City Journal Autumn 2014

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Autumn 2014
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Nicole Gelinas

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"The Catholic Church is rightly outraged at President Obama’s insistence that it pay for workers’ birth control."

This is an extraordinarily dubious characterization of the issues involved. I will not attribute disingenuous motives, but rather issue-of-the-day myopia.

Leave aside contraception. Why should an employer have ANY say in what I do with my doctor? That type of interference is not allowed in attorney/client relationships where a third party is paying. Why is allowed here? Pretty simple question, no?

Pay or don't, but don't get in the way. The only reason that the CC is getting ANY support on this is because people are distracted from the real issue, which is, once again, employers expect to have all the rights. Religious liberty is a side-show here.

Employers are asking to be doctors and to be allowed to dictate the doctor/patient relationship. If they want to provide coverage, fine. Do it. If not, don't do it.

That said, I see no reason whatsoever, not to take a very hard anti-employer position on this. "Pay and shut up" is entirely called for. Or don't pay. Whatever, but to pay and intervene is pretty much slavery.

Then there's this: "'Care providers will “compete” on how to game the system, rather than on delivering better health care at less cost."

Again, not to be snarky, but is that statement a reasonable characterization of what the "system" is set up to do?

Add me to the list of people who don't care that much whether the intrusion is "public" or "private." Not an easy problem to solve, admittedly, but the "religious liberty" fig leaf here is just that.
One solution to reduce medical costs is to take better care of ourselves. Over half the country is overweight, setting the stage for diabetes and expensive cardiovascular illnesses.
Peter from Oz,

Your example is oversimplified. Dogs do get first class care without government intervention, but when a dog's symptoms become too much to care for then the dog is euthanized. That doesn't happen in the human medicine. The reason why our health care system is a "mess" is the fact that the sickest patients utilize the most resources and we are all subsidizing these cases. Until we come up with a way to pay for our sickest patients, the health care system debacle has no end in sight.
SOrry thata should be Government involvement
If I take my dog to the vet, there is no government intereference. The dog gets first class care straight away without delay and I pay for the privilege. Easy. That is how it should be for human medicine too. Government involved has skewed the market.

WOuld we trust te Government to distribute and regulate the eating of food? of course not, so why do we tolerate them interfering in the delievery of medicine, other than licensing doctors and hospitals.

Kim,
Your situation raised several important issues…I would like to discuss several of them.

The notion of employers and/or govt. carriers putting money into an account than can be used for health care and that any savings left over remain with the patient/employee is a way to create some economic incentive for people to be prudent in their use of medical services…..because over treatment 1. is wasteful. 2. often actually harms patients because of excess testing, biopsies and secondary effects of treatment and 3. misallocates money away from situations like yours where the money would be better spent on research and treatment. Sound research done by credible groups (like Rand) estimate that around 30% of medical costs are due to unnecessary and harmful over treatment….that is a big annual number.

The likely alternative to incentivizing individuals to manage their care better is what we
have now…..government and big insures arbitrarily cutting reimbursement to providers (hospitals, doctors, device makers)…..this is an inefficient blunt approach that often penalizes and leads to risk and disincentives to researchers and providers who may well be in a position to find better solutions to difficult medical situations like your own.

Another important issue you raise is access. Top down cuts to providers and arbitrary price setting (the main tools used today and proposed for the future) are what will create more and more barriers to your finding excellent providers and new improved treatments for your condition.

Dr. Stockman in his comment raised the issue of percentages of insurance that actually goes to treatment (vs. administration, profits etc). Right now this is subject to state level insurance regulators who oversee insurers in their state. This approach (vs. market based approaches) is not very effective. The antidote is allowing cross state line purchases of health insurance. Right now we have a geographically fragmented market often where big insurers have monopoly or oligarchy control in their regions…..giving patients freedom to buy across state lines is perhaps the single most important way to create incentives for insurers to compete by dropping prices and reducing wasteful administrative expenditures.

The common theme is that our medical expenditure spending will only get better and more efficient if we increase economic freedom for patients and providers....not by using top down command and control approaches that have gotten us into the mess we have now.


