Terrorism and Healthcare Reform

December 29, 2009

The recent attempt to blow up a US airplane as it was about to land in Detroit may not seem to have much connection to healthcare reform, but on reflection the relationship is proximate and interesting.  The would be underwear bomber was known to the federal bureaucrats charged with protecting us from what is now a decades long concerted effort at destabilizing the US by Muslim extremists.

This is the unifying strand (it’s more like a chain) that connects most of these attacks either thwarted or successful. The government knows that certain people are a threat but can’t bring itself to take preventative action. It knew about the 9/11 terrorists, it knew about Nidal Malik Hasan, it knew about Umar Farouk Abdulmutallab and yet it did nothing. Abdulmutallab was on a terror suspect list that contained 500,000 names. Janet Napolitano the feckless Homeland Secretary who can’t tell whether our anti-terrorist system works or not seems intimidated by a list with half a million names. I’m sure the government has trouble with this long a list. But look at what Google can do with a far greater one. I searched Google for Shakespeare and got this:

Googles's Shakespeare search

More than 50 million hits in 0.13 of a second. I’m sure Google would be glad to keep track of all the governments lists for far less money than the government spends to not be able to track potential bad guys. But the bureaucrats would rather die (or more accurately we die) than relinquish any part of the budget or control. They can’t keep track of anything while Google can scan the entire internet in less than a second.

The new security methods immediately put in place after the failed attack punish the victim rather than go after the villains. It swill soon be so onerous to fly, if it isn’t already, that the fragile airline industry will collapse. The proper solution is so dazzlingly obvious that the government’s failure to adopt it can only mean they’re blind; it’s to vigorously scrutinize those passenger who are virtually the sole candidates for terrorism They are young Muslim males (Muslim females will have to checked as well). Patting down 80 year old grandmothers from Iowa City and putting retired professors of medicine from Lubbock through a whole body scanner is more than a waste to time and treasure it’s a lethal expression of political correctness. Liberty for the terrorists seems more important than that of their potential victims.

We are so weakened by moral idiocy that 14 people are dead in Fort Hood because of a depolarized moral compass. When an assault victim tells the police that his assailant was a 30 year old white man the cops don’t line up 60 year old black women. But when it comes to airline screening we do.

Consider the recent flap about battlefield pregnancies. When a regional commander in Afghanistan ordered that women soldiers who get pregnant in a war zone and their impregninators be disciplined the resulting outcry from women senators and NOW caused the general to be overruled by his superior. He likely will never be again promoted because of the incident. Getting pregnant on the battlefield (no smirk intended) is not a good thing. We have an all volunteer army. There is such a thing as military discipline. The army runs by a different set of rules than does civilian society. The general was right and the overturning of his order weakens the military and out national security.

The barbarians are always at the gates and they always will be. Our seriousness at keeping them out is doubtful. If they get in all our precious rights which are invoked as an excuse for not preventing their entry will be swept away.

What’s all this got to do with healthcare? The same bureaucracy that is making a mess of “homeland security” will be even more in charge of medicine than it already is. How can anyone  think that a 2400 page bill, the contents of which are fully know to no one will extend care and reduce costs? The suspension of disbelief required would make Samuel Taylor Coleridge take even more opium.

If the government can’t manage something as vital as keeping our airplanes from being blown out of the sky how are the going to respond to the same grandmother from Iowa City’s request for a lumbar MRI because of chronic low back pain? Perhaps they’ll send her to the airport for a total body scan which doubtless will be easier to get than the MRI.

The healthcare reform (as in reform school) bill that congress seems determined to pass even if they pay with their professional lives will create scores (likely more than 100) of new bureaucracies and mandates. These will not reform, will not energize, will not make more efficient a system that badly need real reform. Costs will continue to rocket out of control and medical care will degrade. The deficit will reach Alpha Centauri and the bureaucrats will soon outnumber the patients. Our response to terrorism and to increased government control of our lives reflects a serious weakness of national will. The barbarians are still at the gates.

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Massachusetts Health Care Reform – What Does it Mean?

