Women with Breast Cancer suffer higher Death Rates in Britain’s National Health Service

Posted by PITHOCRATES - March 2nd, 2013

Week in Review

The whole push for Obamacare was to provide quality care for all Americans.  Not just those who could afford it.  Health care was going to be classless.  There would be true equality.  No one would receive any better care than anyone else.  Because health care is not a privilege.  It’s a right.  Or so the proponents of national health care say.  And why they supported Obamacare.  A waypoint on the path to true universal care.  Where everyone gets the best health care whenever they need it.  Just like in Britain.  Whose National Health Service (NHS) is what those in America want Obamacare to evolve into.  So health care in America will be just as good as health care in Britain (see British women ‘dying quicker of breast cancer than elsewhere’ by Stephen Adams posted 3/1/2013 on The Telegraph).

Academics at the London School of Hygiene and Tropical Medicine found the proportion of women in the UK surviving at least three years after being diagnosed was 87 to 89 percent, which was similar to Denmark.

In Australia, Canada, Norway and Sweden three-year survival was 91 to 94 per cent for the period examined, between 2000 and 2007…

In Britain only 28 per cent made it to three years, but in Sweden 42 per cent did…

Dr Sarah Walters, lead author, said: “We should now investigate whether the treatment of women with later-stage breast cancer meets international standards. There is particular concern that this is not the case, especially for older women”.

Sara Hiom from Cancer Research UK, which helped with the study, said: “We need to investigate the possibility that fewer women with later stage breast cancer in the UK receive the best treatment for their circumstances…”

“The NHS is also working to ensure all patients are treated as individuals and receive care that meets their healthcare needs whatever their age or condition.”

National health care is great.  As long as you’re not old.  For those old people are very costly to treat.  Because they’re living longer into retirement.  Consuming ever more health care dollars (or British pounds) for a few months more of life.  If Britain wants to get their health care costs under control they could save a lot by not treating some of these highest consumers of health care.  Putting some of them, instead, on the Liverpool Care Pathway.  Where doctors can withdraw treatment to let terminal ill patients die with dignity.  While saving precious health care dollars/pounds for use elsewhere.  Cold and callous, yes, but it is happening.

They don’t call the Liverpool Care Pathway a death panel.  But it is one.  Especially when some people are placed on the pathway without consulting with the person’s family first.  Something to look forward to as Obamacare evolves more into a national health care system.  As well as higher death rates for women with breast cancer.  Where there will be more equality.  As we lower the quality of care for everyone by trying to do more with less.  As health care costs soar due to aging populations.  People living longer into retirement.  And tax revenues fall due to aging populations.  Fewer people entering the workforce to pay for those living longer into retirement.  Leaving death panels as one of the few ways for governments to cut costs.

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The British love their NHS despite a Vast and Growing Number of Patients receiving Horrible Care

Posted by PITHOCRATES - December 30th, 2012

Week in Review

At the 2012 Summer Olympics in London the opening ceremonies included a tribute to Britain’s National Health Service (NHS).  To show to the world how wonderful it is.  And how much the British love it.  As long as they were not a seriously ill patient in the NHS.  Or had a loved one that was.  Because for these people it’s not the beautiful thing they showed in the opening ceremonies (see The cult of the NHS, flinging flans and the plight of poor old Richard Dawkins by Damian Thompson posted 12/28/2012 on The Telegraph).

Just as light entertainers prance across our screens shrieking about “charidee”, so politicians and churchmen intone their devotion to the NHS, like politburo members singing the praises of the Motherland.

Our health service doesn’t deserve this sycophancy. Or, rather, it deserves better than self-serving rhetoric whose subliminal message is: “Look at me! I lurve the NHS more than you do! I am a good person..!”

Nigel Lawson famously said that the NHS was the closest thing the British had to a national religion. He was right – but we need to ask ourselves why a system of providing health care has become so sanctified. After all, the newspapers have been running stories about dirty wards and patients left to die on trolleys for many years.

We know these stories are true; yet we still applaud when Danny Boyle uses the Olympic ceremony to present a rose-tinted vision of dancing nurses and twirling beds – “Busby Berkeley on the cancer ward,” as my colleague Tim Stanley put it.

The problem is that our health service has passed the point where it can work the magic we demand. As we reported last week, Alexandra Hospital in Redditch has apologised to 38 families for neglect that left dying people screaming in pain and one old lady unwashed for 11 weeks. The staff who taunted patients there aren’t typical of their profession – but neither are the invariably “dedicated” nurses of our imagination.

The average nurse is neither more nor less dedicated than the average accountant. But he or she does face much tougher challenges – specifically, of dealing with more and more very old people whose care is difficult and expensive to manage.

Perhaps at the next Olympics the United States hosts they will have a twirling-bed tribute to Obamacare.  For Obamacare will be similar to the NHS.  And no doubt will soon have patients left dying and screaming in pain and unwashed for 11 weeks.  For if the British have these problems the U.S. will most certainly have them when they follow the British down the path of national health care.  Because both the British and the Americans have aging populations.  Only the Americans will have 5 times those very old people who are difficult and expensive to manage.  As we have 5 times the population Britain has.

Just something to look forward to as Obamacare starts going into effect in January.  In addition to going over the fiscal cliff.  And the resulting recession from those massive tax hikes.  So Happy New Year.  It’ll definitely be a year to remember.  And one we may soon want to forget.

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The Left goes after the Youth Vote before they Grow Up and Become Responsible

Posted by PITHOCRATES - October 13th, 2012

Week in Review

The Left always urges kids to vote the moment they turn 18.  That it’s important they exercise their right to vote.  Because their views and opinions are important.  Because they haven’t become corrupted or jaded yet by politics.  We need to listen to the young.  Because they are our future.  And not a bunch of doddering old people who vote just to protect their bank accounts, their homes, their children and their country.  No, these people are just too old and blind to the progressive needs of our country.  Maybe they knew what was important in their youth but they’re completely out of touch today.  And therefore we need the young to help us move the nation forward.  For they may be young but they’re smart, responsible and in touch with the important issues of the day (see Investigators suspect teen in fatal LI crash was ‘high’ by KIERAN CROWLEY, ERIN CALABRESE and DAN MANGAN posted 10/9/2012 on the New York Post).

