Among the issues most commonly discussed are individuality, the rights of the individual, the limits of legitimate government, morality, history, economics, government policy, science, business, education, health care, energy, and man-made global warming evaluations. My posts are aimed at intelligent and rational individuals, whose comments are very welcome.

"No matter how vast your knowledge or how modest, it is your own mind that has to acquire it." Ayn Rand

"Observe that the 'haves' are those who have freedom, and that it is freedom that the 'have-nots' have not." Ayn Rand

"The virtue involved in helping those one loves is not 'selflessness' or 'sacrifice', but integrity." Ayn Rand

23 September 2009

Darwall - Government Medicine vs. the Elderly

Rupert Darwall, a London-based strategist currently writing a book on the history of global warming, wrote an interesting Opinion in the Wall Street Journal on 14 September 2009. He noted that the Patients Association, an independent charity, had examined many end-of-life care cases of the British National Health Service (NHS) and had found "a consistent pattern of shocking standards of care." It gave examples across the NHS of "appalling treatment."

Darwall notes that the usual justification for socialized medicine is to provide access to care for the poor and disadvantaged. But this is best done by a benefits system and refundable tax credits. In reality, it is assumed that health care resources are fixed and it is necessary to prioritize their use for those who can benefit the most from them. So, Britain's NHS is the "national triage service." He notes:
It should come as no surprise that the NHS is institutionally ageist. The elderly have fewer years left to them; why then should they get health-care resources that would benefit a younger person more? An analysis by a senior U.K.-based health-care expert earlier this decade found that in the U.S. health-care spending per capita goes up steeply for the elderly, while the U.K. didn't show the same pattern. The U.K.'s pattern of health-care spending by age had more in common with the former Soviet bloc.
He notes that this assumption of limited resources lies behind Obama's claim that "We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it." Obama claims this threatens our economic competitiveness.

In my opinion, we would not be so tempted to view it from that angle at all except that we only offer tax breaks to companies for the purchase of employee health insurance. If we separated this cost from companies, then it would not affect their competitiveness and it would solve the problem of people losing their insurance when they lose a job or switch jobs. If the tax break for the purchase of health insurance went only to individuals, as it should, then their spending on health insurance would be viewed just like that on any other consumer spending, except that they would get a tax deduction for it. If Americans wanted to spend 1.5 times what other nations do and if they want to spend more specifically to keep granny alive another year or two or five, that would be viewed as entirely their prerogative.

Darwall questions what makes it bad to spend so much on health care? He does say that distortions such as malpractice suits and the absence of consumer price consciousness should be addressed. Putting insurance in the hands of the individual, rather than his company, and allowing high deductible plans with Health Savings Accounts is an effective answer to the issue of consumer price consciousness. Darwall observes that our greater spending on health care "incentivizes new drugs, new therapies and better ways of delivering health care. Government-administered systems are so slow and clumsy that they turn the lump of health-care fallacy into reality."

A 2002 Wanless report, which Blair's government used to justify a large tax increase to fund more NHS spending, found the NHS to be late to adopt and slow to diffuse new technology. The NHS more than doubled its spending from 1999-2000 to 2009-2010, an increase of more than 7% a year [according to Darwall, but I calculate that to be more than 10% a year], and still remains medically backward. This Wanless report examined five country's health care systems and found that only the U.S. was both an early adopter and rapid diffuser of new medical techniques. The U.S. is the world's "principal engine driving medical advance."

Indeed, which nation's scientists and doctors win almost all of the Nobel Prizes in Medicine? Those working in the U.S., of course. And it does not end with the fundamental scientific advances either, as the Wanless report confirms. Yet, Obama wants us to have the backward equivalent of the British NHS simply because he objects to the way we spend so much on granny to give her a year or two or five more years of life!

No wonder he is so sensitive on the death panel issue. It is because this really is one of the main issues, as recognized earlier by the professional publications of Dr. Ezekiel Emanuel, an adviser to Obama on health care issues and brother of Obama's Chief of Staff, Rahm Emanuel. The recent cover story in Newsweek also trod this path. As I have noted before, this path is inevitable once health care becomes a government service, rather than a personal consumer choice. This is so no many how many lies are told by socialist politicians to deceive the People, even if some of those politicians believe the lies.


Jessie said...

I like the idea of having health insurance as an individual thing. Every other insurance is individual (car insurance, house insurance, etc.). Maybe having health insurance should be made mandatory like having car insurance is. People are required to have car insurance so that if they cause an accident the other person is not stuck with the bills that the uninsured person caused. Same with health care...people should have their own insurance so that the rest of us don't have to pay for them. If the government is going to guarantee care for anyone who walks into an emergency room, then mandatory health insurance should help with preventing people from taking advantage. Otherwise, maybe the government shouldn't guarantee care to the uninsured/those who can't pay.

It makes sense that having universal health care is more inefficient, slower for new technologies, etc. because it is such a big organization and it takes time to process things through all the red tape. Things work much faster and more efficiently when they are done between a few. Its just like that game "telephone" where you wisper a phrase to one person, it is passed on, and you see what comes out after everyone has heard it. The more people you have the more screwed up the phrase gets.

Charles R. Anderson, Ph.D. said...

Hi Jesse,

Thanks for your comment.

The main rationale for car insurance seemed to be that one needed to protect others from bodily injury caused by a driver's errors. The driver also had to provide protection for any property damaged. Only in recent times has a part of the reason offered been that the driver had to protect the public at large from his needing medical care due to a car accident. This kind of argument is an outgrowth of an already misdirected system in which the costs of medical care for those who are irresponsible are thrust upon the taxpayers.

Everyone should carry car insurance or be so wealthy they do not need it. This is for the protection of others. Everyone should also carry health insurance, but they should not be required to do so by law. Unfortunately, many more people would have their own health insurance if the states and the federal government did not work so hard to make it much more expensive than it should be for most people. It is common for states to require that everyone in the state be put into a community pool, with prices dependent only upon age, but not upon health, lifestyle, sex, or other factors with medical cost consequences. Many people with few medical needs then have to pay much more for insurance and refuse to do so. People, understandably, want to get true value for their money.

As usual, government is the problem more than it is the solution. Get government out of medicine and let private charity provide for those who really need it. The taxpayer should not be forced to provide for those who will not or cannot pay for their own health insurance.

On the other hand, Americans are generous in their charity to the worthy needy. We do care about other Americans and recognize that situations can arise which reasonable people are unable to handle. This is why my grandfather was so generous to his patients in the Great Depression. He did many a major operation for a chicken or less, but he did it because he cared about his patients and many of them in later years proved that they cared about him. Charity should be voluntary and when it is, it is possible for both the giver and the receiver to maintain respect for one another.