American Elephants

The Hippopotamus in the Health Care Room. by The Elephant's Child

There is a hippopotamus in the health care room, that nobody mentions.   The progress of medicine in recent years has been stunning.  At the time of the Civil War, doctors were just learning about cleanliness in operations and anesthetics like ether were relatively new.  Aspirin to relieve pain was introduced by Bayer in 1900.  Sulfa drugs to prevent infection became available around 1935, though many were allergic.  Penicillin was first mass-produced in 1944, late in World War II.

The progress in medicine since that time has been amazing.  Medical imaging and all sorts of new lab tests measure things we never dreamed of measuring before.  You would think that Americans would relax in the confidence that their wonderful health care system could take care of most of whatever ills or discomforts came up.

What has happened instead is an obsession with health.  Can you pick up a magazine or newspaper that does not have one or more articles on caring for your health?  Radio and television ads extol the value of drugs or over-the-counter remedies.  There are magazines devoted to weight loss, healthy eating, body building, exercise, and specific forms of exercise.  There is a proliferation of gyms — at least in larger towns, and stores that sell gym equipment.  You can find medical advice and information on the internet. There are stores that sell nothing but supplements.

We have become a nation of hypochondriacs.

Grocery stores have special departments for “organic” foods.  Mayors of major cities ban things like “trans-fats” though trans-fats have never been shown to harm anyone.  People have become advocates of “localism” in foods — completely ignoring the blessing of having fresh summer fruits in the stores in midwinter, delivered by air from the Southern Hemisphere.

Some journalists have developed a specialty of writing about food, or health, or exercise.  They report on new studies without the ability to tell whether the sample is significant or if the results are verifiable.  Fraudulent studies about mercury in immunizations causing autism led many mothers to refuse to immunize their children with the result that some diseases like measles have returned.  On any given day you can hear conflicting medical advice.  The manufacturers of Lipitor are advertising on the radio to see their ad in a cooking magazine, at the same time that there are reports in the news that statins don’t do any good.  (check with your doctor)

What is the effect of all this on the health care debate?  We laugh at the San Francisco Board of Supervisors banning toys in happy meals from McDonalds.

My state government has banned phosphates in dishwasher soap.  Excessive phosphates in dishwasher soap may cause 3% of the algae in streams that may or may not disturb fish.  The deposit left by my un-phosphated dishwasher soap may be injurious to my health, I am told.  My dishes have a nasty film, as do my drinking glasses, and they may be becoming permanently etched.

We have gone from butter to margarine, to margarines made with olive oil or canola oil and water whipped in, back to butter, and now the FDA has decided that it’s not fats that are the bad stuff, but carbohydrates.  There are organizations of radical vegetarians who want to eliminate meat, and force everyone to become vegetarian. It never ends.  Michelle Obama has said that what our children eat cannot just be up to the parents.

This is all nonsense.  Just stop it.

Who Will Be Hurt Most by ObamaCare? by The Elephant's Child

John Goodman, of the National Center for Policy Analysis, asks an important question in today’s edition of his Health Policy Blog:

Who will be hurt the most by the health reform legislation Congress passed last year?

The answer is the most vulnerable segments of society — the poor, the elderly and the disabled.  Those who are left of center in Congress voted for a law that will significantly decrease access to care for the very people they claim to care most about.

There are two basic ways to reform health care.  One way, the way Congress chose, is top down.  The other is bottom up. The latter is the economic way of thinking which involves incentives.

The top down approach starts with a social goal, and tries to impose it with regulations and rules, mandates and constant tinkering and re-regulation to fix what doesn’t work.  Those who are left of center seem to be natural control freaks, and cannot resist telling people what to do.  Doctors, nurses, hospital administrators, pharmaceutical companies and insurance companies are all being told that they can no longer conduct their businesses and their lives the way they have, over many years, found to work most efficiently and most successfully.  A bunch of bureaucrats in Washington, who have no experience in any of these fields, are going to tell them how it all must be done.  The program depends for its success on keeping people from acting in their own self-interest.

The bottom up way to reform health care depends on incentives, or allowing people to pursue their own self interest.  And of course you don’t know exactly how it is going to turn out. Health saving saccounts are one example of positive incentives.  When it is to your advantage to spend less and use less health care, it is in your self-interest to spend and use efficiently. Employers who adopted health savings accounts and their employees were very satisfied with them.  Governor Mitch Daniels of Indiana initiated health savings accounts for low-income people and found that they too responded to incentives and liked the program.  ObamaCare has omitted health savings accounts.

