Pajamas Media

119 Comments

1. MD:

Very good article. Only trouble is, I doubt very seriously if the current administration along with agreeing majority members in Congress will see anything other than total Gov’t controlled and MANDATED universal health coverage, a disaster waiting to happen.

May 5, 2009 - 1:34 am 2. mik:

reform! I would also like to see universal health care as, maybe, a competitor to private health insurance. my insurance gets more expensive year after year. can something be done about this?

May 5, 2009 - 4:08 am 3. inklingz:

The problem, as Gairdner points out in reviewing Alan Wolfe’s new book, Liberlism, is that we’re playing a zero-sum game. Liberty and fairness (which he calls ‘equality’, used to mean guaranteeing more equal outcomes) tend to move opposite one another. Said another way, as a state endeavors to increase fairness to one, it diminishes the liberties of another.

So the question starts to become something more like, fairness to whom? And this only raises another set of questions starting with, who should decide? Gairdner points out the absurdity of social engineering in these terms: “there is a plain and simple—very simple—and quite contradictory, equation: government direction (that is, coercion) will make you free”.

State-sponsored programs are redistributive in their very essence and undermine individual liberty. The money that allows them to exist must come either from a redistribution from the more-wealthy to the less wealthy (i.e. taxes) or from future generations to the current generation (i.e. deficits).

Taxes are necessary and will be redistributive in almost any case, but not necessarily for the sake of being redistributive. In other words, it would be difficult to imagine a system where the rich didn’t pay more than their pro-rata share for government services, hence subsidizing the poor—for a state to meets its basic budgetary needs. But it is something else entirely to impose punitive taxes on the rich simply for the sake of leveling the results.

That’s the fairness that modern liberal doctrine seems to propagate. Equal outcomes. It comes in the form of arguments like: “It’s a God-given right to own a home”. Since when? My reading of the Bible certainly does not support that thesis. Jesus himself didn’t own a home! I don’t own a home! Such policies encroach on the liberties that America is supposed to represent.

…more thoughts at http://inklingz.net/?p=132

May 5, 2009 - 5:02 am 4. njcommuter:

As soon as the government is a “competitor” private insurance is dead.

What CAN be done is to undo the myriad of regulations that prevent people from buying what they need. Some of this is well-intentioned meddling on the part of the states; some of it is not well-intentioned at all.

Look how much has been saved by getting the private sector involved in Medicaid. And while there have been problems, there would also be problems under a government plan. If a private insurer shafts you, you may be able to appeal to the government. If the government shafts you, to whom do you appeal?

Oregon’s socialized medical plan recently refused cancer treatment for a woman, but offered to pay for a lethal cocktail so she could commit (legal) suicide. Is that what you want?

May 5, 2009 - 5:07 am 5. Kevin:

Want to see costs go down? For starters stop comprehensive medical care. Start paying for doctor visits out of pocket. Go back to catastrophic health insurance. The insurance pays for hospitalization. Get the government out of medical insurance, end medicare/caid. And clean out the myriad of idiotic laws that force private companies to cover political promises. But this would promote independence, and the statists can’t have that.

May 5, 2009 - 7:17 am 6. JED:

To analyze this problem let us start at the top, and if “words mean something” let us not pay homage to this idea of “health care”. Whatever the problem with costs may be, the whole problem has to be diagnosed before piecemeal remedies can be administered. Cramming trillion dollar solutions into the system before the problem is obvious to all just could be counterindicitive.

If a politician could speak the truth, instead of saying “health care”, he would say “enabling the American populace to continue their self-destructive practices by redistributive funding.”

In the supply/demand side of medicine, the statistical American is sick. He is overfed, underexercised, accident occuring, addictive, and increasingly dependent on someone else coming to his aid. Urban density is a disease rich environment because the virus is also competing for the top of the food chain. The first responsibility for one’s health is the individual. No politician is going to sing that.He is going to promote fear just like the MSM is going to promote disaster.

May 5, 2009 - 8:16 am 7. H Krening:

Excellent article! For years the government has been increasing regulations and mandates, and for years health care has become more complicated and expensive. It’s time to try a new approach, and Dr. Hsieh’s arguments should be taken seriously by anyone wanting freedom, justice for all involved, and getting the best care at the best cost. This issue is not peripheral; it affects us all profoundly. A government takeover will be disastrous for all of us. Getting the government out of medicine is worth standing up for now and long-term, so that others can know that there is an alternative approach. Thanks to Dr. Hsieh for articulating that alternative so well.

May 5, 2009 - 8:36 am 8. Darren:

Thanks for the article, Dr. Hsieh. It seems like “universal” health care would be nice, but it has never worked. And it *can’t* work, either, because forcing people to behave against their own interest can only have bad consequences.

Thanks again!

May 5, 2009 - 8:55 am 9. Kelly:

It seems that people in general are expecting too much from modern medicine. But if you ask most insurance reps they will tell you that prescription drugs are the biggest issue. Legal drug pushing seems to be an acceptable practice and it’s not only in the senior market but that is where it may be most prolific. Unfortunately, with the exception of a few drugs, most seem to give very little in return. The average person does not even understand what the drugs they are given will DO to them. This information is currently widely available if one chooses to research – but I expect this too will end as government control takes over our ability to access information.

Personally, unless I was mentally unable to do so, I would never take a prescription drug without a thorough check of problems, lawsuits, long term side effects and similar research. But I am in a very small category of Americans. Most people I know simply trust the doctor who prescribes it as “all knowing”. Until this ends, we will likely not see improved medical care no matter who is paying.

May 5, 2009 - 9:15 am 10. S D'Ippolito:

High time someone came out and told it like it is. The government *made* this mess, and more is now offered as the solution to it. This is one situation where “hair of the dog” is not the best cure.

Unfortunately the (major) media is hell bent on pushing socialized health care on people and in the din that they create it is hard for most people to discover that government interference in insurance and regulation of the actual care (two different aspects of the problem) are the reason costs are skyrocketing today.

May 5, 2009 - 9:26 am 11. Hotpatch 6:

Have any of you ever heard of a government social program that came in under budget? There will be no way to pay for socialized medicine even if the governemnt takes everything in taxes. I once read something that sums it up nicely: If you think medical care is expensive now, wait until you see how much it costs when it is free!!

May 5, 2009 - 9:28 am 12. Roark:

This article nails it perfectly.

May 5, 2009 - 9:32 am 13. Whistle-Blower:

BALDERDASH
———-
If you want to play semantics, you can very well say that health care is a “need” and not a “right” but that’s all you’re doing….playing the semantics game. You’re really avoiding the fundamental issues.

Classify it under whatever category you wish, health care is an “existential” need – without it, you could die or be paralyzed for life or become blind or a cripple or spread diseases like cholera etc etc.

The end result (if you don’t expire, that is) is that your condition can easily end up costing “society” 1000 times more in the long run than having treated the ailment at its inception.

Therefore, you can’t equate the “need” for health care with the “need” for the latest Ferrari.

One is a “luxury” the other is a “necessity”.

The problem in the US is that health care has for too long been treated as a “luxury”, only available if you have the right type of job (like, say, a Congressman) or have independent means (about .1% of the population).

That is to say, whether health care is available to you depends on your employment status. In an economy such as ours, where tens of thousands (currently more like hundreds of thousands) routinely lose their jobs, health care simply cannot be tied to and dependent on your job status.

Illness is like justice – it is blind. It can strike anyone at anytime. Therefore, it has to be there, no matter what. You know, like the post office and mail delivery.

The only institution that can deliver on such a prospect is the government. Some things are too big or complex or vital for private industry (you know, like defense, intelligence, the postal service and so on).

Most of the civilized world looks at our health care system and are either appalled or, more likely, they giggle. Those dumb Americans, they say.

To me, the entire health care “system” in the US is a bloody travesty. The few times I’ve been involved with it, (I include dental care) I feel like I’m dealing with ferocious vultures or snarling, cackling hyenas. I hate to say it, but even Dr. Hsieh’s article and most of the comments herein,
have the whiff of a reptile, coiled, ready to spring and baring its fangs. It’s repulsive.

I guess we really should do like the ancient Greeks did. Anybody born with a physical defect and the feeble and elderly were simply taken up to the nearest mountain and left there to die. Just think of all the savings we could enjoy by doing such a simple and “justified” act.

Oh Dr. Mengele, where are you when we need you?

May 5, 2009 - 9:36 am 14. The Shadow:

As a commited Christain – I completely disagree with your premise. Helathcare is a right. Under your premise, we don’t have to care about need. If someone is poor and needs healtcare and it is not a right, then they can just eat cake. I think that thinking went out with Louis XIV.

May 5, 2009 - 10:12 am 15. JohnW:

Government policies make health care prohibitively expensive for many people. The proposed solution? Have government take over the entire industry! Brilliant!

IMHO there are 5 reasons driving up the cost of health insurance:
1) 50 individual state markets vs. 1 national market
2) High mandatory minimum coverage levels
3) High malpractice insurance from uncapped jury awards
4) Medicare not fully covering the costs of procedures
5) Illegals immigrants and the uninsured using emergency rooms as primary care, then skipping out on the bill

Does that seem right, Paul?

May 5, 2009 - 10:17 am 16. Hueydoc:

I agree with all the above. The question is- HOW do you get the Governments fingers out of anything short of open revolution ? You cannot. Healthcare may not be a right, but the left thinks so. And if Universal health care is so wonderful, why are there so many illegals coming over just for the medical care here?

May 5, 2009 - 10:49 am 17. KenB:

Whistle-Blower thinks the distinction between a “need” and a “right” is only “playing the semantics game”.

Health care is a service offered by health care professionals to those who need or want such services. The question is, should those who need/want health care services be able to force the health care professionals to serve them? Or rather, should the *government* force such service?

Of course, it should not. This country abolished slavery over two centuries ago.

Dr. Hsieh is correct in saying that a right is “freedom of action.” It is not a claim “on goods or services that must be produced by another.”

May 5, 2009 - 11:08 am 18. Greg:

Great article! Thank you for the focus on fundamentals and the recognition of the painful facts resulting from ignoring those fundamentals.

The trouble with our current culture is that most people now has no clue what rights are and why recognizing them is a requirement for our living together. The above “commited Christian” who so disagrees with the article is a great example: “If someone is poor and needs healtcare and it is not a right, then they can just eat cake. I think that thinking went out with Louis XIV.”

But if someone is poor and needs healthcare and it IS a right, then they can just enslave their neighbor to pay for it or their doctor to provide it. I think THAT thinking went out with the American Revolution.

Unfortunately, such thinking has returned, and it has done so because of the prevalence of this Christian, altruistic idea that needs impose duties and that “good” is almost synonymous with sacrificing for another. As history has amply shown (and this person illustrates with eager talk of a “right” to health care), if you’re unwilling to sacrifice for others, then altruists are happy to MAKE you do it.

People need to learn that this is morally monstrous. Human sacrifice is an abomination, whether you’re talking about a virgin being sacrificed to insure against volcanic disaster for the next hut over, or a doctor being sacrificed to insure against a medical disaster in the next family over.

May 5, 2009 - 11:12 am 19. JackLovell:

The Shadow “If someone is poor and needs healtcare and it is not a right, then they can just eat cake.” – Yes! Not saying you shouldn’t care, nor that I don’t, just saying that it’s up to the individuals who care to take action of their own accord ion the areas that they want to, not for them to be forced to do so by government.

Personal history = I lived in Canada for 3 years and experienced a facial weakness which turned out to be indicative of no problem, fortunately as it took over 2 weeks to get an MRI done and that was at 3.30 AM (yes!! in the morning). At that time there were more active MRI units in Buffalo NY than in the whole of Canada. Even if a hospital came up with funding to buy and install and maintain a new MRI unit, the government would not let them operate it as that would mean that more MRIs than were budgeted for would be done on a daily basis.

