NHS: No, we will not approve use of an effective liver cancer drug

More on the compassion of the single-payer system of health insurance:

A drug that can prolong the lives of patients with advanced liver cancer has been rejected for use in the NHS in England, Wales and Northern Ireland.

Quality care for all. Wait a minute! You there! Not you.

The market does it better, in concert with personal human caring.

Universal health care all about compassion?

I often see the argument that the universal, single-payer plan is all about compassion. So it was almost refreshing to see an editorial from the St. Petersburg Times that stepped far away from that position.

The editorial, titled "Science, not emotion," discussed the new mammogram schedule recommended by the U.S. Preventive Services Task Force. The facts of the matter illustrate how preventive care is not always cost effective care. Women under 50 years of age were getting rather little bang for their mammogram bucks.

The transition to the bitter pill at the end was a bit rough:

The United States spends roughly 16 percent of its gross domestic product on health care — far more than many other developed countries. Britain long ago adopted a less stringent standard: Begin mammograms at 50 and have them every three years. The task force didn't go that far, and its recommendations deserve thorough vetting by the broader medical community. And women in their 40s should always have the option to finance mammograms either out of pocket or through optional insurance coverage.

But a basic tenet of our health care system must include a willingness to base medical standards on science, not emotion. That is the only chance the country has for making health care more available and affordable for all.

Note: "(W)omen in their 40s should always have the option to finance mammograms either out of pocket or through optional insurance coverage."

Um--what about the "right" to health care?

No?

The editors don't quite get it. A government-controlled system is highly likely to decrease availability of mammograms. Take Canada, for example:

In early 2008, women in southeast New Brunswick who wanted a routine mammogram had to wait more than a year to get an appointment. That has changed since the first of two digital mammogram units have been added to the Moncton Hospital.

Rachelle Gaudet, the manager of diagnostic imaging services for Regional Health Authority B, said women now have to wait about 32 weeks to get a routine screening.

Granted, waiting for a year or so provides women more time to save money to pay for the mammogram. But they'll pay more because of scarcity, and they'll have to wait.

The last paragraph from the editorial serves as the paper's admission that single-payer health care is not thoroughly compassionate. If it was, we could base the decisions on emotion instead of science. Or at least science plus economics. We have the science to provide early mammograms. It is economics that ultimately discourages providing them early and often.

Now I'll start hoping that the Times will admit that the single-payer system would discourage medical innovation.

Video: Don't copy European heathcare

I do not recall ever seeing a parallel message from the news pages of a United States newspaper.

Instead, we get stories like this one in the St. Petersburg Times: "Oh, Canada, where health care for all 33 million is free."

No, that's the real title of the story. Seriously.

The genius of Duane & single-payer health care

I haven't gone, just taking a bit of a break. But there's nothing like the intellectually bankrupt comments of a committed liberal to prompt a new post.

Off-and-on commenter "Duane" had the following in the midst of his comments on health care:

Single payer means we can all stop paying for medical insurance. Yes taxes will go up but the disappearance of the massive overhead that insurance companies add will take care of that "increased demand" you think comes with third party payer.

1) Single-payer does nt mean that we can all stop paying for medical insurance. It means that medical insurance will be paid for through taxes. Some folks will end up paying exorbitant prices for their health insurance while others will pay nothing. Liberals addicted to progressive punishment of wealth accumulation will love that arrangement, no doubt. In the end, however, there just isn't any such thing as a free lunch.

2) Yes, taxes will go up, unless we borrow the money and grow the deficit. Though we could do both, which is what would apparently happen under the latest version of the Obamacare plan.

3) The single-payer plan is unlikely to significantly decrease the "massive overhead" that private insurance adds to health insurance costs, except through rationing of health care services (providing less service would probably reduce the need for overhead). Governments tend to operate less efficiently than private concerns since the latter need to concern themselves with profits. Massive overhead is a drag on profits, so private companies are highly motivated to keep overhead costs under control. Medicare, as I understand it, runs higher administrative costs per patient than does private insurance.

4) The third-party payment problem is a classic economic phenomenon. It's like me just "thinking" that printing more money so that everyone will have twice as much will devalue the currency by half, in principle. It's basic economics, not just my personal opinion. When somebody else is paying for something, the demand for that something dependably goes up. Insurance companies know that. That's why co-pays and deductibles are featured prominently in most insurance plans. Plans without co-pays and deductibles are extremely expensive merely because the high premium is likely to make up for the increased use of services.

The Steven Crowder investigation of Canadian health care

Steven Crowder is a funny guy.

But his low-budget expose of the Canadian health care system relegates his comedy to the role of comedy relief. Some of the things we see of the system adopted by our neighbors to the north are downright scary.

Waiting hours in the emergency room? I expect that occurs frequently enough in the States, so most people won't think that's any big deal despite the hints we have that it is always that way in Canada.

Waiting years to have a family physician? That has to open a few eyes, or at least raise a few eyebrows.

