FT214: “The far left has been and always will be an aristocratic-thinking, privilege-seeking people.” —Old Pithy

Posted by PITHOCRATES - March 21st, 2014

Fundamental Truth

Lawyers make a lot of Money without Contributing anything Tangible to Society

An attorney was sitting in his office late one night when Satan appeared before him.  Satan said, “I have a proposition for you.  You can win every case you try for the rest of your life.  Your clients will adore you, your colleagues will stand in awe of you and you will make embarrassing sums of money.  All I want in exchange is your soul, your wife’s soul, your children’s souls, the souls of your parents, grandparents, parents-in-law, the souls of all your friends and law partners.”  The lawyer thought about this for a moment then asked, “So, what’s the catch?”

That’s funny, isn’t it?  Lawyers.  Ambulance chasers.  The butt of so many jokes.  Why?  Well, some will say they deserve it.  Because they do chase ambulances.  And will pass out their business cards if they’re on a sinking ship.  Because sinking ships are good for lawsuits.  And lawyers love to sue.  For they can make a lot of money without contributing anything tangible to society.  All they do is get between two parties when large sums of money change hands.  And put a portion of that money into their pockets.  That’s how they earn their living.  Taking money away from others.  They’re parasites.  Just to get rich.  And the big tort lawyers (those who sue people and businesses) get really rich.  Allowing them to live very privileged lives.

Take a class action lawsuit.  Where they bring a lot of wronged people together to sue a large corporation.  The old David and Goliath thing.  A little person can never take on a big corporation.  But a whole class of them can.  When represented by a tort lawyer.  Who liken themselves as heroes of the little guy.  Taking the big corporation on to make them pay for all the horrible things they’ve done to their clients.  But who do they really help?  Let’s say they win a judgment from a big corporation of $250,000,000.  That’s a lot of money.  From that sum they take their cut.  Let’s say 50%.  Leaving $125 million for the people the corporation wronged.  That’s a lot of money.  So the people won, too, right?  Not really.  For there are a lot of people represented in these class actions.  Let’s say 5 million in our example.  So if you divide the $125 million by 5 million that comes to $25 per person.  So, again, who did the lawyers really help?  The lawyers.  Which is why there are so many lawyer jokes.

In the Private Sector if you want to spend Half of your Life Retired you have to Pay for It

Lawyers vote Democrat.  Because they like being privileged people.  They don’t want the laws changing that allow them to get so rich when money exchanges hands.  Which is why they donate heavily to the Democrat Party.  And don’t donate to the Republicans.  Who complain about the high costs of frivolous lawsuits to businesses in an overly litigious society.  It’s so bad that a footnote in the financial statements of a corporation about a lawsuit is not that big of a deal.  Why?  Because so many corporations are sued that investors are more surprised to see one that isn’t being sued.  This is why Republicans want tort reform.  And pass ‘loser-pays’ into law.  Like many other countries have.  Where the loser in court pays for the attorney fees for the side that wins.  Which would greatly cut down on frivolous lawsuits.  And cut the costs businesses incur from these frivolous lawsuits that they pass on to their customers.  So the lawyers donate to Democrats.  To prevent any tort reform that would change the easy way lawyers have of getting rich.

It’s the world’s oldest profession.  Screwing people for money.  But lawyers aren’t the only ones seeking privilege.  There are a lot of others, too.  Interestingly, they, too, support the Democrat Party.  Such as the United Autoworkers.  They donate heavily to the Democrat Party to keep labor laws favorable to unions.  To make it more difficult for their nonunion competition.  And to use the power of government to force people to pay may for a union-made car.  Allowing their union members to live better lives than those outside of the UAW.  And when even that doesn’t allow General Motors to pay its bills when selling a record number of cars the UAW goes to government for a bailout of their woefully underfunded pension fund.  So their union members can continue to have a more generous retirement at an earlier age than those outside of the UAW.

Teacher unions seek privilege, too.  You hear a lot about how the teachers don’t earn that much.  But then again, they don’t work that much.  Getting 3 months off in the summer.  So you can’t compare their wages to people who don’t get the 3 summer months off.  But for teachers it’s not so much about the paycheck.  It’s the benefits.  Very generous health insurance coverage.  And pensions.  Which have gone the way of the dodo in the private sector.  Because people are just living too long into retirement.  When they first set up these pensions people were dying in their sixties.  The actuaries never saw people living into their eighties as common.  So in the private sector if you want to spend half of your life retired you have to pay for it.  And you work as long as necessary to fund the retirement you want.  The union pensions just can’t work these days as they once did.  Which is why teacher unions like the United Autoworkers and lawyers support the Democrat Party.  They want to keep their privileged lives.

