, for example the right to protect oneself against violent assault to preserve life. However, the right to health care (i.e. compel others to care for you) is not one of these self-evident rights.
The “right” to health care is not endowed by the Creator. Our God-given moral agency encompasses the right to do a great many things. We can clearly see that God endowed us with the ability and right to reason, to speak, and to express our thoughts- in other words the freedom of speech. However, to my knowledge, none of us is endowed with the ability and right to free health care.
The “right” to health care is not unalienable. Unalienable means incapable of being alienated, surrendered or transferred. Clearly, the “right” to health care can be transferred or alienated since it does not currently exist in our country. It is not part of our innate human nature. Parts of our population want that right transferred to us by law. By so doing, they blatantly demonstrate that it is not unalienable.
The “right” to health care interferes with the governmental role of securing true rights. Federally-administered universal health care cannot be instituted without the infringement of other freedoms.
The Declaration establishes that universal access to health care is not a right. However, this doesn't mean that universal health care is an undesirable goal. Resistance to a federally-mandated universal health care is not resistance to the goal of making health care accessible to all mankind, or by definition, universal.
It seems very logical and natural to want all members of the human race to have adequate medical care, regardless of their ability to pay. That concept is already incorporated into modern medical ethics. Many physicians volunteer their time and skill to this end. Many non-physicians volunteer their means to fulfill this goal. This service is ennobling and part of that great right to the pursuit of happiness that our Creator has endowed us with.
However, contrast this humane service to a federally-implemented and mandated universal health care system where. What was once a service becomes literal slavery. The difference may appear subtle- in one case we freely serve because of love of God and men. In the other we are legally compelled to support a dependent population.
This is the difference between freedom and slavery, a difference that the Constitution has perfectly defined for over two hundred years. May we understand that difference and cherish and defend those rights with which our Creator truly has endowed us.
Rusty Scalpel
Friday, August 29, 2008
Smoking Bans Are Bad for America's Health
Main points:
- The dangers of smoking and second-hand smoke is scientifically established, however
- Smoking bans are an infringement on property rights
- Consumers possess economic clout to combat public smoking
- Smoking bans open the door for further, more extreme breaches of Constitutional Rights
a. Smoking is prohibited in all bars, city operated facilities, recreation facilities, restaurants, amusement places, bed and breakfasts...
The debate leading up to the decision was extensive and passionate. The public record for the city meeting leading up to the decision is much more interesting than public records usually are. The arguments in favor of the ban were varied and compelling, as seen in these excerpts from the record.
Tom Mayer... works at the lung health clinic. He tests people who have been exposed to second-hand smoke. He has to talk to people who are experiencing health problems due to a smoking environment.
Nicole Stevens... worked two years in a smoking area of a restaurant. She did not have a choice since she needed a job. She asked that smoking be banned.Fred Peterson... said he is tired of paying for smoker’s diseases. His father, step-father and mother died of smoke related diseases. One-half hour of smoke exposure affects us.
Sarah Shelton stated this is an opportunity for Kirksville to become a pioneer city by passing an ordinance to ban smoking.
Alana DeCooyer... stated it is her right to go into a business without there being smoke there. She does not go into those businesses that allow smoking. Kirksville should set a standard by banning smoking here.
The arguments demonstrate the fact that smoking is indeed dangerous and has had a devastating history of damage. They certainly demonstrate an intellectual progress in that the majority of the participants in the public hearing recognized the dangers of smoking and wanted to halt its destructive effects.
However, was a ban on smoking in public buildings the best course of action to combat smoking? Consider two more excerpts from the record.
Brenda Sewell, owns Uptown Café, presented a petition signed that says business owners should have the right to choose. She said that 80% of her patrons are smokers.
Jan Collins, Washington Street Java, said that her business became smoke free in 2001, and she believes their business has grown.
First of all, let's consider two opposing claims from the record. From the final excerpt from the Pro-Ban group, a citizen claims that she has the "right to to go into a business without there being smoke there." Yet, the owner of the Uptown Cafe states that "business owners should have the right to choose" whether smoking is allowed on the premises.
Whose right is it to determine whether smoking is allowed on a property- the owner of the property or the visitor to the property? I believe that most of us would agree that this is a property right of the owner. Traditionally, the owner of a property determines its use. In addition, many of us agree that it is a constitutional right. It is implicit in the "Nor shall private property be taken for public use" phrase of the Fifth Amendment.
This is not to say that the citizens of Kirksville were obligated to enter smoke-filled public buildings. They still had a right- not the right to "go into a business without smoke being there"- but the right to choose not to go into buildings where smoking is taking place. No one forced them to eat in smoky restaurants- they ate there for reasons of convenience.
This doesn't mean that Kirksville citizens had no say in the use of private buildings. Actually, they had available a means of promoting non-smoking businesses just as profound as the city-wide ban would be. They had an economic vote.
All it would take to bring non-smoking businesses to Kirksville would be for the non-smokers to quit patronizing smoking establishments. The non-smoking establishments like the above-noted Washington Street Java would bloom with such action. Those businesses that continued to allow smoking would be forced to consider prohibiting smoking in their establishment or face the consequences of a smaller customer base.
Within a short amount of time, the policies of businesses would be proportionate to the tastes of the consumers. There would be adequate businesses to accommodate both smokers and non-smokers.
Consider the two votes that Kirksville citizens had. They had a democratic vote, one in which they could compel an entire populace to accommodate to the preferences of the majority. The use of this vote was an attractive option- with it they could significantly decrease public smoking in a single stroke. They also had an economic vote- one in which the local economy would respond to the tastes of its citizens.
Note that by using a democratic vote to establish a smoking ban a precedent would be set. Property rights would be infringed upon by a majority wielding "scientific data" showing harm- a majority enforcing what they felt was "right" and "healthy." But once these rights are infringed, they are forever in jeopardy to the next data-wielding majority who believes they are promoting something "right" or "healthy."
Think of the possibilities-a majority of the population with data showing that organized religion promotes depression, or conversely a religious majority determined to shut down businesses on Sundays. How about a health conscious majority forcing restaurants to serve vegetables with every meal? The action solely depends on a majority view and a rationale.
So even though we understand why Kirksville residents adopted a smoking ban, we must insist that it was bad- bad for the health of America. Freedom, even if it is the freedom to allow smoking in your business, must be preserved. Freedom must encompass the power to choose the wrong. By protecting this freedom, we preserve the power to do right.
Rusty Scalpel
(A final point to consider: how did the smoking ban affect businesses that had already prohibited smoking on their premises. Did they benefit from the ban?)
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