One Passenger Airline charging by the Passenger’s Weight may offer new Funding Idea for Obamacare

Posted by PITHOCRATES - April 7th, 2013

Week in Review

When the price of oil soars it doesn’t affect the railroads that much.  Because fuel costs are not their greatest cost.  Maintaining that massive infrastructure is.  For wherever a train travels there has to be track.  It’s different for the airlines.  The only infrastructure they have is at the airports.  And the traffic control centers that keep order in the sky.  Once a plane is off the ground it doesn’t need anything but fuel in its tanks to go somewhere.  And because the flying infrastructure is so much less than the railroad infrastructure fuel costs are a much larger cost.  In fact, it’s their greatest cost of flying.  So when fuel costs rise ticket prices rise along with them.  And they start charging more bag fees.  As well as any other fee they can charge you to offset these soaring fuel costs.

Boeing made their 787, the Dreamliner, exceptionally light.  To reduce flying costs.  They used a lot of composite materials.  Two large engines because they’re lighter than 4 smaller engines.  They even used a new lithium-ion battery system to start up their auxiliary power unit.  And made it fly-by-wire to eliminate the hydraulic system that normally operates the control surfaces.  They did all of these things to fight the biggest enemy they have in flying.  Weight.  For the greater the weight the more fuel they burn.  And the less profitable they are.

Freight airlines charge their customers by the weight of the freight they wish to ship.  Because there is a direct correlation between the weight of their freight and the amount of fuel they have to burn to carry that freight.  In fact, all shippers charge by the weight.  Because in transportation weight is everything.  But there is one mode of transportation that we don’t charge by the weight.  Passenger air travel.  Until now, that is (see A tax on overweight airline passengers: a brutal airline policy by Robin Abcarian posted 4/3/2013 on the Los Angeles Times).

When teensy-weensy Samoa Airlines debuted its pay-by-the-kilo policy in January, I doubt it expected to set off an international controversy about fat discrimination.

But that’s what happened when news seeped out this week after the airline’s chief executive, Chris Langton, told ABC News radio in Australia that the system is not only fair but destined to catch on.

“Doesn’t matter whether you’re carrying freight or people,” explained Langton. “We’ve amalgamated the two and worked out a figure per kilo.”

Samoa Air, he added, has always weighed the human and non-human cargo it carries. “As any airline operator knows, they don’t run on seats, they run on weight,” said Langton. “There’s no doubt in my mind this is the concept of the future because anybody who travels has felt they’ve paid for half the passenger that’s sitting next to them…”

“Samoa Air, Introducing a world first: ‘Pay only for what you weigh’! We at Samoa Air are keeping airfares fair, by charging our passengers only for what they weigh. You are the master of your Air’fair’, you decide how much (or little) your ticket will cost. No more exorbitant excess baggage fees, or being charged for baggage you may not carry. Your weight plus your baggage items, is what you pay for. Simple. The Sky’s the Limit..!”

One bright note to this policy: Families with small children, who often feel persecuted when they travel, stand to benefit most from this policy. Since Samoa no longer charges by the seat, it will cost them a lot less to fly than it did before.

The appeal of this policy depends on your perspective.  If you’re of average weight sitting next to someone spilling over their seat into yours it may bother you knowing that you each paid the same price for a seat and resent the person encroaching on your seat.  But if you paid per the weight you bring onto the airplane then that person paid for the right to spill over into your seat.  Which they no doubt will do without worrying about how you feel.  As they paid more for their ticket than you paid for yours.  So the person who weighs less will get a discount to suffer the encroachment.  While the person who weighs more will have to pay a premium for the privilege to encroach.

Under the current system the people who weigh less subsidize the ticket prices of those who weigh more.  It’s not fair.  But it does save people the embarrassment of getting onto a scale when purchasing a ticket.  So should all airlines charge like all other modes of transportation?  Or should they continue to subsidize the obese?  Should we be fair?  Or should we be kind?

