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POLICY: Edwards meets Schwarzeneger & uses T word– NFIB flips out

I was at a conference on Saturday when the Asst Sec of HHS in California and the former sec of HHS in Massachusetts managed to twist their tongues around how they were getting to mandates, with shared responsibility, provider contributions, employers cost-sharing, blah blah blah—and never a mention of a thing starting with T and ending with an ax.

John Edwards has decided to be brave and say that he can insure the uninsured with just that—a tax raise. Brave man. Foolhardy, perhaps! Especially as there’s plenty of money in the system now to do it—with just a little bit of redistribution (which Schwarzenegger is also pointing out).

At any rate the vaunted National Federation of Independent Business is out with its head firmly stuck up its rear. So perhaps he’s doing something right.

The National Federation of Independent Business, a powerful lobby that represents small-business owners, said such mandates amounted to a job-killing tax on small companies. “Health care mandates are a nonstarter for our members,” said Stephanie Cathcart, a spokeswoman for the federation.

I’ve said in polite terms what I think about the NFIB’s logic over at Spot-on a while back. Basically their members just can’t add up.

So now it’s time to be a little more direct. The best way to do this is perhaps to let you in on a little email chat with one of their number who thought that I would support his quest to get the Shaddeg bill into law. Clearly not a man who knows his audience. Here goes:

From: Ragley, Jay [mailto:Jay.Ragley@nfib.org] Sent: Wednesday, December 20, 2006 1:23 PMTo: tips@thehealthcareblog.comSubject: Small Business Health Insurance EditorialTo Whom It May Concern at The Health Care Blog:

I don’t know if you link to published editorials, but I would submit the following editorial on some ideas our organization and our members are beginning to suggest in South Carolina.  If you choose to link it, I appreciate it and if not, I appreciate your consideration.

(Link to pro-AHP/Shaddeg bill article, which I didn’t link to—surprise surprise—whatever Eric Novack would like me to do!)

Jay W. Ragley

State DirectorNFIB/South Carolina

So I wrote back:

From: Matthew Holt [mailto:matthew@matthewholt.net] Sent: Wed 12/20/2006 4:59 PM To: Ragley, Jay Cc: Subject: RE: Small Business Health Insurance Editorial

Jay

You’re kidding right? Have you ever read THCB? I think that the NFIB is so, so dumb about this issue that it’s unbelievable. NFIB members offering health insurance are the group that would benefit the MOST from a national health insurance single payer scheme, and yet you insist on getting behind ridiculous solutions that make matters worse and will continue the cost escalation with no controls that cause the problem.

I’ve written about this here http://www.spot-on.com/archives/holt/2006/05/small_businesses_that_cant_do.html#more and I’m not going to berate you further. but I do invite you to respond to my basic assessment of why your position is so wrong for your own members.

 

All the best
Matthew

To which he gamely responded.

From: Ragley, Jay [mailto:Jay.Ragley@nfib.org] Sent: Wednesday, December 20, 2006 4:12 PMTo: matthew@matthewholt.netSubject: RE: Small Business Health Insurance Editorial

Matthew:

 

Thanks for your response.  I did read some of your blog but obviously not enough.  I’m new to NFIB and have been trying to work more with bloggers as most of the MSM don’t care about small business issues.  I’m not aware of any health insurance blogs in South Carolina (mostly political ones down here).

 

I did read the blog posting you sent me and I hope you understand how NFIB determines its public policy positions.  We send ballots to our members throughout the year on a variety of issues.  So, when NFIB supports repealing the death tax, it’s because a strong majority of our members (not a 51% majority) support that position.  So believe it or not, it is the small business membership of NFIB that determines our public policy positions.

 

But as far as a single-payer system, I will ask the same question I asked folks when I worked in DC.  As a supporter of single-payer system, can you claim with any degree of confidence that a government-run health insurance system will not bankrupt the government, the economy or both as we know it in the USA?  Whatever tax you choose to impose to pay for this system will, in all likelihood, lead to lower economic growth, which will lead to lower tax revenues and thus produce deficits, assuming that all other government spending is held constant (a big assumption given the recent spending increases in many government programs besides health care).  So the economy will sour to a degree, the treasury will collect less revenue and the government will have to a) borrow b) cut spending c) raise taxes again.  Seems to me the most likely scenario is raise taxes, which will only exacerbate the problem.  There is no free lunch.

