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
Tuesday, March 31, 2009
Thursday, March 26, 2009
Conscience-Clause Law and Religous Freedom in Health Care
Do health care practitioners have the right to refuse treatment based on religious grounds?
On March 10 the Obama Administration announced a 30-day comment period before rescinding (overturning) conscience clause regulation established during the last days of President Bush's term. To put these soon-to-be challenged regulations in perspective, let's quickly look at the recent history conscience clause laws and religious freedom in health care.
When Roe v. Wade was decided in 1973, there was concern that physicians and other care practitioners would be legally compelled to perform abortions or sterilizations even if they found the procedures religiously repugnant. At that time, Senator Frank Church of Idaho sponsored an amendment that protected federally-funded physicians or hospitals who objected to the procedures on a moral or religious basis from having to perform the procedures. The amendment passed the senate 92-1 and became the first conscience-clause law.
The conscious clause laws were popularly accepted and promoted. Over the next years, nearly every state passed conscious-clause laws. Even Supreme Court Justice Harry Blackman, who had authored Roe v. Wade, approved of such laws as appropriate protection for physicians and hospitals.
In December of 2008, the White House announced that it would be enacting new conscience- clause regulation that would further define the 'right of conscience.' As stated in the new regulation, "The Department is concerned about the development of an environment in sectors of the health care field that is intolerant of individual objections to abortion or other individual religious beliefs or moral convictions. Such developments may discourage individuals from entering health care professions. Such developments also promote the mistaken belief that rights of conscience and self-determination extend to all persons, except health care providers..." The regulation also stated a purpose of aiding for religious entities (such as Catholic hospitals) that might suffer penalties for their abstention from objectionable practices. Bush regulation here
The new regulation established that any health care worker with "reasonable connection to the procedure" could refuse to participate if they found it morally objectionable. This could include nurses, technicians, pharmacy techs, etc. The regulations also left the door open for objections to procedures beyond abortion and sterilization. It could be interpreted to apply to any procedure that health care providers morally oppose.
The Bush regulation stirred controversy and were immediately followed by lawsuits in seven states claiming that the regulation "sacrifices the health of patients to the religious beliefs of medical providers." Organizations like Planned Parenthood called for a recision of the regulation to defend "the rights of patients to receive complete and accurate reproductive health information and services, without fear that health care providers will withhold vital information and services based on their personal biases."
On March 10 the Obama Administration announced a 30-day comment period before rescinding the Bush regulations. The recision of the regulation would not annul standing laws like the Frank Amendment or the Weldon Amendments, but would strike down in its entirety the Bush regulations. And so we return to our original question: What right do medical care practitioners have to decline treatment based on religious beliefs?
The Bush regulations also compel us to us ask specifically, should practitioners' choice to deny treatment be limited to certain procedures? Also, should conscience-clause law protection be limited to the primary provider? Do doctors have more of a right than nurses or technicians to refuse to participate in an abortion?
In contemplating these questions, I can't help but agree with the statement of the Bush regulation that there is a "mistaken belief that rights of conscience and self-determination extend to all persons, except health care providers..." I find myself very uncomfortable with the political wrangling and showdowns between the pro-lifers and pro-choicers when the First Amendment of the Constitution is already explicit:
"Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof..."
Perhaps the executive branch can get away with these regulations because the Amendment specifies only Congress' limits to such lawmaking. At any rate, the practice of legislating through White House regulations is probably far outside of constitutional limits.
I believe that it is 'self-evident' that these 'God-given', 'inalienable' rights are truly universal. They apply to doctors, the same as nurses, the same as all Americans and all humanity.
To be truthful, I don't know how meaningful these regulations really are. My understanding of the Bush regulation is that it simply enforces current law. With it being struck down, current conscience-clause law still stands and has not been changed. However, I believe that conscience-clause law will continue to be severely trampled if the regulation is rescinded.
With regards to the Bush regulation. I think it should stand. It upholds current laws, whereas striking down the regulation encourages the disregard of standing law. Striking down the regulation will encourage evil organizations in their fear mongering and efforts to subject American health care providers to their practices. I believe that the right to religious expression, in the workplace or elsewhere, is a God-given right. Infringement of that right is tyranny.