Joseph Beer, 17, “was driving way too fast” right before the spectacular crash at about 3:40 a.m. yesterday on the Southern State Parkway in Nassau County, a law-enforcement source said.

Authorities suspect Beer “was high” at the time the his new 2012 Subaru STI slid across a section of the highway known as Dead Man’s Curve and went sailing into a group of trees — totaling the car and ejecting all five people inside, the source said.

Only Beer survived — but killed instantly were his four recently graduated classmates from Richmond Hill HS in Queens, all of whom were 18 years old…

Because Beer only had a learner’s permit, he was barred from driving between 9 p.m. and 5 a.m., from driving without a licensed 21-year-old driver in the car to supervise him, and from carrying any passengers under age 21 who were family members.

There but for the grace of God go I.  We’ve all done stupid things in our youth.  Despite things like this happening to someone we know or to someone in our community.  But we are so stupid in our youth that we continue to do stupid things.  Which is why we can’t drink until we’re 21.  And can’t drive after 9 PM without a licensed 21-year-old (or older) driver to help us stop doing stupid things.  But as much as we try to stop these stupid things from happening they do.  Which is why car insurance is so expensive for young drivers.  Because of the stupid things we do in our youth.

Had it not been for the youth vote Barak Obama would not have won the 2008 election.  But if they’re not mature enough to drink until they’re 21 perhaps they’re not mature enough to vote either.  President Obama’s Keynesian policies have devastated the economy.  They caused a credit downgrade for the first time in history.  We have had record trillion dollar deficits in each year of his presidency.  We have a record debt thanks to his deficits.  His stimulus bill rewarded campaign contributors while creating no ‘shovel ready’ jobs.  His bailout of GM and Chrysler did what a normal bankruptcy filing would have done only without screwing the bond holders and giving the company to the UAW to bail out their pension plan while leaving the same structure in place that prevented them from selling vehicles profitably in the first place.  His investments in green energy rewarded campaign contributors instead of creating jobs of the future.  His attacks on oil have raised the price of gasoline and food.  And his attack on coal is setting up the country for an energy future of rolling blackouts and outages.

A lot of old people understand this because they have experienced a lot of this before.  They lived through the disaster of the Carter presidency.  And the Morning in America of Ronald Reagan.  They know that the pro-business policies of Warren Harding/Calvin Coolidge, JFK, Ronald Reagan and George W. Bush produced both economic growth and increased tax revenue.  And they’ve already lived through a decline in American Exceptionalism once during the Seventies and don’t want to live through it again now.  Especially those who immigrated to the United States for a better life.  And they’re seeing it decline again right before their eyes thanks to excessive government spending and attacks on success.  Old people see this.  They’ve experienced it.  Which is why they vote the way they vote.  Not for promises of free birth control or access to unlimited abortion services.  Or the decriminalization of marijuana.  Issues that weigh heavily on the minds of young voters.  Which the Left knows.  And exploits.  Which is how they got Barack Obama elected.  And put the nation into the precarious position it is now in.

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LESSONS LEARNED #51: “The longer you wait to balance your books the harder it will be to balance them.” -Old Pithy

Posted by PITHOCRATES - February 3rd, 2011

Almost half of a Plantation’s Value was its Slaves

Slave labor wasn’t cheap.  First there was the capital expenditure to purchase the slaves.  Then you had to feed them, clothe them, house them, etc.  It took money.  But that money made money.  Mostly on the big plantations.  Where the division of labor was minimal.  And large labor gangs could work a single crop profitably.

The more slaves on a plantation the more land they could work.  So the more slaves on a plantation the more valuable the plantation was.  Like a dairy farm with many dairy cows is worth more than one with fewer cows.  A productive dairy farm makes money.  And it can borrow money to grow.  Ditto for a cotton plantation. 

Now suppose we free dairy cows everywhere.  They’re free to walk off of their farms and pursue their own lives.  What will become of the dairy farm?  It won’t make money.  It won’t be able to pay back its loans.  The farm will lose value.  Because no one will buy it without the cows to make milk.  Dairy farmers everywhere will go broke.  And they will lose their farms.   

If not for the Civil War, Abolition would have been the Greatest of all Bailouts

When we discuss slavery, we focus more on issues of morality.  But the reason we had it for so long is partly due to the economics.  There was a large price tag attached to abolition.  And the question was who was going to pay?  Slavery, though immoral, was legal.  The plantations grew.  They purchased more slaves.  Worked more land.  Incurred debts to grow further.  All based on the collateral of their plantation.  Much of which was their slaveholdings.

Based on the 1790 census, there were just fewer than 700,000 slaves in America.  At the time, the nation’s finances were in a mess.  We were begging Europe to loan us money.  There was no money available to reimburse the slave owners.  And the North didn’t want to pay for this ‘southern’ problem.  There was no easy way to free the slaves without a huge financial hit.  For someone.  So we tabled the issue.  For another generation to consider.  And resolve.

But we didn’t.  By 1860, the slave population topped 3.8 million.  That’s over 5 times the number from the 1790 census.  The cost to reimburse these slave holders had grown to over $3 billion dollars.  That was almost 70% of the 1860 GDP.  In comparison, the total budget of George W. Bush reached as high as 69% of GDP.  Clearly, the cost of freeing the slaves was huge.  It dwarfed all other federal spending.  And this is one of the reasons that it took a war to finally resolve.  And it was our nation’s bloodiest conflict.  More died in the American Civil War than did in WWI and WWII combined.  And the war devastated the southern economy.  Besides the direct war damage, the South was impoverished.  And easy pickings for northern carpetbaggers.

