Category: Health Care

I don’t know which post I like better.

Two excellent posts from Cato@Liberty. First, Michael Tanner provides an update on how well RomneyCare is working in Massachusetts.

Faced with rising costs that threaten to put the program $150–400 million per year over budget, the Massachusetts Connector Authority is now adopting a number of changes to RomneyCare. They include:

  1. Pressuring insurers not to increase premiums (ie. premium caps).
  2. Ordering insurers to cut reimbursements to hospitals and physicians by 3–5 percent.
  3. Reduce the choices available to consumers.

It seems that in the fight between economics and political dreams, economics wins. <sarcasm>How shocking.</sarcasm>

Second, Jim Harper discusses an issue separating Hillary Clinton and Barack Obama with implications far beyond the purported scope of what’s barely been discussed.

Senators Barack Obama (D-IL) and Hillary Clinton (D-NY) disagree quite starkly on whether illegal immigrants should be licensed — or, more accurately, on whether driver licensing and proof of immigration status should be linked.
…

The right answer here isn’t obvious, but it is important.

Many people believe that illegal immigrants shouldn’t be “rewarded” with drivers’ licenses. Fair enough: the rule of law is important. There’s also a theory that denying illegal immigrants “benefits” like driver licensing will make the country inhospitable enough that they will leave. This has not borne out, however. Denying illegal immigrants licenses has merely caused unlicensed and untrained driving, with the hit-and-run accidents and higher insurance rates that flow from that.

The major reason, though, why I agree with Senator Obama is because the linking of driver licensing and immigration status is part of the move to convert the driver’s license into a national ID card. Mission-creep at the country’s DMVs is not just causing growth in one of the least-liked bureaucracies. It’s creating the infrastructure for direct regulatory control of individuals by the federal government.

I agree with this. As a libertarian concern about unintended consequences drives some of my disdain for anything more than limited government. But as a libertarian who understands a little about history and tyrants, concern about intended consequences drives me more. Stupidity in government is bad. Evil in government is worse. Any politician who supports a national ID system is evil and must be stopped from enacting his or her plans.

I’m sure the Left wouldn’t politicize this office.

How far off the rails we’ve gone:

The Bush administration again has appointed a chief of family planning programs at the Department of Health and Human Services who has been critical of contraception.

Susan Orr, most recently an associate commissioner in the Administration for Children and Families, was appointed Monday to be acting deputy assistant secretary for population affairs. She will oversee $283 million in annual grants to provide low-income families and others with contraceptive services, counseling and preventive screenings.

Why do we need an Office of Population Affairs? Since when is it a right to have everyone else pay for you to have (mostly) consequence-free sex? I don’t recall seeing that in the Constitution as a federal power.

The furor, of course, will be about Orr’s presumed position on birth control versus abstinence, as she seems to be an ideal political bone to toss to the social conservative base, as if this will suddenly improve our nation’s morals.

Update: I do not want to remove this because it was here when I first posted the entry. But I can’t find a link to this alleged statement from Orr, via Think Progress. Until I can verify, the quote shouldn’t be here. See comments for more explanation. See this rundown at Think Progress, via John Cole. Particularly this (emphasis in original):

In a 2000 Weekly Standard article, Orr railed against requiring health insurance plans to cover contraceptives. “It’s not about choice,” said Orr. “It’s not about health care. It’s about making everyone collaborators with the culture of death.”

Wonderfully intellectual, no?

Something in Orr’s past intrigues, similar to her position above.

From the Washington Post article:

In a 2001 article in The Washington Post, Orr applauded a Bush proposal to stop requiring all health insurance plans for federal employees to cover a broad range of birth control. “We’re quite pleased, because fertility is not a disease,” said Orr, then an official with the Family Research Council.

I support the goal to stop requiring insurance to cover it, although I would aim for a full reversal rather than just for federal employees. Government should not mandate coverage for any particular service or product. Still, within her limited scope here, Orr gets a temporary pass.

However, she’s an intellectual joke if she wants to pander that fertility is not a disease, by which I think she means “it’s not worth covering under insurance”. There are more ways than just heterosexual, missionary-position intercourse to create a family, and none of them are any less moral or Godly. There are many people who need fertility services and want that coverage. The market should decide whether or not it’s covered.

