51 replies to this topic

[Mangala]

I saw an interesting Star Trek the other night. In this particular episode the doctor (who happens to be a hologram) was downloaded to one planet that used him to treat patients under their medical system. In their system the people with the most important jobs, and most important minds received the best medical care first, and the people with the least improtant jobs received their care last or with decreased care. The doctor in the end tricks the doctors into letting him sneak medical supplies to "lesser" patients in order to treat as many people as possible regardless of their employment. At first I immediately beleived the doctor was justified in trying to change the medical system, but as I thought about it more, how could we go to war if the soldiers were treated first and the general was treated last?

Under our system the same goes for people with the most money. So my question would be, should money be an indicator of overall health need? Should the rich receive longevity treatments first or last? Should our medical system be run in a profit-run organization or a non-profit organization?

Does money correlate with medical needs?

[thefirstimmortal]

There was a time in America when your doctor knew you well, when a hospital stay wouldn’t bankrupt you, when low cost health insurance was available to virtually everyone, even those with pre-existing conditions. For those in need, doctors gave free or low cost care, and there were free clinics and charity hospitals. Few people went without adequate health care.

Today we hear about such care only when politicians or socialist use their imagination to make promises. They never notice that what they promise and never deliver is precisely what Americans took for granted just a few decades ago, before politicians presumed to make things better.

No political program will ever bring the kind of care the politicians promise, because you can’t organize health care by force and expect people to function as they did when they worked together voluntarily.

Today 51% of all health care dollars in America are spent by governments, not insurance companies, employers, or individuals, but by governments. If there is a crisis in health care, (and there certainly is), the government, not the free market, is responsible for it.

If we want to restore good health care, the answer is simple: get the government out of the way.

[thefirstimmortal]

Politicians, reformers and Socialist want us to believe there are more than enough goods and services to provide a good standard of living for everyone in America, and that all we have to do is redistribute them more equally. They assume the shopkeeper in Boston, the wholesaler in Denver, the manufacturer in Cleveland will continue to get up at 5 a.m. every day and work until midnight producing those goods and services, just so the government can confiscate them and give them to someone else.

Once the government takes from those who produce and gives to those who don’t, people inevitably will produce less, the supply will diminish, and the demand will become much greater. So don’t be surprised when government intervention into any market causes prices to skyrocket.

Nowhere is this more evident than with health care. Medical prices have escalated because government subsidies push up the demand for medical services, while government regulations chase medical providers out of the market.
There are five principal tools the federal government has used to make it harder for you to get good medical care:

1.The federal income tax code, which has skewed the payment for healthcare services.
2. Laws that forbid health insurance companies to offer low-cost policies that exclude certain medical treatments.
3. Medicare - a government health insurance program for senior citizens.
4. Medicaid - a program to provide medical services primarily for the poor.
5. Government regulations on doctors, hospitals, insurance companies, and drug companies.

[Mangala]

Mr. O'Rights, what would be your stance on medical care for the rich? Should the people with the most money receive longevity treatments first? Regardless of what has caused the increase in medical care, where is the value put on life?

[thefirstimmortal]

If the road to Hell is paved with good intentions, the road to big government is paved with small steps, each of which seems harmless in itself.

The pattern rarely changes.

1. There is widespread publicity about a crisis.
2. Politicians float a drastic proposal to solve the problem with a new, far-reaching, bureaucratic program.
3. “Moderates” in Congress and the public mount opposition to the government takeover.
4. Eventually the politicians arrive at a compromise, to fix the problem without radical overhaul.
5. Although the moderates congratulate themselves on holding the line against big government, the compromise makes government bigger, more powerful, and more damaging, making the next crisis inevitable.

Because politicians refuse to recognize that government doesn’t work, they never blame the current problem on the program they passed earlier. Instead, while professing their undying faith in free enterprise, they note regretfully that the market has failed to work in this instance. So they propose to fix it with a larger, more bureaucratic system, and the cycle continues with a compromise, more government, more damage, and another proposal.

Health care is an excellent example. From the passage of Medicare in 1965 to a health-care system run completely by the government a few years from now, the politicians have led us along step by innocuous step. Although each step has been presented as the end of the journey, each has added to the problem and made the next step seem necessary.

