Meditates on socialized medicine, and its friends and relatives:

Having lived in Japan for twelve years and had several friends who (unlike me) work in health care, I had a lot of lively discussions about the relative merits of socialized medicine. What always drove me crazy was when people talked as if the money for health care weren't going to have to come from somewhere. There's plenty of great health care available in Japan, but stories have surfaced recently about patients' being turned away or dumped by hospitals, and about desperate Japanese who travel to China for organ transplants. One doesn't want to be like the NYT Style Section and inflate every clutch of three colorful anecdotes into a Major Trend, but the aging society does mean that there will be fewer workers supporting more geriatric patients in short order. Everyone is worried.

Of course, that's a practical, not philosophical, problem. Whittle writes,

Constitutional rights protect us from things: intimidation, illegal search and seizure, self-incrimination, and so on. The revolutionary idea of our Founding Fathers was that people had a God-given right to live as they saw fit. Our constitutional rights protect us from the power of government.

But these new so-called "rights" are about the government — who the Founders saw as the enemy — giving us things: food, health care, education... And when we have a right to be given stuff that previously we had to work for, then there is no reason — none — to go and work for them. The goody bag has no bottom, except bankruptcy and ruin.

And, of course, when the government is in charge of giving out goodies, it gets to set priorities and trade-offs for individuals. Is your need for a procedure "urgent"? What's an acceptable minimum for "quality of life"? Would you prefer to buy less health coverage and more of something else you value more highly? What happens when functionaries start telling fat people they don't deserve bypass surgery because they've spent their lives tunneling through five Entenmann's cakes a week?

Not, I hasten to add, that the current American system is anywhere near perfect...but then, neither is it a free-market system.

Just corrupt, is all—and not all it could be. Yet far, far, better than socialized medicine. More likely to let me decide which goodies are best for me. Which I should have, and which I do not want.

Read the whole thing, and follow over to Whittle's piece, while you're at it.

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P.S. Thanks for your service to our country; please die in the Philippines, though.

h/t: Q and O.

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From The New York Post.

(I'm going to have to throw in a reminder here that I don't want to see any attacks on Ted Kennedy in the cancer context.

I do realize that some people can't help but think of deep water, alcohol abuse, lack of enunciation, and lace-curtain Irish when the man's name comes up; knock yourself out. Any excessively vitriolic or "let him die" kinds of remarks, however, will be subject to deletion, or to whimsical editing for my personal, childish amusement.)

But one cannot help but be struck by the irony: in the quixotic attempt to make sure that every healthy 25-year old is covered by health insurance, we might not pay attention to those "unintended consequences" the Canadians and Britons both endure, and we could end up killing some of the people we were hoping to save.

As with most of these misguided projects, the risks are lower with McCain in the White House, vs. Obama.

. . . [T]he dangers of the liberal health-care agenda are being made clear by the care that a liberal icon, Sen. Ted Kennedy, has received since his brain seizure last month.

One day after an MRI detected a tumor, Kennedy was quickly diagnosed with a malignant glioma—a rare and often-fatal form of brain cancer. Less than two weeks later, his tumor was being removed by one of the world's experts in brain cancer at Duke Univeristy Medical Center. He'll follow up with chemo and radiation therapy tailored to the genetic makeup of his cancer to keep the cancer from spreading.

He'll likely take Avastin, a drug that in experiments with brain cancer has extended survival by months. A new cancer vaccine being developed in partnership with Pfizer could extend his life by six years.

Of course, with his wealth and power, Kennedy would get good treatment anywhere. But the same care is available to every American. Not so - if we make the health "reforms" called for by Kennedy and other liberals.

Filmmaker Michael Moore gives their standard line when he says: "There are problems in all health-care systems, but at least Europeans and Canadians have a health-care system that covers everyone." Problem is, governments that promise to "cover everyone" always wind up cutting corners simply to save money. People with Kennedy's condition are dying or dead as a result.

Consider Jennifer Bell of Norwich, England. In 2006, the 22-year-old complained of headaches for months—but Britain's National Health Service made her wait a year to see a neurologist. Then she had to wait more than three months before should could get what the NHS decided was only a "relatively urgent" MRI scan. Three days before the MRI appointment, she died.

Well, it could be worse: she could have been Cuban, and dealing with the roach-infested facilities that most of those on the island are relegated to. ("But at least everyone's at the same level, there." Um, no. Not the well-connected. Under socialism, one has to kiss up to dictators to get one's needs met. Here, all one has to do is scrape up some cash. That is, of course, an easier project.)