Even if it’s just normal, boring contraceptive services, government has no justification for interference. Since people need and want these services, there is inevitably a market for it, at some price. Maybe that price isn’t conducive to a deal for some services, but that’s economics, not theology. Covering it shouldn’t be mandated, but it shouldn’t be prohibited, either, which is what I think social conservatives want.

This is the problem with the Bush administration specifically, and politics in general. It can’t ever do the right thing for no other reason than it’s the principled action. It can’t control itself from using its own subjective, selfish reasons. Occasionally it’ll hit the correct bullseye, but usually there are intended consequences that are incorrect. Shameful.

P.S. Think Progress bolds Orr’s “fertility is not a disease” comment without reflecting on the validity of such a mandate for insurance. That’s probably an indirect comment on what Think Progress believes about that validity, but I’m not familiar enough with the site to draw a definitive conclusion.

The process of getting it shows why it will fail to deliver utopia.

Medpundit offers a concise summary of the fallacy that U.S. universal health care/coverage will mimic other established universal systems. It also explains why I don’t believe that universal health care/insurance will lead to the end of routine infant circumcision in America. (I removed the links from this excerpt because they make it appear too busy, but they’re worth reviewing at the original entry. Emphasis here is in original text.)

The British are often held up as the standard to which we should aspire. But we don’t live under a British style of government. We live under a government that’s truly government of the people, by the people, for the people. And what the people want, the people get. Witness the influence of disease activism even now on disease specific government funding and treatment mandates. In England, the government only pays for colonoscopies to check for colon cancer if there are symptoms suggestive of cancer or a family history of colon cancer. In the United States, the Medicare pays for a colonoscopy every ten years for everyone over 50, regardless of symptoms or risk. So do many insurance companies., sometimes if not by choice, by mandate. In England, mammograms are only covered for women between the ages of 50 and 70, and then only every three years. In the United States, we pay for mammograms beginning at age 40, yearly, and with no upper age limit. We just don’t have the heart for rationing that they have in other countries.

It’s possible, probable even, that universal coverage would reduce the number of unnecessary circumcisions performed as compared to our quasi-private system now. However, I suspect the decrease will be neither significant nor long-lasting. The fundamental flaw in populism is that it can’t say “no” if a majority demand a “yes”. Principles and rules do not matter. The rights of the minority do not matter.

In this particular procedure, the opinion of the patient will continue to not matter. He is treated as a statistic, at best. If the procedure has the potential to prevent a problem later on, regardless of the actual risk faced, the foreskin’s contribution to that risk, or the consequences of that risk, the illogical defense allowing parents to continue cutting the healthy genitals of their sons will continue.

Remember that populism doesn’t care about proper context in cost-benefit, or even the existence of such analysis. As long as the case could be made, every parent is assumed to be making it. And every infant is assumed to be pleased at that assumption, depsite the undeniable evidence that intact adult males almost never choose or need circumcision.

The out-of-context nonsense we use today is illogical to anyone seriously considering all the evidence. The risks are small. There are less-invasive treatments and preventions available. Comparable countries that do not circumcise manage to achieve the same low levels of disease. These facts are ignored because they contradict our mental conditioning. We believe of circumcision what we want to believe, not what is true. That is why we hear that male circumcision reduces the risk of HIV infection by 60% rather than the more honest explanation of how much it reduces the absolute risk. Sixty percent is far more persuasive than two percent.

For the United States we must be honest and ask if a central planner wannabe who is immune to the rights of individuals enough to issue mandates wouldn’t also be immune to fiscal rationing for non-medically-indicated circumcision, as long as it pleases “the people”.

Via Kevin, MD

Nationalized does not mean sane or restrained.

Megan McArdle links to a recent Matthew Yglesias post on nationalized health care. Here’s the key part of the excerpt she quotes:

In effect, a highly centralized state run health care system is able to put a cap on how much demonstrative caring can be done through the health care system.

