I’ll tell the story in moment but first consider that none of the politically active reform proposals being debated deal with the absence of market pricing for medical care, that system-wide problem that there is a disconnect between the supplier and the consumer, and this problem is absolutely pervasive. You rarely know the prices of what you are getting, and even when you do, the prices are an abstraction: something to know but not act on, since they don’t really affect your premiums as with other forms of insurance.
The result is hardly surprising. End-user costs soar higher and higher and resource use lacks that essential component of economizing by priority. The American system just assumes that there is no such thing as too much technology, too many drugs, too much service, too much care. The consumer, in the end, isn’t really a consumer but a passive conduit of an unchecked contractual relationship between producer and third-party payers who are heavily subsidized by taxpayers.
* “In many cases, rent control appears to be the most efficient technique presently known to destroy a city except for bombing.”
* “Rent control has in certain western countries constituted, maybe, the worst example of poor planning by governments lacking courage and vision.”
* “That great sacred cow — Rent Control — is a textbook case of Economic stupidity.”
It is no surprise that free market economists would oppose rent control, root and branch. It is, however, a bit “man bites doggish” that even economists with sterling left wing credentials would oppose it too, and about as bitterly. The sources of those three quotes? Assar Lindberg, from “The Political Economy of the New Left”; liberal Swedish economist Gunnar Myrdal; and the New York Times’ own Paul Krugman…
If you’re just moving to New York City, big dreams and ideas in your head, living in Manhattan will cost you, on average, $2,253 a month for a studio and $3,026 for a one bedroom. Pricey. If you’re in the middle class, you’re probably railing against the rich Wall Streeters and greedy landlords who are keeping you from making it in Gotham.
Except the average rent for the city in 2008 was only $950 a month.
How is this possible? Because 48% of rental housing is stabilized, meaning increases are regulated, and another 2% are rent-controlled, meaning increases are almost non-existent. Another 14% of units are public housing and other projects.
That leaves only 36% of apartments on the open market, in a city as attractive and competitive as this one. Rent control may keep the average artificially low, but it also makes the rents on the small number of available units artificially high….
Some people fear market rents on the ground that only the rich will end up living in Manhattan. Unlikely; though rents would go up for those with rent-stabilized apartments, an increase in the vacancy rate (now at an engineered 3% or less) would cause other rents to fall. That would provide an opening for those who usually can’t get by in New York — the middle class.
Anyone who has lived in New York has felt the impact of rent control, for better or worse.
The real way to resist DC is not by begging politicians and judges in Washington to allow us to exercise our rights…it’s to exercise our rights whether they want to give us “permission” to or not.
Nullification – state-level resistance to unconstitutional federal laws – is the way forward.
When a state ‘nullifies’ a federal law, it is proclaiming that the law in question is void and inoperative, or ‘non-effective,’ within the boundaries of that state; or, in other words, not a law as far as that state is concerned.
It’s peaceful, effective, and has a long history in the American tradition
By placing the legal obligation to provide healthcare on governments, the ideologically driven expansion of the right to health risks undermining the rule of law, stifling political pluralism, reducing individual and economic freedom and options for effective policymaking. Research shows that the widespread official promulgation of the right to the highest attainable health has not made any difference to health outcomes anywhere in the world. In some cases it has worsened inequalities and imposed an intolerable burden on local judicial systems. It is also worth noting that countries that have high quality health provision tend to be market economies with a high level of economic freedom.
The right to health is highly problematic when construed as an enforceable right, with the state legally bound to enforce it in a particular and ideologically skewed manner. It would be better interpreted as a human aspiration whose implementation should be left to the democratic process and be decided upon the basis of the political convictions of the electorate. Elected politicians would then be free to implement (or reject) whichever kind of health system is deemed most appropriate by the electorate, without being at risk of breaching human rights – be it predominantly private or state managed.
Health as a Human Right
If the development community is serious about human rights and improving health, they would switch their focus away from the “right” to health and toward the fundamental rights to personal and economic freedom currently denied to hundreds of millions of people in poorer parts of the world: the right to free speech andthe right to own and exchange property
An interesting, philosophical and in depth critique of healthcare as a “right.” It’s on the long side (16 pages) but well worth the read.
The challenge of identifying and absorbing relevant medical literature will not abate anytime soon and the proliferation of services that purport to simplify or eliminate this problem for physicians is itself now becoming a distraction. The rapid adoption of web-enabled smart phones by physicians, such as the iPhone, is driving this dilemma from the theoretical realm directly to the bedside. The hope is that if relevant medical literature is immediately available at the point of care, physicians would be more inclined to use it.