TANSTAAFL and single payer health care

In economics, it is said that there ain't no such thing as a free lunch.

That is the phrase behind the acronym "TANSTAAFL."

Various observers have noted that contemporary advocates of single-payer health care appear to throw TANSTAAFL out the window. They appear to believe that something may be had for nothing.

I was reminded of this while doing some research on single-payer health care. I was actually just trying to compile a list of nations who use a single-payer universal system, but I kept running into these crazy pages advocating the single-payer system. I eventually locked in on a page that peddled the single-payer system as an economic stimulus, and offered a study to back it up.

How intriguing, I thought.

The study was produced by the Institute for Health and Socio-Economic Policy, a "research arm" of the California Nurses Association. The CNA spins the study like this:

Medicare for All (Single Payer) Reform Would Be Major Stimulus for Economy with 2.6 Million New Jobs, $317 Billion in Business Revenue, $100 Billion in Wages. The number of jobs created by a single payer system, expanding and upgrading Medicare to cover everyone, parallels almost exactly the total job loss in 2008, according to the findings of a groundbreaking study released today.

• Read the complete press release here

Isn't that awesome? Single-payer health care features all kinds of benefits!

Could there be a catch?

The study certainly does put the very best face on single-payer health care by emphasizing the economic benefits. Despite that emphasis, the catch is difficult to hide. It comes through clearly in the conclusion of the study:

This study demonstrates that a comprehensive Medicare based Single Payer system can make significant contributions to access of quality care for all U.S. residents and in the process generate a much needed and very substantial economic stimulus in the form of jobs, enhanced business and public revenues and increased wages for the public at large.

All this comes at a relatively modest increase in net costs of $63 billion.

Not to insult anyone's intelligence, but the study just explained to you that the benefits will cost us $63 billion. So this "economic stimulus" is perfectly Keynesian. And, of course, the problem with Keynesian stimulus is that the bill comes due eventually. That $63 billion in red ink--who pays for that year after year?

TANSTAAFL.

Either somebody pays the tab--resulting in a subtraction of a portion of the economic pie ($63 billion net)--or else the government eventually has to start denying services in order to meet its financial obligations.

Ironically, these numbers the CNA trumpets as economic stimulus come largely from an increase in the demand for health care services created by the expansion in coverage. That is the curse of third-party payment. This study spins one of the big drawbacks of the single-player version of universal health care into a positive!

clipped from www.calnurses.org

These ladies love the idea of single-payer health care because it takes from other parts of the economy to bolster their segment of the economy. At least until the government institutes wage caps and/or rationing of services. But maybe nobody explained that part to them.

President Obama's recent public statements on health care seem to perform the same type of illusionist's tricks with the economics involved. Obama tells us that we can't afford to do nothing, since the price of insurances is going up so fast. That is why we need to reform things. But even in a system pulled as far from free market principles as ours, the rising cost of health insurance would do exactly what Obama is preaching.

Obama, after all, is saying that we need to spend less on health care. That, coincidentally, is exactly what high prices do. They decease demand for services. Would you use a cell phone if it cost you $5,000 per month? Probably not.

So the increase in prices would automatically tend to decrease health care expenditures.

On the downside, people will get less health care. But how is that different from the plan Obama supports? Just try to divine the source of the savings in his plan.

Digitalizing medical records? That will cost money up front, and it isn't clear it will save much in the long run.

Preventive care? In certain cases preventive care saves money, but many preventive measures are not cost effective at all. And in any event preventive care tends to simply delay an eventual big expense later on. The cardiac arrest you avoid tomorrow may turn into the inoperable cancer you get 10 years hence. The health care system saves money if you die of the sudden cardiac arrest, bottom line.

Let's look at one savings that Obama has emphasized particularly:

The biggest thing we can do to hold down costs is to change the incentives of the health care system that automatically equates expensive care with good care. Now, this is an important concept, so I want everybody to really focus on this. We are -- we've been under the illusion that the more health care we get, the healthier we become. And it turns out that every study shows that the question is, are you getting the right care, are you getting the best care, the high-quality care, rather than are you having a whole bunch of tests ordered that are unnecessary, getting a bunch of treatments that are unnecessary, staying in hospitals longer than may be necessary -- all of which drives up your costs, but doesn't make you better.

One question: How?

You can cut down on diagnostic tests if doctors somehow reduce their liability, but I have yet to detect a thread of tort reform in the Obama prescription for health care.

I don't see how, minus tort reform, the health care system will reduce so called expensive care without the government telling doctors how to do their jobs. Do you? Single-payer advocates help me out. How is that supposed to work?

Grading PolitiFact: Paul Krugman and a mere $1.8 trillion

In which Paul Krugman benefits from PolitiFact's penchant for tunnel vision.



