That’s why I get riled to hear people talking about a “single-payer system,” a.k.a. socialized medicine.  You hear these catchalls constantly; but what do they mean?  Take “no access to healthcare.”  That’s a fave of people who don’t know what they’re talking about.  According to one of them, “People get refused medical procedures because they cost too much so the insurance company denies them.”  Oh really?  The doctor says, “I’m just not willing to do this for you”, is that it?

Actually, NOBODY’S refusing to let you have whatever procedure you want, but they may refuse to PAY for it for you.  There IS a difference.  So if you absolutely must have that CT, go ahead and have it done.  You might get a bill later, but that doesn’t mean you’ve been REFUSED.

In a national system, however, actual, real refusal to do something for a patient occurs.  How’d you like to be diagnosed with cancer, and on a waiting list to get treatment, AFTER already waiting 3 years to see an oncologist?  How’d you like to be having a heart attack, to be told to go home from the ER… you go home, and promptly die?  How’d you like to be a patient in an ambulance, driving around for FIVE HOURS, to different towns, trying to find an ER that, literally, will allow you to be unloaded there?  None of these examples are hyperbole; they’re dead serious truth.  I know, I used to live in the UK, and these are personal examples.

Another sick phrase is “countless Americans don’t get basic care”.  First, if they’re uncounted, how does anybody know about them?  What do they mean, “not getting basic care”?  I guess if you’re too lazy (oops, “busy”) to keep your prenatal appointment, that counts as “not getting care”.  But if you decide later to come to ER, where we HAVE  to see you, due to EMTALA, then you are getting care, so that doesn’t count then.  And the taxpayers get to pay a bigger bill for you, than they’d have had to pay if you’d just kept that appointment.

There’s the money issue for some: they can’t afford to see a doctor in his office, but they have enough to splash around making an ER visit?  But, of course, they don’t INTEND to pay for that visit.  In fact, when we see “self pay” on a patient’s information, we can assume 90% of the time it’s “self” only and no pay; the hospital has to eat the cost.  There are, of course, responsible people who DO pay their bills, but they are sadly the minority.

Say you “don’t have the money” for your meds (because it all got used up on your flashy jewelry, your cell phone—I can’t afford one of those!–tattoos, beer, or cigarettes).   Just come to the ER so the working people can pay for you.  After all, why try to be responsible and actually PAY for your insulin, when you can let things go and end up in a diabetic crisis that we have to pay for?  Oops, again, that doesn’t count as “not getting care” because we just admitted you to ICU, even though you didn’t care for yourself.

Oh, I get it…you OD’d on narcotics (we won’t say how you got them), and your kids didn’t call 911 right away, as they’re so used to you passing out, not a biggie.  And if they called, the medics’d give you that nasty narcan and end the trip, and then you’d be mad at the kids for spoiling the fun.  So they leave you till the next day, THEN call 911.  There, that counts as “not getting access to care”!  (Real life examples from my ER)

Here’s another old hairy one: “The Swedes (or fill in country of choice) have better care than the US.”  Oh, really?  If Sweden was such an Eden, why is their suicide rate so high?  Why are there so many alcoholics that they have a special home insurance company for teetotallers only?  (With, of course, lower rates).

Who scores health-care systems? WHO! WHO scores nations on various aspects of health care, and brownie points are given for having socialized medicine, whereas penalties are awarded for daring to allow such things as medical savings accounts, or not having a high enough progressive income tax.  (See, all you have to do is take away any incentive to exert yourself and earn more money than your neighbors, and ta-dah! EVERYONE’S health improves!)  Of course, WHO couldn’t possibly have an agenda.

Then there’s the issue of life expectancy (different from lifespan).  According to OECD, the US is 18 out of 30 democracies.  But, they forgot to take out homicides and car accidents!  They probably have some reason for why homicides are an indicator of poor health care (as opposed to being an indicator of the criminal-to-unarmed citizen ratio).  If only we didn’t have those pesky old homicides, we’d have a MUCH better health system, number one in fact!

Oh, here’s another oldie (but not goodie):  “People can go bankrupt trying to pay their medical bills”.  Yes, there are people with integrity who DO end up in financial straits because of health bills, but Americans are the most generous people in the world, and we usually are pretty good at chipping in to help someone in a bind.  But in a social-medicine country, that doesn’t happen much…because you’d be DEAD instead of having bills to pay, having had to wait to see a specialist, then to get diagnostics, then to get treatment….

Every choice (whether to have private or socialized medicine) leads to other choices.  So if what the media tells us is true, that “most people favor socialized medicine,” then what they’re really saying is most people would rather be dead than bankrupt.  Huh?