The high cost of healthcare is largely due to government regulation and interference – more won’t make it better.

The message: get government out of lives

May 5, 2009 - 11:20 am 20. NEChris:

#13 Whistleblower. If our healthcare system is mocked by the civilized world, why do the world’s wealthiest people come to the USA for treatment? Because our system with all it’s flaws offers the best quality care. More foriegners would come but don’t have the financial means. These people are forced to put up with the rationed care that is intrinsic feature of government health. Why are you so eager to bring that type of system here? Something is certainly better than nothing for those now denied US healthcare. But the vast majority of American’s healthcare will decline in a goverment system. It can’t work any other way. Access increases, quality decreases has been proven in every government program throughout history. American’s support the needy with our taxes and premiums. We will now be asked to subsidize them by reducing the direct care we recieve in addition to our continued financial support. What about our “right” to healthcare?

May 5, 2009 - 11:22 am 21. Megan R:

For Whistle-Blower, The Shadow, and others who think that health care is a right, and that’s why the government should provide it, I encourage to read this short book by Sally Pipes, as well as some of the other articles Dr. Hsieh has written. This book will help show you that the private sector is more than just the only moral way to provide health care, but it is also the most practical way. You’ll need to do more than say health care is a need in order to claim that it is something the government should provide.
http://liberty.pacificresearch.org/publications/the-top-ten-myths-of-american-health-care-a-citizens-guide

May 5, 2009 - 12:53 pm 22. The Shadow:

Jack Lovell – I work with physicans from all over the world every day in my job. Those in Canada have mostly positive things to say about their system. No system isperfect, but if you were one of the 48 million in the USA who did not have insurance you would not think our system is so great. The two programs in the US that are government operated are very popular with those who are in them Medicare and the VA system. You may not care for your fellow man, but if one of them is uninsured, you will end up paying for them in eh most expensive setting – the ER. and often they do not go there until they are very sick. Change to the healthcare system is coming – the question is what form it will take. So, just stick you head in the sand and when you come up for air you will have a new system to deal with.

May 5, 2009 - 12:59 pm 23. Tom Stark:

As Ray Harvey has written in his beautiful new book Leave Us Alone:

Here’s a very simple test that anyone can perform to demonstrate fully that healthcare is not a right:

Rights are immutable. They apply as much to humans now as they did to humans 5000 years ago.

If healthcare is a right, then, where was the right to a heart transplant 70 years ago, before such things as heart transplants ever existed?

Where is your right to be completely cured of cancer now?

Where is your right to healthcare if there are no doctors anywhere near you? Or if there aren’t enough doctors because medical students stop studying medicine since it’s no longer worthwhile, after all the effort, to live as an indentured servant?

Doctors go through an extraordinarily rigorous degree of training, which most people have no conception of whatsoever. These women and men do it not because they’re forced to but by choice. Neither you nor I nor any government bureau has a right to that work.

No person has the right to anyone else’s life. Your rights stop where another’s begin. And that is the defining characteristic of rights: compossibility.

Of course, Doctor Hsieh, the author of the fine article above, is in a peculiar position, insofar as he is on record as saying that he “hopes Obama wins the election” because, as Doctor Hsieh and his wife explained to us, America is in danger of an imminent rightwing theocracy, which pontiff Peikoff proved (though, interestingly, this same pontiff Peikoff is on record as saying he could never conceive of voting for Barack Obama). I’m afraid that in light of the arrantly absurd position, Doctor Hsieh, along with so many other “objectivists,” irreparably hurt their credibility. At any rate, I, for one, could never take too seriously anyone who peddles such preposterous nonsense as “We don’t have to worry about socialism because it’s dead.”

May 5, 2009 - 1:09 pm 24. G Alston:

#17 — Or rather, should the *government* force such service? Of course, it should not.

The problem is that the median family income vs the cost of health insurance and/or health care is lopsided. In today’s world the average family can’t possibly afford to get sick.

What *is* the actual cost of health care? My wife underwent $87,000 worth of radiation last year. 28 visits, each lasting under 20 minutes. $87,000 !!!

One could argue that the machine costs a great deal of money. Yeah, but the cost of the machinery plus the staff plus the oncology specialist is covered in a month at that rate; that’s paying for the entire machine.

It’s not as simple as a country doc needing to get paid for setting a broken wrist, which is what your argument amounts to.

May 5, 2009 - 1:23 pm 25. SAY NO TO BIG GOVERMENT:

THIS IS EXACTLY WHY WE HAVE TO ORGANIZE NOW TO PREVENT ANY FORM OF GOVERNMENT RUN HEALTHCARE SIGN THE PETITION AGAINST GOV’T GROWTH AND CONTROL EMPOWER THE INDIVIDUAL!!!! http://www.PetitionOnline.com/Indv1776/petition.html
Show Obama, Reid and Pelosi the tea party protests were not “astroTurf” but they were the beginning of a massive movement against massive Government growth and the control that comes with it. Tell them to Empower Individual Americans to take responsibility for their own lives and for the individual to have control over the direction of our country Sign the petition for Individual Empowerment!!! http://www.PetitionOnline.com/Indv1776/petition.html THE ONLY WAY THIS WILL WORK IS IF YOU COPY AND SEND IT TO FRIENDS AND FAMILY THATHAVE THE SAME OPINIONS AS YOU. ALSO COPY AND POST IT ON OTHER NEWS SITES, BLOGS, EMAIL IT TO ORGANIZATIONS ETC

May 5, 2009 - 1:38 pm 26. Doc's Wife:

@ G Alston

Are you kidding?

An oncological radiology machine costs upwards of one million dollars. That does not include the expense to protect the area where the machine is located, routine calibration, additional equipment to run radiology machine (ie. computer, monitor, etc.). That does not take into account the staff needed to schedule, bill, take vitals upon presentation for visit, doctor consults, etc. That doesn’t take into consideration things like overhead, utilities, office supplies and other things needed for the practice. It doesn’t take into consideration the cost of malpractice insurance, student loan repayments, or a plethora of other expenses.

To think that the $87,000 your wife incurred in expenses for her radiation therapy was enough to pay for the machine is naive!

Yes it is expensive…but socializing our healthcare system is not the answer to the problem. That will make the system worse than it is right now!

May 5, 2009 - 2:15 pm 27. mishu:

You may not care for your fellow man, but if one of them is uninsured, you will end up paying for them in eh most expensive setting – the ER.

To wit:Emergency department overcrowding in Canada: What are the issues and what can be done?

May 5, 2009 - 2:17 pm 28. w:

1) Government-run “universal health care” leads to rationing

May 5, 2009 - 2:22 pm 29. Whitey:

1) Government-run “universal health care” leads to rationing

With our current insurance-run health care, providers often have more incentive to deny care than to provide it, in order to maximize profits. This system/business is built upon a fundamental conflict of interest.

2) Health care is not a “right”

Fine, don’t pay a little now, pay a lot later. Because that’s what happens when uninsured people don’t go to the doctor until it’s an emergency. Argue whether it’s a “right” or “need” all you want.

It’s interesting that CNN reports 8 out 10 are happy when 43 million americans (15%) are uninsured. Makes me doubt the validity of the survey.

May 5, 2009 - 2:42 pm 30. G Alston:

#26 — To think that the $87,000 your wife incurred in expenses for her radiation therapy was enough to pay for the machine is naive!

Holy cow. You’re illiterate (and innumerate to boot.)

Let’s see, 20 minutes x 28 days = 560 minutes.

87,000 / 560 = $155.36 per minute.

Machine is on for 8 hrs a day.

8 x 60min x $155.36/min = $74,571/day.

270 days a year (avg) = $20,134,286 a year.

Now, can we move things along or do you want to continue to illustrate how utterly stupid you are?

May 5, 2009 - 2:48 pm 31. Roxanne A.:

Dr. Shieh’s article is excellent! Slavery ended in 1864 in this country and that law applies to doctors, too. It is utterly immoral for the government to make it illegal for doctors and patients to trade freely. Doctors are individuals who put in years of work and study, to learn life-saving knowledge. Who are these people who arrogate to themselves the right to take doctor’s, with their extensive knowledge and BECAUSE of that knowledge, and put them under government control? If any of you are doctor’s would you agree to this? Would you put in 10 to 12 years of work to become a doctor or a specialist so that the government could tell you who your patients will be, how you will treat them, where, what drugs you may prescribe, how much money you’ll earn and like it! etc? And what type of person would be attracted to suchy a deal? Do you really think you’ll get top notch surgeons, as we have now, with a system like that?

Would any of you in your professions or walks of life like it if you were commandeered by the government to provide needy citizens with your talent or profession? Why not? Aren’t you ready to have the citizenry eat you for a song?

There is no way to have good healthcare without freedom. There is no way to find out what IS good health care without freedom. It is the marketplace, reality, that gives us the feedback to know which doctor is good, which drug works, what procedure is necssary, etc. Money is how we reward what works, and deny what doesn’t work. We “vote” with our money. Until the government takes away our ability to use our money. When that happens, you have given government literally the power of death over you. If those of you demanding that all physicians treat you for as little money as you think you can get away with paying, think that’s a good idea, than you deserve the socialized medicine you’re advocating.

May 5, 2009 - 2:59 pm 32. Right is Right:

No Paul, “MEDICAL” care is needed, “Health” is up to the individual. And govt should stay out of all of it. Otherwise, medical insurance company’s will be driven out of business, and no one will get medical care.

May 5, 2009 - 3:42 pm 33. B. Johnson:

Regarding any kind of federal program that deals with public health care, people have evidently forgotten the following. They have forgotten that the Founders made the 10th A. to reserve the lion’s share of government power to serve the people, including health needs, to the state governments, not the Oval Office and Congress.

In fact, Jefferson, while discussing the Founder’s division of federal and state government powers, noted that the Founders had trusted the states, not the Oval Office and Congress, with the care of the people. See for yourselves.

“Our citizens have wisely formed themselves into one nation as to others and several States as among themselves. To the united nation belong our external and mutual relations; **to each State, severally, the care of our persons** (emphasis added), our property, our reputation and religious freedom.” –Thomas Jefferson: To Rhode Island Assembly, 1801. ME 10:262 http://tinyurl.com/onx4j

In fact, Chief Justice Marshall had established the following case precedent which appropriately limits the power of the feds to lay taxes.

“Congress is not empowered to tax for those purposes which are within the exclusive province of the States.” –Chief Justice Marshall, GIBBONS V. OGDEN (1824) http://supreme.justia.com/us/22/1/case.html

So not only was Obama’s stimulus package constitutionally unauthorized, but the stimulus and any proposed health programs are based on constitutionally illegal federal taxes anyway. In fact, much federal government spending on the states these days amounts to the federal government returning to the states money that it had stolen from the states anyway.

The bottom line is that the people need to wise up to the ongoing, illegal usurpation of state powers by the feds and do the following. The people need to work with their state lawmakers and do this. State lawmakers need to go “upstream” of Congress and repeal the 16th A., the amendment that gives the feds the power to tax citizens directly. The problem with that amendment is that it has made it too easy for the feds to lay constitutionally unauthorized taxes, in my opinion.

And once the 16th A. has been repealed and the federal income tax eliminated, the state governments can finance the feds with higher state taxes. The reason for this is as follows. The states can use their greater constitutional powers to serve the people to fight a downhill battle with the feds, eliminating constitutionally unauthorized federal taxes, keeping as many tax dollars in a given state as possible. (Did you hear that California?)

And when state government “leaders” show their voters that they are more interested in protecting the federal government’s welfare than that of their state’s, then they can look for another job.

