Tuesday, April 21, 2009

One Giant Aspirin Won't Solve the Problem

I have a vested interest in the health care debate which is heating up to the point of action--the wrong action--in Washington. This is because after a lifetime of good health and despite diagnoses of chronic lymphocytic leukemia (CLL) in 1994 and non-Hodgkins lymphoma (NHL) in 1995, I've been able to lead an active life, even completing the Seattle Marathon for the Leukemia & Lymphoma Society's fund-raising Team-in-Training program in 2002 (at age 62) in just under six hours.

But now I am more ill. I was released last week from my second hospital visit within one month for pnemonia, and truth is I've suffered one infection after another since last August. Despite good medical care, this is, I guess, the nature of the beast.

Making me well again and keeping me well will be expensive. I'll need perhaps two more infusions of immunoglobins (I had one in the hospital last week), catscans and when my blood is stronger, more chemotherapy. And this comes at tremendous cost, so much so that I feel guilty over it. I am fortunate because I have good insurance to pay for the excellent health care I receive, but I wonder how long that will last: 1. only so long as I remain covered by my husband's secondary insurance and 2. only so long as a health care provider decides that the care needed to prolong my life makes economic as well as medical sense.

Condition #1 will be determined by my husband's lifespan. Condition #2 will be determined by politics.

Already, my physician needs to decide if his office can give me the infusions I need. The problem is that reimbursement to the doctor is less than cost...although perhaps not for me since at the moment I have good secondary coverage to Medicare. Possibly, I can receieve the infusions at the hospital (which charges five times as much as the physician's office but is reimbursed more). Reimbursement is determined by Medicare. My private supplementary insurance also pays according to Medicare's rule book; that is, it cannot exceed the price fixed by Medicare.

The Obama administration is concerned that not all Americans enjoy the coverage I do, and that concern does weigh on me also. However, the president's answer is to turn writing a revolutionary health care plan over to Democrats in Congress...that's the Nancy Pelosi/Harry Reid bunch that send shudders through even the healthy. The plan of attack will be to sell the idea that universal health care will reduce the cost of medical service and make health care available to all. This is an economic policy, not a medical care policy (see Thomas Sowell http://tinyurl.com/dfar8k), and it's bad economics.

Universal coverage will increase the cost of providing healthcare: afterall, more people must be served. The cost savings promised through computerized record keeping will not make up the difference. The only way costs will go down when more people are placed in the system is to reduce the cost of the care given either by shoddy reimbursement leading to curtailing services (defacto rationing of care) or by overtly reducing the services offered (i.e. rationing care). Another intermediate and likely outcome is to delay services, which, perversely, will increase the time people are ill and incompacitated and increase the cost to the overall economy of sick leave and other social services intervention.

Maybe this is necessary in the interest of fairness. That is certainly the argument of advocates who claim large numbers of Americans are uninsured and many face bankruptcy trying to keep up with health care bills.

However, research shows much of this claim is not true. Economist John Goodman of the National Center of Policy Anaylsis refutes assertions that other countries with universal health care have better health care results than the U.S. His extensively documented article is available in PDF format at http://tinyurl.com/d8cfb8. Goodman posits that "all developed countries face...rising costs, inadequate quality, and incomplete access to care." He points out that the acknowledged superior American medical care "uses fewer physicians, nurses, hospital beds, physician visits, and hospital days" than the typical European universal care system.

Goodman continues: "a comparison of the British National Health Service (NHS) and California's Kaiser Permanente found that Kaiser provided more comprehevsive and convenient primary care and more rapid access to specialists for roughly the same cost."

Some medida commentators (Froma Harrop, for one, see http://tinyurl.com/de3ym8) claim worse medical results from American healthcare. That simply is not true. For one example, Goodman points out that after five years, the survival rate for all cancers for men and women is considerably higher in the U.S. than in all of Europe.

Still, what about the uninsured in America? Goodman claims that of 46 million uninsured, 12 million are eligible for Medicaid or the State Children's Health Insurance Program (SCHIP). Of the remainder, 17 million live in households making more than $50,000 annually (one-half of these in households making over $75,000). Many of these uninsured are young and healthy and decide to forego insurance for other priorities. Their lack of insurance does not lead to early death. Even when these suffer a debilitating illness, Goodman points to a Rand study that "suggests...insurance status has little effect on receipt of recommended care" once they see a physician.

As to saving money because of more efficient government accounting practices (which sounds like an oxymoron on the face of it), Goodman found that when "the hidden costs shifted to [private] providers of care and the social costs of collecting taxes to fund Medicare are included...Medicare and Medicaid spend two-thirds more on administration than private insurance...."

In addressing whether the private market can work in health care, Goodman looks at the costs of cosmetic surgery, corrective vision surgery, and walk-in health clinics. These are not dependent on insurance reimbursement, yet they are not only successful, increasing in numbers performed, but have also enjoyed price cuts of up to 30% in the past 15 years.

Health care is an issue that will grow in importance, particularly as the population (read baby boomers) age and there are fewer workers to support the twin entitlements of social security and Medicare. Writing separately in the March 2009 issue of Imprimus from Hillsdale College, Goodman points out that Medicare will eat up one of every 10 federal discretionary dollars in three years. By 2030, the progam will take one of every two tax dollars. This is a dismal prospect for the economy, and for the quality of care people will receive in the not distant future. A strong private market solution, or more likely solutions, to inadequate health care provision is needed quickly...especially before advocates of universal government care can take the country down a road that will insure higher costs and lesser results for all. It's important that Americans wake up to this challenge and think through innovative private insurance plans that will preserve the high quality of our medical care. If not, we will all be in the same boat, but it will be a leaky boat of poor medical results with more suffering and more deaths.


  1. Hello, Terro. You left a post (3 actually!) on my blog yesterday. I responded and then came here for a visit to learn more about you. Had trouble posting my comments, no matter what I tried. Hopefully this gets through. If so, please come by for a visit again - I'll do the same.

  2. Hi Lisa,
    I enjoyed your blog and definitely will visit again. I'm glad you got through on this one!