The Wealth Transfers of the Welfare State give Democrats Money and Privilege

Of course privilege is nothing new to the Democrat Party.  They have long stood for privilege.  Even now.  As the Democrats provide themselves all kinds of exceptions from the Affordable Care Act.  For more expensive and lower quality health insurance is good for the masses.  But not for the privileged elite.  Or their special friends who support them so generously with campaign donations.  Congress has had a history of exempting themselves from the laws they pass for us.  It took the Republican winning of the House in the 1994 midterm elections to change that.  The first Republican-controlled House since 1952 required Congress to be held to the same laws as the rest of us.  A bitter pill for Democrats to swallow.  For their feelings of privilege go way back.

The Democrat Party can trace its pedigree back to Thomas Jefferson’s Democratic-Republican Party.  The party of the slave-owning planter elite.  Who from day one fought for their privilege starting with the Three-Fifths Compromise.  To give them a greater say in the new national government than their voting population allowed.  The planter elite’s South turned into an Old World aristocracy.  With great manors for the landed aristocracy.  And vast lands worked by slaves.  Very similar to feudalism in the Old World.  And something they fought hard to keep.  Their privilege.  The Southern Democrats used the power of the national government (such as the Fugitive Slave Act) to interfere with state laws in the North.  To protect their feudalism by keeping slavery legal as long as they could while the north was industrializing and modernizing.  With paid laborers.  When they lost control of the House due to the growing population in the North they turned to war.  Saying that the national government was interfering with state laws in the South.  And getting poor southern farmers who owned no slaves to fight and die so the southern aristocracy could live on.

When the Southern Democrats lost the American Civil War they scrambled to maintain their privilege.  They unleashed a terror on the freed slaves and Republicans with the KKK.  The Democrats then wrote Jim Crowe Laws.  Separate but equal.  Government-enforced racial segregation.  During debate of the Civil Rights Act of 1964 Democrat and former Exalted Cyclops of the KKK Robert Byrd filibustered for 14 hours.  To keep the South segregated.  With power and privilege in a new aristocracy.  Centered not on land but political power and cronyism.  Even becoming the party for blacks as ironic as that is.  Trading government programs for votes.  And destroying the black family in the process.  Aid to Families with Dependent Children (AFDC) replaced black fathers with government.  And moved single mothers and their children into housing projects that became infested with drugs and crime.  But this large (and failed) welfare state transferred a lot of wealth to the Democrats.  Giving them money and privilege.   That they can use to maintain their power.  By taking care of those who take care of them.  Lawyers, the UAW, teacher unions and other privilege seekers.  For nothing has changed on the left.  They have been and always will be an aristocratic-thinking, privilege-seeking people who want to live better than the rest of us.  While we pay for their privileged lives.

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Medicaid, Medicare and Frivolous Lawsuits make the Best Health Care System in the World more Expensive

Posted by PITHOCRATES - November 23rd, 2013

Week in Review

The American left loves Canada.  In particular their single-payer health care system.  This is what they wanted in the US.  Not Obamacare.  But they settled for Obamacare.  Until they get what Canada has one day.  Because it’s better.  At least, according to a chart.  That shows how wonderful Canadian health care is and how horrible American health care is (see The U.S. Health Care System Is Terrible, In 1 Enraging Chart by Mark Gongloff posted 11/22/2013 on the Huffington Post).

Yes, among this group of big countries, the U.S. spends far and away more on health care than any other. And yet it has among the lowest life expectancies of any developed country. People live longer in pretty much every country in Europe, including Greece, where the economy has been wracked by austerity for years…

Why is our system so terrible? Largely because it is built for profit. Unlike many other countries, the government has no role in either providing care or setting prices, and so prices skyrocket. It’s also too complex, which is one reason the Affordable Care Act, President Obama’s signature reform law, has gotten off to such a bad start.

