Tag: Health Policy

Conservatives routinely use the rhetoric of free markets, free enterprise, liberty, and choice to impose political controls.

Bob Beauprez, the conservative whose campaign for governor self-destructed last year, published a new article this week titled, “Health Care Reform – The Battle is Joined.” Not surprisingly, Beauprez has joined the wrong side.

First comes the rhetoric:

By some estimates as much as 30% of health care cost is administrative overhead, so undoubtedly savings could be realized by streamlining and consolidating paper work. But, where did all this paper work and regulation come from? Right! From the government with a big assist from trial lawyers hungry for a lawsuit. Do you think doctors and hospitals intentionally create more paper work for themselves?

And, now how do they propose to fix it? With more government! Remember that one definition of insanity is doing the same thing over and over, expecting different results. Either they are crazy, or they believe we are to believe this stuff.

Then come the controls:

Required coverage: I reluctantly come to the conclusion that just as motorists are required to have auto insurance, and lenders require homeowners insurance, citizens should have to have health insurance.

My dad and I describe the basic problems with mandated health insurance in a recent column. In brief, such mandates violate the individual’s right to control his or her own life and resources, put politicians in (greater) control of our insurance policies, and fail to fix the underlying problems that are caused by existing political controls.

Beauprez’s many confusions and distortions call for a more detailed reply.

Beauprez’s comparisons to auto insurance and homeowners insurance do not hold. The reason that “motorists are required to have auto insurance” if they wish to use government-run roads (even though many do not obey that law) is that the roads are socialized. It is telling that Beauprez holds up a socialized industry as the standard for medicine. Yet people are not forced to buy auto insurance if they do not use government-run roads. Beauprez wants to force everyone to buy health insurance.

If a lender requires the borrower to purchase homeowners insurance as a condition of the loan, that is properly a matter of voluntary contract, not political controls. But Beauprez is not talking about any sort of voluntary agreement with respect to health insurance: he is talking about legislating new political controls that force everyone to buy health insurance.

Beauprez continues:

Of the 15-17% of the population that is uninsured, the U.S. Census Bureau reports that 56% are 18-34 year old young adults. It is impossible to know for certain, but many of these are no doubt uninsured by choice. Believing they are either permanently healthy, bullet proof, or both, they choose to spend their money on other things than health insurance. If they do get really sick or injured they know that they can go to any emergency room and get treatment whether they can pay or not because of federal law known as Emergency Medical Treatment and Active Labor Act (EMTALA). Some are certainly uninsured because they cannot afford the cost of insurance, but most could afford at least a portion of a monthly premium.

The reality is that when someone doesn’t have insurance the cost of their health care is shifted to those that do in higher premiums, and to taxpayers who fund government programs. Cost shifting from the growing number of uninsured to the insured is a huge reality. The biggest challenge hospitals face is to adjust prices to insurance companies for paying customers to cover losses for services to non-paying uninsured patients they are required by law to treat. That invariably is reflected in higher insurance premiums.

It is simply not true that “when someone doesn’t have insurance the cost of their health care is shifted to those that do in higher premiums, and to taxpayers who fund government programs.”

Beauprez insults my wife and me, who were uninsured for several years. During that time, we paid for routine medical care out of pocket. Not once did we ask any other party to pay for our medical care. Yet Beauprez unjustly insinuates that we were freeloaders.

Why were we uninsured? Was it because, as Beauprez claims, we thought we “are either permanently healthy, bullet proof, or both?” No, Bob, it was not because we were stupid or deluded. I don’t need some failed politician to inform me of my motives, thank you very much.

The reason that we chose not to purchase health insurance at that time was that employer-paid insurance was a horrible deal for us. Because of government controls, such insurance acts to transfer wealth away from healthier workers to those with higher costs. We were having a hard enough time paying bills without financing other people’s health care to boot.

We made a calculated decision not to purchase health insurance. We looked at our realistic health risks given our age and state of health, took steps to independently maintain our health, planned to buy health care out of pocket, and considered how to handle possible (but unlikely) high-cost treatments.

