medicine

Going Galt - Medical Division

I know the Left likes to ridicule anyone who mentions Ayn Rand or Atlas Shrugged. They especially like it when conservatives or Republicans say something about "Going Galt".

It seems to me that one reason for this is a (deliberate?) misunderstanding of what we -- or at least, I -- mean when we say that.

By "Going Galt", it seems to me, we (mostly) mean that someone will not take that next step, make that investment of time, effort, thought, or money, to make their mark in the world and make a difference.

Like Rand's great philosopher Hugh Akston who became a short order cook in a roadside diner, rather than using abilities to their utmost, someone who "goes Galt" might simply choose to do something else, rather than take the extreme Galt/Wyatt/Mulligan option of completely removing themselves from the reach of the looters and the moochers.

In that light, I think Obamacare is going to cause us more problems than many have been imagining. . . .

I have heard from a surgeon whom I trust and respect (though I don't know his source for this information) that much more than half of all surgeons are 55 or older.

Given the basic premise that people do things based on the incentives involved, and given the further premise that Obamacare (or, if it fails, the next incarnation of it) will reduce the financial and professional incentives to become a doctor, my friend believes strongly that we will be in for medical rationing simply because we will not be able to find enough doctors, regardless of what happens due to gov't bureaucratic manipulations.

My friend spent 14 years -- FOURTEEN YEARS -- after college training to become a doctor, then surgeon, then getting his specialty skills.

What makes people think that we will be able to find "volunteers" to go through such a rigorous and lengthy program, all the while incurring massive amounts of debt for the cost of their schooling and training, just so that they can be asked to work 36-hour shifts* for whatever salary a bureaucrat determines they are worth?

My friend loves his work. He does it for the satisfaction he gets from it.  (Now.) But when asked if he would have gone through everything he went through solely for the satisfaction of the job, he says no.  The potential to make a good living for himself and his family was definitely part of the attraction to the career choice in the first place.

There are other jobs he could have loved and been accomplished in performing, while paying well.  Plus they would have afforded him much more time to spend with his family as his children grew up, rather than having to spend significant portions of not just days but nights as well away from home and on call.

The point I want to leave you with is that we can expect to lose men such as him from the medical profession if we insist on making them gov't cogs rather than free actors, capable of making what they can in a market which rewards them for their dedication, efforts, sacrifices, and skills.

Beware what you wish for, Obamacare supporters.  You might just get it . . . and then the supply of producers whose efforts you have appropriated will dry up, relieving you of the burden of looting them.

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* Yes, I know the 24+ hour shifts don't last forever.  And that they are concentrated in the early years of training, but does that really make anyone think that people will jump at the chance to perform such arduous tasks for the pittance the DC paper pushers are willing to fork out?  Really?

The Human Cost of Healthcare Reform

This week the Congressional Budget Office projected enormous cost increases under the current congressional plan for national health care. It was promoted as saving taxpayers money, but the CBO estimates a cost over $1 trillion and it is likely to raise the tax burden for many Americans to close to 60% of their already dwindling incomes, as government bureaucrats balloon the cost of what is already the most expensive health care system in the world. The devastating financial impact of ObamaCare for the nation and every citizen is now overwhelmingly clear. But just in case you still harbor any illusions about how disastrous current proposals for national health care would be, I thought it was time to revisit the other cost — the cost in human suffering and loss of life under socialized medicine.

A key element of the cynically misnamed Affordable Health Choices Act, which is the plan currently being rushed through congress to meet deadlines and criteria set by President Obama, is rationing health care using Comparative Effectiveness Research (CER) methodology where government bureaucrats would set up schedules by which treatment would be allocated based on statistics and cost to benefit ratios rather than the interests and needs of the specific patient. Decisions on care would be matters of policy based on group effectiveness rather than on a case by case basis and doctors would have to abide by these decisions without regard to the welfare of the patient.

The impact of rationing in other nations where it has been introduced as part of the national health care system has been horrendous. It attempts to reduce the financial cost of the system by a trade-off which increases the cost in lives lost and individual suffering. Two nations with many similarities to the United States which have resorted to rationing health care are Great Britain and Canada. In both nations the human cost has been high and the results are easily quantified.The failure of rationing comes down to two basic problems — denial of treatment and very long wait times. Both of these can result in suffering and death for patients, especially those with critical and chronic conditions which are treated easily and routinely in the United States today, but which often result in death in Great Britain and Canada.One telling scenario of denial of care comes with cardiac patients. In the United States if you come into a hospital with an arterial blockage you are usually scheduled for an angioplasty or a bypass in a matter of days, because that is the best way to achieve a long-term solution to the problem. In Canada and Britain the common response is dictated by a shortage of surgeons and facilities, so you are given beta blockers to try to keep your heart functioning and sent away. If you're lucky you'll survive the months that it takes to get you scheduled for surgery or maybe come into the hospital in the middle of an actual heart attack when your chances of surviving the surgery are lower but they may actually operate. Or even better, if you live in Canada they may slap on a heart monitor and have an ambulance drive you to the US for treatment as they do with hundreds of cardiac patients every year. The sad reality is that many who are denied immediate surgical treatment for heart problems just die.In the US a coronary patient is four times as likely to receive surgical treatment as in Britain. In the US only 5% of Americans are made to wait more than four months for surgery. In Canada 27% wait four months or more and in Britain 36% wait four months or more. While the base rate of coronary disease in the US is higher than in other countries because of diet and lifestyle, the rate of survival for those diagnosed with coronary problems is much higher than in other countries because patients get the best and most appropriate treatment more quickly.

