| Wednesday, May 14, 2008 |
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FAQ on Free Market Health Care
By Paul Hsieh @ 12:05 AM   
I've received multiple e-mails in response to my recent letter to the editor in the May 11, 2008 New York Times advocating a free market in health insurance. I appreciate the fact that the correspondents all took the time to read my letter, see my affiliation with Freedom and Individual Rights in Medicine (FIRM), search for the FIRM website, find my e-mail address, and then write me with their comments and questions.
The various correspondents posed a number of good questions about the nature of a free market in health insurance, as well as some more fundamental issues on individual rights and the proper role of government in health care. I've had several stimulating rounds of e-mail discussion with folks from around the country. And even though we didn't always agree on some important issues, all of the e-mails I received were polite and articulate, and I appreciated the many thoughtful remarks from all of the writers.
One correspondent recommended that I post my responses online so that other interested parties would have a place to read a more fully developed and explicit explanation of the ideas related to a free market in health insurance. I thought that was an excellent suggestion. Hence, I've paraphrased and collated an essentialized set of questions (and my subsequent responses) in the form of this brief FAQ.
(This FAQ has also been posted on the FIRM blog here.)
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Q1) In a free market for health insurance, should insurers be able to exclude someone based on a pre-existing condition?
Q2) Why should whether I live or die depend on whether an insurance company finds it too costly to pay for my care? Should my fate be determined by whether a corporation finds it profitable?
Q3) How would a free market guarantee that all Americans will have necessary health coverage?
Q4) What if someone has a bad disease through no fault of his own, can't afford the treatment, and no insurance company will cover him? Who will pay for his care?
Q5) Isn't the purpose of a government to promote the common welfare of all citizens?
Q6) Your position is very harsh and Darwinian. If you were dying of cancer and could not afford treatment, would you really say to yourself, "Oh well, this is my random bad luck, no one has an obligation to treat me and so I must die"?
Q7) Isn't it my social obligation to subsidize the health care of those who can't afford it?
Q8) I agree that health care is not a "right", but isn't it moral for the US government to raise taxes to improve the overall welfare of the nation? Universal health care (ideally administered through a free-market mechanism to the greatest extent possible) would be a good use of that power.
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Q1) In a free market for health insurance, should insurers be able to exclude someone based on a pre-existing condition?
A1) Yes. In a free market, insurers (like any other businesses or individuals) are entitled to set whatever terms they wish for the products they wish to sell. Similarly, customers can choose to accept those terms, decline them, or negotiate with them for some other mutually agreed-upon alternative.
It's also important to note that our current system is far from a free -- at best it's semi-free. Insurance companies are under numerous government constraints about what sorts of services they must/must not offer, who they can/cannot exclude, what sorts of prices they can charge, when they must accept customers, etc. For instance, some states require that a healthy 22-year old man must pay the same premium as a 60-year old man with multiple chronic health problems. Some states require that insurance companies that offer small group policies must accept every group that applies and must accept every member of the group regardless of lifestyle choice or health condition. Constraints such as these make it difficult for customers to purchase insurance in the first place. These constraints are the cause of our current problems and it is those constraints that I wish to see repealed. (For more details, please refer to "Moral Health Care Vs. 'Universal Health Care'" by Lin Zinser and myself.)
Q2) Why should whether I live or die depend on whether an insurance company finds it too costly to pay for my care? Should my fate be determined by whether a corporation finds it profitable?
A2) One should reverse that question. Should an insurance company be obliged to run at a loss? For example, there are many people who wish to force insurers to cover expensive treatments that are of minimal (if any) proven efficacy, such as bone marrow transplant in patients with late-stage breast cancer. If or when such laws are passed, insurance companies don't survive for long or else they pull out of local markets where such laws are in force, thus depriving all the other residents of that locality the possibility of purchasing insurance from that company. If an insurance company cannot be profitable, then they can't provide coverage for anyone.
More fundamentally, should an insurance company be obliged to pay for your care purely because you need it, regardless of the cost to them? The fact that you have a need does not create an automatic obligation on others to fulfill that need.
Q3) How would a free market guarantee that all Americans will have necessary health coverage?
A3) There's a premise in your question that I must disagree with - namely that it's the government's responsibility to guarantee health coverage for all Americans. It is not, any more than it's the proper role of the government to guarantee that every American has a job or a car. Health care is a need, but that's not the same thing as a right.
A right is a freedom of action that an individual possesses, such as the right to free speech. Rights impose no positive obligations on other people, merely the negative obligation to leave you alone. Rights are not automatic claims on the goods and services produced by others -- that is just state-sanctioned theft.
To further concretize the difference between a need and a right, consider an innocent child with a rare disease who will die unless he gets a bone marrow transplant from a matching donor. The only potential donor with the proper tissue match is someone who doesn't want to donate, for whatever reason (maybe he's scared of needles, maybe he's a Jehovah's Witness, maybe he's just an ornery old cuss). We'll also stipulate that the potential donor understands exactly what is at stake for the child, and that he correctly understands that donating bone marrow is a very safe procedure that would involve a few minutes of tolerable physical pain and a couple of hours of his time, but otherwise wouldn't impair his life afterwards. The fact that the child will die without that bone marrow does not mean that the child's family (or anyone else) has the right to strap that potential donor down and forcibly take a marrow sample from him against his will. The child's need does not constitute a right to that other man's bone marrow.
Q4) What if someone has a bad disease through no fault of his own, can't afford the treatment, and no insurance company will cover him? Who will pay for his care?
A4) The short answer is, "Anyone who wishes to do so."
If someone incurs an unfortunate random hardship (even though it is no fault of his own), it does not create an automatic obligation for anyone else to pay for it. Depending on the exact circumstances, I might be willing to voluntarily donate my own time/money to help him out. For example, in my capacity as a physician, I have personally waived my own professional fee more times than I can count out of voluntary charity for patients whom I've thought were worthy recipients. The same is true for nearly every other physician I know. And in general, Americans have been extraordinarily benevolent about voluntarily donating their time and money for innocent victims of natural disasters, disease, and man-made harms (such as 9-11 or the Oklahoma City bombings).
So if someone developed a bad disease that would cost him $100k, and either didn't get insurance or couldn't get insurance, then he essentially has to rely on the voluntary charity of others. His need (genuine as it may be), does not create a right to someone else's property or time.
This isn't limited to health care. The same would be true if an unfortunate homeowner didn't or couldn't purchase flood insurance, then his house was completely destroyed by a freak 100-year flood. His hardship does not constitute any sort of automatic claim on others' assets. Again, I (and many others) might be willing to be offer voluntary charity to help him out. But if no one is voluntarily willing to help him out, then he loses his house.
Furthermore, the very fact that such examples tug at the sympathies of normal decent Americans also means that those Americans will be forthcoming with voluntary charity. And I fully support giving to charities that are consistent with my values and priorities.
Q5) Isn't the purpose of a government to promote the common welfare of all citizens?
A5) No, the purpose of government is to protect individual rights - specifically to protect individuals from the predations of others who would use force to deprive men of their rights to life, liberty, and the pursuit of happiness. This includes protecting honest men from external enemies who would wage war on us as well as internal criminals who would use force to steal, murder, commit rape, etc. Hence the purpose of a government is to create and enforce conditions where men and women can freely and voluntarily exchange ideas, goods, and services to the mutual benefit according to their best rational judgment, without fear that someone else will try to forcibly rob them of those benefits. Man's essential nature requires that he uses his reasoning mind to create the values necessary for sustaining his life. Hence, protecting his right to the free use of his mind (and the right to voluntarily trade with others for the products of their thought and effort free from compulsion) is the basic function of a government.
When a government ceases to be the protector of individual rights and instead becomes one of the chief violators, then it undermines the very reason for its existence. It's akin to a government claiming that "we need to protect the freedoms of Americans from enemies abroad", and then imposing a military draft on young Americans to fight in a war (and violating those draftees' freedom and rights in the process).
Q6) Your position is very harsh and Darwinian. If you were dying of cancer and could not afford treatment, would you really say to yourself, "Oh well, this is my random bad luck, no one has an obligation to treat me and so I must die"?
A6) Yes. My life is my own responsibility. Others may choose to voluntarily help me if am in need, but they should not be legally required to do so (i.e., they should not be forced by the government to help me against their will or punished by the government for failing to help me.)
If I needed $100,000 for a life-saving cancer treatment but couldn't afford it, I would of course do everything legal and moral to try to live. I might borrow money from friends and family, I might ask for charitable contributions, I might sign up for clinical trials of experimental drugs, etc. But I wouldn't hack into my neighbor's bank account and steal that money from his kids' college fund. Or steal $100 each from a thousand of my neighbors. Or ask the government to take it from my neighbors by force.
Similarly, if my next-door neighbor was the only possible matching bone marrow donor to cure my rare disease but he didn't want to donate a sample to save my life, I wouldn't strap him down and take it from him by force. If I had a brain tumor that required a delicate operation in order for me to live, and the only neurosurgeon with the necessary skill was unwilling to do the procedure, I wouldn't force him to perform the surgery at gunpoint (or have the government force him).
That's not being Darwinian -- that's just being moral. Of course, I would prefer to live rather than die of a terrible disease. But I wouldn't want to live if it costs me my integrity and my self-respect. A man can't "save" his life at the price of sacrificing his morality, since morality is the very means that a man survives as a man.
Q7) Isn't it my social obligation to subsidize the health care of those who can't afford it?
A7) No, you have no positive binding obligation to help others although of course you have the voluntary choice. Nor is this limited to health care -- it's an application of a more general principle. If I saw a child drowning in the ocean, in all likelihood I would try to save him if I thought I had a reasonable chance of success. And nearly everyone I know would feel similarly. But if a different passerby chose not to make the attempt for whatever reason, then that's his choice to make and one which I have to respect. He has the right to decide whether he wishes to try or not. Conversely, the drowning child cannot demand that a random passerby must help him as a matter of right -- only out of voluntary charity. If it turned out that a passerby was a strong swimmer but refused to help because he was a total jerk, then I might hold him up to public moral censure -- maybe he'd lose his friends, his job, and the respect of his peers. But the government should not send him to jail for failing to take a positive action that could have saved the child's life (assuming that he wasn't the cause of the child's drowning in the first place).
Just as a passerby should not (and currently does not) have a legally binding positive obligation to help a drowning child even if he is capable of doing so at no cost to himself, he should not be obligated by law to pay for my cancer treatment. There's a crucially important difference between him having the negative obligations not to steal from me or not to deprive me of freedom of speech (i.e., to respect my rights), and any purported positive obligations to pay for my health care or save me from an accident. Again, my right to free speech implies only a negative obligation on his part not to violate it -- it does not require a positive action on his part. On the other hand, any alleged entitlement rights such as a "right" to health care is essentially a demand by me for some forced positive action from others.
Q8) I agree that health care is not a "right", but isn't it moral for the US government to raise taxes to improve the overall welfare of the nation? Universal health care (ideally administered through a free-market mechanism to the greatest extent possible) would be a good use of that power.
A8) If we agree that there is no "right" to health care, then by what right does a government force one citizen to pay for the care of another citizen? That's what any system of "universal care" essentially amounts to. What you consider a moral use of government power is something I consider deeply immoral. And the experience of other nations shows that any attempted system of universal care ends up destroying the free market that makes quality health care possible.