She replies to a hypothetical example of how the government would cap such demonstrative caring through health care with this:

But after the legal revolution of the 1970’s, American public services look, well, like American ones: unable to deny anything to anyone. What would actually happen in the case Matt describes is that the patient would form an activist group, sue, get the treatment, and use the government settlement to buy the kids organic fruit and a trip to Disneyland.

Bingo. This is why I don’t trust the argument that nationalized health care would result in no further government funding for infant circumcision. One boy would get a UTI that results in a kidney infection. The lawsuit shows up, the verdict ignores logic, and we’re back to funding infant circumcision. And we probably end up with pressure to perform it on all male infants because it will save the government money in the long run. We can’t legislate away unintended consequences.

I’m worth mass redistribution. Or maybe it’s just my vote.

I’m a few days late on this, thanks to being wrapped up in fantasy football, but John Edwards cares about me.

Democratic presidential hopeful John Edwards said on Sunday that his universal health care proposal would require that Americans go to the doctor for preventive care.

“It requires that everybody be covered. It requires that everybody get preventive care,” he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. “If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”
…

“The whole idea is a continuum of care, basically from birth to death,” he said.

If I’m going to be in the system… How quaint. Do I have a choice? If and when I choose not to be part of the system, do I get to keep that part of my taxes devoted to covering me, as well as the portion that is my charitable “gift” to everyone else in this scheme?

Obviously he wouldn’t emphasize the womb-to-tomb feature bug if the answer to any of my questions was yes. Also obvious is the basic fact that, being unable to understand that government is the problem in health care, his proposal relies on reducing everyone to a lower level rather than working on (effective) ways to enable the unintentionally uninsured minority to mitigate their financial risk. Note, of course, that Edwards – and every other health care nanny currently running for president – misses this true issue in his quest for womb-to-tomb government services. That won’t earn my vote.

More thoughts at A Stitch in Haste and Cato @ Liberty

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I wouldn’t expect anyone else to have mentioned it, but a side issue from Edwards’ proposal involves routine infant male circumcision. As I’ve written, a liberal, progressive argument for universal health care and/or coverage is that the government will cease paying for unnecessary male circumcision. This will not stop.

Governments already fund unnecessary circumcisions today, when resources are limited. There is no significant push among politicians to redirect those funds into medically necessary expenditures (or taxpayer pockets). They do not care about the necessity of any particular intervention, or even health care in general. Universal health care is simply a means to create a new, dependent constituent group. If that constituency wants infant male circumcision, politicians will cover it. (I’d make an argument that bureaucrats will make the decisions, but doctors make the same mistake in an effort to please their constituents constituents’ parents.)

Politicians believe there is always another group to demonize and tax to fund whatever gift needs to be made to voters for their votes. I am unwilling to hope that any government run by these fools will miraculously reverse its stupidity. Such short-sighted adherence to self-interest is inherent in government whenever it’s controlled by those interested in the exercise of power. Neither rights nor logic plays any part.

Now add the context of a politician like Edwards who wants to mandate that you and I will undergo preventive care. Is it really a long leap to assume that such a stupid person could read the splashy headlines about male circumcision and HIV and ignore the context of voluntary and adult, as well as the truth that condoms remain far more effective at reducing the risk of HIV? Almost everyone in our culture has ignored these last three points in the two years since the first preliminary results were announced, so the answer is a clear “no”.

Politicians will continue to make the erroneous, incomplete argument that the cost-benefit analysis of infant male circumcision is a one-sided consideration, with benefits the only deciding factor. They rarely even recognize potential before the word benefit. If there’s a potential benefit to chase, they will assume that means one less disease to pay for out of the collective in the future. That is incomplete and morally defective, since it ignores the risks, the complications, and the rights interest of the child in making this subjective, medically unnecessary decision. That politicians, parents, and doctors make this error every day proves the fallacy of trusting in the economics of universal health care to rectify an ethical failing.

Should government miraculously reverse itself and stop funding infant circumcision, I still argue that this is largely irrelevant. Many parents will just pay for it themselves. I’ve read too many blog entries of parents fretting over the hundreds of dollars it will cost, yet, considering genital cutting either an “investment” in their son or a “necessary” expenditure so that the boy will be normal common, they proceed anyway, out of their own pockets. To be fair, there will be a long-term reduction, as fence-sitters will decide unnecessary surgery isn’t worth the money, but there will still be many boys facing the knife who should be protected. I’m not okay with that.