May 5, 2009 - 3:50 pm 34. Fantom:

“13. Whistle-Blower:

I guess we really should do like the ancient Greeks did. Anybody born with a physical defect and the feeble and elderly were simply taken up to the nearest mountain and left there to die. Just think of all the savings we could enjoy by doing such a simple and “justified” act.”

I believe that is what Borat Obama has in mind with his “comparative effectiveness research” (CER). If it isn’t cost effective you get Obama’s version of the cliff.

Saving money you wacky leftist loon.. Your president is way way ahead of you

Dr Mengele indeed.

http://www.washingtontimes.com/news/2009/may/01/obamas-health-care-rationing/

May 5, 2009 - 4:11 pm 35. Seerak:

Gov’t controlled and MANDATED universal health coverage, a disaster waiting to happen.

It isn’t a disaster if government control was the GOAL in the first place.

May 5, 2009 - 4:30 pm 36. Seerak:

Under your premise, we don’t have to care about need.

This is correct: under Dr. Hseih’s premise, we don’t HAVE TO care about need. That is, it is not a DUTY, but something every individual is free to decide for himself.

That’s called FREEDOM.

Freedom necessarily involves the possibility that others may see things differently from you, and may make choices you don’t like.

May 5, 2009 - 4:36 pm 37. Seerak:

At any rate, I, for one, could never take too seriously anyone who peddles such preposterous nonsense as “We don’t have to worry about socialism because it’s dead.”

I for one, could never take seriously anyone who imagines that policy would be much different under John “Money is not Speech” McCain.

May 5, 2009 - 4:38 pm 38. Seerak:

The problem is that the median family income vs the cost of health insurance and/or health care is lopsided. In today’s world the average family can’t possibly afford to get sick.

What *is* the actual cost of health care? My wife underwent $87,000 worth of radiation last year. 28 visits, each lasting under 20 minutes. $87,000 !!!

What is interesting is that socialized-healthcare toadies like Alston never, but NEVER, inquire into what exactly is driving up health care costs. Their “thinking” about that question, if they do any at all, usually stops dead at “corporate greed” or some similar such Leftist bogeyman.

Of course, there is good reason why they stop there; if they did keep thinking, they might discover that the health care market has been progressively corrupted by growing government mandates and controls over decades, the fruit of which is the high cost of the current semi-socialized system.

May 5, 2009 - 4:53 pm 39. G Alston:

#38 — What is interesting is that socialized-healthcare toadies like Alston never, but NEVER, inquire into what exactly is driving up health care costs. Their “thinking” about that question, if they do any at all, usually stops dead at “corporate greed” or some similar such Leftist bogeyman.

Wow, what an amazing example of mind reading. I grew up with socialised health care and have watched it kill many of my relatives overseas.

Pointing out that an argument is fallacious isn’t endorsement of the other side. Intelligent people know this.

You have nothing to add outside mindless regurgitation of meaningless platitudes and cliched nonsense. You have no idea what you speak of. Sod off.

May 5, 2009 - 5:19 pm 40. Mike Zemack:

“As a commited Christain – I completely disagree with your premise. Helathcare is a right. Under your premise, we don’t have to care about need.”—The Shadow

Does a “committed Christian” believe that slavery is just; that need is a license to steal; that people who produce the means by which our needs are satisfied should be punished; that those who can support themselves should be forced to pay for the satisfaction of the needs of unknown freeloaders everywhere and anywhere?

The means by which human needs (and desires) are to be met do not just occur free in nature. They must be created. Need has never produced so much as a single morsel of food. Only the productive work of individual human beings guided by reason can bring them into existence. And that productive process requires the freedom from human predators who claim that their need gives them a “right” to take what is not theirs.

There are basically only two ways to acquire the product of another man’s labor—by voluntary means such as trade or private charity, or seize it by force. The first is the civilized method, the second is the criminal method. To declare a “right” to any man-made product or service such as healthcare means to ascribe to government the criminal power to loot and enslave the self-supporting and the producers of healthcare. There is no other way. As Dr. Hsieh correctly states, you have the right to take the non-coercive actions necessary to satisfy your needs, and that’s it.

Committed Christians I know who “care about need” put there money (and time) where their mouths are. They step up personally through private charitable efforts, rather than take the phony route of advocating socialized medicine in the name of compassion.

May 5, 2009 - 5:21 pm 41. John Moore:

3) Free-market health care reform can and does work

I have yet to see a solution that solves the following problem:

You pay (through your employer) health insurance premiums all your life. You then develop a chronic illness and lose your job.

Please explain how this person, without government intervention, will be able to continue to pay for health care?

Currently, insurers, in order to prevent adverse selection (people waiting until they are sick to buy insurance), prevent those who are sick and without insurance from buying in – EVEN if they have been paying into the system all their lives.

May 5, 2009 - 5:32 pm 42. SLJJ:

#1) I do not agree with government health care for various reasons. But I am not going to get into that. My point is; THEY CAN’T EVEN RUN THEMSELVES, AND NOW YOU WANT THEM TO RUN HEALTH CARE??? They don’t pay their taxes but expect it of others, they don’t read the bill, pass it, then blame it on the recipients, they never fess up to anything.

#2) Who is going to pay for this? The people that work. We are enableing people much like giving an alcoholic money or a 6-pack. We are not teaching any self-responsibility. I am all for helping people, but not at the price of my children, and my grandchildren-to-be’s future.

Read the bill (H.R. 676) ******************************************

A)”the top 5 percent income earners.

B) Instituting a modest and progressive excise tax on payroll and self-employment income.

C) Instituting a small tax on stock and
bond transactions.”

(how many times are you going to tax my retirement??? I did this because I knew there wouldn’t be any Soc. Security – and now they want that too.)
Oh no, we are going to CUT taxes – LIARS. And this is only ONE of many taxes proposed.

May 5, 2009 - 5:36 pm 43. John Moore:

Here’s another issue with our current system. I’m curious how the free market will deal with it.

A friend had a cardiac ablation procedure done. It took about an hour at a heart specialty hospital. The facility charge (not doctors, etc) on the bill was exactly $50,000.

The insurance company, a PPO, paid $14,000 and the facility was satisfied.

Anyone without insurance would have found themselves owing $50,000 and medical facilities are notorious for their bill collection practices.,

Another example: A colonoscopy. Facility charge: $5000. Facility accepted $484 from the insurance as full payment. Anyone want to try it without insurance.

Another: My family was literally ordered (by the state rabies control officer) to go to a specific ER immediately because we had potentially been exposed while on a foreign trip. My daughter, a college student, was between schools – a 14 day lapse in insurance. She was hit with a $6800 charge for the initial two shots, and was hounded until she paid it.

May 5, 2009 - 5:42 pm 44. BPT (Australia):

Some good points here and at least you have the honesty to put quotes around “universal health care.” The United Kingdom’s system is bankrupt, financially and morally, and some hospitals even employed workers with terrorist links.

May 5, 2009 - 5:58 pm 45. Eric:

Quite simply, NOTHING can be claimed as a “right” if that right imposes the obligation on someone else to fulfill that right. A person who claims the right to health care is for all intents and purposes laying claim to a portion of someone else’s income. I don’t know about the rest of you but I went to college to enable myself to get a good paying job to benefit me and my family, not some stranger.

How many people with cable TV, Internet, and cell phones are among the uninsured?

May 5, 2009 - 6:07 pm 46. Robert Westafer M.D.:

Real Healthcare Reform: Changing the Incentives and the Rules of the Game; Creating an Electronic Health Record for Every Citizen Who Wants One.

If you have the financial resources of Bill Gates or Warren Buffett you needn’t pay money to a health plan each month, since if you get sick or injured – even very seriously – you have more than enough money to pay all your medical bills yourself.

But those of us with significantly less financial resources must find some other means of dealing with the thousands or even hundreds of thousands of dollars or more of medical expenses that we might incur should a serious illness or injury be our fate.

Enter the concept of “health insurance”.

Large numbers of individuals and/or their employers pay some money each month into one or another big pot called a “health plan”. Those individuals who remain essentially very healthy for many years and then suddenly die or perhaps leave a particular health plan for some other reason – if they have put more money into the pot than was taken out to pay all their medical expenses – wind up helping to pay the medical bills of those members of the health plan who become seriously ill or injured and incur a lot of medical expenses.

Many members of health plans don’t seem to fully understand or perhaps choose to ignore the fact that if they become seriously ill or injured, for the most part their medical bills will be paid by the members of their health plan who have remained healthy. Some Americans believe that healthcare should become a “right” of every American citizen. If a nationalized single payer health plan were enacted, every American citizen who became ill or injured – for whatever reason – and incurred significant medical expenses would for the most part have his or her medical bills paid by all U.S. taxpayers.

For any health plan to work which has a large number of people pooling their money to essentially pay the medical bills of whichever members of the plan become seriously ill or injured, rules must be established as to when and how much money may be taken out of the pot e.g. “legitimate” doctor bills and hospital bills. Equally important is keeping track of the amount of money that is being put into the pot each month in premiums paid by health plan members or their employers. If too much is being paid out in expenses as compared with the amount being received in premiums, the pot will soon become empty and the health plan will go broke.

As previously mentioned, the monthly premiums paid by individuals or their employers go into a health plan’s big pot from which “covered” healthcare expenses are paid. But also from this pot are paid all the health plan’s administrative expenses including what may be big salaries and golden parachutes for CEO’s and other “healthcare executives” – individuals who may be paid to find technicalities of one sort or another in the health plan’s agreements so the health plan can deny or reduce payments, raise premiums, cancel insurance, or in one way or another minimize or exclude “bad risks” from the health plan. All such questionable business practices are done to enable the health plan to make a profit and remain in business.

Currently we are experiencing continual increases in healthcare costs that are unsustainable and which, if unchecked, will soon seriously threaten the future of the entire American economy. Healthcare costs must be controlled, but how? If a healthcare system made up of health plans is going to have a chance of meeting the needs of its health plan members and simultaneously be able to keep costs under control, something very critically important must first occur.

It turns out that a lot of illnesses and many injuries are actually preventable.

Although health promotion and disease and injury prevention receive fashionable and socially acceptable lip service, the fact is that most of the participants in what should be more appropriately called our “sickness and injury care system” actually have no significant financial incentive whatsoever to spend any significant time and energy in genuinely promoting health and helping to prevent disease and injury.

Much to the contrary. Other than the actual members of a health plan – patients and potential patients – and their employers and perhaps the employees of some health plans, most participants in our sickness and injury care system – because of the way they are paid – have an enormous (if unspoken) financial incentive for massive amounts of disease and injury – much of which is preventable – to continue to occur in America. Strictly from a financial point of view, for those whose incomes come solely from the treatment – not the prevention – of illness and injury, the more illness and injury that occurs, the better. And if the illness or injury is serious and requires perhaps many expensive tests, multiple surgical procedures, and other very complicated prolonged treatment in an intensive care unit, so much the better; just as long as those unfortunate individuals who happen to be ill or injured are “covered” by “good insurance”, i.e. health plans that are reliable bill payers.

This is not to say that there are not some excellent very dedicated and hardworking doctors and other health professionals – although they are paid on a fee for service basis to care for illness and injury – who nevertheless attempt to essentially work themselves out of a job by making health promotion and disease and injury prevention a top priority with their patients.

It should also be recognized that some existing health plans – e.g. Kaiser and Group Health – combine insurance, doctors, and hospitals into a single entity in such a way that provides everyone – including all the health plan’s doctors – a real incentive to spend time and effort with patients on health promotion and disease and injury prevention as well as on early diagnosis and treatment.

But unfortunately the above examples represent only a small part of the sickness and injury care system that currently exists throughout America.

