Ontario will try to Fix their Doctor and Nurse Shortage by luring Doctors and Nurses from Quebec

Posted by PITHOCRATES - September 15th, 2013

Week in Review

The political left has long wanted national health care in the United States.  And often point to Canada and their health care system.  For the left does not believe that anyone should be denied their right to medical care.  Or that anyone should profit off of the medical misfortunes of others.  So everybody gets free medical care.  While no one is allowed to profit from the giving of that care.  A noble idea.  But a flawed idea.  For being a doctor or a nurse is not easy.  It requires years of education.  Further years of on the job training.  Enormous school loan debt.  And long and stressful working days.  Not everyone can do it.  Which is why we pay those who do well.  Unless you have national health care.  Which leads to doctor and nurse shortages because they don’t pay their doctors and nurses as well as they do in a private health care system (see Ad aims to lure Quebec doctors to Ontario, targeting values posted 9/12/2013 on CBC News).

An Ontario hospital is trying to lure Quebec-trained health-care workers by tapping into the controversy surrounding Quebec’s values charter.

Lakeridge Health is planning to run the ad, which features a woman wearing a headscarf, in a McGill University student newspaper.

The ad says: “We don’t care what’s on your head. We care what’s in it…”

Empey said the hospital is in need of qualified medical staff and they chose to target the ad at McGill students because they have a strong medical program…

Quebec’s proposed secular values charter, announced earlier this week by the Parti Québécois government, includes a provision that would prohibit public employees from wearing obvious religious symbols while performing their official duties.

That includes the wearing of kippas, turbans, burkas, hijabs and “large” crosses by civil servants while they are on the job.

There isn’t a whole lot of love between French Canada and English Canada.  Personally I love both Canadas.  I spent a lot of time in both and the people couldn’t have been nicer to me.  It’s just each other they have a problem with.  I won’t go into details about that as it is not necessary to make a point.  That point being that English Canada is trying to lure French Canada to come and be doctors and nurses in their hospitals because there is a doctor and nurse shortage.  This despite the fact they don’t love each other.  Which shows how bad that shortage is.

It is admirable that English Canada is offering these French Canadians a place to work without having to suspend their religious principles.  But note one thing English Canada is NOT doing.  Offering these doctors and nurses more money.  Because they just can’t afford to.  So they hope to exploit Quebec’s new secular values charter to cure a problem common to national health care.  Doctor and nurse shortages.  But if Ontario reduces their shortage it will only increase the shortage in Quebec.  For national health care is a zero-sum game.  For someone to win someone must lose.  As there are a finite number of doctors and nurses in Canada.

This is what Obamacare will do for the American health care system.  Create doctor and nurse shortages.  Because Obamacare is going to fix the high cost of health care by paying doctors and nurses less.  Because no one should profit from the medical misfortunes of others.  But it is okay for patients to wait longer to see a doctor.  Apparently.

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Study finds Coal cuts Lives by 5 Years for some who wouldn’t have Survived Childhood if it weren’t for Coal

Posted by PITHOCRATES - July 13th, 2013

Week in Review

Early man did not have a long life expectancy.  Thanks to infectious disease and poor (or nonexistent) medical care people who got sick or injured often died.  Unhygienic living spread communicable diseases which killed large numbers in the community.  The lack of fuel to heat your home or cook your food exposed people to the elements and food-borne bacteria.  Causing illnesses that went untreated and added to the death toll.  And a high infant mortality rates brought down the average lifespan further.

There were a lot of old people in their 70s throughout history.  But go back a couple of centuries so many children didn’t survive their childhood that the average lifespan was in the 30s.  But thanks to the modern world of energy and medicine our life expectancies have never been higher.  Even though coal is taking some years off the additional years it gave some (see Burning Heating Coal Cuts Lives by 5 Years in China, Study Finds by Daryl Loo posted 7/9/2013 on Bloomberg).

People in northern China may be dying five years sooner than expected because of diseases caused by air pollution, an unintended result of a decades-old policy providing free coal for heat, a study found.

Coal burning leading to heart disease, stroke, lung cancer and respiratory illnesses may cause the 500 million Chinese living north of the Huai River — a rough line dividing the country’s north and south — to lose an aggregate 2.5 billion years of life expectancy, according to the research published in the Proceedings of the National Academy of Sciences today.

The government gave free heating coal for people living north of the Huai River over a period of central planning from 1950 to 1980, and such indoor systems remain common today, the study showed. Burning coal in boilers is linked to the release of particulate matter that can be extremely harmful to humans, raising health costs and suggesting a move away from using fossil fuels would be attractive, according to Michael Greenstone, one of four authors of the study.