Chances are that government would step in and prevent airlines from charging by the weight.  Calling it a hate crime.  Even while they are waging a war on the obese themselves. Telling us what size soda we can buy.  And regulating many other aspects of our lives.  Especially now with Obamacare.  Because the obese are burdening our health care system with their health problems the government now has the right to regulate our lives.  And they have no problem calling us fat and obese.  But a private airline starts charging by the weight of the passenger?  Just don’t see how the government will allow that.  For it’s one thing for them to bully us.  But they won’t let these private businesses hurt people’s feelings by being fair.  So the people who are not overweight will continue to subsidize the flying cost of those who are overweight.

Until the government determines obese people are causing an unfair burden on society.  The obese have more health issues.  Which will consume more limited health care resources.  Also, flying these heavier people around will burn more fuel.  Putting more carbon emissions into the air.  Causing more breathing problems for everyone else.  As well as killing the planet with more global warming.  So while the airlines may not want to weigh people when selling them a ticket because of the potential backlash, the government won’t have a problem.  To cut the high cost of health care and to save the planet from global warming caused by carbon emissions they may even introduce a ‘fat’ tax.  Like any other sin tax.  To encourage people to choose to be healthier.  And to punish those who choose not to.  If they can force us to buy health insurance what can stop them from accessing a ‘fat’ tax?  Especially when they do have the right to tax us.

This is where national health care can take us.  When they begin paying the bill for health care they will have the right to do almost anything if they can identify it as a heath care issue.  Because it’s in the national interest.  They’ve painted bulls-eyes on the backs of smokers.  And drinkers.  With tobacco and alcohol taxes.  And you know they would love to tax us for being fat.  Perhaps even having our doctors file our weight with the IRS.  So they can bump our tax rates based on how obese we are.  If the tax dollars pay for health care they will say they have that right.  As the obese consume an unfair amount of those limited tax dollars.  Anything is possible with an out of control growing federal government faced with trillion dollar deficits.  Especially when they can call it a health care issue.

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If Obamacare will be anything like the NHS first there will be Higher Taxes then there will be Rationing

Posted by PITHOCRATES - April 7th, 2013

Week in Review

There is no such thing as a free lunch.  We’ve all heard this expression.  And we know what it means.  Vendors buy customers lunches to get more business.  And customers know whatever they get ‘free’ from a vendor is included in the price they pay for their products or services.  So nothing is free.  Just other people pay for things you get to enjoy.

A lot of people thought national health care was free health care.  Which is why they want it.  Because they can’t stand paying even the co-pays on the high cost of health care.  But by nationalizing health care those high costs don’t go away.  Because doctors and nurses just don’t start working for free.  No.  We pay for free health care by nickel and diming everyone everywhere we can (see Taxes heat up battle against ‘Obamacare’ by Tom Howell, Jr., posted 4/3/2013 on The Washington Times).

A tax on everything from X-ray machines to oxygen tanks took effect at the beginning of this year — one of about 20 taxes and fees included in President Obama’s health care law — and has emerged as the central battleground in the fight by the law’s opponents to repeal parts of the president’s overhaul…

The device tax is one of several that kicked in this year, along with higher taxes on investment income and an increase in the Medicare payroll tax among households making $250,000 per year. Taxes and restrictions on flexible savings accounts, health savings accounts and health reimbursement arrangements are also starting to bite.

The tax penalty imposed on those who refuse to obtain health coverage will kick in next year, with a minimum penalty for low-income individual taxpayers of $95 in 2014, rising to $325 in 2015 and $695 in 2016. Those with higher incomes will end up paying more because their penalty is based on a percentage of their income — 1 percent in 2014, 2 percent in 2015 and 2.5 percent in 2016 and beyond.

And still looming later this decade is a 40 percent excise tax on high-value “Cadillac” health insurance plans, which will not debut until 2018.

The health care law’s $1 trillion in revenue raisers also includes niche targets, such as a 10 percent assessment on indoor tanning services…

…the health insurance tax, an annual fee that taxes health insurance providers relative to the worth of the insurance premiums they collect each year.