In other words, our motive was the exact opposite of what Beauprez alleges. We were not trying to push our health-care costs onto others. Instead, we were paying our own way while refusing to finance the health care of others.

Here’s how politicians have turned employer-paid insurance into a wealth-transfer scheme. Politicians have entrenched high-cost, non-portable, employer-paid health insurance through federal tax distortions. Because of the tax distortion, such insurance serves as pre-paid medical care, not actual insurance to cover unexpected, high-cost treatment. Our hope with term life insurance, auto insurance, and home insurance is to never need to make a claim. We happily pay our routine auto and home expenses out of pocket. Why, then, do most people expect health insurance to cover all or nearly all of their health costs? It is because of the tax distortion. That’s fundamentally why health insurance is so bloody expensive.

And, of course, when practically every purchase of medical care goes through insurance, that adds a lot of processing costs.

When insurance acts as pre-paid medicine, it transfers wealth to insurance companies and to those who often visit the doctor (whether the visits are needed or not). It costs everyone who visits the doctor only occasionally.

Politicians have also required that employer-paid insurance accept all comers, regardless of health, within tightly controlled rates. That’s the equivalent of forcing a life-insurance company to charge the same rate for the same policy for a healthy 25 year old and an 80 year old with cancer. What happens is that some people put off buying insurance until they get sick. This increases the rates for everyone (as Beauprez suggests).

In addition, politicians have added all sorts of additional controls that act to transfer health-insurance dollars to members of special interests. In a comment beneath Beauprez’s article, Brian T. Schwartz writes:

The rationale for compulsory insurance is the “cost shift from uncompensated care” provided to the under- and uninsured, “which makes private insurance more expensive.”

Yet, Health Affairs reports that such uncompensated care is “only 2.8 percent of total personal health care spending.” …

Indeed, politicians have already succumbed to special interests by forcing insurance plans to cover many benefits that you may not need. These mandated benefits laws increase your premiums by 21 to 54 percent. (Council for Affordable Health Insurance, www.tinyurl.com/32ozs6)

So is the result of mandated health insurance to reduce “cost shifting?” On one hand, some people who would otherwise shift their costs onto others would be forced to instead purchase insurance. (However, those most likely to shift their costs onto others are also the ones most likely to avoid the mandate.) But on the other hand, insurance mandates increase “cost shifting” by forcing those with low medical costs to subsidize those with high medical costs. Notably, if some people pay only “a portion of a monthly premium,” as Beauprez suggests, then that means somebody else must pick up the rest of the tab.

One result it to screw young, working families, at the very point in their lives when they’re trying to pay off debts, keep up on bills, start families, and buy homes.

The only just way to reduce “cost shifting” is to remove the political controls that cause it. Beauprez’s plan is to “solve” the cost-shifting caused by political controls by adding new political controls that will expand cost-shifting.

Beauprez also claims, “Insured are far more likely to avail themselves of preventative care, get treatment earlier, and avoid serious acuity and expense.”

Beauprez’s claim is false. When my wife and I were uninsured, we knew that if we didn’t take care of ourselves, we’d face higher expenses down the road. We made sure that we ate healthy foods, exercised, avoided unnecessary risks, and checked up on our health. Now that we have high-deductible insurance that we hope never to need, our incentives are basically the same. On the other hand, when people are “insured” for everything, they have less incentive to minimize their long-term health costs.

Again, the problem is political force that allows the uninsured to demand medical care at the expense of others. The proper solution is to repeal those controls, not impose new controls that force people to buy insurance.

Some of Beauprez’s proposals (none of which are original to him) are fine, such as reducing the tax distortion that has entrenched employer-paid insurance. But his call for mandatory health insurance overwhelms anything positive he might have to say. “Both Ways Bob” simply does not understand the nature of individual rights, the meaning of free markets, or the proper purpose of government.