One final item;” High health insurance costs is what killed the US auto industry.”  Right, the UAW didn’t have ANYthing to do with insisting on old outdated, costly factories that ensured more workers had jobs, (as well as non-competitiveness).  Or the fact that UAW expected bloated wages for doing as little as possible, couldn’t possibly have had anything to do with the problem.  Nope, what we have to do is just give-give-give to anybody that asks for anything, and tax the people that are too stupid to quit their jobs.

Taking the UK or Canada as an example, what will we have to look forward to when socialized medicine is imposed on us?

1.  A lot more foreign doctors.  US citizens may demur at having to invest in rigorous training for maybe $13 to $18/hr (what Medicare currently pays), whereas foreigners may still be drawn to the US as being better than where they came from.

2.  Long waits in ERs.  Canada has some ERs where people wait up to FIVE DAYS. Long waits for treatment, like a three-year waiting list (in Canada) to get an appointment at a pain clinic.  Long waits for diagnostics; two years or longer, as in both Britain and Canada.

3.  IF private insurance is altogether banned, expect to see black-market medicine or “health care brokers” as they have in Canada, who help you get an appointment to see a doctor for a fee.  Otherwise, as in Britain, where it is allowed, private health insurance will be a growth area, as people see through the “Beveridge fallacy.”  (Beveridge being the MP that pushed for Britain’s NHS.)  Expect also, numbers of American going to other countries for medical treatment, as 33% of Canadians now do.

4.  Fewer doctors overall; but the ones who are left will be more realistic about what they’ll get paid.
5.  Initial relief for some businesses in terms of not having to buy insurance for employees, followed by punishing tax burdens, which will crush  businesses.

6.  Stagnant economy (not taking anything else in the economy into account!) due to businesses having to pay such high taxes they cannot re-invest in themselves.  More businesses leaving the USA.

7.  Higher prices (again, not taking anything else into consideration), and lower wages for the jobs that are left, and nobody complaining about it as they’re just glad to be working.

8.  As things get tougher, there will be fewer rummage sales due to people not being able to afford things they don’t really need, or being able to replace/throw out things.  EBay would likely take a beating.

9.  Secondhand stores will still be around, but the pickings won’t be anything like what you see currently in US Goodwills.

10.  Expect more people to be permanently “on the dole”, as they say in Britain.  More who’d rather take what nanny gives them than stand on their own two feet.

Overall, the US will be a lot poorer, if we get socialized medicine, and that without even considering the rest of the economic mess we have.  And one day maybe NObody will be left working to pay for this mediocrity.   Try as they might, the tax-and-spend crowd will be faced with one certainty: no society ever yet TAXED its way to prosperity.

Sincerely,
Emily Matthews

June 15, 2009

National Health Care Is Making Me Sick was originally featured on Whiskey and Gunpowder

What are predictable results of government ramming socialized medicine down our throats?  We can’t stop the programs, so how can we make money from the ineluctable outcome?  A few ideas spring to mind immediately:

1. Has it dawned on anyone in Washington that Socialized medicine just might have some slight effect on insurance companies?  It might be time for us to consider shorting a few viciously…or is that still illegal?!

The health insurance rack…ah, business…is one of the largest in America.  The law as proposed will make it illegal to have private insurance to supplement the government’s “single payer” plan.  A major portion of the GDP will be destroyed in that area alone.  What will happen to those who currently underwrite supplements to Medicare?

No one can prognosticate how many irrational requirements, forbidden activities, and finable offenses will come out of the final legislation, but we can certainly conclude that this shake up and shake down is going to be off the Richter Scale in terms of lost jobs and destroyed capital.  When the government is the HMO there is no place for a private HMO.

2. The proposed law also makes it illegal for doctors to provide services outside of the system and it will determine what doctors and hospitals are paid.  This is certain to lead to staff shortages, probably more quickly than we are anticipating.

A. How many older doctors will retire rather than submit?  Why should they work just as hard for a great deal less money?  Why should they tolerate having their medical judgment overridden by a bunch of penny-pinching bureaucrats?  “First, do no harm” also prohibits doing nothing when treatment is indicated clearly.

B. How many physicians are already considering retiring from the practice of medicine because of the proposed ukases which would require them, under penalty of law, to perform abortions on demand.

C. Any young student with the brains to make it through medical school will tend to decide quickly that it would be far more sensible, faster, and lucrative to become a dentist or a veterinarian.  Any good vet makes at least $100K, but socialized doctors don’t.  This isn’t guesswork; it is the experience in Canada and England.  A quick perusal of the literature reveals also that it is best not to become ill after June and that a dog can get an MRI the same week but people wait months, if they get them at all.