Fact-checking the fact checkers

The issue:





The fact checkers:

Angie Drobnic Holan: writer, researcher
Bill Adair: editor


Analysis:

Time and time again, PolitiFact waffles between addressing the literal truth of a statement and the underlying argument that the statement would supposedly help support. This fact check involving the capable economist/left-wing hack op-ed writer for the New York Times, Paul Krugman, again manifests the problem of finding nothing wrong with the literal truth of a statement while effectively ignoring the underlying argument. That, in fact, was the same pattern Drobnic used in another PolitiFact item I evaluated.

In this case, PolitiFact concerns itself over whether the Bush tax cuts cost the federal government $1.8 billion in revenue. Krugman compares that figure with the proposed cost of a universal health plan, in particular the Kennedy plan recently evaluated by the Congressional Budget Office.

As with that other item, Drobnic offers a number of clues that she perceives an underlying argument. The "Truth-O-Meter" blurb reproduced above notes that Krugman is comparing the cost of the health care reform bill to the "cost" to the government of the Bush tax cuts. I use quotation marks for the second use of "cost" simply because the tax cuts represented decreased income while the former represents an outlay.

But the comparison all by itself means nothing. Who cares whether one is less expensive than the other minus other considerations? Krugman is clear about those other considerations, but Drobnic never picks up on it for purposes of her analysis even though she quotes the relevant passage:

"I'm not that worried about the issue of costs," Krugman wrote. "Yes, the Congressional Budget Office's preliminary cost estimates for Senate plans were higher than expected, and caused considerable consternation last week. But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts."
(bold emphasis added)

There was a time--not that long ago--that Paul Krugman was concerned about that type of cost. Back when the federal deficit was much smaller than it is now:

"[The 2003 tax cut] was wildly irresponsible, third-world irresponsible, banana-republic irresponsible," said Krugman. "We can't afford any of it."

The tax cut came despite indication that the United States would be facing a "catastrophic" deficit, about $550 billion next year.

(The Daily of the University of Washington)

For comparison, the federal budget deficit will reach an estimated $1.1 trillion for 2009. Deficits under President Bush never exceeded $500 billion despite Krugman's claims, though it is fair to pin a substantial portion of the 2009 deficit to the TARP program that both Bush and Obama supported.

So, even though Krugman regarded the $500 billion deficit as "catastrophic" back in 2003 and flatly stated that the U.S. "can't afford" the second round of Bush tax cuts, somehow we can afford to spend about that much if the budget deficit doubles from its "catastropic" levels to an even higher percentage of the GDP.

Will Drobnic take note of any of this? No such luck:

We wanted to know if Krugman was right that the initial cost estimates for health care legislation by the Congressional Budget Office were less than "the $1.8 trillion cost of the Bush tax cuts."

So Drobnic seems willing to let the underlying argument escape scrutiny in favor of double-checking the comparison of the initial CBO estimate to the estimated loss of revenue from the Bush tax cuts.

In the course of that meaningless exercise, Drobic at least pays attention to the respective durations of the tax cuts and the health care reform bill. However, she appears to overlook at least one critical point in comparing the two: The CBO estimate offers no apparent attempt to calculate the cost of financing health care reform through deficit spending. As Drobnic notes, the think-tank estimate that best supports Krugman explicitly applied that factor to the Bush tax cuts:

The left-leaning Center on Budget and Policy Priorities agrees with Krugman. The center's 2009 report on the Bush tax cuts states:

"The 2001 and 2003 tax cuts added about $1.7 trillion to deficits between 2001 and 2008. Because they (were) financed by borrowing — which increases the national debt — this figure includes the extra interest costs resulting from that additional debt. This figure also includes the cost of 'patching' the Alternative Minimum Tax to keep the tax from hitting millions of upper-middle-class households, a problem the tax cuts helped cause. Over the next decade (2009-2018), making the tax cuts permanent would cost $4.4 trillion, assuming that the tax cuts remain deficit-financed."

So even the wrong analysis was performed badly.

In addition, the initial CBO report explicitly stated that it had not taken into account several factors likely to increase the costs of the bill. As a result, it should have been obvious that in the end it did not really matter to Krugman what the reform bill would cost. If the CBO had estimated the costs at $2.2 trillion instead of $1 trillion we should expect Krugman to say that the costs don't really bother him since we can supposedly clearly afford it. Even though that runs directly counter to what he was claiming in 2003.

Mr. Krugman can take comfort in the knowledge that PolitiFact has not found him out as the inconsistent political hack that he is. PolitiFact rates Krugman "Mostly True" since it is "probably" true that the CBO's initial cost estimate for the Kennedy health care reform bill was less than the estimated revenue cost of the Bush tax cuts.

After reading many studies on the cost of the Bush tax cuts, it seems to us that Krugman is in the ballpark with his $1.8 trillion estimate. But we believe there are a couple of important caveats to his comparison. First, his wording implies that CBO's much-discussed estimate is for universal coverage, but it's not. Also, he doesn't offer a time frame for the Bush tax cuts, so we can't be sure he is comparing the same number of years. Finally, the health care plan is still very much in flux, and the CBO estimate is based on an early and incomplete bill. So we find Krugman's claim Mostly True.