 

So unless the single-payer crowd can find a way to not wreck the federal budget and the world’s most dynamic economy, my members will keep telling me to find free-market solutions.  They’re risk takers and would rather have the opportunity to grow at the best rate possible.I guess small business owners aren’t happy with a Japan-like growth rate; they want the opportunity to grow at any rate they desire and create for themselves, business, employees and family.

By now of course I’m getting a little feisty on that basic math question:

 

From: Matthew Holt [mailto:matthew@matthewholt.net] Sent: Wed 12/20/2006 6:34 PM To: Ragley, Jay  Subject:RE: Small Business Health Insurance Editorial

I understand that you represent your members and that their policies are what you follow. I would also humbly ask how many of your members know what share of GDP is spent on health care here versus Japan, Korea, Taiwan, Germany, France et al…you know the answer. Those countries spend virtually 50% the amount we do on health care. So you explain to me how spending 50% less on something bankrupts us faster than spending at our current rate (and our faster growth rates).

If government imposes a tax to pay for health care, but at the same time removes the cost of providing health care from business, how does that hurt business? It’s a revenue neutral move. And more importantly in the long run the example of all those other countries is that government (or some proxy for it) has a much better shot at controlling health care costs because the taxpayer realizes the correlation between increasing costs and their taxes going up. But in this country we don’t bother making that equation, and so we keep paying more and more for health care.

But I guess if you pay money to a private insurance company that incidentally keeps 15-25% of your money in its pocket for doing not much, then that’s not a tax–so it’s OK to spend money on health care that way. But I get very confused when you tell me other countries are "going bankrupt" when they are containing spending much better than us, because they are using the government rather than an ineffective insurance sector to control spending. Are you telling me that if they spent at our rates of GDP they would be better off?

And BTW whatever you believe about the Laffer curve, you may have noticed that taxes going down can also lead to huge government deficits. Or were you not paying attention for the last 5 years?
Matthew

To which, like a true booty-mercantilist, he resorted by appealing to my own best interests!

From: Ragley, Jay [mailto:Jay.Ragley@nfib.org] Sent: Wednesday, December 20, 2006 4:51 PMTo: matthew@matthewholt.netSubject: RE: Small Business Health Insurance Editorial

Matthew:
 
Lots to digest here but not enough time tonight for a response.  Will get back to you.  Although I have to wonder, wouldn’t your consultant company go out of business with a government health insurance system?  I mean, you would have to get a job with the government I guess.
 
JWR

And I’m afraid I went for the non-technical KO:

From: Matthew Holt [mailto:matthew@matthewholt.net] Sent: Wednesday, December 20, 2006 4:55 PMTo: ‘Ragley, Jay’Subject: RE: Small Business Health Insurance EditorialSo is it about doing the right thing, or hanging on to my business at any cost? Sounds like a paper-pushing unionized bureaucrat’s view to me!

And don’t worry–there are LOTS of people for whom a single payer system WOULD be very bad news (Insurers, drug cos, many doctors, many hospitals, etc) I just don’t think that small businesses can be counted amongst them!

Matthew

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32 replies »

  1. There are three rarely mentioned reasons as to why Americans pays more per person for healthcare than socialized countries. Sadly, may of our increased cost are because the rest of the world is socialized.
    1 Drugs. Ever wonder why much of the worlds drug companied are in the USA? The rest of the socialized world has price controls on medicine. So when the drug companies need a billion dollars to develop a new life saving drug they charge the American healthcare system. This causes a two-fold difference when comparing American healthcare costs to the rest of the world. Basically American healthcare payers are subsidizing the rest of the world. This causes one to wonder what would happen to drug development is America healthcare became socialized.
    2 Research and development. In America we do massive amounts of R&D because companies can make tons of money. American hospitals almost always have newer and better equipment to attract patients. In socialized countries they wait around a few years for the equipment prices to come down. This is another two-fold difference as Americans are subsidizing the R&D costs of other socialized countries. Again it is scary to think of what would happen if American healthcare R&D companies had to sell to a socialized American healthcare system. Do you really think that new high tech scanner or the new surgery tools would be developed as fast or at all?
    3 We have a higher regard for live. In America we will spend a million dollars trying every last possible idea to save a child who has a server disease. We do this because the largely insurance companies have to pay what the doctors request. In a socialized system doctors have to decide who is best served with the limited resources. If they have a choice between spending a million dollars on one bleak case or three moderate cases they will always sacrifice the bleak case. We don’t have to make that choice in America.
    PS – For the infant mortality rate, you have to remember the other countries abort problem babies a lot more than we do in America. It goes back to Americans having a higher regard for life.