The same pattern holds true with cancer. Overall Britons and Europeans in general die at a higher rate from all forms of cancer than US citizens and the difference is dramatic in cases where early detection and treatment are important. For example, women with breast cancer in Britain have a 46% death rate as opposed to 25% in the US. Men with prostate cancer in Britain have a 57% mortality rate while in the US only 19% die and the death rate is declining rapidly because of early detection. It's the same with colon cancer. In Europe as a whole there is only a 8% survival rate, in Britain there's a 40% survival rate and in the US there's a 60% survival rate. With cancer of the esophagus only 7% survive while in the US 12% survive, although it's still one of the most deadly forms of cancer. Both long- and short-term recovery and survival rates for all forms of cancer are also significantly higher for US patients. Rationed care has limited diagnostic facilities like MRI machines and has created long wait times for specialist doctors. In fact, 40% of cancer patients in Britain never get to see a cancer specialist at all, and the National Health bureaucrats have denied basic tests like pap smears and ruled out powerful chemotherapy medicines as too expensive, all of which has cost lives. With diseases like cancer where early detection and treatment are vital,  resource rationing means a lot more dead patients.

The human cost of delay of care caused by rationing is particularly significant. One key element of this is the wait time to see a specialist who can provide the best treatment for specific ailments. In the US 74% of patients get to see a specialist within four weeks. In Canada only 40% get seen that quickly and in Britain only 42%. In many cases these delays can cost lives, but the cost of suffering has to be considered as well. In both Canada and Britain the wait times are even longer for conditions which are not life threatening, but can be very painful and seriously reduce quality of life. In Britain a hip or knee replacement can take more than five months and in Canada it can take as long as eight months. That's a very long time when pain is literally crippling.

An unsurprising irony is that as our congress looks at health care reform, activists in Canada, Britain, and a number of other countries are also looking at health care reform. The difference is that they are trying to figure out ways to introduce more choice and more market elements and reduce rationing at the same time we are plunging headlong into the same mistakes which they made a generation ago and which they now realize have left them with unacceptable failures in their systems with thousands of preventable deaths every year and millions stuck on waiting lists for essential treatment.

This is how bad it can get with government-run, single-payer systems, which may have a cost in lives and suffering, but do at least bring down the cost of health care. Imagine how much worse it could be with a combination of government bureaucracy and rationing and the high prices of private insurance and you have some idea of what ObamaCare will be like. It is likely to have all the flaws of socialized medicine while preserving most of the shortcomings of our current private insurance system, because the thousand-page bill which congress was considering is largely authored by lobbyists for the health care, pharmaceutical and insurance industries. It's like yet another bailout for these industries at a high cost in life, suffering and taxation to the American people.

Even the far left agrees that the health care plan currently being rammed through congress serves the interests of big insurance, medical and pharmaceutical companies while doing more harm than good to the average citizen. It rations and reduces the quality of medical care. It massively increases costs and forces small businesses and individuals to purchase insurance plans at inflated prices which they cannot afford or pay substantial penalties which they also can't afford. It passes many of these costs on to the public in huge tax increases. It doesn't solve the key problem of inflated insurance and health care costs and is projected to still leave 20 million people uninsured.

This may be the most monumental legislative disaster ever given serious consideration in the notoriously profligate halls of congress. This plan is not what the American people have in mind when they think of health care reform. It ignores their needs and sets their interests aside to pander to statist radicals and big business. The American people deserve better.

American Health under Fire

Forty-seven million uninsured. An HMO withholding approval to save a dying young woman. One in six dollars spent in America going to health care (1) (notes below), which is 4.3 times more what America spends on national defense (1). Despite that, one in four Americans saying health care is a serious national problem in 2008 (2). Not less than 81% of Americans "dissatisfied" with health care in America (3). The specter of socialism looming as 64% of Americans recently polled say it is the federal government's responsibility to make sure all Americans have health care coverage (3).

Let's not exaggerate the problem. The number of uninsured grew from 12 millon in 1989 to where it stands today mostly because of legal and illegal immigration (4), making the uninsured a one-time problem. We all know how Michael Moore gets hysterical. His last movie made much of the fact that Cuba's health care system has a lower infant mortality rate than America's, but undeniably America still leads the world in health care, with the finest hospitals, doctors, professionals, and innovations in the practice of medicine.

