Conspicuous Consumption: The American Healthcare Boondoggle

We’ve often said, even before Obamacare really screwed it up, that one of the major problems in American health care is the disconnect between who receives it, and who pays for it. Since we pay for our insurance and our insurance pays for our healthcare, we are pretty much removed from the equation as to what we get for our money. The chart at the right indicates, if nothing else, that we spend an inordinate, not to say, ridiculously excessive amount on health care administration. This is an overhead cost, that essentially provides no value at all to the consumer. It happens because it is in no one’s interest (except the consumer, who isn’t in the loop) to reduce it. For instance, Daniel Flynn in The American Spectator tells us.

At St. Vincent’s Hospital in Worcester, Massachusetts, visitors immediately encounter a waterfall, trees, massive rocks, and a pathway for hospital-goers interested in a stroll all located underneath a glass atrium. The massive indoor nature preserve of sorts appears about half the size of a football field. It provides peace and tranquility in a place in need of such comforts.

Once one gets past the beauty and grandeur of it, thoughts run to the expense. Americans spend $3.5 trillion on healthcare annually. The lavish look of so many hospitals reminds that these institutions bankrolled in part by third parties — taxdollars and insurance companies — do not cut corners. The sheer majesty of so many big-city hospitals — and even, as this one shows, medium-sized city hospitals — acts as metaphor for the entire healthcare system. We waste a lot of money.

IU Health in Indianapolis boasts a monorail-like People Mover that shuttles patients, families, employees, and anybody else who cares to ride between hospitals for free. Cedars-Sinai in Los Angeles offers deluxe maternity suites featuring such perks as access to a “personal doula,” “soft colors and recessed lighting to offer a soothing environment for laboring women,” and an “in-room refrigerator stocked with complimentary chilled juices and bottled water.” Even hospitals labeled “struggling” struggle to avoid lavish spending. The New York Postreported in 2016 that Brooklyn’s SUNY Downstate Medical Center paid consultants $83,000 for such frills as “pricey rooms at the Carlyle Hotel on the Upper East Side, a booze-infused ‘team dinner’ at the Docks Oyster Bar in Midtown, and sticker-shock limo bills.”

None of that is bad stuff, intrinsically. But at what cost, and how much of it is subsidized by those who would rather spend less, still receiving excellent care but without the fripperies. I don’t know about you, but if I’m sick enough to be in the hospital, I care quite a lot about the quality of the medical staff, and yes, the janitorial staff as well. I’m not particularly interested in a half a football field of tropical rainforest at the front door. My priorities just don’t extend to that.

Nor do I really wish my hard earned dollars be spent on lavish care without cost in the maternity ward, I’m fine with providing it, assuming the users want it and are paying for it. Same goes for my money paying for stays at hotels where I can’t afford a cup of coffee, most likely. These are consulting doctors, send them to Motel 6, if they want better, let them pay for it. I don’t blame them, but why am I (and you) paying for it, on top of what are most likely very high consultancy rates.

Here’s a different model.

Dignity Health St. Rose-Dominican Neighborhood Hospitals increasingly specializes in opening micro hospitals. Rather than 1,000 beds, they may contain a dozen. Some average 11-minute wait times for care. They deliver babies, replace knees, respond to heart attacks, and treat gunshot wounds. For care requiring more specialization and expense, such as cancer treatment, they might refer patients to larger institutions.

“We only transfer 5 percent, or sometimes in other locations, 4 percent of our patients,” Laura Hennum of Dignity Health St. Rose-Dominican Neighborhood Hospitals told CNBC. “We treat or discharge the vast majority of patients we see.”

The convenience and cost of such an institution appeals. Obviously, the basic idea appealed to Apple, which launches a series of well-publicized AC Wellness clinics to serve employees. Apple, like Amazon, Berskshire Hathaway, and JP Morgan Chase, thinks that a better, cheaper way exists to provide quality healthcare.

