[July 28, 2008 @ 8:50 pm] David Catron

Last week, at an event hosted by the Center for American Progress Action Fund, one of John McCain’s health care advisors (Al Hubbard) pointed out the following:

When a third-party pays for a service or product—we consume it as if it was free…It’s interesting, if you would think about, the employers rather than providing health care insurance they provided food insurance. So every time you go to the grocery store you just take out your food insurance card, you give it to the cashier, she scans it, and you’re outta there. Pretty soon, you would start buying caviar, expensive steak, and you start buying more than you need …

For anyone acquainted with basic economics, Hubbard’s assertion is unremarkable. It is blindingly obvious that if consumers are insulated from the cost of something, they will consume more of it than they need.

But there are soi-disant health care wonks out there who remain stunningly ignorant of economics. Thus, we get this post, in which Ezra Klein fancies himself outing a ”revealing slip”: 

Caviar and oysters … are luxury goods, sensual pleasures that we love to experience when finances permit, but understand we can do without when incomes tighten … By contrast, colonoscopies and MRIs aren’t a good time … Diagnostic tests and medical treatments are not luxury goods.

One would think that even a guy with Klein’s limitations could see that the man wasn’t saying MRIs are “sensual pleasures.” Even dumber is Klein’s assertion about medical decision making:

Hubbard characterizes the purchase of medical tests as “our decisions,” but that’s inaccurate. They are our doctor’s decisions. We don’t want to make those purchases; we’re informed that we need to make them. Then we try and figure out how to pay for them.

It is clear that Klein cannot imagine patients as autonomous entities capable of critical thinking. In this he has a lot of company among “progressives.” They are wrong. These are indeed “our decisions.”

Take Klein’s colonoscopies, for example. They are routinely recommended by PCPs for all patients older than 50. It’s a precaution. There is no reason that you can’t say “Nah, I’ll do it on the next check up.”

Refusing to do the routine colonoscopy does involve a tiny risk, but so does driving an automobile.  And, as adults, we have the right to take that chance, particularly if we must write a check for the procedure.

Under our current (hopelessly perverse) third-party payment system, it never occurs to most people to say “no.” Why? Because, as Hubbard correctly points out, the colonoscopy seems “free.”

Most medical decisions are not urgent. Hubbard’s only point is that, in a system that required us to write a check for medical services, we would be more circumspect about how much we consume.

Is that really so hard to absorb?

[July 26, 2008 @ 12:02 pm] David Catron

The primary difference between those who promote market-based health care reform and the people who prefer a government-imposed solution is their respective opinions of the customer’s intelligence.

The former believe that patients are capable of critical thinking while the latter think we are too dumb to know what’s good for us. An excellent example of the patients-are-dumb view can be found at Health Beat:

85 percent of Americans report being satisfied with the quality of care they receive—despite the fact that patients get, on average, just 55 percent of the care that experts recommend for most major medical conditions.

For the post’s author, Niko Karvounis, the huge number of satisfied patients is not a sign that the system works reasonably well despite its flaws. It is, instead, proof that patient opinion should be ignored.

The lesson here is clear: if you really want to improve health care in the U.S., you need to look beyond superficial preferences and into the nitty-gritty of how health care is delivered in our system.  

In other words, disregard the ”superficial preferences” of the customers and give them what the “experts” say they should have. This is seriously patronizing stuff.

And it gets worse. This post gets truly creepy when the purpose of polls is discussed. Karvounis apparently thinks “getting polling right” means using public opinion surveys as re-education tools:

Clearly we can’t expect polls to be the only—or even the central—way of educating the public on the relationship between care delivery and cost. But they could do a much better job at exploring if and how the public understands this relationship.

Er … Niko … the purpose of public opinion polls involves measurement. Legitimate enterprises use them to gauge public preferences so that products and services can be tailored to consumer needs.

Illegitimate enterprises use polls to manipulate public opinion so that shoddy merchandise (e.g. government-run health care) can be shoved down the customer’s throat.