The health care law is supposed to help with the cost problem somewhat. But it is built on the existing privatized system, which means it will probably not make a significant difference. A public option, also known as a “single payer” plan, would help. But that still seems like a pipe dream — although maybe Obamacare’s clumsy rollout will bring it closer to reality.

First of all it should be noted that Canada has one of the finest private health care networks in the world.  Outside of their single-payer system.  Which is something they share with all nations that have some form of national health care.  A private health care network for those who want and can pay for it.  And why is Canada’s private health care network the best in the world?  Perhaps you can guess why when you hear the name of it.  The Untied States health care system.  Just south of the border.

That’s right, for those with the means don’t wait in line for less than the best of health care.  They spend their own money to go to the front of the line to get the best health care available.  In the United States.  Often administered by Canadians.  Because the US pays the best doctors and nurses more than they can get in Canada.  So Canadian doctors and nurses, too, travel south across the border.

The US is one of the only countries where their poor suffer from obesity.  Because of generous food assistance programs.  Also, because we are a for-profit nation our food industry has figured out to give us more food for less.  Our beverage sizes have gotten so big giving us so much value for the money that Mayor Bloomberg tried to limit the size of beverages in New York.  And all American restaurants give us free refills.  Because they can.  While some European countries will charge extra for a package of ketchup.  All of this more food for less has led to our obesity problem.  Giving Americans heart disease and diabetes.  Shortening life expectancies.

US doctors are dropping out of Medicaid.  And Medicare.  More so now that the Affordable Care Act (Obamacare) is rolling out.  Why?  Because the government pays for these nonprofit programs.  And they are constantly trying to reduce their reimbursements.  Because the aging population is straining the Medicaid and Medicare programs.  And the government has addressed this problem by ‘discounting’ Medicaid and Medicare billings.  For years doctors and hospitals have tried to recover these shortfalls by charging more.  Especially insurance companies.  Greatly increasing the cost of health care and health insurance.  But the discounting grew so great that many health care providers just dropped these programs.  Because they couldn’t pay their people, their lab costs, their overhead, etc.  Especially since Obamacare has taken money from Medicare.  And ‘forced’ states to expand their Medicaid rolls.  But these discounted reimbursements aren’t the only thing raising health care costs.

While most of Europe has loser-pay laws to curtail frivolous lawsuits the United States doesn’t.  Because of the trial lawyers.  Who get quite wealthy suing doctors, hospitals and pharmaceuticals.  Exploding the cost of malpractice and liability insurance.  Which increase the cost of doctors, hospitals and pharmaceuticals.  Forcing them to raise their prices to recover these costs.  Making American health care more costly.

These are the reasons why the US spends more per capita on health care than all other nations.  Because they have the best health care system in the world.  And the best costs more.  While the government forcing health care providers to work below costs (Medicare and Medicaid) and the cost of frivolous lawsuits raise these costs even more.

The American health-care system is not terrible.  Single-payer systems are.  Because they all have a private health care network.  Which they wouldn’t have if single-payer systems were the best systems.  Just ask the Canadians who use their private network.  The US health care system.  Who will probably be the second greatest losers under the Affordable Care Act.  After the Americans.

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FT163: “To cut medical costs Obamacare will pay hospitals, doctors and medical malpractice lawyers less.” —Old Pithy

Posted by PITHOCRATES - March 29th, 2013

Fundamental Truth

Health Care Costs are High because of the Lack of Competition and Medical Malpractice Lawsuits

Obamacare is a pathway to national health care.  They designed it to get as many employers to drop health insurance for their employees as possible.  By making the penalty for not providing it less than the cost of providing it.  As more employers drop their health insurance plans private health insurers will have to raise rates on the fewer remaining on their plans.  Causing more employers to drop their health insurance plans and pay the less costly fine instead.  Once Obamacare destroys the private health insurance industry the government will step in as the insurer of last resort.  And transform Obamacare into a true national health care system.  Like the National Health Service in Britain.  The ultimate goal for those on the left.

There is support for Obamacare and the national health care it will evolve into.  Especially those who hate doctors, hospitals and the pharmaceutical companies getting rich on the suffering of others.  Who will sue them at the drop of a hat.  And there is a large and prosperous medical malpractice legal community getting rich by helping these people sue.  Helping the little guy get justice from these rich people and rich companies.  Who put profits before people.  Which is why so many people want national health care.  To get the profit incentive out of health care.  And limit the outrageous salaries of those in the health care industries.