Anyway, who will make the argument that politicians embrace the individual rights of their children and refrain from removing healthy body parts from their own sons? I’ll theorize that at least one candidate running for president with a universal health care platform has ignored the violation of his¹ son’s rights and circumcised the boy, to say nothing of the members of the theoretical decision-making apparatus should a universal health care scheme be implemented.

¹ This ignores Sen. Clinton because I assume she did not have her daughter’s genitals cut. However, she should be included in any consideration of politicians and bureaucrats willing to perpetuate the violation of the genitals of male children.

I retract my praise of the Bush Administration.

Remember back to October when I wrote about this story:

In its statement, USAID said the funding “should not have occurred, and there will be no further circumcisions performed with U.S. Government funds until the PEPFAR Scientific Steering Committee reviews data from ongoing clinical trials and considers any recommendations on male circumcision from the normative international Agencies.” PEPFAR is the Bush anti-AIDS program.

I guess the “results” are in. Were they even in doubt?

President Bush’s $15 billion anti-AIDS program will begin investing [SIC!] significant money in making circumcision available to African men seeking to protect themselves from HIV, top U.S. health officials said Sunday.

Recent research showing that circumcision dramatically cuts the rate of HIV infection is highly convincing [ed. note: <sarcasm>I’m shocked.</sarcasm>], a delegation of U.S. officials, led by Health and Human Services Secretary Mike Leavitt, told reporters in Johannesburg.

Countries taking part in the President’s Emergency Program For AIDS Relief have been invited to seek money to expand access to the procedure.

If you want to know how carefully our $15,000,000,000 will be spent, guess:

Circumcision funding would be small at first, with budgets in the hundreds of thousands of dollars for individual countries. But it is likely to grow to be “an important part” of the program in coming months and years, said Kent R. Hill, an assistant administrator for the U.S. Agency for International Development.

Small at first, but likely to grow in the coming months. Surely we’ll have a definitive answer by then.

The cells in the foreskin of a penis are especially vulnerable [ed. note: Are we sure?] to HIV, and removing the foreskin makes a man about 60 percent less likely to contract the virus, studies in South Africa, Kenya and Uganda have shown. The research reinforces studies showing that regions with high circumcision rates generally have lower rates of HIV.

About those regions… “Generally” isn’t enough, unless you’re world health experts or the United States government. Then definitive proof isn’t necessary, nor is the obvious point that $15,000,000,000 buys a lot of condoms, which have a definitive, significantly higher success rate at preventing HIV, pregnancy, and other STDs than male circumcision’s “about 60%”. I’m sure the Bush administration is waiting for “broad international consensus” on the issue of condoms and their effectiveness.

As I said in October:

I’m not sure where funding AIDS prevention in Africa falls within the Constitutional responsibilities granted to the United States government, but that’s not my issue.

Today, it’s my issue. Where is funding AIDS prevention circumcision in Africa noted within the Constitution? Which article grants that power? All of the immoral actions of our government weren’t enough, so we had to have this? Really?

Of course, what could possibly go wrong with government handling HIV/AIDS policy? I’m sure our $15,000,000,000 will be spent wisely. It sure will buy a lot of garlic, beetroot, lemons and African potatoes.

Unfortunately, this is also support for another belief of mine. There is a push within the anti-circumcision movement to promote a single-payer health care system in the United States because it would presumably require the bureaucrats to stop funding unnecessary surgeries to fund necessary medical care. This will not work because our politicians are short-sighted. They make decisions for political gain. As long as there is a desire by parents to hack away parts of their sons and an ignorant denial of science and ethics acceptance that this is okay, infant circumcision will continue in America. It doesn’t matter if it’s funded by insurance, government, or parents. It will continue. Just because rationing decisions must be made does not mean that rational decisions will be made.

The worst part of this is easy to predict. This money will be used to fund infant circumcisions, regardless of what the parties involved are now claiming. That’s just the inevitable line of (non-)thinking from public health officials. If it wasn’t, we wouldn’t have seen the push for infant circumcision six days after the latest findings on voluntary, adult circumcision were released in December. Voluntary and adult always get lost. Always.