Yet it is clear that something must be done. If the trend keeps up, the middle class will have to make extraordinarily difficult kitchen table decisions: cut back on health insurance or food or education. Some large American companies increasingly feel at a disadvantage. They feel they have to pay for their employees' health care, when their foreign competitors do not. Obama supports "single-payer," which is a soft way of talking about socialized medicine (5). An Obama presidency coupled with a Democratic congress would likely mean the end of free market health care in America.

In these shaky times, the political tide in 2008 is dredging up a leftist economic policy. The tide is strongest in health care. Our goal must be to ride this wave to the extent we must, while steering the country into the safe cove of market economics. The free market will not stay free without a fight.

Socialism does not work. I speak as an ex-socialist. It took me years to shake off the blinders and see the light. Socialism could only work if human beings were infinitely flexible, so that if you could imagine it theoretically, it could work in real life. That's where socialism's problem starts. Human nature is not something we can change, as I eventually came to realize. People like to buy and sell what they want. People want to take risks. They want to own a tiny little bit of the world and have it as their own. People want to control their own destiny, and not be told what to do in every aspect of their lives. People want wealth, even just a little wealth, but socialism does not deliver the goods. Socialism has been tried. It has failed. Most dramatically, East Berliners voted with their feet, turning the monicker of "democratic socialism" into a bad joke. With the sole exception of the starvation state of North Korea, every former socialist country in the world now looks to China as their model. The China model, love it or hate it, has nothing to do with state ownership of private property. It has at its core the private ownership of property, and the freedom to buy and sell as you please. Socialism's inevitable failures are costly. Over 100 million lie dead from communist rule. There is no faster way to stifle innovation and destroy the quality of people's lives than to rip people's freedom away from them. The government must let people live their own lives. Socialism slices away human freedom, and so is unacceptable.

The experience of Britain's National Health System, with a country of rotting teeth, antiquated care, and long lines, and of Canada's national system, with the long waits for basic care and Canadians hopping the border for simple medical procedures, tells us more than we need to know.

Socialized medicine, or "single payer," would wreak an untold disaster upon the health and quality of life of Americans. Our country has led the way forward against disease, disability, and injury. Smallpox and polio are all but wiped out. The art of medicine has advanced to an unbelievable degree, with much thanks to Americans. Great institutions of American health care are renowned throughout the world: names like Sloan-Kettering, Mayo, and Johns Hopkins. Socialized medicine will take decisions out of doctors' hands, and prevent them from innovating and providing the best care. Socialism would take the art out of medicine and turn clinics and hospitals into factories. The quality of health care in America depends on patients, doctors, and nurses all being free to be at their best. Expanding government will increase taxes, hurt the economy, and take the freedom out of health care.

Take a look at the list of the Nobel Laureates in Medicine and you will see that there is one country that has dominated that famous prize, especially since World War II, and that country has a free market medical system. Of course, it is the United States of America (6). If we allow socialism to take root in America, there is no telling what damage will eventually be done to medicine and the American way of life. Even if we cast out socialized medicine after only a few years, those years will be lost, and whatever is lost will have to be rebuilt. Our institutions are so valuable and vulnerable, we can't risk throwing it all away for the pipe dream of socialism.

Our health care problem today is a case of market failure. Disease and injury being what they are, people will always need health care, and they won't be in a position to bargain much over the price. The markets for health insurance and health care have broken down. Health care costs have spiraled out of control, and are heading north. The price of health care has grown disproportionately to the quality of care. We must find a way forward to uphold our free market system, resolve this market failure, and keep America great.

This blog will focus exclusively on health care policy. It will argue for a market-oriented approach to health care reform. Free market basics will be stressed like being able to choose whatever doctor you would like no matter what your insurance is, and being able to get health insurance for your family at a decent price. Common sense also matters. Health insurance companies are private companies. They need to have the incentive to minimize costs while maximizing the health and well-being of their insurance customers.

The pressure to adopt socialized medicine is already large, and will grow larger. Obama has hinged his campaign on a promise he can't keep: he says will make our health care system perfect. Americans just might be desperate enough to believe he has a miracle under his sleeve. The trouble is, people don't understand why he is wrong. The voters don't understand the most basic principles of economics: scarcity, and the law of supply and demand. 

McCain must have a savvy response to the health care crisis. The first part of the response is that Republicans care about health care, deeply want all Americans to have access to good health care, and will work hard to achieve that. This is emotional, and comes out of human compassion. The second part of the response is a smart, market-oriented policy to get us there. That's where this blog comes in.

Thank you to TheNextRight.com for the opportunity to start this blog. I am taking the name of Xenophon here to honor that figure who is associated with a long and successful struggle to survive against great odds.

 

(1) http://www.nchc.org/facts/coverage.shtml

(2) http://www.health08.org/polls.cfm

(3) http://www.gallup.com/poll/4708/Healthcare-System.aspx

(4) http://www.cis.org/articles/2005/back1405.html

(5) http://blogs.wsj.com/washwire/2008/08/19/obama-touts-single-payer-system/

(6) http://en.wikipedia.org/wiki/Nobel_Prize_in_Physiology_or_Medicine

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