Health Care discussion continues; a few words on economics; musing on age.

View 799 Wednesday, November 20, 2013

“Transparency and the rule of law will be the touchstones of this presidency.”

President Barack Obama, January 31, 2009

 

Christians to Beirut. Alawites to the grave.

Syrian Freedom Fighters

 

What we have now is all we will ever have.

Conservationist motto

 

If you like your health plan, you can keep your health plan.

Barrack Obama, famously.

 

One thing I am learning about getting old is that while I can still think clearly, and still write some good sentences, everything not only takes longer, but often with all the good intentions in the world I just don’t have the energy to do what I have set out to do. Today was an example, but fortunately not typical. It isn’t typical because I am still fighting a bit of pain in my jaw which I hope is the effect of having a wisdom tooth removed yesterday, and not a sign that there are other teeth badly needed attention.

I had intended to post a couple of letters with replies relevant to the health care mess, and continue with a short exposition on facts about the difference between insurance and institutionalized medicine. Both have good points but they lead to entirely different systems. Or I think they do. And I doubt we can ever say enough about deserving and undeserving poor and how government – as opposed to Associations – might choose to deal with each.

Unfortunately I had errands to attend to, the main one being to go to Petco and get another large sack of dog food. Sable was weaned on the Max brand of dry dog food and although she is great at begging – Huskies are pack dogs and expect the leader of the pack to share with them – most of her diet comes out of a sack. This brand doesn’t bring about doggy breath, and she has thrived on it. Of course with her leg cancer ‘thrive’ is not the word many would use, but on the gripping hand she was supposed to be dead six months ago and she doesn’t know that. And she very much likes going to Petco. I mean, what’s not to like? Everyone she meets thinks she’s beautiful and the place has all those great smells, and a big tank of mice who don’t at all seem to mind having a wolf watch them play.

But somewhere in my errands I ran out of energy. That happens to me more often than it should, and it particularly happens when I’m recovering from something like this tooth extraction.

So it goes. I keep trying. I read the papers every morning, and try to follow what’s going on in the world. That’s not always cheerful.

From a long time friend and advisor who has long had familiarity with administration including medical:

"Part 1) Jerry Pournelle asks "…why I am expected to pay for someone else’s misfortunes."

Part of the answer is that you already pay. You directly pay for Medicaid and state, county, and municipal medical care."

Northwestern Physician didn’t even attempt to answer the question here. Why indeed am I expected to pay for Medicaid, state/county/municipal medical care? We shouldn’t be, unless we voluntarily enter in to pools to cover health costs (i.e. products insurance companies offer).

Then there is:

"Jerry and many others have suggested that this increase of insured will increase the use of health care and thus drive up spending. This is valid and the ACA attempts to slow the growth of health care costs. This, to me, is where we need to focus a lot of attention."

"So we spend more privately and more in public funds. By one measure, you are paying more now just in public funds than some countries pay for all of their public care."

So, has Medicare, Medicaid, state/county/municipal medical care reduced the cost of health care? Couldn’t prove it by the good Doctor’s references. Insurance companies have been the leaders in attempting to reduce the cost of health care (good ole profit motive). Yet, despite the innovations in health insurance (PPOs, HMOs, PMOs, Managed Care, Utilization Studies, anti-Fraud initiatives, Catastrophic Coverage, etc.), health care costs continue to rise? You’ll look closely and see that every insurance initiative (including Medicare/Medicaid payment limits on procedures) ends up with continued rising health care costs. Certainly, technology advancements are part of this, as well as medical malpractice nuisance suits. Still, continue to investigate and you’ll notice that provider/clinic (good Doctor?) billed amounts and procedure counts rise in relation to each cost saving measure! Chicken and egg… maybe. But most providers are actually complicit in this cycle! Providers are not required to accept insurance patients (though they may be lawfully required to treat emergency cases with or without guarantee of payment by the patient). They willingly participate in insurance plans in order to receive the bulk of their billings (~80%) and leave the collection of payment (premiums) and risk to the insurance companies.

What’s the answer to lower health care costs? First is the realization and acceptance of the fact that EVERYONE DIES regardless of state of health. Next, I’d trust the free market (providers & insurance companies) – of course with some public assistance: Medicare works well enough for the aged; and state support in each county for the indigent, afflicted, infirm, and hospice could be done for cheaper that the ACA is being set up. To facilitate that, I’d expand the Public Health Service to include a Medical Corps of providers (physicians of all specialties, nurses, NPs, PAs, and other providers) with attendant logistics to support localized health care services.

Of course there is a difference between necessary and sufficient conditions. Also necessary would be tort reform. There are others.

Health care reform

http://market-ticker.org/akcs-www?post=226151

Karl Denninger says that the main problem in health care is that all the anti-trust laws don’t apply. he gives the example of a clinic in Oklahoma which accepts only cash and publishes their rates – they charge about 20% of what others charge. So cancel Obamacare and apply anti-trust.

I would add keep the county health care system alive, forbid employment related health care, wait a year (maybe an election cycle) and then see what the problems are at that point.

One could also decide that all pension plans, as such, are immoral since they involve one person promising that someone else will pay for something. Purchasing an annuity is different since that is strongly regulated.

God’s blessings.

Arthur Bolstad

Karl Marx predicted that capitalism had within it the seeds of its own destruction, namely the competitive drive to increased concentration. Adam Smith warned that capitalists would work together to use government to restrict competition, and to make entering business increasingly difficult, with the result that there were be fewer and fewer businesses which would become increasingly larger.