If the government took away fuel to heat and cook with how would that impact their life expectancies?

Yes, it’s sad that breathing particulate matter can remove 5 years of your life.  But how many more years did these people live because of coal?  They had to stay warm somehow.  And they needed to cook their food with something.  If they didn’t have coal these people would have been collecting firewood year round and burning that inside of their homes.  Releasing particulate matter into their homes anyway.  Only with a rise in lost appendages from swinging an axe.  More infected wounds from axe slips.  And they’d have rodents living in their wood piles.  Bringing disease into their homes.  Carried by the fleas on these rodents.

Coal may be taking 5 years away these people.  But they may be taking these years from a person who might not have survived his or her childhood if it weren’t for coal making their home a better place to live in.  It’s time we stop seeing only the bad that coal does.  And start recognizing the good that coal does.  For when it comes to human existence the good of coal far outweighs the bad.  For look where coal has taken us.  To the highest life expectancies in our history.  And it is still making our world a better and healthier place by creating electric power.  The essential ingredient in making the best medical care possible.  Thank you, coal.  Some of us appreciate the good that you do.

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Thanks to Advances in Medical Care People are Living long enough to Bankrupt Social Security and Medicare

Posted by PITHOCRATES - December 16th, 2012

Week in Review

People talk a lot about an aging population.  The cost impact on Social Security.  Medicare.  And pensions.  Something the actuaries are experts at doing.  Calculating costs.  The only problem for Social Security, Medicare and pensions is that when the experts calculated these costs medical care wasn’t as good as it is today.  And people were dying a lot earlier than they are today.  And this is the cost impact of an aging population.  People that are NOT dying as early as the actuaries originally calculated (see A sick world: We live longer, with more pain and illness by Kate Kelland posted 12/13/2012 on Reuters).

The world has made huge progress fighting killer infectious diseases, but as a result we now lead longer and sicker lives, with health problems that cause us years of pain, disability and mental distress…

The Global Burden of Disease study, led by the Institute for Health Metrics and Evaluation (IHME) at Washington University, finds that countries face a wave of financial and social costs from rising numbers of people living with disease and injury.

Social Security, Medicare and pensions are going broke because people stopped having babies during the Sixties and Seventies like they used to have before then.  As birth control and abortion came into vogue.  This became a big problem because it followed the baby boom.  The rate of older sicker people leaving the workforce who no longer paid income taxes grew at a greater rate than younger healthier people entering the workforce who paid income taxes.  And the older people are living longer.  So long that they can get sicker and become more costly to care for.  All because they’re living 10-20 years longer than the actuaries originally calculated.  Thanks to advances in medical care.

Things will get worse before they get better until the last of the baby boomers die.  And these two growth rates approach each other.  And pass.  Going from an aging population to one that grows younger.  So the number of taxpayers once again grows at a greater rate than tax consumers.  Which Obamacare will help speed along with their quasi death panels.

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Obamacare to Penalize Hospitals for Readmitting Sick People

Posted by PITHOCRATES - December 1st, 2012

Week in Review

Now that we passed Obamacare we’re starting to find out what was in that bill.  Which, according to Nancy Pelosi, was the only way for us to find out what was in it.  By voting blindly for it.  Then wait for them to implement it.  They’re doing that now.  And some of the things that we’re learning are in the bill are a little scary (see Hospitals Face Pressure From Medicare to Avert Readmissions (from the New York Times) by JORDAN RAU posted 11/26/2012 on The New York Times).

Medicare last month began levying financial penalties against 2,217 hospitals it says have had too many readmissions. Of those hospitals, 307 will receive the maximum punishment, a 1 percent reduction in Medicare’s regular payments for every patient over the next year, federal records show.

One of those is Barnes-Jewish Hospital in St. Louis, which will lose $2 million this year. Dr. John Lynch, the chief medical officer, said Barnes-Jewish could absorb that loss this year, but “over time, if the penalties accumulate, it will probably take resources away from other key patient programs.”

The crackdown on readmissions is at the vanguard of the Affordable Care Act’s effort to eliminate unnecessary care and curb Medicare’s growing spending, which reached $556 billion this year. Hospital inpatient costs make up a quarter of that spending and are projected to grow by more than 4 percent annually in coming years, according to the Congressional Budget Office.