At a practical level, if I needed major medical care and couldn't afford it, I'd much rather rely on a pure free market plus voluntary charity from my fellow Americans, than a British-style system of government "universal care".
Although critics of the free market regularly claim that it would lead to "people dying in the streets", this would not actually happen unless Americans were far more impoverished and callous than they are today. The free market is our best protection from that scenario. And if Americans ever became that impoverished and callous, then no system of government-run universal care would be sustainable or even possible.
On the other hand, the nationalized health systems routinely deny care to people who have theoretical "universal coverage". Those patients *do* end up dying because of the allegedly "compassionate" government system.Labels: Activism, Health Care
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| Sunday, May 11, 2008 |
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My Health Care LTE in New York Times
By Paul Hsieh @ 1:00 AM
The May 11, 2008 New York Times printed my LTE in response to their earlier article from May 4, 2008, "Even the Insured Feel the Strain of Health Costs". My letter is the fourth one down on this page, and they included a mention of FIRM:To the Editor:
The skyrocketing costs of health insurance are the result of onerous government regulations, such as mandatory benefits.
Many states require insurance plans to include benefits like chiropractor care or in vitro fertilization. Such mandatory benefits raise insurance costs by about 20 percent to 50 percent, according to the Council for Affordable Health Insurance.
More fundamentally, mandated benefits violate an individual’s right to contract freely with insurers and providers according to his rational judgment for his best interest. Instead, a bureaucrat decides how the individual must spend his own money.
Eliminating these mandates would make health insurance available to millions of Americans who desperately want it but cannot now afford it.
The proper solution to the health insurance crisis is not more government, but a free market.
Paul Hsieh
Sedalia, Colo., May 4, 2008
The writer, a doctor, is co-founder, Freedom and Individual Rights in Medicine. Labels: Activism, Health Care
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| Friday, May 09, 2008 |
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Changing the Wind: The Opposition's Perspective
By Paul Hsieh @ 1:14 AM
At FIRM (Freedom and Individual Rights in Medicine), we may or may not necessarily win the battle over any specific piece of legislation. But as Lin Zinser has pointed out, that's a secondary goal. Our main goal is the promote the idea of free market health care and to make it part of the mainstream discussion, so that policy makers and the general public regard it as a serious alternative to the status quo.
Or to borrow a point from Richard Ralston of AFCM (Americans for Free Choice in Medicine), "Don't worry about changing the politicians. The politicians will wear their fingers to the bone sticking them in the air to test which way the wind is blowing. Instead, work on changing the wind. If you change the wind, the politicians will follow."
One indication that we are having the desired effect comes from our ideological opposition. A few months ago, Michele Swenson, an advocate of Canadian-style "single payer" health care for Colorado posted the following on the weblog for ProgressNow.org, which is one of the "progressive" leftist advocacy organizations in Colorado. She was complaining about the horrible media bias towards free market health care, and the appalling lack of coverage for her beloved single-payer "solution". Here's an excerpt:Open Letter to Denver Media: The information blackout by the Denver Post and Rocky Mountain News regarding Single Payer health care reform - their bias toward 'free-market' solutions
Throughout the process of the Colorado Blue Ribbon Commission for Health Care Reform, the two large Denver newspapers have consistently failed to present factual information about the Colorado Health Services Single Payer Proposal -- the one that was most favorably evaluated by the Lewin Group.
Since March of 2007 both the Denver Post and the Rocky Mountain News have each printed a number of commentaries by 'free-market' health care advocates Brian T. Schwartz and Paul Hsieh, as well as commentaries by Sen. Andy McElhany and ex-Senator Mark Hillman. Only Rep. Claire Levy was granted a commentary in the Post that dissented from the predominant 'free market' view.
At least five commentaries since the Spring of 2007 have been submitted by myself and others about the advantages of the Single Payer proposal, as well as the broken system of third-party multi-payer commercial health insurances. The information has been ignored by the Post and the News. Only out-state papers like the Pueblo Chieftain and some northern Colorado papers, including the Fort Collins Coloradoan and the Northern Colorado Business Report, have consistently printed different perspectives of health care reform, including the Single Payer perspective... Our opposition definitely knows that we are out there. And they are clearly feeling a bit on the defensive.
So we must be doing something right if the statists are demoralized over what they believe to be a media bias towards the "predominant 'free market' view"!
Of course we still have a long ways to go. And there will be inevitable ups and downs throughout the process. But I believe that we can take heart from our opponents' statements and recognize that we are changing the direction of the wind.Labels: Activism, Health Care
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| Thursday, April 10, 2008 |
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Against Mandatory Insurance
By Diana Hsieh @ 3:52 PM
This morning, Ari Armstrong and other FIRM Activists strongly encouraged writing in opposition to Massachusetts-type legislation requiring all Colorado residents to purchase individual insurance. For the reasons that Paul recently detailed in this Denver Post op-ed and on the FIRM blog, such legislation would be a disaster for Colorado health care. So, I just wrote and sent the following letter (or a slight variant thereof, depending on the recipient) to the sponsors of the bill, the members of the Colorado Senate's Health and Human Services Committee, my Colorado representative and senator, and to the Colorado governor.
It's particularly important to vocally oppose mandatory insurance, as it's widely supported by Republicans and Democrats. To the Democrats, it's just a more trendy form of universal health care than "single payer" plans. To the Republicans, it's a way to force people to "be responsible." Happily, FIRM has changed the minds of some Republicans in Colorado -- but given that three of the five sponsors of this bill are Republicans, obviously we have more work to do!
Dear So-and-So,
I am writing to ask you to oppose Senate Bill 217, which would impose mandatory health insurance in Colorado.
The government of Colorado ought to respect and uphold our rights to life, liberty, property, and the pursuit of happiness. That requires allowing people to make their own decisions in life -- whether right or wrong.
Mandatory health insurance would violate those basic American rights. It would force people to spend THEIR money as THE GOVERNMENT sees fit, regardless of the circumstances of their lives. This legislation would force people to spend money on health insurance -- at prices inflated by other mandates requiring coverage for services they don't want and won't use and by massive government welfare programs and regulations. As a result, many people will not be able to afford goods of greater value to them -- like an apartment in a better neighborhood or tutoring for their child.
No one should have to sacrifice even a trivial pleasure like a night at the movies because the government forces them to spend their money to pay for services they won't ever need -- like alcohol rehab, the HPV vaccine, autism treatment, prostate cancer screening -- as this legislation would do. (Those are already-existing Colorado mandates. This legislation would encourage even more, as special interest groups lobbied for their "indispensable" service to be covered.)
That's not the end of the wrongs of mandatory insurance -- by any stretch of the imagination. As shown by the less-than-shining example of Massachusetts, this law would drive health care costs upward, encourage doctors to retire or move to another state, decrease access to quality care, create a massive new bureaucracy, and imperil the state's finances.
This legislation is MORALLY WRONG. Please DO NOT support it.
If your goal is to fix the genuine problems in our health care system, then you MUST advocate FREE MARKET reforms. Eliminate the tax incentive for employer-provided health care. Eliminate all mandates and other regulations on health insurance. Eliminate regulations on medical providers. Gradually eliminate welfare programs.
Then, health insurance might become what it should have been all along: a person's own safety net for major injury or illness, with all ordinary medical expenses paid for out-of-pocket. That's how other forms of insurance work -- and they work well as a result.
I support Freedom and Individual Rights in Health Care -- see http://www.westandfirm.org -- and I hope that you'll do the same.
-- DMH
Diana Hsieh
Sedalia, Colorado
Ph.D Candidate, Philosophy
University of Colorado, Boulder I'm sure my letter could have been more eloquent and polished, but sometimes activism is just about what's possible in the time that you have available.Labels: Health Care, Politics
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| Friday, February 22, 2008 |
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NY Times on British Health System
By Paul Hsieh @ 8:30 AM
The February 21, 2008 New York Times has published an article suprisingly critical of the British socialized National Health Service (or NHS). Here are some excerpts:Paying Patients Test British Health Care System
...One such case was Debbie Hirst's. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist's support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.
By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.
"He looked at me and said: 'I'm so sorry, Debbie. I've had my wrists slapped from the people upstairs, and I can no longer offer you that service,' " Mrs. Hirst said in an interview.
"I said, 'Where does that leave me?' He said, 'If you pay for Avastin, you'll have to pay for everything'" -- in other words, for all her cancer treatment, far more than she could afford.
Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.
...But in a final irony, Mrs. Hirst was told early this month that her cancer had spread and that her condition had deteriorated so much that she could have the Avastin after all -- paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense. I blogged about this issue last month ("Better Equal Than Good"). Now that this issue has gotten the attention of the New York Times, perhaps patients like Debbie Hirst and Collette Mills will finally get some justice (and medical care) from the NHS.
Note the central moral issue: Being allowed to spend one's own honestly-earned money on something that will benefit one's own life is considered "unfair" by the British government.
When a government uses force to stop people from acting in their rational self-interest, it is no surprise that the results are misery and death.
(Via Amit Ghate, who has a good post on this topic as well.)Labels: Health Care
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| Monday, February 11, 2008 |
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Update on FIRM Activities
By Paul Hsieh @ 12:01 AM
Lin Zinser, executive director of FIRM (Freedom and Individual Rights in Medicine), has just posted the following summary of our first year of activities to the FIRM blog. I hope this provides a concrete example of (and inspiration for) anyone who is interested in what can and has been accomplished through philosophically principled political activity.
(And thank you, Lin, for driving all around the state giving talks, appearing on radio and TV programs, attending nearly all of the mind-numbing 208 Commission meetings, and talking with our Colorado state legislators. And thanks also go to John Powers for his support of FIRM in the form of website design and sleek graphics for the brochure copies of Dr. Peikoff's essay that Lin has distributed around the state, to Jennifer Armstrong for her design of the FIRM logo and to Diana for creating the website and mailing lists and giving FIRM its online presence.)
-- Paul Hsieh, MD
* * *
FIRM: Year End Results
by Lin Zinser
Today we celebrate the achievements of the FIRM coalition over the past year. FIRM was begun at the end of January 2007, and comprises a group of Colorado citizens with diverse careers, interests and ideas about what medicine and health insurance should (and could) look like in Colorado (and in America, for that matter). They come from different political parties and ideologies.
What these people do agree with is that the government should stop regulating, controlling and intervening in decisions that individuals make about what medical procedures they should have, whether to buy health insurance, and if so, what type of health insurance is appropriate for them and their families, and who should be their provider of services, among the thousand other decisions that people make regarding their health every year.