The economist David McCord Wright more than once speculated that one reason why America seemed not to have gone the way of Europe into increased cartelization was trust busting activity by state and federal government. I encountered Wright when Pepperdine asked me to take over a beginning economics class after the professor had a stroke; he had been using Wright’s economics text as the textbook for the class. It was early in the semester, and I had to add that large lecture class to my already large teaching schedule in political science. I took on the challenge, but I wasn’t going to start with a new textbook: the students already had David McCord Wright, whoever he was, and that was the book I would use.

I had never read it, but I was impressed and thought it more rigorous on fundamentals than the more popular Samuelson text, but I also took a crash course in both economics and David McCord Wright since I had managed to get a Ph.D. in political science without ever having taken freshman economics. Fortunately we all survived, and I am pleased to say that at least one of my students went on to graduate school in economics so I must have had at least partial success in my one semester as an economics teacher…

But it is also clear that in the forty years since that time the United States has stopped taking anti-trust very seriously. The aerospace industry, the publishing industry, oil and energy, automobiles, and just about any other economic field you can name have become more and more concentrated, and the necessity of competition among many large but not dominating firms is no longer recognized.

That needs to be considered when looking at the health care business; but then I think it needs to be considered when looking at just about everything. I don’t think there should be Big Banks that are Too Big To Fail, and instead of the Big Five or Big Ten, I think there ought to be the Big But Not Dominating Fifty in most major industries. That would leave room for firms that just want to make profits on a business model of supplying excellence and make no pretense at efforts for Big Growth. But of course we are a long way off from applying that sort of principle to education and medicine; we are so certain that the people need protection from grafters and snake oil salesmen that –

But that is for another time.

: Insuring people against their self-destructive behavior

Jerry:

You discussed issues of American health care and the Affordable Care Act in your November 19 View. The Northwestern Physician claims the US ranks worst in pregnancies in adolescents, among other measures he says put the U. S. far below the standards set by other nations. You asked why you should be billed for a heart transplant for a 55-year-old massively obese man who smoked all his life. Both of you moved beyond the prevention and treatment of communicable and infectious diseases, the traditional concerns of medicine, and discussed instead conditions resulting from the behavioral choices made by rational human beings.

Your considerations emphasize that medicine is a moral profession rather than a technical profession.

For example, when faced with a 14-year-old girl with an unwanted pregnancy the physician must first ask "What OUGHT we to do?"

Recognize that the answer to that moral question can have consequences that endure for a lifetime, if not for eternity.

Dr. John Patrick, retired professor of pediatrics from the University of Ottawa and founder and president of Augustine College has been lecturing on these questions for many years. When speaking to medical students at the University of Minnesota (I believe in 2004) he said:

But a very profound change has occurred in the nature of etiology.

If I asked physicians with more than 30 years of experience, "What proportion of patients that you saw when you began in medicine came to your office or to see you because of an act of God or nature, and what proportion came because of their own behavior?" the answer will usually be, "Oh, 70% God and nature, 30% behavior."

"And what about now?"

"Oh the ratio is completely reversed."

And if you’re in a city clinic they’ll laugh and say all of them come because of behavior.

[Starting at 47 minutes 10 seconds into the lecture "Hope for the Unborn" at

http://www.cmf.org.uk/media/?context=entity&id=300

<http://www.cmf.org.uk/media/?context=entity&id=300>

Let us recognize that turning our health care over to the federal government leads inevitably to the bureaucratic regulation of the minutest and most intimate aspects of the life of every individual. Already our use of toilets is regulated, though perhaps not yet policed. Many would approve of criminalizing the eating habits of the morbidly obese, and then controlling the food available to each and every one of us. Eventually the regulators will deal with the sexual behavior of teenagers in the name of reducing the cost of health care. Ultimately the government will coerce abortions for many reasons decided on by the bureaucracy. (As I described previously and you posted on October 9, 2013 at

https://www.jerrypournelle.com/chaosmanor/?m=20131009 <https://www.jerrypournelle.com/chaosmanor/?m=20131009> )

Unfortunately, what we the people OUGHT to do about criminalizing the dietary and lifestyle preferences of free men and women is not even being discussed.

The federal government seems to believe that men and women, far from being volitional creatures made in the image of God and thereby charged with getting wisdom, are instead no more than mice, slaves to their desires and appetites. The government imagines we can be "cured" through the application of bureaucratically-enforced techniques rather than through the development of moral behavior among the citizenry.

Best regards,

–Harry M.

But surely the people must not be free to make bad choices? Do not they deserve the protection of the smart and educated, as mankind has always enjoyed the protection of the smart and educated?

 

Measuring the temperature of the Earth

Dr. Pournelle –

We are very good at measuring the temperature of planets. It strikes me that we should use the same techniques to establish an integrated temperature for the Earth. Why not place an infrared telescope on Luna and use it to measure the temperature of the nite side of the entire Earth? I would think that with judicious choice of wavelength, the temperature of the surface, integrated as a whole, could be measured. This would eliminate all discussions about sensor locations, weighting, and unmeasured areas. Of course, readings would need to be taken each nite, since the portion of the Earth visible would be different every nite, and there would be seasonal variations as well. Sounds like a good project for NASA.

I suppose that this is such an obvious idea that it has been considered and discarded for a reason that has escaped me.

Bob

Bob Salnick

Freedom is not free. Free men are not equal. Equal men are not free.