There are two ways to look at this.  The government’s way.  Keeping those greedy hospitals from readmitting patients just to bill the government more.  Or the patients’ way.  Seeing Obamacare forcing hospitals not to readmit sick people.  Which would be basically the same as telling them to go and die.  It’s not called a death panel.  But someone in the hospital will have to decide whether to readmit the patient and suffer financial consequences.  Or please the government and not readmit these people.  Which, of course, would be a decision probably resulting in death for these patients.  Not the warm and cuddly Obamacare they told us about.  But it would be the only way the government could reduce health care costs.  Simply refusing to give people medical care.  For death is cheaper in the long run than hospitalization.  Something no doubt the government bureaucrats have factored in their Obamacare.

Medicare’s tough love is not going over well everywhere. Academic medical centers are complaining that the penalties do not take into account the extra challenges posed by extremely sick and low-income patients. For these people, getting medicine and follow-up care can be a struggle…

Various studies, including one commissioned by Medicare, have found that the hospitals with the most poor and African-American patients tended to have higher readmission rates than hospitals with more affluent and Caucasian patients…

Some researchers fear the Medicare penalties are so steep, they will distract hospitals from other pressing issues, like reducing infections and surgical mistakes and ensuring patients’ needs are met promptly. “It should not be our top priority,” said Dr. Ashish Jha, a professor at the Harvard School of Public Health who has studied readmissions. “If you think of all the things in the Affordable Care Act, this is the one that has the biggest penalties, and that’s just crazy.”

Interesting.  Not only does Obamacare use death as a cost-cutting means it also will discriminate against the poor and minorities.  While at the same time making hospitals less safe as money will go to the government in fines instead of combating infections and preventing surgical mistakes.

Death panels and less safe hospitals.  Funny, I don’t recall them telling us this is what they were giving us Obamacare.  Then again, if they told the truth they probably wouldn’t have gotten the votes.  So health care will get incredibly worse.  These policies and our aging population will accelerate our once quality health care system to something akin to what we could find in a third world country.

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FT95: “Yes the VA is successful national health care…if you call NOT covering 93% of the population universal coverage.” -Old Pithy

Posted by PITHOCRATES - December 9th, 2011

Fundamental Truth

Since the Vietnam War Congress has made some VA Hospitals little more than Third World Hospitals

There are about 3 million people serving in the military.  This includes active duty and reserve personnel.  The current U.S. population is just over 300 million.  So if you do the math that’s approximately 1% of the population.  That’s a very small sliver of the population.  And yet they offer to sacrifice everything – including their lives – for the other 99%.  Wow.  Talk about selfless duty to country.  And to their fellow Americans.

Unfortunately some of these men and women suffer wounds serving their country.  Some severe wounds.  They receive state of the art medical care within hours of their wounding.  At the Landstuhl Regional Medical Center in Germany.  And later at the Walter Reed National Military Medical Center.  Then they return to civilian life.  The Veterans Administration (VA).  And the VA hospitals throughout America.  That aren’t as nice as the Landstuhl Regional Medical Center.  Or the Walter Reed National Military Medical Center.

Since the Vietnam War Congress turned against the military.  Gutting military budgets to pay for a burgeoning welfare state.  To buy votes.  Ronald Reagan put a stop to that.  Rebuilt the military.  But Congress did a lot of damage.  They made some VA hospitals little more than third world hospitals.  A second tier of health care that was good enough for the people that they didn’t like.  Even as late as the Eighties some VA hospital had a higher mortality rate than a comparable hospital in the private sector.  Sadly, a VA hospital was a place to put veterans.  And forget about them.

The VA System is a Pretty Small Health Care Program and Small Programs are easy to Fund and to Run

Thankfully, things changed.  The quality of VA health care today is much better.  Thanks to a surge in defense spending that paid for a lot of wars since the Eighties.  But things are changing again.  And Congress is scheduling more cuts in defense spending.  So Congress can use this money to pay for their ever burgeoning welfare state.

Currently the VA is about as good as it gets.  And those who love a good welfare state point to it as a fine example of a well-ran national health care program.  They say, see?  We just need to expand this system to cover all Americans.  All we have to do is to scale up the program a bit.  Of course this all depends on how large ‘a bit’ is.