More from Goldberg:

Consider, too, the chemo drug Kennedy is receiving: Temodar, the first oral medicine for brain tumors in 25 years. Temodar has been widely used in this country since the FDA approved it in 2000. But a British health-care rationing agency, the National Institute for Comparative Effectiveness, ruled that, while the drug helps people live longer, it wasn't worth the money—and denied coverage for it.

Barack Obama—and other Democrats—have been pushing a Senate bill to set up a similar US "review board" for Medicare and any future government health-care plan.

After denying this treatment completely for seven years, the NICE [. . .] relented—partly. Even today, only a handful of Brits with brain tumors can get Temodar. And if you want to pay for Temodar out of your own pocket, the British system forces you to pay for all of your cancer care—about $30,000 a month.

That's one of the evils of some Medicare rules, even here and now: there should never be a rule against buying something extra "a la carte." And yet most of these bureaucrat-driven systems won't let you get anything "on the side" that your insurance won't pay for. That's just evil.

Goldberg continues:

Things are no different in Canada, where the wait for an MRI (once you finally get a referral) has grown to 10 weeks. For Canadians relying on their government health care, the average wait time from diagnosis of cancer to surgery is beyond the guideline set by both the US and European societies for surgical oncology.

And HealthCanada, the government system, similar[ly] refuses to pay for treatments that are often covered in America. Chad Curley, a 37-year-old auto worker from Windsor, Ontario, had a brain tumor like Kennedy's but can't have surgery because his is too large to be operable.

His tumor didn't respond to Temodar, and the same doctors now treating Sen. Kennedy told him and his wife that the Avastin combination could stop his tumor from growing and add months to his life. But HealthCanada wouldn't pay to use Avastin to treat his tumor.

I want our health-care "system" in which patients have the power to affect their care. I don't want someone else deciding what I do and don't need. Under socialized medicine, these calls are being made by people who haven't even met the patients. That's not okay.

h/t: Flopping Aces.

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Over at McArdle's digs, Henke takes a look at this piece on the perverse incentives created by the FDA.

Jon—who is, BTW, my blog-nephew, and far more successful than his Aunt Joy—suggests:

There's a research project in this for some enterprising investigator.

• Find out how many medical treatments and procedures have been declined by health insurance companies and health care providers over the past 5 years.

• Contrast that with the potential medicines, procedures and devices that have been rejected, delayed or buried in regulatory tape, and the likely treatments and procedures those would have provided.

I would speculate that you'll find the unintended consequences of FDA regulations have had a far larger impact than the cumulative declined treatments of the health care industry.

Well, yeah. But there is, as the original article points out, a mindset that can't quite make the leap of faith that might suggest we could make progress in biotech as rapidly as in computing and electronics. The only factor that can make inroads against the socialist-medicine mindset has to do with anti-aging technology that is "skin deep": because insurance isn't expected to cover cosmetic surgeries, these are more likely to be innovative than other types of medicine.

But even these often have to clear one major roadblock, and that is the FDA.

Vaguely related: I sometimes wonder how the history of health would have been different if it weren't for the Dalkon Shield. Did the pendulum swing too far in the other direction? Is that how we got into this fix?

(The longevity issue—and Henke's take thereon—got a 'Lanche yesterday.)

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Over the past five years I've run the gamut from excellent entertainment-industry health insurance . . . to no insurance . . . to amazingly sucky, exorbitant coverage that costs us thousands more a year than it "really" costs, because we have to continue A the H's production company in order to qualify for it, when we'd really like to let that go and slash our overhead.

And most of my friends are freelancers; I suspect they, like me, would be thrilled to get something decent for a semi-reasonable cost that wouldn't be pulled out from under them every time they changed jobs or careers.

I realize that a lot of people "expect" employers to pay for health care, but (1) a that number will decrease as people no longer "expect" that they'll necessarily be working staff jobs, and (2) a lot of people, given the choice by their companies, would prefer to take the cash versus the benefits. Or some of the cash, versus the benefits. Or having the flexibility to work anywhere they want to, rather than being "married" to one company or another due to some "pre-existing condition."

I remember sitting in my publisher's office in 1990 when I was living on $16,000 a year in West Los Angeles, with a commute to Burbank and a diet that consisted largely of macaroni and cheese.

This publisher was trying to convince me that, at the age of 28, I should purchase health insurance through the company. The problem was that it would have cost me a lot of money that I simply didn't have.