  2. David Hogberg,
    I read your article, and I’m not sure I agree, although it is interesting.
    For instance, take this section :
    “Life expectancy is a poor statistic for determining the efficacy of a health care system because it fails the first criterion of assuming interaction with the health care system. For example, open any newspaper and, chances are, there are stories about people who die “in their sleep,” in a car accident or of some medical ailment before an ambulance ever arrives. If an individual dies with no interaction with the health care system, then his death tells us little about the quality of a health care system. Yet all such deaths are computed into the life expectancy statistic.”
    You are assuming that person never had contact with the health care system. Just because someone died in their sleep, does not negate the possibility that preventive care, or lack thereof, probably played a part in their death, especially if they died unnaturally young.
    (Obviously a car accident is out of the realm of health statistics, but most countries do keep on record the number of deaths caused by what type of things. I find it hard to believe the statistics cannot be adjusted accordingly to only include non-accidental, non-murder, medical related deaths. Very, very hard to believe.)
    If this happens to many people, it skews the life expectancy lower. Of course, if you have a massive war, and people are being shot to death at a young age, and the life expectancy of men drops dramatically, correlating that with the healthcare industry would be a bit more difficult. (But if it is possible to keep statistics on those who died of medical causes versus those who didn’t this is actually a very good and broad indicator of a healthcare system.)
    But in many, if not most, cases, especially in America and Europe, preventive and old age care WILL determine life expectancy. Access to new medicines and better treatments WILL determine life expectancy.
    And these are all good indicators of whether a health care system is equitable in its treatment of the people under its care. Or whether there is a lack of preventive care in comparison to other nations.
    Your article tells us to be wary of propaganda, but I think you may be stretching the ideas of indicators a little too far yourself. It depends on how they are being used, I just find it very hard to believe that they cannot be adjusted for the type of information needed to draw correct conclusions.

  3. David,
    Does the WHO and all the other organizations that gather this data not know those facts?
    Are you telling me they just take statistics at face value and can’t compensate for the, -apparent-, common knowledge that France and Belgium are fudging their infant mortality rate stats?
    This is all very amusing, since seems like it’s going to be a big part of moore’s new propaganda piece “sickos.” I’m glad the health care system is getting attention, but I’m not glad it’s from him.
    Sometimes I think he’s working for Bush and crew. What a way to devalue a point than repeatedly make horrible arguments for it.
    Sort of like “universal health care in the US would be great, just like Canada’s.” hah!

  4. WE’RE THE GOVERNMENT & HERE TO HELP
    I’m from a family of small business people. Yes, of course — having monoliths to concentrate financial risk such as Microsoft and the federal government makes absolutely 100% sense. Like Airbus 380!
    As for the health care plans in Taiwan, Japan, South Korea, et al. — great! All we have to do, is become like them culturally. Which will take only about, say, 50 years.
    The current payer system is fracked. No one argues that.
    The challenge is not to make more of a mess, than is already in place. Relying on one source makes about as much sense putting all your funds on Black-17 at Casino Royale.

  5. Well, let me enter the hornets’ nest here. In particular, let me address this comment by NDDB: “I still can’t believe you [Stuart Browning] don’t know infant mortality and avg life expectancy are indicators of a health of a nation, please… go here before you talk about the subject in public again.”
    Those two measures might be indicators of the “health of a nation,” but they are not indicators of a the quality of a health care system. I’ve given this a full treatment here , so let me make a few quick points.
    1. Life expectancy is determined by factors such as GDP per capita, sanitation, genetics, etc. Studies that have looked at health care indicators such as health care spending per capita or doctors per capita find that such measures have no effect.
    2. Infant mortality is measured too inconsistently across nations to be a useful indicator. France and Belgium, for example, don’t count any infant born prior to 26 weeks, while Switzerland doesn’t count any infant measuring less than 12 inches–regardless of whether those infants show any signs of life. In short, a lot of nations inflate their infant mortality stats by excluding a lot of high risk infants.