I know I just ripped Glenn Reynolds…

… but allow me to imitate him for a moment. Megan McArdle says:

As a class, the old and sick are already luckier than the young and healthy. Again, for individuals within that class–those with desperate congenital conditions, for example–this is not the case. But I’m not sure it’s terribly compelling to argue that we should massively disadvantage a large group of people in order to massively advantage another, equally large group of people, all to help out the few who are needy, or deserving, or unlucky.

I agree. Read the whole thing.

Thus always with socialists?

A few days ago, Andrew Sullivan linked to a story about (now deceased) English broadcaster Tony Wilson with this quote:

“I’ve never paid for private healthcare because I’m a socialist. Now I find you can get tummy tucks and cosmetic surgery on the NHS but not the drugs I need to stay alive. It is a scandal,” – socialized medicine patient Tony Wilson

The title of this entry doesn’t refer to any sense of hypocrisy. Mr. Wilson’s friends chipped in to pay for a five-month’s supply of the medicine he needed, so I’ll accept that he was stuck on his socialist beliefs. But I am not surprised at the irrational disbelief and outrage at finding out that socialism doesn’t work. It probably is a scandal that the NHS will pay for something unnecessary while rationing away from something necessary. But again, this isn’t a surprise.

In socialism, rationing decisions will be made by bureaucrats. Bureaucrats can’t know, and almost by definition don’t care, about individual needs or desires. Their job is to manage with limited resources, so they will make the tough decisions. There is some balance of uninformed and political involved, but neither should be reassuring or viewed as a path to competent choices. Success is percentages and luck, not merit.

As such, I’m fascinated by this mixed-up e-mail sent to Andrew Sullivan by a reader:

Every healthcare system, public or private, must choose which care to provide and the cost versus efficacy arguments must be weighed carefully. It is always bad to base public policy on a single anecdote and we certainly should not be denying people Sutent solely because someone taking it died within the month. It is telling, however, that you used this story to bash the NHS for being conservative with other people’s money – rather than bash the drug company for refusing to sell its product at a price the customer is willing to pay.

The first statement I’ve bolded is misleading if you don’t dissect it properly. Of course difficult rationing decisions must be made. This is true of any good or service with a finite supply. The correct analysis is who does the choosing. In public health care, it’s the government, with a preference for your opinion only if you’re politically connected or important. In private health care, the individual makes the decision.

The second bolded statement demonstrates what advocates for socialized medicine claim is the fatal flaw of the free market. We must bash the drug company because it didn’t sell at whatever cost the customer is willing/able to pay. No. Life has costs and no party should be expected or forced to offer something in a way that doesn’t meet its preferred terms. The result can be viewed as heartless, but coerced compassion is merely coercion, not compassion.

It would be better to run with this quote from Mr. Wilson:

“I used to say some people make money and some make history – which is very funny until you find you can’t afford to keep yourself alive.

Decisions have consequences. Socialists are just as capable of making “bad” decisions as capitalists. It’s a tragedy when anyone can’t afford to keep himself alive. I am not advocating heartlessness. I do not believe that a free market system should or would allow poor patients to die. I’m just saying it’s more effective to raise standards for everyone rather than setting a maximum standard so that everyone can be covered minimally on the public dime.

It is not reckless or immoral to earn wealth. Mr. Wilson apparently contributed much to his industry, but eschewed personal financial gain for his efforts. I wouldn’t make that choice, but it’s not my place to force him to earn wealth. But wealth isn’t a zero-sum game. It doesn’t have to be finite, to be stolen and shared.

To me, there is no greater achievement than when a man can take care of himself. I accept that someone can disagree. Everyone is free to pursue a goal of voluntary collective responsibility and support. But don’t try to force me to join you. If your economic idea can’t survive without force, it’s immoral.

Too conditioned to question the system?