I am very appreciative for all of you who have supported the efforts of FIRM, and want to provide you the tangible record of your efforts. Briefly, in a summary form, they are as follows. From January 30, 2007, to January 31, 2008, FIRM coalition supporters had the following public results:
Letters to the editor -- 48 (including one in "USA Today")
OpEds/Columns -- 26
Citations in Media -- at least 10, perhaps more
Articles/Essays -- 2
Talks/Panel Discussions -- 9
Media appearances -- 6
Formal Proposal Submissions to 208 Commission -- 1
Public statements to 208 Commission -- 17
Letters to 208 Commission during their request for public comments -- at least 5, undoubtedly more
Letter to Colorado Medical Society -- 1
Public Statements to Medical Organizations -- Total 1
Public Statement to Colorado Joint Legislative Committee on Health and Human Services -- 1
Distribution of "Health Care is Not A Right", by Leonard Peikoff -- over 1,000 copies
These are fabulous results. The war is not yet won, and it will be difficult. Last year, at this time, one of the popular ideas in the public was the individual mandate to purchase insurance. This year, at least, it looks like there will not be a push for the individual mandate to purchase insurance in the State of Colorado, and that is due in no small part to the efforts of FIRM supporters -- of their own, individual efforts. Individual mandates are not dead, but they are no longer thriving.
This year, it appears that the effort will be to expand government health insurance to all of the uninsured children in the state, increasing the number of people on government programs that don't work, giving families the illusion of coverage, at an expensive price tag for all, including taxpayers. We expect to see additional restrictions on insurance policies, including benefit mandates and rating issues as well. So there is work yet to do.
Below are the details that support the summary above. I applaud every name on the list, and I also applaud all of you who have written, sent comments and forwarded any of these efforts to friends, family, co-workers, doctors or other health-care providers. Please remember as you read the list, that not everyone on the list may absolutely be in 100% agreement with all aims of FIRM. FIRM is a coalition, and its ideas are expressed in its Statement of Principles and Goals. These individuals have expressed their adherence to some of these goals in these particular writings or public statements.
A special thanks to Paul Hsieh for blogging so diligently and for co-writing with me an excellent article on the state of medicine and health insurance in America.
I have used smaller type so that this blog post is not so long.
Letters to the editor -- Total 48 (including one in "USA Today")
Diana Hsieh, Rocky Mountain News, 2/5/2007, "Paul Campos: Health Care"
Brian Schwartz, Denver Post, 3/3/2007, "Universal Health Care"
Richard Watts, Rocky Mountain News, 4/16/2007, "End government health-care meddling"
Richard Watts, Craig Daily Press, 4/19/2007, "Health Care"
Paul Hsieh, Denver Post, 4/24/2007, "Health Care is Not a Right"
Russell Shurts, Rocky Mountain News, 4/25/2007, "Health Care in Colorado"
Richard Watts, Rio Blanco Herald Times, 4/26/2007, "Health Care"
Paul Hsieh, Denver Post, 4/30/2007, "Two Arguments Why Health Care is Not a Right"
Brian Schwartz, Denver Post, 4/30/2007, "Fair Health Care"
Brian Schwartz, Rocky Mountain News, 5/3/2007, "Medical insurance restrictions are costly"
Brian Schwartz, Boulder Daily Camera, 5/3/2007, "Health Care: The government would worsen it"
Ralph Shnelvar, Denver Post, 5/6/2007, "Debating health care systems in U.S., Canada"
Hanah Krening, Denver Post, 5/23/2007, "Proposals to reform health care in Colorado"
Paul Hsieh, Pueblo Chieftain, 5/27/2007, "Socialized Medicine"
Richard Watts, Steamboat Pilot, 5/30/2007, "Too Much Control"
Richard Watts, Rocky Mountain News, 5/31/2007, "Health Care"
Richard Watts, Glenwood Springs Post-Independent, 5/31/2007, "Don't Allow the Government to Dictate Your Health Care"
Gina Liggett, Denver Post, 6/6/2007, "Free Market Health Care Reform"
Gina Liggett, Boulder Daily Camera, 6/9/2007, "There is No 'Right' to Any Health Care"
Gina Liggett, Grand Junction Daily Sentinel, 6/13/2007, "Need vs. Right"
Gina Liggett, Carbondale Valley Sentinel, 6/14/2007, "Need vs. Right"
Gina Liggett, Pueblo Chieftain, 6/17/2007, "Health Panel Stacked Deck"
Brian Schwartz, Denver Post, 6/19/2007, "'Universal' Health Care"
Richard Watts, Grand Junction Free Press, 6/21/2007, "Health Care is Not a Right"
Richard Watts, Boulder Daily Camera, 6/22/2007, "Health Care is Not a Right"
Martin Buchanan, Denver Post, 6/27/2007, "Health Care For All: Whose Responsibility Is It?"
Gina Liggett, Rocky Mountain News, 6/28/2007, "Health Care is Not a 'Right', It's a Need"
Russell Shurts, Rocky Mountain News, 6/29/2007, "Social Responsibility"
Gina Liggett, USA Today, 6/29/2007, "Moore In Denial"
Brian Schwartz, Rocky Mountain News, 7/2/2007, "Health Insurance"
Diana Hsieh, Colorado Springs Gazette, 7/3/2007, "People, not government, responsible for health"
Gina Liggett, Denver Post, 7/6/2007, "Health Care in the US"
Gina Liggett, Northern Colorado Business Report, 7/6/2007, "Free Health Care?!"
Richard Watts, Rocky Mountain News, 7/7/2007, Health Care"
Paul Hsieh, Rocky Mountain News, 7/12/2007, "In-Store Health Clinics"
Diana Hsieh, Rocky Mountain News, 7/17/2007, "Free Market Medicine is the Answer"
Gina Liggett, Colorado Confidential, 7/21/2007, "Health Care"
Paul Hsieh, Denver Post, 7/31/2007, "Rising Health Care Costs"
Richard Watts, Denver Post, 7/31/2007, "SCHIP Program"
Lin Zinser, Rocky Mountain News, 8/7/2007, "Health Care in Colorado"
Brian Schwartz, Rocky Mountain News, 8/13/2007, "Free Markets Key to Affordable Health Care"
James Schroeder, Grand Junction Daily Sentinel, 8/28/2007, "Single Payer Health Plan Would Be Costly and Unfair"
Brian Schwartz, Denver Post, 8/31/2007, "Health Savings Accounts"
Brian Schwartz, Denver Post, 9/7/2007, "Funding Health Care"
Russell Shurts, Grand Junction Free Press, 9/13/2007, "We Shouldn't Be Forced"
Brian Schwartz, Boulder Daily Camera, 9/24/2007, "We Do Not Have Free Market Care"
Brian Schwartz, Boulder Daily Camera, 1/4/2008, "Free Market Health Insurance Needed"
Brian Schwartz, Rocky Mountain News, 1/17/2008, "Politically Controlled Insurance Is a Disease"
OpEds/Columns -- Total 26
Brian Schwartz, Boulder Daily Camera, 2/11/2007, "Government-run auto repair? Yes!"
Ari Armstrong, Boulder Weekly, 2/15/2007, "Colorado Medical Socialism"
Ari Armstrong, "What's Right With Colorado Health Care", 4/8/2007, Independence Institute
Brian Schwartz, Rocky Mountain News, 4/28/2007, "Government controls violate rights, raise costs, cut access"
Paul Hsieh, Rocky Mountain News, 6/2/2007, "Free market holds key to ensuring quality for Coloradans"
Paul Hsieh, Boulder Daily Camera, 6/10/2007, "Socialized Medicine is Wrong for State"
Paul Hsieh, Pueblo Chieftain, 6/10/2007, ""Blue ribbon panel prescribes wrong approach on health care"
Linn and Ari Armstrong, Grand Junction Free Press, 6/11/2007, "Health socializers ignore benefits of liberty, harms of controls"
Brian Schwartz, Denver Post, 8/5/2007, "Don't Model State Reforms on Medicaid: How Should Colorado Lawmakers Fix A Broken System"
Russell Shurts, Rocky Mountain News, 8/7/2007, "Socialized Medicine Just Another Gang Operation"
Ralph Shnelvar, Boulder Daily Camera, 8/14/2007, "Your Government Doesn't Care"
Brian Schwartz, Boulder Daily Camera, 8/26/2007, "Warning: Medicaid is Hazardous to Your Health"
James Schroeder, Grand Junction Free Press, 8/23/2007, "Beware of unintended consequences of health care proposals"
Linn and Ari Armstrong, Grand Junction Free Press, 9/3/2007, "Reformers demand more labor for politically-run medicine"
Paul Hsieh, Ayn Rand Institute, 9/18/2007, "'Single-Payer' Health Care Is Anything but Free"
Brian Schwartz, Rocky Mountain News, 9/26/2007, "Government Control Is Bad For Your Health"
Linn and Ari Armstrong, Grand Junction Free Press, 10/15/2007, "Insurance Mandates Threaten Your Health"
Linda Gorman, Independence Institute, 10/24/2007, "It's Official: Medicaid Managed Care Does Not Save Money"
James Schroeder, Grand Junction Daily Sentinel, 11/18/2007, "Expanding Medicaid Eligibility Will Mean Fewer Doctors Accept It"
Brian Schwartz, 11/21/2007, Independence Institute, "Ritter's health care cure would prove more crippling to Coloradans"
Linda Gorman, Independence Institute, 12/3/2007, "Health care "reform" in Colorado: Go home and die; it's cheaper"
James Schroeder, Grand Junction Free Press, 12/26/2007, "Here's Your Prescription"
Brian Schwartz, TCS Daily, 1/14/2008, "Compulsory Medical Insurance as Collective Punishment"
Linn and Ari Armstrong, Grand Junction Free Press, 1/21/2008, "More Political Control of Medicine Comes With Higher Costs"
Linda Gorman and Ari Armstrong, Rocky Mountain News, 1/30/2008, "A Very Costly Health Care Solution"
Brian Schwartz, Colorado Springs Gazette, 1/31/2008, "Compulsory Insurance as Collective Punishment"
Citations in Media -- At least 10, perhaps more
Lin Zinser quoted in Colorado Springs Gazette, 5/22/2007, "State health care commission narrows focus"
Paul Hsieh quoted on Mike Rosen Radio show, 6/7/2007
Brian Schwartz cited in Face the State, 8/27/2007, "Does the Effort to Provide Government Health Care For All Kids Leave Too Many Behind?"