But of course my publisher thought I should be covered. He didn't want this enough to pay his staffers salaries we could actually live on, but he wanted it. Sort of. At least, he wanted to lecture me endlessly on the point while I was scrambling to make his deadlines.

At some point I just told him that I'd gotten insurance through one of my parents. He knew I was lying, but what could he do?

Save me the paternalism. Just give me the cash.

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Yeah. We do have a problem in this country with health insurance. Not quite the one my statist friends imagine, but one nonetheless. Mostly, between the litigiousness of our culture and the activism of various special interests groups, it's hard to get basic care; the state tends to mandate that every possible health-care scenario be covered under any plan. Meanwhile, the insurance companies are subsidized, and few people feel like they are paying "real money" for their care.

So costs rise, and a lot of the self-employed are priced out of the market. My husband and I wouldn't have insurance at all if we couldn't get it through his corporation, but that means we have to keep the corporation open, though it's no longer cost-effective to have it in other arenas.

Therefore, I'm intrigued by the latest from Olympia Snowe's office about a new act that might (might) make insurance more affordable and portable, and put it within reach of some self-employed types who don't have catatrophic coverage right now:

SHOP Act One-Pager

Small businesses find it difficult to afford health insurance for their employees:

• SHOP will allow small businesses to band together in a statewide or nationwide pool to obtain lower health insurance prices by spreading their risk over a larger number of participants.

• SHOP will keep prices low by offering a range of private health plans that have to compete for business.

• SHOP will provide small business owners with a tax credit of up to $1,000 per employee ($2,000 for family coverage) if they pay for 60% of their employees’ premiums.

• SHOP will provide small business owners with a bonus if they pay for more than 60% of the premiums.

Small business owners pay higher prices when they have older workers and face large premium hikes when even one employee experiences a serious illness:

• SHOP would make insurance rating based on health status and claims experience illegal so that premium increases will be more stable and predictable.

• SHOP ensures that the variation in premium rates will be reduced so that small businesses will be better able to afford coverage without facing as much of a competitive disadvantage if they have older workers.

Selecting a health insurance plan is confusing and choices are often limited:

• SHOP will provide a web site with comparative information about a variety of private health plans.

• SHOP will allow new health plans to be offered nationwide but will continue to rely on state insurance commissioners to ensure that all health plans meet state requirements for financial solvency, network adequacy, and claims and appeal procedures.

SHOP helps the self-employed:

• Self-employed individuals face extremely high costs when trying to purchase health insurance in the individual insurance market:

• SHOP will allow the self-employed to purchase insurance in the same pool as small businesses.

• SHOP will provide self-employed individuals with a $1,800 tax credit ($3,600 for family coverage) to purchase health insurance.

Anyone have any thoughts on this? Here's a snippet from the press release:

A bipartisan group of senators, with the support of small-business and labor union lobbyists, on Wednesday unveiled legislation they said would go a long way toward expanding healthcare coverage for the largest segment of the uninsured.

Senate Majority Whip Dick Durbin (D-Ill.) said that he has been working since last January with the National Federation of Independent Business (NFIB) and the National Association of Realtors (NAR) to develop the legislation. He hopes it will break a deadlock that has stalled past efforts to facilitate access to health benefits for small-business owners, their employees and the self-employed.

Durbin has found support from Republicans, most notably Maine Sen. Olympia Snowe, the ranking member on the Senate Small Business and Entrepreneurship Committee who is also the billÂ’s lead co-sponsor. And in addition to the business groups, the Service Employees International Union (SEIU) has endorsed the bill.

According to the nonpartisan Kaiser Family Foundation Â’s 2007 employer health benefits survey, 59 percent of companies with fewer than 200 employers offer health insurance to their workers, compared to 99 percent of larger firms.

“Contrary to popular belief, most people who don’t have health insurance are not out of work,” said Durbin.

“We have to find a reasonable way to help small businesses that want to provide good health insurance to their owners and their workers, and also the self-employed, who’ve been left behind too many times,” he said.

Standing with Durbin Wednesday was NFIB President and CEO Todd Stottlemyer, who represents an organization that traditionally leans toward Republican ideas.

“This is the largest portion of the uninsured population in the United States,” Stottlemyer said. The Durbin-Snowe bill could “break the decades-long logjam that has blocked small-business [healthcare] reform legislation,” he said.