December 26, 2009

Massachusetts Health Care Reform — Near-Universal Coverage at What Cost? That’s the title of an article in the November 19th, 2009 issue of the New England Journal of Medicine.The authors of the piece, Joel S Weissman, PhD. and JudyAnn Bigby, MD, work for the the Massachusetts Executive Office of Health and Human Services. You can read the article for yourself (it’s available to all), though it’s so vague that your not likely to take much away from it. Their last paragraph is of interest.

In Massachusetts, achieving near-universal coverage was the right first step, providing thousands of residents with access to care and protection against financial uncertainty due to medical bills. Now, tackling costs has risen to the top of the agenda. As we move toward national health care reform, we must balance individuals’ needs for high-quality care with the obligation to be socially and fiscally responsible.

What do you think the translation of this bit of bureaucratic code-speak into simple English is?

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If It’s Broke Make It Worse – More Healthcare Reform Incoherence

November 25, 2009

I’ll just put up a few items which speak for themselves which won’t stop me from a few comments. Paul B Ginsburg has an article in tomorrow’s NEJM – Getting to the Real issues in Health Care Reform. He describes the bills emerging from the House and Senate which would “reform” the country’s healthcare “system”. His tone is dispassionate and analytical. It’s like a matter of fact description of someone walking down the middle of an interstate highway at a peak traffic hour naked save for a canvas sack over his head. Ginsburg’s concluding paragraph is a gem of nonchalant inadvertence:

If combined House-Senate reform legislation makes it to the President’s desk for signature, enactment would be only a start to the reform process. regulations will need to be written, organizations (such as exchanges) will need to be built, and midcourse corrections will need to be legislated to deal with the unforeseen consequences. And since only tentative steps will have been taken to reform care delivery, policymakers will inevitably have to return to battle on that front.

Doubtless Ginsburg is right. If you are not horrified by the above you don’t understand where we’re headed. Dr Ginsburg (he’s a PhD) works for the center for Studying Health System Change in Washington, DC. The legislation about to emerge from congress is his retirement plan, his children’s education, the educations of his grandchildren and that of his descendants down to the end of recorded time.

MSNBC, which is more left than Warren Spahn, quotes a piece from the NY Times about the ever increasing incidence of medical bankruptcy. If you actually read the article you’ll find this in the 11th paragraph: How many personal bankruptcies might be avoided is unpredictable, as it is not clear how often medical debt plays a back-breaking role. There were 1.1 million personal bankruptcy filings in 2008. In essence the argument is made that we should reform healthcare because it will relive bankruptcy due to overwhelming medical bills though we don’t know whether or not this is a common event.

MSNBC also reports that one in four American mortgage holders are under water – ie, they owe more than their homes are worth. This would seem to be at least as big a problem as medical bankruptcy, probably worse. Why not have mortgage reform which would have the government compete with banks in offering low cost mortgages which would never be allowed to sink beneath the surface of our turbulent economic sea? Come to think of it we already did. Do you remember how that worked out?

Once you realize how much fun it is to reform things there’s no reason to stop spreading the enjoyment to every state, county, precinct, ward, and boulevard of our benighted and largely unreformed land, especially when it really doesn’t cost anything as the Chinese seem willing to pay for it all.

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House Healthcare Bill

October 29, 2009

Below is the complete text of the House Healthcare Bill – all 1990 pages. I haven’t read it but a quick search finds “tax” in it about 275 times. I wonder if anyone has read it.

House HCR bill

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New Doctors Poll

September 16, 2009

There’s been some back and forth in the comments section of Medicare’s Overhead about what doctors think of the healthcare reforms bills now before congress. It started when I said that I didn’t think many practicing physicians favored any of these proposals. A new poll commissioned by Investors Business Daily says that two thirds of doctors oppose this legislation and that 45% would consider quitting if it passed.

It’s not hard to find a poll that supports your preconceived notion of anything important, but I still think it unlikely that most doctors would support the kind of “reform” that may be forced on them and their patients. An interesting finding is that More than seven in 10 doctors, or 71% — the most lopsided response in the poll — answered “no” when asked if they believed “the government can cover 47 million more people and that it will cost less money and the quality of care will be better.” The other 29% must have flunked math – a subject that has always bedeviled physicians.

