We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Our Recent Essays Behind the Front Page
Saturday, July 25. 2009
"Let science decide," and other thoughts about medical care, with a surprise appearance by Little Susie The Crack Whore
I guess it didn't occur to her that doctors know some science - and they also know something else: they know their patient. No two patients are alike. People do not want an "approved treatment protocol" - they want to work it out with a doc who is working for them, and is not a de facto civil servant. I think what Sebelius means is not "science": she means a board of cost-containing medical efficiency experts.
However, I do not think anybody wants a government to have that sort of power. Governments create omnipotent monopolies.
It's one thing for a private medical insuror to tell you they don't cover in vitro fertilization, and another for the government to tell you that you cannot have it because "science says" that it's not cost-effective. In the former case, it's a freely-entered association, as Milton Friedman would say, and if you want the in vitro badly enough, you can save your pennies and get one. Furthermore, I'd much rather make an appeal to a private biz than to the government.
We suspect that the government wants two things: 1. To get more folks on the Government Plantation and, 2. To control Medicare costs. Re the latter, the O might be right that it may have been unwise for his Grandma to have a hip or knee replacement when she was dying from cancer - but he is correct that 80% of medical costs occur in the final year of life. However, unless somebody has terminal cancer or something comparable, how do you know it's somebody's final year of life in advance?
Another related issue is the equating of "health care" (a dumb term) with medical insurance. I suppose with the high costs of medical technology and hospital treatments, those costs are out of reach for the average person (which is why we buy cheap catastrophic, ie high-deductible medical insurance) but, for most purposes in life, a regular office visit for a bad sore throat or a camp physical doesn't cost very much at all, while an ER visit for your bad sore throat can set you back $750.
We agree that it is foolhardy for anybody who is not wealthy - especially for a family - to carry no catastrophic major medical insurance, because bankruptcy sucks. We also think it is foolish for people to expect insurance to cover every office visit: the whole point of insurance is supposed to be that you hope you never need it.
However, years of Medicaid (for the poor), Medicare (which pays for everything, at low rates), union-driven medical benefits and work-related medical benefits have produced a sense of entitlement and, we would argue, have driven up the cost - and the quality - of medical treatment in the US.
What is the right role for government in medical care? We don't know, and we don't trust anybody who says they know. Fact is, government already controls much of it via Medicare, Medicaid, and now SCHIP. It has been incrementalism at work, with the long socialist view. One thing we do know is that fewer and fewer Docs want to accept Medicare, and few ever accepted Medicaid except for charity clinics and inner city Medicaid mills staffed by foreign medical graduates.
Why do so many Docs opt out of Medicare? Because of the paperwork requirements and the unsustainable rates of reimbursement. When people get a doctor's bill, they often forget that it's not a bill for his time: it's a bill for his rent, his machines, his two nurses, his insurance coder, his bookkeeper, his receptionist, his staff's benefits, his malpractice insurance, etc. Your local Internist and Pediatrician is not getting rich on $65 office visits these days. In fact, they are struggling.
No, the big costs are tests, some medicines, hospitalizations, cancer treatments, dialysis, the ICU, etc. The big ticket items - and those costs are not compressible. They can only be rationed if costs are to be cut. We do not think those costs should be cut, because we believe that such decisions are a matter of personal choice and freedom and, as they always say, "All you have is your health." Or your disease, as the case may be.
We wish we knew the right answers to all of these issues but, despite the problems, we will say one thing: With the best, most innovative and most available medical care in the world, one must be extremely careful about messing with it. Freedom is always messy. We re-link Cardinal at Tigerhawk's defence of American medicine.
That is a bit cold, Mr. V.
Written by The B and BD together.
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I'm a cop who knows a lot of crack whores. I've tried to prosecute men who assault them.
Step 1 in building such a case is to get medical records. In one instance I got permission from the crack whore victim to obtain records of her treatment. The hospital records administrator gave me a dirty look, then hauled up box after box containing records of many many ambulance trips to the ER and hospitalizations. (She's HIV, BTW.)
This particular girl is now off crack and off the street. I'm proud of her. She recently got meningitis and called me from the hospital. They'd just given her a CAT scan.
Don't tell me the uninsured in this country don't get first-rate treatment.
I never understood why they call it health insurance. Health is a personal condition, not a commodity or service you can buy, so you can't insure it. Second, insurance is to protect you from an unpredictable catastrophic economic loss, not pay routine expenses. What the politicians call health insurance has nothing to do with health or insurance. They are just claiming somebody else, some millionaire somewhere, will pay your doctor bill.
Never forget that the practice of medicine is both a science and an art. Physicians sometimes get the science wrong, but bureaucrats will always get the art wrong.
A few observations on why the present "Health Care Reform" bills may not be a good idea for children and other living things.
While the current bills do occasionally touch on these issues, they do not specifically:
1. Address the obscene cost of educating health care professionals (e.g. educating a basic MD costs over $500,000, plus interest).
2. Revise the U.S. Tax Code to allow Doctors and other Medical professionals to expense their own Education costs. (e.g. Most corporations can expense the cost of educating their employees. Why not allow the Health Care folks to expense their own educational costs?)
3. Restructure the health care regulatory system to anything resembling "effective" (e.g. see the FTC vs. Solvay/Watson/Par Androgel case).
4. Provide for automation (e.g. computer assisted diagnosis, automated lab tests, national clearing house for ID/history/billing, etc.)
5. Address personal security issues arising from a National Medical ID card (Ahem - It will also be a National ID card!)
6. Revise the tax code to subsidize medical equipment and drug development by giving developers the option of amortizing OR expensing their costs (e.g. there ARE reasons an MRI costs $2,500)
7. Provide for "Medical courts" competent to address medical issues. Nor does it set standards for existing courts to appropriately control the cases heard or to resonably limit awards (e.g. Dow-Corning case).
8. Recognize that your health care is NOT a free-market activity nor should it be controlled by Politicians who "wanna play Doctor".
9. Define limits for government control of health care policies, practices and procedures (e.g. the "war on drugs" has been effective, hasn't it?)
10. Re-create the Public Health Service to address issues of community health and safety (e.g. Immunizations, epidemics, food safety, etc.)
And this is the short list...
So please, don't do this because I'm asking. Do it because the idea of Nancy Pelosi giving you a hot-oil enema scares the living daylights out of your precious self.