BCWUW4: Benny Hill Style

Be careful what you wish for:

Previous BCWUW4 posts here. Via Don Surber.

Orwellian outcomes: universal healthcare

Tony Blankley peers into a possible future:

After first squeezing the private insurance policies by undercutting their offerings with a subsidized federal government health insurance, the government then could undercut the private insurance further by denying the insurers tax deductibility unless they complied with federal health service regulations. As only the wealthiest could afford to buy private health insurance if the cost were not deductible, private health insurance companies would be compelled to follow federal benefits and cost regulations.

At that point, almost all Americans would get their health care pursuant to federally regulated systems. Then the president would be able to begin to deliver on his twin pledges to reduce the cost of entitlements and make health care overall contribute to lower deficits.

The federal regulators could do merely what the British regulators do currently:

--Constantly reduce the compensation of doctors and all other skilled health care providers. (As domestically trained American doctors became scarcer, more not-as-well-trained foreign doctors would be needed.)

--Limit the availability of medical technology. (In Canada, patients have to wait for months for MRIs, so those who can come to America for immediate diagnostic services.)

--Ration available treatment to fit the federal budget requirements. The universal digitalized health data could be used to justify non-treatment on a cost-benefit basis. For example, hip replacement for older people may be denied because they are not likely to live long enough to justify the expense.

At that point, Americans would (too late) understand more fully what happens when health care is a right rather than a service purchased by a sturdy, free people in an unfettered free market.

BCWUW4: be careful what you wish for.

How universal healthcare becomes do-it-yourself

Mike Penning, the shadow health minister, said: "It is a scandal that millions of people are resorting to pulling out their own teeth as a result of Labour's disastrous mismanagement of National Health Service dentistry.

BCWUW4: Be careful what you wish for. Previous post here.

Universal healthcare will not increase access to services

but, rather, decrease access:

Try to follow this logic: Last week the Medicare trustees reported that the program has an "unfunded liability" of nearly $38 trillion -- which is the amount of benefits promised but not covered by taxes over the next 75 years. So Democrats have decided that the way to close this gap is to create a new "universal" health insurance entitlement for the middle class.

Such thinking may be a non sequitur, but it will have drastic effects on the health care of all Americans -- and as it happens, this future is playing out in miniature in Medicare right now. Desperate to prevent medical costs from engulfing the federal budget, the program's central planners decided last week to deny payment for a new version of one of life's most unpleasant routine procedures, the colonoscopy. This is a preview of how health care will be rationed when Democrats get their way.

At issue are "virtual colonoscopies," or CT scans of the abdomen. Colon cancer is the second leading cause of U.S. cancer death but one of the most preventable. Found early, the cure rate is 93%, but only 8% at later stages. Virtual colonoscopies are likely to boost screenings because they are quicker, more comfortable and significantly cheaper than the standard "optical" procedure, which involves anesthesia and threading an endoscope through the lower intestine.

...

The problem is that what "works best" isn't the same for everyone. While not painless or risk free, virtual colonoscopy might be better for some patients -- especially among seniors who are infirm or because the presence of other diseases puts them at risk for complications. Ideally doctors would decide with their patients. But Medicare instead made the hard-and-fast choice that it was cheaper to cut it off for all beneficiaries. If some patients are worse off, well, too bad.

...

All this is merely a preview of the life-and-death decisions that will be determined by politics once government finances substantially more health care than the 46% it already does. Anyone who buys Democratic claims about "choice" and "affordability" will be in for a very rude awakening.

Good-bye innovation, good-bye less risky and more effective technologies. Let's save costs (not lives).

BCWUW4: Be careful what you wish for.

Universal healthcare starves 110 patients in one year in one country

of Great Britain (via Don Surber):

The Scottish Government statistics also showed 1,884 people were diagnosed with malnutrition in Scottish hospitals in 2008, of whom 110 died – one in 17. This is twice as bad as the situation in 1998 when a similar number – 1,805 – were diagnosed with malnutrition, but only 51 of these patients died from it – one in 35.

BCWUW4: Be careful what you wish for.

Very, very careful. Holding life expectancy and population constant, that's 1 in 600 people.