They will tax us every chance they get.  Because ‘free’ health care is more costly than the kind you pay for out of pocket.  Because when it’s ‘free’ you will use it more often.  “If it’s free it’s for me.”  And because the consumption of health care resources will rise so will all of these new taxes as they scramble to find a way to pay for this ‘free’ health care.

A lot of people no doubt draw some comfort in the fact that the rich will pay the majority of these taxes. But all of these taxes will eventually filter down to the average American as businesses raise prices to cover these taxes.  And those “Cadillac” health insurance plans?  They’re just not for rich people.  Very sick people often spend a fortune on these plans to reduce their overall costs of their treatments.  Which means the 40% tax on these plans will make these plans unavailable to them.  Causing great upheaval in their lives as they transition from their private plan and doctors to the state plan and doctors.

Eventually the costs will grow greater than all this new tax revenue.  As it has in the United Kingdom.  Where they have had to turn to cost cutting, consolidation of health care clinics and hospitals, longer travel distances to see a health care provider, longer wait times, rationing and denials of health care treatment.  Because their ‘free’ health care grew so costly with their aging population that they just can’t treat everyone.  Patients sometimes have to wait an hour or more for an ambulance.  And wait another hour or more at the hospital before a bed opens up for them so they can be unloaded from the ambulance.

And then there’s the Liverpool Care Pathway for the Dying Patient.  A quasi death panel.  Basically unplugging a patient to let them die with dignity.  Sometimes without telling the patient’s family about this hospital decision.  Where critics say it’s more about freeing up limited health care resources than about dying with dignity.  Especially with a costly and aging population.

So this is our future with Obamacare.  As the government takes over health care taxes will rise further.  And quality will fall.  As they try and stretch those limited resources to cover more and more patients.  Especially with a costly and aging population.

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An Aging Population taxes the NHS such that Patients are Neglected and Marked for Death by Informal Death Panels

Posted by PITHOCRATES - November 24th, 2012

Week in Review

Conditions in some British hospitals grow appalling.  As patients are left in their own filth.  And ‘do not resuscitate’ orders are placed in their files.  Often without consulting their families.  All in an effort to hurry up the death of these most burdensome patients (see Why can’t the NHS get basic care right? by Nick Triggle posted 11/22/2012 on BBC News Health).

Reading the 53-page dossier on poor patient care put together by the Patients Association, you cannot help but be moved by the harrowing stories.

There is the case of a man placed in a dementia-friendly ward with staff, who were given strict instructions to check on him because he had a history of going walkabout, but was able to escape and subsequently drowned in a nearby river.

There are tales of patients left in soiled sheets, their dignity stripped from them, and others being left for hours in pain, their cries for help ignored…

Of course, in an organisation the size of the NHS – it sees 1m people every 36 hours – there will always be cases where standards have slipped…

I recently asked a senior nurse working in a large hospital what she thought had gone wrong.

Her answer was quite clear. She told me: “We have had to become immune, desensitised, to cope with what we do. Every day we see suffering and we can’t always help.

“That does not explain or excuse some of the clear examples of neglect we have heard about. But it has created a culture that means these things can happen.”

She went on to say that at the heart of the problem was the fact that there were many people in hospital that should not be there.

It is an often-quoted fact that two-thirds of emergency admissions are among people with long-term conditions, which covers everything from heart disease to dementia.

Even with national health care people use the emergency rooms for non-emergency conditions.  This was one of the driving forces in passing Obamacare.  We’re paying for these people already in higher hospital costs.  So we might as well give these people health insurance so they don’t use our emergency rooms for non-emergency conditions.  Well, guess that won’t be happening.

It’s not only that these people shouldn’t be there, but when they are there they are getting ‘death panel’ treatment.  As Triggle wrote the previous day, “A number of the patient stories involved people who had been left in soiled sheets and there were examples of patients having a “do not resuscitate order” placed on them without proper discussion with their families.”

