This is an excerpt from one of President Obama's town halls last week about health care:
Sturm: But at 100 the doctor had said to her, I can’t do anything more unless you have a pacemaker. But the arrhythmia specialist said, no, it’s too old.Her doctor said, I’m going to make an appointment...and when the other specialist saw her, saw her joy of life and so on, he said, I’m going for it...
My question to you is, outside the medical criteria for prolonging life for somebody elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, quality of life? Or is it just a medical cutoff at a certain age?
President Obama: We actually have some - some choices to make about how we want to deal with our own end-of-life care...I don’t think that we can make judgments based on peoples’ spirit. [my own emphasis added] That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people.
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The proponents of the President's plan were taken aback when former Alaska Governor Sarah Palin decried the President's plan as including "death panels" that will decide what care elders receive at the end of life. They claimed that this was merely an insidious scare tactic and have launched a "get the real facts out" campaign to combat these claims.
There's only one problem: the President has advocated exactly the type of "death panel" that Gov. Palin warned us about, just under a different guise and different nomenclature. The unvarnished truth here is that no matter how much powdered sugar you bury a turd in, it still ain't gonna be a donut.
Obama says he wants to establish a panel to decide which treatments are most effective. That means taking the decision away from a doctor and patient and having a government panel make a decision for you. They'll make an arbitrary decision based on some accounting tables, not on your individual medical circumstances.
We don't spend health care dollars on healthy people. We spend them on people who fall ill. And something like 70% of medical spending in the US is in the last six months of a patient's life. So if a government panel of bureacrats starts making decisions on who deserves what medications and treatments based solely on accounting calculations and NOT ON MEDICAL EVIDENCE, then what else do you call this kind of legislation? Arbitrary-decide-what-medicine-you-get-at-the-end-of-your-life panels. A bit cantankerous of a title compared to 'death panels' but it's the same thing.
Thursday, August 20, 2009
Monday, August 17, 2009
We'll Send You A Pain Pill In The Mail, If It Ever Gets There
President Barack Obama has spent most of the last few years tethered very closely to his teleprompter, moving from fringe candidate in a party primary to become the leader of the free world as the President of the United States. For good reason, his campaign manager Rahm Emanuel and his chief policy advisor David Axelrod have made sure he's stayed "on message" while delivering speeches all over the country and the world. This is nothing new, and it is hardly irregular for a politician to simply read from a speech when addressing the public. Nothing wrong with that.
What's been slightly odd is how much Obama is dependent on his teleprompter for assistance when speaking. For such a gifted speaker, it is odd that he requires the constant use of that machine to help him through his speeches. Again, there is absolutely nothing wrong with this; I'm merely making a curious observation.
It's quite curious in light of what happened last week during a town hall meeting the President held, one of several he is attending all over the U.S. trying to sell the public on his proposed health care reforms. It's difficult to use a teleprompter in such environments simply because (unless extremely well staged) it is challenging to predict exactly what kind of queries the President would face from the live audience at such an event. Hence, the President is forced to ad-lib, and more or less shoot from the hip. Theoretically, it's not too difficult for a talented orator such as Obama to paraphrase his ideas on a subject that he has focused on so closely of late.
It's quite curious then that when Obama had to answer a question about how private insurance companies will be able to compete with a public option for health insurance (which would be subsidized by taxpayer dollars) that he had to go a bit off script and talk from the cuff. The video of his response has gone viral all over the net, the crucial point of which was:
"UPS and FedEx are doing just fine. It's the Post Office that's always having problems."
With these words, Obama committed a potentially-fatal political Freudian slip. His point, taken in whatever context you wish, seems to be that a government-run enterprise is far less adept at supplying a necessary service than it's private, for-profit brethren. But the President is advocating just that: he wishes that we replace a privately-run system of for-profit health insurers with a government-run public option.
