Category: Health Care

If Oliver Stone¹ analyzed health care.

Because yesterday turned into a snow day with double-digit-hours of Xbox 360 time, I missed Steven Pearlstein’s essay dissecting America’s health-care system. There are too many ridiculous statements to fully fisk Mr. Pearlstein’s biased ideas. Instead, I want to address (in more detail than I expected) a couple of his essay’s more egregious flaws. First, his premise:

Or, put another way: Although doctors, hospitals, insurers and drug companies say they, too, want things to change, any comprehensive reform would reduce their incomes and their profits.

All this becomes quite clear from a new study on the U.S. health-care system released without fanfare last month by McKinsey Global Institute, the independent research arm of the giant consulting firm, which counts many health-industry giants among it clients.

There’s the usual talk of expensive college loans and so forth. He (weakly) addresses the counter-point, so I’ll just add that there’s a difference between the level of precision needed to correctly code software to produce accurate financial statements and the level of precision needed to operate on a human heart and keep the patient alive. This should be obvious to dismiss the misconception that doctors and medical care are mere commodities that can controlled by the government.

The study aimed to determine why the United States spends nearly double the average of other industrialized countries on health care — with no better, and in some cases inferior, medical outcomes. Even after adjusting for wealth, population mix and higher levels of some diseases, McKinsey calculated that we spend $477 billion a year more on health care than would be expected if the United States fit the spending pattern of 13 other advanced countries. That staggering waste of money works out to 3.6 percent of the nation’s entire economic output, or $1,645 per person, every year.

It’s interesting that we spend more money, but why should we expect that the United States will or should fit the spending pattern of 13 other advanced countries, all with at least some degree of socialized health care? How many stories of long delays and surgeries denied do we need to hear about before we decide that we should analyze our spending based primarily on our needs and wishes? The notion from this study, as Mr. Pearlstein states repeatedly, is that this $477 billion excess is wasted and unnecessary. Perhaps it is, and Mr. Pearlstein provides a useful explanation or two. Unfortunately, he fails to notice these explanations as a cause for this waste, instead assigning the blame squarely on a “greedy” medical system. For example:

What we have here is pretty good circumstantial evidence of Pearlstein’s First Law of Health Economics, which holds that if you pay doctors on the basis of how many procedures they do, and you leave it to doctors and their insured patients to decide how much health care they get, consumption of health services will rise to whatever level is necessary for doctors to earn as much as the lawyers who sue them.

Universal health care will fix this problem, of course. Public money means some procedures and tests will be deemed unnecessary. I’m willing to theorize that this will cost at least one patient her life in the course of any future socialized health care system in America. Of course, it would be foolish for me to pretend that it won’t or can’t happen under private health care insurance. But who should bear the responsibility of making the decision on what might be appropriate, the patient or a bureaucrat?

But that’s not the point of that excerpt. Notice Mr. Pearlstein’s flawed theory of economics. Physician greed will lead to an excess. The fact that the patient is insured to an extent that he will never see the full cost of these procedures means nothing. Ignore that there are few incentives for the doctor or the insured patient to discriminate in choosing a test. That’s just silly. It must be physician greed, carried through their investments in medical labs. I would change his pet theory to Pearlstein’s First Law of Progressive Health Economics.

He continues:

Don’t be distracted by arguments that American doctors need to make more because they have to pay $20 billion a year in malpractice insurance premiums forced on them by a hostile legal system, or an equal amount for all the paperwork required by our private insurance system. The $58 billion in what the study defines as excess physician income is calculated after those expenses are paid.

Excess income. The patient is paying those fees that lead to “excess” income, no? He can refuse, of course, but why would he? He’s not paying the bulk of the bill. I wonder what his analysis would be if he were paying the bill. Let’s not forget a fundamental fact here, either. These patients are letting doctors make decisions that assess and propose fixes for their health. Should we fault them for being cautious? Again, who is the better judge for how much testing he wants done?