Brian Schwartz quoted in Denver Post, 8/31/2007, "Experts pan health savings accounts"
James Schroeder quoted in Grand Junction Daily Sentinel, 10/12/2007, "Community Discusses Health Care Reform"
Brian Schwartz quoted in Rocky Mountain News, 10/5/2007, "Audience at health care forum backs single-payer proposal"
Ari Armstrong and Brian Schwartz cited in Rocky Mountain News, 10/13/2007, Jason Salzman Column
Brian Schwartz and Paul Hsieh quoted in Colorado Springs Gazette editorial, 1/3/2008, "Health Care, Ho! State Should Avoid Repeat of Massachusetts"
Linda Gorman cited in Rocky Mountain News, 1/10/2008, "Mandatory Health Plan Participation Opposed"
Linda Gorman and Brian Schwartz cited in Face the State, 1/31/2008, "Minority Report Critical of Health Commission Findings"
Articles/Essays -- Total 2
Paul Hsieh, Colorado Medicine (March-April 2007 issue), "An Open Letter to Colorado Physicians"
Lin Zinser and Paul Hsieh, The Objective Standard (Winter 2007-2008 issue), "Moral Health Care vs. 'Universal Health Care'"
Guest Speaker/Panel Discussions -- Total - 9
Lin Zinser, "The Crisis in Colorado Health Care", 4/17/2007, Colorado Springs Republican Women
Lin Zinser, Aurora Rotary Club, 6/11/2007
Lin Zinser, Grand Junction, 7/19/2007
Lin Zinser, Castle Rock Republicans, 7/20/2007
Lin Zinser, Jefferson County Town Hall Meeting, 8/18/2007
Lin Zinser, Greeley Centennial Rotary Club, 9/6/2007
Lin Zinser, El Paso County Republican Women, 9/17/2007
Lin Zinser, Mesa County Republicans, 9/21/2007
Lin Zinser, Gateway Rotary Club, 9/26/2007
Media appearances -- Total 6
Lin Zinser, 5/10/2007, Amy Oliver Radio Show
Lin Zinser, 5/18/2007, John Caldera TV Show "Independent Thinking"
Brian Schwartz, 6/17/2007, John Andrews Radio Show
Lin Zinser, 7/26/2007, KNZZ Report Radio Show
Lin Zinser, 7/26/2007, Grand Junction TV 5:00 news
Lin Zinser, 9/6/2007, Amy Oliver Radio Show
Formal Proposal Submissions to 208 Commission -- Total 1
Brian Schwartz, "Free Markets, Affordability & Individual Rights"
Public statements to 208 Commission Meetings -- Total 17
Paul Hsieh (read by Lin Zinser), 1/30/2007
Brian Schwartz, 10/4/2007
James Schroeder, 10/11/2007
Lin Zinser, 1/30/2007, 1/31/2007, 2/21/2007, 3/28/2007, 4/27/2007, 5/17/2007, 5/18/2007, 6/19/2007, 7/18/2007, 8/23/07, 9/24/2007, 11/02/2007, 12/13/2007, 1/10/2008
Letters to 208 Commission during their request for public comments -- Total at least 5, undoubtedly more
Lin Zinser, Diana Hsieh, Paul Hsieh, Betty Evans, Richard Watts, and others
Letter to Colorado Medical Society - Total 1
James Schroeder, November 2007
Public Statements to Medical Organizations - Total 1
Paul Hsieh, Arapahoe-Douglas-Elbert Medical Society, 6/21/2007
Public Statement to Colorado Joint Legislative Committee on Health and Human Services - Total 1
Lin Zinser, January 31, 2008
Labels: Health Care, Politics
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| Sunday, January 20, 2008 |
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The International Physician Brain Drain
By Paul Hsieh @ 8:34 AM
For some reason, far more physicians are choosing to come to the US from Canada, Australia, and the UK than the other way around:
From "The Metrics of the Physician Brain Drain", New England Journal of Medicine, Volume 353:1810-1818, Number 17, October 27, 2005. (The PDF version is here.)
The article does not state any conclusions about the factors that give rise to this result. Of course, my own guess is that the medical practice is relatively more free (i.e., less socialized) in the US than in those other three countries, thus making it a more desirable place for doctors to work and live.Labels: Health Care
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| Wednesday, January 09, 2008 |
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Yaron Brook on Health Care
By Paul Hsieh @ 8:08 AM
Forbes.com has just published the following excellent opinion piece by Yaron Brook on health care:The Right Vision Of Health Care
Yaron Brook 1.08.2008
With the primary season in full swing, the presidential candidates are fighting over what to do about the spiraling cost of health care--especially the cost of health insurance, which is becoming prohibitively expensive for millions of Americans.
The Democrats, not surprisingly, are proposing a massive increase in government control, with some even calling for the outright socialism of a single-payer system. Republicans are attacking this "solution." But although they claim to oppose the expansion of government interference in medicine, Republicans don't, in fact, have a good track record of fighting it.
Indeed, Republicans have been responsible for major expansions of government health care programs: As governor of Massachusetts, Mitt Romney oversaw the enactment of the nation's first "universal coverage" plan, initially estimated at $1.5 billion per year but already overrunning cost projections. Arnold Schwarzenegger, who pledged not to raise any new taxes, has just pushed through his own "universal coverage" measure, projected to cost Californians more than $14 billion. And President Bush's colossal prescription drug entitlement--expected to cost taxpayers more than $1.2 trillion over the next decade--was the largest expansion of government control over health care in 40 years.
Today, nearly half of all spending on health care in America is government spending. Why, despite their lip service to free markets, have Republicans actually helped fuel the growth of socialized medicine and erode what remains of free-market medicine in this country?
Consider the basic factor that has driven the expansion of government medicine in America.
Prior to the government's entrance into the medical field, health care was regarded as a product to be traded voluntarily on a free market--no different from food, clothing, or any other important good or service. Medical providers competed to provide the best quality services at the lowest possible prices. Virtually all Americans could afford basic health care, while those few who could not were able to rely on abundant private charity.
Had this freedom been allowed to endure, Americans' rising productivity would have allowed them to buy better and better health care, just as, today, we buy better and more varied food and clothing than people did a century ago. There would be no crisis of affordability, as there isn't for food or clothing.
But by the time Medicare and Medicaid were enacted in 1965, this view of health care as an economic product--for which each individual must assume responsibility--had given way to a view of health care as a "right," an unearned "entitlement," to be provided at others' expense.
This entitlement mentality fueled the rise of our current third-party-payer system, a blend of government programs, such as Medicare and Medicaid, together with government-controlled employer-based health insurance (itself spawned by perverse tax incentives during the wage and price controls of World War II).
Today, what we have is not a system grounded in American individualism, but a collectivist system that aims to relieve the individual of the "burden" of paying for his own health care by coercively imposing its costs on his neighbors. For every dollar's worth of hospital care a patient consumes, that patient pays only about 3 cents out-of-pocket; the rest is paid by third-party coverage. And for the health care system as a whole, patients pay only about 14%.
The result of shifting the responsibility for health care costs away from the individuals who accrue them was an explosion in spending.
In a system in which someone else is footing the bill, consumers, encouraged to regard health care as a "right," demand medical services without having to consider their real price. When, through the 1970s and 1980s, this artificially inflated consumer demand sent expenditures soaring out of control, the government cracked down by enacting further coercive measures: price controls on medical services, cuts to medical benefits, and a crushing burden of regulations on every aspect of the health care system.
As each new intervention further distorted the health care market, driving up costs and lowering quality, belligerent voices demanded still further interventions to preserve the "right" to health care. And Republican politicians--not daring to challenge the notion of such a "right"--have, like Romney, Schwarzenegger and Bush, outdone even the Democrats in expanding government health care.
The solution to this ongoing crisis is to recognize that the very idea of a "right" to health care is a perversion. There can be no such thing as a "right" to products or services created by the effort of others, and this most definitely includes medical products and services. Rights, as our founding fathers conceived them, are not claims to economic goods, but freedoms of action.
You are free to see a doctor and pay him for his services--no one may forcibly prevent you from doing so. But you do not have a "right" to force the doctor to treat you without charge or to force others to pay for your treatment. The rights of some cannot require the coercion and sacrifice of others.
So long as Republicans fail to challenge the concept of a "right" to health care, their appeals to "market-based" solutions are worse than empty words. They will continue to abet the Democrats' expansion of government interference in medicine, right up to the dead end of a completely socialized system.
By contrast, the rejection of the entitlement mentality in favor of a proper conception of rights would provide the moral basis for real and lasting solutions to our health care problems--for breaking the regulatory chains stifling the medical industry; for lifting the government incentives that created our dysfunctional, employer-based insurance system; for inaugurating a gradual phase-out of all government health care programs, especially Medicare and Medicaid; and for restoring a true free market in medical care.
Such sweeping reforms would unleash the power of capitalism in the medical industry. They would provide the freedom for entrepreneurs motivated by profit to compete with each other to offer the best quality medical services at the lowest prices, driving innovation and bringing affordable medical care, once again, into the reach of all Americans.
Yaron Brook is managing director of BH Equity Research and executive director of the Ayn Rand Institute. You can post comments in response to this op-ed on the Forbes web site. (So far, most of the comments are negative.)Labels: ARI, Health Care
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| Friday, January 04, 2008 |
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Colorado Springs Gazette OpEd on Health Care Reform
By Paul Hsieh @ 10:08 AM
The January 4, 2008 edition of the Colorado Springs Gazette has published a good editorial on health care reform in Colorado. Both Brian Schwartz and myself were cited in their OpEd. Lin Zinser and Ari Armstrong also gave their editor (Wayne Laugesen) a great deal of background information, although their names don't appear in the piece.
Once again, this shows that it is possible to get good ideas circulated amongst the wider culture, as long as one is willing to do the work necessary to advocate them.
Here is the full text of their OpEd:Health care, ho!
State should avoid repeat of Massachusetts
THE GAZETTE January 3, 2008
For Colorado Democrats, a regulatory fix of the state's ailing health care system may seem irresistible during the upcoming 2008 legislative session. Imagine the attention major health care reform, or statewide "universal health care," would garner from the media in August, when the country's Democrats converge in Denver for the Democratic National Convention. Colorado could be held up as the example of how it can and should be done. Democratic leaders could be lauded for aiding 792,000 uninsured men, women and children.
House Speaker Andrew Romanoff, as quoted in The Gazette, says Coloradans are tired of waiting on a federal government that "cannot or won't fix" the health care crisis. The Blue-Ribbon Commission on Health Care Reform, appointed by legislative leaders and the governor, will present its recommendations to the Legislature on Jan. 31. The commission plans to recommend that all Colorado residents be mandated to buy insurance that meets minimum standards, and state subsidies would be extended to more of the state's poor.
Before politicians get too ambitious, however, they should take a closer look at the health care reform led by a leading Republican: Mitt Romney, the former governor of Massachusetts.
"The majority of the commission favors a government-heavy proposal," says Dr. Paul Hsieh, a Denver physician who has studied the new Massachusetts system. "They're crafting it similar to the Massachusetts model."
A year old, the Massachusetts system is resulting in rationing and shortages of care, and higher costs to taxpayers than originally expected. The Patriot Ledger newspaper tells of Lee Sampson, a 47-year-old unemployed medical transcriptionist. Sampson bought into Commonwealth Care, a state-subsidized insurance cooperative. She had to buy insurance by Jan. 1 to avoid tax penalties and fines.
But Sampson, like a growing number of other Massachusetts residents, is learning that mandatory insurance doesn't mean doctors will treat her. To receive benefits from the plan, Sampson must find a primary care physician. She reported calling 50 doctors' offices within a half-hour drive of her home. All rejected her. Most explained they were overwhelmed and accepting no new patients.
Massachusetts, like Canada, will learn that mandating health care as a universal right results in a demand for services that exceeds the supply. The demand for medical services under the new Massachusetts system has become so great, and so expensive, that state officials are cutting back on the compensation doctors receive for services, while raising patient co-pays. The medical community, struggling with high demand and inadequate reimbursement, is cutting costs by rationing services for patients like Sampson.
Ask Americans if they would enjoy free universal health care, like the Canadians have, and many will say yes. Ask the same folks if they'd like to wait several months for an MRI, a heart scan or chemotherapy -- as Canadians often do -- and they'll give a resounding "no way."
Yet one can't argue that our nation's health care system is well. As reported by The New York Times, health care costs are going up at twice the rate of inflation. With soaring costs come rising insurance rates, which fewer employers and individuals are willing or able to pay. Based on U.S. Census data, 10 million Americans were uninsured 15 years ago. Today, more than 46 million live uninsured.
