American Elephants


Pay Attention to The Bitter Truths About NHS — And Our Future? by The Elephant's Child

I refer frequently to Britain’s National Health Service, which is the oldest of the “single payer” health care plans, initiated right after World War II, when Labour returned to power. When Obama’s health care advisers began talking about health care, they all expressed their admiration for NHS. In devising a health care plan, they talked a lot about how the big costs all came from old people in their final years. And they talked about things like life years and useful life, and did a lot of comparing a vigorous young person with many life years ahead — contrasting it with useless old people.

Well, I had this strange idea that that’s what the practice of medicine was all about, caring for people and their health problems throughout their lives, from every kid’s broken arm to the failing health of someone who has lived a long and valuable life. The Inuit supposedly left their old people to die out on the ice when they were no longer useful, and there have been tribes who eat their enemies as well. Are we still struggling to find an ethical way to deal with life?

Britain still has private health care for those who can afford it. The NHS provides care that is free at the point of service, and just what every liberal wants as their most cherished goal. But it doesn’t work. The incentive for the people immediately becomes to use as much as they want because it has no (visible) cost. This inevitably drives costs up sharply. The incentive for the government immediately becomes to control costs. The government who hires, fires and pays for the medical establishment, cannot do much about the people whom they urged to use all the medical care they want, but they can put a lot of pressure on the medical establishment to cut costs.

Escalating problems and the inevitable results should be obvious to the dimmest intelligence, but  politics and ideology get in the way. Not everyone believes in incentives, in spite of  overwhelming evidence that they are what moves events.

Can’t have people piling up waiting to get into the emergency room, ordered to fix that, hospitals took to holding people in ambulances so admissions would be spread out more equally. Cut costs more, and pretty soon hospitals were saving money by keeping the same sheets on the bed. When all the incentives become to cut costs, the old folks don’t get clean sheets or fresh water, and start dying of dehydration and starvation in the hospital.

ObamaCare incentives are just the same. We are just taking our first stumbling steps down the same long road to perdition. Nobody has even experienced actual ObamaCare yet. So far it’s all just the incredible fiasco of the rollout. The exposure of Obama’s lies about the law is just the surface. Everybody’s insurance is getting cancelled, if not this year — just wait until next year. Premiums are drastically higher, deductibles reach levels that almost make insurance useless. People don’t know if they are actually enrolled. They don’t know if their doctor will still be available to them, or who will be in their physician network. They don’t know if the drugs they need will be in the formulary. All is uncertainty. Much of the details of enrollment and payment have not yet been written.

A panicky HHS is just making up new ObamaCare ‘laws’ on the spot. They’re extending deadlines for making payment for coverage, requiring insurers to accept premium payments, changing due dates, ‘strongly encouraging”  insurance companies, HHS won’t release real numbers, and those numbers include those who haven’t paid anyway. Glenn Reynolds asks: “Where, exactly, do they get the authority for all these exemptions, waivers, and extensions?” Good question.

Please read this article from yesterday’s Telegraph, and do read the whole thing. This is the state to which the NHS has fallen, and it is our future if we don’t fight to stop it. See the related articles listed in the column. They are not just talking about dirty sheets, they are talking about lives lost unnecessarily.  Unnecessarily!



Rollout: Fail. Access to Care: Fail. Higher Premiums, Huge Deductible: Of Course. by The Elephant's Child

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Remember this photo? Obama had called all the physicians together from their busy rounds to help him make a push for the wonders of ObamaCare, and rushing right to the Rose Garden from the hospital, they naturally didn’t take time to change, but all wore their white coats so you could be sure that they were doctors and not just a bunch of White House aides dressed up in white coats…….oh!

Well they may not get the policy right, and the regulations will be all screwed up,  and the roll-out will be a fiasco, but they will get the theatrics right. You can fool some of the people some of the time…

Zeke Emanuel and Scott Gottleib wrote an op-ed in the New York Times making light of the claim about shortages of physicians. The prospect of 30 million newly insured people added to the rolls plus the increasing numbers of baby boomers, the pig in the python of demographics,  reaching retirement age is going to put enormous strain on Medicare, and on the medical profession. The Association of American Medical Colleges says their members aren’t able to train enough physicians to fill the need. Dr. Gottleib clarified his remarks in a later post to point out that there will be plenty of doctors, but you may not have access to them. And now we’re reading about doctors who just won’t participate. Let’s call the whole thing off!

Gottleib and Emanuel cite Massachusetts “where Obamacare-style reforms were implemented beginning in  2006, adding nearly 400,000 people to the insurance rolls.”

My understanding, and I’m unsure of this, is that the Massachusetts reform was intended only to force the uninsured to sign up for insurance — and that mandate is what ObamaCare tried to copy. Massachusetts didn’t attempt to reform the entire practice of medicine, they just wanted people to get insurance and stop the drain on emergency room costs. The insurance mandate went into force in 2006, and a 2009 survey showed that wait times to see a specialist in Boston were nearly double those in other major cities.