3. What effect will this have on the cost of medical and nursing schools?  Silly question; tuition will go up because it costs the same amount to offer instruction and classrooms whether they are full or half full.  We can prognosticate that less qualified applicants will be admitted because fewer will apply.  Corners will be cut wherever possible.  Fewer courses will be offered.  Why train in procedures likely to be forbidden?  Standards will be lowered.  It may even become a great deal easier to pass the exams to be able to write “M.D.” after one’s name.

4. What is to be done with the clerks in all doctors’ offices who do nothing except handle insurance paperwork–and keep their doctors up to date on how to write up bills and lab requests to obtain the greatest return from insurance companies?  Some of them may find jobs in the new bureaucracy, but one putative benefit of socialized medicine is that less paperwork will be needed to provide better records.  Good insurance clerks are paid well, and deservedly so, for theirs is specialized work.   We can suppose that those who train typists to transpose doctor’s recorded notes may find less business (knocking out their schools and a good at home source of income for quite a few), because a pretty good guess is that over-scheduled, under-paid doctors aren’t going to generate the sort of records we are accustomed to now.

5. The AMA and insurance companies have enormous lobbies, which makes one wonder why there isn’t any outcry from those areas.  That is really a very interesting point upon which to speculate.  What does the AMA expect to get out of this that is worth the price of tolerating bureaucrats to set fees and determine procedures? Do they think that going along will prevent even more Draconian cuts and restrictions, or can someone in the Bar today come up with a better answer to “Cui bono?”

6. Pharmaceutical companies spend lots of money in Washington; could it be that they do not expect the prices of their products to be cut as proponents of socialized medicine insist is one way costs will be controlled?  Perhaps a lessening of the restrictions that make developing a new drug cost billions has been tendered?  Again, what’s in it for Merck and Roche and Lilly not to scream their heads off? A good prediction is that only generics will be allowed to be prescribed, which is bad news for those of us for whom Synthroid is not an adequate substitute for Armour Thyroid, and a very nasty lump for Armour, which gets $90 from me, alone, every time I fill my prescription, instead of three or four bucks.  What is the point of developing proprietary drugs if the cost cannot be recouped many times over?

7. We old-timers are being told we will simply have to learn to live with our aches and pains and that services will be cut for us in order to care for the younger population better.  Doesn’t it make you feel all warm and fuzzy to know that you may not get a life-saving procedure because it “costs too much at your time of life and the money will be better spent on millions of lawbreakers granted amnesty and citizenship, instead?”  Already there are services to help us find superior medical and dental care at deeply reduced prices in India, for example.  However, if/when “Cap and Trade” is pushed through, what is that going to do to the airline industry?  We may well end up with no viable way to obtain adequate health care at any price short of suborning our private physicians.  I joked with mine when I saw him for routine blood work a couple of months ago that between the coming depression and socialized medicine we might end up skulking to meet in an alley at midnight, me with a chicken in my hand.  My brilliant young physician, with enormous student loans, looked grim, and said, “I’ll take it!”  Back in The Great Depression a chicken was considered a good fee, by the way.

8. Where will peripheral specialties come into all of this?  Lasik surgery, for example.  Will such surgeons be exempted, or will they be driven out of business because glasses were good enough for Benjamin Franklin?

“Is there a lawyer in the house?”  It will, one can only suppose, be forbidden for medical personnel to assist in times of crisis, accident, or disaster since the law as drafted forbids practicing outside of the system.  Few do anyway these days because of the danger of lawsuits.

If anyone here will admit to being an attorney, please take a shot at explaining the Constitutional justification for government controlled medicine, since it obviously isn’t going “to promote the general welfare.”  While you’re at it, explain how anyone can justify making it a crime for a duly trained and licensed doctor to treat patients who seek his care.

For preliminary actions…just off hand, I would not invest in a chain of dialysis clinics or expect MRI apparatus to sell as well.   We should probably be leery of many pharmaceutical companies.  On an individual level, it might even be a good idea to go get heart by-pass surgery now if you expect to need it in the next few years, although there are better choices.

So…I’ll raise my glass of Lambrusco (full of healthful substances and a modest jolt of alcohol), and look forward to hearing your views on how to profit from what is coming our way.

Regards,
Linda Brady Traynham

May 5, 2009

What You Can Expect from Socialized Medicine was originally featured on Whiskey and Gunpowder

“The federal government recorded a $1.3 trillion loss last year — far more than the official $248 billion deficit — when corporate-style accounting standards are used, a USA Today analysis shows.