Proponents of a government-run “single-payer” system will certainly home in on the $84 billion a year that McKinsey found that Americans spend to administer the private sector portion of its health system — a cost that national health plans largely avoid. But as long as Americans continue to reject a government-run health system, a private system will require something close to the $30 billion a year in after-tax profits earned by health insurance companies. What may not be necessary, McKinsey suggests, is the $32 billion that the industry spends each year on marketing and figuring out the premium for each individual or group customer in each state. Insurance-market reform could eliminate much of that expense.

This is the heart of the debate, isn’t it. Government can run the system better, to the tune of $84 billion in eliminated² waste. Right. Show me one government-managed program that has managed such a task. Just one.

¹ I watched the end of Wall Street last night. I still enjoy it tremendously, but Oliver Stone’s assumptions about capitalism and wealth creation are preposterously amateurish. However correct his analysis of the finance in the 1980s may be, resting underneath the entire premise is that making money is a dirty deed. This is obscenely lacking in nuance, as evidenced by most every line Martin Sheen uttered in the movie.

² The basic issue here is how much of that $84 billion is wasted trying to comply with a myriad of absurd, interventionist government regulations. I guess the argument is sound that government-run health care would eliminate this, but creating the burden is not a justification for nationalization to eliminate that burden.

Incentives Matter

I don’t understand people who refuse to believe that basic economic incentives can be ignored or legislated away with nothing more than noble intentions. First, the premise:

As you know the United States is the only industrialized nation that does not have some form of universal health care. Over the past year or so several forms of “mandated” health care have been proposed: Massachusetts, Gov. Schwarznegger in CA, Wyden, Edwards. I will diary another week on why any “mandate” plan, tried no where else in the world, cannot work well. But for now let’s quickly look at all those other systems that really are in place elsewhere.

I don’t understand why mandate is in quotes there. Both states want to require specific actions and expenditures by its citizens. That sounds like a mandate. Perhaps the DailyKos diarist meant to put health care in quotes. Moving on.

Why do we need to really know how other countries do it?

Well, they all have better quality of care and outcomes than we do. And they control costs better.

Better quality of care? Better outcomes? Cheaper? Dubious, at best. Broader scope of who gets covered, perhaps, but that is not the same as quality of care and outcomes, and certainly not costs. The better strategy here would be to look at what’s preventing us from reaching that broader scope of who gets covered with superb health care without a pre-determined solution. Supporters of universal coverage appear to have analyzed the economics and found that economics is a right-wing conspiracy imperfect at meeting needs. I disagree:

The most highly-privatized system in Europe is probably Switzerland. Even there, private insurance companies are required by law to be nonprofit, their premiums, benefit structures and plans are set by the government, they are required to community-rate (i.e. they are not allowed to screen out the sick and deny them coverage, the fundamental way that U.S. insurance companies make money), and – get this – if one of them happens to enroll a healthier population and make more money, they have to give it away to the companies that made less.

I don’t understand how this is supposed to be privatized. If the context is just that it has the least government interference in Europe, okay, I guess it could pass such a claim. But “privatized” is not a word I’d use to describe that scenario. Forced non-profit status and revenue redistribution is hardly a free market solution.

To figure out the long-term flaw, start with the foundation: there’s no profit incentive. Socialism is a bad assumption because it reduces freedom when even one person is uninterested in participating, but let’s first fight the fight further along in the process. What’s the incentive? What motivates people to keep coming to their jobs? What motivates people, once there, to control costs? What motivates people to innovate within a system designed to first control cost? I’m at a loss. Someone please explain what I’m missing.

I’m not getting that answer from this diary, so I’ll excerpt what comes next.

Can you imagine U.S. health insurance companies being any more likely to go for that than for single-payer? They might as well go out of business! The idea that a system like that is going to make a proposal more “politically feasible” is totally ridiculous. That’s why I say in the talk that just as fundamental to the idea of “one-payer” is the notion that for-profit insurers must be eliminated. Also, the added cost of the Swiss multi-payer system makes it the most expensive. The reason we advocate single-payer for the U.S. is that it saves more money, AND it is also “ready to go out of the box” because we already have one single-payer system (Medicare!) and all the infrastructure and know-how ready to make it work.