While it's expedient for politicians to promise a solution in the form of a program, Massachusetts will continue showing us why it doesn't work. Government intervention, in fact, explains the failures of our current system. The IRS code drives most Americans to buy health insurance through employers. That means insurers don't have to compete for consumers, because for most Americans, shopping around for a better deal involves a career change. And because health insurance has been packaged as a "free" benefit from employers, patients have spent the past half-century consuming health care without challenging the price. For those with health plans, "insurance" has morphed into pre-paid service, seemingly paid for by someone else. Imagine a system in which large employers provided auto insurance. Would employees balk at the cost of this "free" benefit, demanding a better price? If the insurance covered routine oil and lube jobs, the way health insurance covers physicals, would consumers demand lower prices from Grease Monkey? Doubtful.
State legislators can't change the morass of federal regulation that has led to a health care system unrestrained by the conventional market forces that control other services and goods. But legislators can improve access to health care by eliminating most of the state controls that prohibit affordable coverage. State law, for example, requires that health insurance plans include coverage for childhood autism -- even for consumers with no prospect of children. Regardless of a consumer's personal needs, any policy he or she buys in Colorado must cover alcohol rehab, mental health and maternity treatments -- to name a few. Why not a law that says all cell phone plans must come with 80-channel cable TV?
Brian Schwartz, an Arvada-based optical engineer, proposed to the Blue Ribbon Commission a market-based health care reform package that mostly involved deregulation. Commission member Linda Gorman fought for it, but others scoffed.
"One commissioner said we already have a free market in health care, and it has failed," Schwartz told The Gazette. "But we don't have a free market. If you're a widow, you have to buy a policy that covers marital therapy, maternity and prostate cancer. You have no need for this, but if you want insurance you're required to buy it. Mandates raise your premium by 20 to 50 percent."
Government, as we're seeing in Massachusetts, can't make health care affordable and abundant. Market forces can and will -- if politicians ever allow them to. Labels: Health Care
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| Monday, December 03, 2007 |
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Facts and Fictions
By Diana Hsieh @ 7:09 AM
A recent NY Times article helpfully explains the facts behind some misleading statistics concerning health care, particularly:
"The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance."
"Some 47 million Americans do not have health insurance."
"Health costs are eating up an ever increasing share of American incomes."
The author concludes by saying that, "As we look at reform plans, we should be careful not to be fooled by statistics into thinking that the problems we face are worse than they really are."
That's true, but it does not go far enough. Neither gloomy statistics nor scary anecdotes could ever justify violating the rights of doctors, hospitals, and other health care providers, as well as insurance companies, patients, and taxpayers. The government should protect everyone's rights to property and contract -- not violate them with burdensome entitlements, regulations, and taxation. That's the only possible solution to the problems in today's health care system.Labels: Health Care
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| Monday, November 12, 2007 |
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Death by Godly Politics
By Diana Hsieh @ 7:50 AM
Paul sent me this horrifying story of a woman allowed to die of a totally non-viable ectopic pregnancy due to Nigaragua's strict anti-abortion law. Presumably, the doctors didn't dare to save her life for fear of prosecution.
Two weeks after Olga Reyes danced at her wedding, her bloated and disfigured body was laid to rest in an open coffin -- the victim, her husband and some experts say, of Nicaragua's new no-exceptions ban on abortion.
Reyes, a 22-year-old law student, suffered an ectopic pregnancy. The fetus develops outside the uterus, cannot survive and causes bleeding that endangers the mother. But doctors seemed afraid to treat her because of the anti-abortion law, said husband Agustin Perez. By the time they took action, it was too late.
Nicaragua last year became one of 35 countries that ban all abortions, even to save the life of the mother, according to the Center for Reproductive Rights in New York. The ban has been strictly followed, leaving the country torn between a strong tradition of women's rights and a growing religious conservatism. Abortion rights groups have stormed Congress in recent weeks demanding change, but President Daniel Ortega, a former leftist revolutionary and a Roman Catholic, has refused to oppose the church-supported ban.
Evangelical groups and the church say abortion is never needed now because medical advances solve the complications that might otherwise put a pregnant mother's life at risk.
But at least three women have died because of the ban, and another 12 reported cases will be examined, said gynecologist and university researcher Eliette Valladares, who is working with the Pan American Health Organization to analyze deaths of pregnant women recorded by Nicaragua's Health Ministry. When I researched this issue about a year ago, polls showed that about 10 to 12 percent of Americans support a similar ban on abortion regardless of threat to the life of the mother. That's frightening.
Also, at the bottom of the article, you'll find a map of the world highlighting the countries with a total ban on abortion.Labels: Health Care, Religion
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| Monday, September 17, 2007 |
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"Single-Payer" Health Care Is Anything but Free
By Diana Hsieh @ 4:17 PM
My very own Paul Hsieh just published an op-ed on health care through the Ayn Rand Institute: "Single-Payer" Health Care Is Anything but Free. Here it is, in full.
"Single-Payer" Health Care Is Anything but Free
By Paul Hsieh
Michael Moore's latest movie "SiCKO" sings the praises of the Canadian "single-payer" socialized medical system. Some Americans want a similar system implemented in the United States. Defenders of the Canadian system frequently claim that patients don't have to worry about money when they're sick--the health care is free. But is this really true?
No.
First, it is ludicrous to think the system is free. Each citizen is forced to pay for his neighbors' medical care in the form of high taxes. (As a percentage of GDP, total taxation is 28 percent higher in Canada than in the United States.) The government, rather than individuals, then decides how that money is spent.
Even worse, in the name of "equal access" the government generally forbids patients from purchasing medical services outside of its system. Canadian law makes it difficult or impossible for citizens to spend their own honestly earned money on medically necessary care for themselves or their loved ones, even when both the doctor and the patient are willing.
To control costs, the government restricts access to crucial medical services via infamous waiting lists. This imposes a second, hidden, cost on patients: their time.
According to the Vancouver-based Fraser Institute, "Canadian doctors say patients wait almost twice as long for treatment than is clinically reasonable, . . . almost 18 weeks between the time they see their family physician and the time they receive treatment from a specialist."
Because of the waiting lists, mortality rates for treatable conditions such as breast cancer and prostate cancer are significantly higher in Canada than in the U.S. A Canadian woman who discovers a lump in her breast might wait for months before she receives the surgery and chemotherapy she needs, with the cancer cells multiplying rapidly as each week goes by. If she lived in the United States, she could receive treatment within days.
This tax on time is especially cruel because the burden falls hardest on the sickest patients, i.e., those with the least time to spare.
Consequently, Canadian patients routinely suffer and die while waiting for their "free" health care. The National Center for Policy Analysis notes, "During one 12-month period in Ontario, ... 71 patients died waiting for coronary bypass surgery while 121 patients were removed from the list because they had become too sick to undergo surgery."
To guarantee "free" health care, a government must force the individual to pay for everyone else's medical care and limit his freedom to pay voluntarily for his own. With bureaucrats deciding who receives what, the individual is therefore forbidden from spending his money according to his own rational judgment (and the advice of his doctors) as to what's best for his health. When a government forces people to act against their own interests, it's no surprise that the results are misery and death.
Fortunately, Canadians are starting to recognize the problems inherent in "single-payer" health care and are taking very small steps towards limited private medicine. America must not repeat Canada's mistakes. As P. J. O'Rourke said, "If you think health care is expensive now, wait until you see what it costs when it's free."
Paul Hsieh, MD, guest writer, is a practicing physician in the south Denver metro area. He is a founding member of the Colorado group Freedom and Individual Rights in Medicine (www.WeStandFIRM.org). His e-mail address is: paulhsiehmd@gmail.com.
The Institute promotes Objectivism, the philosophy of Ayn Rand--author of "Atlas Shrugged" and "The Fountainhead."
Copyright (c) 2007 Ayn Rand(R) Institute. All rights reserved. Labels: Health Care
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| Friday, September 07, 2007 |
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Book Recommendation
By Diana Hsieh @ 7:00 AM
Lin Zinser recently posted this book recommendation on the FRODO e-mailing list. I thought it worthy of reposting on NoodleFood, and Lin was kind enough to give me permission to do so. She wrote:
I am currently reading one of the most significant books about political activism that I have ever read. Many of you may have picked up copies at OCON this summer. For those of you who have not, I urge you to buy this book and read it.
The book contains a series of essays, written by various authors about the proper methods, strategies and tactics of political action on a specific topic. It is a book with the most consistently good moral arguments that I remember reading outside of Ayn Rand. (Although some use religious arguments, they are perfunctory, almost add-ons, rather than central theses.)
These authors understand moral arguments and their importance. They are deeply ideological. They are passionate. They are rational. They debate the important political topics relevant to achieving a political purpose, such as, what are the proper considerations in voting for a party or a political candidate; should one form a separate political party or infiltrate existing parties; is it ever proper to use force to achieve political ends, particularly when force is being used against you; is it more profitable to advocate gradual change or to hold out for absolute and complete perfection; what is the moral and the practical, and do they ever conflict; and other interesting crucial matters pertaining to political action used to achieve a particular goal.
These essays were written by 19th century abolitionists. The book is Anti-Slavery Political Writings, 1833-1860, and is edited by C. Bradley Thompson (executive director of the Clemson Institute for the Study of Capitalism).
All of these authors condemn slavery, are on the "same side" in the war against slavery, and yet their arguments with each other are sharp, clear, compelling and harsh. Passion and reason radiate throughout these essays. Brad Thompson's introductory essay and his comments on each selection are illuminating and distill the essence and fundamental nature of the issues involved. His choice of these selections is truly inspired because these particular essays focus one one the essence of the debate. This book emphasizes the practical nature of philosophy.
If you want to understand how abolitionists brought slavery to the forefront of American thought in less than 10 years; if you want to study how a good, moral political movement changed the world in 30 years; if you want to get involved in political action today, but you want to do it in a principled, moral way -- this is the book to read, understand and study. Whether your concern is foreign policy, health care, immigration, or education, this book is an excellent resource and tool. I should add: Brad Thompson's course at OCON in June, American Slavery, American Freedom was not only stellar but also very relevant to politics today. I highly recommend buying it when it becomes available. The book and the course would make a great pair, I imagine.Labels: Health Care
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| Thursday, August 09, 2007 |
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Republicans and Health Care
By Paul Hsieh @ 7:00 AM
FIRM is a non-partisan organization, and hence is not a supporter of either political party, nor any particular political candidate. And although Rudolph Guiliani makes some good points in this recent opinion piece in the August 3, 2007 Boston Globe, others have taken issue with his statement that, "Most Republicans believe in expanding individual choice and decision-making."
In particular, the FreeMarketCure.com weblog notes:Let's see: When the GOP was in charge of the Senate and the Oval Office, it passed COBRA and EMTALA, two major expansions of government regulation into health care. When the GOP controlled both house of Congress, it passed HIPAA, another big expansion of government regulation into health care, plus a new government health insurance program, the State Children's Health Insurance Program (SCHIP). Now, Republicans like Orrin Hatch and Chuck Grassley are leading the charge for a big SCHIP expansion. Finally, Republican Senator Pete Domenici is pushing for a nationwide "mental health parity" benefit mandate, one that President Bush says he will sign if it passes.