  6. Stuart,
    I’m almost out of patience-power, and I know that if I point to any statistic from the UN, WHO, Red Cross… etc, you’ll just dismiss it saying “liberals” “crazy commies with their biased media”. Whatever.. it really doesn’t matter, you haven’t proven anything I need to disprove.
    So that’s #1 & #3.
    As to your questions 2 :
    http://www.google.com/search?hl=en&q=infant+mortality+rates+as+indicator&btnG=Google+Search
    Honestly, why should I have to do that for you?
    “A society’s infant mortality rate is considered an important indicator of its health status,”
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=12700217
    Like I said, we are not Canada, not all single-payer systems are the same.
    But I am wasting my time (1) you don’t have the time to use google, then you are just a troll. (2) You are making arguments based on anecdotes, that is a dead give away : troll (3) You keep making apples to oranges comparisons, even when it’s pointed out that the US healthcare system will drastically differ from Canada’s.
    (4) I still can’t believe you don’t know infant mortality and avg life expectancy are indicators of a health of a nation, please… go here before you talk about the subject in public again :
    http://www.pnhp.org/facts/international_health_systems.php?page=all

  7. Ok – I am new to this discussion but already I disagree and / or take outright offense at several of the assumptions that are being made in this discussion – on both sides of the argument.
    The one issue that effects me emotionally as well as intellectually is the assumption that the orthopedic patients, who are maintained on pain meds while they wait for their surgeries, are “addicts”. This is hardly the case and using emotional and stigmatizing labels (by creating images with words of our grandmas and grandpas wandering around dark alleys looking for a fix) to inflames the discussion and diverts the reader from the matters at hand. As a multiple decade “user” of narcotic pain meds due to my medical condition, I cannot take seriously any comments about health care reform that are made in the same posts that refer to legitimate pain med users as “addicts”. In my opinion, if the debaters wrongly infer a conclusion from one set of empirical data (eg: all users of long term pain meds are addicts; patients waiting for ortho surgery take narcotic pain meds long term; therefore all waiting ortho patients are drug addicts), then it seems reasonable to question all the conclusions that are being presented for our consideration.
    My second, more intellectual unease concerning the references to the Canadian system is based on the outright assumptions in these posts that all national health systems are the same – that any system that the US adopts will be EXACTLY like the Canadian system (regardless whether that system is good or bad). I point out, since when are Americans passive sheep? Aren’t we known for our rebellious and nonconformist actions? Don’t we seem to successfully attain the unattainable? the impossible? Are we not “can do” people? Why is it so impossible to consider that we may learn from other oountries’ mistakes and successes and synthesize a truly US system? I know that we have lost our leadership role in many aspects of social progress recently but that doesn’t mean our heritage has been completely bred out. Maybe in keeping with that heritage we should more properly refer to this reform as a Health Care REVOLUTION !?

  8. NDDB,
    You’ve got to be kidding. I’m almost out of battery power on my laptop – but just let me ask three questions:
    1. What rankings are you referring to?
    2. Do you really believe that infant mortality rates are even a remotely reasonable proxy for the quality of a health care system?
    3. Do you really believe the propaganda out of Cuba – a totalitarian state with no free press?
    Canada is very relevant. It’s a pure single-payer – and that’s what being advocated here in the US.

  9. Stuart,
    Here’s an interesting fact : This is not Canada. No where has anyone said “let’s try to mirror Canada’s healthcare system, with all it’s flaws as well!”
    Let’s try to build a better healthcare system. If you did some research, you’d see that some of the countries that are ranked as having the best healthcare in the world have nationalized healthcare.
    So, pulling out inconsequential anecdotes from one country doesn’t prove anything. It doesn’t carry 1/100th of the weight you seem to think it does.
    In fact, Cuba has a lower infant mortality rate than the US, which is used as an indicator of a country’s healthcare system. There a single anecdote, from a country with a nationalized healthcare system. Look it up if you want.
    I guess I have balanced the scales… now can the real discussion continue?