Several questions arise from that. What about the investors in those for-profit insurers? I understand that many liberals view capitalism as bad, but retirees hold shares in those for-profit insurers. Pension funds, both private and government, rely on those companies to diversify portfolios. What do we do when we eliminate for-profit insurers? What about the blue-collar workers who’ve had promises made to them? Why hate them through this plan? Whatever the solution, I bet the answer includes Social Security.

The Swiss system is the most expensive. The only alarm bell to go off here is that the multi-payer aspect makes it expensive? How intentional and pre-ordained does the path to that conclusion have to be ignore the missing incentives in the Swiss system? Without the promise of profit, there is no incentive to control costs. Someone else will presumably cover whatever expenses arise. This is not the structure of a healthy system.

The end of that excerpt is the best. We already have one single-payer system that works. Forgive me for asking dense, obvious questions, but if Medicare works, why is there complaining that poor people can’t get insurance coverage? If it works, they’re getting the health care they need. Do we care about health care or health insurance? This seems like little more than misdirection to get more government control in more areas. It’s a feel-good solution being promoted only because it feels good to tell people what they should have, without incentives. Once again, count me out. I’m not interested.

Link via Balloon Juice because there’s only one DailyKos diary I read.

“Soak the rich” is not shared responsibility.

I haven’t had time to work my way through John Edwards’ proposed health plan (pdf), but I’ve read enough to know that it’s a preposterous joke that would end in fully socialized health care. No thanks. But instead of summarizing such a silly idea, I’d rather briefly explore Ezra Klein’s analysis of the plan. (Link courtesy of Balloon Juice.) I suspect it’s a fair representation of a good swath of left-leaning liberals who buy into the economically unsound view sold by most prominent Democrats. Consider:

In other words, the public sector will finally be allowed to compete with the private sector, and consumers will be able to decide which style they prefer. For Democrats, this is a significant step forward. From there, the plan offers the usual mix of sliding subsidies to ensure affordability, individual mandate to universalize coverage, pay-for-performance promises, and public health fixes. You’ve heard those bits before. What’s new, and what’s important, are the community rated health markets that include public insurance. Indeed, the plan satisfied every plank of my progressive health reform test from last week.

The plan will cost between $90 billion and $120 billion a year, and according to Edwards, taxes will have to be raised to pay for it. Readers should remember that this is the first full health reform plan from a major candidate in the 2008 election. As such, it has widened the field of the debate, and unless the other candidates want to explain why they lack the boldness of Edwards’ plan, they’ll have to offer similarly comprehensive proposals. What they will have to match is full community rating, a public insurance option, total universality, scaleability towards more public involvement, and a willingness to propose something comprehensive enough to require revenue increases to fund. In other words: The goalposts have been moved. To the left.

I don’t like this at all. The public sector has no business competing with the private sector. Aside from the centuries of data demonstrating that private markets work better, the public sector isn’t tasked with such endeavors. It must tackle public concerns like national defense. Individual choices of managing personal risk is entirely different. The public sector can’t know what my preference is for medical insurance. Inevitably, I will be forced to pay for something I don’t want or need, or I will be forced to pay for something for someone else that I don’t believe is appropriate. Why should a third-party be involved in that decision?

From what I’ve seen of Mr. Edwards’ tax plans with respect to health coverage, he believes that the rich should pay more and that the IRS can find unpaid taxes to minimize the new burden. Nonsense on both counts. The “rich” have no obligation to the “poor,” just as no man has any specific obligation to another man. That’s what individual, private sector transactions are for. People can create their own network of obligations and commitments. With such a radical shift, and massive increase in the tax burden of a few, those proposing such a change must prove why their new path is justified. If consumers can decide which version they prefer, why will some still get stuck with the bill for those who prefer the other? Using the barrel of a government gun to make me pay for someone else’s choices is wrong, regardless of how much money I make.