The issue of slavery was less costly to resolve sooner than later.  But the price was always so great that the institution continued on because no one was willing to bear the costs at any time.  This only guaranteed that the final reckoning would be greater.  Which it was.  The final cost was so great it nearly destroyed the nation.  And bitter feelings linger to this day.

Never Let a Good Crisis Go to Waste

Woodrow Wilson and his fellow Progressives were going to change the world.  But that didn’t work so well.  In fact, a lot of their meddling just crashed the economy.  Secretary of the Treasury Andrew Mellon helped President Warren Harding fix the economy.  And we got the Roaring Twenties.

But the Progressives kept tinkering.  And Republican Herbert Hoover was even a bit of a Progressive himself.  Anyway, some government mismanagement (and inept Federal Reserve actions) gave us the Great Depression.  Our nation’s greatest crisis.   Which Franklin Delano Roosevelt (FDR) would exploit to transform the nation with his New Deal.

FDR’s economic policies failed.  Only capitalism re-unfettered for the war effort brought the nation back.  Even though he failed he is still remembered fondly by most Americans.  He stood fast with our allies and defeated Nazi Germany.  And he gave us Social Security.  Which, financially speaking, will cost the nation more than defeating the Nazis did.

The Great Ponzi Scheme Social Security

Social Security was originally intended to help poor widows who had struggled through the Great Depression.  It has subsequently grown to cover retirement and disabilities.  Not a big deal then.  The actuaries crunched their numbers.  They took into account immigration, birthrates, life spans, death rates and other important stuff.  Like actuaries are wont to do.  And they figured it would work.  Because we had a growing population.  With a lot more younger people entering the workforce than there were old people retiring and collecting benefits.

So, like a Ponzi scheme, Social Security was as sound as a pound.  As long as their assumptions held.  But they didn’t.  Immigration slowed.  Our life spans increased.  And worse, we just weren’t having as many babies as we once did.  Now we had more people retiring and collecting benefits.  And fewer entering the workforce to pay for these retirees.  The pyramid inverted itself.  The base was smaller than the tip.  And that just ain’t good for a Ponzi scheme.

Everyone predicts Social Security will go bankrupt.  They’ve been trying to fix it through the years.  To extend the solvency.  By reducing benefits.  Raising taxes.  And raising the retirement age (to decrease the years retirees collect benefits).  These ‘fixes’ have pushed insolvency out a few more years.  But it hasn’t addresses the elephant in the room.  Old people.  They’re living longer than the actuaries ever imagined.  Worse, because they’re living so long, they’re getting all kinds of medical problems that are costing Medicare and Medicaid a lot of money.  And, you guessed it, they’re going bankrupt, too.

Why Fix something Today that we can Leave for Future Generations?

Because there are so many seniors in these programs no politician wants to touch them.  They’re the ‘third rails’ of politics.  Seniors vote.  And if you cut their benefits, they’re probably not going to vote for you.  Every politician knows this well.  So, like slavery, they table the issue for a later generation to address.  But every day that passes, more seniors join the ranks of the retired and begin collecting benefits.  While fewer people enter the workforce to pay for their retirement.  Which guarantees that the cost to fix these problems will grow ever larger.

The day of reckoning will arrive.  It always does.  For the issue of slavery it was civil war.  Over in Europe as they struggle to control their out of control spending they’re having riots.  Which sometimes happens when you take away stuff from large numbers of people.  Let’s hope it doesn’t come to that here.  But one thing that we can be pretty certain about.  Fixing this problem is going to hurt someone in the wallet.  And the longer we wait, the greater that someone will hurt.

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The State of the Union Address Ignores the 800 Pound Gorilla in the Room: Old People.

Posted by PITHOCRATES - January 26th, 2011

Old People:  God Love them but they’re Killing Us

The State of the Union Address was very similar to the one last year.  And a lot of Obama’s campaign speeches.  He still wants to invest (i.e., spend).  Even though record spending to date hasn’t helped anything.  We have record debt.  And deficits.  The nation is broke.  And yet he still wants to spend.  I mean, ‘invest’.

But we can’t ‘invest’ anymore.  We don’t have the money.  We can’t borrow anymore.  Or print anymore.  Without creating problems we can’t walk away from.  We have to reduce the deficit.  For real.  Can’t just talk about it.  And we can’t keep raising taxes.  Because that would stall the economic recovery.  If there was any economic recovery to stall.  No, we can’t indulge in these fantasies anymore (see How Obama’s speech muddied the budget debate by Robert J. Samuelson posted 1/27/2011 on The Washington Post).

What we got were empty platitudes. We won’t be “buried under a mountain of debt,” Obama declared. Heck, we’re already buried. We will “win the future.” Not by deluding ourselves, we won’t. Americans think deficits are someone else’s problem that can be cured by taxing the rich (say liberals) or ending wasteful spending (conservatives). Obama indulged these fantasies.

If deficits stemmed mainly from the recession, this wouldn’t matter. They would shrink as the economy recovered; tax collections would rise and spending (on unemployment insurance, food stamps) would fall. Unfortunately, this isn’t the case. In fiscal 2010, the deficit – the gap between government spending and revenue – was $1.3 trillion. Of that, about $725 billion was a “structural” deficit, says Mark Zandi of Moody’s Analytics. That is, it would exist even if the economy were at full employment (5.75 percent by Zandi’s estimate).

Ouch.  Even Reagan’s tax cuts of the Eighties couldn’t fix this.  There’s a problem on the spending side.  A huge problem.  We have to address this problem.  If we don’t, nothing we do on the revenue side will amount to a hill of beans.