It is typical for such conservatives as Beauprez to follow a call for more political force, more state interference in the market, with a sentence like this:

“Any objective observer with even minimal experience with our free market system understands that private competition with limited government interference works.”

Here’s the latest from the Colorado Freedom Report:

Insurance mandates threaten your health
“Insurance mandates are morally wrong because they violate the rights of individuals to control their own lives and resources. The government has no more right to force us to buy health insurance than it does to force us to buy shoes, houses, hamburgers, or Bibles. … Instead of trying to force people to buy health insurance, why doesn’t Dr. Pramenko take a look at why health insurance is too expensive for some people to afford?” (by Linn and Ari Armstrong)

Restore Liberty in Health Care in Colorado
“The role of government in regard to health care should be to cease and desist. The proper role of government is not to force anyone to do anything. Government’s proper role is to protect every person’s right to liberty. But subsidies, tax distortions, insurance mandates, employer mandates and individual mandates violate this right and wreck the market.” (by Richard Watts)

In his October 12 article for The Daily Sentinel of Grand Junction, Mike Saccone writes:

Dr. Jim Schroeder warned four members of a statewide health reform commission that over-involving government in doctor-patient relations could push a large number of physicians to leave the business.

“The role of government should be to get the hell out of the way and let the doctors meet with the patients,” Schroeder said, his voice wavering with emotion.

Schroeder said any attempt from policymakers to expand existing government-managed health insurance programs or to create a single-payer, government-run health insurance program could allow the state to lower how much it pays physicians for their work.

“If you’re not paid for what you’re doing… you’re not going to stay in the field,” the local pediatric cardiologist said.

Schroeder’s comments came as part of a Thursday evening forum the Senate Bill 208 Commission hosted in Grand Junction to receive feedback on its five possible health care reform proposals.

These meetings all seem to go about the same way. Those who seek “concentrated benefits” of government wealth transfers show up in large numbers, while those on whom the costs are dispersed mostly stay away. Yet, as I noted previously, Brian Schwartz spoke eloquently at one of the meetings of the hazards of government-controlled medicine. I was heartened to read Dr. Schroeder’s comments. And Richard Watts tells me that he advocated liberty in medicine at a hearing in Craig.

Of course, the issue of payment discussed in the article is only one of many problems with government-run medicine. Medicaid and Medicare already pay doctors less than what services cost to provide. The bureaucracy and political meddling also induce especially the best doctors to leave the field. Political controls harm doctors as well as their patients, as both groups look to influence politicians and bureaucrats, rather than enter into voluntary, mutually beneficial relationships with each other.

Unfortunately, many who work in related fields are drawn by the siren song. Saccone continues:

Kristy Schmidt, director of community and consumer relations for the Marillac Clinic, said requirements for individuals to have their own health insurance are a good idea.

“Having everyone pay into the system will decrease costs for all,” Schmidt said.

But Schmidt’s statement is false. Forcing people to purchase health insurance violates their rights to control their own resources without addressing the underlying problems caused by existing political controls. Obviously, the point of the mandate is not to “decrease costs for all.” The point is to force some people to subsidize others through insurance. Because politically-enforced insurance would act more like pre-paid medical care, it would encourage people to seek more care without regard for cost, thereby increasing average “costs for all,” at least until price controls and rationing kicks in.

No, Dr. Schroeder offers the correct diagnosis and the correct remedy: “The role of government should be to get the hell out of the way and let the doctors meet with the patients.”

Chris J. Wiant, M.P.H., Ph.D., wrote the following comments for the October 7 Rocky Mountain News:

While 770,000 Coloradans are without health insurance, twice that number of citizens do not have dental insurance and, therefore, lack access for preventive and restorative services. They must wait until their dental problem becomes a medical emergency before they are likely to get service. …

Therefore, it is my hope that Colorado’s Blue Ribbon Commission on Health Care Reform takes seriously the need to include dental care as part of an overall strategy in fixing our health-care system in Colorado.