We could fix the problem almost overnight.

[thefirstimmortal]

Government has been involved in medicine since before any of us was born. And over the past 30 years its involvement has grown rapidly. Its policies are the cause of medical care’s high cost and the difficulty of obtaining health insurance, the two problems the politicians now propose to cure with more government.

There are many ways the state of your health, the quality of medical service you receive, and the price you pay are affected by federal or state government interference.

[thefirstimmortal]

Government restricts your access to health care by forbidding you to seek advice and treatment from an unlicensed physician. And laws forbid nurses and other experienced health-care specialists from performing many services, even though they may be qualified to do so and would charge less than a doctor.
So you must go to a licensed physician for almost any care at all. If his fees seem high, it may be partly because the government limits the competition he must face, and partly because he has to charge you for the costs he pays to stay in good standing with state and federal regulators.

[thefirstimmortal]

Today “telemedicine” makes it possible for your doctor to transmit tests and X-rays to non-local physicians who have more experience or more sophisticated equipment for analyzing a particular problem. This increases your chance of being cured, and cured quickly. It also can be cheaper, because it bypasses trial-and-error treatment and eliminates the need to travel long distances for consultation and treatment. But many states prohibit you and your doctor from consulting a doctor who isn’t licensed in your state.

[thefirstimmortal]

Government courts have fostered a litigation explosion that makes malpractice insurance extremely expensive for your doctor. To limit this expense, many doctors won't take on new customers, and some have left the profession altogether. This reduces the supply of doctors and lifts medical costs even higher.

Doctors have to guard against any possibility of a lawsuit. So your doctor may order expensive tests for you, to assure that later you won’t complain in court that he failed to explore every possibility.

If you could agree in advance that you wouldn’t sue for malpractice except in certain specified circumstances, the doctor could afford to charge you less. And if he could refuse to treat anyone who didn’t sign such an agreement, he could charge you a lot less. Unfortunately, government courts in most states refuse to honor such an agreement. And physicians can also be sued just for turning down a patient.

[thefirstimmortal]

Government keeps you from obtaining any medicine that it hasn’t yet approved. Getting a new drug approved from the FDA (Food and Drug Administration) costs a company on average $300 million (this is now the updated cast, although I quoted 230 million recently, I have updated my facts), and can take as long as 10 years. By the time the drug finally gets approval, it may have been available for years in other countries, while you were stuck with a less effective, more expensive alternative.

[thefirstimmortal]

Because drug companies in other countries don’t have to run the FDA gauntlet, medicines often cost much less overseas, and in some cases are available only overseas. It would be nice if you could order these medicines, which would save money and allow you more choices. But you can’t, because the government usually won’t let you. And if you get caught trying, they may even put you in jail, even if the drug you were buying is the only known cure for a fatal disease.

[thefirstimmortal]

The FDA claims to save lives by keeping unsafe drugs off the market. But the drugs banned here don’t cause bodies to pile up in countries where the drugs are legal. On the contrary, Americans die because the FDA forcibly prevents them from taking the drugs they need.

For example, the FDA approved propranolol for limited use in 1968, but refused to allow it to be used for angina or hypertension. Then it reversed itself and approved the drug for angina in 1973, and then for hypertension in 1976. A study by Arthur D. Little, Inc. estimated that roughly 10,000 Americans died for lack of propranolol every year the FDA prevented their doctors from treating them with it. Dr. Mary J. Ruwart, a scientist with Upjohn Co., says more Americans may have been killed by being denied access to this one drug than by the use of all unsafe drugs in the 20th century.

Robert Goldberg (a senior research fellow at Brandeis University’ s Gordon Public Policy Center) has pointed out that, in the same way, “the FDA has sat on or rejected drugs for depression, schizophrenia, kidney cancer, and epilepsy, not because they were unsafe, but because in the final analysis the agency didn’t think the drug was so important or effective.”