The real issue isn’t the deficit. It’s the exploding spending on the elderly – for Social Security, Medicare and Medicaid – which automatically expands the size of government. If we ended deficits with tax increases, we would simply exchange one problem (high deficits) for another (high taxes). Either would weaken the economy, and sharply higher taxes would represent an undesirable transfer to retirees from younger taxpayers.

And there it is.  Old people.  God love them but they’re killing us. 

So How do we Reduce the Deficit and Care for the Elderly?

Old people are killing us.  There’s no getting around that.  But we just can’t abandon them in their retirement.  But we have to do something with Social Security and Medicare before they bankrupt the country.

The first thing we need to do is the easiest thing.  Repeal Obamacare.  If we don’t, it’s just going to be Medicare writ large.  We haven’t suckered anyone into dependence yet.  So just end it.  Before we do.  This will eliminate a future problem.  So we can address the current ones.

Defined benefit pension plans are a thing of the past.  They’re chronically underfunded.  And mismanaged.  Just look at our biggest cities.  Those public sector pension plans are bankrupting them.  Meanwhile, most businesses have moved away from them.  Instead, they use 401(k) plans.  Or other plans where the employee is in charge.  Not the employer.  Best thing about these?  They’re portable.  You contribute.  And the money is yours.  No matter how long you work at a company.  The government needs to move in this direction.  They need to make a transition from a defined benefit pension plan (i.e., Social Security) to a personal retirement plan (i.e., a 401(k), an IRA, etc.).  The oldest people will be more in the Social Security system as we know it.  The younger people will be in a personal retirement plan.  And don’t start bitching about the risk of putting our retirement money into the stock market.  First of all, stocks are cyclical.  They usually climb after they fall.  Second, Social Security is going belly up.  Once it does, you ain’t getting anything out of it anyway.  So it’s a moot point.  At least with the stock market, we have a chance to retire.

The government has to get out of health care.  It’s a very complex thing.  And the most unqualified people shouldn’t run complex things.  Like pensions, we need to put people in charge of their health care.  We need to transition to private health insurance.  And remove the obstacles in the health insurance industry (restriction of competing across state lines, tort reform, etc.).  We have to move away from Medicare.  People need to buy their own private health insurance policies.  The oldest people in the system can get vouchers to help them.  The younger ones just need to learn NOW that they will have to take care of themselves.  The best thing about this?  Your health insurance will be portable.  You’ll never have to work again at a place you hate because of their health insurance benefit.  You can do whatever the hell you want to.  Because you will be paying for your own health insurance.  And you’ll take the same insurance with you no matter how many times you change your job.  Your days of bitching about a change in your prescription coverage will be over.  Because you will be getting exactly what you choose to buy.

Now, doing the above is going to cost.  Because there is no such thing as a Social Security trust fund.  Or Medicare insurance.  It’s all pay as you go.  Today’s taxes pay for today’s beneficiaries.  So when the young transfer out of the existing systems, there will be a huge funding shortfall for these systems.  We will have to borrow to cover this transition period.  But we will have to show that this borrowing is a temporary thing.  So that our creditors won’t fear that we’ll be dancing with default.  And how do we do that?  By making huge tax cuts. And by making sweeping rollbacks in regulation.  You make the United States so business friendly that jobs come running back to this country.  Because business owners will see that if you want to be profitable in business, you have to locate your business in the United States.  Sure, there will be some revenue shortfalls in the beginning of the transition.  But in the long run, the economic expansion will shower Washington in tax revenue.  Even at lower tax rates.  And because businesses are being so profitable, they’ll be bidding up labor rates to get the best employees.  Because they’ll have to.  You see, in a bustling economy with portable retirement and health insurance plans, no one will have to work where they don’t want to.  Everybody wins.  Employers.  Employees.  Even government.  Because they will finally escape the huge costs of Social Security and Medicare.

Getting back to the Founding Fathers

So there you have it.  A simple and doable plan.  In bullet form, the plan is:

  • Repeal Obamacare
  • Privatize Social Security
  • Privatize Medicare
  • Cut taxes and rollback regulation
  • Live happily ever after

Simple.  And the transition pains will hurt far less than bankruptcy.  Of course, there is a downside to this simple plan.  At least for Big Government liberals.  Because this plan gives us limited government.  Like the Founding Fathers wanted.  Which isn’t all that bad for liberals.  Because in this plan they’ll lose their jobs in a booming economy where there will be other jobs available for them.  Unlike being laid off when the Great Recession turns into another Great Depression.

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It Ain’t 1996 – Obama’s path to Reelection isn’t Quite the same Road Clinton Traveled

Posted by PITHOCRATES - January 24th, 2011

Obama Doesn’t have the Healthcare and Economic Edge Clinton Had

Clinton was lucky.  Hillarycare (Clinton’s attempt to ‘nationalize’ healthcare) was a disaster.  It crashed and burned.  So it was off the table come reelection time.  And he had a smoking hot economy.  He had both a real estate bubble and a dot-com bubble.  Now, strictly speaking, bubbles aren’t good things.  Because they burst.  And recessions follow the bursting.  But until they burst, you got a smoking hot economy with low unemployment numbers.  Just the kind of things that gets presidents reelected.  REDSTATE has a list of other things, but let’s focus on items 3 & 4 in their list (see Why 2012 Is Not 1996 by Dan McLaughlin posted 1/24/2011 on REDSTATE).

3: Obamacare passed; Hillarycare didn’t: As unpopular as the Clinton Administration’s health care plan was, it wasn’t a major issue in the 1996 campaign because it had failed and, with Republicans controlling both Houses of Congress, it wasn’t coming back…Not so Obamacare, which remains very much a live issue.