Wiant’s assertion is false. It is simply not true that people who lack dental insurance therefore “lack access for preventive and restorative services.” They have all kinds of access. Since Chris J. Wiant, M.P.H., Ph.D., is apparently ignorant of this fact, I’ll describe how people may access dental care.

Step One: Locate a phone book.

Step Two: Look up “dentist” in the phone book. It’s under “D.”

Step Three: Using a telephone, call a dentist in the phone book.

Step Four: Make an appointment to see the dentist.

Step Five: Go to see the dentist at the appointed time.

Step Six: Pay the bill.

As an alternative to the first two steps, look on-line — I found 2,080 dentists listed through DexKnows — or ask friends for a referral (which is what my wife and I did).

My wife and I do not have dental insurance. Indeed, we have never used our high-deductible insurance to cover any medical cost. We pay all of our medical and dental costs out of pocket (or out of our Health Savings Account, which is an extension of our “pocket”). And we like it that way.

My wife and I have both been very proactive in seeking out (and purchasing) “preventive and restorative” dental services. For example, just within the last few weeks, I had my first cavity filled (which was tiny because I went in as soon as I noticed it), and my wife had a filling replaced. Months ago I had a cracked molar repaired. We both get regular check-ups and cleanings.

Our dentist does an outstanding job. He is worth every cent that we’ve ever paid him — and much, much more. We get a spectacular value for our money with him, and I am proud to pay him for the services that he renders. Now that’s “access.”

We don’t need Chris J. Wiant, M.P.H., Ph.D., to force us to purchase dental insurance that we neither want nor need. And that’s really what he’s saying here. It is now common knowledge that the 208 Commission has endorsed an “individual mandate” for Colorado, meaning that the Commission wants to force people to buy “insurance” that’s approved by politicians and bureaucrats (as opposed to, say, removing the political impediments that make insurance too expensive for some people to purchase).

But Wiant is concerned with the fraction of people lacking dental insurance who have trouble with Step Six. But they don’t need “insurance” (i.e., government-managed, pre-paid care that others are forced to fund) in order to have “access.” Those without funds to pay for dental services can and should set up payment plans or turn to voluntary charity.

Wiant’s article is indicative of what we can look for if the political takeover of medicine advances. Special interests will continually lobby to have their favored services included in the politically-enforced mix. As people “access” more of the “free” (or nearly free) services, the result will be price controls and rationing. Real “access” will be reduced.

By the way, “Chris J. Wiant, M.P.H., Ph.D., is president and CEO of the Caring for Colorado Foundation.” And what manner of group is that? According to its web page:

In November of 1999, Anthem Insurance, a for-profit company, purchased Blue Cross Blue Shield of Colorado, which had non-profit status. This sale yielded proceeds of $155 million. As mandated by Colorado state law, the profit from the sale was dedicated to benefit the health of the people of Colorado. Caring for Colorado Foundation, a non-profit 501(c)(4), tax-exempt Foundation, was endowed to fulfill this responsibilty (sic).

Let us leave aside the absurdity of state laws stacked on federal tax codes micromanaging mergers. Chris J. Wiant, M.P.H., Ph.D., is, by advocating more political control of medicine, actively undermining ” the health of the people of Colorado.”

Brian Schwartz continues to speak out as voice for liberty and free markets in medicine.

David Montero quotes Schwartz in an October 5 article for the Rocky Mountain News.The subject is a meeting of October 4 sponsored by the 208 Healthcare Commission.

Montero closes his article:

And at least one speaker, Brian Schwartz, proposed getting government out of health care entirely – calling Medicaid a “failure” and an example of why single-payer won’t work. Instead, he advocated the free-market system.

“Should we have single-payer food and housing?” he asked. “Didn’t we settle that with Soviet Russia and North Korea? Why is health care different?”

Congratulations to Brian! And thank you for speaking out at a meeting stacked with advocates of political force in medicine.

You wouldn’t hire an accountant to fix your pipes, and you wouldn’t hire a plumber to audit your financial records. When doctors start prescribing huge doses of corporate welfare, it’s clear that they’ve strayed rather far from their calling.

