A Glimpse of Obamacare through the Death of a Child in the NHS

Posted by PITHOCRATES - April 8th, 2012

Week in Review

The problem with health care everywhere is twofold.  Our aging populations.  And our longer life spans that allow people to have more illnesses.  So improvements in medicine are compounding the problem.  By allowing people to live longer so they can consume more medical services.  And unlike manufacturing we can’t use new technology to increase efficiencies.  At least not yet.  So the only way to control costs is to spend less.  Treating only those who are sick.  And sending those who are not quickly on their way.  A health care triage system.  Where they quickly weed out the non-sick to make room for the sick.  To make sure they don’t waste their limited funds and services on those who don’t need it. 

It works well on paper.  But it has one serious drawback in practice.  The ‘assembly line’ triage can only catch the glaringly obvious.  Like a missing leg.  Or blood squirting out of a cut artery.  But if everything looks okay on the outside and the standard tests come back negative, doctors can discharge a patient.  Missing something a little more rare and unusual.  Like dehydration and kidney failure in an otherwise healthy child (see Doctors failed to spot toddler’s fatal illness on THREE occasions before he died by Jill Reilly posted 4/6/2012 on the Daily Mail).

A devastated mother is demanding to find out why her young son died after medics sent him home three times in less than two weeks. 

Harry Connolly died of dehydration and acute kidney failure after medics repeatedly failed to diagnose his illness…

Mrs Connolly said: ‘The fact remains that Harry died as a result of dehydration and acute renal failure despite being admitted to hospital twice and attended by an out-of-hours doctor in the space of just five days.

‘He would have survived if he’d remained in hospital from 26 April and fully rehydrated, he would have survived had he been readmitted on 28 April, and would have survived had the out-of-hours doctor referred him to be readmitted on 29 April.

Suppose the doctors admitted a similar child who proved not to be sick.  Taking a bed in pediatrics.  Taking a doctor away from other patients.  Taking nurses away from those more ill.  Taking up time on diagnostic equipment that they could have used on others actually ill.  Perhaps pushing back someone else in line.  Who may die because of the delay.  Then the doctor responsible for admitting a healthy child has to stand before an administrator.  To explain the waste of resources.  The death of a patient they couldn’t save thanks to the waste of said resources.  And the unnecessary expense of all those tests on a healthy child.  Exceeding the department’s budget.

Sadly, these are real concerns for those in the health care industry today.  Especially in national health care systems.  Like Britain’s National Health Service (NHS).  That are bursting at the seams because of the explosion in costs because of that aging population.  And their longer lives.  Taxing available resources so much that doctors have to carefully ration health care services.  To make sure that they are available for the patients who need them most.

This is the world of national health care.  Where you try to take care of everyone.  With resources that can’t save everyone.  Where the rationing of services leaves some to die.  And causes others to die that they could have saved had they only spent a few more moments on their diagnosis.  So if you want a glimpse into the world of Obamacare, here it is.  It will be like the NHS.  Only bigger.  And because it’s bigger it won’t be as good as the NHS.  Which is the problem with health care for everyone.  We don’t have resources to cover everyone in a national system.  Because the bureaucracy to run it will consume so much of the budget.  Requiring some sort of triage system.  Or death panels.  To ration those limited services.  To choose who to save.  And who to send home.  To let nature take its course.

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LESSONS LEARNED #65: “The only thing the market is inefficient at is funneling money to anti-business politicians.” -Old Pithy

Posted by PITHOCRATES - May 12th, 2011

Microsoft Learns the hard way about the Costs of Lobbying

Once upon a time Microsoft had no lobbyists.  Microsoft grew to dominate the PC operating system with no help from the government.  Bill Gates became the richest man in the world with no help from the government.  And how did that go over with the government?  Not well.

Because of complaints by Microsoft’s competitors, the U.S. Justice Department began antitrust proceedings against Microsoft.  The complaint?  Microsoft was giving away something for free that others wanted to sell.  A web browser program.  Internet Explorer (IE), to be specific.  The competitors said that Microsoft had an unfair advantage when they bundled IE with their operating system.  Because why would people pay for something that they can get for free?  Consumers never complained about getting something free.  Just other corporations trying to make consumers pay for something that they could get free from Microsoft.  So the Justice Department went after Microsoft so consumers could no longer get something for free.  In other words, the antitrust case against Microsoft was to raise prices.  Which is kind of the opposite reason for an antitrust case.