  10. jd – So, reporting the words of a Canadian physician is spreading rumors?
    Well here’s another “rumor” straight from a Canadian surgeon: some hospitals there have instituted “disruptive physician” policies that allow hospital administrators to arbitrarily punish doctors who speak out about the shortages and rationing by cutting their already insufficient OR time.
    But I guess the doctor is obviously a psychopath, huh, jd?

  11. Peter– one more comment here… and, as always, I speak (write?) only for myself. At the risk of being repetitively repetitious, there is agreement on both sides as to the unsustainability of the current healthcare spending ‘trajectory’.
    I argue every day for changes and ideas that I believe will move the US system toward one that will be around for (1) my career, (2) my family’s health problems.
    I would easily say that in a system with the changes that I have recommended over the last 2 years, many doctors would make less; most insurance companies would make less; some groups might be ‘better off’ than today; other groups might feel’ worse off’; spending would be more likely to stabilize; we might be able to stop stealing from our children and grandchildren’s future.
    JD- no idea what you are talking about. Anecdotes have value for what they are– take them or leave them. Do with them what you want— but you missed the point of the story— that the system is certainly not designed wiith such nefarious intentions, it is just that the bureaucratic policy makers are so far away from actual delivery of healthcare services, that their ‘noble’ central planning has adverse effects in practice.
    ps- are odd physicians psychopaths or are psychopath physicians just odd?

  12. Stuart,
    It may surprise you that I’ve actually spent time looking into the systems of other nations. The primary reason that I’ve done this is to understand how they could cover everyone at half the cost of our system which leaves out a chunk of the population, while keeping quality (on the whole) about the same. What I’ve discovered is that every nation has its own system, and there are enormous differences between them on almost any metric you like, except one: cost. They get the job done for far less money than we do.
    I’ve also learned that the wait lists you point to only apply to a few nations, and then only for some treatments which are not given high priority or not seen as providing the value that other treatments do. Yes, there is rationing in a few cases. No, it isn’t nearly as bad as you make it out to be (as peter or someone else provided evidence for upthread). And it doesn’t make those nations have lower quality of life than ours.
    Now, you can have a problem with this on Libertarian grounds, but things are much shakier for you when you try to claim that universal healthcare systems have worse health outcomes, or lower quality of life, or are less efficient.
    And to Eric, I was not engaged in ad hominem attack. I was engaged in a strong criticism of an act that I regard as scurrilous. I did not refer to some unrelated things he did in his past in order to discredit him. Sure, I got a little angry and then played a mean joke at the end. I try not to do that sort of thing very often, but I couldn’t let the blood libel stand unchallenged. Replace “Canadian doctor” with “American insurance executive” or “Jew” to see why his spreading of those rumors is unacceptable. Of course, if he actually can show people admitting that they make people wait in hallways hoping they get blood clots and die, then it is no longer libel. I just don’t think he does, or ever will, because I don’t think it happens except perhaps with the odd psychopath physician.

  13. Matthew,
    Very nice, too bad the guy didn’t seem to understand a word of what you said.
    This is an interesting site : http://www.pnhp.org/
    Physicians for a national health program – basically physicians who are FOR a single payer system, so perhaps they don’t feel it will hurt them either.

  14. Matthew,
    Only one slight problem with moving health care to single payer government system and expecting to cut costs 50%. All of the entities now playing in this arena own the legislative process. Once all the money comes from the government bank, they will ensure through their lobbying that they get their “fair share.” And I’m certain that rather than seeing costs at 1/2 of previous expenditures as with other countries, we’ll see it rapidly double. But remember its all for the patient anyhow!!! At least thats what I keep hearing.
    The operating system must be totally reformed before we change payers or add more lives, otherwise the fat cow just gets fatter.

  15. So Stuart, take away subsidzed apartments in Miami and the wait for housing goes away, take subsidzed medical care away from citizens and the wait times for ER goes away – eureka!