The VA’s successes are in large part due to its size.  It’s small.  For we don’t have that many veterans.  Currently they are only about 7% of the total population.  Which is less than our black population (which is about 10%).  So the VA system is a pretty small health care program.  And small programs are easy to fund.  And to run.  Not like a large national program.  Such as Medicare.  Which isn’t even universal.   But it is full of fraud and waste.  Just like any program will be that expands from serving 21 million to serving 300 million.  That’s an increase of 1300%.  Which would be like taking the existing VA system and building another 13 just like it.  All funded by guess what?  The mother of all tax hikes.  And do we really want to give government that kind of money with their record of reckless spending and deficits?  Because you know what will happen.  They’ll eventually use some of that money elsewhere.  To pay for other unfunded parts of the burgeoning welfare state.  Requiring higher taxes to fund national health care.  Or further rationing.

A VA-Type System won’t Work because you can’t Raise Taxes enough to give the Other 93% the same Quality of Care

The health care crisis is government made.  Going back to the wage controls of World War II.  When employers couldn’t offer higher wages to attract the best workers.  So they started offering benefits.  Which got around the government’s regulation of the private sector.  And gave us employer provided health care.  And the heath care crisis.

Health care costs grew because other people paid for our health care.  There wasn’t a problem before other people started paying.  When we paid health care was affordable.  Because there were market forces in health care.  Now there are fewer.  And those who favor a big welfare state want to remove all market forces.  Which will only continue the trend of increasing costs.  And when the government doesn’t have the tax revenue to pay these escalating costs they’ll start rationing services.  Because it will be the only thing they can do.  Just like other nations with national health care have done.

The VA is a success story for the 7%.  Because 7% of 300 million is a much smaller number than 300 million.  A VA-type system just won’t work for the other 93%.  Because you can’t raise taxes enough to give the other 93% the same quality of care.  So that leaves one option.  Lowering the quality of care for everyone.  Including the 7% who paid for their care by spilling their blood.

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Rich Liberals Champion the Poor to Maintain their Privileged Lives

Posted by PITHOCRATES - April 2nd, 2011

Per-Vote-Subsidy replaces Corporate and Union Money

Canada has a spoils system when it comes to public financing of political campaigns.  The big pile of public money ‘donated’ by the Canadian taxpayer is divided between the parties by vote.  The more votes a party gets, the more tax subsidies that party gets.  The Canadian prime minister, Stephen Harper, wants to do away with these subsidies (see Harper vows to scrap per-vote subsidies by CTV.ca News Staff posted 4/1/2011 on CTV.ca).

Currently, political parties receive a $2-per-vote subsidy, but Harper has long opposed the system, which was brought in by the Liberals when corporate and union donations were banned.

He said Friday that political parties already enjoy “enormous tax advantages” and taxpayers should not have to support parties they don’t support with their votes. Harper added that the subsidy only helps to ease the way for frequent elections.

Interesting.  Unlike the United States, Canada does not allow corporations or unions donate to political parties.  And when that ban went into place, the liberals brought in the per-vote-subsidy.  It takes money to win political contests.  And when you shut down two big sources (corporations and unions), that money has to come from somewhere else.  So the liberals decided to get that money from the taxpayer.  Fair, right?  I mean, without these subsidies, political power falls to the rich.  And that’s not fair, is it?

The Liberals are the Rich trying to Buy Political Power

When they banned corporate and union donations that left private donations.  From actual people.  So I guess we would have to see how that money flowed to see whether the per-vote-subsidy is fair and serves its purpose.  To keep the rich from wielding political power over the poor (see Analysis: Fears about scrapping per-vote subsidies wildly off target by Patrick Brethour, Vancouver, posted 4/2/2011 on The Globe and Mail).

Data compiled by the website Punditsguide.ca show that funds raised by the parties largely come from small donors, in amounts that would make few Canadian households cringe…

Take the Conservative Party in 2009, which raised… an average [per person] donation of $174.60…

The story is pretty much the same with the other parties: the NDP, with an average donation of $169.11; the Bloc Quebecois, average $102.63; Green Party, $123.21; and the Liberals, with an average of $239.23, the highest of the major federal parties.

Looking at the average per-person donation, it appears the liberal donors are richer than the conservative donors.  Kind of goes against everything the liberals tell us.  That conservatives are nothing but a bunch of rich fat-cats who want to use the poor as footstools.  Either that or conservatives are just cheap bastards.

The same picture emerges when looking at the distribution of donations by size. For the Conservatives, about 10 per cent of the funds raised came from those giving between $1,000 and the maximum of $1,100; conversely, two-thirds came from those giving $400 or less. The NDP were similar, with 7 per cent coming from the highest donated amount, and 70 per cent coming from donations $400 and under. The Liberals – who have fulminated against the perils of the rich controlling the political process – were actually the party most dependent on big donations, with 35 per cent of their cash coming from donors giving between $1,000 and $1,100, while sub-$400 donors accounted for just 38 per cent of the funds the party raised.