Can we afford it like Krugman said? Or can we not afford it like Krugman said?


The grades:

Angie Drobnic Holan: F
Bill Adair: F

Ignoring the interesting part of Krugman's statement was the equivalent of intentionally offering softball questions to an interview subject.


Afterword:

Drobnic's piece had a hilarious little interlude where Kenneth Thorpe declared the relatively easy affordability of a universal health plan:

There's one other implicit assumption in Krugman's statement. He writes, "But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts." We know the CBO report scored the first draft at $1 trillion, but we also know that CBO determined the draft was not a "universal" plan — only about a third of the uninsured would be covered. But would a truly "universal" bill still come in under $1.8 trillion?

"Absolutely," said Kenneth Thorpe, a health care expert at Emory University. He said draft version of the bill could be modified to expand coverage to everyone and trim costs, and he thinks the total cost of that would likely be just over $1 trillion. He said the Senate Finance Committee is working on a new plan, though it has not been released to the public.

"I think that you can provide universal health care coverage for all 46 million of the uninsured for just over $1 trillion," he said.

I cannot disagree with Thorpe. All 46 million could be insured for just over $1 trillion. Would they get great care? Probably not. Would the result tend to decrease quality of care for the system overall and progressively degrade the system? Very probably. Can we afford it? Pay attention to Paul Krugman, circa 2003.

The common thread in the push for health care reform is the issue of controlling costs. Third party payment is a dependable disaster in terms of controlling costs. That remains about as true for private insurance as for government insurance. Private insurers use a number of methods to control their risk, including the refusal to cover preexisting conditions. Unless the government does the same thing, it will have two primary methods of controlling costs:

1) Capping/dropping the pay of health care workers
2) Rationing services

Be careful what you wish for, single-payer advocates.

Grading PolitiFact: Obama and the "biggest drivers of the federal deficit"

In which PolitiFact overlooks a forest on account of a tree.


Fact-checking the fact checkers


The issue:



Sometimes PolitiFact deals with the surface meaning of a statement. Sometimes PolitiFact deals with the underlying argument. Prepare to plunge beneath the surface of this statement like a ... hovercraft.


The fact checkers:

Angie Drobnic Holan: writer, researcher
Bill Adair: editor


Analysis:

Cutting to the chase, let's just assume that PolitiFact did a superb job of evaluating the surface claim. Yes, over the long term Medicare, Social Security and Medicaid serve as the biggest drivers of the deficit, but record deficit for the current year was driven by a number of other factors, notably TARP and the stimulus package.

What about the underlying argument? Writer Angie Drobnic Holan knew that there was an underlying argument:

During a town hall on health care, an audience member asked President Barack Obama about the cost of health care reform, and whether the government could afford to do it.

Obama's answer was a variation on the sales pitch, Can you afford not to?

Drobnic opened her piece with the above. She identified Obama's underlying argument. But the evaluation ("Mostly True") of Obama's statement completely ignores the underlying argument, even though PolitiFact sort of skewers it in an offhand sort of way:

So if Obama is right that Medicare and Medicaid are driving the deficit, then health care reform can fix the long-term deficit, right?

Wrong.

That was not exactly Obama's argument. But this is an excellent time to review what Obama actually said:

Q With the cost of health care, I'm pretty satisfied with my own plan -- it's not everything that it should be or could be -- but I am concerned that -- of the government taking over health care and, you know, Social Security isn't doing real well, at least that's what we're being told, and how can we know that the government is going to be able to handle the cost of health care? Isn't that going to tax me? Isn't it going to be taxing my benefits? Those kind of things.

THE PRESIDENT: Right. Well, look, I think it's a very legitimate question. I guess the first point I'd make is, if we don't do anything, costs are going to go out of control. Nobody disputes this. Medicare and Medicaid are the single biggest drivers of the federal deficit and the federal debt -- by a huge margin. And at the pace at which they're going up, if we don't do some of the things that we've talked about tonight -- changing how we pay for quality instead of quantity; making sure that we are investing in prevention -- all those game-changers that I discussed earlier -- if we don't do those things, Medicare and Medicaid are going to be broke and it will consume all of the federal budget. Every program that currently exists under the federal budget, except defense and entitlements, all that would be swept aside by the cost of health care if we do nothing.

So that's point number one. Point number two is that a lot of what we're talking about is reallocating existing health care dollars that are not being spent wisely. And almost everybody agrees that there is a lot of room for us to improve how we're spending existing health care dollars.

And point number three -- there is going to be a need, initially, for some additional revenue, and I talked about our suggestion, my administration's suggestion, the best way to do that -- capping itemized deductions for people making over $250,000 a year.

But I also believe that if we are doing this right and we're bending the curve on health care, then you, who keeps a private plan, will see reductions in your out-of-pocket costs over time, so that instead of your health care premiums going up three times your wages over the next decade, it may only go up by the amount that inflation goes up generally. And that's real money in your pocket. That's real savings that would offset any potential increases.