We all know how recklessly inefficient and slow the "snail mail" carriers seem to be with delivering our things. It's also notable that while UPS and FedEx, as noted by Obama, are consistently profitable amidst difficult markets and changing economic dynamics. Meanwhile, the U.S. Postal Service is enormously unprofitable, having lost more that $6 billion last year alone, and must be propped up by public funds. Long before GM stood for Government Motors or Clunkers could be redeemed for Cash, the U.S. taxpayer was bailing out the USPS due to it's inability to compete in the competitive marketplace.
So let's briefly review: the President wants us to trust us to give up our privately-run, for-profit health insurance to be replaced with a public, government-run option. This, in spite of the overwhelming evidence that another government-run institution is grossly incapable of doing just that. And let's not forget that the USPS only has to deliver the mail and some packages, a task far more trivial than having to allocate life-saving medicines and procedures to patients in need of these resources.
We all know that the Post Office is hardly the only government-run organization notorious for ineffectiveness and inefficiency. Have you visited a DMV or a Medicaid clinic lately? Yet the President insists that the current health care system is untenable and filled with exactly the sort of "waste, fraud and abuse" that other government-run institutions have made famous. He is adamant that without competition from a publicly-backed health insurer, private insurance companies won't be able to allocate health care resource effectively. This appears to be a very troubling argument.
Perhaps he has a point about public and private firms, however. After all, we wouldn't be able to appreciate FedEx and UPS without the mass incompetence of the Post Office to compare them to.
What's been slightly odd is how much Obama is dependent on his teleprompter for assistance when speaking. For such a gifted speaker, it is odd that he requires the constant use of that machine to help him through his speeches. Again, there is absolutely nothing wrong with this; I'm merely making a curious observation.
It's quite curious in light of what happened last week during a town hall meeting the President held, one of several he is attending all over the U.S. trying to sell the public on his proposed health care reforms. It's difficult to use a teleprompter in such environments simply because (unless extremely well staged) it is challenging to predict exactly what kind of queries the President would face from the live audience at such an event. Hence, the President is forced to ad-lib, and more or less shoot from the hip. Theoretically, it's not too difficult for a talented orator such as Obama to paraphrase his ideas on a subject that he has focused on so closely of late.
It's quite curious then that when Obama had to answer a question about how private insurance companies will be able to compete with a public option for health insurance (which would be subsidized by taxpayer dollars) that he had to go a bit off script and talk from the cuff. The video of his response has gone viral all over the net, the crucial point of which was:
"UPS and FedEx are doing just fine. It's the Post Office that's always having problems."
With these words, Obama committed a potentially-fatal political Freudian slip. His point, taken in whatever context you wish, seems to be that a government-run enterprise is far less adept at supplying a necessary service than it's private, for-profit brethren. But the President is advocating just that: he wishes that we replace a privately-run system of for-profit health insurers with a government-run public option.
We all know how recklessly inefficient and slow the "snail mail" carriers seem to be with delivering our things. It's also notable that while UPS and FedEx, as noted by Obama, are consistently profitable amidst difficult markets and changing economic dynamics. Meanwhile, the U.S. Postal Service is enormously unprofitable, having lost more that $6 billion last year alone, and must be propped up by public funds. Long before GM stood for Government Motors or Clunkers could be redeemed for Cash, the U.S. taxpayer was bailing out the USPS due to it's inability to compete in the competitive marketplace.
So let's briefly review: the President wants us to trust us to give up our privately-run, for-profit health insurance to be replaced with a public, government-run option. This, in spite of the overwhelming evidence that another government-run institution is grossly incapable of doing just that. And let's not forget that the USPS only has to deliver the mail and some packages, a task far more trivial than having to allocate life-saving medicines and procedures to patients in need of these resources.
We all know that the Post Office is hardly the only government-run organization notorious for ineffectiveness and inefficiency. Have you visited a DMV or a Medicaid clinic lately? Yet the President insists that the current health care system is untenable and filled with exactly the sort of "waste, fraud and abuse" that other government-run institutions have made famous. He is adamant that without competition from a publicly-backed health insurer, private insurance companies won't be able to allocate health care resource effectively. This appears to be a very troubling argument.