Micro hospitals appear as a small piece of this puzzle. Americans spend an average of over $10,000 per person on healthcare annually. The $3.5 trillion we now collectively spend looks to approach $6 trillion by 2026.

That sounds like a good model to me, at least for most of us. No frills, but prices we can afford, likely. I’ve said before that we will never solve our healthcare payment problem (our healthcare system has some problems, but they are a somewhat different set, and I don’t think solvable on the local level) until once again we are paying out of pocket for at least routine care, and routine can include more than we expect. There is no structural reason why we should need insurance for anything under about ten thousand dollars, and for many people considerably higher than that. We don’t use insurance to replace our car after all except after a catastrophic accident, yeah, too often we finance it, but that is a choice we make.

What we are beginning to see are private companies such as Amazon and Apple, moving into the field. Why? because it is a field rife with useless overhead, which might be fairly easy to cut, leaving a better financial experience for the customer (I mean us, not our insurance company) while being a pretty profitable venture, given some real management. It can go too far the other way, of course, cutting not only into the meat but the bone, but if we don’t do something health care is going to eat the economy.

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The Swamp and Machete Report.

Senator Steve King had a few things to say about a couple;e of his colleagues, who scuttled the ‘Skinny’ Obamacare repeal the other day,, after promises going back to the corrupt passage of the monstrosity.

He’s right in all details, of course.


There was a knife attack in Hamburg the other day, which killed one and wounded several. The perpetrator shouted Allu Akbar, or Aloha Snackbar, or something. The police are puzzled by what the motive may have been. I’m puzzled that the Germans keep electing such cretins as Mutti Merkel, but I’m a simple man who believes in right and wrong, and self-defense, as a person, and a society.


Joe Klein writing at Warsclerotic has some very appropriate thoughts about the war going on between the deep state (in the State Department) and the President.

The State Department’s own “deep state” is trying to sabotage President Trump’s foreign policy agenda. From the Israeli-Palestinian conflict to Iran, Qatar and climate change, the State Department, under Secretary of State Rex Tillerson, is reported to be in “open war” with the White House. Key high level positions remain vacant as Obama holdovers “continue running the show and formulating policy, where they have increasingly clashed with the White House’s own agenda,” according to the Free Beacon. Secretary Tillerson has reportedly run interference to protect the Obama holdovers from being removed, allowing resistance to President Trump’s foreign policy agenda to flourish within the State Department.

The first casualty of this internal coup by the State Department’s deep state is Israel. The shadow of the Obama administration’s anti-Israel bias was reflected in a report the State Department released on July 17, 2017 entitled Country Reports on Terrorism 2016. It praised Palestinian Authority President Mahmoud Abbas for reiterating “his commitment to nonviolence, recognition of the State of Israel, and pursuit of an independent Palestinian state through peaceful means.” The report referred to what it called “significant steps during President Abbas’ tenure (2005 to date) to ensure that official institutions in the West Bank under its control do not create or disseminate content that incites violence.”

The State Department report brushed aside clear evidence of a continuing barrage of incendiary rhetoric appearing on official Palestinian Authority and Fatah social media outlets and of inflammatory statements by Palestinian officials, including Abbas himself. Instead, it claimed that the Palestinian Authority “has made progress in reducing official rhetoric that could be considered incitement to violence.”

The State Department report conveniently skipped over the fact that Abbas remains committed to paying regular salaries to Palestinian terrorists imprisoned for killing Jews and to terrorists’ families. Their perfidiously named “Martyrs Fund” has a treasure chest of about $300 million dollars. That blood money comes in part from foreign aid to the Palestinian Authority, some of which is contributed by American taxpayers. President Trump has spoken out against the ‘pay to slay Jews’ terrorist payments, but the State Department has turned a blind eye. Obama holdover Stuart Jones, the Acting Assistant Secretary of State for Near East Affairs, is reported to have steered Secretary Tillerson into making the erroneous claim that the Palestinian Authority had ceased spending U.S. taxpayer funds to pay terrorists, according to the Free Beacon’s sources.