For the most part – because of the way they are compensated – the majority of doctors and other professional providers, acute care hospitals and long term care facilities, pharmaceutical manufactures and pharmacists, medical and surgical equipment manufacturers and personal injury and malpractice attorneys – among others – depend mightily on massive amounts of disease and injury occurring in America; and these participants in our sickness and injury care system would be significantly negatively impacted if a lot of the preventable illnesses and injuries were actually prevented. This must be changed.

Unless the incentives and rules are changed to give as many participants as possible a real financial stake in health promotion and disease and injury prevention, in early diagnosis and treatment, and in maximizing health and minimizing disease and injury, healthcare costs in America will never be brought under control. Making appropriate changes in the incentives and the rules of the game is the real task and challenge of “healthcare reform”.

What about financial incentives for individual health plan members? Should individuals receive a financial incentive to be healthy? It is well recognized that engaging in regular exercise, abstaining from tobacco, and eating moderately so as to maintain a reasonably normal body weight are all significant factors in helping to promote an individual’s health and wellness. These healthy behaviors can all be confirmed by simple tests performed or ordered in a doctor’s office. Why shouldn’t those individuals who practice these health promoting behaviors and comply with recommended immunization schedules and appropriate preventive screening examinations such as for colon cancer and breast cancer pay significantly less in premiums to their health plan each month than those who don’t?

To really reform healthcare we must find ways – through changes in incentives and the rules of the game – to actually prevent what is preventable, to maximize early diagnosis and treatment, and minimize disease and injury with all its associated cost. We must find ways for participants to be part of our “healthcare system” and not just a part of our “sickness and injury care system”.

Significant changes in the rules of the game for our legal system – tort reform – is also critically important so that the gaming of the system now being done by personal injury and malpractice attorneys and their clients can be ended and so that the exorbitant costs to physicians and other professionals for malpractice insurance can be dramatically reduced.

Truly transforming our “sickness and injury care system” into a “healthcare system” by making significant changes in the incentives and the rules of the game may seem to be a formidable task and one that probably has never really been done before on a large scale anywhere in the world. But it is a worthy task and a critically important task for the future of America and its people.

One significant part of this process is developing the capability of creating an electronic health record for every American citizen who wants one. We need a standardized framework that will allow every American citizen to have an individual electronic health record – a computerized medical record – that can be accessed by all the doctors who care for a particular individual, regardless of wherever on the planet the doctors or the patients happen to be. It would be like having your own personal online banking account that only you have the password to, but which you can share with the doctors who are caring for you, wherever you or they may be.

I applaud those who are using their energy and expertise to upgrade our deplorable current paper medical records system and bring medical records in America into the 21st century. Developing a standardized framework for an electronic health record – for every citizen who wants one – created by your doctor with your assistance, with proper security and safeguards – is something that our national government can and should do as a part of healthcare reform.

If done well, electronic health records will be transformational in helping doctors efficiently and effectively care for patients and will save an enormous amount of time, effort, and money which is currently wasted on needless and frequently inaccurate duplication. And having an accurate electronic health record for an individual will also facilitate appropriate health promotion and disease and injury prevention for that individual. Like the telephone and the computer, someday we will all wonder how we ever got along without individual electronic health records.

All this requires action, not just words. Now is the time for Americans and their leaders and doctors and other health professionals to step up to the plate and begin the process of transforming our “American Sickness and Injury Care System” into an “American Healthcare System” that is worthy of our great country.

Robert Westafer M.D.

May 5, 2009 - 6:11 pm 47. momof3:

“Classify it under whatever category you wish, health care is an “existential” need – without it, you could die or be paralyzed for life or become blind or a cripple or spread diseases like cholera etc etc.”

You realize that 1) those things can and do happen anyway and 2) modern plumbing has saved more lives than any medicine ever did (your cholera example, for one). Actually, your first example is that without it you could die. You do realize that everyone dies, right? No matter what? This is a society. Your right to listen to your music as loud as you want stops where it encroaches on my right to not listen (per the law) and your right to have healthcare ends when it encroaches into my wallet.

“The only institution that can deliver on such a prospect is the government. Some things are too big or complex or vital for private industry (you know, like defense, intelligence, the postal service and so on)”

Is this sarcasm? The Post Office is not tax-funded (or wasn’t until recently) and is going under in any event. Defense is a federal job clearly spelled out in the Constitution and is also frequently subcontracted to private industry. As is intelligence, if we even have such a thing any more.

“you were one of the 48 million in the USA who did not have insurance you would not think our system is so great. The two programs in the US that are government operated are very popular with those who are in them Medicare and the VA system. ”

First off, that 48 million number is very misleading if not an outright lie. It includes illegals and people who simply would rather have the phone/car/house whatever than pay for health insurance. I might like to drive a nicer car too, but the insurance comes first. Second, who exactly is satisfied with medicare and the VA? The VA’s general hatedness is well documented even by the MSM. Medicare can’t be financially supported, so how exactly are we going to expand it to everyone in this country-legally or no? Not even 60% taxes would cover that.

Another little fact people for universal healthcare ignore is the tax rate. Socialized medicine countries pay roughly 50% in taxes. If you lived on only half your income, it would be pretty easy to afford health insurance, don’t you think?

As far as medical machinery like the radiation units: $1 million is low for the price tag. By about a factor of 20, once you factor in building the needed facility and support eqiupment. Not to mention the specialist that has to be flown in to fix it at any hour. On top of the daily costs.

May 5, 2009 - 6:32 pm 48. venividivici:

22. The Shadow:

Jack Lovell – I work with physicans from all over the world every day in my job.

Working the concession truck in the hospital parking lot hardly qualifies you to judge what kind of healthcare system should be put in place to replace the current one.

18. Greg:

Great article! Thank you for the focus on fundamentals and the recognition of the painful facts resulting from ignoring those fundamentals.

The trouble with our current culture is that most people now has no clue what rights are and why recognizing them is a requirement for our living together. The above “commited Christian” who so disagrees with the article is a great example: “If someone is poor and needs healtcare and it is not a right, then they can just eat cake. I think that thinking went out with Louis XIV.”

But if someone is poor and needs healthcare and it IS a right, then they can just enslave their neighbor to pay for it or their doctor to provide it. I think THAT thinking went out with the American Revolution.

I hear you, but the morons who can’t think beyond the words “uninsured!!!!!” and “emergency room!!!!!!” haven’t the slightest clue of how to think in abstractions. It’s like an entire segment of the Western world has performed a frontal lobotomy on itself.

May 5, 2009 - 6:44 pm 49. The Shadow:

Veni – nice try – lets just say I know quite a few because I publish their books and journals and you?

May 5, 2009 - 7:19 pm 50. The Shadow:

mike z – you completely lost me on your jump from healthcare to slavery – There is no connection except in your mind. as for Charity — I along with many liberals give of my time and money as so many of the conservatives I know, but that does not solve the enormous problems in our health care system -

May 5, 2009 - 7:27 pm 51. The Shadow:

Megan B tell that to the 48 million without healthcare

May 5, 2009 - 7:31 pm 52. Geoff:

“The two programs in the US that are government operated are very popular with those who are in them Medicare and [b]the VA system[/b].”

Hahahahahahahahahahahahahahaha

May 5, 2009 - 7:32 pm 53. Seerak:

I hear you, but the morons who can’t think beyond the words “uninsured!!!!!” and “emergency room!!!!!!” haven’t the slightest clue of how to think in abstractions. It’s like an entire segment of the Western world has performed a frontal lobotomy on itself.

Hey, aren’t you the militant pragmatist guy who couldn’t get past the the words “but they’ll die if we don’t force them to make 401(k) payments” in the comments to another one of Dr. Hsieh’s article some time ago when faced with precisely that sort of abstract, principled argument against paternalism?

May 5, 2009 - 7:35 pm 54. Seerak:

My apologies for that run-on in my last comment (bleah)

Pointing out that an argument is fallacious isn’t endorsement of the other side. Intelligent people know this.

Refuting an argument does not offer one, and neither does mouthing off. Intelligent people know that. It means (leaning over) you’ve got nothing.

I grew up with socialised health care and have watched it kill many of my relatives overseas.

As an expat Canadian, I saw it do that in person — and more. Suffice it to say I emigrated for a reason.

May 5, 2009 - 7:48 pm 55. Praetorian:

Unfortunately, arguments such as “government run healthcare leads to rationing” aren’t going to work this time around. Namely because those opposed to universal aren’t dealing with an novice. Moreover, they are patently false. The public is on to you guys and they won’t believe the lies. Please understand that whether or not it is the government or private entities administering health care there will be controls. There always have been and there always will be. In fact, if I had to make a choice I would rather have a government bureucrat seeing over things like healthcare than some private industry bean counter whose only concern is their bottom line and the shareholders. Medicare, for instance, is one of the most successful (government) programs ever conceived if you measure a programs success by outcome (healthier and longer living seniors). This is what people forget about for profit healthcare or insurance of anykind actually. Their only reason for being is to take in more money in premiums than they pay out in claims. Private health insurance companies don’t care about your health they care about profit. The reason why the health insurance industry (i.e. conservative Republicans) is against this is because they know they will die and they should, but you can’t blame them for self preservation. Unfortunately, for the good of the nation they need to die and they will.

May 5, 2009 - 8:01 pm 56. venividivici:

49. The Shadow:

Veni – nice try – lets just say I know quite a few because I publish their books and journals and you?
May 5, 2009 – 7:19 pm

Operating the printing press at the medical publishers doesn’t qualify you to say what kind of health care system we should have.

Case in point, you keep claiming that universal coverage will lead to fewer emergency room visits, but empirical results disprove that theory:

http://www.boston.com/news/local/massachusetts/articles/2009/04/24/er_visits_costs_in_mass_climb/

“More people are seeking care in hospital emergency rooms, and the cost of caring for ER patients has soared 17 percent over two years, despite efforts to direct patients with nonurgent problems to primary care doctors instead, according to new state data.”

“The large portion of visits in which the patient didn’t require immediate treatment, or could have been treated in a doctors’ office, remained essentially unchanged over those years at 47 percent.

Massachusetts officials yesterday cautioned against drawing conclusions about whether the state’s new insurance mandate has failed to ease overuse of the emergency room, saying more years of data are needed to measure the law’s impact. But the numbers may provide an early view of how difficult it will be to meet the high expectations for the law.”

“Several physicians and policy makers said the state information, along with other new data from Harvard researchers, suggests that emergency room crowding and rising costs will not be solved by providing people with health insurance alone, despite optimistic talk by politicians who advocated for the law.

What is needed, they said, are more primary care doctors and nurses, and a new payment system that encourages intense monitoring of patients with diabetes, asthma, and other chronic illnesses.”

Yeah, good luck getting “more primary care doctors and nurses” when you decrease the financial rewards of being a primary care doctor or nurse.

Is there any single theoretical proposition held by the left the plays out as they expect in reality? I submit there is not. Once again, an example of how detached from reality lefties are.

May 5, 2009 - 8:04 pm 57. venividivici:

Private health insurance companies don’t care about your health they care about profit.

No, they actually do want you to stay healthy and continue to pay premium. That premium is then invested in a diversified portfolio that earns the company investment gains. Over time, those investment gains outweigh the amount that the company will pay out in claims later in your life by a fairly small amount. Over the past three years, eyeballing the data, UnitedHealth Group looks like they’ve had between 4% and 6% Net Income Margins, meaning between 94% and 96% of all premium they took in went right back out the door in some way, shape or form.

http://finance.yahoo.com/q/is?s=unh&annual

Even a copper/gold mining company, Freeport McMoran, had higher Net Income Margins, not counting last years non-recurring charge.

http://finance.yahoo.com/q/is?s=fcx&annual

The idea that health insurance companies are gouging people is not borne out by the data.

May 5, 2009 - 9:21 pm 58. venividivici:

In fact, if I had to make a choice I would rather have a government bureucrat seeing over things like healthcare than some private industry bean counter whose only concern is their bottom line and the shareholders.