4: The Economy: The unemployment rate is the most obvious of numerous economic indicators showing the U.S. economy in bad shape in 2011: unemployment, as low as 4.3% when voters elected the Democrats to control Congress in November 2006, was 6.5% when Obama was elected and 8.5% when he was inaugurated, and he expended much political capital arguing that his “stimulus” package would fix this with federal spending on “shovel-ready” projects; instead it peaked at 10.6% in January 2010, and remains above 9% a year later. These are very high numbers historically; since 1960, the unemployment rate has been above 6% on election day five times, and the only time the party in power wasn’t booted was 1984, when the 7.2% rate was the lowest it had been since before President Reagan took office and had plunged more than three points in two years. By contrast, the unemployment rate in 1996 was 5.4%, down from 7.4% when Bill Clinton was elected. If Obama can’t make the argument that Presidents Reagan and Clinton made – that they were not only making major headway on unemployment but in better shape than they were when elected (in Reagan’s case, the slight drop in unemployment was accompanied by an enormous drop in interest rates and inflation and a stock market boom) – he’ll face an electorate that is much more suspicious of entrusting him with the economy for four more years.

Historically speaking, history will favor who is not Obama in 2012 on these two issues.  And they’re about the biggest issues you can have.  A recession that just keeps on keeping on.  And a massive explosion in new spending.  Which can’t possibly help anything economic.

Old People and Jobs:  One Unpleasant Tradeoff

And there you have the ultimate showdown.  Obamacare versus the economy.  More spending and even more taxes.  Or less spending, less taxes and more jobs.  On one side you have emotional tugs of the heartstring (we have to help those poor uninsured people).  The other you have reality (we can’t raise taxes or borrow anymore without ending up like Greece).   

Obama may go Clinton.  And Clinton scored some big points with Welfare reform.  Obama has a chance to reform Medicare.  It is, after all, a part of Obamacare.  Gutting Medicare.  But Medicare is not welfare.  Those old people are a powerful voting bloc.  Will anyone, especially a Democrat, throw himself onto that ‘third rail’ (see Health care and the contest of credibility by Michael Gerson posted 1/25/2011 on The Washington Post)?

With Jack Lew and Gene Sperling in charge of its economic policy, the administration’s Clintonian direction is clear. It will seek higher revenue, cuts in defense, spending caps and more aggressive health-care price controls. When measuring deficit reduction, the last is the most important. It is the combination of cost inflation, an aging population and expansive health entitlements that push America toward the fate of Greece. Unless this problem is addressed, no tax increase or cut in discretionary spending will cause federal outlays to flatten at a sustainable percentage of the economy.

Higher revenue means higher taxes.  This is why Obamacare ‘reduces’ the deficit.  It has more new taxes than new spending in it.  But it’s a poor way to reduce the deficit.  If you have a problem because you’ve spent too much on your credit cards, what’s the easiest way to fix that problem?  Increase your revenue (i.e., your salary)?  Or cut your spending?  Of the two, you have far more power over spending cuts than you do on increasing your revenue.  So the smart money always goes on spending cuts to cut any deficit.  If you’re spending too much you just stop spending so much.  Pretty simple and straight forward.

But the 800 pound gorilla in the room is spending on old people (Medicare and Social Security).  We’re spending a fortune on increasing the life of the old so they can keep on collecting social security.  You’d have to be an idiot to not see the problem with that in an ‘entitlement-based’ government.

“The fact is,” says Yuval Levin of the Ethics and Public Policy Center, “Medicare is going to crush the government, and if Republicans leave it unreformed then the debt picture is very, very ugly. They might never – literally never – show the budget reaching balance. Not in the 10-year window and not if they take their graphs out a hundred years. Obama could probably show balance just past the budget window in the middle of the next decade because of the massive Medicare cuts he proposes, even if in practice they will never actually happen.”

Incidentally, those “massive Medicare cuts” he proposed was how he got CBO to favorably score Obamacare.  Without those cuts Obamacare would never have gotten any traction because of the massive cost.  Even with the massive tax increases.

So you see the grim picture? 

The Democratic approach to Medicare cuts would give doctors and providers less and less money while expecting them to cover the same services. “In reality,” says Levin, “providers won’t just provide the same care for less money – some will stop taking Medicare patients, some will go out of business, and some will reduce the level of care or amenities. That’s what we see in every system that takes this approach to cost control: waiting lines, dirty, unsafe hospitals with horrible food and amenities.”

And this is nationalized healthcare.  Healthcare for everyone.  All at an equally horrible standard.  Unless you’re in the government, of course.  Or are affluent enough to fly somewhere where there still is quality healthcare.

Pity the Poor Democrat son of a bitch Running in 2016

Obamacare benefits don’t really kick in until after the 2012 elections.  So when rationing kicks in and the ‘death panels’ start thinning the herd, it will be after the 2012 elections.  This may help.  The quality of our healthcare (Medicare and Obamacare) won’t really really suck until later.  However, taxes, regulations and mandates (and waivers) are kicking in before the benefits.  So the economy will still be in the toilet.  There might still be some tricks in the election bag to pull off reelection.  Who knows?  But one thing for sure.  Pity the poor Democrat son of a bitch running in 2016.  Because he or she will have to answer for the unprecedented mess their predecessor gave us.  Perpetual recession.  And horrible healthcare.

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Estate Taxes and Social Security – are the Dead People or Cash Piñatas?

Posted by PITHOCRATES - December 18th, 2010

The Lord Taketh Away.  And the Lord Giveth.

I sat in some construction meetings for a small church building a new nave.  I learned a few things about churches.  And construction.  First of all, church projects have a lot of alternates in their bid proposals.  Because they always want more than their budgets can pay for.  But they’re ever hopeful.  When they pass that basket around.  To add some of those alternates.  Even ask for donations during construction.  From the contractors building their new nave.  But the biggest thing I learned was the value of dead people.