So they don’t want them in the hospital.  And if they get into the hospital they are just letting them die.  Through informal and unofficial death panels.  To free up limited health care resources.  Sad.  But this is the reality of national health care.  Combined with an aging population.  Which is forcing the NHS to get by on less funding.  While that aging population is taxing their limited resources.  Something all the opponents of Obamacare warned.  But the Democrats passed their health care bill anyway.  For they don’t care about the ultimate quality of health care.  But the power national health care gives them.

The liberal Democrats always note the size of classrooms when trying to get more funding for teacher pay and benefits.  Saying that large classrooms are bad.  That smaller classrooms in more schools throughout the community though more costly will provide a higher quality education.  The same is true in health care.  More clinics throughout the community though more costly will provide a higher quality of health care.  And keep a lot of patients out of the hospital.  The NHS would like to do that.  But the budget constraints due to an aging population make that impossible.  Leaving hospitals little choice but to pin ‘do not resuscitate’ orders on their more burdensome patients.  Which will likely happen under Obamacare.  As the US also has an aging population.

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Rationing of Health Care Resources leaves those with Rare Diseases without Treatment in NHS

Posted by PITHOCRATES - October 21st, 2012

Week in Review

So you think Obamacare care will provide everyone the same level of high quality health care?  Think again.  Or take a look at the UK.  For even though the UK has national health care under the NHS everyone still does not receive equal health care treatment.  Especially those with rare diseases that will be costly to treat (see Patients with rare conditions face postcode lottery by Denis Campbell posted 10/20/2012 on the guardian).

Seriously ill patients with life-threatening rare diseases are being denied vital drugs because of a postcode lottery across the NHS that campaigners say is frustrating and unfair.

New research reveals that patients with a rare condition have much less chance of accessing “orphan” medication if they live in England rather than Scotland or Wales. “Orphan” drugs treat patients with a condition affecting fewer than five in 10,000 people.

While the European Medicines Agency (EMA) has approved 68 drugs for use with patients with rare conditions such as unusual forms of cancer and epilepsy since 2000, the National Institute for Health and Clinical Excellence (Nice) has assessed only 18 of them, recommending that seven become available on the NHS in England and Wales, and another five under certain restrictions…

Nice insisted the low number of such drugs it had examined was due to a lack of referrals from the Department of Health, as it can only assess the cost effectiveness of medications which ministers there ask them to look at.

But the DoH denied patients with rare conditions were missing out and insisted that the absence of a Nice appraisal should not stop them getting what they need. “There is no evidence of a ‘postcode lottery’ in access to these drugs”, said a spokesman.

First of all why do they have a government agency (Nice) even doing this?  One reason.  Costs.  So they must ration their limited health care resources.  For if they just give anyone life-saving medications regardless of costs it will limit what other treatments the NHS can provide.  Costs are real.  Just because you have a national health care system doesn’t make them go away.  Of course, in a national health care system costs take on a whole new meaning.  For they fund health care with tax dollars.  Tax dollars controlled by bureaucrats, not health care professionals.  So instead of a doctor deciding what’s best for the patient (as it is in America until Obamacare fully kicks in) a doctor must balance doing what’s best for the patient with what’s best for the state.  For spending too much money on someone who is just going to die in a short period of time is just not an efficient use of tax dollars.

Yeah, no doubt you’re thinking about that ominous phrase some say they included in Obamacare but they did not call out by name.  Death panels.  Where some government bureaucrat (or a panel of bureaucrats) makes life or death decisions in determining a patient’s care.  Not by consulting with the patient’s doctor but by consulting a table of acceptable health care treatments for someone based on the expected return of that health care investment.  They may not call these death panels but if the expected return on the health care investment does not meet the minimum acceptable return for that investment then the patient doesn’t get that life-sustaining treatment.  And will die.

So what can we expect in the future of Obamacare?  Well, it will probably have something like Nice.  A panel that makes decisions with assumptions and math like this (see Measuring effectiveness and cost effectiveness: the QALY from the Nice website).