The comment period before recision (overturn) of the Bush regulation ends on April 9. Comments can be sent to proposedrescission@hhs.gov. Or comments can be directly submitted here. Remember that these comments go directly to the Department of Health and Human Services. Demands and impassioned pleas will probably not go as far as well-constructed argument. In particular, the department has asked for:
On March 10 the Obama Administration announced a 30-day comment period before rescinding (overturning) conscience clause regulation established during the last days of President Bush's term. To put these soon-to-be challenged regulations in perspective, let's quickly look at the recent history conscience clause laws and religious freedom in health care.
When Roe v. Wade was decided in 1973, there was concern that physicians and other care practitioners would be legally compelled to perform abortions or sterilizations even if they found the procedures religiously repugnant. At that time, Senator Frank Church of Idaho sponsored an amendment that protected federally-funded physicians or hospitals who objected to the procedures on a moral or religious basis from having to perform the procedures. The amendment passed the senate 92-1 and became the first conscience-clause law.
The conscious clause laws were popularly accepted and promoted. Over the next years, nearly every state passed conscious-clause laws. Even Supreme Court Justice Harry Blackman, who had authored Roe v. Wade, approved of such laws as appropriate protection for physicians and hospitals.
In December of 2008, the White House announced that it would be enacting new conscience- clause regulation that would further define the 'right of conscience.' As stated in the new regulation, "The Department is concerned about the development of an environment in sectors of the health care field that is intolerant of individual objections to abortion or other individual religious beliefs or moral convictions. Such developments may discourage individuals from entering health care professions. Such developments also promote the mistaken belief that rights of conscience and self-determination extend to all persons, except health care providers..." The regulation also stated a purpose of aiding for religious entities (such as Catholic hospitals) that might suffer penalties for their abstention from objectionable practices. Bush regulation here
The new regulation established that any health care worker with "reasonable connection to the procedure" could refuse to participate if they found it morally objectionable. This could include nurses, technicians, pharmacy techs, etc. The regulations also left the door open for objections to procedures beyond abortion and sterilization. It could be interpreted to apply to any procedure that health care providers morally oppose.
The Bush regulation stirred controversy and were immediately followed by lawsuits in seven states claiming that the regulation "sacrifices the health of patients to the religious beliefs of medical providers." Organizations like Planned Parenthood called for a recision of the regulation to defend "the rights of patients to receive complete and accurate reproductive health information and services, without fear that health care providers will withhold vital information and services based on their personal biases."
On March 10 the Obama Administration announced a 30-day comment period before rescinding the Bush regulations. The recision of the regulation would not annul standing laws like the Frank Amendment or the Weldon Amendments, but would strike down in its entirety the Bush regulations. And so we return to our original question: What right do medical care practitioners have to decline treatment based on religious beliefs?
The Bush regulations also compel us to us ask specifically, should practitioners' choice to deny treatment be limited to certain procedures? Also, should conscience-clause law protection be limited to the primary provider? Do doctors have more of a right than nurses or technicians to refuse to participate in an abortion?
In contemplating these questions, I can't help but agree with the statement of the Bush regulation that there is a "mistaken belief that rights of conscience and self-determination extend to all persons, except health care providers..." I find myself very uncomfortable with the political wrangling and showdowns between the pro-lifers and pro-choicers when the First Amendment of the Constitution is already explicit:
"Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof..."
Perhaps the executive branch can get away with these regulations because the Amendment specifies only Congress' limits to such lawmaking. At any rate, the practice of legislating through White House regulations is probably far outside of constitutional limits.
I believe that it is 'self-evident' that these 'God-given', 'inalienable' rights are truly universal. They apply to doctors, the same as nurses, the same as all Americans and all humanity.
To be truthful, I don't know how meaningful these regulations really are. My understanding of the Bush regulation is that it simply enforces current law. With it being struck down, current conscience-clause law still stands and has not been changed. However, I believe that conscience-clause law will continue to be severely trampled if the regulation is rescinded.
With regards to the Bush regulation. I think it should stand. It upholds current laws, whereas striking down the regulation encourages the disregard of standing law. Striking down the regulation will encourage evil organizations in their fear mongering and efforts to subject American health care providers to their practices. I believe that the right to religious expression, in the workplace or elsewhere, is a God-given right. Infringement of that right is tyranny.