By the way, I suspect that Charlie and I -- again, 3 percent of the population -- we're the ones who would see our taxes go up a little bit to pay for that initial outlay.

(whitehouse.gov)

David Hattenfield asked the president whether he could expect higher costs, particularly via taxation, as a result of the proposed health care reform.

Obama's response is curious, to say the least. His acknowledgment of the role of Medicare, Social Security and Medicaid in the federal deficit merely establishes the legitimacy of Hattenfield's question. It literally does nothing to address it. Sure, we can suppose along with Drobnic that the president was saying that those programs are so expensive that we cannot afford to delay health care reform, but isn't that salesman's argument obviously specious? The proposed legislation would expand Medicaid and set up a public health care plan along the general lines of Medicare. Reducing medical costs in the private sector is a separate issue.

We could analyze additional portions of the president's statement, such as the claim that preventive care would produce substantial savings. The purpose here, however, is simply to evaluate PolitiFact's attempt at fact-checking.

Here again, we have a substantially true statement used to mislead. Obama took the very programs that produced Hattenfield's concern over the government's ability to effectively address the health care issue and, according to Drobnic, used those programs as the very justification for reform.

Obama's reward for snake-oil salesman tactics? "Mostly True."


The grades:

Angie Drobnic Holan: F
Bill Adair: F

It was maddening to see Drobnic flirt with addressing the underlying argument, then ignore it for purposes of the "Truth-O-Meter" rating.

Are there no islands in the Fever Swamp?

I dropped "Comments From Left Field" from the Sith blogroll for serial incompetence.

Today, I stopped off at "The Daily Kos" for port side edification.

As luck would have it, the very first story I looked at proposed a "simple" version of the single-payer health insurance plan that consisted of eliminating the social security tax and replacing it with a 10 percent payroll tax apparently dedicated to funding medical care.

Some of us might wonder how we fund Social Security after making that move. That is where the silver lining comes in.

Yes, a blogger published this plan at The Daily Kos. But problems were quickly pointed out in the comments section, and the blogger almost as quickly understood the problems:

Stupid on my part. The numbers I've had in my head are from our total MediCare and Medicaid expenditures, which were $750 billion in 2007, and have little do do with the $850 billion collected from FICA etc.

Clearly I need to spend more thought on this, though I believe that this is the way to go for paying the bills, though to maintain a robust Senior Retirement plan the rate will obviously have to be higher, more like 13-14% shared.

Well, almost understood the problems. Social Security is on the fast track to insolvency with a weakened economy and burgeoning expenses brought on by boomer retirement. Ditto for Medicare, since the bulk of medical expenses occur during the twilight years. Seven percent for FICA probably won't cut it without an associated cut in benefits (how do we define "robust"?).

But let's assume that FICA can remain the same. The idea was to fund medical care through payroll taxes.

It turns out that the proposal was entirely based on dubious reasoning. The writer took total health care costs for 2007 and tried to devise a tax plan for today that would raise that amount of money.

The problem is obvious: Health care spending is increasing rapidly.

The source used by the Kos kid to provide a $2.4 trillion baseline for 2007 went on to project an increase to $3.1 trillion by 2012.

I suppose that leaves the option of cranking the payroll tax up a percentage point or so every year.

Some liberals seem to have faith that there will always be enough "rich" people to tap for the added costs, but these numbers reflect huge percentages of the GDP. As a percentage of rich person income and/or assets the numbers are unsustainable.

Now take a guess why conservative critics predict that single-payer health care will result in lower quality rationed health care.

The truth about the truth about health care (Updated)

Robyn "Blumñata" Blumner is back at it again this week with another nonsensical foray into editorial journalism.

Not that Blumñata has been on vacation since the last time I dissected one of her granfalloonian offerings. She finally wrote something focused enough to warrant a relatively focused reply. Much of her work this year consists of laundry list attacks on either the Bush administration or conservatives in general.

This week she puts her abysmal knowledge of economics on display as she writes in favor of single-payer health care.

Universal health care is a benefit that a large majority of Americans say they want. It would grant Americans some semblance of the kind of peace-of-mind that Canadians and Western Europeans enjoy. We wouldn't have to worry that a job loss would also put our family's health coverage at risk. And on and on.

A large majority of Americans want universal health care? A pity that Blumner failed to name her source. Here is one, from 2003, that calls her claim into question.

In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system. That support, however, is conditional: It falls to fewer than four in 10 if it means a limited choice of doctors, or waiting lists for non-emergency treatments.
(ABCNews.com)

Focusing simply on the first sentence, one would think that universal health care appeals greatly to Americans. But the four in 10 mentioned subsequently is not a majority, and doctor shortages and waiting lists are quite likely with universal health care.

At least we can say that Americans like the idea of pie-in-the-sky health care. Who could be against that minus the problems?