If someone dies from taking an FDA-approved drug, Congress holds lengthy hearings to see how FDA approval can be made even more difficult. But if thousands of people die while the FDA strings along the pharmaceutical companies, there are no hearings, no TV soundbites, no one-liners for the press, no grim-faced TV anchor men, no outraged editorials, no attention whatsoever, just a lot of prematurely dead people whose families have no political pull. If you were an FDA decision-maker, which way would you lean?

[thefirstimmortal]

Even after the FDA approves a drug, you can’t buy it without written permission from a government licensed doctor, even if you’ve used it many times before. And because government has made it so easy to sue a doctor, and collect, many doctors won’t approve prescription refills without an office visit. The drug itself may cost only $20, but it might cost you $220 to get it.

[thefirstimmortal]

Some ailments can be treated effectively, and sometimes more cheaply, by non-prescription means, such as over-the-counter medicines, vitamins, selected foods, and even aspirin (in the case of potential heart conditions).(But despite the first amendment, the FDA won’t let the sellers of many of these products advertise their health benefits, even those that are widely accepted in the medical profession The FDA has actually conducted armed attacks on health-food stores to confiscate offending vitamins and other nutrients.

Even aspirin makers are forbidden to tell you that almost all doctors and heart specialists believe a daily aspirin reduces the chance of your having a heart attack. How many deaths and expensive bypass surgeries would be avoided if more people knew about the preventive power of aspirin?

The government’s own Center for Disease Control has asserted that folic acid supplements help pregnant women prevent spina bifida and other birth defects, but the FDA forbids (or at least they did 5 years ago) vitamin makers from putting this information on their labels.

[thefirstimmortal]

Government courts also have driven many surgical devices off the market. Ingredients such as Teflon and silicone are disappearing from the market because of lawsuits against chemical companies. E. I. Du Pont, for example, decided to stop selling polyester for medical devices. Total annual sales of polyester amount to only $200,000 for Du Pont, but potential lawsuits can run into the millions, so the reward is just not worth the risk. This trend will make it harder to obtain such things as heart pacemakers, artificial grafts, and other devices.

[thefirstimmortal]

Federal law dictates that all private or government hospitals that receive any payments from Medicare must treat anyone who shows up at their emergency rooms. This affects almost every hospital in the U.S. because each one has at least one patient covered by Medicare. If the patient can’t pay, you and other paying patients have to make up the difference.

[thefirstimmortal]

Government subsidies keep researchers busy on projects chosen by politicians for their most-favored backers, even if more lives could be saved with other projects.

[thefirstimmortal]

.

Research on rare diseases has come almost to a halt because the demand for potential drugs won’t be large enough to recoup the enormous cost of getting them through the FDA.

[thefirstimmortal]

You can’t deduct medical expenses from your taxable income unless you’re self-employed, in which case you can deduct only a small part of them.

But an employer can deduct all the cost of the medical benefits he provides for employees. So your employer pays you less and
provides health insurance instead, which is tax-free for you.
Further, the tax incentives encourage your employer to reward you with additional fringe benefits rather than raises. So he’s likely to provide “first dollar” insurance, wherein all medical expenses are covered, rather than just catastrophic illnesses or accidents.

Since you don’t have to pay any of the bills, you have no incentive to economize. Neither do the millions of others with similar plans. Together, they push up the demand for medical services, and its cost.

In a true free market, rising costs discourage demand for a product, allowing prices to ease back down. But the tax system has separated the consumer from the price, the patient from the cost, so demand continues to rise, even as prices are rising.

[thefirstimmortal]

Almost every state has laws that force insurance companies to cover certain conditions and procedures in every medical policy, regardless of the consumer’s needs. These add-ons include such things as psychiatric care, birth services, teeth-whitening, abortions, toupees, chiropractic services, cosmetic surgery, alcohol and drug rehabilitation, sex therapy, acupuncture, and marriage counseling.

Obviously, the add-ons run up the cost of your policy, and the state won’t let you buy a cheaper one, even if you want to. So it’s not surprising that many people feel health insurance is too expensive, and choose to go without it.