This church had grandiose plans.  A pipe organ.  A light dimming system.  A sound system.  And some really nice (and expensive) chandeliers (they install some plain-Jane lights until they could afford the more spectacular lighting).  But, alas, they did not raise enough money to include all of these things.  And to make matters worse, they ran into some unexpected costs.  They had to make cuts.  Even some of the things that they had already approved.  The owner’s representative was not a happy camper.  He had to sit in a lot of meetings to reach a consensus on what to cut from the project.  But there was never any consensus.  Then, one day, he came to the construction meeting with a big smile on his face.

Someone had died.  And he was a parishioner.  A well-to-do parishioner.  The owner’s rep got a heads up on what the dead guy had bequeathed to the church.  And it was enough to not only keep the approved alternates.  But big enough to add a few other things.  And he smiled.

Death and Taxes – A Liberal’s Favorite Things

In all fairness to the church, they did a lot of charitable work in their community.  But there are other people who smile when old people die.  And they’re not helping the community as much as stuffing their pockets and the pockets of their friends.

Social Security is a great cash piñata for the government.  That’s why they are dead set against privatizing Social Security.  You see, it’s a numbers game.  Or racket.  Working people pay into a ‘retirement fund’ while they work.  Then when they retire, they get ‘benefit payments’.  And if you die the day after retiring, the government gets a big smile on their face.  Why?  Because they get to keep your ‘retirement fund’.  And that just wouldn’t happen if you had your retirement in a 401(k).

Private retirement investments (IRA, 401(k), insurance policy, etc.) are private property.  If you die before using those benefits, they go to your spouse, kids or other next of kin.  It’s your money.  And it stays in your family.  Well, some of it, at least.

When people use other investments other than the federal government, the government has other ways of getting your money when you die.  It’s called the estate tax.  The government sees the death tax as a statement of their generosity.  Instead of a 100% tax rate upon your death like with Social Security, it’s closer to 50% (depending on the current tax code).  Like George Harrison sang in Taxman, the government is basically telling us that we should just be thankful they’re not taking it all.

The Final Solution for Efficiency’s Sake

Liberal Democrats are obsessed with death.  To them it’s convenience and efficiency.  They like euthanasia.  They talk a lot about dignity at the end of life, but it’s also a great money saver.  As some sick and dying people can take a long time to die.  And Medicare and Medicaid pay for a lot them while they’re taking their time to die.  But euthanasia can change that.  And has.  In some of the more ‘bluer’ (i.e., liberal) states.

They like abortion, too.  They talk about it empowering women.  But is also a great money saver.  When unmarried teens get pregnant and they carry their baby to term, that baby will consume a lot of government benefits.  Of course, this is a double-edge sword.  The use of abortion (and birth control) has reduced the birthrate.  At a time the size of government has been expanding.  Which means there will be fewer taxpayers down the road to pay for that expanding government.

Of course, Obamacare brings it all home for the liberal Democrat.  The government will make healthcare a model of efficiency.  By deciding who should get treatment.  And who should get a pill to help them manage their pain.  Until they die.

Scary, isn’t it?  They deny it.  And they don’t use the word ‘death panels’ in the Obamacare legislation, but there are boards.  Who make healthcare decisions.  Based on cost.  And the only way to make healthcare more efficient is to spend less.  And you spend less when more sick and old people die.  And when it comes down to it, what is an old person?  Someone who is no longer a useful taxpayer.  But, instead, is a tax consumer.

And keeping them alive is just bad business when you’re in the business of life and death.

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LESSONS LEARNED #40: “Big Government is more efficient when old people die sooner.” -Old Pithy

Posted by PITHOCRATES - November 18th, 2010

Big Government is a Ponzi Scheme

When it comes to government funding, birthrates and death rates are key.  Think of government as a great Ponzi scheme.  Ponzi schemes work when more people pay into the scam than collect from the scam.  Like in a pyramid scheme.  Those collecting benefits are the few at the top.  Those paying in are the many at the base.

An increasing birthrate means more taxpayers for each successive generation.  This keeps the base of the pyramid growing.  A steady or increasing death rate keeps the top of the pyramid smaller than the base.  A declining death rate, on the other hand, will flip the pyramid upside down.  Because the population at the top will grow larger than the population at the bottom.

Big Government tries to keep as many people as possible dependent on government.  Lots of different programs attach lots of different people to the welfare state.  But when it comes to big numbers, old people can’t be beat.  The lion’s share of government assistance goes to them via Social Security and Medicare.  And they are the most politically active.  That means they vote.  And when they vote, they vote to keep their benefits.

Of course, this is a dual-edged sword.  Yes, old people can provide a loyal voting base to sustain Big Government.  But on the other hand, the cost of their benefits is growing so large that it is undermining the very foundations of Big Government.  How?  By the double whammy of a falling birthrate and a declining death rate.  For various reasons, fewer people are being born.  And old people are living longer.  This has flipped the pyramid in the great Ponzi scheme upside down.  The growth rate of those collecting benefits is greater than the growth rate of those paying into the scheme.

An Increasing Life Expectancy is Bankrupting Social Security

FDR signed Social Security into law in 1935.  The average life expectancy in 1930 was approximately 59 years.  The retirement age in the Social Security Act of 1935?  65.  That’s right, the average American would have been dead for 6 years before qualifying for Social Security retirement benefits.  That’s a 6 year cost cushion.  But not everyone died at 59, though.  So a lot of people lived to receive those benefits.  But one thing the actuaries were sure about then, this Ponzi scheme was going to be a big winner.  For Big Government.

The average life expectancy increased to approximately 70 years in 1960.  In other words, people were living approximately 11 years longer.  That 6 year cost cushion just became a 5 year cost exposure.  That’s a swing of 11 years.  The actuaries in 1930 never saw this coming.