  16. There’s alot here to respond to – some good points – however, to start – let me respond to Peter’s point about the US ER room crisis and the long wait times there.
    The long wait times in the ER here are a precursor to what single-payer will be like for all medical procedures. Just as there are waiting lists for subsidized apartments here in Miami Beach where I live, so there are also waiting lists for free health care in the ER – just as in Canada. “Free” must always be rationed, Peter. Always.
    Why did you use that example, Peter? It merely bolsters my arguments – not yours.

  17. “Peter, have you actually read the IOM report in full? You do understand that the conclusions of the report do not exactly support the claims you are making?”
    Eric, what claims do you think I’m making? Please tell me what is in the full report that does not support the claim you think I’m making. There is no problem with Er’s? My point in posting the report was to show that the U.S. system as well has deep problems dispite Stuart’s support for it. His disdain and wild accusations for single pay somehow are used to justify the U.S. system. That the U.S. system is in a much better position to fix itself. Canadian Single pay, even with wait time problems, is doing a better job of providing access to healthcare and fixing problems while controlling costs. Your’s and Stuart’s solutions seem to be to abandon all government involvment while turning this thing over to private enterprise for a fix. Not possible.

  18. Stuart, if all you go looking for is information that reinforces your own beliefs, you’re not doing research.
    Your canard about Canadians on “long wait lists for orthopedic surgery who also have substance abuse problems” is a severe problem right here in America. Look at the dual-eligible population, those eligible for both Medicare and Medicaid because they are poor and either disabled or old. These are the sickest of the sick, the portion of our population driving the highest costs. There are 6 million of them. They have multiple comorbidities, and in 83 percent of all of them, drug addiction is a comorbid condition. But we’re not talking crack or heroin addicts here. We’re talking people who are hooked on pain killers because surgeries will not be approved because of cost. So they are kept on pain killers eternally. Hardly a milieu for Reaganite optimism, is it?
    We ration here in America, but we don’t do it rationally. We do it based on ability to pay. The only reason you don’t believe that is because you don’t want to.

  19. The comments here make me sad because as hominem attacks reflect poorly only on the ‘poster’.
    Fact– Canadian healthcare system is not the panacea. Strict government rationing is bad for everyone.
    Fact– The US healthcare system is in trouble. The spending curve is, over the long term, unsustainable. Peter believes that complete government control is the solution– though I would like his thoughts on other features of OECD healthcare systems– government funding for medical education and strict medical liability restrictions (I suspect here is where he suddenly wants to go ‘a la carte’ on other country’s approaches??). Stuart and I believe that many of our system’s problems today stem from too much government intervention, price controls, tax discrimination, and government payment for greater than 60 percent of the total healthcare bill in the US.
    Everyone can supply anecdotes, good and bad from both systems. Peter, have you actually read the IOM report in full? You do understand that the conclusions of the report do not exactly support the claims you are making?

  20. Stuart, any euthanasia going on here?
    “Crisis Seen in Nation’s ER Care
    Capacity, Expertise Are Found Lacking”
    By David Brown
    Washington Post Staff Writer
    Thursday, June 15, 2006
    “Emergency medical care in the United States is on the verge of collapse, with the nation’s declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner.
    That’s the grim conclusion of three reports released yesterday by the Institute of Medicine, the product of an extensive two-year look at emergency care.”
    Full article here: http://www.washingtonpost.com/wp-dyn/content/article/2006/06/14/AR2006061402166.html
    Fact Sheet from Institute of Medicine here:
    http://www.iom.edu/Object.File/Master/35/040/Emergency%20Care%20Findings%20and%20Recs.pdf
    You’ll have to buy the full report if you’er interested.
    But I guess the Washington Post is just a liberal biased rag spreading lies. Got any film on patients for this U.S. issue Stuart?

  21. jd – No hiding behind rumours here. I have Canadians on film saying some of these things themselves – from their own personal experiences. Doctors, surgeons & patients. All footage yet to be published.
    As for compulsive lying, you could do no better than to observe the continued references by some here to life expectancy as proof of the superiority of government-financing in Canada and the UK.
    Per your holier-than-thou tone – jd, what have you done to ascertain the truth about the system in Canada, the UK and elsewhere concerning the rationing of medicine? I would urge you to open your eyes and read the english language press. My web site is a good place to start as I’ve done some of the hunting myself to make it easy for lazy asses like yourself.