Of course, Mr. Klein’s entire premise is absurd, so everything preceding his final point adds little but easy counter-arguments. “Comprehensive enough to require revenue increases” is an ideological assumption, not a practical foundation. It shouldn’t be hard to see the byzantine mess that can evolve if bold vision requires only greater revenue. Too many supporting universal, taxpayer-funded health care seem confused that poor people receiving inadequate care and groups of people lacking health insurance are the same problem. They are not. You can solve one in this debate. Either everyone gets coverage and medical care becomes rationed, or people in need of medical care who can’t pay for it get the specific, immediate care they need, with the question of who pays being a separate discussion. If it’s the latter, this babble about universal health care is a utopian dream. If it’s the former, why do supporters believe that worse health care for most Americans is justifiable to give poor people what they’re generally already getting?

The short version is better. Wishing it so and making it so aren’t the same action.

Maryland will probably try to force Wal-Mart to subsidize this.

Maryland is really stepping into stupidity with its foray into addressing the current politically desirable hot potato health insurance crisis. I’m not sure which is worse, Gov. Martin O’Malley’s plan, or the naked defectiveness of politicians from a plan in the General Assembly. Consider:

Gov. Martin O’Malley (D) will call for expanded coverage of the state’s 780,000 uninsured — one in seven residents — in his State of the State address today, aides said, highlighting a proposal that would bring more of the poorest residents into public programs and require private insurers to allow young adults to remain on their parents’ plans until age 25.

What kind of nonsense is that last new regulation, other than an outright admission that politicians love to coddle people into ignoring reality and the consequences of their own choices. At what point will parents be allowed to kick their children off of their policy? If it’s so desirable for insurers to include young adults on their parents’ insurance, wouldn’t they have already offered such policies? Might current burdensome regulations and perverse incentives be the reason why those under 25 “can’t” purchase affordable health insurance? Making those worse will help? At some point, maybe people can leave the care of their parents and go directly to the care of the state. No one ever has to make any tough choices for himself. Even if he wants to make those choices.

General Assembly leaders are offering more ambitious plans that would add a $1 tax on cigarettes to pay for covering tens of thousands of low-income workers and offer subsidies to small businesses that provide coverage. Many workers who can afford insurance but choose not to pay for it would have to buy it or face penalties.
…

The governor opposes a tobacco tax increase, and even if lawmakers approve it, there is some sentiment to use the revenue to cover other needs. And despite the momentum in the Democrat-controlled legislature, initiatives of this magnitude often take more than a single session to sell.
…

A $1-a-pack increase in the tobacco tax also is the centerpiece of an effort by the Maryland Citizens’ Health Initiative to expand health care access through Medicaid and drug treatment. Although other states have approved tobacco tax increases to pay for health care, Senate President Thomas V. Mike Miller Jr. (D-Calvert) has expressed concern that if the tax acts as a deterrent to smoking, the revenue source could plummet.

If it might not work, why are Maryland’s elected officials so ready to implement it? Because it might work? And even if it works, the outcome might be bad? What? Politicians can’t control themselves, even when they allegedly have good intentions. They will botch the implementation of the noblest of plans. They should not be allowed anywhere near such an important, vital aspect of individual life.

Continuing to hide costs is not exposing them.

Robert Samuelson’s column about health care proposals in today’s Washington Post is interesting. I agree with the gist of what he says, but there are a few phrases that rub me wrong. They’ll be used to advance stupid(er) plans. For example:

For decades, Americans have treated health care as if it exists in a separate economic and political world: When people need care, they should get it; costs should remain out of sight.

Who defines need? In a health system with even minimal government involvement, the wrong person will influence need. That’s minor, I think, because his implication is clear enough to everyone but the most obtuse and/or ideological. But his follow-on, that costs should remain out of sight, is the problem now. Perpetuating that only changes the assumption that medical care should occur regardless of cost to essential medical care should occur regardless of cost. Again, if we can’t define need beyond a placeholder for a basic point, absent individual circumstances, we’re doomed to end up where we are after reforming the system.