But even Blumñata admits there are problems:

But expanding health coverage to everyone is going to mean higher taxes in some form as well as other sacrifices, such as enforceable cost controls on the medical establishment and some practical limits on patient medical services. Expensive medical procedures that don't demonstrably work or have about the same outcomes as cheaper methods are going to have to be eliminated from coverage. Drugs too will have to prove their efficacy. Welcome to the age of generics.

Higher taxes is a huge drawback to universal health coverage. This represents a core inconsistency with both President Obama's domestic policy and Blumñata's thinking.

Think about it. Mr. Obama is selling health care reform as an economic salve. But that is ridiculous. Sure, decreased spending on health care decreases the percentage of GDP spent on health care--but it also decreases the GDP, particularly where the expenses return workers to their jobs faster.

***
Interruption via update: To make myself clear, decreased spending on health care decreases the GDP generally, while the rapid return of workers to their jobs shrinks the percentage of GDP spent on health care as a percentage of GDP generally.

I apologize for the poor job I did expressing that idea.
***

But back to her list of admitted problems.

• cost controls
  
• limits on patient medical services
  

To be sure, Blumñata offers only one example in support of these euphemistic-sounding drawbacks. Expensive treatments that do not work well would be eliminated as options, she says, and where two treatments offer about the same benefit the more expensive of the two would be sidelined.

It is neither that simple nor that benign.

Cost controls will very probably include restrictions on your choice of doctors as well as limitations on seeing a specialist. They will probably include (perhaps only when the money starts to run out) assessments on the quality of life a patient expects following treatment. They will include rationing of services, which will grow gradually more pronounced as the wealth of medical resources produced by our past systems turns obsolete. As for Blumner's example of reduced availability of medications, doctors often have clinical reasons for choosing a more expensive medication. Patients do not always respond the same way to medicine, and some medicines do not work well in conjunction with other therapies.

The benign-sounding push toward efficiency is, by analogy, an initiative that removes tools from the doctor's toolbox, and, instead of your doctor, the government will decide which tools belong in there.

Knowing there will be costs and how much Americans hate the thought that lunch may not be free, opponents to health care reform have already launched a "Harry and Louise" style scare campaign. A group called Conservatives for Patients' Rights expects to spend up to $20 million on television ads that feature patients and doctors in Canada and Britain complaining about long waits for surgery or how they couldn't get needed medications under their national health care.

Sometimes the truth hurts, which is probably why single-payer proponents like Blumñata want to poo-poo the real problems with the idea by labeling it as a "scare campaign." The poll above shows how support for universal health care shrinks based on the existence of its traditional drawbacks. Conservatives who want to publicize those drawbacks are simply trying to scare people. Or something:

It is designed to make you want to desperately cling to the status quo.

I doubt it, for the admitted problems with the current system stem largely from government involvement, including the ramifications for malpractice within the framework of the U.S. legal system. Other problems stem from attaching health care to employment--a problem presidential candidate John McCain had hoped to address with his health care reform plan--and the third party payment system as represented by private insurance, Medicare and Medicaid.

As for the supposed desperation:

PRINCETON, NJ -- Despite ever-increasing healthcare costs and widespread dissatisfaction with the U.S. healthcare system, a majority of Americans remain satisfied with what they pay for their own healthcare, the quality of the healthcare they receive, and their healthcare coverage.
(gallup.com)

What, Blumñata never told you that? Most of you are supposed to be desperate! Now get with the socialist pogrom! Er, I mean program.

Of course, President Barack Obama isn't suggesting that we adopt a single-payer system like these other countries have — which is too bad in my view.

Obama has said that he prefers the single-payer plan. But he also clearly realizes that an immediate switch to a single-payer plan is a high political risk. His plan immerses the medical system frog in a pot of tepid water and starts heating it gradually from the bottom. Before you know it, you're cooked.

Reality: Obama Has Consistently Said That If We Were Starting From Scratch, He Would Support A Single Payer System, But Now We Need To Build On The System We Have
(barackobama.com)

No doubt that prospect makes Blumñata impatient.

People in the United States seem to like our own single-payer government-run program: Medicare.

Sure they do. So long as they aren't thinking about the incredible waste in the Medicare system along with the fact that it already consumes over 16 percent of federal spending (Social Security included). National defense takes up about 19 percent.

clipped from www.factcheck.org

The Medicare budget just keeps expanding, and the baby boomers will push its expenses to even more amazing heights. Sorry if that sounds scary, but it is reality. There is one way to avoid the problem: Cut and/or ration services. The only part of his plan for Medicare that Obama will currently admit, so far as I'm aware, is the part that expands the government's share of medical costs and raises taxes to pay for it. Is that fiscal responsibility? Seriously?

Back to Blumñata:

And as to the poor Canadians who can't get decent medical care? A 2008 Harris poll of how the citizens of 10 developed countries feel about their health care system found the United States dead last, with fully a third of Americans saying our system needs to be completely rebuilt. Meanwhile, Canada's system was third-highest in popularity.