The comment period before recision (overturn) of the Bush regulation ends on April 9. Comments can be sent to proposedrescission@hhs.gov. Or comments can be directly submitted here. Remember that these comments go directly to the Department of Health and Human Services. Demands and impassioned pleas will probably not go as far as well-constructed argument. In particular, the department has asked for:
- "The scope and nature of the problems giving rise to the federal rulemaking," including specific examples, "and how the current rule would resolve those problems."
- Information, with examples, to support or refute allegations that the regulation "reduces access to information and health care services, particularly by low-income women."
- Whether the rule is clear enough "to minimize the potential for any ambiguity and confusion" that might result from it.
- Whether the objectives of the rule could be accomplished "through nonregulatory means, such as outreach and education."
Tuesday, March 24, 2009
Letter from Reader
After a couple weeks of break for finals, FMP is back online. We thank Nathan Reed for this submission, with which we wholeheartedly agree.
I've been pretty outraged on a daily basis since January 2009 about the happenings in Washington D.C. Now I'm just sad for our country. What is happening now is the death of the chance for success. That is the “American Dream”; the CHANCE (not guarantee) to raise your lifestyle through dedicated hard work and innovation in any field of your choosing. The “American Dream” is NOT entitlement to free healthcare, housing, etc. It is NOT allowing congress to choose which companies must be saved, which the government should take over, and which companies and EVEN INDIVIDUALS to tax at confiscatory rates. This country is currently on a path that Ayn Rand depicted decades ago. A 90% tax (that members of BOTH parties voted for) on a select few individuals! A confiscatory power that president Obama is now seeking to extend to anything/anyone that our D.C. prima donnas don't like. After legislators ENABLED the behavior they feign outrage about by saving these failing companies in the first place! They are KILLING the wealth, dreams and motivation for anyone aspiring to be more and do more with their lives than merely subsist. Anyone that manages to make a good living is suspect.
Liberals and socialists would like to assume that most people operate from purely humanitarian motivations – that this is how it should be, but our country has proven in the last 230+ years that self-interest is the greatest motivator of the human spirit. This country rose to relative success in the world by refusing to deny that universal truth. Furthermore, self-interest is individual, and the freedom to pursue the goals that tickle our self-interest is another bedrock of our past success. Society cannot reasonably expect an individual to put their all into any task when the effort of their work is not met with some form of compensation that the worker finds acceptable. That is the beauty of money – its buying power allows you to reward yourself in an acceptable way for the job that you completed.
To change tracks due to personal interest, I’d like to predict the consequences of universal healthcare provided by the government. Like with government subsidized housing, costs will inflate as demand increases because going to the doctor is “free”, or at least “cheaper” after D.C. picks up some of the tab. Why go to the family physician in the morning when it costs the same to get fixed right now at the ER? Doctors will be expected to pay off hundreds of thousands in student loans in a payout system that doesn’t rise with inflation, but actually decreases from time to time because government has to squeeze them to help control costs. There will be fewer people that train for the minimum of 11 years to become physicians due to the lack of benefit from that training (that dirty self-interest thing again). After some years comes rationing of care. No, the legislators (not doctors) in charge of deciding what kind of care you can receive won’t come out and say that you’re too old, or the therapy you require is too expensive to be worth saving your life. Instead, they will make people jump through hoops to get their care. You can’t get your lung cancer treatment unless you’ve stopped smoking for at least a year. You can’t have more than one heart surgery every 10 years because it’s been “proven” to congress’ standards that you should be able to go at least 12 years if you had eaten right and lost that extra weight. I know that there are people that don’t believe me, but just look at some of the news coming out of the U.K., our “model system” as touted by Tom Daschle. Good thing he didn’t get the Health and Human Services secretary position he was offered (tax cheat writing/voting for taxing legislation), but do you think the model will change? Yeah, let’s be just like the U.K. because they should be our model, not the other way around? Oh, and throw a little Chavez in there when we don’t like your business.
It’s all just so sad, as well as stressful that I’m going to have to find some place in the not too distant future to make a living doing what I love, and to MY standards. Hopefully it’s here, but then again, who is John Galt?
