Sunday, June 14, 2009

Yin vs Yang on Health Care: Conservatives make a few points

=== A contrarian view of health care ===

In case any of you have come to the false conclusion that I am a reflexive liberal democrat -- simply because I oppose the hijacked monstrosity that the Republican Party has become, let me make clear that I retain plenty of ways that I can exercise contrary orneriness toward the American left. There are times when even the Frankenstein, undead monster than conservatism has become can startle you, by uttering cogent and reasonable “Goldwater-style” objections, instead of the shrill mania pouring from the Murdoch-Limbaugh-Fox nexus.  We should be ready, whenever this happens, to heap on positive reinforcement rewards!  The biggest reward of all?  To actually listen.

One example is where decent conservatives point out genuine drawbacks to the state-run, “universal single payer” health care systems so widely touted in liberal circles.  As one who lived for extended periods in both Britain and France, I have to tell you that their systems have much we can learn from.. and also some serious flaws.  Without any doubt, they are vastly more fair than ours, and do a far better job at both preventive care and ensuring healthy lives for all kids -- which (as I said last time) should be the core goal of any system.

If we must make a zero-sum choice between Canadian and US health care, then by all means, let’s dump a horror story, in favor of dull, unimaginative and paternalistically meddlesome decency.  But I am always suspicious of zero-sum games. If we’re to improve, we should recognize what the current U.S. system does well.

Let’s start by giving conservatives their say. Here’s a quote from Dennis Gartman's eponymous newsletter. "Canada is a wonderful place to have a nasty gash on one's forehead stitched, or to break one's nose in a game of pickup baseball; but have cancer, or need eye surgery, or want an MRI, and the business of medicine in Canada and/or the UK breaks down badly in favor of medical care here in the US. For example... and we wish to thank The Investor's Business Daily for the data noted here this morning

           "... here in the US men and women survived cancer at an average of just a bit better than 65%. In England only 46% survive. In the US, 93% of those diagnosed with diabetes receive treatment within six months; in Canada only 43% do, and in the UK only 15% do! For those seniors needing a hip replacement and getting one within six months, 15% get it done in the UK; 43% get it done in Canada ... and in the US 90% do! For those waiting to see a medical specialist, 23% of those in the US (fail to) get in within four weeks, while 57% in Canada have not yet done so, and in the UK 60% are still waiting after four weeks.  ......  When it comes to proper medical equipment, in the US there are 71 MRI or CT scanners available per million people. In Canada there are but 18, and in the UK there are only 14! Ah, but the best figure of all is this: 11.7% of those 'seniors' in the US with 'low incomes' say they are in excellent health, which in and of itself sounds rather low ... rather disconcerting ... and an indictment of the system itself, doesn't it? But in Canada only 5.8% do!


            "Yessiree bob, ya' jus' gotta' luv that collectivized, socialized medical care! Let's all go break a collective arm and enjoy the benefits of socialized medicine in the Commonwealth! (Canada) ... but heaven help you if you've got something really, really wrong. If that's the case, you'll be running south to the border faster than you can reach a specialist anywhere in Canada; of that we are certain."


Oh, sure, you can spot the use of cherry-picked statistics, right away. (See below.).  And you’ll note how Gartman airily dismisses the general preventive care that should be the heart and soul of any national system, especially aimed at kids, waving it away as stitching a “gash in the forehead.”  Also, I’d like to see comparison of his figures broken down by age group!  And, frankly, I’d like to smack his smug, dismissive face.  (He is not one of the of those “reasonable conservatives” I was talking about.)

Nevertheless, putting aside his reactionary reflex and total lack of humility, after his side allowed the calamity of the Bush years, still, Gartman has a point. Because what people tend to ignore is that all health care systems practice rationing.  There is simply no way to avoid it, as we all would pay any price, for any chance of health.  Thus, there is very little market elasticity.  We’ll take our dying loved one to the best doctor, period, and screw the price and screw second best.  Capitalist principles are very dicey here.  So are paternalistic ones.

The chief difference between the US and the rest of the civilized world is that we let profit-driven insurance companies do the rationing, and they do it based solely on profit considerations and whatever they can get away with.  By exiling people who have health conditions, by eliminating the poor, by refusing service for the passive or meek or less influential or less-litigious.  On the other hand, those who can pay, and fiercely enforce their insurance contracts, can get their companies to cover vast and endless expenses for procedures aimed even at extending, futilely, the very last and most painful phases of life.  The phases that take up to a fourth of all medical expense, in the United States.

Europe etc are different.  There, socialist-oid state committees ration procedures, based on criteria that seem to make sense both to those committees and to generally accepted social consensus.  While it seems both logical and laudable that they prioritize children and young adults and illnesses that can likely be cured -- a proper role for paternalistic single-payer systems -- it still seems heartless and callous that they pay for this by telling old people, or those with chronic or “hopeless” conditions that little will be spent on them.  Indeed, this is why many of the elderly rich, all over the world, fly to America for treatment.