Canadian reporter reports on the Canadian universal healthcare system

Nadeem Esmail writes (via Don Boudreaux):

First things first: Canadians are funding the developed world's second most expensive universal access health insurance system. On an age-adjusted basis (older people require more care) in the most recent year for which comparable data are available, only Iceland spent more on universal access health insurance system than Canada as a share of GDP, while Switzerland spent as much as Canada. The other 25 developed nations which maintain universal health insurance programs spent less than we did; as much as 38 per cent less as a percentage of GDP in the case of Japan.

With that level of expenditure, you might expect that Canadians receive world-class access to health care. The evidence finds this is not so.

Consider the case of waiting lists. In 2008, the median wait time from general practitioner referral to treatment by a specialist was 17.3 weeks in Canada.

Canada's waiting lists are also, according to the available evidence, among the longest in the developed world. ... waiting times of more than six months for elective surgery than Australians, Germans, the Dutch, and New Zealanders, but slightly less likely than patients in the United Kingdom; and were least likely among the six nations to wait less than one month for elective surgery; - Canadians are most likely to wait six days or longer to see a doctor when ill, and are least likely to receive an appointment the same day or next day among the six universal access nations surveyed; and - Canadians are least likely to wait less than one hour and most likely to wait two hours or more for access to an emergency room among the six universal access nations surveyed.

That is hardly the sort of access you might expect from the developed world's second-most-expensive universal access health insurance system.

Access to medical technologies is also relatively poor in Canada. In a recent comparison of age-adjusted inventories of medical technologies, Canada ranked 14th of 25 nations for which data were available in MRI machines per million population, 19th of 26 nations in CT scanners per million population, eighth of 21 in mammographs per million population, and tied for second last among 21 nations in lithotripters per million population. Clearly, Canada's relatively high expenditures are neither buying quick access to care nor are they buying high-tech health-care services for the population.

Governmental restrictions on medical training, along with a number of other policies affecting the practices of medical practitioners, have also taken their toll on Canadians' access to care. Among 28 developed nations that maintain universal approaches to health insurance, a recent comparison found Canada ranked 26th in the age-adjusted number of physicians per thousand population. It should come as no surprise that Statistics Canada determined that nearly 1.7 million Canadians aged 12 or older could not find a regular physician in 2007.

While our taxes can and do pay for important and valuable services for all Canadians, we need to critically assess whether we are receiving value for the dollars we are spending.

In the case of health care, Canadians are paying for a world-class health-care system but are not receiving one in return.

And Canadians with money can always opt into the US system, so they can access better services without the long waiting times. This loophole is not adjusted for when comparing outcomes between the two countries.

BCWUW4: Be careful what you wish for.

BCWUW4 (be careful what you wish for)

Hillary's debate shadiness, by Don Surber:

That left is not pleased CNN’s handling of the Democratic debate in Las Vegas. I expect people like Allahpundit at Hot Air to nose around and discover the “townspeople” asking questions at the debate were Hillary plants. It is a given that Hillary will cheat like hell.

But the left is pouncing. It is going for the throat: CNN, the least trusted name in news. Marc Ambinder broke the story about the coed who was told to ask Hillary only an innocuous girly question about jewelry instead of grownup question on nuclear waste. Even then Hillary blew it by saying “both.”

We are seeing a rerun of 1992, when “60 Minutes” and others threw their reputations in front of the train to protect Bill from disclosures of bimbo eruptions and the like.

The difference is now the left is giving the Clintons heat. Maybe the left now realizes that it was had in the 1990s. There was no Hillarycare, no Kyoto and no gay marriage on Bill Clinton’s watch. In fact, the left was handed DOMA and welfare reform.

The irony is the lefties demanded the Democratic candidates boycott a Fox News debate in Las Vegas. How did that work out having Wolf Blitzer instead of Brit Hume question Hillary? How is it better to have Carville instead of Hannity and Colmes analyze the debate?

UPDATE: Doug Ross has more: all 6 "undecided" voters interviewed by CNN have strong ties to Clinton.

BCWUW4: Mark Perry on Sweden's health care system being inaccessible

up to 40% of patients cannot even make a phone connection.

Be Careful What You Wish For.

