Quotulatiousness

September 9, 2009

An example of the polarizing nature of the health debate

Filed under: Cancon, USA — Tags: — Nicholas @ 13:26

This is a classic polarizing topic for debate . . . so much so that very little information is exchanged between the sides because they’ve already made their minds up and facts are not going to change anything. I’m not over-fond of Canada’s healthcare system: my dealings with it have been quite uneven, but generally not good experiences. That aside, there are positive things about the system along with the negative.

The American debate is well past the point of rationality. As an example, the other day I read an announcement that a well-known person was struggling with cancer and that the prognosis was not good (and I’m deliberately not linking to the discussion in question). The responses on that particular page split fairly evenly into three groups:

  • People who expressed their sympathy and hopes for her recovery.
  • People who pounced on her illness as a reason for implementing Obama’s healthcare proposals right now.
  • People who used her illness as a way to decry socialized medicine in all its forms.

Comments from group two failed to notice that the family lives in Canada. Comments from group three failed to notice that this was a human being in pain, facing an even more painful future. Neither group covered themselves with glory.

I can’t even say I was surprised. Disgusted, but not surprised.

September 2, 2009

NHS better than Canadian health system, says Jeremy Clarkson

Filed under: Bureaucracy, Cancon, Health — Tags: , — Nicholas @ 00:03

It’s always surprising to find a British author willing to call their massive National Health Service (NHS) “a monster that we can barely afford”, but that’s exactly what Jeremy Clarkson says in his latest Times column. But that’s merely an aside. The venom in this article is reserved for Canadian healthcare, specifically in Quebec:

Some say America should follow Canada’s lead, where private care is effectively banned. But having experienced their procedures while on holiday in Quebec, I really don’t think that’s a good idea at all.

[. . .]

Now, we are all used to a bit of a wait at the hospital. God knows, I’ve spent enough time in accident and emergency at Oxford’s John Radcliffe over the years, sitting with my sobbing children in a room full of people with swords in their eyes and their feet on back to front. But nothing can prepare you for the yawning chasm of time that passes in Canada before the healthcare system actually does any healthcare.

[. . .]

After a couple of hours, I asked the receptionist how long it might be before a doctor came. In a Wal-Mart, it’s quite quaint to be served by a fat, gum-chewing teenager who claims not to understand what you’re saying, but in a hospital it’s annoying. Resisting the temptation to explain that the Marquis de Montcalm lost and that it’s time to get over it, I went back to the boy’s cubicle

[. . .]

And they also had the cash to employ an army of people to slam the door in your face if you poked your head into the inner sanctum to ask how much longer the wait might be. Sixteen hours is apparently the norm. Unless you want a scan. Then it’s 22 months.

At about 1.30am a doctor arrived. Boy, he was a piece of work. He couldn’t have been more rude if I’d been General Wolfe. He removed the bandages like they were the packaging on a disposable razor, looked at the wound, which was horrific, and said to my friend: “Is it cash or credit card?”

August 24, 2009

Infant mortality rates in the US

Filed under: Health, USA — Tags: — Nicholas @ 07:54

Steve Chapman looks at one of the bigger question marks in the debate over health care in the United States: why such a high infant mortality rate?

The American medical system has the latest technology, the greatest variety of new drugs, and unparalleled resources. But anyone who thinks we’re getting something great for our dollars inevitably encounters a two-word rebuke: infant mortality.

The United States is the richest nation on Earth, but it comes in 29th in the world in survival rates among babies. This mediocre ranking is supposed to make an irrefutable case for health care reform. If we cared enough to insure everyone, we are told, we would soon rise to the health standards of other modern nations. It’s just a matter of getting over our weird resistance to a bigger government role in medical care.

[. . .]

No one denies the problem. Our infant mortality rate is double that of Japan or Sweden. But we live different lives, on average, than people in those places. We suffer more obesity (about 10 times as much as the Japanese), and we have more births to teenagers (seven times more than the Swedes). Nearly 40 percent of American babies are born to unwed mothers.