Yep, and a good part of this also goes back to the failed GOP leadership in the Senate. That is a large part of why all those Obama appointees are still scattered around the government (and there are tons of them). The Senate under McConnel just can’t find enough votes as the majority party to confirm (with 51 votes out of 100, or 101 is Pence is in the chair). Or maybe they don’t want to, they seem to be more considerate to the Democrats that to the Republican rank and file that elected them. I suspect that Draining the Swamp™ will proceed much better after more than a few GOP Senators get primaried.

 

Week in Pictures, Single Payer Edition

A sad start to the week for pictures this week, Charlie Gard died yesterday, a week short of his first birthday.

Farewell Charlie, and Rest in Peace.

He will be long remembered, and both he and his valiant parents remembered in many prayers.

On the other hand, the feckless GOP in the Senate seems to want an American equivalent. Or perhaps they are simply greedy enough to forget who they work for

Apparently, Hillary wrote a book, not that anyone really cares.

In other news…

Look closely, I swear she has a gun! 🙂

As usual, mostly from PowerLine

Have a better week!

Charlie Gard, Green Cards, Right to Life, and Ownership

Sometimes a story just reaches out and grabs you, and won’t let go. For me, Charlie Gard is that story. I’m convinced that eventually, the NHS will kill him, it’s not like it will be novel for them or anything. But in the meantime, I, like so many others, including the US Congress, the President of the United States, The US Right to Life movement, The British Right to Life movement, most Christians, and the Pope, one does what one can.

The biggest problem, I suspect is that the NHS when it made it the cold conclusion that this child must die, assumed that his parents were simply sheeple that would do what they were told to do. Well, they’re not, they are thinking, feeling people, who love their son, and are willing to fight all comers for what they think is right for him. They may be wrong in their assessment. They assuredly are not wrong in their determination. I and many others honor them for it.

In any case, this happened.

Does it matter that Charlie and his parents are now legal residents of the United States? Probably not really. That’s what this is, it is the coveted American Green Card, awarded by special act of the US Congress, carrying with it all the rights guaranteed an American, including the Right to Life, Liberty, and the pursuit of Happiness. It’s the right thing to do, but probably non-effectual. There is only one more thing Congress could do, declare Charlie an honorary citizen of the United States. In this context, it has been done only once, to attempt to prevent the Soviets from killing Raoul Wallenberg. He was so designated because of his work in saving tens of thousands of Jews from the Nazis in Budapest as the Swedish Special Envoy. Apparently, he was killed at the Lubyanka in 1947.

What we have here is simply a pissing match, the NHS, and the British and European courts vs the decent people of the world. The NHS will likely win the match, but they have done themselves much damage, in their cold, unblinking desire to kill this baby, no matter what anybody thinks.

For a good many American readers, I suspect they have also killed Obamacare for good, if the Congress can’t get its thumb out, then Congress will change. I think we’ve had enough, and enough of us remember Sarah Palin’s remarks on ‘Death Panels’ to recognize one when we see one. And we don’t like what we see.

The American doctor has examined Charlie, and thinks improvement may be possible, and so argued, for five hours in concert with the doctor from the Vatican’s Childrens’ Hospital. The NHS was reportedly unmoved.

Ted Noel, MD writing at American Thinker has done the best job of explaining the difference between the systems in play here.

[…]And because these medical circumstances were not rare, I helped write my hospital’s policy on Futility of Care.  But Charlie Gard’s case is different from the ones I was involved with.

When Charlie Gard entered Great Ormond Street Hospital in London, England’s single-payer health system, the National Health Service, took over.  At first, it seemed that this was a good thing, since his parents didn’t have to pay extra for his care.  But they didn’t have a choice.  They weren’t in the small minority who are either wealthy enough or favorably employed to access private insurance.  So Charlie was swallowed by the Blob.

Thus far, there didn’t seem to be any difference between single-payer and private insurance.  Both start with the same level of medical care. But shortly, the differences became manifest.  When Charlie’s rare diagnosis became clear (only 16 known cases), the NHS refused to allow any sort of alternative approach.  Charlie had struck the iceberg, and the Carpathia was nowhere to be seen.