The Obama administration is reducing access to new healthcare solutions

in the name of Effectiveness:

In Britain, a government agency evaluates new medical products for their "cost effectiveness" before citizens can get access to them. The agency has concluded that $45,000 is the most worth paying for products that extend a person's life by one "quality-adjusted" year. (By their calculus, a year combating cancer is worth less than a year in perfect health.)

Here in the U.S., President-elect Barack Obama and House Democrats embrace the creation of a similar "comparative effectiveness" entity that will do research on drugs and medical devices. They claim that they don't want this to morph into a British-style agency that restricts access to medical products based on narrow cost criteria, but provisions tucked into the fiscal stimulus bill betray their real intentions.

The centerpiece of their plan is $1.1 billion of the $825 billion stimulus package for studies to compare different drugs and devices to "save money and lives." Report language accompanying the House stimulus bill says that "more expensive" medical products "will no longer be prescribed." The House bill also suggests that the new research should be used to create "guidelines" to direct doctors' treatment of difficult, high-cost medical problems.

BCWUW4: Be careful what you wish for.

BCWUW4: British Healthcare Horrors

Steve Bainbridge quotes Ezra Klein and adds:

The New York Times has a front page story today on the British system of rationing. It’s a long read, but an important one. And right up towards the top, you see why. The British system has made a choice. They have valued six months of life at $22,750. That’s all they can afford, they say. So here’s the question: In a government system in the US, should the government be on the hook for more than that? If six more months of life—not a cure, but a six month reprieve-- would cost $50,000, should we pay for that, keeping in mind that that money is coming from priorities like education and food stamps and wages increases? Or should we have limits? Should the system itself ration?

The real question, however, is who decides? Do you really want some government official deciding whether you get $23,751 worth of care?

What I find particularly objectionable about the British rationing system is the effort they make to prevent private funding. If I can afford to spend $100,000 to buy a six month reprieve, why should the government tell me not to do so? Yet, in the UK, opting for private funding of a single treatment apparently can result in your exclusion from the rationed care system in its entirety.

Liberty not egalitarianism is the basic principle on which the USA was founded. As Andrew Sullivan comments:

One reason I’m a conservative is the British National Health Service. Until you have lived under socialism, it sounds like a great idea. It isn’t misery - although watching my parents go through the system lately has been nerve-wracking - but there is a basic assumption. The government collective decides everything. You, the individual patient, and you, the individual doctor, are the least of their concerns. I prefer freedom and the market to rationalism and the collective. That’s why I live here.

Be Careful What You Wish For.

How to treat victims of stroke under a universal healthcare regime

Realize the hospital will not treat you, and marry into a family where the mother-in-law can correctly diagnose and treat you because her husband had previously suffered from stroke.

(Via Richard Fernandez)

BCWUW4: Be careful what you wish for.

Healthcare quotes of the day

As [my British dentist] put it starkly, why risk a lawsuit doing a root canal that takes several hours to do properly when you could just pull the tooth and be done with it? I went private.--Delia Lloyd

... the drug companies only spend about 15 cents of every dollar on research and development. That's compared to more than 30 cents in administration and marketing and more than 20 cents on shareholder equity. As an investment in R&D, I think any venture capitalist would say a company spending 15 percent on research is not a robust innovation engine.--Jerry Avorn

This makes about as much sense as saying that Dr. Jerry Avorn cannot be that smart because his brain only weighs about three pounds. Presumably, you can't be really smart--really innovative--unless your brain is at least 30 percent of your body weight! --Megan McArdle

... Jerry Avorn, chief of the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital, announces that companies don't do anything. It's no mystery how Dr. Avorn formed this belief: he pretty clearly has absolutely no idea what companies do. But the fact that he mistakes his ignorance for a fact about the universe makes me wonder if pharmacoeconomics is what my college boyfriend's roommate used to do with a few grams of cocaine and a copy of Mankiw's Principles. ... I am completely unsurprised to find out that Dr. Jerry Avorn has completed no work in economics, and indeed, so far as I can tell, no work in anything except being a professor of medicine? I'm sure he's a very good researcher on how patients use drugs. But he's pretty clearly no sort of expert at all on how companies actually make them--or anything else gracing our store shelves.--Megan McArdle

BCWUW4: Be careful what you wish for.