In fact, the Liberals outperformed among big donors, raising $3.2-million to the Conservatives’ $1.7-million. The Tories made up that ground, and more, with small donors.

And what do these numbers tell you?  Liberals rely on rich people for their political donations.  Conservatives rely on the little guy, the average working person who can barely afford to donate $200.  And the big corporations and the big unions pour money into liberal political parties.  In ‘soft ways‘ these days.  In Canada.  In the United States.  All around the world.  So much money that it was hard for the little guy to fight against it.  Leaving political power in the hands of the rich.  Much like the liberals say they want to prevent with the per-vote-subsidy.  But, in fact, that’s exactly what they want to do.  Leave political power in their rich hands.

You see, the crony capitalists and the snooty rich don’t like the little guy.  They like the good life that few can enjoy.  And sometimes they need special favors from government to continue that privileged life.  Which is why they donate to liberal parties.  But when they banned ‘hard money’ donations from corporations and unions, liberals had to scramble for other financing.  Because the majority of people don’t support their views.  So they need to ‘force’ donations through these per-vote-subsidies.  For it is the only way they can continue to rule against the will of the people.

The People who Supported Obamacare get Obamacare Waivers

It’s always about the money.  Whenever you’re confused about some political debate, just ask yourself this simple question.  Where’s the money?  Take health care, for example.  The goal of Obamacare was to provide everyone with high-quality yet affordable health care insurance.  Sort of like paying for a Big Mac and getting filet mignon.  Impossible, yes, but that’s what they told us. 

Big Business and the unions were all behind it.  Everyone (employers and unions) wants to dump their health care costs.  That’s why they were anxious for that public option.  Well, they didn’t get the public option.  Not yet.  First Obamacare has to put the private insurers out of business.  Once it does that then the government can step in as the insurer of last resort and, presto, they’ll get their national health care.  But leaves a costly problem for the here and now.

To ‘pass’ CBO, they had to include some onerous requirements.  The new law forced everyone to buy insurance.  The insurers had to cover preexisting conditions.  And they forbade insurance companies to recover their full overhead expenses.  Suddenly affordable insurance was going to become unaffordable.  Or people were simply going to lose their insurance because they couldn’t afford the premiums that were necessary to comply with the requirements of Obamacare.  So many of those who supported this legislation want no part of it.  For themselves, that is.  It’s okay for us.  But not for them.  So they’re asking that the law does not apply to them.  Only us (see List of health reform waivers keeps growing by Jason Millman posted 4/2/2011 on The Hill).

The number of waivers the Obama administration has awarded for a provision of the year-old healthcare reform law grew by 128 in March.

With the new waivers, that means 1,168 businesses, insurers, unions and other organizations have received one-year exemptions from a healthcare reform provision requiring at least $750,000 in annual benefits.

Nancy Pelosi said we needed to pass Obamacare to learn what was in it.  Apparently another 128 insurance plans learned what was in it this past March.  And they want out.  Like the majority of Americans.  Which really begs the question why Obamacare?  It isn’t popular.  They had to pass it quickly before anyone could read the bill.  None of the unions want it.  So why have it?  Because liberals want it.  And why do politicians want anything?  Follow the money.

The Free Market provides High Quality and Low Prices

Hillary Clinton tried to socialize our health care.  Now Obamacare is a short step from doing just that.  Because they said only government could step in and fix our health care system.  That the so-called free market had failed.  Really now?  Because that’s the one thing that has been missing from our health care system.  Market forces.  Doctors providing medical services for a fee that their patients actually pay for.  Not a third party insurance bureaucrat.  But the actual patient.  Until now, that is.  And that free market?  It works.  It’s providing a fully funded quality system that people of average means can afford (see High-end medical option prompts Medicare worries by Ricardo Alonso-Zaldivar, Associated Press, posted 4/2/2011 on the Sun Journal).

Every year, thousands of people make a deal with their doctor: I’ll pay you a fixed annual fee, whether or not I need your services, and in return you’ll see me the day I call, remember who I am and what ails me, and give me your undivided attention.

But this arrangement potentially poses a big threat to Medicare and to the new world of medical care envisioned under President Barack Obama’s health overhaul.

The spread of “concierge medicine,” where doctors limit their practice to patients who pay a fee of about $1,500 a year, could drive a wedge among the insured. Eventually, people unable to afford the retainer might find themselves stuck on a lower tier, facing less time with doctors and longer waits.