Nathan Reed
I've been pretty outraged on a daily basis since January 2009 about the happenings in Washington D.C. Now I'm just sad for our country. What is happening now is the death of the chance for success. That is the “American Dream”; the CHANCE (not guarantee) to raise your lifestyle through dedicated hard work and innovation in any field of your choosing. The “American Dream” is NOT entitlement to free healthcare, housing, etc. It is NOT allowing congress to choose which companies must be saved, which the government should take over, and which companies and EVEN INDIVIDUALS to tax at confiscatory rates. This country is currently on a path that Ayn Rand depicted decades ago. A 90% tax (that members of BOTH parties voted for) on a select few individuals! A confiscatory power that president Obama is now seeking to extend to anything/anyone that our D.C. prima donnas don't like. After legislators ENABLED the behavior they feign outrage about by saving these failing companies in the first place! They are KILLING the wealth, dreams and motivation for anyone aspiring to be more and do more with their lives than merely subsist. Anyone that manages to make a good living is suspect.
Liberals and socialists would like to assume that most people operate from purely humanitarian motivations – that this is how it should be, but our country has proven in the last 230+ years that self-interest is the greatest motivator of the human spirit. This country rose to relative success in the world by refusing to deny that universal truth. Furthermore, self-interest is individual, and the freedom to pursue the goals that tickle our self-interest is another bedrock of our past success. Society cannot reasonably expect an individual to put their all into any task when the effort of their work is not met with some form of compensation that the worker finds acceptable. That is the beauty of money – its buying power allows you to reward yourself in an acceptable way for the job that you completed.
To change tracks due to personal interest, I’d like to predict the consequences of universal healthcare provided by the government. Like with government subsidized housing, costs will inflate as demand increases because going to the doctor is “free”, or at least “cheaper” after D.C. picks up some of the tab. Why go to the family physician in the morning when it costs the same to get fixed right now at the ER? Doctors will be expected to pay off hundreds of thousands in student loans in a payout system that doesn’t rise with inflation, but actually decreases from time to time because government has to squeeze them to help control costs. There will be fewer people that train for the minimum of 11 years to become physicians due to the lack of benefit from that training (that dirty self-interest thing again). After some years comes rationing of care. No, the legislators (not doctors) in charge of deciding what kind of care you can receive won’t come out and say that you’re too old, or the therapy you require is too expensive to be worth saving your life. Instead, they will make people jump through hoops to get their care. You can’t get your lung cancer treatment unless you’ve stopped smoking for at least a year. You can’t have more than one heart surgery every 10 years because it’s been “proven” to congress’ standards that you should be able to go at least 12 years if you had eaten right and lost that extra weight. I know that there are people that don’t believe me, but just look at some of the news coming out of the U.K., our “model system” as touted by Tom Daschle. Good thing he didn’t get the Health and Human Services secretary position he was offered (tax cheat writing/voting for taxing legislation), but do you think the model will change? Yeah, let’s be just like the U.K. because they should be our model, not the other way around? Oh, and throw a little Chavez in there when we don’t like your business.
It’s all just so sad, as well as stressful that I’m going to have to find some place in the not too distant future to make a living doing what I love, and to MY standards. Hopefully it’s here, but then again, who is John Galt?
Nathan Reed
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
Government-Monitored Health Care Hidden In Stimulus Package
Bloomberg: Government Control of Health Care Hidden in Obama Stimulus Plan
An astute reader just sent us this Bloomberg article stating that provisions have been slipped into the stimulus package that would create a federal electronic medical record database. The article states that it also provides for National Coordinator of Health Information Technology that could monitor this database. This coordinator can make sure doctors are using treatments that are federally approved and cost effective, the article says. It also claims that the National Coordinator can penalize doctors who do not utilize the database.
We'll research this and post more later in the day. Get ready to call your senators.
Rusty Scalpel
An astute reader just sent us this Bloomberg article stating that provisions have been slipped into the stimulus package that would create a federal electronic medical record database. The article states that it also provides for National Coordinator of Health Information Technology that could monitor this database. This coordinator can make sure doctors are using treatments that are federally approved and cost effective, the article says. It also claims that the National Coordinator can penalize doctors who do not utilize the database.
We'll research this and post more later in the day. Get ready to call your senators.
