Matthew Holt

Sunday mumbles

If you can’t quite remember why we’re doing this health reform stuff, here’s a very amusing defense of the current health care system by Jonathan Adler at Newsweek (hat-tip to Jon Cohn).

Meanwhile by any measure July was the most read month on THCB with sitemeter telling us that there were some 129,000 visits. Thanks to everyone for coming, but to be fair while we could expect health reform month to ramp up the visits a little, this shows the power of Google. If you search “Obama health care”, this excellent article by Bob Laszewski comes up near the top of the front page… Hopefully some of the new readers will see that it’s 18 months old and stick around to catch the new developments. But kudos to Bob L for doing such a great job here and of course on his own blog Health Care Policy & Marketplace Review.

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19 replies »

  1. If as B.O. says “Of course we need a vigorous debate on health care…” why was it so important to rush it through!!! That is the bottom line on why people are “ticked” off. This problem is 30 years in the making and it can’t be solved overnight!!!
    If no one “is standing between you and your doctor” why wouldn’t every doctor give every gold plated treatment to everyone to get them healthier?…Somebody somewhere is standing there putting the brakes on..!!!

  2. The Dr. Who Knows the Truth, I really applaud your commitment to making healthcare affordable. No doubt, there is a tremendous amount of self-interest in any business, and health insurance is not an exception. But I wouldn’t oversimplify the issue of financial risk insurance companies bear:
    http://health.howstuffworks.com/health-insurance1.htm
    What you suggest is that you become an “insurer” for your customers, collecting premiums and providing services when they come to you, covering your expenses from that pool of money. But what if some sort of catastrophic event, like an epidemic, forces you to spend more money treating your patients, than is there?
    Again, I am all with you on the need to reform both demand and supply side of healthcare, but let us be realistic…

  3. EHR Guy: Yeah, thanks for the link. Graham Walker (the ER resident to whose site you linked) is a nice smart mid-western guy from Kansas who will readily admit that he tends to “rant” in favor of single-payer. I don’t personally find his presentation all that compelling.
    He was “interviewed” during medical school and listed Quentin Young as one of his major formative influences. Dr. Young is a gracious and kind man about whom I will not speak ill. I stayed as a guest in his home in Hyde Park when I interviewed for residency at the University of Chicago. His hospitality was second to none. I do not think it a betrayal of trust to mention that I slept beneath a framed portrait of Vladamir Lenin. Dr. Young is a proud Hyde Park socialist whose advocacy for single-payer care springs from an ideological conviction that socialist ideals will create the greatest good.
    I believe support for single-payer often results from laudable good intentions. Unfortunately, we know what road is paved by good intentions. In my opinion, those advocating single-payer health care have allowed their imagination outrun our ability to engineer sustainable economic systems.
    Before we attempt to “design” 1/7th of the economy, perhaps we should be chastened by the words of Fredrich Hayek and Adam Smith. In “The Fatal Conceit” Hayek quipped: “The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design.” And in “The Theory of Moral Sentiments” Adam Smith wrote: “[A man of the system] seems to imagine that he can arrange the different members of a great society with as much ease as the hand arranges the different pieces upon a chess-board. He does not consider that the pieces upon the chess-board have no other principle of motion besides that which the hand impresses upon them; but that, in the great chess-board of human society, every single piece has a principle of motion of its own, altogether different from that which the legislature might choose to impress upon it.”
    Matt: I thought you liked jokes. Besides, the link to Mankiw’s blog was very meta. Mankiw actually posted little more than a Thoma/DeLong-esque extended quote followed by links to sites debating the idea presented. At least one of the links in the post was to Krugman. Does that make you feel better?
    Mankiw has an undergraduate degree in economics with summa cum laude honors from Princeton, a Ph.D. in economics from MIT, teaches at Harvard, has written two widely-used textbooks in both macro and micro economics, and is in the top twenty economists ranked at ideas.repec.org. (repec = research papers in economics). I’m sure not “everything” he writes is a joke.

  4. Dear The Dr. Who Knows the Truth,
    You have been elected as the single-payer doctor to go guy.
    If only most doctors thought like you!
    Thanks,
    The EHR Guy

  5. The truth is health insurance is a joke. What makes anyone who actually uses their brain think that by paying some technocrat in nowhereville Nebraska, 300.00 a month + your employer paying another 4 -800.00 a month + %20 of your income going to Medicaid and Medicare is somehow going to give you health care. These institutions do not provide health care they are money making organization whose only products are pieces of plastic that state that they promise nothing. I am health care. If everyone paid me 100.00 a month I could provide you with all the health care you could ever use. But, you keep on paying the insurance company and the Medicaid and Social Security office and all you going to end up is sick and broke. I am a doctor. I am 90% cheaper than health insurance so is the hospital…what else to you need?

  6. Regarding my above comment:
    Mr. Holt linked to an absurd article by John Adler and described it as “very amusing.” I thought it might be even funnier if written from the opposite perspective. The result is my “comment.”
    So Mr. EHR guy, go ahead and hire up your reader. They might even get you some useful information. But I’ll warn you, it’s not a rousing call to arms for single payer.
    JD, thanks for the tip.