Kevin, MD links to a story from England. The headline to the story states “I was too shy to talk to my doctor – and it nearly killed me”. That’s an interesting way of characterizing the facts. While the man, Andrew Wilson, did delay seeking treatment for six months, in part out of embarrassment, he also said he was too busy. If it said his delay almost killed him, it’d be much closer to the truth.

Unfortunately, the headline ignored what was clearly a much larger factor. Consider:

‘But as I doubled over in agony, I thought: ‘I wonder if…’ His GP gave him a prescription to treat an upset stomach. ‘Having suffered bowel problems for six months, I mentioned bowel cancer, but he said there was nothing to worry about and told me to come back if the pain persisted.
…

‘I rang my GP but he told me not to worry – “It’s probably piles,” he said.
…

‘My GP had said to me before I left for the States: “Don’t go on the internet and look up your symptoms or you will give yourself a fright.” But I was already frightened.’

The easier of at least two conclusions is medical incompetence for ignoring the symptoms because Mr. Wilson didn’t fit the typical bowel cancer case. But is it possible that in addition to, or in place of, incompetence, socialized medicine is to blame? The people are paying and the people don’t want to waste money on low probabilities, even though low probabilities mean that someone will actually have cancer. That’s sane?

The “right” to health care doesn’t include the right to live in spite of the well-considered economic rationing decisions of the majority? No. The article makes a cursory nod to its own title when it includes “many people are too embarrassed to report symptoms until they become debilitating.” That does not justify the title.

Before we rush into socialized medicine, we should understand the warning signs cancerous economics. Or are we too embarrassed to consider that economic populism is wrong?

Partisanship vs. the People

Michael Gerson, who’s too regularly full of wrong ideas, discusses child health insurance in today’s Washington Post.

The column is useful enough, since it discusses how to get children covered by health insurance, as well as a glossed-over failure within the existing government structure of providing insurance for children. There’s room for disagreement, despite his opening suggestion, but his conclusion is better than creating a new bureaucracy to do what the government already does. (The government shouldn’t be doing this, and his solution for adults is lacking.)

One sentence is worth excerpting. The story is lost a bit when reading this in isolation, but the context remains.

Fulfilling the most basic parental responsibilities can’t be legislated.

Why not? Politicians (and pundits) seem convinced that many such actions can and should be legislated. At least in Virginia, the laws for restraining children minors under the age of 16 while riding in motor vehicles suggests that basic parental responsibilities are legislated.

I happen to agree with his original statement. (We legislate feeding children sufficiently, for example, but that’s not what Mr. Gerson means by most basic.) As he mentions in his column, almost 6 million children eligible for Medicaid or State Children’s Health Insurance Program aren’t signed up because their parents haven’t filled out the paperwork. That makes no sense. I’m sure most of those 6 million children aren’t signed up because their parents don’t know they’re eligible, but I don’t see how a free society can force people to sign up for public insurance, just because they’re eligible. Providing health care to their children, yes. Accepting public assistance, no.

When we hear that 47 million Americans don’t have health insurance, that means 250 million do. We should learn from the majority more than we decipher problems from the minority. I’m left wondering why, with programs already available, we should create new programs for children and adults in the hopes that we’ll eventually get to everyone. Shouldn’t we investigate why parents aren’t signing up for something that already exists rather than create a new boondoggle that will fall short of politicians’ plans? Our current crop of presidential candidates don’t think so, so the real lesson is that big government conservatism and big government liberalism are more interested in big government than political philosophy. Surprise. Won’t single-payer health care be fun?!?

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A little Michael Gerson bonus, extending from his statement. As he concluded in his Independence Day column:

In America we respect, defend and obey the Constitution — but we change it when it is inconsistent with our ideals. Those ideals are defined by the Declaration of Independence. We have not always lived up to them. But we would not change them for anything on Earth.

So what’s in the Declaration of Independence that Mr. Gerson cherishes?

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.

How is same-sex marriage, which Mr. Gerson opposes, not the pursuit of happiness? Is he going to get ignorantly stuck on the reference to the individual’s Creator, read that as a euphemism for his God, and call government intervention okay? He clearly believes he can legislate happiness. If he believes we can’t legislate the most basic parental responsibilities, why not? Legislating signing up for insurance is easier and likely to be more effective than legislating happiness.