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 23, 2009
Schiffonomics Concerning Inflation and Healthcare
The Little Book of Bull Moves in Bear Markets by Peter Schiff, reviewed by Cato
I recently had the opportunity to read a book by Austrian economist Peter Schiff – The Little Book of Bull Moves in Bear Markets. In this book Schiff makes the case that the U.S. economy has transformed from a manufacturing economy that produces to a service economy that consumes. He points out that 47% of the new jobs created since 2000 have been in the service industry related fields and that economic growth along with wealth creation can only be made through production, Schiff argues that these elements have created a bubble economy that will deflate with the collapse of the dollar. The dollar collapse will occur when foreign investors, who are currently financing our annual deficits through credit, lose confidence and demand payment of the treasury bonds. Schiff cautions that the only way to preserve wealth with declining value of the dollar is to move wealth in non-dollar based assets such as precious metals and stocks traded with foreign currency.
Being an individual with not very much wealth, most of his suggestions about wealth preservation did not apply to me. The one suggestion that I did find applicable was his advice towards those with student loans. Schiff advised if you have variable rate student loans you should consolidate them at a fixed interest rate before the dollar collapses and interest rates rise.
Below are some excerpts that I found interesting:
Health Care
“In the face of these harsh realities, legislators on both sides of the aisle have begun calling for universal health coverage, but that won’t solve the problem either. The government doesn’t have enough money to provide health care for all Americans, and it won’t be able to keep borrowing. The only way to pay for universal health coverage would be to tax a populace that is already reeling from economic setbacks, an idea that’s sure to be deeply unpopular. Indeed, in the coming years, the government will have a hard time funding Medicare and Medicaid, the two national health plans already in place.” Pg194 The Little Book of Bull Moves in Bear Markets
“In the end, it may not be the quality of health care that contracts, but the quantity, as a poorer United States seeks to economize and some of the excesses get wrung out of this bloated system. For that to happen, however, the government will have to get out of the health care business and return this important segment of our economy to the private sector, subject to free-market forces—where it should have been all along.” Pg 195 The Little Book of Bull Moves in Bear Markets
Inflation
“I pointed out that mailing checks straight to the taxpayers instead of channeling money through the banking system meant that consumers could bid up consumer prices immediately. This avoids the usual time lag when the Fed’s expansions of the money supply, such as the $436 billion injected recently, have to filter through the asset markets before eventually affecting consumer prices. I’m being sarcastic, of course but the point is valid.” Pg 18 The Little Book of Bull Moves in Bear Markets
Why the Government Likes Inflation
Inflation is used for political reasons to stimulate the economy and counteract down-cycles that are perfectly normal and corrective of excesses but are unpopular with voters.
Government debt and other obligations such as social security become more manageable when payable with cheaper dollars.
Inflated incomes increase government revenues by forcing people into higher tax brackets.
Inflation helps finance entitlement programs that would otherwise cause tax hikes.
Pg 27-28 The Little Book of Bull Moves in Bear Markets
“The motive for choosing to print money is purely political. The other way to do it would be to raise taxes, which would cause a public uproar costing elected officials their jobs. Not that the voters would stand for any reduction in social programs. The voters want it both ways, and the elected politicians have found a way to accomplish that.” Pg 46 The Little Book of Bull Moves in Bear Markets
I think Schiff’s book does a great job of explaining what is going on with our economy. His arguments and the Austrian view fit very well in line with those of FMP. Like many I hope the dollar does not continue to lose value and collapse. However with the current trend of unfunded stimulus packages, government entitlement programs, and current war in Iraq and Afghanistan, one can only wonder how much insult the United States dollar can stand.
CATO
Friday, January 16, 2009
Immediate Savings of Cash-Only Practices
In the past I've argued that America's health care problems can be boiled down to price. The price of health care is too high. Unequal access to health care, patient dissatisfaction, and the rising price of health insurance are all a result of this high price. I believe that cash-only clinics can bring down the price of health care, making it more affordable and available to all Americans.
For those who may not be familiar with them, cash-only clinics are clinics where patients pay for services at the time they are received. Generally speaking, these clinics do not accept any health insurance. Patients simply pay the doctor (cash, check, or credit card) when they go to the doctor. Both the patient and the doctor immediately save money for the following reasons:
1) Physicians do not have to hire extra staff to work with insurance companies. Many offices have more employees working with insurance companies than they have physicians. Simply dropping those salaries can translate to significant savings.
2) Physicians save money by avoiding insurance claim denials, costs associated with bill collection, and lag time in waiting for reimbursement from insurers, Medicare and Medicaid.