At the same time, the mantra of practicing medicine that is evidence-based is ringing ever louder. Thus far, it seems to this reviewer that most physicians apply it most strenuously when criticizing other physicians’ decisions rather than applying it to their own practice. Nevertheless, large well-respected compilations like the Cochrane Abstracts are available and widely used. They offer well constructed summaries of evidence-based diagnostic and treatment guidelines for thousands of pathologies. It is into this nexus that the “Evidence Central” app enters.
Consider the recent revelation that the Obama administration has been making very large, undisclosed payments to MIT Professor Jonathan Gruber to provide consultation on the President’s health care plan. With this lucrative arrangement in place, Gruber spent the entire year offering public justifications for Obama’s health care plan, typically without disclosing these payments, and far worse, was repeatedly held out by the White House — falsely — as an “independent” or “objective” authority. Obama allies in the media constantly cited Gruber’s analysis to support their defenses of the President’s plan, and the White House, in turn, then cited those media reports as proof that their plan would succeed. This created an infinite “feedback loop” in favor of Obama’s health care plan which — unbeknownst to the public — was all being generated by someone who was receiving hundreds of thousands of dollars in secret from the administration (read this to see exactly how it worked)…
So Sunstein isn’t calling right now for proposals (1) and (2) — having Government ”ban conspiracy theorizing” or “impose some kind of tax on those who” do it — but he says “each will have a place under imaginable conditions.” I’d love to know the “conditions” under which the government-enforced banning of conspiracy theories or the imposition of taxes on those who advocate them will “have a place.” That would require, at a bare minumum, a repeal of the First Amendment. Anyone who believes this should, for that reason alone, be barred from any meaningful government position.
Glenn Greenwald.read the whole article. very interesting.
The Lord spoke to Noah and said, “In six months I am going to make it rain until the whole world is covered with water and all the evil things are destroyed. But I want to save a few good people and two of every living thing on the planet. I am ordering you to build an ark.” And, in a flash of lightning, he delivered the specifications for the ark. “OK,” Noah said, trembling with fear and fumbling with the blueprints, “I’m your man.”
Six months passed, the sky began to cloud up, and the rain began to fall in torrents. The Lord looked down and saw Noah sitting in his yard, weeping, and there was no ark.
“Noah!” shouted the Lord, “Where is My ark?” A lightning bolt crashed into the ground right beside Noah.
“Lord, please forgive me!” begged Noah. “I did my best, but there were some big problems. First, I had to get a building permit for the ark’s construction, but Your plans did not meet their code. So, I had to hire an engineer to redo the plans, only to get into a long argument with him about whether to include a sprinkler system.
“My neighbors objected, claiming that I was violating zoning ordinances by building the ark in my front yard, so I had to get a variance from the city planning board.
“Then, I had a big problem getting enough wood for the ark, because there was a ban on cutting trees to save the spotted owl. I tried to convince the environmentalists and the U.S. Fish and Wildlife Service that I needed the wood to save the owls, but they wouldn’t let me catch them, so no owls.
“Next, I started gathering up the animals but got sued by an animal rights group that objected to me taking along only two of each kind.
“Just when the suit got dismissed, the EPA notified me that I couldn’t complete the ark without filling out an environmental impact statement on Your proposed flood. They didn’t take kindly to the idea that they had no jurisdiction over the Supreme Being. Then, the Corps of Engineers wanted a map of the proposed flood plan. I sent them a globe!
“Right now, I’m still trying to resolve a complaint with the Equal Opportunities Commission over how many minorities I’m supposed to hire. The IRS has seized all my assets claiming that I am trying to leave the country, and I just got a notice from the state that I owe some kind of use tax. Really, I don’t think I can finish the ark in less than five years.”
With that, the sky cleared, the sun began to shine, and a rainbow arched across the sky. Noah looked up and smiled. “You mean you are not going to destroy the world?” he asked hopefully.
“No,” said the Lord. “The government already has.”
White House budget director Peter Orszag has claimed that the bill’s 40% excise tax on high-cost insurance plans is key to reducing health costs. Yet the Senate Majority Leader’s new version specifically exempts “individuals whose primary work is longshore work.” That would be the longshoremen’s union, which has negotiated very costly insurance benefits. The well-connected dock workers join other union interests such as miners, electrical linemen, EMTs, construction workers, some farmers, fishermen, foresters, early retirees and others who are absolved from this tax.
In other words, controlling insurance costs is enormously important, unless your very costly insurance is provided by an important Democratic constituency.