"Most" Republicans believe in believe in expanding individual choice? Heck, I'd settle for half. Although individual Republicans may vary, I don't see any principled opposition to socialized medicine coming from them as a party. Certainly, the health care proposals of high-profile Republicans such as Mitt Romney and Arnold Schwarzenegger are as bad as any that have come from Democrats such as Hillary Clinton or Barack Obama.Labels: Health Care
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| Friday, August 03, 2007 |
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Public Debate on Free Market Medicine
By Diana Hsieh @ 9:10 AM
Two days ago, the Denver Post published two good letters defending free market medicine from FIRM supporters Paul Hsieh and Richard Watts:
Rising health care costs and the SCHIP program
Re: "Uninsured grow as hospital costs soar," July 27 news story.
The real culprit behind rising medical costs is government interference in medicine. In the sectors of medicine where there is the least government regulation, such as cosmetic surgery and LASIK, we see a continual decrease in prices and improvement in quality. This is the normal pattern of a free market, and something we take for granted in the rest of the economy. Just ask anyone who's bought a DVD player recently.
Instead of more government regulation of medicine, we need less. Free-market plans, such as health savings accounts combined with high-deductible catastrophic insurance, preserve the patient's right to spend his money as he sees fit, and have been proven to cut costs while preserving high-quality medical care.
Free-market medicine is the only genuine cure for rising health costs.
Paul Hsieh, M.D., Sedalia
Re: "Child health care funding is vital," July 22 editorial.
Your editorial claims that the State Children's Health Insurance Program (SCHIP) should be expanded. It indicates that President Bush supports renewing SCHIP but not expanding it, and that Sen. Ken Salazar claims that SCHIP is a moral obligation. But SCHIP, like all entitlement programs, forces some to subsidize the expenses of others.
Each parent has the moral responsibility to care for the health of his or her own children, and parents need to evaluate their decision to have kids based on their ability to finance appropriate care. It is morally wrong to force anyone to subsidize the expenses of someone else's children, whether for health care or any other cost.
Anyone who wishes to help those who cannot afford medical care should do so voluntarily through private charity, not by trying to use the force of government to extort money from others. The funding of SCHIP should be neither renewed nor expanded. Instead, this immoral program should be abolished.
Richard Watts, Hayden Yesterday, they published two letters in reply:
"Laughable" health debate
Re: "Rising health care costs and the SCHIP program," July 31 letters to the editor.
Letter-writers Paul Hsieh and R. Stamp, in their separate ways, demonstrate why the "debate" over health care is so laughable. Hsieh extols the power of the marketplace to lower health care costs, suggesting that government is the reason for high costs. I'm so glad we will all be able to afford LASIK surgery and cosmetic procedures. Seeing how $1,500 of the cost of an American-made car pays for health insurance, I suspect that Dr. Hsieh would also attribute government meddling and overregulation for the demise of U.S. industry as well. What the good doctor fails to mention is that the biggest difference in health care costs between the U.S. and other industrialized countries, aside from better outcomes abroad, is inflated physician salaries here.
Stamp suggests funding the State Children's Health Insurance Program not with general funds but by, say, raising the tobacco tax. News flash: that's precisely how the proposed SCHIP program is to be funded.
The primary problem critics have with "socialized medicine" is the fact that it works.
Chardo Holicky, Denver
...
Tuesday's letters on health care costs and SCHIP are disturbing.
One writer doesn't understand that "DVD players" and "health care" are different. The "free market" fails for health insurance because adverse selection causes the healthier to drop out, increasing costs on those remaining. This leads to spiraling increases in dropouts and costs. This understanding earned a Nobel Prize; it's not a secret.
Another sees providing SCHIP for children to be a moral obligation of parents. Perhaps so, but when parents fail their children, it's a moral obligation of society to not penalize children for "choosing the wrong parents." Whatever happened to the concept of equal opportunity?
Another writer charges SCHIP looks like a "toehold for socialized medicine." Some don't realize that it's practical to use government when privatized approaches fail. And privatized health insurance fails in America and elsewhere. Americans seem to be the last to realize it.
Bob Powell, Colorado Springs I'd like to address this anti-conceptual argument that markets work for DVD players but not for medicine head-on. The fact is that markets don't merely work for medicine, they are crucial for it. Any recommendations on how best argue that point?Labels: Health Care
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| Wednesday, July 18, 2007 |
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Letter Published After All
By Diana Hsieh @ 8:28 AM
Hooray! My June letter to the editor was published in the Rocky Mountain News after all. It appeared in yesterday's print edition, but you can read it (plus a ton of comments) online: Free-market medicine is the answer.
Update: Whoops, that probably made no sense whatsoever. I wrote up a post a few days ago with my letter to the Rocky Mountain News which I'd presumed wasn't to be published after all despite a phone call from them because so much time had passed. When I wrote the above, I thought I'd published that blog post, but it was actually just in the queue. In any case, here's text of the letter I sent to the News:
Dear Editor,
At a weekend rally in Denver, filmmaker Michael Moore advocated the total government takeover of medicine with heartbreaking tales of peoples’ medical disasters ("Filmmaker Moore presides at Colorado health care rally," June 25th).
He neglected to mention that "single-payer" socialized medicine makes medical disasters routine due to inevitable rationing of care.
In Canada, patients are forced to wait weeks and months for diagnostic tests, appointments with specialists, and treatment as their deadly cancer cells multiply. In Britain, most NHS kidney patients over the age of 55 are allowed to die rather than offered dialysis. As usual, the working poor suffer the most: they are unable to afford treatment outside the government system they've already bought with taxes.
The only reliable protection against medical disasters is a genuinely free market in medicine. Only when medicine is freed of burdensome government regulations, mandates, and entitlements will patients will be able to pay for their own routine health care and purchase affordable catastrophic insurance. That's the reform Colorado needs.
Diana Hsieh
June 25, 2007 Although I haven't checked word-for-word, that seems to be almost exactly what was printed. Also, in my original post, I mentioned that I'm eager to write some more "morally radical" letters in the next few months. So stay tuned!Labels: Health Care
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| Tuesday, July 03, 2007 |
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Healthcare Letter
By Diana Hsieh @ 11:51 PM
Hooray! The Colorado Springs Gazette printed the letter on healthcare I sent them last week. It's hardly a stunning bit of prose, but I'm happy to see it published:
TAKING CHARGE
People, not government, responsible for health
Marcy Morrison, the sole El Paso County representative on Colorado’s 2008
Commission for Health Care Reform, claims that her goal is to insure as many
people as possible (“Morrison works to insure more Coloradans,” Metro, June
25). That’s morally wrong. The government should not attempt to enforce
universal medical coverage, nor universal healthy diets, nor universal
fashionable haircuts. The only proper function of government is to protect
our rights.
In medicine, that means protecting the rights of health care providers,
insurers and patients to contract for the services they deem in their best
interest, free from government regulations, mandates and entitlements.
Only then can people act as responsible adults, rather than as wards of the
nanny state.
Diana Hsieh
Sedalia Labels: Health Care
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| Saturday, June 02, 2007 |
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My Op-Ed Opposing Socialized Medicine in Colorado
By Paul Hsieh @ 8:37 AM
The Rocky Mountain News just published my op-ed opposing socialized medicine in Colorado:
Free market holds key to ensuring quality for Coloradans
By Paul Hsieh, M.D.
June 2, 2007
The Colorado Blue Ribbon Commission on Health Care Reform recently selected four health care reform proposals for eventual consideration by the Colorado legislature. Although they differ in their details, these differences are dwarfed by their fundamental similarity - they all entail a massive increase in government interference in medicine in the name of "universal coverage."
All four plans inject government force into the doctor-patient relationship. They include some combination of forcing all residents into a single health program, forcing some or all individuals and/or businesses to purchase a state-approved insurance policy, requiring insurance companies to provide new additional benefits, establishing a new bureaucracy to set payments to the doctors for services they provide, and doubling the Colorado Medicaid population.
These are just disguised forms of socialized medicine.
Similar programs already have been tried in states and other countries. They have all failed, resulting only in higher costs and lower quality patient care. The TennCare disaster - Tennessee's failed attempt at "universal coverage" - offers an important lesson for Colorado.
In the 1990s, the Tennessee government expanded the state Medicaid program to include people earning up to 300 percent of the federal poverty line, i.e., a middle-class family of four making $55,000 a year. The state also forced insurance companies to offer expensive new benefits and forced employers to either buy health insurance for their employees or else pay into a state fund for the uninsured. Many employers chose the second option, shifting their employees' health costs onto taxpayers. Because of the new regulations, many insurance companies withdrew from Tennessee, forcing more patients into the state health plan.
The Tennessee government initially offered a generous benefits package. Predictably, costs skyrocketed because patients had no incentives to spend prudently. In response, the government attempted to control costs by slashing payments to doctors and hospitals.
Hospitals closed and doctors left the state in droves. Many doctors who remained stopped seeing TennCare patients since they lost money on each one. Families with sick children often had to drive long distances to find a doctor who would see them. And they had no alternatives to TennCare because the state regulations had all but destroyed the insurance market. Ironically, TennCare ended up causing the most harm to the very people it was intended to help - the working poor and rural patients.
Nor did TennCare save money. Instead, it nearly bankrupted the state budget.
The problems of TennCare are not aberrations that can be fixed with a few minor reforms. They are inherent in any system of government medicine. Under such systems, bureaucrats and politicians decide what care individuals can receive, not doctors and patients. This has long been the case in Canada's "single-payer" socialized medical system, with its infamous waiting lists for critical medical tests and treatments. For the sake of my patients and myself, I don't want this to happen in Colorado.
Socialized medicine is not the cure for Colorado's health care problems. Forcing everyone into a government-run medical program because some people are uninsured would be just as wrong as forcing everyone to live in a government-run housing project because some people are homeless.
Instead, Colorado should adopt free market reforms such as the FAIR Program ("Free-Markets, Affordability & Individual Rights") proposed by Brian Schwartz, Ph.D. Such programs are especially good at providing affordable quality care for the working poor and rural patients. They work precisely because they encourage individual responsibility and they respect the right of the individual to spend his health care dollar according to his best judgment.
Colorado has an opportunity to become a real innovator in health care reform. Instead of recycling failed government programs, we should set an example for the rest of the country by adopting free market solutions. Only the free market can provide Coloradans with the high-quality, affordable health care they need and deserve.
Dr. Paul S. Hsieh is a practicing physician in the southern metro area. He is a founding member of the Colorado group Freedom and Individual Rights in Medicine.Labels: Health Care
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| Friday, May 25, 2007 |
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Great Letter to the Editor on Healthcare
By Diana Hsieh @ 10:56 AM
Hannah Krening's excellent letter to the editor was published in yesterday's Denver Post. (It's halfway down the linked page.)Proposals to reform health care in Colorado
As a Colorado taxpayer, breast cancer survivor and one whose first husband lost a long battle with cancer, I want to say that the state 208 Commission's recent choices of proposals to evaluate all add up to one thing for me: I hope I never have a life-threatening condition again in Colorado if any of these proposals become reality. And I hope that nobody I love has to be subjected to the rationing, waiting and other debilitating results of what they evidently believe are the best of intentions.