Yeah, good luck appealing a bureaucrat’s decision. At least with a private company, you can sue them for breach of contract if you really are covered or even switch providers, under certain conditions.

Just who do you think is going to go work for the government’s health care bureaucracy? It’s going to be the people from the private insurance companies. There’s only one way to do the kind of actuarial work required to determine if treatment is warranted in a particular case or to price out the amount of tax revenue needed to compensate physicians. So, what is the “extra goodness” that a government bureaucrat will bring to the table for you, once competition is removed from the equation? Will there be a smiley-face sticker on your “Treatment Denied” letter? Will the letter telling you your taxes have to go up again this year because the health insurance program is underfunded come with a bag of Skittles?

May 5, 2009 - 9:36 pm 59. John Moore:

Yeah, good luck getting “more primary care doctors and nurses” when you decrease the financial rewards of being a primary care doctor or nurse.

The current administration (which I loathe, but they’re right on this one) are trying to increase the payments of government programs for “cognitive care” (primary care).

As for getting more primary care doctors, since the AMA monopoly on medical school slots causes fewer MD’s to graduate in the US than in 1970, it is not surprising that we are running a bit short. There are plenty of qualified people who are screened out by a selection process designed to keep the prices high for members of the guild. Of course, it doesn’t work any more (due to oligopsony purchase of care), but that hasn’t stopped them.

May 5, 2009 - 9:40 pm 60. Lark:

“Render unto Caesar what is Caesar’s” does not mean imposing top-heavy government solutions or putting faith into action solely with votes and blind trust that politicians will make good on their promises to “fix” everything.

Profit motivation is soft journalism’s easy scapegoat for health care costs, but what about the convoluted web of state and federal regulations that are often at odds in their intended purposes, not to mention serve competing public policy goals. “Some of the complexities of the regulation of health care coverage in the US have not been known to the general public until recently.” (Source: http://www.paho.org/Spanish/HDP/hdd/usa.pdf.) Cuba’s idyllic, centralized health care system cannot and should not provide a model for the United States–its population equates to that of Ohio. An influx of immigrants would strain Cuba’s health care resources. For an American family making $40,000, a private, well-regulated insurance policy of $500 per month with a $1000 deductible produces a rate of 33% when added to a full federal income tax liability of 15%. That’s still competitive with Britain or France’s “free” income tax rates. That still allows for state subsidized insurance for high risk populations. That still includes government health care programs. When you consider that the U.S. scenario still could be improved with expanded competition, streamlined regulations, coordinated government agencies, patient-tailored insurance policies, and tort reform, universal health care falls short of its promise.

Often doctors historically accepted barter, or whatever poor patients could offer, but payment was exchanged for services. The doctor-patient relationship was primary, not paperwork driven. Don’t forget many hospitals originated as, and some still are, non-profit, ethics-oriented organizations. Watch those doctors’ freedoms disappear further if universal health care or proposed legislation is enacted. (That a homemade pie you were planning on taking to the church bake sale for the cancer patient? We’ve got government regulations for that too…)

Caesar was an emperor, and the quoted response was made to a question that was heavily and politically motivated. We forget that in this grand experiment, we are Caesar.

May 6, 2009 - 1:51 am 61. Kally:

It would be like having your own personal online banking account that only you have the password to, but which you can share with the doctors who are caring for you, wherever you or they may be.

May 6, 2009 - 4:34 am 62. Old Buckeye:

Would it make any sense to unbundle health insurance premiums from the employer and let people buy what they wanted from whom they wanted? I mean insurance, doctor visits, lab tests, the whole shebang. I’m posing the question here, trying to see why that wouldn’t work. I know why health insurance was originally tied up to employment, but why does it have to be now? Wouldn’t that really free up the markets?

May 6, 2009 - 6:37 am 63. venividivici:

Old Buckeye,

I think the short answer is yes to all of those.

Also, I have a health savings account and the great thing is that if I leave my employer, I can take all that money with me and open up a new one with my new employer. They contribute about the same as they would in health insurance premium directly into my account. I then decide if the spending I make is worth getting reimbursed for out of that account or if I will just pay out of pocket and let the dollars accumulate in the account.

May 6, 2009 - 7:08 am 64. The Shadow:

veni wrong again – I make the decisions about what we publish – what are your meager qualifications/ You overlook the proven fact according to a study in teh NEJM that admin cost of our current system are 30% versus 15% in the Candaian system. That ia money that can be spent on real healtcare not paying an administrator to overrule your MD. You also ingnore tha moral question about the healthcare of those who either have no insurance or are under insured

May 6, 2009 - 8:19 am 65. The Shadow:

Veni – If you think that the most important thing for an insurance company is your health, you have never worked for a for profit company

May 6, 2009 - 8:21 am 66. The Shadow:

Fantom – Your ignorance about CER is bottomless. CER will happen no matter who is in charge because we have to under stand if procedures are efficacious before we continue to pay for procedures that do not work. Part of controlling the cost of health care in the future wlll be making sure that the procedures will benefit patients

May 6, 2009 - 8:28 am 67. Eric:

Great OpEd, comprehensive and concise. Thank you for writing it.

May 6, 2009 - 8:29 am 68. David W. Lincoln:

Dr. Hsieh, it looks like you are familiar with “Code Blue” by Dr. David Gratzer. My compliments on you having the backbone to say what you said.

May 6, 2009 - 9:10 am 69. Kelly:

I’ve had periods of my life WITH insurance and periods of my life WITHOUT it. I never had a difference in healthcare because of insurance. I’ve had a major difference in doctors and have learned to choose my own doctor based on their care, expertise and their record. But I’m someone who reads extensively and uses the library and internet to learn more before simply trusting someone with my health. Too bad THIS isn’t what we are doing to help people help themselves. Until we DO require people to learn, we will never solve the healthcare problem – no matter who pays the bills.

May 6, 2009 - 11:34 am 70. Hotpatch 6:

As a MEDICARE recipient and a disabled veteran, I can say that neither the MEDICARE or VA medical system are efficient or cost effective. I cringe at the thought of American medical care becoming a mirror image of the VA system!

May 6, 2009 - 2:06 pm 71. RSP:

Well said Dr. Hsieh.

May 6, 2009 - 3:10 pm 72. ChipD:

Part of the problem is we are using very poor language to talk about this- the debate seems to boil down to whether health care is a “right” and therefore anyone can demand it anywhere, under any circumstances, or it is a prviledge of those who can afford it.

When we accept that those are our only two choices, we put ourselves in a false dilemma- “rights” are so fixed, so ironclad, that the worries of free-market advocates are justified- is there no obligation for anyone to contribute to their own health care? That seems silly.

However, maybe health care is not a “right” but more of a societal good- if a person is indigent and in need of chemotherapy, are we prepared to simply watch them die? That is even more absurd.

Maybe we don’t have a legal obligation to provide free chemotherapy- yes, maybe it would be financially inefficient to do so- but providing a basic floor of essential health care only for those who truly can’t pay for it, like we already do with emergency room visits, would benefit society. A large percentage of bakruptcies are triggered by an uncovered illness; Communicable diseases can be caught and treated before they explode into pandemics, with taxpayer supported basic health care.

Think of schooling- Free schooling was not always popular, but the citizens of America discovered that providing education at the taxpayers expense gave back a benefit to the society at large- it isn’t an expense, it is an investment.

Make all the snarky comments you want about the public school system, but it is still a gem compared to 3rd world nations which have mobs of uneducated, unskilled people roaming the streets.

May 6, 2009 - 3:12 pm 73. HueyDoc:

The Shadow
You “Knowing doctors” is not the same as working in an Emergency Room any more than “Knowing an Astronaut” means you understand orbital mechanics. If you think people with no insurance wait until they are very ill to go to the ER, then you are an uninformed fool. I just spent 12 hours in the ER as the ER Doctor (and yes – I “Know” some doctors too) and I can tell you that 80% of the people there did not need to be there. And they did not come in for “life or death emergencies”. One illegal checked in all 4 of her kids and wanted them tested for Swine flu because they had recently “been” to Mexico( more like recently CAME from Mexico). None of them were sick and she didn’t even have Medicaid, no insurance whatsoever. She refused to go to the Health Clinic NEXT DOOR because they charged $5 to be seen and she screamed at the insurance lady when asked about payment ” You can’t charge me and you can’t refuse to see me!”. She was not an isolated incident- repeat her story 30 times yesterday at ONE hospital, then multiply this cr*p times all the ER’s in the US and you might see the light. The Medicaid patients are even worse because they know they will never see a bill and have unlimited FREE medical care- and abuse the h*ll out of it! I have literally seen Medicaid patients call an ambulance for a mosquito bite or to ask for a bandaid, or even just to have a ride into town- when they get to the ER, they jump off the stretcher and say “thanks for the ride” and walk out the door to the liquor store down the street. Is this what you want The Annointed One to give all of us? Can you say “Collapse of the System”?
And you, Dr Westsafer- by your verbosity and attitude, you sound like a physician-management tool who no longer practices medicine but runs roughshod over your physician “providers” in your own little kingdom. Thank God we kicked your type of medicine out of town years ago. Your kind pushes profit over anything else- including patient’s lives.
To me and others, that’s no better than the phlegmatic beauracrat that doesn’t care if you live or die, as long as the paperwork is filled out correctly. Which is what Government Medicine means.

May 6, 2009 - 3:41 pm 74. Darrell:

Thanks Paul for a great article. We need to wake up the American people to the problem and the solutions.

I would like to add the following ideas:

1. Allow anyone to practice medicine and only require them to be honest about their credentials. Why should I have to visit a doctor when I just have a cold and a Physician’s Assistant or Nurse would do just fine? This would break the AMA’s stranglehold on the medical industry (which is implemented through colluding state governments).

2. Allow drug companies to decide who can prescribe their medications or whether any prescription is required. Require them to test safety only and be honest about the results of the test. Again, if I know why I’m sick, why should I be required to see a doctor before purchasing a medicine? Drug companies might require prescriptions for dangerous drugs to reduce the likelihood that they would be misused.

Deregulation would also be possible in other areas and would lead to substantial cost savings. The problem is too much regulation, not too little government involvement.

May 6, 2009 - 3:51 pm 75. Darrell:

Whistle-Blower wrote:
“If you want to play semantics, you can very well say that health care is a “need” and not a “right” but that’s all you’re doing….playing the semantics game. You’re really avoiding the fundamental issues.”

Actually, the distinction is critical. You may need medical care, but you’re not going to get it if you destroy the system that makes it possible by attempting to enslave those that provide it.

The Dems are trying to kill the goose that laid the golden egg in order to get all the gold at once …

May 6, 2009 - 4:07 pm 76. venividivici:

64. The Shadow:

veni wrong again – I make the decisions about what we publish – what are your meager qualifications/ You overlook the proven fact according to a study in teh NEJM that admin cost of our current system are 30% versus 15% in the Candaian system. That ia money that can be spent on real healtcare not paying an administrator to overrule your MD. You also ingnore tha moral question about the healthcare of those who either have no insurance or are under insured

Hey, dumbass, I have an MBA and you and your type don’t seem to have qualms about telling businessmen like me how to run our businesses, so blow it out your ass. As a health care consumer, I have every right to state my preferences. If you have a problem with that, again, you know what they say.

On that NEJM study, I didn’t see anywhere in there where they controlled for the cost of the patient’s time. I can reduce overhead tomorrow across the health insurance industry by cutting the number of claims processors and making patients wait as long as they have to wait in Canada. Unless you think people’s time costs nothing (which, in your case, is probably an accurate estimate), you’re comparing apples and oranges.