April Washington’s October 3 article for the Rocky Mountain News reports, “[A] commercial was created by the Physician Committee For Responsible Medicine [that] seeks to spotlight contributions from the agricultural industry’s political action committees.”

According to the article, Neal Barnard, president of the group, said, “Senators take millions from corporations that produce bacon, burgers, and other fatty foods. Then Congress buys up these unhealthy products and dumps them on our school lunch programs.” (See the group’s news release.)

The travesty! The injustice! The solution, then, is to roll back federal intrusion in our diet, right? Of course not.

Washington continues, “Between 1995 and 2004, more than $51 billion in federal agricultural subsidies went to producers of sugar, oil, meat, dairy, alcohol and feed crops to be used to fatten cows and other farm animals, according to the physicians group based in Washington, D.C. … The watchdog organization is urging Congress to overhaul the Farm Bill and shift more funding to producers of healthy foods such as fruits and vegetables to help combat childhood obesity.”

In other words, these doctors don’t have any problem with federal elites determining people’s diets; they just want to be the ones in control of the purse strings.

The group details the subsidies it doesn’t like on its web page. However, the federal government should not be in the business of subsidizing any agricultural crop or of buying food (excepting military use). The problem is not that the wrong elites are in charge; the problem is that elites are in charge. The money in question rightfully belongs to the people who earn it, and they have the right to decide what food to buy on a free market.

An “Animal Rights” Agenda

I began to suspect that the Physicians Committee for Responsible Medicine has a broader agenda when I noticed that the group’s web page states, “We promote alternatives to animal research.” The group’s archive of news releases includes the following entries:

The Secret to Long-Term Weight Loss Might Be a Vegan Diet, Research Finds: New Study in Obesity Shows a Vegan Diet with Social Support Helps People Lose More Weight Over Two-Year Period than Conventional Low-Fat Diet
(Sept. 10, 2007)

Prostate Cancer Survival Improves with a Low-Fat Vegan Diet, New Study Shows: Levels of Hormones that Feed Tumors Are Lower in Men Who Consume Less Fat and More Fiber
(Sept. 4, 2007)

Nesquik Commercial Voted Most Deceptive Ad in Online “Badvertisements” Poll: Voters Weight In on Dairy Commercials’ Faulty Health and Beauty Claims
(Aug. 16, 2007) …

Doctors Sue University of California Over Animal Welfare Act Violations: Dog and Monkey Experiments at U.C., San Francisco, Under Fire
(July 31, 2007) …

Residents Sue City of Chandler Over Covance Animal-Testing Facility: Seven Local Plaintiffs and Physicians Group Accuse City Officials of Improper Collaboration with Covance, Violating State Open Meetings Act, Failing to Give Proper Notice of Hearings, and Violating City Zoning Ordinance
(July 3, 2007)

Are you seeing any patterns here? PCRM is not exclusively an “animal rights” group, but it certainly is an “animal rights” group.

A quick Google of the group came up with Wikipedia’s entry, which in turn pointed me to an article published August 1, 2004, by The Observer. That publication states:

Beauty and the beasts

Jamie Doward and Mark Townsend
Sunday August 1, 2004

Kevin Jonas understands the media. As well he should. Over the years the president of Shac USA, the American wing of the militant group campaigning to close down Britain’s Huntingdon Life Sciences, has had a good tutor.

As Jonas, 26, himself pointed out at an animal rights conference in Washington recently: ‘I come from the school of thought and from essentially the school of training of Peta – People for the Ethical Treatment of Animals.’ …

With such deep pockets Peta is able to disburse millions of dollars every year across a global network of interest groups, including the Physicians Committee for Responsible Medicine (PCRM), which opposes animal experiments on scientific grounds and whose members (95 per cent of whom do not have medical degrees) have well documented links with Shac and other militant animal rights groups.