Social Security had its first crisis in 1975.  To save the program, they increased payroll taxes and decreased benefits.  Another crisis came in 1983.  Now they started taxing some Social Security benefits.  Even taxed federal employees (who previously didn’t pay these payroll taxes).   And they would increase the retirement age for later retirees.

By 2000, the average life expectancy increased to approximately 77 years.  That’s another 7 years.  That’s a swing of 18 years from 1930.  A huge actuarial miscalculation.  The population was getting far older then the FDR administration ever guessed.  And, to make matters worse, the birthrate was declining.

A Declining Birthrate is Bankrupting Social Security

The birthrate (per thousand of population) had been declining from 1910 (30.1) to 1920 (27.1) to 1930 (21.3).  That’s about a 10% decline from 1910 to 1920.  And a 20% decline from 1920 to 1930.    Perhaps that’s the reason for the 6-year cost cushion they gave themselves.  They saw fewer babies being born.  Which meant fewer taxpayers would be paying for later retirees.

The birthrate fell to 19.4 in 1940.  Though it was falling, it wasn’t falling as much.  Only 9% from 1930 to 1940.  Then came the baby boom generation.  The birthrate in 1950 shot up to 24.1, a 24% increase from 1940.  More babies meant more taxpayers.  This birthrate held pretty steady in 1960.  No doubt the LBJ administration felt optimistic. 

LBJ exploded federal spending.  He added Medicare and Medicaid.  Made Social Security more generous.  And why not?  Things were looking up.  Birthrate-wise.

But it was short-lived.  The birthrate went from 23.7 in 1960 to 18.4 in 1970.  That’s a 22% decline.  The birthrate was 15.9 in 1980.  That was a 14% decline from 1970.  Or a 33% decline from 1960.  Birth control and abortion were taking their toll on the U.S. birthrate.  Fewer babies meant fewer future taxpayers.  And fewer taxpayers could pay for less government, not more.  The LBJ administration was wrong to feel optimistic.

The Selfish Baby Boomers Invert the Ponzi Scheme Pyramid

The baby boom generation has really thrown a wrench in the works.  The government used their spike in the birth rate as a baseline for future government spending.  But they screwed the government in the end.  Instead of being good little taxpayers by making even more little taxpayers, they stopped having babies.  They didn’t stop having sex.  They just stopped having babies.  It was the era of free love.  And ‘free love’ had no room for babies.

And it’s these baby boomers that are working themselves up to the top of the pyramid.  But being the selfish ingrates that they are, they’ve left no one to follow behind them to keep the Ponzi scheme going.  And to make matters worse, they’ll be living longer in retirement than anyone ever guessed.

It’s a perfect storm of sorts.  A declining death rate.  An even more declining birthrate.  And a huge chunk of the population about to go on the public dole.  But it gets even worse.  The boomers will be living longer in retirement because of huge outlays in Medicare spending to keep them alive.  In other words, the government is spending a fortune to make their financial problems worse.

Amnesty, Catholics and Dead Retirees May Save Social Security

They’re trying to fix things on the taxpayer side.  The Big Government legislators are desperate to give illegal aliens amnesty and citizenship.  To them it’s simple math.  More people equal more taxpayers.  And these taxpayers will be Catholic.  Catholics don’t use birth control and abortion like Americans currently do.  Their birthrate is less likely to decline.  (Approximately 1 in 5 of young children in the United States is Hispanic already.  They project that to increase to 1 in 4 within a few decades.)

On the benefit side, they’ve already raised the retirement age to 67.  And there’s talk about raising it to 69.  If more people die before they’re eligible to collect retirement, that’s a lot of benefits the government doesn’t have to pay.  They’re also talking about cutting the Medicare budget.  The less they spend, the more may die.  And dead people don’t consume Medicare benefits.

There’s no getting around the fact that old people are a huge drain on government.  Though they worked hard to get these people dependent on government, their continued living is becoming more of a burden than a benefit.  An increasing lifespan is anathema to Big Government.  Old retirees take more than they give.  Young workers, on the other hand, give more than they take.  The government needs more young workers.  And fewer old retirees.

(Social Security + Medicare) Spending = 2 X Defense Spending

To be efficient government has to minimize costs in relation to revenue (i.e., taxes).  And there’s an 800 pound gorilla in the room.  Old people.  Nothing can impact the budget more.  Even war.  Social Security and Medicare combined make up approximately 40% of the federal budget.  Defense spending is approximately 20%.  A blind man can see the gorilla.  Government needs these old people to hurry up and die.

And now add Obamacare to the equation.  Which will cover more people than Social Security.  The costs will be astronomical.  Social Security, Medicare and Obamacare will easily eclipse 60% of the total federal budget.  That kind of spending cannot be sustained.  Greece, France and Great Britain have proven this in the 21st century.

That’s some serious cost to contain.  And how do you contain that kind of cost?  You do what the Left says the private health insurers do.  Deny coverage to sick people.  And they will.  They’ll have to.  And with the power of life and death literally in their hands (i.e., death panels), they’ll be able to.  They’ll be able to maximize the number of young workers (by treating them).  Minimize the number of old retirees (by not treating them).  As well as minimize the number of undesirables who take more than they give (by not treating them).  Or even take more serious measures with those seriously ill or impaired (euthanasia).

Don’t think it can happen?  It’s happened in other Big Government states.  In fact, the Progressives even talked about the scientific benefits of eugenics and euthanasia here in the United States in the early 20th century.  To deal with undesirables.  So, yes, it could happen here.  Because it almost once did.

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FUNDAMENTAL TRUTH #40: “Big Government is more efficient when old people die sooner.” -Old Pithy

Posted by PITHOCRATES - November 16th, 2010

Revenues Must be Greater than Costs in Both Private Business and Government

Private business must make a profit.  That means the costs of their business can NOT exceed their revenues.  There may be times when costs do exceed revenue.  Such as during a recession.  Or when another business offers the same goods or services for less.  If these periods last too long, a business must act.  Find ways to increase their revenues.  Or cut costs.