65. The Shadow:

Veni – If you think that the most important thing for an insurance company is your health, you have never worked for a for profit company

Then why are the largest “wellness” programs nearly all affiliated with health insurance companies?

Look, I understand that your d*ck gets hard thinking about the government running the health insurance business. I get it. You’re a born loser who can’t take care of himself and needs “big government” to make sure the bad mans don’t cheat your poor wittle self. Just don’t think that you’ll get it without me pushing back and calling big government interference in markets what it is: a power grab clusterfark.

May 6, 2009 - 4:09 pm 77. John Moore:

Then why are the largest “wellness” programs nearly all affiliated with health insurance companies?

Duh! Because they believe it will reduce the number of medical matters they will have to pay for. Also, because their customers (corporations) demand it.

May 6, 2009 - 5:08 pm 78. venividivici:

77

So, then, they care about your health, even if only to avoid having to pay claims. Well, gee, how evil of them.

Like I said, these companies are making about 5% net profit margins. That’s not a lot of money, although to you financial illiterates who see how many billions in profits it adds up to, and forget that the real important number is the percentage margin, I guess I’m wasting my time.

Knock on wood, by the time I become a major consumer of health care, I’ll be a very rich man with about an 8 figure net worth, so I’ll go wherever in the world I need to go to escape the system, which will probably be India by then. It’s you losers that will be stuck with what you thought you wanted. Rock on.

May 6, 2009 - 6:57 pm 79. The Shadow:

Veni – unfortunately for you the system is going to change where you like it or not – I have dealt with enough MBAs in my carer to know that the degree is meaningless without an understanding of an industry. Obviously from your comments you know squat about the business of medicine

May 6, 2009 - 7:51 pm 80. Anonymous:

Like I said, these companies are making about 5% net profit margins. That’s not a lot of money,

Hey, I’m not an insurance company basher. I’ve worked in the industry. I think, however, that the system itself is seriously broken.

Nevertheless, anyone who thinks “they have your health at heart” is missing the point. They have their business at heart.

May 6, 2009 - 7:59 pm 81. DMG:

I understand this is probably a right of center type blog. All arguing, name calling and credential brandishing aside. We have a problem in this country with paying for health care. There are those who believe health care is a right. I’m one of those people. Dr. Hsieh does not. So we have a difference in philosophy. I understand that there are some who may abuse the system, I’ve seen them, but they are not the majority. And I’m sure most of the physicians on this board do not practice anecdotal based medicine. But there are people, liberal and conservative, rich and poor who are getting financially devastating medical bills. When times get tough, paying for food and heat trumps paying medical bills. There are physicians and surgeons who are not getting paid for services rendered. And there are people who are not doctors stepping between physician and patient. Whatever your politics there is a problem that needs to be fixed. How are we going to do it? Fight the same old finger pointing Liberal vs. Conservative fight of intransigence until nothing is accomplished?

May 6, 2009 - 8:03 pm 82. The Shadow:

Hueydoc:

You case proves my bigger point that we need to get everyone healthcare so they don’t use the ER; so they get preventive health care. I doubt if the cases you cite are the major reason for the rising health care costs. I suspect it is related more to the increased use of technology. I wonder if you think the current system is hunky dory. Some type of universal healthcare is coming – The only questions are what form will it take and will it be able to stem the rising costs

May 6, 2009 - 8:08 pm 83. Praetorian:

#76 veni: “Look, I understand that your d*ck gets hard thinking about the government running the health insurance business. I get it. You’re a born loser who can’t take care of himself and needs “big government” to make sure the bad mans don’t cheat your poor wittle self. Just don’t think that you’ll get it without me pushing back and calling big government interference in markets what it is: a power grab clusterfark.”

We don’t have to argue with you about this. You can think what you want but ultimately it doesn’t matter. The only people that will listen to your stupid prattle are those who hang out with other teabaggers. You losers have destroyed this nation enough with your failed ideology and policies Bottom line: we have the power and the numbers to push this through and it WILL BE. Universal healthcare is coming and we’re gonna shove it right down your conservative throat whether you like it or not. Capiche?

May 7, 2009 - 1:32 am 84. Whistle-Blower:

THIS SAYS IT ALL (READ IT AND WEEP)
—————-
FROM: The Wall Street Journal – 7 May 2009
——————————————-

Talking about the difference between someone unemployed in the US and Europe:

“…..For Mr. Butt, losing his job as a raw-materials buyer for a German auto-parts maker was a serious blow.

But state benefits will replace the bulk of his salary until May 2010. And he still has full medical insurance under Germany’s universal system.”

(NOTE ESPECIALLY LAST SENTENCE ABOVE)

“Mr. DeRoberts, who lost his job at a Chrysler assembly plant in Belvidere, Ill., near Rockford, last year, saw his medical benefits expire several months later. He says he can’t afford to pay the premiums on his own.

“It’s scary being without insurance,” Mr. DeRoberts says, but adds: “What do I give up? Food?”
————————

Full article at:
http://online.wsj.com/article/SB124155150793788477.html

May 7, 2009 - 4:49 am 85. venividivici:

79. The Shadow:

Veni – unfortunately for you the system is going to change where you like it or not – I have dealt with enough MBAs in my carer to know that the degree is meaningless without an understanding of an industry. Obviously from your comments you know squat about the business of medicine

As I said, I will have the means to buy my way out of the rationing that is coming down the pike. You are free to enjoy your “free” health coverage, although good luck finding a doctor. By making it less rewarding and making being a government bureaucrat more rewarding, you’ll end up with more of the latter than the former. Actually, you probably don’t understand MBAs and the value of the degree any more than I understand the actual practice of medicine. All businesses are built on certain drivers, the primary driver of all businesses being human nature and the profit incentives the business provides. I don’t need to know anything specific about an industry to know that.

80 Anonymous

There is an alignment of interests between the company and you vis-a-vis you remaining healthy. For a realist, like myself, this is as much as one can hope for. I guess in some fantasy world there are companies that provide goods and services without regard to profits, but I like to keep myself grounded in reality and in reality, people do things because it is in their best interest. It is in the best interests of a health insurance company that you remain healthy, pay your premium and don’t incur claims.

We don’t have to argue with you about this. You can think what you want but ultimately it doesn’t matter. The only people that will listen to your stupid prattle are those who hang out with other teabaggers. You losers have destroyed this nation enough with your failed ideology and policies Bottom line: we have the power and the numbers to push this through and it WILL BE. Universal healthcare is coming and we’re gonna shove it right down your conservative throat whether you like it or not. Capiche?

Maybe it’ll get passed and maybe it won’t. If it does, health care costs will bankrupt the country, instead of just bankrupting individuals. Genius.

I’d like you see you personally try shoving something down my throat. Whether health care is free or not, at that point, you’d need some. Capiche?

May 7, 2009 - 5:28 am 86. venividivici:

You losers

Praetorian, I’m not the one looking for Big Daddy Government to subsidize me. Where I come from, the person looking for subsidies is the loser.

Also, I wouldn’t want to be a government health care rationing bureaucrat whose job it was to deny people health care all day, in a nation where there are so many armed citizens. Phew, that’s gotta be a dangerous job.

May 7, 2009 - 5:34 am 87. venividivici:

Whistle-blower,

While tragic for that individual, where do you think that money for the state benefits in Germany comes from? A money tree? It comes from capital taken by the state from individuals, who can then NOT utilize that capital in other ways that may be more beneficial to society overall than paying for Mr. Butt’s unemployment compensation and health insurance.

As Bastiat says, the superficial economist looks at the seen effects and the profound economist looks at the seen and the unseen. All of you supporters of the German policy are clearly superficial economists.

May 7, 2009 - 5:40 am 88. Darrell:

83. Praetorian:

“We don’t have to argue with you about this. You can think what you want but ultimately it doesn’t matter. The only people that will listen to your stupid prattle are those who hang out with other teabaggers. You losers have destroyed this nation enough with your failed ideology and policies Bottom line: we have the power and the numbers to push this through and it WILL BE. Universal healthcare is coming and we’re gonna shove it right down your conservative throat whether you like it or not. Capiche?”

Quit threatening people! How would you like it if those of us opposed to government health care were to threaten you?

When you say that, “we’re gonna shove it right down your conservative throat whether you like it or not,” you’re threatening us with force or violence if we don’t comply with your wishes. Evidently, you like the idea of being a slave master. But we will never bow to you or your cronies.

It is ironic that the first black president acts like a slave master attempting to extract tribute from those he clearly views as his subjects. Perhaps it’s time for another revolution.

May 7, 2009 - 7:19 am 89. Geoff:

“we’re gonna shove it right down your conservative throat whether you like it or not”

Thank you for the succinct description of the Democrat mental process.

May 7, 2009 - 7:26 am 90. Praetorian:

# 85 veni: “Maybe it’ll get passed and maybe it won’t. If it does, health care costs will bankrupt the country, instead of just bankrupting individuals. Genius.”

Opinion is not proof. Healthcare as it stands now is bankrupting our country. I wonder why the U.S. Chamber of Commerce (i.e. business) is behind the idea of nationalized healthcare? Can’t get much more conservative than that. I think your immature opinions are a bit misguided. They are certainly not conservative by any reputable means. I think they stem mainly from the false fires of an overheated mind. You shoot from the hip or are listening to druggie Rushie too much. Go splash some water on yourself.

# 88 Darrell: “Quit threatening people! How would you like it if those of us opposed to government health care were to threaten you?

When you say that, “we’re gonna shove it right down your conservative throat whether you like it or not,” you’re threatening us with force or violence if we don’t comply with your wishes. Evidently, you like the idea of being a slave master. But we will never bow to you or your cronies.

It is ironic that the first black president acts like a slave master attempting to extract tribute from those he clearly views as his subjects. Perhaps it’s time for another revolution.”

I say such things not out of threat because we don’t need to do that. Like I said, the Democrats have the numbers and the power and healthcare is their number one priority. So it WILL be passed. And what a beautiful legacy that will be for hard working American families I say such things because I want the rage to build inside you. I want your hate to grow. Then, when it is passed (as will be the case with a slew of other things) I want you to feel the deep hurt and a sense of despondency. I want you to wonder why other Americans don’t see things your way. You see, I don’t have to argue with any of you on the points of intelligent discussion because you’re incapable of it. You are blinded by rage that things aren’t going your way. , so it is great fun to taunt people like you because it is our hope that you DO snap and incite your, so called, “revolution.” Then you and your ilk will be stamped quite swiftly I’m guessing. Moreover, the American people will stand by and clap their hands as it is done! They’ve had enough of you guys. That is because American politics by its very nature plunders its extremists, taking from them anything of value and leaving them nothing of value, not even gratitude.

On a separate note, and speaking of hard working American families. National healthcare will not only be good for the nation and business but it will have the added benefit of adding to the base of Democratic voters. Democrats will be viewed as the party who cared enough to give families and children healthcare, while republicans will be viewed as the party that cruelly stood by and said NO! Once healthcare is finished you won’t be able to pry that vote out of their cold-dead-hand . . .

May 7, 2009 - 10:21 am 91. Doctor T:

The “46 million” without healthcare is a number taken from census results. Ignoring for the moment the potential misrepresentation of that number as it comes from the question “Was there any time in the last year that you did not have healthcare insurance?”. 17 million of those are eligible for healthcare under state insurance and 8-10 million have incomes in excess of $50,000/year but choose not to get insurance as they are healthy and young and CHOOSE not to get insurance.

Also realize that if these uninsured get sick, they still can get healthcare, and usually do by going to their local emergency room.

There is a lot of truth to the fact that we can decrease healthcare costs. If everyone has insurance of some sort, then doctors, hospitals and clinics will get some reimbursement instead of having accept nothing and go after some lesser amount from the uninsureds. This has a small, but real impact.