3) Patient compliance improves, decreasing visits to the physician and cost of their personal health care. When faced with directly paying for medical costs, patients are more likely to value and comply with the care recommendations they receive. For example, patients paying for each prescription out-of-pocket will be less likely to blow off taking meds for their full course than insured patients who can get another prescription for a recurring infection with a $5 copay.
4) Patients are more likely to proactively improve their own health. A patient directly confronted with the cost of health care is more likely to use means immediately available to improve health before visiting the doctor. These means may include dieting, exercise, better sleep, and reduced recreational drug intake to improve their health. Patients who make these self-improvements are likely to save thousands of dollars in medical bills. Having to physically pay at the doctor's office can make this difference. Which patient with diabetes is more likely to control blood sugar through weight loss and exercise- the patient whose insurance plan insulates them from the cost of their health care or the patient who must write a check for every insulin shot and doctor's appointment?
5) It costs less to directly pay for health care than it does to pay for health insurance. We might fret after reading points 3 and 4, worrying that patients might put off needed health care when they have to directly pay for it. However, let's remember that health care actually costs less than health insurance. By saving the cost of the middleman, patients can afford more and better health care.
6) Doctors save money by focusing on patients' needs, not on insurance company protocol. Doctors are able to tailor care to patient's needs and budgets. They do not have to run excessive diagnostics. They are able to prescribe the precise medications that patients need and are not confined to the list of meds covered by patients' insurance policies.
A cash-only system redefines the role of doctors and patients. It restores patients' direct responsibility for their health care and doctor's direct responsibility to patients. Patients save money by shouldering this responsibility and by physician competition in a real medical market. In this way cash-only clinics address the real medical problem, making health care immediately more affordable and available to Americans.
Rusty Scalpel
For those who may not be familiar with them, cash-only clinics are clinics where patients pay for services at the time they are received. Generally speaking, these clinics do not accept any health insurance. Patients simply pay the doctor (cash, check, or credit card) when they go to the doctor. Both the patient and the doctor immediately save money for the following reasons:
1) Physicians do not have to hire extra staff to work with insurance companies. Many offices have more employees working with insurance companies than they have physicians. Simply dropping those salaries can translate to significant savings.
2) Physicians save money by avoiding insurance claim denials, costs associated with bill collection, and lag time in waiting for reimbursement from insurers, Medicare and Medicaid.
3) Patient compliance improves, decreasing visits to the physician and cost of their personal health care. When faced with directly paying for medical costs, patients are more likely to value and comply with the care recommendations they receive. For example, patients paying for each prescription out-of-pocket will be less likely to blow off taking meds for their full course than insured patients who can get another prescription for a recurring infection with a $5 copay.
4) Patients are more likely to proactively improve their own health. A patient directly confronted with the cost of health care is more likely to use means immediately available to improve health before visiting the doctor. These means may include dieting, exercise, better sleep, and reduced recreational drug intake to improve their health. Patients who make these self-improvements are likely to save thousands of dollars in medical bills. Having to physically pay at the doctor's office can make this difference. Which patient with diabetes is more likely to control blood sugar through weight loss and exercise- the patient whose insurance plan insulates them from the cost of their health care or the patient who must write a check for every insulin shot and doctor's appointment?
5) It costs less to directly pay for health care than it does to pay for health insurance. We might fret after reading points 3 and 4, worrying that patients might put off needed health care when they have to directly pay for it. However, let's remember that health care actually costs less than health insurance. By saving the cost of the middleman, patients can afford more and better health care.
6) Doctors save money by focusing on patients' needs, not on insurance company protocol. Doctors are able to tailor care to patient's needs and budgets. They do not have to run excessive diagnostics. They are able to prescribe the precise medications that patients need and are not confined to the list of meds covered by patients' insurance policies.
A cash-only system redefines the role of doctors and patients. It restores patients' direct responsibility for their health care and doctor's direct responsibility to patients. Patients save money by shouldering this responsibility and by physician competition in a real medical market. In this way cash-only clinics address the real medical problem, making health care immediately more affordable and available to Americans.
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
FMP Back Online
After a long break for finals and the holidays, Free Market Physician is back in action with our weekly entries. We start off 2009 with a piece from our guest contributor, Cato.
Rusty Scalpel
Rusty Scalpel
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
Monday, November 10, 2008
The Fall of Capitalism?