After first contact with a doctor who might be able to help, Charlie’s parents set up a crowdfunding page and raised £1.3 million (about $1.7 million).  That’s enough for any conceivable therapy.  They had become financially able to relieve the NHS of any need to care for Charlie.  All the NHS had to do was say, “Yes.”  Instead, the NHS asserted its ownership of Charlie, and multiple courts agreed.  The hospital got court orders to discontinue life support.

What would have happened in the U.S.?  When there is no reasonable probability of returning a critically ill patient to meaningful life, the situation is to be presented to the patient’s health care surrogate.  This “Legally Authorized Person” is encouraged to recognize that further care is futile and should not be undertaken.  With the LAP’s consent, it would become possible to withdraw futile care.

It is critically important to note that the LAP (typically close family) has the authority to tell the medical staff to continue care or not.  It is not up to the doctors or the hospital.  It does not matter that continuing futile care burns out staff and consumes resources.  The family is the final authority, because the family members are the ones who own all rights in this situation.  It would be unethical to proceed without their consent, because they are protecting the patient’s natural human rights, even if they conflict with the medical prognosis.

I know that speaking in terms of “ownership” sounds strange coming from a doctor.  But this is the key fact, based in natural law.  Charlie Gard’s parents “own” him.  They begot him.  They cared for him.  And when he became ill, they cared even more for him by seeking expert assistance.  They are primarily responsible for Charlie.  But single-payer NHS changes everything.

When Charlie Gard came through that Emergency Department door, the NHS took ownership of him.  It’s a classic case of the Golden Rule: “He who has the gold makes the rules.”  (Apologies to Saint Matthew.)  In essence, the NHS said that since it is paying the freight, Charlie is now the property of the State.  His parents were involuntarily dispossessed of their son.  The NHS stole him by force of law.  Parental rights inherent in natural law were “stripped away by strangers.”

That’s all of it that I can give you (and probably more than I should, sorry Dr. Noel) but this is important stuff, so read the entire article.

You know, a long time ago, a dead white guy, a Greek, wrote an oath that supposedly doctors still abide by. His name was Hippocrates. In it, he stated that above all,

“First, do no harm”

What is a Good Judge?

Poise the cause in justice’s equal scales,
Whose beam stands sure, whose rightful cause prevails.
William Shakespeare

The other day, the AP wrote this:

Many conservation groups say U.S. Supreme Court nominee Neil Gorsuch is too conservative and too much like the man he would replace, the late Justice Antonin Scalia, to be considered a friend of the environment.

But when it comes to Gorsuch’s judicial record on issues like pollution and environmental regulation, he can’t be painted as someone who always finds in favor of businesses, according to an Associated Press review of his rulings.

Funny thing, maybe the AP doesn’t understand is that judges represent neither the environment, business, employees, the people, or even the government. Their mission is to represent the law, and justice, and to ensure its fair and equitable dispensation upon all parties, notwithstanding any other factors.

As a judge for the Denver-based 10th U.S. Circuit Court of Appeals, Gorsuch has ruled both for and against causes that environmentalists hold dear.

He voted in 2015 to uphold a Colorado law that requires 20 percent of electricity sold to consumers in the state come from renewable sources.
***
But Gorsuch has also ruled against the EPA, as in a 2010 case in which the court found that the agency was wrong to classify land in New Mexico as Indian country when a company sought to obtain a mining permit.

I like the way John Hinderaker puts it here…

There is no “but” about it. A competent judge will rule for or against a party based on the law and the facts, not the identity of the parties. Only a corrupt judge–we have several such liberals on the current Supreme Court–will ascertain a political narrative and vote to advance it.

Indeed we do!

Then the AP offers very high praise to Judge Gorsuch, although I doubt that they understand that they do.