People actually paying to see a doctor?  Imagine that?  Just like in the old days.  Before there was a health care crisis.  The patients are happy.  The doctors are happy.  And making a very nice living.  You can’t get much more of a win-win situation, can you?  Who could find fault with this?

The trend caught the eye of MedPAC, a commission created by Congress that advises lawmakers on Medicare and watches for problems with access. It hired consultants to investigate.

I guess the government could.  Big Brother is everywhere.  And he is looking at this free market solution.  And Big Brother is not amused.  People paying for their own medical care?  That’s a problem for those in government.  A big problem.

Several members said it appears to be fulfilling a central goal of Obama’s overhaul, enhancing the role of primary care and restoring the doctor-patient relationship.

Yet the approach envisioned under the law is different from the one-on-one attention in concierge medicine. It calls for a team strategy where the doctor is helped by nurses and physician assistants, who handle much of the contact with patients.

John Goodman, a conservative health policy expert, predicts the health care law will drive more patients to try concierge medicine. “Seniors who can pay for it will go outside the system,” he said.

MedPAC’s Hackbarth declined to be interviewed. But Berenson, a physician and policy expert, said “the fact that excellent doctors are doing this suggests we’ve got a problem.”

You see, one-on-one concierge medicine is bad because it lets doctors work freely with patients.  The government would prefer something along the current lines.  You treat patients.  And then we’ll think about paying you.  And how much we’ll pay you.  Like in the Medicare program now.  That way you’re our bitch.  But if you work outside the system, you and your patients will be free.  And we don’t like that.  Why?  Follow the money.

Follow the Money for the Money Never Lies

Politics is always about the money.  Always has been.  Always will be.  Because it takes money to gain and maintain political power.  Whether you’re running a political campaign.  Or supporting a campaign with your union dues in exchange for political favors (such as legislation that limits competition so unions can maintain their high wage and benefit packages).

Liberals are a minority of the population.  Wherever you are.  The majority of people don’t belong to a union or work for the government.  This majority has jobs.  They take care of their family.  And want Big Brother to leave them alone.  Union dues from a small percentage of the population can greatly influence elections, though.  They can’t donate directly.  But that money finds its way to liberals.  Liberals in the U.S. desperately need this money.  In fact, union dues have become so important to the ruling liberal elite that they created an entire new class of union-paying people.  The public sector union class.  Who has but one purpose.  To launder tax dollars from taxpayers to the Democrat Party.

The 2010 mid-term elections shook up the political establishment.  Conservative governors are fighting back against this new political class.  And the liberal left is attacking these governors.  Even President Obama sent activists to Madison, Wisconsin, to protest against Governor Walker as they voted to make their public sector workers live more like the rest of the people in Wisconsin.  This is why Obamacare is so important to the left.  Health care is 17% of GDP.  That’s a lot of money.  That’s why the public option is so important.  Why nationalized health care is so important.  Because of this money.  Liberals want this money to pass through Washington.  Where they can easily skim a little off the top for their political needs.  And to live well.  Without actually having to work.  Like that majority that pays all those taxes.

Life’s greatest question can be easiest answered by following the money.  For the money never lies.

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LESSONS LEARNED #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 15th, 2010

ONCE UPON A TIME, in a distant land, there once lived a merry people.  And life was good.  They lived together in sweet harmony.  They worked long and hard to sustain their happy life.   And when people fell ill, they went to the doctor.  And after treatment, THEY PAID THEIR OWN DAMN BILL!

But those days are gone.  We don’t pay our own doctor bills anymore.  Health care is no longer between a doctor and a patient.  There’s somebody else involved now.  Someone who says what a patient can or cannot have.  Someone that tells doctors what they can or cannot do.  And our doctors have a bull’s-eye on their backs.

Medical care has taken a back seat to medical costs.  It’s not about what’s best for the patient.  It’s about what costs the least.  Think of a graph.  Increasing along the bottom are medical services rendered.  Increasing up the y-axis are costs.  On this graph picture two curves.  One that plots costs of medical malpractice lawsuits (very high when the doctor provides no medical services and decrease as the amount of medical services increase).  The other that plots costs of doctor reimbursements for services rendered (very low when the doctor provides no medical services and increases as the amount of medical services increase).

This is what a doctor considers when seeing a patient.  They don’t want to.  But the system forces them to.  Because of the conversion of health insurance (to protect your personal financial wealth) into a benefit/entitlement (to get free stuff with other people’s money).  And the rise of that other benefit/entitlement, the malpractice lawsuit as a vehicle to early retirement.