Factors like these are linked to low birth weight in babies, which is a dangerous thing. In a 2007 study for the National Bureau of Economic Research, economists June O’Neill and Dave O’Neill noted that “a multitude of behaviors unrelated to the health care system such as substance abuse, smoking and obesity” are connected “to the low birth weight and preterm births that underlie the infant death syndrome.”

August 15, 2009

QotD: The biggest risk in moving to a single-payer system

Filed under: Health, Quotations — Tags: , , — Nicholas @ 11:05

My objection is primarily, as I’ve said numerous times, that the government will destroy innovation. It will do this by deciding what constitutes an acceptable standard of care, and refusing to fund treatment above that. It will also start controlling prices.

Now, at this point in the discussion, some interlocutor starts chanting what I’ve come to think of as “the mantra”: othercountriesspendlessandhavelongerlifespans. Then they ask me how I can ignore the overwhelming evidence that national health care is superior to our terrible system. Now, what’s odd about this is that all of those countries do precisely what I am concerned about: slap price controls on the inputs, particularly pharmaceuticals. Their overwhelming evidence indicates that I am 100% correct that a government run system in the US will destroy the last really profitable market for drugs and medical technology, and thereby cause the rate of medical innovation to slow to a crawl.

[. . .]

The things that make markets innovate — profit potential — have been mostly squeezed out of the system. The things that hasten market discover — prices — have also been increasingly relegated to central authority. Having something like that in the United States would produce exactly the outcome I’m worried about. So if Matt is right, and this is where the slippery slope ends up, my nightmare will have been realized.

Megan McArdle, “What Does It Mean To Have a Private Health Care System?”, Asymmetrical Information, 2009-08-13

August 14, 2009

If it isn’t Astroturf . . .

Filed under: Health, Politics — Tags: , — Nicholas @ 12:34

. . . maybe it really is grassroots? Jesse Walker decodes some of the hysteria around both the protests and the official responses:

Clashes keep breaking out at the “town hall” meetings devoted to discussing health care reform. Usually the excitement amounts to some angry questions and heckling, but sometimes there’s more. Six people were arrested at a demonstration outside a meeting in St. Louis. Violence erupted at a town hall in Tampa after opponents of ObamaCare were locked out of the building. A North Carolina congressman cancelled a meeting after receiving a death threat; the pro-market group FreedomWorks, which was involved in some of the protests, fielded a death threat of its own. Supporters of the president’s health care reforms, who used to tout the support he’d received from the pharmaceutical and insurance industries, are now accusing the very same companies of riling up “mob violence” to stop the plan.

As the charges and countercharges fly, here are three maxims to keep in mind:

1. It isn’t Astroturf after the grassroots show up.

[. . .]

2. It isn’t unprecedented if there are obvious precedents. When someone like New York Times columnist Paul Krugman claims that the “mob aspects” at the meetings are “something new and ugly,” all he’s demonstrating is that he’s an economist, not a historian. When it comes to bands of angry citizens being disruptive, it isn’t hard to find earlier examples in American history. It isn’t even hard to find earlier examples in 21st century American history. Just go to Google and punch in phrases like “guerrilla theater,” “antiwar protest,” and “Code Pink.”

[. . .]

3. It isn’t fascism if…actually, you can stop there. IT ISN’T FASCISM, you numbskulls.

August 12, 2009

QotD: “an abject failure for the Obama administration”

Filed under: Health, Politics, Quotations, USA — Tags: , , , — Nicholas @ 12:34

But who would have thought that the sober, deliberative Barack Obama would have nothing to propose but vague and slippery promises — or that he would so easily cede the leadership clout of the executive branch to a chaotic, rapacious, solipsistic Congress? House Speaker Nancy Pelosi, whom I used to admire for her smooth aplomb under pressure, has clearly gone off the deep end with her bizarre rants about legitimate town-hall protests by American citizens. She is doing grievous damage to the party and should immediately step down.

There is plenty of blame to go around. Obama’s aggressive endorsement of a healthcare plan that does not even exist yet, except in five competing, fluctuating drafts, makes Washington seem like Cloud Cuckoo Land. The president is promoting the most colossal, brazen bait-and-switch operation since the Bush administration snookered the country into invading Iraq with apocalyptic visions of mushroom clouds over American cities.