“He follows the law,” said Merrill Davidoff, the landowners’ attorney. “And in this case the law favored the plaintiffs — the landowners — not the government or the government contractors.”

If only all our judges did!

And that brings us to something that John and I have both written much about: administrative law. John says this

There is one major contemporary issue on which judicial philosophy bears strongly. That is the legitimacy of the administrative state. As I have said repeatedly, the government we live under does not resemble the one that is described in the Constitution. Today, we are governed mostly by a fourth branch, nowhere mentioned in the Constitution, the permanent federal bureaucracy. These office-holders persist from one administration to another, and in many cases resist any effort to bring them into line with a new administration’s policies. They are unelected, unaccountable, frequently incompetent, and almost always Democrats.

If I were president, the only question I would ask a prospective Supreme Court nominee is whether he or she will be willing to take a hard look at whether the administrative state comports with the Constitution. The AP eventually gets to this central issue:

A ruling that most worries some environmental groups came in a case that had nothing to do with the environment. In a much-noted immigration case, Gorsuch was critical of the longstanding Chevron doctrine, which gives deference to federal agencies’ interpretations of ambiguous statutes. Conservationists say that could be trouble for agencies like the EPA, which have the task of interpreting and implementing rules.

“If you look back at the Supreme Court’s rulings involving Chevron, most of those are environmental cases,” said Billy Corriher, deputy director of legal progress at The Center for American Progress, a nonprofit liberal advocacy group. “And I think that’s because the EPA really enforces a lot of statutes that are pretty broad, it gives them broad authority to regulate certain pollution and it leaves it up to the experts to determine exactly what threshold of pollution is acceptable and what threshold is dangerous. Judge Gorsuch would want to get rid of that standard and basically allow judges to substitute their own judgment for the judgment of the agency experts.”

That’s about as twisted as a corkscrew. The problem with administrative law (and Chevron gives overmuch weight to the agencies) is that legislation is not to be made by the agencies, they are there to execute the law the Congress has passed. That the Congress has abrogated their responsibilities under the law is no excuse. As John says.

The Constitution is not about rule by experts (even real ones, as opposed to bureaucrats) but rule by the sovereign people. Hopefully, Judge Gorsuch understands that.

via A Pro-Environment Judge Is a Bad Judge | Power Line

Swampcare v Obamacare

Well, Ryan’s healthcare plan is out. What is no surprise is that it is a statist, big government plan, not as bad as Obama’s but pretty bad all on its own.

Dan Mitchel wrote back in 2010

The only way to fix healthcare is to restore the free market. That means going back to a system where people pay out-of-pocket for most healthcare and use insurance to protect against genuine risk and catastrophic expenses. The time has come to reduce the size and scope of government. …Change Medicare into a system based on personal health accounts and shift all means-tested spending to the states. …the flat tax is ideal from a healthcare perspective since it gets rid of the healthcare exclusion in the tax code as part of a shift to a tax system with low rates and no double taxation.

This video, narrated by Julie Borowski for the Center for Freedom and Prosperity, looks at the Obamacare/third-party payer issue.

via Our Healthcare Policy Problem Is Much Bigger than Obamacare

Yep, and for that matter, back in 2013, I wrote this,

Understand this, 404Care isn’t healthcare, it’s a chance to buy insurance, executed properly, in some alternate universe it might even have been useful. But here, where the sky is blue, it’s not. Why? Because with the limited number of plans available and the narrowness of providers, you’re screwed. You’re screwed, even if your identity doesn’t get stolen, which is likely as well.

Why? Because healthcare is properly defined as having a doctor and/or hospital take care of you when you are sick or injured. Depending on your choices, insurance is a valid way of paying for that (which is required, since Obamacare, before that doctors and hospitals were required to provide minimal, lifesaving care, free, if necessary.) 80 years ago, chickens and/or eggs worked, cash nearly always works, nearly anywhere. The way this is written, since I’m from Nebraska, if I go see Mt. Rushmore, and get food poisoning (because I’m too stupid to refrigerate my potato salad, say) I’d better be tough, cause I ain’t going to see a doctor in South Dakota, unless I have cash, of course.