Perhaps he has a point about public and private firms, however. After all, we wouldn't be able to appreciate FedEx and UPS without the mass incompetence of the Post Office to compare them to.
Wednesday, August 5, 2009
Gettin' Edu-mah-cated: Health Care Economics
Sara B: Thanks for responding. You're officially the first to reply to my first post. Now to the business at hand. This is the crux of Sara's response to my previous post:
There are a number of issues with this idealization, however, and it all centers around one simple concept: scarcity. There is never any rational end to each person's "needs". Some people may "need" to eat and drink more than others. Some families require larger houses and larger, less fuel-efficient cars. Some people value open spaces and parks. Others love urbanization and crowds. The Marxist ideal makes no room for this difference in needs (no matter how subjective they are), tastes and new technologies. It simply assumes that everyone has the same basic requirements and that is all enough. So, without a finite restriction on demands for various goods and services (remember, there are hundred of thousands of services and products available), then only a limitless supply of those goods and services will suffice.
However, there are limited resources in the world. There are only so many able-bodied people, so much time, and so much natural resource to go around. That means there is a shortage of production to fulfill the limitless needs and desires of people. That necessitates us having to choose how to use our limited resources the best way possible. We can organize our usage in several ways, but they tend towards one of two extremes: a central planning body can dictate the production and consumption of goods, or a perfectly competitive free market can allocate our supplies and demands for us.
The primary problem with a central planning body is that due to constantly changing market conditions (prices and quantities of goods and incomes of consumers), it is simply too grandiose a task for any group of people, no matter how sophisticated a computer model they might have to efficiently allocate these resources. That means that no matter how hard they try, they cannot make sure that the right amounts of the right goods and services are provided to the right consumers at the right time. At least, no more so than a market can.
I don't mean to belabor an economics lesson here. This same logic applies to health care. There is a limited supply of health services out there for our consumption. Doctors, nurses, hospitals, and medical equipment are not simply limitless. Additionally, production of all these resources is very time-consuming and expensive. For example, it takes 4 years of college, 4 years of medical school and four more years of internship and residency to "produce" a doctor. And it costs about $1,000,000,000 on average to produce a new pharmaceutical drug. So somewhere, we must pay to incentivize doctors to go into the medical field, and we must pay for drugs to be created.
In the places where a central planning body has taken over the payment part of allocating health care resources (Great Britain, Canada, Australia), the result is a functional catastrophe. In spite of the altruistic intentions of their creators, these systems have failed miserably at providing even the most basic care for most citizens. The result has been more scarcity of health care resources, not less. The people who allocate resources for these countries have no ill intentions. They want everyone to get health care when they need it. But for the aforementioned reasoning, they cannot allocate resources effectively. Too many resources are wasted in one area, and not enough are delivered in another. They simply can not handle the task at hand because the conditions within the market are changing too quickly for them to catch up.
Rather, in a (pardon the pun) healthy marketplace, if there exists a demand for a product or service, that demand pulls the necessary resources from the market and moves them to the proper channels so that they are delivered to the person asking for them in the proper way at the desired time. This demand is evidenced to the marketplace when individuals show willingness to spend their own money on health care, signaling to health care providers that a profit opportunity is available. Thus, those doctors, nurses, pharmaceutical companies and medical equipment makers can step in and provide a necessary good or service.
I'm not advocating that the current system is just perfect and ought to be left alone. I'm sayign that the kind of changes that Nancy Pelosi, Harry Reid and Barack Obama are advocating are exactly the wrong kind of change. Any number of focused legislative changes could be enacted to spur the kind of changes in the market that you and I both want to happen. We both agree that everyone who needs health care deserves it and should have access to it. We simply disagree on the best way to make that happen. I'll post again with some of my own ideas on how to get the improvements in the health care market we seek.
"I like to think of the universal health care plan as one way we look out for each other. I think of my community as a collective being; everyone contributes towards a better good. It can't always be 'me, me, me.' One must be altruistic and caring."