What these people don’t understand is that it’s just not their high salaries that run up the costs of health care.  Two large reasons for the high cost of health care are the lack of competition and the cost of medical malpractice lawsuits.  Obamacare will address one of these issues.  But probably not the one those who hate the profit incentive in health care would expect.  Or want.

When the Government pays for Health Care they also pay Medical Malpractice Damage Awards

They are still writing the law for Obamacare.  So anything we say will be conjecture.  But we can see where Obamacare is going by looking at where it will end.  National health care.  And there are numerous examples of that in the world.  Such as the National Health Service (NHS) in Britain.  Here is how they address medical malpractice (see Medical Malpractice Liability: United Kingdom (England and Wales) posted on the U.S. Library of Congress website).

Given that damages awarded could reach millions of pounds, which would negatively affect the budget of these Trusts in providing healthcare to the population, a number of programs (known as “schemes” in England) were established to address claims for medical negligence…

Part of the mandate of the NHS Litigation Authority is to avoid litigation, where possible.  Its Framework Document notes that it aims to “maximise the resources available for patient care, by defending unjustified actions robustly [and] settling justified actions efficiently.”[28]  Furthermore, the Litigation Authority notes that it “encourage[s] NHS bodies to offer patients explanations and apologies.[29]  We seek to avoid formal litigation as far as possible and our historical data show that only about 4% of our cases go to court, including settlements made on behalf of minors, which must be approved by a court.”[30]

The mandate of the NHS Litigation Authority further requires it “to minimise the risk that patient care in a particular community is jeopardised by a large settlement against a local NHS body.”[31]  It thus aims to “to spread the costs of settlements more evenly over time”[32] through the use of periodical payments made to the claimant throughout their life, as it considers that this is the fairest method of settling the costs of personal injury claims when costs are significant.[33]

When the government pays for health care they also pay medical malpractice damage awards.  And anything they pay in a medical malpractice award is money they cannot spend on providing medical services to sick people.  So the mandate of the NHS is to fight medical malpractice claims robustly.  By throwing out frivolous lawsuits.  And settling out of court legitimate lawsuits.  Such that only some 4% make it to court.  And a jury trial.  The ultimate objective of malpractice lawyers.  Who want the sympathies of a jury to award massive judgments against rich doctors, hospitals and pharmaceuticals.

Medical Malpractice Lawyers will be the Big Financial Losers when Obamacare evolves into National Health Care

Medical malpractice lawyers get rich from winning big lawsuits.  That have a big cash award.  Which is how they want their money.  In a big lump-sum.  Because that’s how medical malpractice lawyers get rich.  Quickly.  And that’s not going to happen with settlements paid out over time over the life of the claimant.  Like in the NHS.  They don’t want a stipend.  Stipends don’t buy mansions, luxury cars, private jets, yachts and exotic vacations.  And if their clients are so inconsiderate to die too soon they will selfishly deny these lawyers a portion of that income stream.  However meager it is.  If they even get a piece of that income stream.

Republicans are for a business-friendly environment.  To generate economic activity.  And that business-friendly environment includes low taxes and low regulatory costs.  As well as tort reform.  To limit the high cost of frivolous lawsuits.  Something the trial lawyers vehemently oppose.  So they throw their support behind Democrats.  Who are generally for a less business-friendly environment.  And have no problem with suing ‘greedy’ corporations.  For the richer the trial lawyers get the more campaign donations they get.  So there is a special relationship between the Democrat Party and trial lawyers.  They take care of each other.  Until, that is, Obamacare becomes like the NHS.

The Democrats and their supporters, including the trial lawyers, attack the profit incentive in health care.  Together they have helped to bring Obamacare into law.  Which will begin the long process of removing the profit incentive from health care.  As well as destroying the private health insurers that the medical malpractice lawyers have grown so wealthy by suing.  It will be interesting to see if they will continue their special relationship with the Democrats as health care moves more towards a system like the NHS.  As the medical malpractice lawyers will be the big financial losers when that happens.  Because they just won’t be able to sue the federal government like they have sued the private insurance industry.