“The loss reflects a continued deterioration in the finances of Social Security and government retirement programs for civil servants and military personnel. The loss — equal to $11,434 per household — is more than Americans paid in income taxes in 2006…

“Modern accounting requires that corporations, state governments, and local governments count expenses immediately when a transaction occurs, even if the payment will be made later.

“The federal government does not follow the rule, so promises for Social Security and Medicare don’t show up when the government reports its financial condition…

“Unfunded promises made for Medicare, Social Security, and federal retirement programs account for 85% of taxpayer liabilities. State and local government retirement plans account for much of the rest…

“The Financial Accounting Standards Advisory Board, which sets federal accounting standards, is considering requiring the government to adopt accounting rules similar to those for corporations. The change would move Social Security and Medicare onto the government’s income statement and balance sheet, instead of keeping them separate.

“The White House and the Congressional Budget Office oppose the change, arguing that the programs are not true liabilities because government can cancel or cut them.

“Chad Stone, chief economist at the liberal Center on Budget and Policy Priorities, says it can be misleading to focus on the government’s unfunded liabilities because Medicare’s financial problems overwhelm the analysis.

“‘There is a shortfall in Medicare and Medicaid that is potentially explosive, but that is related to overall trends in health care spending,’ he says.”

$59 Trillion Review

1. The shortfall is misleading because Medicare overwhelms the analysis.
2. The apparent solution, then, is to ignore Medicare and Medicaid, as if they did not exist.
3. Besides, “the programs are not true liabilities because government can cancel or cut them.”

Yeah, right. Let’s see it. Let’s see Bush (or any politician, for that matter) come on TV and say we are canceling Medicaid, Medicare, and Social Security.

The best we can hope for is a complete revamp of our medical system. I talked about this in “Health Care Costs Soar — What Are We Getting for It?”

U.S. Is Dead Last

A study of comparative performance of American health care shows that you can find much better care, but you can’t pay more. The Commonwealth Fund reports:

“Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries… Compared with five other nations — Australia, Canada, Germany, New Zealand, the United Kingdom — the U.S. health care system ranks last or next to last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes.”

Competing Plans

1. President Bush announced his plan for “Affordable, Accessible, and Flexible Health Coverage” in the State of the Union message.
2. California Gov. Arnold Schwarzenegger has his health care plan.
3. Democratic Sen. Ron Wyden has a health care plan.
4. Families USA, the self-proclaimed “voice for health care consumers,” pans Bush’s health savings account approach while offering its own plan.

Darn near anything is better than what we have now, but none of the above programs Is remotely close to what is needed. All of the above ideas are patches to our current broken system.

In “Health Care Costs Soar — What Are We Getting for It?,” I was attempting to be practical when I suggested we “take a look at New Zealand and start all over from there. Reducing expenses by two-thirds and improving care dramatically at the same time has to be a good start.”

Is a single-payer, government-sponsored system like New Zealand’s ideal? No. It is not. It’s far from ideal. But is it orders of magnitude better than what we have today? Most likely, it is. Certainly, I was correct when I suggested that we start all over. What’s debatable is from where.

Ideally, one can argue that the best solution is for the government to get out of the way and let the free market work. From a practical standpoint, however, I am wondering if something like what New Zealand or the U.K. have is the best we can get. Perhaps it is. In fact, given the current political state of affairs, it might be hoping for too much. The problem is that right now, we have purposeful disincentives every step of the way.

Purposeful Disincentives

1. Insurance companies do not make money paying claims. The result: Paperwork and bureaucracy are both increased on purpose so that claims are not paid.
2. A visit to the emergency room might be 100% paid on most policies, but a doctor’s office visit might have a huge deductible. The result: Needless emergencies.
3. Medical liability costs are soaring. The result: Every test (no matter how unlikely the benefit) is taken.
4. There is competition for services and bragging about technology between hospitals. The result: The latest medical equipment is everywhere, even if it serves two patients a year. Costs are passed on by charging $10 a pill for simple aspirin.
5. Drug imports from Canada are restricted. The result: Drug costs are soaring.
6. Government policies mandate payment for fertility treatments. The result: Women 40-plus years old are covered for the costs of artificial insemination treatments as many as five times before they get pregnant.
7. Medicaid (for the first year) is not qualified. The result: You get one year automatically on Medicaid before getting audited and kicked off if you do not qualify. There are no post actions to go back for payments. You are simply dropped.

The time to start over is now. Start over from where is what is debatable. We can debate ad nauseam the correct approach. But the closer we can get to a free market approach, the better off we will all be.

Regards,
Mish

June 1, 2007

$59 Trillion in the Hole (and Counting) was originally featured on Whiskey and Gunpowder