Hmm. Blumñata left out the poll's conclusion to the effect that all the nations surveyed had majorities calling for health care reform.

Regardless of what system a country has it falls far short of satisfying public expectations. Most systems always seem to be in a crisis or near crisis.
(harrisinteractive.com)

It is true that the U.S. system ranks last among the nations surveyed in terms of native popularity. But there could be innumerable reasons for that other than quality of care, including the existence of a pervasive negative message from the national press.

Blumñata again:

But the folks coordinating the ads don't let the facts stand in their way.

They'll face a stiff challenge in ignoring more facts than our own Blumñata. Rather than start in on how those folks play with the facts, she engages in four paragraph's worth of personal attacks against Rick Scott of Conservatives for Patients' Rights. Supposedly it is relevant that the hospital group Scott once headed, HCA, was found guilty of various wrongs even if Scott himself was charged with nothing and convicted of nothing.

Too cute.

After apparently exhausting her supply of facts misrepresented by Scott (without ever starting on it), Blumñata runs off to attack the strategy she says Republicans will use to oppose Obamacare:

Republicans in Congress are positioning themselves in this camp too. They're working from a 28-page attack plan by GOP strategist Frank Luntz, an expert on phrasing political positions for maximum advantage. The plan lays out ways to defeat Obama's health care reforms by painting Democrats as wanting "to put Washington politicians in charge of your health care."

The charge is absurd since Obama's intention is to leave current health insurers in place while offering a government plan as an alternative. But there may be real trouble in holding congressional support together when the new costs and sacrifices necessitated by a $120 billion universal health care plan start coming clear.

Somehow, Blumñata has worked in an editorial position with a newspaper for over 15 years without apparently realizing that Congress controls the expenditures of the government. Along with not realizing that government insurance automatically carries a competitive advantage over private insurance. Know of any private insurance companies that can levy general taxes in order to support their bottom line?

How long did it take for Florida's state-sponsored homeowner's insurance entity to its current status as Florida's #1 homeowner's insurance company?

The Florida Legislature created Citizens Property Insurance Corp. in 2002 when it merged two existing state-backed insurance pools, the Florida Residential Property and Casualty Joint Underwriting Association and the Florida Windstorm Underwriting Association. Commonly called Citizens, it is now Florida's largest home insurer. As of November 2007, Citizens insured more than 1.4 million homes, condos and businesses in Florida.
(SunSentinel.com)

FYI, the Florida Residential Property and Casualty Joint Underwriting Association was established way back in 1992. The Florida Windstorm Underwriting Association is comparatively ancient, kicking off in 1970 to cover properties in the Florida Keys. In any event, they demonstrate the tendency of government entities to grow. A big part of that growth stems, in this case, from the state insurers exemption from leverage rules applied to private insurers.

So, yes, the plan set forth by Obama does increase the government's role in health care and that role is likely to incrementally increase, leading to exactly the types of problems characteristic of single-payer programs--unless the political pressure brought by groups such as Scott's prevent it.

And for Blumñata it isn't just the supposed misrepresentations by Scott, it is the method they supposedly intend to employ.

She quotes a portion of the Frank Luntz "attack plan," but where is the rest of the so-called "attack plan"? I have been unable to find a copy of it online. If it is so bad, then why not publicize the whole thing? Why quote tiny portions from the 28 pages without any surrounding context?

Maybe that's the only way to keep Luntz from misleading people? Keep the people from accessing the information?

Bottom line, Obama's health care reform as part of an economic stimulus is a dangerous fantasy. And the resulting health care system will surely deliver a lower quality of care even if it satisfies people who believe they would have to pay for their own care otherwise. Speaking of free lunch.

When dingbat healthcare activists attack (Updated)

While spelunking the dripping caverns of the Fever Swamp (Comments From Left Field) today, I came across this little item shared by "mattbastard":

clipped from www.communitycounts.com Polls consistently show the majority of Americans strongly support a single-payer healthcare system. In a recent survey conducted by New York Times/CBS (1/11-15/09), respondents indicated they preferred a single-payer model 2 to 1 over a privatized system. Why then, is a single-payer model not being seriously considered and discussed as part of the major healthcare reform proposals under your administration?

Am I automatically suspicious of claims backed by polls? Pretty much.

I did my Pavlovian duty and checked for a New York Times/CBS poll for the appropriate time frame, and I believe I found it.

Then I looked for the public support of a single-payer system supposedly contained therein.

Not so much luck on that one. This is all I found:

92. Should the government in Washington provide national health insurance, or is this something that should be left only to private enterprise? IF GOVERNMENT, ASK: Should the government insurance be for all medical problems, or only for medical emergencies?

• 32 percent thought that health care should be left exclusively to private enterprise
• 9 percent answered DK/NA
  
• 49 percent of the total surveyed preferred the first answer to the second question

So what does this poll result mean? Not much, even if the results were not presented in such a ragtag manner. The wording of the first question seems to imply that only those who answered "government" were asked the second question, which means we are talking about a group that does not think that private enterprise should handle health care exclusively.