You can keep your doctor; you can keep your insurance, if you’re happy with it, Obama keeps assuring us in soothing, lullaby tones. Oh, really? And what if my doctor is not the one appointed by the new government medical boards for ruling on my access to tests and specialists? And what if my insurance company goes belly up because of undercutting by its government-bankrolled competitor? Face it: Virtually all nationalized health systems, neither nourished nor updated by profit-driven private investment, eventually lead to rationing.

I just don’t get it. Why the insane rush to pass a bill, any bill, in three weeks? And why such an abject failure by the Obama administration to present the issues to the public in a rational, detailed, informational way? The U.S. is gigantic; many of our states are bigger than whole European nations. The bureaucracy required to institute and manage a nationalized health system here would be Byzantine beyond belief and would vampirically absorb whatever savings Obama thinks could be made. And the transition period would be a nightmare of red tape and mammoth screw-ups, which we can ill afford with a faltering economy.

Camille Paglia, “Obama’s healthcare horror: Heads should roll — beginning with Nancy Pelosi’s!”, Salon.com, 2009-08-12

August 10, 2009

Healthcare systems compared

Filed under: Cancon, Economics, Health — Tags: , , — Nicholas @ 12:55

No, not the usual red-in-tooth-and-claw US system of mercenary medicine against the shimmering city-on-the-hill of [Canadian | British | Swedish | Generic European] socialized medicine. This one is a bit easier to compare: human verses pet healthcare. Theodore Dalrymple discusses the issue:

As a British dog, you get to choose (through an intermediary, I admit) your veterinarian. If you don’t like him, you can pick up your leash and go elsewhere, that very day if necessary. Any vet will see you straight away, there is no delay in such investigations as you may need, and treatment is immediate. There are no waiting lists for dogs, no operations postponed because something more important has come up, no appalling stories of dogs being made to wait for years because other dogs — or hamsters — come first.

The conditions in which you receive your treatment are much more pleasant than British humans have to endure. For one thing, there is no bureaucracy to be negotiated with the skill of a white-water canoeist; above all, the atmosphere is different. There is no tension, no feeling that one more patient will bring the whole system to the point of collapse, and all the staff go off with nervous breakdowns. In the waiting rooms, a perfect calm reigns; the patients’ relatives are not on the verge of hysteria, and do not suspect that the system is cheating their loved one, for economic reasons, of the treatment which he needs. The relatives are united by their concern for the welfare of each other’s loved one. They are not terrified that someone is getting more out of the system than they.

And, yes, I know it’s extremely bad form to quote yourself, but here is what I wrote on the subject back in 2004:

It boggles the mind to think that it is possible for pets to receive faster, better-organized, more personalized, and more friendly healthcare than their human owners are able to get. And it’s absolutely true.

My wife works in a vet clinic. I know how much the staff at the clinic care about their patients and the families of their patients. They do their very best to ensure that the cats are properly diagnosed and treated. But they are paid for their work . . . by the families of the patients.

One of the comments on Marcel’s original post talks about “the Vet’s next Porsche purchase”. That by itself shows the utter ignorance of the commentator: you do not go into veterinary medicine to get rich. For the length of academic study, it’s probably the worst-paid bio-science field there is. The veterinarians, vet assistants, and vet technicians could all earn significantly higher wages in other fields for the same investment of time and money in training.

Medicine, whether for humans or for other animals, is an expensive field: typical Canadians don’t really know this, as a rule, because we don’t pay for it directly. Vets, as a rule, don’t have the latest and greatest equipment because they are running private businesses which have to finance equipment purchases out of their own funds. They generally have the best compromise they can manage between what’s available and what’s affordable.

Treatment for patients must be decided with an eye to costs: Fluffy may need treatment X, but if it’s going to cost hundreds or thousands of dollars, Fluffy’s owner is left with an unwelcome decision to make. We never think of this in terms of our own healthcare: instead of rationing by dollars, we ration by time. The resources are still scarce, but we pretend that delaying surgery for a painful ailment is better than paying extra to get the surgery done sooner; in fact, in Canada, there’s no choice involved at all.