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Stupid Republicans Help Smart Democrats Lose Elections

Posted by PITHOCRATES - November 22nd, 2010

Figures don’t Lie, but Liars Figure

Is a 70 degree Fahrenheit a warm day?  Or a cold day?  It depends on your perspective.  If you’re from Norilsk, Russia, you’d probably say it’s warm.  If you’re from Al’Azizyah, Libya, you’d probably say it’s cold.  70 degree Fahrenheit is a fact.  But it means different things to different people.  And neither the Russian nor the Libyan is wrong.  Weather is relative.

The Republicans won control of the House of Representatives, a majority of the state governorships and a majority of the state legislatures in the 2010 midterm elections (see Election 2010 posted on The New York Times for election results).  Some say this is a rejection of the Obama/Pelosi/Reid agenda.  Some say the Democrats lost so much because the Obama/Pelosi/Reid agenda did not go far enough.

Interesting, huh?  The same data reviewed by different people who then reach such different conclusions.  Are the election results as relative as the weather?  Or is Mark Twain closer to the truth?  “Figures don’t lie, but liars figure.” 

Old, Stupid White Men Vote Republican?

There is a political divide across the country.  You can see it when you look at the election map.  The nation is mostly red.  With some blue on the coasts.  And around the big cities in between.  I look at that and I have an idea why it looks like that.  The Washington Post, on the other hand, has a different interpretation (see Political divide between coasts and Midwest deepening, midterm election analysis shows by T.W. Farnam, Washington Post Staff Writer, posted 11/21/2010 on The Washington Post).

The Republican Party’s big gains in the House came largely from districts that were older, less diverse and less educated than the nation as a whole. Democrats kept their big majorities in the cities.

Translation?  Old, stupid white men vote Republican.  I see it differently.  What are big cities full of?  Poor people.  And welfare.  Big city governments.  With big union pay and benefits.  Big bureaucracies that employ the unemployable and increase the costs of doing business.  Big universities.  University professors.  University students.  Art museums.  Theatres.  A liberal and libertine party atmosphere (which draws the young).  Teen pregnancy.  Abortions.  STDs.  Drug addicts.  Prostitutes.  Etc.

The Obama coalition remained intact. Democrats remained strong in areas with the party’s core of minorities and higher-educated whites. But movement of white working-class voters away from the party is a concern for Democrats, especially because of President Obama’s traditional weakness with those voters.

Higher-educated whites?  Yeah, right.  A lot of those degrees are from the big universities in the big cities.  Women’s studies.  Art History.  Philosophy.  American Studies.  English Lit.  Communications.  Poetry.  And, of course, Law.  Very popular with the anti-business crowd.  And, as it turns out, very unpopular with actual businesses. 

Higher educated, perhaps.  But an education that has little market value.  So they end up working for a nonprofit dependent on government funding.  Or work as another piece of deadwood in a bloated government bureaucracy.  Or file frivolous lawsuits and are dependent on government NOT to reform tort law.

“There’s definitely been a hardening of Democratic support along the coasts since 1994,” said James Gimpel, a political scientist at the University of Maryland.

New York City, Boston, Seattle, San Francisco and Los Angeles.  Coastal cities.  Homes of the uber liberal.  Here they sip their lattes and look down their noses at flyover country. They’re only 20% of the population.  But when you concentrate 20% of the population in these small geographical areas, those areas will have liberal majorities.  While at the same time if you pull that 20% out of the rest of the country, that big geographical area they call flyover country is left conservative.

The Poor, Unemployable and Irresponsible Vote Democrat

It’s not that Republicans are old, stupid white men.  Democrats have lost so much of the country because they and their agenda don’t appeal to people who have jobs.  So who do they appeal to?  The poor, unemployable and irresponsible.  And lawyers.  Who all tend to be anti-business.  Like the Democrat Party.

Saying the reason why you lose elections is because the electorate is stupid is figuring with facts.  The facts say otherwise.  Besides, when the young is a strong demographic for you, you kind of lose that argument.  Young people are uneducated and inexperienced.  Young people fill our Colleges.  And they’re going there not because they’re smart.  They’re there going to get ‘smart’.

Meanwhile, the higher educated liberals often have those useless degrees.  Because they care about people, not profits.  So they don’t do anything so coarse as to get a degree that might help a business earn a profit.  Instead, they’ll subsist off of government funding.  Or by suing businesses for unearned wealth.