I'm not in favor of the private sector handling the insurance of all medical benefits, so I'd end up answering the second question in addition to the first. I wouldn't necessarily want the government insurance (to whatever degree it is used) to pay only for emergencies, so I suppose it ends up that I couldn't take that option. So, once I got through answering this poll, the dingbats at Community Counts would apparently assume that I favor a nationalized single-payer health insurance system if I allowed the poll to steer me toward the "government all" category. But hardly anything would be further from the truth.

I introduced these concerns over at CFLF. Let's see what happens (be forewarned: The CFLF crew are a potty-mouthed lot).



Update:

Sadly predictable! I had permitted myself false hope that the blunder would be acknowledged.

clipped from commentsfromleftfield.com

matttbastard on
March 23rd, 2009 9:14 pm

Sorry, trolling will get you nowhere, Bryan.

I don’t feed the desperately link-starved.

But thanks for the love, regardless.

Bryan on
March 24th, 2009 12:01 am

If I take the Web site URL away, will you take the criticism seriously?

Blumner speaking up for socialism

The latest Robyn Blumner (St. Petersburg Times) editorial has the former ACLU lawyer and current self-described atheist pimping single-payer healthcare.

She kicks off her column with a reference to Michael Moore's "Sicko" film, and apparently can't bring herself to criticize Moore or the film.

But the column's about attacking free market capitalism, not about Moore.

I think it is undisputable that this nation's greatness emanated from its cultural roots in the Enlightenment. We as a people have few outward characteristics in common, but we share a set of understandings that have largely liberated human beings to live up to their potential. This includes a fealty to reason, the rule of law, individual rights, popular sovereignty, the common good and equal opportunity.
(St. Petersburg Times)

Equal opportunity? I'm afraid I haven't yet encountered that one in a list of Enlightenment values.

Here's a list from Temple University.

• a deep commitment to reason,
• a trust in the emerging modern sciences to solve problems and provide control over nature,
• a commitment to the idea of progress in material wealth and in human civility,
• a belief in the essential goodness of human nature,
• an emphasis upon the individual as master of his fate and fortune, and
• an engagement with the public sphere of discussion and action.

I suppose that "equal opportunity" can be twisted somehow out of "an emphasis upon the individual as master of his fate and fortune," eh?

The Reformation probably had no less influence on the early nation, but Blumner's on a roll, and we don't want to have to play catch-up.

But these ideas almost sound quaint today. The Bush administration has done more damage to our national identity than any one before it. You can't be a nation of equal justice when the president has eyes only for the fairness of process for loyalists like Scooter Libby. You can't have the rule of law when the vice president claims laws don't apply to him. You can't have a nation of reason when the government elevates faith and politics over fact and science.

Blumner slips very naturally into the Bush's fault refrain modern liberals love so well. Clinton's many pardons somehow did not undermine equal justice; nor did his perjury (the same crime of which Libby was accused). And having the Senate refuse to convict Clinton even though he was plainly guilty apparently didn't harm our national identity, either.
Same with the Cheney example. Congress is effectively exempt from laws to which the rest of us are subject, and that type of thing is rife in the government right on down the line (you'll be reminded of it the next time you see a police officer gratuitously running a red light).
Blumner doesn't appear to have an example backing her claim about "faith and politics over fact and science." Pity.

Moore clues us in to how Americans have been scared off of single-payer health care, one of the government benefits that gives Canadians and Europeans great peace of mind. The medical establishment called it "socialized medicine" raising the specter of Communism.

Blumner apparently wants her readers to think of communist gulags rather than communist mismanagement of the economy. But the latter is exactly the problem with single-payer health, along with well-known (to everyone except Blumner, apparently) drawbacks of third-party payment for services.

Communism and socialism share economic inefficiency, and it is not part of the traditional American value system to put one's reliance in the government ("an emphasis upon the individual as master of his fate and fortune"--not an emphasis upon the government as mater of his fate and fortune).

Take away market incentives, and health care will get worse--it's a solid prediction of economics, and the only check on the prediction is the government's potential to put limits on services--as is traditionally the case in nations with single-payer systems.

The median waiting times for specialized services was 4.0 weeks for specialist visits, 4.3 weeks for non-emergency surgery, and 3.0 weeks for diagnostic tests.
(statcan.ca)

Oh, Canada!

Total number of patients waiting for admissions: 822,545
(doh.gov.uk)

That's for the first quarter of 2005-2006. Of those 822,545 there were 438,128 who waited less than 2 months. In other words, the median wait time was in the same ballpark as for Canada's national health system.

In the free market system, those who can afford expensive procedures subsidize those who can't easily afford those procedures, and the profits allow individuals to decide on whom to bestow services provided free or under cost.
Nationalized health care removes that freedom. So much for that "Enlightenment value."