Apple continues to innovate and create new products that people want.  This keeps their revenues greater than their costs.  GM, on the other hand, has not.  Their costs have exceeded their revenues.  So they have cut back on production.  And laid off people.  But, in the end, they still needed a government bailout to survive.

Government can tax and print money.  And run perpetual deficits.  So they don’t hold themselves to the same standards as private business.  But if they tax too much or print too much money, it can push the economy into recession and/or inflation.  So they try to make their revenues (taxes) cover as much of their costs (government spending) as possible. 

A Growing Population Can Fund Social Security and Big Government

If you go back 100 years, there was no Social Security.  No Medicare.  No big federal government.  That’s the way the Founding Fathers wanted it.  They minimized the money and reach of the federal government.  Because they were students of history.  They knew governments tended to oppress their people when they had money and power.

In the first century or so of our nation, it was easier to keep the size of government small.  Our population was small.  A big federal budget would require huge per capita taxes.  But that changed as the population grew.  Soon, it was possible to have big federal budgets from modest federal taxes.

We saw the growth of Big Government beginning around the turn of the 20th century.  First it was Woodrow Wilson and the Progressives.  Then came FDR.  He gave us Social Security.  Which was basically a Ponzi Scheme.  It worked at first as all Ponzi Schemes do.  As long as more people are entering into the scheme than collecting benefits, Social Security was sound as a pound.

Population Growth Rate and Big Government Peak and Crash in the 1970s

A growing population means a growing tax base.  The more babies are born, the more future taxpayers there will be.  And when FDR gave us Social Security, it wasn’t uncommon for a family to have 10 or more children.  That’s a lot of future federal taxes they could count on.

Then came LBJ.  He saw what FDR did.  Liked it.  Then tried to outdo him.  He gave us his Great Society (to end poverty and racial injustice).  And Medicare (health care for those 65 and older).  And other stuff.  But these programs were very, very expensive.  So he raised taxes.  A lot.

Then it all crashed in the 1970s.  The increase in taxes to pay for all that government spending stalled the economy.  When they tried to stimulate it with monetary policy, they unleashed inflation.  The U.S. dollar was convertible to gold then.  Which is a bad thing when you’re printing money.  For when you depreciate your currency, you increase the value of gold as measured by your currency; it takes a lot more devalued dollars to buy the same amount of gold.

Well, foreign governments exchanged their dollars for gold.  So much so that Nixon suspended the convertibility of dollars into gold in 1971.   Without the gold restraint on printing money, they printed even more.  We had both recession and inflation.  Stagflation.   Double digit inflation, interest rates and unemployment.  This malaise made Carter a one-term president.

Birth Control and Abortion – The Death Knell of Big Government

So what happened?  Where did it go all wrong?  It goes back to the number of taxpayers.  Something happened between FDR and the 1970s.  We weren’t having as many babies.

Instead of 10 or more children in families, many families were having only 2 or 3 kids.  Widespread use of birth control and abortion drastically reduced the population growth rate of the country.  Fewer taxpayers were being born than before.  Which meant that more people would be entering retirement than there would be new taxpayers entering the work force to pay for these retirees.

This is how Ponzi Schemes fail.  When there are more people drawing benefits than paying into the scheme, the whole house of cards collapses.  And this is a big problem for government.  To support their massive spending, they need more, not fewer, people entering the work force.

How can Government Save Social Security and Medicare?  Old People Just Need to Hurry Up and Die.

Well, there’s a couple of ways to address this problem.  First there’s the revenue side.  They can increase the taxes they collect.  By raising tax rates on individuals.  Or by simply creating more individuals to tax.  Such as amnesty for illegal aliens.  But both of these options are difficult to do without hurting your chances at getting reelected.

Then there’s the cost side.  They can cut benefits.  Increase the Social Security retirement age.  But these, too, have political consequences.  Because these old coots tend to vote more than any other demographic.  Which can make them a real pain in the behind.

Of course, if they would jut die before reaching retirement age, the government doesn’t have to pay them or their survivors.  And if they’re dead, they won’t be consuming any Medicare benefits.  You see, not only are they the most vocal group at election time, but they are also the most costly when it comes to government benefits.  The government could kill two birds with one stone if these old codgers would just hurry up and die.

One Way for Big Government to Cut Health Care Costs:  Death Panels

The government doesn’t see your mother or grandmother.  They’re looking at numbers in columns.  They are having trouble increasing the numbers in one column (tax revenue).  And are having trouble keeping the numbers in the other column from growing (benefits).  Because of old people.  Who don’t work anymore.  Or pay much in income taxes.  But they consume the lion’s share of the benefits.  They’re the biggest thorn in the government’s side.  If it wasn’t for them, their programs wouldn’t forever be facing bankruptcy.  You can see why they aren’t the government’s favorite people.

So they increase the retirement age.  In hopes more will die before reaching retirement.  And those who do reach retirement age, well, they’ll have fewer years left to enjoy their benefits.  And they make cuts in the Medicare program.  Disallow some reimbursements.  Maybe prod a few seniors to an earlier death.  Why?  Because these kinds of cost savings are the only cost savings that will have any impact in a government-managed system.

Then there’s the holy grail of Big Government.  Government-managed universal health care.  Obamacare, in its latest manifestation.  And, of course, it will end up just like Social Security and Medicare.  For the same reasons Social Security and Medicare ended up the way they did.  But Obamacare will have a new twist.

Government panels will determine who gets medical treatment.  And who doesn’t.  Based on a ‘return on investment’ analysis used to manage and optimize health care costs.  Will medical treatment result in more taxpaying years for the patient?  If yes, treatment approved.  If not, treatment not approved.  If anything, the government’s death panels will be a model of efficiency.  On paper.

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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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