The hard questions won’t sit still, because health care (now a sixth of the economy, up from one-eleventh in 1980) is too big to be hidden. Myths abound. Contrary to conventional wisdom, the doubling of premiums for employer-provided coverage doesn’t mean companies shifted a greater share of costs to workers. In both 1999 and 2006, premiums covered 27 percent of costs, says Paul Fronstin of the Employee Benefit Research Institute. It’s simply the rapid rise in total health spending that’s depressed workers’ take-home pay.

Unless we advocate a complete separation of employer and health insurance, using take-home pay as a measuring stick will create sub-optimal solutions within the confines of our already bungled system. And note the key word, depressed. That’s not an accident. People are “suffering,” so something must be done. If the share of costs from premiums is consistent, take-home pay lower than it would be without employer-paid insurance is merely a signal from the market that costs are escalating. To Mr. Samuelson’s earlier point, this should remain out of sight? Without the incentive to accept health insurance benefits as compensation, individuals would see the direct cost of their choices through greater expenditures, rather than “depressed take-home pay”. Presumably, they could then better define need based on their own situation.

Fix it where it’s broken.

I doubt I’ll watch tonight’s State of the Union speech. The posturing and applause and general pomp is unappealing. I’m content to read the speech and grab the important bits out of it. I can add some Xbox 360 into the time I’d spend watching nothing happening. That’s always a winner.

One important indication in the pre-speech buildup is this story about President Bush’s proposed approach to the alleged health care insurance crisis in America. He’s correct to address this situation because there is a flaw. And although he’s not proposing the optimal solution, what he’s suggesting beats any other idea going. (Massachusetts and California) Consider:

President Bush will propose a deep tax break for Americans who purchase their own medical insurance and would finance it with an unprecedented tax on a portion of high-priced health-care plans that workers receive from their employers, according to the White House.

The initiative, which the president briefly previewed in his radio address yesterday [Saturday], has a dual purpose: It would create a financial incentive for the estimated 46 million to 48 million Americans who lack health insurance to buy it. And it would rein in the soaring cost of health insurance by encouraging workers in high-priced plans to seek more modest coverage.

“Today, the tax code unfairly penalizes people who do not get health insurance through their job,” Bush said. “It unwisely encourages workers to choose overly expensive, gold-plated plans. The result is that insurance premiums rise and many Americans cannot afford the coverage they need.”

That grasps the true problem. People want “everything under the sun” coverage, which is not surprising because perverse tax incentives have taught Americans to expect that. Like much in our society, we’ve hidden the costs and focused solely on the benefits. This should go away. We must understand that there are consequences to our choices that can’t be wished away through government involvement or incentive.

There are details to be worked out if Congress (Democrats) agree, but I don’t know that we’ll have quick agreement since the president’s plan isn’t socialistic enough. As such, I won’t comment until there are firmer reactions. But it might be useful to look at an editorial in today’s Washington Post about President Bush’s plan.

There are weaknesses in the president’s proposal. Rather than embracing tax deductions, which are most valuable to people in high tax brackets, Mr. Bush could have made his proposal even more progressive by recommending a refundable tax credit that would be worth the same to everyone. Moreover, there’s a danger that ending the tax privilege for employer-provided insurance will cause companies to discontinue coverage, driving more buyers into the individual market, where it’s hard to buy insurance at a reasonable price, especially if you already have a medical problem. The administration promises to support state efforts to redeploy federal Medicaid dollars in ways that would make the individual insurance market work better. But success here will depend on the states, and the details are sketchy.

The problem with the current system is not that it’s regressive, although it is. The problem is that our current system of tax incentives disrupts the normal private market that individuals could participate in by pushing efforts to group plans. Groups require many different things, and most corporations offering group plans are not in the health insurance administration business, so we ended up with a few plans offering everything. This is ineffective and expensive. (I don’t need pregnancy coverage or mammograms, for example, yet I had it in my corporate-sponsored plan before I went independent.)

The solution, though, is not to make the tax incentives progressive. Punishing a new group instead of the old group is still punishment. That is not the government’s job. The market will do that reasonably well. If “the rich” want super-extra coverage, they’ll pay for it. Most people, when seeing the cost in the individual market, will demand more specific coverage. In this regard, driving more buyers into the individual market is exactly what we want. We’ll get better, cheaper solutions that way because needs and cost will remain in view. They’ll tend to balance to meet customer demands, rather than the current system of hiding everything but the coverage.