My husband and daughter have a genetic form of type-2, insulin-dependent diabetes. Each had the genetic marker, so they have diabetes. Period. They have a much higher risk of stroke, cardiovascular and heart-related illnesses. I, on the other hand, have a 50% chance of carrying the genetic marker for early-onset Alzheimers. I am glad I'm past the age of 40, when my cousin was diagnosed, and just past when my mother at 48, was diagnosed. I may beat the odds, but out of 4 siblings, two of us WILL get it. I, my husband, and 2 daughters carry diagnoses of bipolar disorder, depression, and anxiety disorders. I don't think the government or any other entity can or should create a situation where we can put the money in the bank that we now spend on medications and medical care. People without such genetic and chemical issues will, in fact, put thousands of dollars into the bank, or a Caribbean cruise, or high-end cars, while we keep buying our medications, paying for insurance, and living with the genetic and biological luck of the draw. I'm less concerned about us having as much money as people who didn't draw the health hand we did, than that we are simply able to, in the free market, find generic medications, smart and affordable health-care providers, and live this life with joy and not envy.
For competitive markets to work, consumers need valid information on the products and services offered. Perhaps more importantly, they need the knowledge to process the information. Finally, non-competitive activities have to be limited.
Francis Stocker, M.D. February 06, 2012 at 6:42 AM
The issues are complex. The Republican candidate are reduced to a few slogans.
In Massachusetts, the medical loss ratio - the percentage of premium dollars paid by heath care insurers to pay for care has risen to a more respectable 92%. In other states, it is all over the map and in the 60's in some Colorado plans. Obama plan allows for 80%- a rediculously low level.
One small part of the complex problem. Solutin one is to reduce over all expendtures.
Francis Stocker, M.D.
This is really sad... yes, ANYONE (the guy) seeking to continue jogging, ostensibly to remain healthy, as well as look good, is more rational than the mom who wants to maintain 'perky' breatst. Valid analog would be the guy who wants to maintain his suntan... looks good, but has risks, as does breast surgery!

HOWEEVER, this evil arose... it should be covered by current medical insurance practices.... if the guy developed ANY cancers, should he ever be sent looking for whatever MD could have Rx'd his suntan for medical/psych health? Not even for this free-marketer.
Did Steve Cuozzo ever consider eating hot dogs instead of Pate and cavier. I assume as a food critic he gets to eat foods I can't afford. By his logic he should be eating hot dogs from a street vendors cart.
An interesting article, however might I shed a little more light on the process that governs medical device usage within the European Union. All products of this, and in fact other sorts, are regulated centrally by a European Union body that works to assure common standards, whatever gains approval, via the CE Mark, is automatically licensed for use throughout all member states in line with inter-government agreements. This applies irrespective of any national doubts that may surface.
What is this rush to get government into the act? In my estimation the problem with medical insurance in this country is the government. There is nothing wrong with the health care We have the finest health care in the world. Our doctors and scientists have discovered most of the medicines and methods of surgery used today.

The government is like a bull in a china shop when it attempts to fix anything. They always try to make one size fit all and it's impossible with a country of this size. They fix it here and break it there. Keep the government out of health care except where it should, which is to make sure we have drugs that won't kills us (at least not right away) and, on a local level, clean hospitals and licensed physicians, nurses and technicians.

Paul, I've thought your idea is the best one for a long time.
There is the problem of DIABETES which has become an epidemic in the US. It is a disease that is avoidable, aside from Juvenile Diabetes . In view of television programs that display gross Gluttony, each individual MUST be made RESPONSIBLE for their BEHAVIOR and not rely on the TaxPayer to cover the costs of their medical care due to uncontrolled
overeating AGRICULTURAL WELFARE should also be addressed. Sugar was "cheaper" beyond the US while Agricultural Price Supports were allocated to a family in Palm Beach, keeping in mind that Sugar is detrimental to health. It is now being added to an exclusion list in EUROPE along with Tobacco/Alchohol. Do away with Candy for Halloween/Valentine's Day, events promoted for the income of the manufacturers. Behavior should be made primary in the issue
of Public Funded Healthcare
Tony, a family member used metformin for years in addition to taking insulin for type 1 diabetes and his kidneys didn't fail, his heart did. Every medication we ingest carries risks but the benefits at times outweigh the risks.

While we now enjoy the best health care system in the world, the problem is that patients are largely insulated from the cost of care and as a result they seek, request and demand the maximum services available and doctors and hospitals are glad to oblige in order to maximize revenue, reduce liability costs and enhance patient satisfaction.

The way to overcome resistance is evident in many Health Savings Account catostrophic plans: employers grant employees several thousand dollars a year into the HSA account....and if employees don't spend it they keep the money. Suddenly patients start asking "do I really need the mri?" and "is there a less expensive generic medication?" and yes "Doctor, what is the charge for the procedure you are recommending?"

Restoring economic freedom for providers and patients is the proper answer. Top down rules and controls imposed by government and/or insurer bureacrats will always have unintended consequences.
Metformin can cause kidney problems - failure!