Massachusetts healthcare "reforms" reduce access to healthcare

The Boston Globe reports (via Don Surber):

Despite Boston's abundance of top-notch medical specialists, the waits to see dermatologists, obstetrician-gynecologists, and orthopedic surgeons for routine care have grown longer - to as much as a year for the busiest doctors.

A study of five specialties shows that the wait for a nonurgent appointment in the Boston area has increased in the past five years, and now averages 50 days — more than three weeks longer than in any other city studied.

BCWUW4: Be careful what you wish for.

BCWUW4: Subsidized housing

Be Careful What You Wish For:

The squat brick buildings of Grove Parc Plaza, in a dense neighborhood that Barack Obama represented for eight years as a state senator, hold 504 apartments subsidized by the federal government for people who can't afford to live anywhere else.

But it's not safe to live here.

About 99 of the units are vacant, many rendered uninhabitable by unfixed problems, such as collapsed roofs and fire damage. Mice scamper through the halls. Battered mailboxes hang open. Sewage backs up into kitchen sinks. In 2006, federal inspectors graded the condition of the complex an 11 on a 100-point scale - a score so bad the buildings now face demolition.

Grove Parc has become a symbol for some in Chicago of the broader failures of giving public subsidies to private companies to build and manage affordable housing - an approach strongly backed by Obama as the best replacement for public housing.

BCWUW4: New findings on our healthcare system

from Sherry Glied, via Tyler Cowen:

... the efficiency of operation of the health care system itself appears to depend much more on how providers are paid and how the delivery of care is organized than on the method used to raise the funds.

It is GPs which help the poor, not additional spending on technology or surgery

...patterns of health service utilization in developed countries suggest that the marginal dollar of health care spending -- money used to purchase high tech equipment or specialist services -- is less progressively spent than the average dollar.

And there is evidence that the more a government spends on health care, the less it spends helping people in money ways. That is, there is crowding out.

Putting $1 of tax funds into the public health insurance system effectively channels between $0.23 and $0.26 toward the lowest income quintile people, and about $0.50 to the bottom two income quintiles. Finally, a review of the literature across the OECD suggests that the progressivity of financing of the health insurance system has limited implications for overall income inequality, particularly over time.

Be careful what you wish for.

BCWUW4: Government heathcare

results in more death.

Be Careful What You Wish For.

BCWUW4: If the US goes universal healthcare

Canada is in big trouble (via Freakonomics). And of course, the U.S., too.

Be careful what you wish for.

BCWUW4: Don Surber rounds up how nationalized healthcare systems manage costs

Refuse to treat citizens.

Be careful what you wish for. A market cannot say "no" to you, only "how much".

A government program? What can't a government say?

All those who think Canada's universal healthcare is superior to the U.S system

may wish to reconsider:

The actress Natasha Richardson, who died on Wednesday from a brain hemorrhage after a fall on a beginner’s ski slope in Quebec, was not admitted to a hospital until nearly four hours after her accident, according to ambulance dispatch records obtained by the New York Times on Friday.

That is nearly three hours later than the timeline officials at the Mont Tremblant ski resort, about 90 minutes north of Montreal, offered on Tuesday, the day after Ms. Richardson’s fatal fall.

The first paramedics to arrive were turned away after Ms. Richardson declined treatment, ambulance records show, though they reported seeing the 45-year-old actress briefly from a distance. In that instance, they said they saw her sitting on a stretcher — not laughing and walking off her fall, as a resort spokeswoman said on Tuesday.

Those discrepancies seemed to introduce new questions about whether Ms. Richardson, who suffered an epidural hematoma — an accumulation of blood between the brain and the skull — after her fall, could have been saved had she been treated faster.

BCWUW4: be careful what you wish for.

I learned something cool about Canadian healthcare

from John Stossel on ABC's 20/20 last night. Some patients actually have access to advanced technologies and treatments just like Americans enjoy, and the waiting times are practically non-existent, very similar to the quick turnarounds in the U.S.

Unfortunately for its citizens, it is a privatized system for Canada's pets. The six-minute video can be found here.

Stossel, as usual, does a great job demonstrating how as bad as things are in our health care system, its much better than Canada or Europe, and how much industrialized countries rely on our medical innovation and how their wealthy come to the U.S. because it is far superior to the single-payer systems in their home countries.

BCWUW4: Be careful what you wish for.