The answer is to get government out of the insurance/health business altogether, not to encourage government to create the “correct” incentives. It can’t know the perfect mix, so it will screw it up. President Bush is not there, but he’s found the map.

Coalition of the Willing and Unwilling

From yesterday’s Washington Post, this report on a new “consensus” on healthcare reform:

On the surface, it looked to be just another Washington news conference, part of the white noise of the political and policy process.

But this one was different. There, at the National Press Club, stood the president of the Business Roundtable, representing the country’s largest corporations; the president of the Service Employees International Union, the country’s most vibrant union and one of its fastest-growing; and the president of AARP, the formidable seniors lobby. They put aside their usual differences to deliver a clear, simple message to President Bush and congressional leaders of both parties:

We stand ready to give you the political cover you need for a centrist, bipartisan fix for a broken health-care system.

Or, if you refuse, we stand ready to embarrass you and run you out of office.

That’s interesting enough, if it were actually true. But I reject any claim that those three groups have the authority to speak for the nation as a whole. Only the AARP represents a sizeable portion of the nation, and that’s not enough to provide any claim to policy making. Populist rent-seeking never appeared so obvious.

In my case, I’m a small-business owner. I’m only 33. I’m not in a labor union. Who’s got my voice? Me, of course, and willingly so. But this is no one’s concern. The only outcome that matters is coming up with a solution that represents 20th century forces in the 21st century. This press conference could have just as easily occurred in 1907 as 2007.

What does that consensus look like?

It starts with universal coverage, accomplished either through a mandate on everyone to purchase basic health insurance or a mandate on all employers to offer it.

That much we already know, because we think people just aren’t motivated enough (the former proposal) or that more of what we already have will fix the problem (the latter proposal). There is no need to understand why we got here. Once we have a solution worked out, we’ll find the path backwards to where we are to tell the correct story. It’s insanity.

A few of suggestions warrant consideration, and by consideration, I mean outright dismissal.

Finally, it sets a deadline for physicians and hospitals to switch to computerized health records, along with a program to provide no-interest loans to buy the necessary hardware and software.

I’m sure that physicians and hospitals have delayed computerizing health records because no-interest loans were not available. Or it could be that the economic efficiency created by the process wasn’t supported by the cost. Or maybe it’s that physicians and hospitals are in the business of providing care instead of information technology. Only in a world where universal assumptions pass as analysis for the multitude of scenarios in which physicians provide care can an outcome that a universal solution will work. Of course, it’s a lot easier to say that when you impose a no-interest loan requirement. I’m certain “no-interest” means taxpayers will pick up the cost to subsidize this. It would be important to remember that something economically-justified would pay for itself, despite the cost of interest. It’s silly to let that get in the way, though. PEOPLE ARE DYING IN THE STREET!

Hospitals and insurers would have to agree that 85 percent of their revenue would go to providing direct care, capping profit and administrative expenses at 15 percent.

Wow. Central planning at its most crass. We know what expenses should be, as well as a fair profit. There need not be a direct tie to quality here. Fifteen percent for admin expenses and profit is enough. This will not end well.

Health insurers would have to accept the obligation to sell insurance to everyone, with only modest variation in rates for age and health status.

I guess actuaries should start looking for other work. It hasn’t proven to be useful, anyway, since risk can just be ignored. What could go wrong?

Sorry, folks, hospital’s closed. Moose out front shoulda told ya.

More single-payer “goodness”, this time from the U.K.

Patients are being denied basic operations, including treatments for varicose veins, wisdom teeth and bad backs, as hospitals try frantically to balance the books by the end of the financial year, The Times can reveal.