  7. Dear pidgas,
    I’m going to hire someone to read your comment.
    It’s too long and it really doesn’t say anything tangible.
    It’s always polite never to use more characters in the comment than are in the post.
    But if you are saying that single-payer is the way then you’ve made my day.
    Thanks you,
    The EHR Guy

  8. Go ahead, shoot me. I like the reforms advocated by the House and Obama on health care in the United States. I’ll get insurance now – Gubment insurance! Damn pretty!
    I’m with that woman who wrote the president supporting “socialized medicine” and added: “Be sure and leave the employer based insurance system untouched like you’ve promised.” That’s the spirit!
    I am entitled to the same insurance that members of Congress get. Frankly, I’m entitled to the best insurance anyone gets. Why shouldn’t I be? Blue Dogs need to just focus on finding the money to make it happen. I’m just a regular guy who, like 50% of my fellow Americans, either paid no net income tax or actually received a subsidy check from the government. The other 50% are morally obligated to take care of me – duh. Why else would they pay for so much?
    I like that if I have cancer and the treatment my doctor prescribes doesn’t meet the QALY cut-off, I get the second choice with only a few minor side-effects. It’s fine. You’ve gotta remember: you only need one kidney and one lung. My coverage won’t change because of this illness, well technically. If, God forbid, the cancer recurs – I’ll be lucky to catch it given the shortage of doctors and testing equipment. Even if I do, treating the recurrence would be considered “heroic” by the government and I’d go straight to palliative care. Thank God for the QALY. It’s something to die for, indeed. How else could we tell whether something is worth the cost?
    I’d like government-issued “insulation” from health care costs. It would mean that my cost for second-choice treatment is NADA! That’s as it should be — face cancer and receive treatment deemed “cost effective” by government. For free! Nice.
    I like the cost-containment strategies used by the government for health care. Those actuaries and technocrats are so caring and sympathetic. What, you don’t think so? Tell me that the statutory formula determining the “sustainable growth rate” restriction on expenditures doesn’t make you feel cared for. Tell me that you wouldn’t want your mother’s care determined, at least in part, by budgetary targets obtained by multiplying the Medicare Economic Index and the Update Adjustment Factor using the Sustainable Growth Rate on your Conversion Factor? This means that the further “off course” from budgetary targets we get, the tighter spending restrictions are ratcheted down. Hope you got your cancer “last year.” We can’t afford to spend as much this year. That’s fair.
    Speaking of fair, it seems fair to me that cost-cutting bureaucrats at the government—not doctors—decide what’s available. After all, the government know best.
    Yes, government provided care would rock. I learned recently about something called the “loading fees” of insurance companies. That’s how much of every health-care dollar gets spent by insurance companies on things other than the medical care—paperwork, marketing, profits, etc. Thank God the government is even LESS efficient. When administrative costs are compared on a per-person absis, Medicare’s administrative costs are only 56 dollars higher per person – and we get so much MORE!!! [1]
    The good news is that we won’t pay anywhere near $8,000 a year per family for care anymore. It’s also good news that Dad won’t get that totally superfluous hip replacement either. His pain isn’t bad enough yet – he can still get to the garage and back with his walker. The sourpusses who wanted to think twice about the direction of reform say he wouldn’t get that hip. Well, guess what! He wouldn’t and and he wouldn’t die sooner either. Voila! Measure THAT in your statistics. He can still get his own beer (and aspirin), he’s fine.
    And why are those supporters of private insurance so jittery about a “public option?” Jeesh – there are over 1000 health insurance companies out there. Do they really fear the competition of one more insurance provider just because it can’t ever technically go “out of business.” The government even says it can’t be subsidized. If it loses money it loses money and will eventually go out of…wait. That’s right, it can’t go out of business! It’s the ultimate “too big to fail” business! No wonder it has such nice low premiums! BONUS!
    [1] http://snipr.com/okv77 [gregmankiw_blogspot_com]

  9. Put the screws on big business insurance carriers and cut executive salaries.
    The doctors have become defacto employees of the insurance carriers.
    The guy who runs the not for profit Highmark in Pittsburgh is earning 3.5 million (dollars)to rape its customers.

  10. Funny, I had copied exactly the same paragraph as Nate and was going to paste it here and rant a bit. But I see the job is done.
    9/10 of the article is funny, but that part is beyond the pale.

  11. Everywhere I post comments traffic grows, and not to boast! 🙂
    Just kidding! Congratulations! This is an excellent blog. It truly sets standards not only in healthcare blogging but through the whole blogosphere.
    On another note:
    Single-payer is the way, so let’s not delay!
    Despite all stimulus, healthcare IT is NOT picking up. Hospitals claim lack of endowments and access to credit/cash.
    Both reform and modernization are beginning to sound like hogwash to me!
    Thanks,
    The EHR Guy

  12. linking this is a new low even for you Matt.
    ” According to a University of Minnesota study, up to 47 percent of all the money going into the health-insurance system is consumed in “loading fees.” Even good insurance companies spend close to 30 percent on nonmedical stuff.”
    If the centered their debate on the earth being flat would you link that? What if Newsweek argued we shouldn’t go to the moon becuase the cheese is to soft. Garbage like this needs buried in the trash where it came from. Sadly there a millions of Americans to dumb to know better that actually beleive this crap.

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