Bringing more government involvement into health care "reform" is not a solution. It
is a recipe for disaster. Of the proposals considered, only one reflected my views: the "FAIR" proposal, which has been cast aside. Only by reducing government involvement in health care will we get the kind of justice that will bring about the best care for all at the best possible price. We must remember that health care is not and cannot be free: the skills of doctors, researchers and technology companies must be fairly compensated. The alternative is slavery of the few taxpayers who will foot the huge (unworkable) bills and of the providers of health care who will ultimately leave the profession in order not to be enslaved by it.
This is not regulation on some dispensable part of our lives. This concerns everyone's survival, to some degree; nobody will be untouched by the outcome of this process. We have a lot to lose.
Hannah Krening, Larkspur Hannah's experience with cancer gives her special credibility in the current healthcare debate in Colorado. Similarly, that Paul is a practicing physician gives his voice tremendous weight. Lin is gaining ever-more traction as a genuine health care policy expert in Colorado, thanks to her diligent study of the nuts and bolts of the subject over the past few months. Brian Schwartz (of WhoOwnsYou.org) has standing in the debate because he submitted a proposal to the 208 Commission.
When Lin began FIRM, I don't think that any of us appreciated the importance of that kind of special credibility. Yet it makes sense: people are more swayed by the opinions of people with experience and expertise than the random opinions of unknown persons.
So in your own activism, don't just rely on your general knowledge of the relevant philosophic principles. That's boring, to both yourself and others. Instead, ask yourself what unique perspective you can contribute to the debate. Focus on the issues (or subissues) in which you have some notable experience or expertise. Appeal to that when you write, as Hannah's letter did. Even if your particular issues or subissues aren't the most exciting or sexy or crucial in the total context, you'll do better in the fight. You'll likely be far more motivated to write and speak at all. And if you speak as someone with some special knowledge, insight, and concern, your words will carry more weight.
So if you're having trouble motivating yourself to write and speak, even though you know that you should fight for the future of this country for your own sake, think about what you as an individual can bring to the debate. I've been struggling with just that kind of inadequate motivation on the health care debate this week, but I know that I'll be excited to jump into the fray once I clearly answer the question of how I can use my expertise as a moral philosopher, as the wife of a physician, as the daughter of a breast cancer survivor, and so on to give myself an angle in the debate. If you're feeling unmotivated, perhaps you might ask yourself the same kind of question.Labels: Health Care
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| Tuesday, May 22, 2007 |
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208 Farce
By Diana Hsieh @ 9:02 PM
Colorado's 208 Commission for Health Care Reform has chosen its four proposals to evaluate. Basically, after a pro-government-medicine biased analysis by some consulting firm, the Commission will recommend one plan to the Colorado legislature. As expected, the selected plans range from awful to disastrous. Lin Zinser has posted a helpful analysis of them to the FIRM blog.
On Sunday, I dashed off the following letter to the commissioners:
Dear 208 Commissioners,
I wish to express my profound disappointment with the Commission's choice of healthcare reform proposals to evaluate. All four proposals are basically the same: all would significantly increase the already-overwhelming burden of government regulations, mandates, and entitlements in medicine. If implemented, the results would be exactly the same as in other countries and states, i.e. runaway costs, rationing of services, and declining quality. The only difference between these four proposals is the speed with which each would destroy the high quality of medical care now available in Colorado.
You could have chosen to give a serious hearing to something genuinely different, namely the free-market approach of Brian Schwartz's "FAIR" proposal. Instead, you've decided that only plans that inject tons more government force into medicine will be considered.
What a farce.
Diana Hsieh
Sedalia, CO Obviously, I cannot hope to change the decision of the Commission at this point, but clear and strong opposition can convey the message that their "idealistic" plans for reform would be serious political risk.Labels: Health Care
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| Saturday, May 12, 2007 |
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Letters to the 208 Commission
By Diana Hsieh @ 1:29 PM
Today is the last day for public comment to Colorado's "208 Commission on Health Care Reform." If you're already written, thank you! If you live in Colorado but haven't yet written, please please please do so. You can make a difference! Even just a quick paragraph advocating free market reforms would be fantastic. If you have more than a spare moment to craft a letter, you should look at Lin Zinser's We Stand FIRM blog post about writing the commission. Below, I've included the letters from Lin Zinser, Paul Hsieh, and myself.
From Lin Zinser:Americans can freely choose where to live and what kind of housing we can afford. We can choose whether to buy a car and, if so, what kind, size and price we want to spend. We can choose what kind of food to eat and whether we want it ready-made, as in restaurants or fast food joints, or whether we want it partially made, or from fresh ingredients -- where we do the preparation. We can choose what kinds of entertainment we seek, including movies, CDs, books, or whether to attend live events like wrestling matches, theater, concerts or the opera. We can choose what kind of work we do, our place of employment, and some can choose what hours to work, and whether to work from home, an office or outdoors. These are among thousands of other choices Americans make in our lives -- and because we live in America we have more choices than most other people in the rest of the world.
We can choose to live simply, without electricity -- as a friend's 93 year old grandmother chooses to do because she thinks simple is better, or with as much technology and space as Bill Gates can buy. We can choose to buy clothes at second hand shops -- as many of my financially well-off girl-friends do, or we can choose to spend hundreds of dollars on a haircut as Presidential Candidate John Edwards does. We can shop for groceries at Walmart, 24 hours a day, or at Whole Foods, where we pay more for organic foods. Our economic choices are not forced on us by our political status or our government.
These are the kinds of choices that people from around the world come to America to experience -- for a lifetime. People from around the world also come to America to get the latest medical technology, the newest life-saving drug, and some of the most radical treatments available, even if incompletely tested or proven -- in order to save their lives.
Think about one astonishing fact -- the people in countries with universal, mandatory health coverage -- including the Europe, Great Britain and Canada -- even if taken together, have not created the wonderful, magnificent changes that we have seen over the past 40 years in medicine in America even though their population is more than 3 times the American population. In most of these countries, such wonderful life saving treatments, even if adopted from America, are restricted or rationed.
Why has America led all of these countries in medical advancements that have enhanced the quality of life of all, including premature infants, people with failing organs, cancer victims and aging Americans? Why is there no rationing in America? Why do people come to this country for advanced treatment s for cancer and other diseases? The answer is Capitalism -- the social, economic and political system which allows men and women to use their minds in freedom, thus providing creators and producers the financial incentive -- the profit motive -- to investigate new (hence unproved and untried) technologies and new science, even at the risk of failure.
Government controlled health insurance and medicine do not foster change and innovation. They foster the status quo. One reason is that any government program, looking at unproved and untried methods or strategies, cannot spend taxpayer dollars on them for political reasons -- the risk is too great. Additionally, Government tends to enforce one standard of doing things -- one way of treatment -- whether it's the post office or health care. It took Fed Ex and UPS to provide choice in how fast a package could be delivered. There is one Medicare part A for all Americans 65 or older. Medicaid participants don't have choices -- they have limited options. But, how many choices do Americans make with regard to food, clothing, housing, transportation and entertainment every day of our lives.
The only reasonable principle for health insurance and medicine is the principle uniquely forged by the founding fathers. It is the principle enshrined by the Declaration of Independence and the US Constitution -- that all are created equal with the inalienable rights to life, liberty and the pursuit of happiness. Those inalienable rights require a social-economic-political system that promotes freedom of action -- the freedom that allows Americans to make all of the choices I mentioned -- and more. In Colorado, we need American health insurance and American medicine with its innovation and enhancement of the quality of life -- not another European government program of the status quo.
Lin Zinser
Executive Director
Ideas Matter!, Inc.
www.WeStandFIRM.org From Paul Hsieh:Dear 208 Commission:
Here are my responses to the two questions on which you have requested public input, regarding the health care proposals under consideration:
"(1) What are the one or two most important features that you feel must be included in any Colorado health care reform?"
The most important feature would be reduction or elimination of mandates on individuals, insurance companies, and employers. This will allow patients, doctors, and payers to negotiate the best agreements for themselves without being constrained by government force. Mandates on employers and insurance companies (such as mandatory benefit packages, guaranteed issue and/or community ratings) drive up costs without providing better care. Mandates on individuals violate the freedom of contract between patients and their doctors and force one set of patients to subsidize the health care of another set of patients. Individuals can and should be allowed to decide for themselves how to most wisely spend their health care dollars.
"(2) What is the most important principle that should be considered in any reform effort?"
The most important principle is that only free market capitalism can guarantee good quality health care at the lowest prices for patients. Countries and US states in which allocation of health care resources are left to the government inevitably spend more money for poorer-quality care. Plus the decision making become irreversibly politicized, which harms patients who don't have powerful political friends. The free market is the only way to protect the individual rights of patients and doctors. Hence, we must avoid more government mandates, or mandates disguised as limited "choices" within a set of government-selected options.
Patients, providers, and payers working within a free market will come up with innovative and cost-effective solutions that would never occur to central government planners. To deprive patients of that opportunity violates their basic rights and will cause them harm.
Reference: The Cure: How Capitalism Can Save American Health Care, book by Dr. David Gratzer, a physician who has practiced in both the US and Canada. Among other points, he shows how the government-run medical system results in higher mortality rates for treatable conditions in countries like Canada vs. the USA. Any government-run system of health care will result in more deaths of Colorado patients from to treatable diseases such as breast cancer, prostate cancer, heart disease, stroke, etc.
Thank you very much,
--------------------
Paul Hsieh, MD
Sedalia, CO
paulhsiehmd@gmail.com From Diana Hsieh:
Dear 208 Commissioners,
I am writing to encourage you to uphold free market principles in your deliberations about health care reform proposals. A free market in health care -- as opposed to the current system of massive regulations, mandates, and entitlements -- is the only moral and practical option. All the problems from which medicine currently suffers (such as high prices for medical care, non-portable insurance, and the over-use of emergency rooms) stem from government interference in the free market.
Only free markets permit doctors, nurses, and other medical providers to act for the best interests of their patients. Only free markets allow patients to choose how to best spend their hard-earned money to secure and promote their own health. Any other system -- meaning any system with regulations, mandates, and entitlements -- injects bureaucrats into what ought to be wholly private decisions. Patients are told that they must wait months for critical care -- or they are simply denied care altogether. That kind of government meddling is inevitable. When government pays for medical care, neither doctors nor patients have any incentive to use the available medical services judiciously. Then, to prevent total financial ruin from runaway costs (and fraud), the government must step in to limit the use of medical services, whether by rationing care or denying care. Unless the system is scrapped, people will suffer and people will die. That's what the supposedly noble ideal of "universal coverage" means in practice.
The 208 Commission has a wonderful opportunity to help repeal the mandates, regulations, and entitlements that currently burden medical care for the doctors and patients of Colorado. If you do that, you can make Colorado a genuine leader in health care reform!
-- DMH
Diana Hsieh
Sedalia, CO Please feel free to post your letter to the 208 Commission in the comments.Labels: Health Care
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| Tuesday, May 08, 2007 |
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208 Commission
By Diana Hsieh @ 9:06 PM
Lin Zinser just posted this entry about Colorado's 208 Commission on healthcare reform to the FIRM blog. I think it's important enough to repeat here on NoodleFood.