NHS trusts throughout the country are making sweeping cuts to services and delaying appointments in an attempt to address their debts before the end of March. Family doctors have been told to send fewer patients to hospital, A&E departments have been instructed to turn people away, and a wide range of routine procedures has been suspended.
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A letter from [North Yorkshire and York Primary Care Trust] chief executive, Janet Soo-Chung, says that all non-urgent admissions must be approved by an assessment team or they will not be paid for. A&E departments in Harrogate, Scarborough, South Tees and York have been told that they will not be paid for treating patients with minor ailments who could go elsewhere.

No patients will be given a hospital appointment in less than eight weeks, and none admitted for elective surgery unless they have waited a minimum of 12 to 16 weeks. Those treated quicker will not be paid for.

The United States will be no different if we implement a single-payer system. Given the timeline progression of other single-payer systems, I’m probably at the perfect age (33) for our system to break down around the time I retire. Wonderful. I’ll pass, thanks.

Source: Socialized Medicine

A Vision of a Future America

Smokers receive little sympathy for their habit and its consequences. Some of that is warranted, as I’ve told both of my brothers who smoke. It’s a stupid habit that’s known to cause serious health problems. Who in their right mind would start today, knowing what we know. But there are no apparent bounds to human stupidity, so smoking survives¹. That informs the public debate, but should not dictate it. It does, though, an it will increase if we move to a single-payer health care system. Are we immune to liberty-despising lunacy like this?

Smokers who refuse to give up the habit should be denied some types of surgery, a respiratory expert says.

Matthew Peters said denying smokers joint replacement surgery, breast reconstructions and some other types of elective surgery was justified because the operations were more risky and costly when performed on smokers.

“In healthcare systems with finite resources, preferring non-smokers over smokers for a limited number of procedures will deliver greater clinical benefit to individuals and the community,” Associate Professor Peters said in the latest issue of the British Medical Journal.

“To fail to implement such a clinical judgment would be to sacrifice sensible clinical judgment for the sake of a non-discriminatory principle.”

To be fair, in the context of a silly idea, it has its logic. But the rules must be convoluted to get there.

To Mr. Peters, greater clinical benefit to individuals results from denying procedures to smokers. I’m quite certain that the smokers will not derive greater clinical benefit. What Mr. Peters really means is the community. There is no individual in single-payer health care, just a utilitarian cost-benefit analysis where the parameters are set by an outside party. Perhaps the smoker values hip replacement surgery enough to pay for it himself, where the non-smoker will only have it done because it’s paid for by the government. There are only two people who can make that decision, and the bureaucrat isn’t one of them.

In a private market, the smoker would pay the added insurance expense for his habit, and would weigh the risk decision with his physician. All people are not alike, so it’s feasible that smoker X will have a different risk than smoker Y. Again, who is better qualified to make that individual decision, based on relevant facts, the doctor or the bureaucrat?

“Therefore, so long as everything is done to help patients stop smoking, it is both responsible and ethical to implement a policy that those unwilling or unable to stop should have low priority for, or be excluded from, certain elective surgical procedures,” he said.

I have no interest in seeing this in America. I don’t smoke, I don’t drink, and I’m a vegan. According to the standards of a bureaucrat, I probably come out alright, unless a bureaucrat deems insufficient milk intake a danger to bone health, for example. Then, like everyone else in America who isn’t perfect, I’m screwed. Should I be sent for dairy re-education to make sure my bones don’t become brittle? Extreme, yes. Impossible, no. “So long as everything is done to help patients stop …” and “those unwilling or unable to stop” are the clues.

I’ve determined the possible effects of my health choices. I understand what I could face and I’ve compensated as well as I can. And I’m willing to pay for the consequences, both in health and dollars if I’m wrong. That individual calculation gets pushed aside in the world of single-payer health care. Liberty demands that we not embrace that nonsense, but economics and quality of care dictate the same. Pick your preference. Unless you hate both, the choice is easy.

Source: Bodyhack

¹ I’m not talking recreational smoking, although that’s dangerous. I’m talking about addiction. When smoking begins to cause serious health problems and the smoker can’t quit, that’s the where stupidity can lead. Or should I say excess stupidity. And yes, as the rest of this entry will show, people are entitled to what is in my opinion excess stupidity to harm themselves.