Health care reform that ignores the opinions of the patients will produce a health care delivery system that will make our current system look like a Swiss watch by comparison.

Americans understand this, so Karvounis (and many other advocates of government-run health  care) conclude that the hoi polloi just don’t get it. But the people are smarter than they think.

[July 22, 2008 @ 9:42 pm] David Catron

I spent last week cycling along the Thames, visiting various towns upriver from London. The Brits were unfailingly pleasant. Wonderful people. Which is why this story from the BBC really pisses me off:

People with rheumatoid arthritis should have access to a particular class of drugs limited, NHS advisers say … The National Institute for Health and Clinical Excellence said patients in England and Wales should only be able to try one anti-TNF drug.

In other words, the health care commissars of the UK have decided that an arthritis patient whose condition doesn’t respond (or stops responding) to a particular anti-TNF (a drug that helps reduce joint pain, swelling, mobility and fatigue) doesn’t get a second chance:

NICE is systematically taking away clinically effective and proven treatments from patients and giving them just one roll of the dice when it comes to anti-TNF treatment.

And why is NICE taking this cruel position?

NICE said that giving patients two, or even three, anti-TNFs is not cost-effective …

So what if tens of thousands of patients must live with treatable pain? Who cares if these people have already paid (via taxes) for decent health care? Not the apparatchiks at NICE.

I guess this is what is meant by “Perfidious Albion.” The people I met in England deserve better than this.  So do we.

[July 10, 2008 @ 9:59 pm] David Catron

As expected, the Senate has gutted Medicare Advantage, effectively killing the last hope of market-based Medicare reform. The “news” media and the AMA are spinning this act of stupidity as a victory for beleaguered physicians over mean-spirited Republicans and insurance company robber barons.

But the physicians didn’t win a victory. All they got was a temporary stay of execution. The reimbursement cuts will be back with a vengeance, probably in 2010, and they will stick next time.  Instead, the docs were duped into euthanizing their only real hope of escaping the endless cycle of pay cuts and metastisizing Medicare regulations.

And it wasn’t the insurance companies who lost. The real losers were low-income, rural and minority seniors. Medicare Advantage is very popular with these patients because of its lower co-pays, more comprehensive benefits, and the increased primary care access the program provides in underserved areas. Per the Heritage Foundation:

According to a 2007 CMS report, 57 percent of Medicare beneficiaries have incomes between $10,000 and $30,000 annually, compared to 46 percent of beneficiaries in traditional Medicare. Also, 27 percent of Medicare Advantage enrollees are minorities, compared to 20 percent of enrollees in traditional Medicare.

The Senate’s craven and short-sighted vote condemns these patients to the tender mercies of traditional Medicare which, due to its unsustainable fiscal situation, will increasingly be forced to cut benefits, raise co-pays, and restrict access. This is what the Democrats, the AMA, and a few pusillanimous Republicans (a tautology, I know) have accomplished.

Good work guys.

[July 6, 2008 @ 2:43 pm] David Catron

I have written here, here, and here about the British government’s cruel policy of refusing to pay for up-to-date cancer drugs because they are “too expensive.”

And what does the government of Perfidious Albion consider worthy of funding? MailOnline provides a chart showing expenses for which Brit taxpayers must reimburse members of Parliament:

David Catron

My personal favorite is the last item: “Rent on one additional home in London or constituency.” That’s right. The British government refuses to pay for cancer drugs for dying patients, but it pays for the second homes of MPs.

This is what happens when government officials decide how to allocate health care resources. They always put political or personal considerations ahead of the patients. Always.

[July 2, 2008 @ 6:28 pm] David Catron

As I pointed out last week, state-mandated insurance benefits are an important contributor to health care inflation. Such mandates have also increased the ranks of the uninsured.

There is a glimmer of hope, however, in a piece of legislation introduced by Congressman Jeff Fortenberry of Nebraska. Today’s American Spectator contains my article on mandate madness and the Fortenberry legislation.