The Reid bill also gives a pass on the excise tax to the 17 states with the highest health costs. This provision applied to only 10 states in a prior version, but other Senators made a fuss. So controlling health costs is enormously important, except in the places where health costs need the most control.
So should I become a longshoresman or join the Amish? hmmmm…
Federal health care reform will require most Northern New Yorkers — but not all, it turns out — to carry health insurance or risk a fine.
Hundreds of Amish families in the region are likely to be free from that requirement…
A professor and lawyer at Yeshiva University in New York complained last summer that exempting groups for religious reasons could run afoul of the Constitution. Marci A. Hamilton, who teaches at the University’s Benjamin N. Cardozo School of Law, wrote at Findlaw.com in August, “If the government can tolerate a religious exemption, then it must do so evenhandedly among religious believers with the same beliefs. This is sheer favoritism for a certain class of religions, or even for one religion.”
So it looks like the Amish can opt out of the new national health mandates. This brings up all kinds of interesting questions….
Looks like a real live Constitutional fight is brewing.
Here’s a helpful tip. Next time you have surgery, ask the surgeon one simple question:
Will you use checklists as part of the procedure?
There are 40,000 commercial flights in America every day. And planes rarely, rarely crash. 100,000 people die in America every year due to medical errors. That’s the equivalent of a jumbojet with 273 people inside crashing every day. Minimize your risk when you enter our nation’s healthcare system. Print this checklist out and bring it to your doctor. Then ask the question. If they don’t use checklists, demand that they do in your case or find an institution that does.
For more information, see this article by Atul Gawande:
Pronovost recruited some more colleagues, and they made some more checklists. One aimed to insure that nurses observe patients for pain at least once every four hours and provide timely pain medication. This reduced the likelihood of a patient’s experiencing untreated pain from forty-one per cent to three per cent. They tested a checklist for patients on mechanical ventilation, making sure that, for instance, the head of each patient’s bed was propped up at least thirty degrees so that oral secretions couldn’t go into the windpipe, and antacid medication was given to prevent stomach ulcers. The proportion of patients who didn’t receive the recommended care dropped from seventy per cent to four per cent; the occurrence of pneumonias fell by a quarter; and twenty-one fewer patients died than in the previous year. The researchers found that simply having the doctors and nurses in the I.C.U. make their own checklists for what they thought should be done each day improved the consistency of care to the point that, within a few weeks, the average length of patient stay in intensive care dropped by half.
The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. (When you’re worrying about what treatment to give a woman who won’t stop seizing, it’s hard to remember to make sure that the head of her bed is in the right position.) A second effect was to make explicit the minimum, expected steps in complex processes. Pronovost was surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions. In a survey of I.C.U. staff taken before introducing the ventilator checklists, he found that half hadn’t realized that there was evidence strongly supporting giving ventilated patients antacid medication. Checklists established a higher standard of baseline performance.
At Newark Liberty Airport last Sunday, a TSA agent left his post, and a young man walked past it to kiss his girlfriend good-bye. Then the young man turned and left the secured area and left the airport. So far no harm, no foul. But because the government’s surveillance cameras in the airport didn’t work, the feds panicked and ordered over 10,000 passengers to leave the terminal, go out into the 15-degree Newark, NJ cold at night, and then re-enter the airport. Flights were delayed and missed, kids did not get to school on Monday morning, and soldiers were listed as AWOL. All because the government overreacted to a kiss. This humiliated the feds: New Jersey’s 86-year-old senior Senator Frank Lautenberg demanded that the guy who kissed his gal be hunted down and prosecuted because of the chaos he caused. He caused? Let’s see; the government has cameras that watch us every time we scratch our noses, and when those cameras don’t work, the government blames the person whose picture it was supposed to be taking? Come on…
Can the government keep us safe? I don’t think so. Airline travel is safer today because pilots have guns, cockpit doors are like bank vaults, and the passengers have become courageous. All this was done by individuals in the private sector, not by the government. I’ve said it before and I’ll say it again, if the feds had not stripped us of our natural rights to keep ourselves safe – by keeping and bearing arms – 9/11 would never have happened. How about letting the airlines decide who gets on the planes, rather than a TSA worker who leaves his post? When industry competes for your business, you fly where you want to go, you get there in comfort and safety, and you do all this at a competitive cost. When the government runs the show, you stand in the cold night air for six hours because of a kiss. The government can’t deliver the mail, it can’t operate surveillance cameras at an airport; it can’t pay back its debts; it can’t tell the truth. That would be the same government that wants to manage your healthcare.