[thefirstimmortal]

Some states force insurance companies to set premium rates that don’t “discriminate” by age, gender, or other factors. Since the cost of insuring a healthy 25-year-old is about one third of that for a normal 60 year old, the single, one size fits all mandated rates make insurance prohibitive for most young people. Not surprisingly, a lot of them join the ranks of the "uninsured" the folks the politicians believe the free market has failed.

[thefirstimmortal]

Government Insurance
(It's not Socialized Medicine)

The tremendous runup in health-care costs started in 1965 when Congress created Medicare, which put the government squarely in the health insurance business, and Medicaid.

Medicare is a health insurance program for the elderly, with compulsory “premiums.” Medicaid is a program by which state governments use federal money to pay for health care for low-income people.

When Medicare was passed in 1965, Congress projected its costs into the future, and estimated it would cost $3 billion for 1990, the equivalent (after adjusting for inflation) of $12 billion in 1990 dollars. The actual cost in 1990 was $98 billion, further evidence that no government program stands still.

The payroll tax in 1967 was a modest 0.9% (divided between employer and employee). It has risen steadily and is now 2.9%. And the amount of your earnings that can be taxed has risen as well. In 1993 Congress removed the ceiling entirely, so that all earnings are taxed now.
But despite these tax increases, Medicare will be bankrupt by the year 2007 if the tax isn’t raised further. The program’s actuaries project that the rate has to rise to 4.3% by 2006. But, of course, any projection will be revised upward before its target date arrives.

Because the politicials consistently underestimate Medicare's costs (refusing to recognize that coercion distorts supply and demand), Medicare tax increases never catch up with ever rising expenses, and so the tax increases just keep coming.
Every year or two, with great fanfare Congress passes a 5-year or 7-year deficit-reduction package that includes large cuts in Medicare and Medicaid spending. Always the actual cuts are scheduled for the later years of the plan, with the details to be worked out by some future Congress. Meanwhile, the current Congress holds a press conference and congratulates itself for cutting spending and reducing the deficit.

But when the later years arrive, there are no cuts, just more increases. The big tax increase and deficit-reduction package in 1990, for example, assumed that Medicare cuts would save $60 billion over five years. Instead, additional Medicare spending over the next five years amounted to $166 billion.

In the mid-1980s, Congress introduced a series of cost-control provisions in Medicare. But since then, costs have risen at twice the rate of health-care costs in general.

The pattern is virtually the same for Medicaid. When Congress passed it in 1965, it cost $1 billion per year. By 1993 it was up to $76 billion per year. In the 1980s alone, Congress expanded Medicaid services 24 times, adding about $20 billion per year to its cost.

Because these programs impose so many requirements, the health-care system now has far more administrators per patient and far fewer doctors and nurses per patient. Those big medical bills aren’t paying your doctor’s country club dues; they’re financing a bigger and bigger health-care bureaucracy.

[thefirstimmortal]

Medicare often pays only a third or so of the actual cost of a hospital stay. The American Hospital Association estimates that hospitals lose an average of $900 on every Medicare patient treated, amounting to $9 billion a year in losses. Hospitals have to pass the unpaid remainder on to you, other paying patients, and insurance companies, making hospital stays and insurance more expensive than they should be.

[thefirstimmortal]

By 1992, Medicare and Medicaid accounted for 31% of all medical spending in the U.S.
Health care can hardly be called a “free market.” More money is spent on medical care now by governments than by all private companies and individuals.

[thefirstimmortal]

Despite all you have just read, the politicians blame “greedy” doctors, hospitals, insurance companies, and pharmaceutical companies for today’s health-care problems.

They say the free market has failed to provide proper health care for everyone. But that’s an absurdity. It is government that has failed. It has taken over health care, dominating every aspect of it, and is therefore responsible for every problem the politicians now complain about.

Government doesn’t work. And so it isn’t to government that we should look for remedies.

[thefirstimmortal]

In the health-care debate of 1992, 94, words like compassion, right, need, and fairness showed up frequently. But a number of relevant words were ignored.

For example, I never heard the words force or coercion in public discussion about the issue. And yet the Health Security Act, the President’s 1993 proposal for universal health insurance, had a great deal to do with force. There are some revealing terms in the proposal, such as prison (which shows up 7 times), penalty (111 times), fine (6), enforce (83), prohibit (47), mandatory (24), limit (231), obligation (51), require (901), and so on. For example, a person withholding information about his medical history could go to prison for five years.