Having used the QALY measurement to compare how much someone’s life can be extended and improved, we then consider cost effectiveness – that is, how much the drug or treatment costs per QALY. This is the cost of using the drugs to provide a year of the best quality of life available – it could be one person receiving one QALY, but is more likely to be a number of people receiving a proportion of a QALY – for example 20 people receiving 0.05 of a QALY.

Cost effectiveness is expressed as ‘£ per QALY’.

Each drug is considered on a case-by-case basis. Generally, however, if a treatment costs more than £20,000-30,000 per QALY, then it would not be considered cost effective.

How a QALY is calculated

Patient x has a serious, life-threatening condition.

•If he continues receiving standard treatment he will live for 1 year and his quality of life will be 0.4 (0 or below = worst possible health, 1= best possible health)

•If he receives the new drug he will live for 1 year 3 months (1.25 years), with a quality of life of 0.6.

The new treatment is compared with standard care in terms of the QALYs gained:

•Standard treatment: 1 (year’s extra life) x 0.4 = 0.4 QALY

•New treatment: 1.25 (1 year, 3 months extra life) x 0.6 = 0.75 QALY

Therefore, the new treatment leads to 0.35 additional QALYs (that is: 0.75 -0.4 QALY = 0.35 QALYs).

•The cost of the new drug is assumed to be £10,000, standard treatment costs £3000.

The difference in treatment costs (£7000) is divided by the QALYs gained (0.35) to calculate the cost per QALY. So the new treatment would cost £20,000 per QALY.

During an ABC News’ June 24 special, Questions for the President: Prescription for America, there was the following exchange (see Lungren says Obama would have government require a centenarian to get a pill, not a pacemaker posted 7/28/2009 on PolitiFact):

The exchange began when Sawyer introduced Jane Sturm, who takes care of her mother, Hazel, now 105. When Hazel was 100, Sturm said, the doctor told her she needed a pacemaker. Both mother and daughter said they were game, but an arrhythmia specialist initially said no, before seeing Hazel’s “joy of life” in person.

Sturm asked the president, “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?”

After joking that he’d like to meet Sturm’s mother and “find out what she’s eating,” the president said, “I don’t think that we can make judgments based on peoples’ spirit. 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…”

Obama continued, “And all we’re suggesting — and we’re not going to solve every difficult problem in terms of end-of-life care. A lot of that is going to have to be, we as a culture and as a society starting to make better decisions within our own families and for ourselves. But what we can do is make sure that at least some of the waste that exists in the system that’s not making anybody’s mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what? Maybe this isn’t going to help. Maybe you’re better off not having the surgery, but taking the painkiller. And those kinds of decisions between doctors and patients, and making sure that our incentives are not preventing those good decisions, and that — that doctors and hospitals all are aligned for patient care, that’s something we can achieve.”

This is the kind of information Nice provides.  Cool, calm, bureaucratic number crunching to determine what the proper medical treatment should be.  Balancing those two factors.  What’s best for the patient.  And what’s best for the state.  For spending too much money on someone who is just going to die in a short period of time is just not an efficient use of tax dollars.

So what can you expect from Obamacare when it’s your mother or grandmother in the hospital desperately needing treatment?  Well, the doctor may come out to the waiting room where you’re sitting scared and distraught and say, “I’m sorry.  But the National Health Efficiency Board has calculated your loved one’s quality-adjusted life years.  Or what we in the health biz call QALYs.  Sadly, her treatment would only result in a net gain of 0.18 additional QALYs.  While our guidelines clearly state that this number shall not be less than 0.22 for such an investment of health care resources.  I am truly sorry for your soon to be loss.  So here’s a prescription you can fill on your way out for a pill to manage her pain until she dies.  Thank you and good day.  Next!”

This is the problem when someone else pays your bills.  That someone else has a say in your treatment.  Whether they are called death panels or not.