Another example occurred in the Medicare drug benefit.  Your costs are significantly less when you use a generic rather than a name brand drug, though some new drugs have no generic version. When you reach a total expenditure of $2830, you reach what is called “the donut hole.” a point when you have to pay the full cost of your drugs, until you reach the next level, when all are paid except for a small co-pay. This has been an incentive tor people to request generics, and to use less expensive drugs when they work as effectively. That incentive worked efficiently to keep drug benefit costs far less than they were expected to be.  For those who could not afford to pay the full cost of drugs in the “donut hole” there was help available. The left, unable to grasp the idea of incentives, eliminated the donut hole in ObamaCare. Without incentives costs will rise sharply.

The bureaucrats are convinced that preventive care can keep people from getting sick and costing the health care system much more money.  Free tests to prevent people from becoming ill will be hugely expensive.  Doctors usually don’t order a test unless there is a symptom or a particular worry that indicates a test would be worthwhile.  The incentive here is to have lots of tests.  If everyone in America succeeds in getting all the recommend preventive services (no deductible and no co-pay) primary care doctors would have to spend more than 7 hours every day delivering services to healthy people.

The Left is so convinced of the collectivist vision of universal health care that they ignore incentives entirely.  It is an economic mistake.

Who Is Barack Obama? by The Elephant's Child

On January 19, USA Today had an article entitled “Who is Obama? Pragmatism makes him tough to define.”  The article begins:

“A socialist? A steady hand? A sellout?
Halfway through his first term — or only term, if Republicans can eject him in the 2012 elections — President Obama’s leadership style has made him something of a political enigma.

Barack Obama has been our president for just over two years, and we’re still wondering who he is. This is astounding.  I Googled “Who is Obama” and got 418,000,000 hits.  Richard Epstein has described him as having the perfect political personality— completely contained and not revealing of himself. Obama has described himself as a blank slate.  And he has reinvented himself regularly.  Things which he has a long public record of opposing, he favors, and the reverse as well.

In tomorrow night’s State of the Union speech he is expected to reinvent himself as a pro-business president, deeply concerned about jobs and the economy.  And yet, no one in the media calls him a flip-flopper, no one suggests he is lying.  He flashes that dazzling smile, and lo and behold, he is a pro business president.  After all, didn’t he hire General Electric CEO Jeffrey Immelt to head his jobs commission?  And William Daley, his new chief of staff, is a banker. Yet he wants to create jobs by spending more taxpayer money.

He reinvented himself with his speech in Tucson, as a caring and compassionate president.  The speech was widely praised, and I praised it myself because it was, I think, the first speech we have heard that was not all about him.  He got the tone right, but whoever handed out tee shirts at a memorial service was deeply tacky.

David Axlerod, former chief of staff and public relations man, says he excels at the role:

“He is at his best when things are at their worst,” he says. “When things look the darkest and people are downbeat and wringing their hands, he’s always the guy who says, ‘OK, what do we do next?’ “

The USA Today article is deeply interesting because it makes you think, even if you get no closer to the question of just who Barack Obama is and what he believes.  Regular visitors probably don’t have much doubt about where we come down.  But what do you think?  Who do you think he is? And why are we still asking that question?

A Heroic Recovery. by The Elephant's Child

Powerline has posted the story of Staff Sgt. Patrick Zeigler who had just returned from a tour of duty in Iraq in November 2009, and was at Fort Hood to prepare for beginning Officer Candidate School.  He was randomly targeted by Major Nidal Hasan who shot him four times, once in the head.  That shot wiped out twenty percent of Zeigler’s brain and left a large hole in his skull. Eight operations, a long course of rehabilitation, and a lot of stubborn determination — and he  has made a miraculous recovery.  It is a moving story.  Powerline provides a link to the remarkable blog of his fiancée and now his wife.  Don’t miss that as well.

It is a story worth pondering, for the contrast of the media treatment of the Tucson tragedy and the Fort Hood Massacre. Tucson, which as we know was the fault of  Sarah Palin and Rush Limbaugh’s influence on a schizophrenic young man who may never have heard of either of them.  The Fort Hood massacre was the work of a dissident who might have been a peaceful Muslim but clearly had no relation to Islamic terrorism despite his Imam’s connection with Al Qaeda in Yemen, which was surely just a coincidence.

It is a very strange story.  But how wonderful that modern medicine can perform such miracles, and that victims can recover against all the odds.  We wish the Zeiglers complete recovery and great happiness, and the same to Congresswoman Giffords and her husband.

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