That was the Democrats’ proposal. But lest you think the Republicans don’t believe in forcing people to do the right thing, their principal proposal included the terms prison (1 time), enforce (37), penalty (64),fine (12), prohibit (19), and require (482).

Even the plan publicized as the most “free market” of the eight major proposals contains the words penalty (5 times), prohibit (5), require (54), enforce (1), and so on.

But coercion is nothing new in government-run health care. Medicare already has plenty of fines and penalties. For example, a doctor is fined merely for filing the wrong form, or failing to file a form for every visit by a patient.

[thefirstimmortal]

The health-care debate has ignored the most important factor: government involvement in health care means forcing people and institutions, doctors, patients, hospitals, insurance companies, to do what they don’t want to do. And such plans never work out as promised.

Ignoring the coercion lets the health-care advocates seem compassionate, as attempting to help people get insurance or better medical care. But if there were no brass knuckles inside the velvet glove, the government wouldn’t be wearing it. Coercion is there, and that means the outcome will differ considerably from the rosy future the politicians descibe.

[thefirstimmortal]

Government already is very busy in the health-care industry, where it eats up the time and resources of doctors and hospitals, pushes up medical prices, and slows new medicines from coming to market, thereby causing needless deaths.

If medical prices are too high, it is because government has inflated demand and restricted supply. If too few people have health insurance, it is because government rules have priced too many young people and too many healthy people out of the insurance market.

If doctors’ waiting rooms are crowded and service is skimpy, it is because government has restricted the supply of physicians, driven others out of the profession, overloaded the remaining physicians with paperwork, and prevented patients from getting low-cost help from other qualified health-care professionals.

[thefirstimmortal]

So what should be done?
There are only two choices.

1. You can imagine, as Mangala does, the perfect solution and try to force people to carry it out for you. Or.
2. You can get government out of the way, so people can handle their problems as they see fit.

We know which road Mangala and the politicians prefer to take.

[thefirstimmortal]

In 1995 a bipartisan bill was introduced in the U.S. Senate to reform health care. Politicians and journalists greeted the bill with approval, calling it realistic and non-controversial, compared to the far-reaching plan the President introduced two years earlier. The common description of the new bill is that it contains the “few simple reforms everyone agreed on,” instead of pushing to re-create the health-care system entirely.

Here were the bill’s “few simple reforms”:

It prohibited an insurance company from denying coverage to an individual with a pre-existing condition, such as cancer, diabetes, or a heart condition. Insurance companies could charge him higher premiums for the first year of the policy, but thereafter must charge him The same rate as someone without such a condition.

It forced insurance companies to allow a worker who leaves a job to convert his group coverage to an individual policy and take it with him.

It forces employers to provide insurance coverage for all employees, including those with chronic conditions, if they provide coverage for any employee.

It includes a list of benefits that every health-insurance policy must include.

Proponents said these reforms did’t place an undue burden on insurance companies, and they will make health insurance available to millions of people who don’t have it. Now, what’s wrong with this picture?

It ignores the obvious:

1. Insurance companies are in business to make profits.
2. Insurance companies make profits by selling health insurance to as many people as possible.

So companies already do everything they can think of to get everyone covered. If there is a realistic way to insure people with pre-existing conditions, they will do it? If they can keep as customers the people who are changing jobs, they will do it?

If people who spend every working moment trying to expand the insurance market don’t know a way to do these things at an affordable cost, why should we believe career politicians, who can’t even balance the federal checkbook, know the answer?
What the politicians planned to do, which they carefully aviod, is to point a gun at the insurance industry and force it to lose money.

Are social problems that simple, that all you have to do is imagine a perfect world, point a gun at someone or some industry, issue some orders, and the problem is solved?

If you pin them down, the politicians will acknowledge that, yes, they plan to force insurance companies to make changes they don’t want. But they will be such harmless, simple changes. And we all have to make some sacrifices to solve this problem.
And thus we start on the final leg of the journey to the total government takeover of the health-care system.