Over the years Peta has given more than $1.3m to the organisation whose research is regularly cited by Shac supporters as scientific proof that animal testing does not work. In 2001 Neil Barnard, the group’s president, joined Shac’s Jonas to co-sign hundreds of letters sent to the bosses of companies involved with Huntingdon, urging them to break their links with the firm.

(The Observer apparently misspells the name “Neil Barnard,” while April Washington spells it “Neal Bernard.” According to PCRM’s web page, the correct spelling is “Neal Barnard.”)

The left-wing SourceWatch also notes the relationship between PETA and PCRM, though SourceWatch downplays the connection:

PCRM does partner with PETA on some issues of common interest, including a campaign to reduce animal use in toxicity testing. However, PCRM has not received any monies from PETA or the PETA Foundation since 2001, and such funding has never been a significant part of PCRM’s budget.

When Fat is Good

As an aside, the PCRM doctors ought not bash “fatty foods.” Okay, they obviously mean foods with high levels of saturated fat. However, the amount of saturated fat in a burger depends on the quality of meat and the method of preparation. Besides, eating even bacon and burgers in moderation can be consistent with a basically healthy diet. And, as I learned, it’s unhealthy to eat too little fat, though unsaturated fat generally is better. For example, almonds are half fat by weight, and they’re listed among WebMD’s “25 Heart-Healthy Foods.” If you eat too little fat, you may suffer severe health problems or death.

Here’s what the Mayo Clinic has to say about fat:

Your body needs fat to function properly. Besides being an energy source, fat is a nutrient used in the production of cell membranes, as well as in several hormone-like compounds called eicosanoids. These compounds help regulate blood pressure, heart rate, blood vessel constriction, blood clotting and the nervous system. In addition, dietary fat carries fat-soluble vitamins — vitamins A, D, E and K — from your food into your body. Fat also helps maintain healthy hair and skin, protects vital organs, keeps your body insulated, and provides a sense of fullness after meals.

But too much fat can be harmful. Eating large amounts of high-fat foods adds excess calories, which can lead to weight gain and obesity. Obesity is a risk factor for several diseases, including diabetes, heart disease, cancer, gallstones, sleep apnea and osteoarthritis. And too much of certain types of fats — such as saturated fat or trans fat — can increase your blood cholesterol levels and your risk of coronary artery disease.

Chris Barge’s story for today’s Rocky Mountain News states:

Calling itself “Partnership for a Healthy Colorado,” the group emphasized that reform is needed because the cost of caring for the uninsured and underinsured is passed on to Colorado’s insured majority.

The group acknowledged that it had not arrived at any agreement on a proposal for reform, or how to pay for it.

But there was agreement that something must be done. …

“The members of this partnership are diverse and we don’t always agree on everything,” said Amy Fletcher, associate director of the Business Health Forum. “But we’re here to say that, when it comes to health care, something must be done in Colorado.”

Something, anything must be done — except to actually figure out what’s wrong with medical policy and fix it. Various members of the “new” coalition, including the Service Employees International Union, the Colorado State Association of Health Underwriters, and the Colorado Medical Society, have already advocated more political control of medicine.

Yet political controls of medicine — tax distortions that entrench expensive, non-portable, employer-paid insurance, massive tax spending, and reams of federal and state mandates — are what have caused prices to skyrocket and quality to suffer.

In addition, the claim that “the cost of caring for the uninsured and underinsured is passed on to Colorado’s insured majority,” when taken as a broad assertion, is simply a lie. When my wife and I were uninsured, we paid for all of our own medical expenses out of pocket. The article’s claim insults those who pay their own way.

To the extent that the the statement is true, it is true only because politicians have mandated treatment, forced insurance companies to guarantee coverage, subsidized costs, and made insurance so expensive that many workers cannot afford it. But will the “new” coalition advocate the repeal of the political controls that have caused the problem? Obviously not. Instead, I predict, it will urge politicians to force people to buy insurance. Because, in the eyes of such reformers, the solution for failed political controls is more political controls.