The other pernicious effect of hiding the actual costs is to increase the demand for relatively trivial treatments (which could often be taken care of by family doctors, walk-in clinics, or even pharmacists). If you never see a bill, you never feel any reason to limit your personal demand on the system. It’s rational for you to extract as much personal benefit from the system as possible: you paid taxes to support it, right?

August 7, 2009

The error of being generous to your opponents

Filed under: Economics, Government, Health, USA — Tags: , — Nicholas @ 12:48

Megan McArdle is called to task for making a mistake . . . through being too generous to her opponents:

I erred so low because I was trying to be charitable to the cause of national health care. You see, the reason that insurance premia are so high in New York State is that New York State enjoys community rating, guaranteed issue, and a very generous bevy of mandatory services. The result is that the cost of insurance is very, very high. What I failed to realize was just how radically out of line New York’s rules had pushed its health care costs. The average premium across the United States has increased about 25% since 2004. In New York, the rate of inflation has apparently been about 16 times that. I wasn’t “aware” that insurance premiums have doubled and tripled over the last seven years, because for the country as a whole, this isn’t true.

So yes, John, the Atlantic’s economics expert didn’t realize just how much the kind of regulations Democrats are now pushing had managed to screw up New York’s health insurance market. In trying, while writing a blog post on the fly, to err on the side of charity towards my ideological opponents, I grossly misled my readers. Massive state interference in the insurance market is clearly much, much worse than I — the eternal pessimist! — managed to imagine. Thanks for calling that oversight to my attention.

Observe and report, citizen!

Filed under: Government, Politics, USA — Tags: , , — Nicholas @ 12:37

QotD: It’s not insurance, it’s welfare

Filed under: Health, Quotations — Tags: , — Nicholas @ 00:06

Have [New York Times writers and editors] no understanding of risk management? If it is controversial for health insurers to reject sick applicants, it should be controversial for life insurers to refuse to insure the already dead, and for car insurers to refuse to insure cars that have already been wrecked.

Doing that may be required by Congress and cheered by the New York Times, but that doesn’t make it a good thing for America. It doesn’t even make it insurance. It’s welfare. We can debate whether such welfare is good policy, but let’s discuss it honestly. Calling welfare “insurance” muddies thinking.

Requiring insurance companies to cover the sick takes away insurers’ power to encourage safer behavior. This will soon turn insurance into a form of expensive, taxpayer funded welfare.

John Stossel, “Welfare, Not Insurance”, John Stossel’s Take, 2009-08-05

July 22, 2009

Looking for Canadian health stats?

Filed under: Bureaucracy, Cancon, Health — Tags: , , — Nicholas @ 09:59

Kathy Shaidle has some useful advice for Americans who may be looking for information on the Canadian healthcare system.

Up here, the key word in discussions is “wait times”. That’s what we say, when you say “rationing.” The ONLY way for our system to work is to “hope” somebody ahead of you in the line for care dies, and you can take their place. A very cynical, nasty way to run a country, to say the least.

So go to Google.ca (especially the “News” section) and look up “wait times” if you want to get the real Canadian conversation on our health care system.

July 20, 2009

QotD: TANSTAARTHC

Filed under: Economics, Health, Liberty, Quotations — Tags: , , — Nicholas @ 12:37

There. I said it. Someone had to.

The acronym would be TANSTAARTHC. Nowhere near as euphonius as TANSTAAFL.

I broach the subject because I can’t seem to turn on a TV or radio without hearing, “Health care is a human right.” The phrase has entered the zeitgeist. Google it and you’ll get 25k hits. Google “right to health care” and you get 200k. Maybe I’m not listening hard enough, but I hear no one questioning its validity.

A right is intrinsic. It’s not given to you, it’s something you’re born with. Its existence is not dependent on the actions of others. In fact, only by the actions of others can it be taken from you.

F. Paul Wilson, “There ain’t no such thing as a right to health care “, Libertarian Enterprise, 2009-07-19

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