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FUNDAMENTAL TRUTH #22: “The only problem with health care these days is that it’s approached from a cost basis more than a medical basis.” -Old Pithy

Posted by PITHOCRATES - July 13th, 2010

THE PROBLEM WITH cost cutters is their vision.  They see costs.  Not the big picture.  Rockefeller was a notorious cost cutter.  Even determined he could save money by using a few less welds on his oil barrels.  But he saw the big picture, too.  He grew sales.  Something that cost cutters have trouble doing.  He didn’t.  In fact, he was so good that it took the government to stop his sales growth.

Roger Smith was a numbers man.  He managed costs.  Starting in the accounting department of GM, he reorganized GM to make better sense.  On paper.  To make nice, neat, bookkeeping-like ordered sense.  Things tend to work better on paper, though, than in reality.  Suffice it to say that few laud Smith as the greatest CEO of GM.

Robert McNamara was also a numbers man.  And he ran the Vietnam War by the numbers.  He carefully determined what U.S. forces could NOT attack.  (Any place outside South Vietnam was basically a sanctuary for the enemy.)  And he introduced the body count.  There was no strategy to win.  Just a policy to verify you were killing more of theirs than they were killing of yours.  Wars of attrition, though, take years.  And lives.  On both sides.  Americans don’t like sitting back and waiting for enough of their sons to die to declare victory.  McNamara failed to see the big picture.  Strategy.  He just tried to make the combat efficient.  Which did little to inhibit the enemy from making war. 

Managing costs is important.  It can improve profits.  But it can’t grow sales.  And if you can grow sales, you’ll be able to pay your costs.  Even if they are high and inefficient.  Few companies fail because they have a cost problem.  They file because they have a revenue problem.  They lack sales.  Cost cutting cannot fix this problem.  It can temporarily help reduce operating losses.  But if you don’t increase sales, you’ll probably fail in the long run.

There are detail people.  And people with vision.  Rarely are people both.  Rockefeller was.  Smith and McNamara were detail men.  They could not see the forest for the trees.  And this is the problem in health care.  We’re not looking at the big picture of medical care.  We’re looking at the details of cost. 

YOU WOULD THINK that doctors would oppose the government taking over health care.  Because when governments do, they tend to put salary caps on doctors.  Kinda diminishes the return on all that costly medical training.  I talked to two recently who favor a national solution.  Why?  Because of costs.  They like Medicare.  Because it’s simple.  Most of their patients are seniors.  So the bulk of their billings are uniform.  Medicare reimbursements.  They like anything that simplifies their overhead costs.  Private insurance companies don’t do this.  They’re not all the same.  Different people to call.  Different procedures.  Different approved tests.  Different paperwork.  And more of it.  And a bigger staff to handle it.

Doctors hate paperwork.  No doctor ever went through medical school because they wanted to shuffle paper.  Or because they wanted to fend off malpractice lawsuits.  Doctors are under a bureaucratic assault.  They spend more time with paperwork than with patients.  And paperwork does have a cost.  As do frivolous lawsuits.  A government takeover would standardize the one.  And, hopefully, eliminate the other.

I understand these doctors’ concern.  But they can’t see the forest for the trees.  Government is not going to approach health care from a medical basis.  They’ll approach it from a cost basis.  They’ll use statistical analysis.  They will manage care to maximize cost efficiency.  They will approach health care like Smith did in GM and McNamara did in Vietnam.  They’ll crunch the numbers.  Then determine what health care is cost effective.

THEY PROBABLY NEED no introduction.  Most people are family with the British comedy troupe called Monty Python.  Funny, a bit naughty and rather bookish, they’ve appealed to the masses across generations.  They spent a lot of time researching before making some of their movies.  Reading books.  The realism it adds made some of the funniest scenes.  A Roman centurion gives a Jewish terrorist a Latin lesson at the point of a sword (Life of Brian).  Dennis the constitutional peasant arguing with King Arthur (Monty Python and the Holy Grail).  And this scene from The Meaning of Life during a live birth lampooning the British National Health Service:

Nurse:  The administrator’s here, doctor.

First Doctor:  Switch everything on!

[They scramble to do so.  Machines turn on with flashes and sounds.  The administrator enters.]

Administrator:  Morning, gentlemen.