Snowe, who has sponsored small-business health-insurance legislation in past Congresses, echoed the bill’s importance. “Indisputably, rising costs of health insurance has been the No. 1 issue of concern for small businesses, and rightly so,” she said.

Sen. Blanche Lincoln (D-Ark.) joined Durbin and Snowe at the announcement. Sens. Norm Coleman (R-Minn.) and Amy Klobuchar (D-Minn.) also are original co-sponsors, Durbin said. All but Klobuchar sit on the Finance Committee. Executives from the NFIB, the NAR and the SEIU also spoke at the event.

Although only about 75,000 of the SEIU’s 1.9 million members are self-employed or work for small businesses, reducing the number of uninsured “can’t just be about our members,” said Mary Kay Henry, the union’s executive vice president.

The legislation would combine annual tax credits up to $2,000 per worker for small-business owners and $3,600 for the self-employed with state- and federally based insurance pools designed to spread risk for insurers and reduce premiums for workers. The measure also limits insurersÂ’ ability to use patientsÂ’ medical histories to exclude them or drastically hike their premiums. The bill would leave most of the regulation of the insurance plans to state authorities.

The senators highlighted the diversity of interests backing the bill: The NFIB has traditionally aligned with Republicans and the SEIU with Democrats.

Underscoring this point, Durbin joked about his first meeting with Stottlemyer about the bill, which took place shortly after Democrats assumed control of Congress. “It was a rare visit by the NFIB in my office. I think it was the first … in my congressional career,” Durbin said.

In essence, the situation right now is that a lot of people are being forced to buy the "extended warranty" on the human body, or do without any sort of help at all if they get into a jam. And we all know who benefits from extended warranties . . . don't we?

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In The Atlantic. I read this one on paper. If the online version sucks, I'm not responsible. (Who knows? Maybe it's been copyedited since the magazine went to the printer, and bad words were added.)

Actually, I've noticed a similar phenomenon to the one Postrel describes, but on a different level: when I changed health-care plans (rather, when I got health insurance after a year or two off, in the wake of losing my lovely Motion Picture coverage), I noticed that I had a really bad feeling about the level of care based on precisely the visual criteria that Postrel alleges we neglect. Which leads me to believe that aesthetic standards are higher among providers that cater to the entertainment industry than they are for other elite Angelenos.

Which would, of course, be a shocker. But when I made my first visit to my new GP and saw how dirty the carpeting was, and how crowded with posters the examining room, and how cluttered his desk was, and how there was a television on in the waiting room—tuned in to some horrible channel—I had a very bad vibe about it.

Postrel is right: these things matter in a way that many businesspeople—including those in the business of health care—aren't quite ready to admit.

Needless to say, this is yet one argument against a single-payer healthcare system. Unless we want hospitals to look, even more consistently, like post offices.

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So the "epidemic" has plateaued, some are suggesting.

Perhaps our immune systems are learning to fight the virus that creates obesity. That would really stop the disease from spreading.

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going on over at James' place.

My favorite part is Dave's demolishing of the "left/right" construct. Always annoying, those labels.

(Note to self: decide on this blog's style for "health care" vs. "healthcare." And, for crying out loud, pick the latter.

"The cobbler's children have no shoes." To my shame, it's been four and a half years—but I still don't have a style sheet for this site.

I must go now and hit myself over the head with The Chicago Manual of Style, or perhaps Words Into Type. Or maybe Web 11.

Your average proofreader sure knows how to have fun on a Saturday night. Yesirree.)

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Here.

This is a nice entry-level essay.

I can't seem to read a lot of the books written by TV and radio people, and Stossel is no exception: he is not a major-league prose stylist. However, when you want an issue broken down into easily digested chunks, he's your man. And the things he's able to accomplish on his television specials are extraordinary. He knows how to make use of a visual medium to show things that can't be expressed in words to the same effect.

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. . . as we try to reform health care.

The thing I dig about this Arnold Kling analysis is that it points out the flaws in current proposals from both the right and the left. So, go.

H/t: Insty.

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. . . on healthcare in Europe vs. the United States:

Because I'm unhappy with our current state of medical progress, the most important single issue to me is which system encourages research and development. The answer, of course, is that neither does it nearly as well as I'd like, though the U.S. system is pretty clearly better than the European.

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Two very different approaches to improving healthcare in this country.

I love the quote from Gratzer: "The problem and the predicament of American health care can be stated in a single, paradoxical sentence: Everyone agrees that it's the best in the world, but nobody really likes it."

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