  22. At long last, Stuart Browning, have you no shame? What a convenient, unfounded, scurrilous rumor for you to spread: that hospital administrators in Canada want hip replacement candidates to die.
    It sounds like the kind of crap that people on the left in the US peddle about health insurers: that they want their sick members to die. I’ll bet you hate that bit of slander, and yet don’t insurers and Canadian hospital systems have similar incentives to deny care? I’ll answer for you: they do. It’s just that one institutional incentive comes from budgets constrained by taxes and the other takes the form of claims payment rules constrainted by premiums and profit.
    But in fact people who work for insurers in the US and hospitals in Canada are not Hollywood charicatures of evil. They are almost to a person normal people, with normal human consciences, and though they may try to pinch pennies for their employers they essentially never want to kill people in order to do so. At worst, they become calloused to the suffering of others…in Canada and the US.
    It’s so easy to demonize, especially when you hide behind a rumor that you can disown once you’ve smeared your target. For all I know, you made that rumor up out of spite and misguided ideology.
    Hmm, maybe I should try it. I heard a rumor that Stuart Browning is a compulsive liar who likes to dress in bee costumes. I can’t prove it. It’s just something I heard from a good friend of his.

  23. It appears that they do – except it’s right out in the open.
    I had a Canadian surgeon tell me a few weeks ago – off the record – that elderly patients with broken hips regularly wait for days on gurneys in his hospital in the hope (of the hospital administrators) that they will develop a blood clot and die – thus saving the hospital money.
    Whether this is true or an exaggeration, I have no way of knowing at this point. However, for a Canadian surgeon to make this claim should give pause.

  24. Well Stuart, it was not simply a “news” column. It was a study done by the Canadian Institute for Health Information. You can browse their website for a lot of factual info on Canadian healthcare – good and bad.
    Here you go: http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=home_e
    “Some older people are continually strung along with no intention of ever giving them a hip. I’ve talked to patients and doctors in Canada who have confirmed this for me.” Really, Canada has an underground systm of government euthanasia?

  25. Peter – your news column doesn’t really prove much of anything related to my question. People there wait months, years and sometimes – yes, forever for joint replacements. Some older people are continually strung along with no intention of ever giving them a hip. I’ve talked to patients and doctors in Canada who have confirmed this for me. Can you say “euthanasia on the sly”?
    As far as the uninsured waiting – that’s just overheated rhetoric. Health care resource shortages are not artificially created in the US, medicine is not rationed. Anyone willing and able to pay for healthcare can receive it quickly. Those unable to pay are charity cases. Your solution turns everyone into a charity case – and deprives Americans of important personal liberties.

  26. “hip and knee problems during the long, multi-year wait.”
    How many years Stuart? 2, 3, 4? Before you throw out all inclusivive numbers like that you should research what’s happening in Canada on wait times – seems they can go about fixing things a lot faster than here.
    “Wait Times in Canada
    The 10 Year Plan outlines strategic investments directed toward reducing waiting times for access to care, especially for cancer, heart, diagnostic imaging, joint replacement and sight restoration services. To support the reduction of wait times, the Federal Government committed to investing $4.5 billion over the next six years, beginning in 2004-05, in the Wait Times Reduction Fund.
    The Wait Times Reduction Fund will augment existing provincial and territorial investments and assist jurisdictions in their diverse initiatives to reduce wait times. This Fund will primarily be used for jurisdictional priorities such as training and hiring more health professionals, clearing backlogs, building capacity for regional centres of excellence, expanding appropriate ambulatory and community care programs and/or tools to manage wait times.”
    And from the Canadian Institute for Health Information
    http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_07mar2006_e
    “Joint replacements: Joint replacement surgeries grew significantly in the five years leading up to 2002–2003. Together, knee and hip replacement surgeries increased 30%, amounting to 11,340 more surgeries over this period. According to the Canadian Joint Replacement Registry, waits for a knee replacement are longer than for a hip replacement, with half of all patients undergoing surgery within seven months for knees and four-and-a-half months for hips. However, 10% of knee replacement patients wait 21 months or more, while 10% of hip replacement patients wait 15 months or more. These results reflect submissions from selected orthopedic surgeons in eight provinces.” end quote
    And how about this finding:
    “The volume of surgeries a province performs, however, appears to have little bearing on its wait times. Health policy experts said this is likely because demand for services often increases with supply.”
    “The University of Calgary’s Dr. Tom Noseworthy said there “is a potentially limitless volume” for some procedures, which he said speaks to the need to set strict criteria for which patients are appropriate surgical candidates.”
    Gee and what’s driving all these hip and knee replacements – could it be WE’RE ALL TOO FAT!
    Increase in hip, knee replacements linked to obesity
    Last Updated: Wednesday, October 25, 2006 CBC News
    More Canadians are receiving hip and knee replacements, and the number of surgeries is up 87 per cent over the past 10 years, according to a report released Wednesday.
    The annual report by the Canadian Institute for Health Information links the trend to increasing rates of obesity.
    In 2004-2005, nine out 10 patients who had knee replacements were considered overweight or obese. Eight out of 10 hip replacement patients also carried extra pounds.
    So Stuart, how much money should Canada throw at this problem? Everything it has? Does this prove the U.S. system is better because wait times from over supply and high prices are less? And what about the wait times for the under insured or uninsured, does that count?