Government may not know how to create or expand business activity.  But they sure know how to hurt a business.  Microsoft still bundles IE with their operating system.  But they learned a very important lesson.  And, today, Microsoft spends millions of dollars on lobbyists.  To lobby politicians for nothing in particular.  But to pay tribute.

There was no Health Care Cost Crisis before World War II

Once upon a time people paid their doctor’s bill.  Really.  They’d see their doctors.  The doctor would bill them.  And they would pay.  Of course, that was a long time ago in a mystical place.  The United States.  Before World War II.  Yeah, I know.  Crazy talk.  Paying your doctor’s bill.  But some crazy sons of bitches really did. 

Of course, back then, medicine wasn’t socialized yet.  Market forces controlled medical costs.  How, you may ask?  Simple.  The people ‘buying’ the medical services paid the bill.  Medical services were just another service provided by licensed professionals.  Like a plumber.   And though plumbers are expensive, they are affordable.  Because if they weren’t affordable, there wouldn’t be a market for their plumbing services.  As it was for doctors.  Before World War II.  Doctor services were affordable.  Because if they weren’t, there wouldn’t be a market for their medical services.  And it worked like this until World War II.  When health care became a benefit.  And benefit administrators came between buyers and sellers of medical services.

Let’s do a little experiment.  Let’s say you work for a company that is putting together a company picnic.  The company is paying the tab for all 20 employees attending.  And you get a company credit card to buy the food with no restrictions given.  What are you going to buy?  Hotdogs and hamburgers?  Or filet mignon?  Now, later in the summer, you’re having a family BBQ.  There’ll be 20 people in all.  But this time you’re paying the entire bill.  What are you going to buy?  Hotdogs and hamburgers?  Or filet mignon?  Chances are that you’ll be eating different food at these events.

The Price Mechanism doesn’t work if someone else Pays our Bills

Do you see how having someone else pay for your benefits affects your purchasing decisions?  You’ll be enjoying filet mignon on the company’s dime.  But you’ll be satisfied with hotdogs and hamburgers on your dime.  This is the problem in post World War II health care.  There are no market forces anymore in health care.  Someone else is paying for your benefits.  So you don’t care what the costs are.  So you’ll never object to getting the filet mignon of health care benefits.  Even if you’re a single guy.  And your employer is paying for insurance that includes breast and cervix exams.  If you were paying the full cost of your health insurance bill, though, you probably would not pay for breast and cervix exams.  Sure, they’re nice.  But as a guy you would probably never use these benefits.  So you probably wouldn’t pay for them.

This is a big reason why health care costs are so out of control today.  There are no market forces in play to control costs.  Other people pay for our benefits.  So we never ask, “Can I afford this?”  Which everyone does before hiring a plumber.  Dr. Gratzer, a physician and senior fellow at the Manhattan Institute, wrote that Americans pay only twelve cents for every dollar of health care services they receive.  Which means 88% of the American health care is already socialized medicine.  In other words, other people pay for 88% of an American’s health care.  And when other people are paying, how often do you ask, “How much does this cost?”

This is why health care costs are out of control.  Elsewhere in the economy prices serve as a mechanism to adjust supply and demand.  Not in health care.  No one knows the prices in health care.  Because no one asks.  And the further we go in this direction the worse it’s going to get.  Yet that is exactly the direction some in government want to take health care.  Why?

Politicians Matter more than the Cost of Health Care

Because the market is efficient.  It works very well when left alone.  Just ask Bill Gates.  Or anyone who saw a doctor before World War II.  The market works.  But it has one drawback.  It doesn’t need government.  And for those who are looking for a career in politics, that’s a problem.

Microsoft wasn’t harming any consumers.  They were hurting other businesses that couldn’t make consumers spend more money.  So the politicians stepped in.  To show they mattered.  And cared.  Also, Microsoft was obscenely wealthy.  A little lobbying on their part could fill a few campaign war chests.  And provide a nice vacation or two.  They just needed to see the light.  How things worked in Washington.

But becoming a senator or a representative needs more than a fat war chest.  You need people to vote for you.  And a good way to do that is to get as many people dependent on government as possible.  Either as patients in a new national health care system.  Or as employees in a vast new bureaucracy for the new national health care system.  Which is why they’re not turning to the free market to fix the cost problems in their health care system.  Like they are in the UK and Canada.  They don’t want to fix the cost problems.  They want the dependency created by a new national health care system.  They can worry about costs later.  After they’ve taken over one-sixth of the U.S. economy.

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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.

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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.

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