What better way to illustrate how cost takes center stage in our health care today but by some personal anecdotes?  So here is a smattering of our collective pasts.

I WAS IN some junior officer training program.  It was the last full day.  The last training we did was a run on the obstacle course.  It was hot.  Humid.  I kept pushing myself.  Now, I’ve suffered dehydration and heat exhaustion before, but whatever hit me wasn’t that.  I looked okay.  I had one of those ‘spike driven through your skull behind the eye’ migraines.  Nausea.  Some other discomforts.  All we had left was retreat.  Where we formed, though, we faced into the setting sun.  I asked my CO if he would excuse me from retreat.  I just wanted to hit my bunk.  To die.  Or sleep it off.  Whatever it was.  Training was over.  After retreat, they were going to open the pool for us. 

Well, he denied my request.  And made me feel like a little girl for even asking.  (I regret that moment of weakness to this day).  After I was dismissed, he called me back and said, “And if you do vomit in rank, vomit with bearing.”  “Yes, sir,” I replied and saluted.  Made it through without vomiting.  Crawled into my bunk.  When my CO saw that I was not partaking in the ‘mandatory’ fun he came to see me.  Was about to send my ass to the infirmary.  But whatever I had passed.  I felt fine.  The following day it was as if nothing had happened.

When you got through something like that, you’d be surprised how it impacts you.  You ignore things.  And live with things. 

I HAD A WART once under my thumbnail.  I made an appointment with my doctor to have it removed.  The day before my appointment, though, was a very busy day at work.  Didn’t sleep well the night before, either.  So I was tired.  And drinking coffee.  Apparently, I was the only one.  In the afternoon, half a pot was still remaining.  From the morning.  Nice and black.  Thick, too.  Like tar.  Strong.  I finished that pot.  Later that night, I had heart palpitations.  I rationalized it was from drinking too much coffee.

While getting that wart removed, I mentioned in passing the heart palpitations from the night before.  Laughing about it.  Last time I drink a pot of coffee, I said.  The doctor looked up from the wart and said, “Heart palpitations?  That’s serious.  This,” he pointed to the wart, “is piddling.  Heart palpitations?  That’s serious.”  The next thing I knew was getting an EKG and sent home with a heart monitor strapped to my chest.

I now thought about those things I was ignoring and living with.  Perhaps I was being irresponsible.  I mean, I was feeling things in my chest.  When I went in to get the results of all those tests, I told him about those things I’ve been ignoring and living with.  My test results were fine.  I asked him about those other things.  He asked, “How old are you?  You’re fine. You just have some anxiety.  Here’s some Xanax.”

When I mentioned heart palpitations, he couldn’t laugh it off with me.  For one, he was a doctor.  It’s what doctors do.  Save lives.  But he also buys malpractice insurance.  He was leaving himself open to a lawsuit if he didn’t do everything expected when a patient says he has had heart palpitations.  Once those tests came back confirming it was most probably the excess amount of coffee I drank that day that gave me the palpitations, I was just a young, healthy man.  Who did not justify any further testing.  At least, my insurance company wasn’t going to reimburse any further testing.

My test results looked good.  Feeling things in the chest, though, could mean something.  A stress test might be prudent.  But unless something turned up in that test, the insurance company wouldn’t reimburse that cost.  Which meant I would ultimately end up paying for it.  And stress tests are expensive.  Of course, if I paid cash outside the bureaucracy of the health insurance maze, it could be less.  So I said let’s do the stress test.  I’m buying.  I took the test.  Did okay.  Didn’t die.  Nothing strange happened.  The cost?  About half of what they would have charged had it gone through the myriad levels of overhead that process an insurance claim (at the health insurance company, at the hospital where the test was done and at my doctor’s office).

And I continued to ignore and live with those things I was feeling in my chest.  Even stopped taking the Xanax.  If I was feeling any anxiety, it was from my little episode in the health care machinery.

BUT THINGS SEEMED to only get worse after a year or so.  I started wondering that maybe I was only making things worse by ignoring them.  So I went to the doctor.  I explained what I was feeling.  He did the perfunctory tests that shrunk the lawsuit window.  Again, things looked good.  “How old are you?” he asked.  “You’re fine.  Look, we can keep doing tests but it’s going to get expensive.  Your insurance isn’t going to pay for them if nothing turns up.  And, I gotta tell you, I don’t think anything’s going to turn up.”