If Medicaid which pays 12 cents on the dollar for health care came up to Medicare levels of 30 cents on the dollar then that would also lead to lower overall costs as the charges on those (who do pay) do not need to be raised to make up the difference.

Here is the big one. If Malpractice claims, most of which are frivolous or opportunistic lottery mentality attempts at a windfall could be stopped we’d see huge decreases in costs. This is for the following reasons. Doctors would not order as many unnecessary imaging and lab tests. Costs would decrease dramatically.

If doctors were not as afraid of getting sued they’d be more free to practice medicine and spend less time on defensive practices.

If Doctors spent less on malpractice insurance then those costs would not be passed onto the consumers.

May 7, 2009 - 1:29 pm 92. Mike Zemack:

The Shadow [#50]

The issue is force…specifically, the initiation of force by one person against another. Whether the force-initiator is a neighbor or a government official operating under cover of law, the principle is the same. It is the difference between voluntary charity and legalized armed robbery. You will continue to be “completely lost” until you stop evading what I said in paragraphs 3 and 4 of my comment #40. The connection between socialized medicine, in any form and by any name, and slavery is clearly validated by the facts of reality.

The dictionary defines slavery…in part…as; “a condition of submission to or domination by some influence…servitude…the state of being under the control of another person.” To the extent that a person works for earnings that are forcibly transferred to the unearned benefit of another person, he is a slave. To the extent that a doctor or other provider is forced by government to work under terms and conditions that are contrary to his best judgement and interests, he is a slave.

No, the slavery is not total, at least not yet. But when America accepted the first dollar of wealth redistribution, it started down the path that ends in total enslavement. A government granted the power to enslave a single human being for a single minute of his life, possesses the power to enslave an entire nation. It is only a matter of time and degree. The progressive slide down that path over the past century is clearly seen, particularly in medicine, and it continues apace. I submit in evidence the calls for totalitarian, centralized control of medicine advanced by The Shadow as a cure for what massive government intervention itself created…“the enormous problems in our health care system.”

May 7, 2009 - 1:34 pm 93. JED:

#90 Praetorian:
Where is the proof that HealthCare is bankrupting our country?
The bankrupcy every thirty seconds Obama-Speak includes bankrupcies due to gambling and drug addictions as well as probate.
Is there a HealthCare problem in this country or is it another invented problem like man made global warming?
Healthcare has to be paid by taxes and that is towards slavery.

May 7, 2009 - 1:43 pm 94. Nonnie Mouse:

There seems to be a good deal of confusion between “health care”; i.e., insurance and medical care. The first has nothing to do with the quality or availability of the second.

May 7, 2009 - 1:50 pm 95. talamanca:

I lived in Costa Rica for several years and they had socialized health care in the hospitals, but meager services were accessible only to residents. They couldn’t afford all the ex-pat bums and Nicaraguans, so they had to ration. The pharmacy however was voluntary trade, quick and cheap. Dollars were good. A lot of doctors chose to work at pharmacies and practice from there. You go up and explain your condition. They tell you about the medicine and you leave paying $15 or so. I am not speaking of advanced medicine here. I’m speaking about little things that are common, like birth control, bot fly poison, malaria pills and antibiotics. Our regulations force our medical industry to treat us in such a manner that makes it very expensive for simple procedures, like broken arms and stomach parasites. Perhaps if those common procedures were deregulated we could have some taco stand practices that poor people could actually afford. Oh my god! Well, its not a novel idea. Their have always been poor mans doctors. Only now they have spend money and time traveling to remote villages to set up shanty clinics were there are no regulations. Try it in New York and your treated like a demon.

Mark

May 7, 2009 - 2:04 pm 96. Praetorian:

#95 talamaca, Your example (Costa Rica) is a poor one and an even worse comparison. The healthcare system that the Obama Administration and the Democratic Party envision is more along the lines of what they have in Germany and France. Their health benefits are very generous and if you were to ask, many of those who receive them they would tell you that they love the system they are in and the healthcare they get. Conservatives, in this country, are primarily against this kind of health care system because it will put many of their courtiers out of business (meaning less political contributions) and, as I said before, the many new Democratic voters a nationalized system, by default, will create. Conservatives are not against the Obama plan for health care because they believe they have something better. If you believe that then you’re really naive.

May 7, 2009 - 3:25 pm 97. venividivici:

90. Praetorian:

# 85 veni: “Maybe it’ll get passed and maybe it won’t. If it does, health care costs will bankrupt the country, instead of just bankrupting individuals. Genius.”

Opinion is not proof. Healthcare as it stands now is bankrupting our country. I wonder why the U.S. Chamber of Commerce (i.e. business) is behind the idea of nationalized healthcare? Can’t get much more conservative than that. I think your immature opinions are a bit misguided. They are certainly not conservative by any reputable means. I think they stem mainly from the false fires of an overheated mind. You shoot from the hip or are listening to druggie Rushie too much. Go splash some water on yourself.

How is healthcare bankrupting the country when it’s individually-paid for in most cases? Yes, it bankrupts SOME INDIVIDUALS when they have medical problems and can’t pay for the resulting treatments (and, as I will show you, the Medicare unfunded liabilities are huge). However, that issue can be dealt with via bankruptcy law and doesn’t require a wholesale change to health insurance provisions. If socialized, health care will bankrupt the country. Look at the tax burdens already put upon German citizens to finance their health care insurance system and the Boomers aren’t even in their peak health care consumption years. It’s a tsunami even worse than the pension tsunami that’s coming (google pension tsunami, there’s an excellent blog by that name that lays it all out). The reason the French and Germans like their system is because, like our Social Security system, the demographics were relatively favorable for the first cohort to go through. If you don’t understand that, I can’t help you.

Even without nationalizing health insurance for the under-65 crowd, our Medicare unfunded liabilities are nearly 4 years of GDP, i.e. everything the US produces over a four year period is the equivalent of what’s already been promised to people. And that’s a good 20 times more than it was estimated it was going to cost. Take that and apply it to the entire country, making allowances for the fact that younger people will consume less health care, but are still twice as many as the proportion of people eligible for Medicare and we are talking a period of time (birth to age 65) that is much longer than the life expectancy of someone on Medicare and you easily add another 4 years of GDP to the unfunded liabilities. So, you’re going to work 8 years of your life just to pay for your own and everyone else’s health care, because the Medicare “trust fund” is going to go into deficit by the time the Boomers make their way through the system and then taxes are going to have to skyrocket. Signing up for that voluntarily is just raw stupidity. Companies with debt burdens 8 times their annual cash flow are, for all practical purposes, bankrupt. No possible amount of “cost savings” from getting people out of the habit of using the ER (which won’t happen because some people are just idiots, see the link to the Massachusetts experience with universal insurance to date, which has been NO drop-off in ER usage as a percentage of total health care usage) is going to overcome those numbers. As much waste (another perennial favorite of alleged Medicare “reformers”) as there is in non-Medicare health care now, there will probably be just as much after nationalizing it. For whatever reason, you like the sound of “national health care” and are basing it off a flawed analogy to France and Germany, but you won’t like the reality at this stage of the demographic game.

So, even if you disagree with the philosophical premise of the original article, which you obviously do, although you offer nothing in the way of a cogent critique beyond “Obama won”, as if winning an election were so all-important that if you decided you wanted to fly off the Empire State Building all you’d have to do to make it happen is say “Obama won”, the practical barriers to achieving anything remotely good are insurmountable. Health care providers won’t be your slaves and it’s not as if the people who are capable of that sort of intellectual achievement are a dime a dozen.

I would bet that the Chamber of Commerce is for it because the members want to offload promises they’ve made to employees over the years via OPEB contracts. Again, that is an issue that should be renegotiated between the individual employers and the employees who are owed those health care dollars and doesn’t require a change for everyone.

The rest of your post is too stupid to merit response (actually, it all was, but I had a couple of spare minutes on my hand as I was waiting for something).

May 7, 2009 - 4:29 pm 98. Manny:

Very good post, Dr Hsieh, but I am disappointed neither you nor your commenters expanded on European health care.

In all international studies comparing health care quality and cost, European countries take the top positions, especially France and the Scandinavian countries like Denmark and Sweden. The US comes far below, usually because health is too costly. In other words, Dr Hsieh, you earn too much.

Are you sure you want reform?

May 7, 2009 - 5:54 pm 99. venividivici:

Manny,

Can you link to the study you think is the best?

May 7, 2009 - 7:06 pm 100. The Shadow:

Mike Z — Your post is so illogical that it defies any reply

May 7, 2009 - 8:11 pm 101. The Shadow:

Veni – Praetorian has sketched you to a tee

May 7, 2009 - 8:12 pm 102. The Shadow:

Hotpatch 6 I wonder what you would do if the Government took away Medicare and the VA from you?

May 7, 2009 - 8:16 pm 103. The Shadow:

Anyone one else her put a high value on the MBAs that come in to screw up their companies?

May 7, 2009 - 8:19 pm 104. Tim R:

Very good article.
Socialism is always immoral and unnatural to how the humans best operates.

BTW Praetorian, if you think France is a good example you are being ignorant. It is well documented that as France has increased their socialistic type practises, the standard of living relative to other countries has dropped.
France has dropped in the ranks and it’s really quite sad.

The US is still the best place for health care in the world (even though it is becoming more and more socialist). The US has innovated the most in terms of medical care than any other country. And the US is one of the few places where you don’t have a waiting list.
Last I heard, British doctors are actually refusing treatment of curable diseases to over 65s! Simply placing them on palliative care. This is incredibly scary and it stems from an anti-human collectivist attitude of sacrifice for the greater good.

May 8, 2009 - 1:06 am 105. venividivici:

101. The Shadow:

Veni – Praetorian has sketched you to a tee

With a convincing statement like this, how could I possibly disagree? Like I said: at retirement, me, 8-figure net worth, you and Praetorian, 8-figures, if you include the numbers after the decimal point, combined. Who’s more valuable to society again, me or you two bozos?

You two morons run along now and circle jerk each other over your copies of “Das Kapital”.

103. The Shadow:

Anyone one else her put a high value on the MBAs that come in to screw up their companies?

On my most important client assignment, I helped the client identify over one hundred million dollars in incremental corporate value (translated for an idiot like you, I made them a lot of money). That’ll be the day I “screw up” a company. If I walk in the door of your company, it’s to talk to the CEO, not you and if I say, “Get rid of that guy The Shadow, he’s not adding any value”, it’s very likely it will happen. Fear the reaper, d-bag. How’s it feel knowing that I don’t even work at your company, but if they hired me as a consultant, on day one I’d be more important to the management than you are after however many years of working there?

May 8, 2009 - 5:15 am 106. venividivici:

And Pederastorian and Shadumbo want to add to this entitlement burden.

“A recent forecast by the Congressional Budget Office—an economic forecasting agency that is controlled by the Democrats in Congress, not by some conservative private sector outfit—shows that Medicare and Medicaid alone are going to crowd out everything else the federal government is doing by mid-century. And that means everything—national defense, energy, education, the whole works. We’ll only have health care. If, on the other hand, the government continues with everything else it is doing today and raises taxes to pay for Medicare and Medicaid, the Congressional Budget Office estimates that, by mid-century, a middle-income family will have to pay two-thirds of its income in taxes!”

http://www.hillsdale.edu/news/imprimis/archive/issue.asp?year=2009&month=03

May 8, 2009 - 6:46 am 107. Darrell:

90. Praetorian: “I say such things not out of threat because we don’t need to do that. Like I said, the Democrats have the numbers and the power and healthcare is their number one priority. So it WILL be passed. And what a beautiful legacy that will be for hard working American families.”

Hmmm. Erosion of our freedom is a beautiful legacy? I wonder if your children or grandchildren will feel the same way.