That's a nice idea. You're restating the idea of "From each according to his abilities, to each according to his needs". This maxim was first espoused by Karl Marx and Friedrich Engels in Das Kapital. I'm not pointing this out to make a silly name-calling, straw-man argument. I'm simply pointing out the fact that you're talking about Marxist socialism in another name.
The idea behind this is pure nirvana: everyone works as hard as they possibly can, no matter what they get for it. Natural differences between people will always arise, and the best and brightest will produce more than the rest of us, and everyone is better off from all this additional production. Additionally, in this utopia, everyone simply takes as much as they "need" to get by.There are a number of issues with this idealization, however, and it all centers around one simple concept: scarcity. There is never any rational end to each person's "needs". Some people may "need" to eat and drink more than others. Some families require larger houses and larger, less fuel-efficient cars. Some people value open spaces and parks. Others love urbanization and crowds. The Marxist ideal makes no room for this difference in needs (no matter how subjective they are), tastes and new technologies. It simply assumes that everyone has the same basic requirements and that is all enough. So, without a finite restriction on demands for various goods and services (remember, there are hundred of thousands of services and products available), then only a limitless supply of those goods and services will suffice.
However, there are limited resources in the world. There are only so many able-bodied people, so much time, and so much natural resource to go around. That means there is a shortage of production to fulfill the limitless needs and desires of people. That necessitates us having to choose how to use our limited resources the best way possible. We can organize our usage in several ways, but they tend towards one of two extremes: a central planning body can dictate the production and consumption of goods, or a perfectly competitive free market can allocate our supplies and demands for us.
The primary problem with a central planning body is that due to constantly changing market conditions (prices and quantities of goods and incomes of consumers), it is simply too grandiose a task for any group of people, no matter how sophisticated a computer model they might have to efficiently allocate these resources. That means that no matter how hard they try, they cannot make sure that the right amounts of the right goods and services are provided to the right consumers at the right time. At least, no more so than a market can.
I don't mean to belabor an economics lesson here. This same logic applies to health care. There is a limited supply of health services out there for our consumption. Doctors, nurses, hospitals, and medical equipment are not simply limitless. Additionally, production of all these resources is very time-consuming and expensive. For example, it takes 4 years of college, 4 years of medical school and four more years of internship and residency to "produce" a doctor. And it costs about $1,000,000,000 on average to produce a new pharmaceutical drug. So somewhere, we must pay to incentivize doctors to go into the medical field, and we must pay for drugs to be created.
In the places where a central planning body has taken over the payment part of allocating health care resources (Great Britain, Canada, Australia), the result is a functional catastrophe. In spite of the altruistic intentions of their creators, these systems have failed miserably at providing even the most basic care for most citizens. The result has been more scarcity of health care resources, not less. The people who allocate resources for these countries have no ill intentions. They want everyone to get health care when they need it. But for the aforementioned reasoning, they cannot allocate resources effectively. Too many resources are wasted in one area, and not enough are delivered in another. They simply can not handle the task at hand because the conditions within the market are changing too quickly for them to catch up.
Rather, in a (pardon the pun) healthy marketplace, if there exists a demand for a product or service, that demand pulls the necessary resources from the market and moves them to the proper channels so that they are delivered to the person asking for them in the proper way at the desired time. This demand is evidenced to the marketplace when individuals show willingness to spend their own money on health care, signaling to health care providers that a profit opportunity is available. Thus, those doctors, nurses, pharmaceutical companies and medical equipment makers can step in and provide a necessary good or service.
I'm not advocating that the current system is just perfect and ought to be left alone. I'm sayign that the kind of changes that Nancy Pelosi, Harry Reid and Barack Obama are advocating are exactly the wrong kind of change. Any number of focused legislative changes could be enacted to spur the kind of changes in the market that you and I both want to happen. We both agree that everyone who needs health care deserves it and should have access to it. We simply disagree on the best way to make that happen. I'll post again with some of my own ideas on how to get the improvements in the health care market we seek.
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