What all the noise then and now is about is how to pay for it. Medical care in this country is very expensive. Mostly that is so because of bureaucracy, of the government, of the insurance companies, and of the healthcare industry (although to be fair, much of the industry’s bureaucracy is driven by the other two).

In 2010, John Goodman wrote,

Almost everyone believes there is an enormous amount of waste and inefficiency in health care. But why is that? In a normal market, wherever there is waste, entrepreneurs are likely to be in hot pursuit – figuring out ways to profit from its elimination by cost-reducing, quality-enhancing innovations. Why isn’t this happening in health care?

As it turns out, there is a lot of innovation here. But all too often, it’s the wrong kind.

There has been an enormous amount of innovation in the medical marketplace regarding the organization and financing of care. And wherever health insurers are paying the bills (almost 90 percent of the market) it has been of two forms: (1) helping the supply side of the market maximize against third-party reimbursement formulas, or (2) helping the third-party payers minimize what they pay out. Of course, these developments have only a tangential relationship to the quality of care patients receive or its efficient delivery.

The tiny sliver of the market (less than 10 percent) where patients pay out of pocket has also been teeming with entrepreneurial activity.  In this area, however, the entrepreneurs have been lowering cost and raising quality – what most of us wish would happen everywhere else. For example:

  • There are more than 1,000 walk-in clinics spread across the country today – posting transparent prices and delivering high-quality, low-cost services;
  • Whole businesses have been created to provide people with telephone and e-mail consultations because third-party payers wouldn’t pay for them;
  • Mail-order pharmaceuticals are a huge and growing market – one which emerged to offer price competition to consumers who buy their drugs out-of-pocket;
  • Wal-Mart didn’t introduce the $4-a-month package price for generic drugs in order to do a favor for Blue Cross. It is catering to customers who pay their own way;
  • Concierge doctors are also providing patients with innovative services – services that health insurers don’t cover.

Nothing has changed. Except that the GOP has taken ownership of Obamacare, well it might accidently be a little better, but not much. David Harsanyi says this.

First of all, the preferred free-market plan for health care policy should be no plan whatsoever. The idea that we need a federal, top-down strategy to manage a huge chunk of the economy is at the very heart of the problem. We don’t need a federal “plan” for health care any more than we need a federal plan for food or clothing. Yet, Republicans have allowed liberals to frame the entire health insurance debate in these anti-market terms.

So the American Health Care Act is obviously weak tea, falling far short of a promised free-market solution, much less a full “repeal” of Obamacare. It’s a half-measure that endeavors to fix Obamacare with small doses of deregulation while failing to repeal its core. It’s almost as if Republicans were trying to mollify their constituents and save Obamacare at the same time.

Donald Trump tweeted out something about a three-phase rollout, but the specifics of the other two parts have yet to be confirmed as of this writing. Perhaps the full proposal will reflect better on Republicans, although considering the noise moderate senators have been making and Trump’s own views on entitlement programs, it’s unlikely to meet conservative expectations. So what can be done?

In a piece highly critical of the planThe Washington Examiner’s Philip Klein, who’s done some of the most insightful writing on Obamacare, states: “the GOP will either be passing legislation that rests on the same philosophical premise as Obamacare, or will pass nothing at all, and thus keep Obamacare itself in place.” What if this is the choice?

We know the Democratic Party’s plan for health care: constrain markets to create monopolies that can be controlled by a federal regulatory regime (this is why liberals oppose markets expanding across state lines); and rather than worrying about access, choice, or cost, continue to incentivize the growth of the welfare state. When this situation becomes untenable, pass single-payer. What Democrats understand, but Republicans often don’t, is that you can reach your goals incrementally.

He asks this: “is something better than nothing?”

Perhaps, at the margins, but the basic problem is that the government has been driving healthcare fiscal policy since World War II, and the market distortions are continually getting worse. Swampcare isn’t going to help much, if at all

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