Praetorian: “I say such things because I want the rage to build inside you. I want your hate to grow. Then, when it is passed (as will be the case with a slew of other things) I want you to feel the deep hurt and a sense of despondency. I want you to wonder why other Americans don’t see things your way.”

Good luck with that. I know why some people agree with you. Because they’re idiots.

Praetorian: “You see, I don’t have to argue with any of you on the points of intelligent discussion because you’re incapable of it.”

Speak for yourself.

Praetorian: “You see, I don’t have to argue with any of you on the points of intelligent discussion because you’re incapable of it. You are blinded by rage that things aren’t going your way. , so it is great fun to taunt people like you because it is our hope that you DO snap and incite your, so called, “revolution.” Then you and your ilk will be stamped quite swiftly I’m guessing. Moreover, the American people will stand by and clap their hands as it is done! They’ve had enough of you guys. That is because American politics by its very nature plunders its extremists, taking from them anything of value and leaving them nothing of value, not even gratitude.”

I’m sure the Bolsheviks were also cheering their victory in Russia. Then came the Gulags. You see, whether we win or lose, you’ll get what you deserve, Trotsky.

Praetorian: “On a separate note, and speaking of hard working American families. National healthcare will not only be good for the nation and business but it will have the added benefit of adding to the base of Democratic voters. Democrats will be viewed as the party who cared enough to give families and children healthcare, while republicans will be viewed as the party that cruelly stood by and said NO! Once healthcare is finished you won’t be able to pry that vote out of their cold-dead-hand . . .”

I wonder whether the average American will be cheering when they find out that their health care is being rationed. I wonder how they’ll feel when the quality goes down the toilet. I wonder how they’ll feel when innovation dries up. I wonder how they’ll feel when they find out that they had the best medical system in the world but that they were deceived by the Democrats. I wonder how they’ll feel when they find out that the best system in the world was destroyed by the greed of the lying, power-hungry Democrats. Don’t congratulate yourself just yet.

May 8, 2009 - 9:22 am 108. Darrell:

98. Manny: “In all international studies comparing health care quality and cost, European countries take the top positions, especially France and the Scandinavian countries like Denmark and Sweden. The US comes far below, usually because health is too costly.”

Actually, the U.S. takes the top position in terms of quality by far. Would you be willing to take lower quality for lower cost if you or one of your loved ones was dying?

We could significantly reduce costs without reducing quality by instituting free market reforms. Instituting more government control will radically reduce the quality long before any cost savings are realized. That’s not a trade-off that any rational person would choose.

May 8, 2009 - 9:36 am 109. Darrell:

99. venividivici: Can you link to the study you think is the best?

Veni, the link is listed in one of the replies above, but I will repeat it here:
http://liberty.pacificresearch.org/publications/the-top-ten-myths-of-american-health-care-a-citizens-guide

You can buy the book or download the pdf for free from the website. I downloaded it and read it and it is an excellent reference. It should be required reading for anyone interested in the health care debate.

BTW, I have no connection to that website.

May 8, 2009 - 9:46 am 110. momof3:

I am so tired of people saying France or Germany or pick-your-small-homogenous-european-nation has such a great system. Yo uealize many of these countries have fewer citizens than we have ILLEGALS, right? Twenty million or more-all sucking healthcare they pay not a dime for in taxes or in medical bills-increasing by a million or so a year. You can not tax citizens enough to cover them. And you know no lib is going to deny noncitizens care. So there is no way on earth socialized medicine will not bankrupt the country. No possible way.

Give them all amnesty and let them start paying income tax, and we’ll have just as many illegals in 2 years. Probably more, since the first ones will have been seen to get such a great deal.

May 8, 2009 - 3:06 pm 111. venividivici:

109 Darrell

I’m reading the PDF now. Good stuff.

May 8, 2009 - 5:11 pm 112. Worksinhealthcare:

I am a pediatric physical therapist. I routinely treat children with private insurance, Medicaid, and private pay. Medicaid coverage is so poor that my decision making process is markedly different for children on government health care, as I know they will receive a fraction of the services needed to best deal with their conditions. Children with severe neurological conditions(traumatic brain injury, cerebral palsy, spinal cord injury) are routinely denied treatment that any other insurance provider would deem necessary. Private health care companies pay for these treatments as they recognize the connection between improved health/ mobility/ independence and reduced lifetime health costs. Medicaid does not. Wisconsin Medicaid is particularly nonsensical. Everyone, including young children, have 35 lifetime physical therapy visits. Once they are gone, you can apply for more sessions, but in nearly all cases treatment is denied. Examples of recent denials I have received:
A 19 year old one year status post traumatic brain injury had gained the ability to hold her head upright and turn her head to track conversations and people in the room. (A HUGE DEAL- imagine not being able to control where you are looking!). She also gained improved ability to consistently bear weight through her legs when transferring out of her wheelchair. (Another big deal- her mother had been lifting her. Imagine lifting your teenager any time she needed to be moved). Denied- “No functional progress.”

A seven year old with cerebral palsy had frequent respiratory infections. In PT she gained the trunk control to sit independently and gained sufficient respiratory control to cough and to swallow her own saliva without choking. (The respiratory component is huge- when a child with limited motor control dies, it is generally due to pneumonia). Denied- “No functional progress.”

The hardest part of my job is talking with parents who know their child’s independence, health, and ability to safely get through the day will be compromised due to Medicaid restrictions. Increased government control over health care will wreak havoc among the countries most vulnerable populations, as having health insurance is not the same as getting appropriate health care.

May 9, 2009 - 8:49 pm 113. Mary:

I am an American citizen and long time expatriate; my work took me to Europe more than 30 years ago. Having spent the first half of my life on the East Coast I can comprehend the resistance in America to actually paying something to help your fellow man, this is what the resistance to national health care boils down to.
Our health insurance in the Netherlands covers us 100% for absolutely everything – and every single citizen has the same coverage, irregardless of income or stature in society.

How is it possible that Amricans don’t even want to provide themselves with free top notch health care? I pay ( for myself and my 19 year old son) less than $ 200 per month. It covers absolutely eveything you could ever need.
Shocking ( and very very sad) to think that the supposedly richest country in the world can deny it’s citizens such a basic need – and that not enough citizens really care enough to actively effect such changes.
Once again, the States don’t look so good in comparison – not when you’ve seen and personally experienced how other countries manage so superbly well.

May 11, 2009 - 1:35 pm 114. Mary:

The more I read the angrier I become, everyone talks about the costs, the costs, the costs, the costs.
What is money anyway except a man made invention.
What is health and caring for your fellow man? It is what we can do to be good citizens of this earth. So many of these comments are shocking, totally without any feeling, compassion for or understanding for the brotherhood of people.
Money, money, money – and yet, strangely enough – America is running short of it – how many other Western societies have people living in dugouts under city bridges?

The president cannot do it alone, wake up America and take your proselytizing seriously – such a religious folk , with no respect for the neighbor who suffers, incomprehensible.
Money, money, money – this is your God.
Scary and truly very sad. The country will never profit from this divisive nonsense, but many will suffer needlessly.
It shames me once again.

May 11, 2009 - 2:04 pm 115. john hunt:

We have the unequivocal moral highground, so stand tall and proudly proclaim our philosophies. This highground is reflected in most of the comments above, and it is this: we all believe that the use of force or threat of force to accomplish ones aims is entirely unjustified unless in defense against others’ force.

The progressives use force and threat of force to accomplish their narcissistically-born plans for the greater good. And they justify the use of offensive force by saying their pet project “won’t be done otherwise”, or “greedy people will not contribute to the needs of others unless they are forced to help.” More recently, they say that the “majority clearly want this” and claim the moral high ground on this basis.

The arguments against this progressive idiocy are too easy to counter. But the nutshell is that NOTHING we do forces them to NOT provide health care to those in need, or prevents them from voluntarily getting together to PAY for health care for those in need. We do not force them in any way. But they want to force us.

ANd that is theft, that is rape, that is extortion, that is embezzlement, that is enslavement. The progressives have not an ounce of claim to the moral highground. As long as we lovers of individual liberty are willing to FIGHT, are willing to SPEAK, are willing to suffer economic consequences, are willing to TAKE BACK OUR LIBERTY, we will win.

If we instead behave as sheep, then we deserve to be Stalinized. The era of ANTHEM, of 1984, of Animal Farm is upon us.

A little rebellion in our every day lives is now absolutely necessary.

I have already quit the practice of medicine in America because of the progressive collectivism. It is one stand I can make. Few will make this stand. But consider it. Our children depend on us..

May 11, 2009 - 5:44 pm 116. momof3:

“How is it possible that Amricans don’t even want to provide themselves with free top notch health care”

IT’S NEITHER FREE NOR TOP-NOTCH! That you don’t get that makes anything else your senseless bleeding brain pops out immaterial. And if money is nothing-a construct as you call it-then try no longer paying for your food rent etc, and see if that argument flies with the providers of THOSE services. I’m betting not.

May 11, 2009 - 7:29 pm 117. Worksinhealthcare:

Mary- Very few people with actual exposure to Medicaid are in favor of increased government sponsored health care. Having “free coverage” does not translate into having the services you need. Next month two more of my pediatric clients (both with lifelong neurological disorders) will have used up their lifetime PT, OT, and Speech allotments. While these children have “free health care,” some government administrator has decided deny further therapy funding. Free health care works great for those who are healthy and require only basic services, but good luck getting quality care for a major, lifelong issue. If your 19 year old was born with cerebral palsy or spina bifida, you might have a different opinion of your current health care coverage.

Regarding the money comment: Medical development costs money. I am paying off seven years of student loans. Treatment payments pay my salary, pay malpractice coverage, rent for our facility etc. I have spent time in the Mayo Clinic research facilities. Research is also very expensive. Developing medical technology, drugs,new treatment techniques, educating medical professionals- health care costs are more than just the cost of the raw materials in a drug. Right now many health care facilities lose money every time they treat a Medicare or Medicaid patient. The rest of us re-subsidize Medicare/caid in higher medical bills. If health care facilities were only reimbursed based on those standards, many facilities would cease to exist.

May 12, 2009 - 7:57 pm 118. Darrell:

114. Mary: “The more I read the angrier I become, everyone talks about the costs, the costs, the costs, the costs.
What is money anyway except a man made invention.
What is health and caring for your fellow man? It is what we can do to be good citizens of this earth. So many of these comments are shocking, totally without any feeling, compassion for or understanding for the brotherhood of people.”

Mary, yes, money is a man-made invention as are most other things of value on this earth. Money is a medium of exchange that holds and represents the value of products and services that can be purchased with it.

When you ask what money is, you are implying that its value is not real, that it is unimportant and can be squandered without real consequences. But squandering money is the equivalent of squandering the goods and services that it represents. And, since goods and services are produced through the effort of the people that produce them, you’re saying that it is ok to squander that effort. And, since people’s lives depend upon the exertion of productive effort, you’re saying that it is ok to squander people’s lives.

It is the thinking of people like you that has caused all of the suffering in history. Contrary to the image you attempt to project, you are not putting a high value on life, you are, instead, putting a very low value on human life. By saying that people should be forced to provide for other people, you are treating the lives of the providers as worthless. Rather than being lauded for your compassion, you should be condemned for your heartless disregard for the lives and liberties of others.

May 13, 2009 - 1:33 pm 119. Laz:

Look, in Europe and Canada they have primary care physicians who know you and progress with you from birth to as long as they practice in the area. Not only that all information is electronically entered so that anywhere that information is available. If Michael Jackson tried to have 4 doctors, sure he goes to four doctors. No problem, but then he tries to get four doctors to prescribe drugs, they see that he is prescribed already and deny him the drugs. That is called efficiency, It ould have saved Michael and if it’s not changed thousand are going to die

Jul 24, 2009 - 5:15 am

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