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NHS closes Emergency Departments to Save Costs while Angering Britons

Posted by PITHOCRATES - October 14th, 2012

Week in Review

Some of the most expensive services in health care are emergency departments.  Or A/E departments in Britain.  For accident and emergency departments.  Because you need a lot of staffing to handle everything from a heart attack to severe trauma from an accident to a difficult pregnancy.  Doctors, nurses, technicians, orderlies, pharmacists, administrative, cleaning, security, etc.  Not to mention the diagnostic equipment.  Medical devices.  Medicine.  Oxygen.  It adds up.  So it’s no surprise that the NHS is looking at A/E closures to cut costs (see 28,619 Mail on Sunday readers write to Government to stop A&E closures… and Ministers still do nothing by Nick Craven and David Rose posted 10/13/2012 on the Daily Mail).

Thousands of you sent in your protests against A&E closures – and this week we delivered two bulging mailbags full of your demands to David Cameron’s doorstep.

Nearly 30,000 Mail on Sunday readers have called for the Government to reverse the policy of downgrading and axeing local casualty departments across England and Wales.

A total of 28,619 protests were lodged – 17,170 coupons, 7,377 emails and 4,072 text messages – all prompted by fears that the policy for big, centralised A&E departments could risk lives as it leads to longer journey times to hospital…

Changes in London could result in a massive 47 per increase in the number of people served by each A&E department.

You ever waited for a long time to see a doctor in a crowded emergency waiting room?  Before Obamacare in America?  It was not uncommon on a busy night to wait for up to 3 hours if you had a non-life-threatening condition.  Now imagine being in that waiting room with 47% more people waiting with you.  Which could easily extend that wait time to 4-5 hours.  Or more.  Which is what will happen as Obamacare mutates into a national health service like they have in Britain.  Which is what the proponents of Obamacare want.  National health care.

At that time even the proponents of Obamacare won’t like Obamacare.  And they, too, will mail in enough complaints to fill two bulging mailbags.  (Based on the US having five times the population of the UK, that would probably be 10 bulging mail bags.)  Because these people will want everything for nothing.  But they won’t understand the cost of everything.  Or why the health service will have to cut costs, increase wait times and ration health care treatment.  And they will.  Because the NHS is.  And they can probably do national health care better than Obamacare ever will.

As as well as travelling longer distances after answering 999 calls, it will have to pick up seriously ill patients who turn up at the so-called ‘urgent  care centres’ which are set to replace A&Es but in reality cannot treat any life-threatening conditions.

At just one of the hospitals where A&E is due to close, Ealing, there is already an urgent care centre which transfers up to 50 patients a day to casualty.

Currently, this is a short journey down a corridor, but if casualty closes, as planned, all the patients will have to be transferred by blue-light ambulance to an A&E somewhere else, probably West Middlesex 20 minutes away, or Northwick Park, 45 minutes away.

To cut costs national health care services have really only one option.  As they cannot tell people to have 10% fewer accidents and health care emergencies.  Which leaves health care overhead.  If you close an emergency department (A/E department) you can save some money.  Close a few and you can save a lot of money.  So they do.  And make people travel further for their health care.  Up to 45 minutes by ambulance.  Perhaps an hour or more by car.  Even longer by train for those non-life-threatening emergencies.

This is the future of health care in America.  Under Obamacare.  And whatever that evolves into.  The NHS had some good years.  Before the British population began aging.  Now the British population is older.  More people are leaving the workforce while fewer are entering to replace them.  And as they leave the workforce they’re consuming more and more health care services.  Causing the cost strains in the NHS.  And the need for those cost savings.

This would be the starting point for the Americans.  They would not have the good years the NHS had.  Because right from the get-go they will be struggling with the costs of an aging population.  Which they will have to tackle right away by cutting costs, increasing wait times and the rationing of health care treatment.  Meaning that when trying to provide everything for everyone they will end up providing only for those some bureaucrat deems worthy of those limited health care resources.  They won’t be called death panels in the new health care law.  But they will be death panels.  Because someone will have to decide who gets those limited health care resources.  And who doesn’t.  Because they just won’t be able to give everything to everyone.  As the proponents of Obamacare think they will be able to.  And they will be none too happy when they learn this unpleasant little fact.

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