What is seldom mentioned is an added drawback to that system.  All the money that America spends (or grotesquely overspends) on unpleasantly difficult conditions - those with a poor prognosis - often results in improved science, treatment and success! In other words, the American system serves as the world’s medical R&D test bed.  This is why MRI machines were available here - for those who could pay out the nose - long before state commissions would buy them overseas.  (And boy, was I glad to get home and use one, back in 1992, even though it cost me $1,000!  Back in Europe, where I had lived, there simply weren’t any available.  At all.)

Is the rightwing wrong about Health Care?  Sure they are, as they have made a habit of being wrong about just about everything, ever since their movement and party drank Rupert Murdoch’s Koolaid and slid into mania, years ago.  The present US Health Care System is a travesty and outrage, period.  Nevertheless, the insistence of the Left upon simply adopting what they see overseas, without discussing the drawbacks, is both lazy and doctrinaire.  It is not worthy of a nation of innovators.

=== Start Down the Road Incrementally ===

Hence, let me return to something I said  before. We could derive the topmost benefit of European style health care if we start by simply providing health care to all kids!  Now, immediately.  Without any “insurance” rigmarole.   Take care of children.  Period. Right away.  Just do it!

One method that would take a one page piece of legislation?  Simply take Medicare and extend it to the other end of the spectrum, the other demographic group that is both helpless and deserving, by simple definition.  Or else, use the kids to experiment with single-payer.  Either way, the political opposition would be in a tough spot putting up much resistance!  Americans are inherently more socialistic when it comes to children than we feel toward adults (who, we think, almost instinctively, should stand on their own two feet.)  Moreover, it lets us act upon prevention and lifelong health investment in youth, by far the best use of medical care dollars.

Seriously, why isn’t this a no-brainer?  A win-win that would let Obama achieve wonders at a stroke, while keeping both cost and complexity down and achieving the greatest bang for the buck.  Poor parents would be relieved of their greatest fear and then be able to bargain better for their own, narrower coverage.  Can anyone explain why this isn’t even mentioned?

And then, with our future safeguarded and the very worst injustice solved, we can gather the best and most sensible people from all sides to compare apples, oranges, grapes and every possible plan for dealing with adult working Americans.

==A bit on Politics==

Lighting the political lamp...  Let’s start with evidence that something special is going on. Everybody, you must watch this. Get to know the guy.  And make your conservatives watch, too. 

Of course, if there are folks on the right who remain impervious to reality.  (As there are some on the left.)  Indeed, the more sensible and moderate and consually wise Obama seems, the more extreme the fantasies concocted by the crazies.  And the more imperative it becomes, for reasonable conservatives to choose the real world.

Speaking of which...

=== Some Conservatives Really Are Openminded ===

My friend, John Mauldin, the brilliant economic analyst, appears to have joined PIMCO’s Bill Gross and other “conservative realists” in breaking away from the standard right-wing doctrine about taxes.  Not in all ways or on all issues. But enough to declare independence form Rupert Murdoch’s party line.

For example, they are much more concerned about trillion dollar deficits than about the purported investment-stifling effects of somewhat higher taxes on the upper class.  Not only are they resigned (and imply some contentment) at seeing the Bush Era’s biggest set of “largesse” breaks for the wealthy expire, next year, they hint that a modest increase might be the least-bad way to reduce both those deficits and inequities in society.  You haven’t seen the punditocracy comment on this trend very much, on TV.  But it is a sea change among the brightest, reality-oriented conservatives and may represent the front of real change in republican circles, at least among those who see reason and patriotism and pragmatism as higher virtues than dogmatism.

And now... partly in order to honor those rational conservatives, and meet them partway, here’s something sure to rile a number of you.  A remise on last time’s topic of health care.  Only from an alternative perspective.

=== ADDENDA ===

“The Obama administration is warning lawmakers that the trust fund that pays for highway construction will go broke in August unless Congress approves an infusion of as much as $7 billion...  Sen. George Voinovich, R-Ohio, said it's clear that Congress must raise the federal gas tax, which is now 18.4 cents per gallon.”

Naturally, I agree with Voinovich.  Our gas taxes are among the lowest on the planet and have encouraged wastrel attitudes for two generations.  Still, I’d like to add one suggestion.  While the gas tax is being raised, also transform it from a flat rate to a PERCENTAGE of the cost at the pump.   That way, it can automatically be indexed to rise when consumption does, and some of that rise can be dedicated to filling strategic reserves and a rainy day fund, to kick in when hard times next return.

*  One of you said:
     “I sincerely hope that those who would mock Dr. Brin’s "10,000 McVeighs" prediction are paying some attention.The murder of Officer Johns at the Holocaust Museum, the murder of Dr. Tiller, the murder of five chilean students in Miramar Beach Florida by a man obsessed with "Illegals" , and now the murder of a nine year old girl and her father by the Minutemen.”   
 Alas. Folks, you ain’t seen nothing, yet.

And finally, oooog.  See why libertarianism is often its own worst enemy. What a shame.