Emmanuel and Gottleib believed that although the numbers showed shortages of doctors, doctors would just be forced to be more productive, and their numbers could be supplemented with nurse practitioners; but we are also facing a shortage of nurses, and a shortage of professors in nursing schools. They seem to expect technology — televised short appointments with people at a distance or at home to replace office appointments with all the time involved. And there is good news on the technology front, I wrote about new diagnostic tools just entering the marketplace back in September, and there is big prize money waiting for whoever can develop Dr. McCoy’s medical tricorder, but we’re not there yet. Depending on inventions that have not yet been invented, but already taxed, seems an exercise in futility.

I’m not sure that “wait times” for an appointment with a specialist are a truly useful statistic. Depends on whether you’re visiting the cardiologist because you keep having chest pains, because you’re embarking on an important job and your company wants you to have a complete going over, or because your blood pressure is too high. The wait time to see an internal medicine physician in 2013 was 50 days — but it makes a big difference if it’s just a routine checkup or a serious concern. If the latter, do they squeeze you in shortly, or is it still 50 days?

I wouldn’t bet too much on technology. ObamaCare’s new medical device tax has had terrible effects on device makers. The White House and HHS have little understanding of business, and no understanding that slapping a big tax on all medical devices can devastate an industry, and deter would-be inventors.

The more I read about ObamaCare and its problems, the clearer it becomes that those who devised this mess had no understanding at all of the business of medicine, the business of insurance, and the businesses of its supporting entities. They wanted to give people free medical care. They believed that doctors were all rich and charged too much when they should be giving care as a public service. They believed that insurance companies cheated their customers and hospitals charged too much (look at those charges for ordinary aspirin), and they do not and did not understand the complexity of all the people of a nation and their health needs.

They regarded it as a political game in which they could get more votes for their party if they gave people “free” health care. They had no idea how to pay for it, but doctors and hospitals didn’t need to get so much money, and old people cost way too much when they hadn’t very much longer to live and weren’t worth spending money on.

The people who are making the decisions about what will be covered and what will not are people who have made a lifetime of politics and have never participated in the private sector. It has always been politics and the next election, and winning. Washington D.C. is largely unaffected by the recession or unemployment, and truly loses touch with the people who depended on them to represent them faithfully.



Expert Failure: Takes Monumental Hubris to Fail This Badly. by The Elephant's Child

Every time you think the news cannot get weirder — it does. It has snowed in Cairo for the first time in 100 years, and in Israel, where the snow caused major power outages. Greenpeace has informed kids that there will be no Santa Claus because of a shortage of snow and ice at the North Pole. And a couple of scientists have announced that, by golly, there really was a Medieval Warm Period and one in Roman times as well. The media also announced breathlessly that there is a giant caldera under Yellowstone Park, and if it blew it could destroy the whole country. And a Merry Christmas to you too.

There are well known facts behind this reportage. The earth is always warming and cooling in long cycles. It warmed a little in the twentieth century and it has been cooling for the past 17 years, which means there’s apt to be more snow and ice, and the arctic ice is growing, not retreating (which it does in the summer). The Roman and Medieval Warm periods have been long known to science and history, the people living then told us about where grapes were growing and food was more plentiful. And perhaps much of this is reported simply to get ObamaCare Failure off the front pages.

According to a Duke University/CFO Magazine Business Outlook survey, a quarterly poll of corporate finance chiefs, nearly half of U.S. companies say they are reluctant to hire because of the impact of the Affordable Care Act. One in five respondents said they are likely to hire fewer employees because of the law. Another one in 10 said they may lay off current employees, and 44 percent of companies said the will consider reducing health benefits to current employees in response to the health care law.

“The impact on the real economy is massive. Nearly one-third of firms may either terminate employees or hire fewer people in the future as a direct result of ACA,” said  Campbell R. Harvey, a professor of finance at Duke’s Fuqua School of Business.

In California, Doctors are boycotting California’s ObamaCare Exchange, and won’t participate. An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state’s ObamaCare health insurance exchange and won’t participate, the head of the state’s largest medical association said.

The Center for Medicare and Medicaid says that at least 15,000 ObamaCare enrollments did not get to the insurers. The data transmission failed as much as 15 percent of the time in the middle of October, but it is better now, maybe.

Many in New York’s professional and cultural elite have long supported President Obama’s health care plan. But now, to their surprise, thousands of writers, opera singers, music teachers, photographers, doctors, lawyers and others are learning that their health insurance plans are being canceled and they may have to pay more to get comparable coverage, if they can find it.

They are part of an unusual, informal health insurance system that has developed in New York, in which independent practitioners were able to get lower insurance rates through group plans, typically set up by their professional associations or chambers of commerce. That allowed them to avoid the sky-high rates in New York’s individual insurance market, historically among the most expensive in the country.

All those “experts” who thought they were so smart — it’s just ordinary hubris all the way down. Nothing works, nothing will work, and some people who are cancelled in the middle of treatment are going to die because of expert stupidity.

Let’s call the whole thing off.




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