Again, he was looking at the cost-service tradeoff.  He felt he had minimized his costs.  He did enough testing to protect himself from a frivolous lawsuit.  And he didn’t do more testing than the insurance companies would reimburse.  Further testing would be on my dime.  Not that I didn’t think my life was worth the investment, but more tests would mean more missed work.  And with me feeling he wasn’t going to do anything but throw darts in the dark, I didn’t pursue additional testing.  It didn’t appear that anything big was wrong so I continued to live with those feelings.

THIRD TIME’S A charm.  After another year or so, I went to another doctor.  Again, I thought I might be doing more harm by ignoring these things.  Being further away from my original heart tests, I didn’t really discuss them this time.  Which was good.  It was a red herring.  You start talking ‘heart’, you look at all things ‘heart’.  High risk.  High costs.  But if you don’t start from ‘heart’, you can explore things that are lower risk and lower costs.  I had some serious acid reflux.  Acid regurgitating up your esophagus can mimic heart attack symptoms.  Who’d a thunk it?

HAVING AN INTERMITTENT problem is hard to diagnose.  All but impossible if you’re young.  I was a young college student.  With intermittent stomach pain.  I went to a doctor.  He felt me up to see if it was appendicitis.  I didn’t feel anything when he pressed over my appendix.  So he ruled that out.  “How old are you?” he asked.  “You’re fine.  You just need to get drunk and get laid.” 

A couple of years later, I was still feeling that intermittent stomach pain.  So I went to another doctor.  (It was a clinic.  The doctor I saw last since retired.)  He felt me up.  Ruled out appendicitis.  Sent me for an upper GI (where you drink a cup of barium and they x-ray your esophagus and stomach).  Test came back.  Everything looked fine.  “How old are you?” he asked.  “You’re fine.  Just drink some Maalox.”

So I drank some Maalox for awhile.  Didn’t seem to help.  Another year and another trip to the doctor.  And another upper GI.  The instructions this time called for a wait time before one last x-ray.  This x-ray showed an ulcer.  Just past the stomach at the beginning of the small intestine.

MY MOTHERINLAW WENT into the hospital with chest pains.  She was in her mid-sixties.  She spent the night in the ICU.  The next morning they transferred her to the cardiac care wing.  They did just about every test they could.  She was elderly.  Elderly people have health problems.  So doctors do ALL the tests to slam shut the lawsuit window knowing that the health insurance company or Medicare will reimburse for most of those tests.  They found nothing.  She went home.  Without them doing anything or being able to explain what had happened.  They had practiced due diligence to protect themselves legally.  And the health insurance company would rule that any further testing would be frivolous and unnecessary, only to produce additional revenues for the hospital and doctors. 

This repeated a few times until they found pancreatitis and stones in her bile duct. 

IT’S NOT THE doctors.  It’s not the hospitals.  Or the insurance companies.  It’s the system.  When other people pay your way there has to be rules.  For a free ride is not free.  We just make other people pay.  The problem with all things free?  We over consume.

How many plates of food do you eat in a restaurant when you pay per plate?  One?  How many plates of food do you eat when you eat at an all-you-can-eat buffet?  The answer?  More.  It’s happening in health care.  Those with insurance don’t care a whit about cost.  Don’t give me generics, I have insurance.

But someone is paying all those bills.  And they see this over-consumption.  They raise their premiums to cover it.  But when they do, they find some people stop buying their health insurance.  Which means they have to raise their premiums again.  More people stop buying.  So they need to raise their premiums again.  But they can’t keep doing this.  So they have to put in some kind of spending rules.  Say what they will reimburse and what they will not.  And they force the poor doctor to police this mess who is trying to help you get well at the same time.  All the while trying to keep the lawyers off his back.

It’s worse on the Medicare side.  For private health insurance has some young, healthy people paying for insurance who aren’t consuming medical care.  Everyone in Medicare is sick and/or old.  Big consumers of medical care.  The trend has been to micromanage the rules more as the consumption of medical care has outpaced the taxes collected to pay for that care.  And with an aging population, those costs are running well ahead of tax receipts.  It’s not a question of if the program will go bankrupt.  But when.  And a national health care system will only be worse.  The added costs will require massive taxation and cost management worse than any hated HMO.

AND LOST IN the shuffle is the patient.  Who, once upon a time, went to his doctor.  And the doctor did what was best for the patient.  And the patient paid the doctor for his services.  And everyone lived happily ever after.

www.PITHOCRATES.com

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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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