  27. Hmm. I do believe Dr Thom’s comments are a little odd. Whether John Edwards is the root of all evil due to being a trial lawyer is open to question. But it’s worth reminding ourselves that a) lawsuits in health care are barely more prevalent here than elsewhere (see Anderson, in Health Affairs a while back) and b) most corporations are delighted to keep malpractice reform live as an issue so that they can link it to wider tort reform. Given that the Federal government has basically given up its job enforcing regulations, the legal system is playing a relatively important role. I wish we had a more rational system than that, but I know who I blame.
    Meanwhile, if you don’t want to see patients–surely no one is forcing you. But you are the unlucky inheritor of 100 years of political decisions made largely by your forerunners. And they do eventually have consequences.
    Eric. C’mon–how many times have you shouted out for the Shaddeg bill on this blog?

  28. Peter – There are Canadians on long wait lists for orthopedic surgery who also have substance abuse problems. You see, they have to take strong narcotics to handle the terrific pain caused by bone-on-bone hip and knee problems during the long, multi-year wait.
    Since you’re so into sacrifice, would you be willing to “share their pain” when the statist system that you advocate is in place and rationing health care according to the edicts issued by the elite folks who “understand this stuff” (as Mr. Holt puts it)?

  29. Boy Matt you really got some providers backs up – good for you, you must be saying something right. I find it amusing that no provider has proposed anything about them sharing the pain with the premium payers for a fix to our out of control healthcare costs. They only engage in protect my financial butt tactics and let them eat cake responses.
    “donate his wealth to a charity benefiting health care providers with depression and substance abuse problems, he would get my attention.”
    Did I read that correctly, docs, nurses, insurers, hospital CEO’s are drug addicts, drunks and mental incompetents because the present “system” is driving them over the edge. Another, if I only had more money my life would be better delusion.

  30. Matthew- not sure I understand the reference to me… but, I am a strong supporter of the treatment of insurance like other sectors of our modern economy.
    A state brave enough to consider expanding choices and reducing state bureaucracy for health insurance will become a magnet for entrepreneurs, reduce the number of ‘uninsured’ and leave more money in the state treasury to maintain a ‘safety net’ for those that truly need it.

  31. Doctors, hospitals, insurance companies, drug companies … Anyone else Mr. Holt?
    You forgot to mention the other class of people that a single-payer system would be bad for: sick people.

  32. Two observations Mr. Holt:
    I would like to know how much standing John Edwards has with the practicing physician community regarding any aspect of health care. I’m the guy you are hoping will care for these newly insured, and he has absolutely none with me. Now if he did something bold, like apologize to the medical community for being part of the problem and donate his wealth to a charity benefiting health care providers with depression and substance abuse problems, he would get my attention. Until then any post with healthcare reform and John Edwards in the title is a waste of 1s and 0s.
    If you want less of something, tax it. Gov. Schwarzenegger’s plan will result in fewer practicing physicians no matter how much he increases reimbursement.

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