A loving father and mother watch their son grow up and approach an age of independence. Upon reaching that age he leaves home and begins college. However, once in school, the young man begins skipping classes, frequents the bars, and becomes a real party animal. He eventually drops out of school and is unable to maintain a steady job. His parents are heartbroken and comment, "We should have never let him leave home."
Compare this to a situation that is unfolding nationally. Several weeks ago the House Committee on Oversight and Government Reform held a hearing in which they hounded former Fed Chairman Alan Greenspan for the free market policies of his administration. If he had implemented more regulation, they pressed, the economy would not have stumbled. As reported by the forever-impartial New York Times, "A humbled Mr. Greenspan admitted that he had put too much faith in the self-correcting power of free markets and had failed to anticipate the self-destructive power of wanton mortgage lending."
The feeling in both above situations is the same: If we had not allowed so much freedom, things would not have gotten out of hand. If the boy's parents had forbidden him leaving home, he would not have wasted his life. If the government had taken control of the economy, we would not have the current recession.
But let's analyze the rationality of these feelings, starting with the parents. We sympathize with them in their sorrowing for their son's wasted years. Yet, we cannot pretend that they could prevent their son's actions once he left home. They could try to influence him, but he is an independent adult. Their belief that they could have controlled his actions is incorrect. Any effort to truly control his life would have been morally wrong.
The national reaction to our economical slump is likewise irrational. "If the Fed had just taken control..." we lament. Here, like the mourning parents we forgot ourselves. First of all, we forget the actions of the past and try to pin the blame on a free market for falling stock prices and bank failures. But more importantly, we forget what America's free-market capitalism is.
These days our free-market capitalism is often thought of as just another economic system. Our European allies have abridged it without regrets. Many, far too many, in our own nation want to do the same.
But capitalism is not an economic system. There is no structure or control involved in capitalism. Capitalism is the free-market economic state that comes as a result of liberty. Thus, if capitalism is substituted by another system, we have not merely swapped one system for another. We have swapped freedom for control. We have taken away American liberties.
The goal of capitalism is not to amass national wealth. The goal of capitalism is not to maintain our status as the world superpower. Capitalism is not maintained for the sake of the stock market. In fact, capitalism has no goal. Capitalism is simply the result of economic freedom. And so, we do not casually give up capitalism because our stock portfolio isn't doing well. Indeed, we fight furiously and bleed and die to maintain it because the loss of capitalism is tyranny. It is the loss of our God-given, won-by-blood American freedoms.
A sound byte from a speech by Ezra T. Benson (Secretary of Agriculture during the Eisenhower Administration) has been floating around the web. In it he describes a confrontation that he had with Nikita Khrushchev ("First Secretary of the Communist Party of the Soviet Union") during the 1959 visit that Khrushchev made to see American agriculture:
Rusty Scalpel
(I regret not having a primary source for the Ezra T. Benson quote. To listen to the quote click here and scroll to 8:15.)
Compare this to a situation that is unfolding nationally. Several weeks ago the House Committee on Oversight and Government Reform held a hearing in which they hounded former Fed Chairman Alan Greenspan for the free market policies of his administration. If he had implemented more regulation, they pressed, the economy would not have stumbled. As reported by the forever-impartial New York Times, "A humbled Mr. Greenspan admitted that he had put too much faith in the self-correcting power of free markets and had failed to anticipate the self-destructive power of wanton mortgage lending."
The feeling in both above situations is the same: If we had not allowed so much freedom, things would not have gotten out of hand. If the boy's parents had forbidden him leaving home, he would not have wasted his life. If the government had taken control of the economy, we would not have the current recession.
But let's analyze the rationality of these feelings, starting with the parents. We sympathize with them in their sorrowing for their son's wasted years. Yet, we cannot pretend that they could prevent their son's actions once he left home. They could try to influence him, but he is an independent adult. Their belief that they could have controlled his actions is incorrect. Any effort to truly control his life would have been morally wrong.
The national reaction to our economical slump is likewise irrational. "If the Fed had just taken control..." we lament. Here, like the mourning parents we forgot ourselves. First of all, we forget the actions of the past and try to pin the blame on a free market for falling stock prices and bank failures. But more importantly, we forget what America's free-market capitalism is.
These days our free-market capitalism is often thought of as just another economic system. Our European allies have abridged it without regrets. Many, far too many, in our own nation want to do the same.