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Healthcare Abroad and at Home

August 7, 2009

The Wall Street Journal has an interesting article about healthcare in France. It details the financial difficulties that France’s national healthcare plan is experiencing.medical spending graph The data on this graph need a little explaining. It presents the percentage change in medical (not health as it states) cost in four countries. To accurately analyze the data you need to know what the rate of growth in GDP in these countries has been. If GDP rose greater than medical costs the problem of medical expense is a manageable problem.

France GDPAs the next graph shows, France growth in GDP has been anemic to non-existent. Thus the sharp rise in medical spending is a terrible strain on the French economy made worse by the French public’s unwillingness to confront its problem.

The UK’s National Health Service seems to be in even worse shape. UK GDPIt’s never been considered to be a model of good medical care as has France’s system. But until the current world-wide recession the UK’s GDP has had a rate of growth much better than France. But last year GDP in the UK has fell much more than France’s. This is going to put the NHS in Britain in even greater peril.

The US with it’s strange amalgam of national (Medicare and Medicaid make up 50% of the country’s medical spending) and private medical care is in a similar situation. Until the economic collapse growth of GDP was pretty good.US GDPBut like France and the UK medical spending has risen faster than GDP and is unsustainable.

The Japanese seem to be doing better than than anyone else. Medical expenses have gone up far less than elsewhere. The Japanese have the longest life expectancy in the world. Commentators typically attribute this to the Japanese medical systems focus on prevention which is wishful thinking. Prevention, however desirable it may be, doesn’t save money. The Japanese have the highest smoking rates in the world; the same is true for salt intake, hypertension, and suicide. Yet they live longer than anyone else. Why? Medical care likely has almost nothing to do with this longevity. The Japanese are a genetically homogeneous population. Their longevity is most likely the result of a good toss of the genetic dice.
Japan GDP

Japan’s GDP has not been robust over the past decade and fell off the cliff last year. The country’s expenditure as a percent of GDP will increase a lot more than it has before the economic downturn. Even without Japan’s current fiscal difficulties there ‘s not much we can learn from them. They are almost all the same. We are the most diverse country on earth. They willingly conform to national directives. We are notoriously unruly and resist regimentation. Their system cannot be transplanted to the US. Incidentally, organ transplantation is rare in Japan because it culturally unacceptable. Another difference between them and us.

The European experience shows how medical care is too expensive no matter how you deliver it. The Canadians are also breaking their medical bank. Until we ask the essential question – why is medical care so expensive? – we will waste our time and worse our money on futile solutions that can’t possibly work. The Congress is currently considering ways to “reform” healthcare that have no element of reform in them. Rather they will make a deeply troubled “system” worse, more expensive, and slower.

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Reality Strikes

May 19, 2009

The May 14 issue of the New England Journal of Medicine contains an article, Picking the Right Poison — Options for Funding Health Care Reform, that sets a new tone for the journal. It looks at health care reform through a clear lens. Funding universal health care is going to cost a lot of money. Be assured that whatever the estimate of its cost now is, its true cost will be many multiples of whatever number is currently presented.

Jonathan Oberlander the author of the perspective piece rightly concludes that health care reform cannot pay for itself by making the system more efficient. Rather expansion of coverage will generate additional costs. Raising taxes seems inevitable, hence picking the right poison. This choice usually means taxing someone else.

Reducing benefits is another option. This, of course, will be presented as getting rid of fat. One man’s meat is another man’s fat. Oberlander’s statement, “There is, then, no easy way to pay for comprehensive health care reform,” may get him thrown out of the club of right thinking analysts for whom nothing good is hard.

He compounds his truth telling by adding that “reformers may have to retreat from the goal of providing all Americans with comprehensive insurance.” That such a radical approach to healthcare reform made it into the NEJM suggests that hard reality may be intruding on good intention, that intent and outcome are not the same.

Remember the immortal words of Russell Long, Huey’s boy, “Don’t tax you, don’t tax me, tax that guy behind the tree.”

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