First and Second Doctors:  Morning Mr. Pycroft.

Administrator:  Very impressive. Very impressive.  And what are you doing this morning?

First Doctor:  It’s a birth.

Administrator:  Ah, what sort of thing is that?

Second Doctor:  Well, that’s when we take a new baby out of a lady’s tummy.

Administrator:  Wonderful what we can do nowadays.  [A machine makes a ‘ping’ sound.]  Ah!  I see you have the machine that goes ‘ping’.  This is my favorite.  You see we leased this back from the company we sold it to.  That way it comes under the monthly current budget and not the capital account.  [They all applaud.]  Thank you, thank you.  We try to do our best.  Well, do carry on.

This is funny.  Because it’s true.  When we approach health care on a cost basis.  You must show you need and use every piece of expensive equipment you have so it stays in the budget.  And the administrators administrating health care don’t understand health care.  They understand and make their decisions based on numbers in columns.  And speaking of numbers in columns.

 ONE THING STANDS out more than everything else when looking at numbers in columns.  In one cost column in particular.  Of all the costs in columns, one dwarfs all others.  The costs in treating very sick and very old people.  You can cut and trim the budget everywhere else but you won’t make a dent in overall costs.  Unless you cut and trim this one column.  Manage these costs.  Do some statistical analysis on these costs.  For if you cut THESE costs, it will make a difference.  It could even stave off bankruptcy without having to further raise taxes.  Yes, we can make the system more financially sound if we just stop treating so many sick and old people.

But it’s a body count mentality.  You have to willingly accept a defined number of additional deaths.  The Soviets were willing to trade 10 lives for one against the Nazis.   A steep price to pay.  But it did wear the Nazis down and lead to victory.  There was a similar ratio in Vietnam with America on the better side of that ratio.  But it was still too high a price for Americans.  It goes against our nature to think in terms of ‘acceptable’ losses.

But there will have to be a line that health care will approach but does not cross.  Where there are ‘acceptable’ losses.  Statistical analysis will take into account probable remaining years of life in a potential patient.  If few, the system will assign an appropriate value of care to match the health care expenditure with the expected return on the medical treatment.  People with more probable years of life left will receive more health care treatment.  People with fewer years left will receive less.  We’ll help manage their pain until they no longer feel that pain.  For it would be inefficient to spend a lot of money on someone who is going to die ‘soon’.

Perhaps I can best summarize this in song.

When you were young and your heart was an open book
You used to say live and let live
(you know you did, you know you did you know you did)
But in this ever changing world in which we live in
Makes you give in and cry
Say live and let die
Live and let die
Live and let die
Live and let die

(Live and Let Die, Paul McCarthy)

And that’s what bureaucrats will use all that statistical analysis for.  To determine who to let die.  You can sugarcoat it anyway you’d like, but it comes down to this.  A bureaucrat, not a doctor, will have the power of life and death as they decide what health care is appropriate and prudent.  As it must be under a system where bureaucrats distribute limited resources on a cost basis.  They will have no choice but to deny care that is not in the budget.

ONE PUZZLING THING about health care is that it is perfectly acceptable to approach it from a cost basis but not on a revenue basis.  For it is immoral to profit on health care.  Pity, because introducing market forces is one sure way to bring down costs.  People are willing to pay for medical services.  They pay for abortions.  And abortion clinics are readily available.  The free market laws of supply and demand work for abortions.  And so they would for other outpatient medical services. 

Instead of running a battery of tests because an insurance company requires this incremental approach of the cheap stuff first, you could go to an MRI (or some other expensive procedure) clinic and pay out of pocket.  Because they do nothing but MRIs, they achieve economies of scale.  The clinic makes money by offering low cost, high quality MRI scans that result in a high sales volume.  You benefit because you miss less work.  The doctor benefits because he gets your MRI scan results without additional paperwork to process.  I’m sure a market is there just waiting for an entrepreneur to come along.  I mean, if you can make money by performing abortions, you should be able to make money with some non-invasive, high-tech machines.

HEALTH CARE SERVICES will not become more affordable and more readily available by cutting costs.  If the bean counters try, they’ll damage the quality of health care.  Because the bean counters rarely look at the big picture.  You need someone with vision.  Because no cost cutter ever saved a business.  Or made the world better.

www.PITHOCRATES.com

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