But capitalism is not an economic system. There is no structure or control involved in capitalism. Capitalism is the free-market economic state that comes as a result of liberty. Thus, if capitalism is substituted by another system, we have not merely swapped one system for another. We have swapped freedom for control. We have taken away American liberties.
The goal of capitalism is not to amass national wealth. The goal of capitalism is not to maintain our status as the world superpower. Capitalism is not maintained for the sake of the stock market. In fact, capitalism has no goal. Capitalism is simply the result of economic freedom. And so, we do not casually give up capitalism because our stock portfolio isn't doing well. Indeed, we fight furiously and bleed and die to maintain it because the loss of capitalism is tyranny. It is the loss of our God-given, won-by-blood American freedoms.
A sound byte from a speech by Ezra T. Benson (Secretary of Agriculture during the Eisenhower Administration) has been floating around the web. In it he describes a confrontation that he had with Nikita Khrushchev ("First Secretary of the Communist Party of the Soviet Union") during the 1959 visit that Khrushchev made to see American agriculture:
"As we talked face to face, he indicated that my grandchildren would live under communism. After assuring him that I would do all in my power to assure him that his and all other grandchildren would live under freedom, he arrogantly declared in substance: You Americans are so gullible. No, you won't accept communism outright. But we'll keep feeding you small doses of socialism until you finally wake up and find that you have communism. We won't have to fight you. We'll so weaken your economy that you fall like over-ripe fruit into our hands."In a time of economic turmoil, may we stand fast in the liberties with which God has blessed us. May we reject the doses of socialism that are so constantly being offered us. Any threat to the American free market is a threat to American freedom. Let us be alert and treat those threats as such.
Rusty Scalpel
(I regret not having a primary source for the Ezra T. Benson quote. To listen to the quote click here and scroll to 8:15.)
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 22, 2008
Reader Recommendation: "Affordable" Health Care
Thanks for this suggestion to read economist Walter Williams' article "Affordable Health Care." The article points out that socialized medicine schemes in other countries have turned out very poorly. It recognizes some of the following shortcomings:
In Canada, the average waiting time for treatment by a specialist is between 5 and 40 weeks. The average wait time for an MRI or CT is 4 to 28 weeks.
One out of three Canadian physicians refer patients to the United States and the Canadian government pays over one billion dollars for health care in the United States each year.
Great Britain's National Health Services has a goal of having a maximum wait time of 18 weeks for general practitioner services and diagnostic tests. Many people in both Canada and Great Britain have illnesses that become incurable due to lack of care during long waits.
Great Britain Prime Minister Gordon Brown hopes to adopt a "presumed consent" that would essentially make the bodies of Britons property of the state. The plan makes every citizen an organ donor at the time of their death, unless they carry a card or have family at hand at the time of death that state otherwise.
Rusty Scalpel
In Canada, the average waiting time for treatment by a specialist is between 5 and 40 weeks. The average wait time for an MRI or CT is 4 to 28 weeks.
One out of three Canadian physicians refer patients to the United States and the Canadian government pays over one billion dollars for health care in the United States each year.
Great Britain's National Health Services has a goal of having a maximum wait time of 18 weeks for general practitioner services and diagnostic tests. Many people in both Canada and Great Britain have illnesses that become incurable due to lack of care during long waits.
Great Britain Prime Minister Gordon Brown hopes to adopt a "presumed consent" that would essentially make the bodies of Britons property of the state. The plan makes every citizen an organ donor at the time of their death, unless they carry a card or have family at hand at the time of death that state otherwise.
Rusty Scalpel
Saturday, October 18, 2008
Reader Recommendation: Hawaii Drops Universal Healthcare Failure for Children
"And we're supposed to believe that a program that can't work in a state of about 1.3. million people is supposed to work for an entire nation?"
America seems to be in love with universal health care right now, but is any government-administered universal health care system economically feasible? Thanks for this reader recommendation: Hawaii ends universal child health care and commentary- we'll be talking about it more in the future.
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 19, 2008
Reader Recommendation: Amateurs Outdoing Professionals
This article, written by economist Thomas Sowell, demonstrates why centrally planned economies will always lag behind free markets. His comments indicate what we can anticipate from a centrally planned medical economy. Thanks for the recommendation!
Rusty Scalpel
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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