Between now and Saturday, May 12, 2007, is the only real opportunity to voice your concerns to the 208 Commission through the public comment. After May 12, there is no opportunity for public comment before they select the 3 to 5 proposals, which they will do at public hearings on May 17 and May 18. These 3 to 5 proposals will be the ones submitted to the state legislature next January for its consideration. This means that you and your voice could be heard by the legislature through the commission.
There are currently 11 proposals being considered. I have summarized the 11 proposals briefly below -- at the end of this post.
Only one of the proposals recommends deregulation of the insurance market and of Medicaid. That proposal was submitted by Brian Schwartz, PhD, and his full proposal (worth reading) is called FAIR (Free Markets, Affordability and Individual Rights). (You must download it - it's toward the bottom of the page).
The Commission numbered each tendered proposal -- and the FAIR plan is number 21. The other plans include individual mandates, insurance company benefit mandates, insurance company guaranteed issue and community rating mandates, employer mandates, provider mandates, or some combination of the above. My summary of all eleven is provided at the end of this post.
The Commission is requesting comment on 2 issues related to these proposals:
1) What are the one or two most important features that you feel must be included in any Colorado health care reform?
2) What is the most important principle that should be considered in any reform effort?
There are two ways to provide comment to the 208 Commission. 1) You may submit a comment in writing by e-mail to 208Commission@coloradofoundation.org It is crucial to send your comments this way. Any comment sent to this address will be posted on the Commission website and distributed to all Commissioners for review in advance of the May 17-18 meeting. But the e-mail must be received by May 12. Comments sent to individual commissioners, or received after the deadline will be ignored.
Alternatively, there are five meetings planned across the state this week -- May 10 and May 12 -- for public comment and where you have the opportunity to speak before one or more commissioners. They still want you to submit written testimony at the time of your oral presentation.
This is the last opportunity to express your opinion about the most important principle (and features) to be used to select any proposal. This is the time to speak about capitalism v. government control, the individual rights of doctors and other providers v. the needs of some patients, and freedom in medicine and health insurance v. insurance mandates and other instances of government force.
To be effective to the Commission, any written (or oral) comments must state specifically ONLY the principle and or features that are most important to health care reform, and to give specific reasons for that choice. They are not interested in your advocacy or rejection of any particular proposal.
Some examples of written comments to the 208 Commission might be
- The most important feature to include in any health care reform would be to eliminate all mandates -- whether they require individuals or employers to purchase health insurance, or whether they impose benefit packages on insurance companies, or impose mandatory guaranteed issue and/or community ratings of insurance companies; or any mandate on the care or treatment (including the cost for that care) provided by any health care provider. Mandates violate the freedom of contract between individuals, doctors and insurers. They also increase the cost of health insurance policies for the healthier citizens by subsidizing the cost of those who are not as healthy. OR,
- The most important principle to consider in any health care reform would be that only capitalism can provide the best quality of medicine and health insurance at the lowest possible price. For example, the United States leads the world in innovative, new science and technology in medicine because of its tendency towards market based solutions, not in spite of them. Government controlled medicine and insurance advocate the status quo, and are resistant to change. To continue to have better and better technology to save more premature births, to enhance the quality of the lives of diabetics, heart patients, cancer victims old age survivors, as well as countless other conditions, we must turn to capitalism and capitalism alone, for its infinite choices and solutions, made by individuals in a free market. OR,
- The most important principle to consider is that government involvement in medicine has caused the problems we face in health care today and we need to get government out of medicine. For example, the 1942 IRS ruling distorted the market to favor employer-purchased health insurance policies over individual purchased ones, thus taking the responsibility for the purchase of health insurance from the individual, eliminating portability, transparency of the costs of medical services and health insurance, and encouraging too much coverage for routine care, while discouraging catastrophic care coverage. Another example is EMT ALA, which required all hospitals with emergency rooms (and their doctors) to treat any person, regardless of ability to pay, who believed they had an emergent health issue. This caused doctors and hospitals to treat some people, while getting paid nothing. This in turn caused hospitals and doctors to charge others who could pay more, and caused some hospitals and doctors to stop providing care -- to close emergency rooms and to stop practicing at hospitals with emergency rooms. We need to eliminate provider mandates. OR,
- The most important principle of any health care reform would be respecting individual rights of doctors, insurers, employers and individuals. Doctors and hospitals must be free of mandates that require them to participate in any program (e.g., EMT ALA). Insurers must be free to contract and provide whatever benefits they deem profitable or appropriate (eliminate all mandates including mandatory guaranteed issue and community rating). Employers and individuals must be free to purchase health insurance at whatever level they deem appropriate (e.g., high deductible - HSA, basic minimum, catastrophic only, etc.). No one has a right to force others to provide him or her health care or health insurance -- even though many governments have treated both as temporary privileges -- granting benefits which it can then take away depending on cost, majority vote, or other illusory standard
Again, these are examples. The crucial thing is to pick the most important principle for health care reform, or one or two features that are important to consider in health care reform, and make them your own. Feel free to use any of these, expanding or narrowing them to suit your situation. There are many more specific examples for any principle or feature that could be used.
NOW IS THE TIME to send your comments to the 208 Commission. The Commissioners need to understand what is important to you, what principles are crucial to you and how those principles are manifested in features of the various proposals.
To assist you in understanding the essential features of all eleven plans being considered for submission to the legislature, I have summarized them below. You may read the full proposals at the 208 Commmission website by downloading any or all from this page. I used the commission number for each plan. These 11 proposals are as follows:
#21 – FAIR (Free Markets, Affordability and Individual Rights) proposed by Brian Schwartz, PHD. Plan proposes to lower cost of health insurance by eliminating all insurance benefit mandates, thus allowing people to obtain less coverage for fewer dollars. Eliminates single-group of one which eliminate guaranteed issue and community rating for that market.
Seeks to encourage high deductible HSA health insurance plans.
Medicaid Reform seeks to transfer more enrollees into private insurance market. It also uses cost-sharing to eliminate over-consumption of some Medicaid services. He also advocates reduction of asset sheltering for long term care in Medicaid. He also advocates increasing access to home care and, most provocatively, to allow Medicaid to compete for funding with voluntary charities in the private market.
#16 -- The Colorado Health Services Program, proposed by Health Care for All Colorado Coalition – is a single payer, publicly financed program. It covers all primary, preventive, specialty, surgical care, automobile and work-related injuries, prescription drugs, mental health services, chiropractic, dental, basic vision, audiology, home health and hospice services, among others. It states that all providers and hospitals will be paid the same for the same level of service, thus eliminating the drive for profit in determining the quality of care. It is explicitly egalitarian and states that every resident has equal access to program benefits. There is no opt-out provision.
It calls for a statewide, fully integrated information technology network to track outcomes, utilization and expenditures. Removes profit motive from financing resulting in a truly egalitarian health care system. Would create the Colorado Health Services: a non-profit government "insurance company," administered and governed as a public utility with five districts and it would be strictly regulatory - no outside supervision or control. All of its decisions final. It would also determine malpractice, but allow its findings to be public in malpractice litigation in a court of law.
#12 – A Plan for Covering Colorado, proposed by the Committee for Colorado Health Care Solutions – requires a single insurance pool – in which all insurers would be required to participate and would be mandatory guaranteed issue and community rated. All individuals, including all state employees, and employers will be mandated to purchase insurance through the single pool. Employers would be mandated to pay a portion of the employees' health insurance or pay an assessment to the state per employee. Individuals (and employers) would be limited to opt for one of 6 to 10 standardized benefit plans. Policy mandates would include a list of essential services, but could include options of type (PPO or HMO), choice of provider panels, and amounts of co-pays or deductibles allowed. Employers required to allow workers to pay their share of premium through payroll deduction. So employers become the enforcement mechanism -- they collect the premium and forward to the state.
This single insurance pool wold be administered by new public authority – Colorado Health Insurance Purchasing Authority. It will define benefit packages, define and periodically update a standard set of benefits based on effectiveness and cost, define and certify “high-value" providers, define subsidy and premium assistance requirements to be provided to low to middle income individuals. Consumers with premium assistance can opt for only 2 plans, with one an HMO. Authority will also decide guidelines for performance of providers, and of course, determine the amounts paid to the providers.
#11 – Community of Caring proposed by a coalition of CCHN, CCC, CA and CBHC. Individuals have mandate to purchase adequate health insurance; there is also an employer mandate to contribute to employee coverage; Insurers must guarantee insurance regardless of health according to community rating. The plan will provide subsidies to low-income and small businesses and expand Medicaid to more people. Benefits will include preventive care, routine medical services, maternity, diagnostic testing, hospitalization, emergency care, outpatient surgery, mental health and substance abuse treatment, physical, occupational and speech therapies; in-home, hospice, and nursing facility care; durable medical equipment and pharmacy, plus oral health benefits.
Creates a quasi-governmental entity that is exempt from TABOR called Health Insurance Partnership. Also creates and funds the Community of Caring Collaborative Board and the Safety Net Stabilization Program. It will establish comprehensive benefits package, competitively negotiate contracts with private health plans; implement quality standards for insurers and providers; and collect taxes from individuals and employers for the program, and collect monies from state agencies and premiums from health insurers for more funding. It says it will provide a variety of products that modify cost sharing or offer enhanced benefits.
#10 – Healthy Colorado Now – proposed by the Colorado Coalition for the Medically Underserved. Employer Mandated on pay or play basis, which means that employers must pay for insurance or pay an assessment per employee to the state. Policies are guaranteed issue, community rated, standard benefits. There will be a default enrollment system with individual mandates, but the employer is ultimately responsible if the individual doesn't purchase insurance. Benefits will exclude services without proven benefits or with poor cost benefit ratios, so no experimentation or new technologies can be tested or tried. There will be spending caps per individual beneficiary. There will also be a limitation of expensive and heroic services.
Creates the Personal Responsibility Option in Colorado (PRO-CO). Governed by non-profit, non-governmental authority called the Colorado Health Authority. Adopt "medical home" standards, which mandates that every individual must choose a primary care physican who then becomes a gate keeper for specialty services. The plan supposedly creates incentives for standardized care. It will implement new information technology, define standard policy benefits, and provide quality and performance standards. Every non-ERISA insurer must offer at least the PRO-CO benefit package. Individuals do have the option to buy higher levels of coverage. Evidence based medicine.
#9 – An Individual Based Insurance System proposed by the South Denver Metro Chamber of Commerce. Individual and Insurance Company mandates. Mandatory maintenance routine care policies (up to $100,000) and mandatory preventive care (required to get annual exam). Guaranteed issue, community rating. Catastrophic care funded by 5 to 20% of maintenance policy premiums – with financial backing of the pool from a state governmental safety net similar to the role of the FDIC. Mandated benefits on maintenance policies – may limit benefits on cosmetic, self-inflicted, treatment without a reasonable scientific basis, highly experimental, infertility and repetitive injuries caused by extreme choices.
Creates Colorado Health Commission to investigate quality and cost factors that "drive" cost and quality. Discounts for health lifestyle choices. Massachusetts style connector to link insurers and consumers. Vouchers for poor. State clinics for poor and uninsured – one per county.
#7 – Connecting Care and Health for Colorado proposed by CCHI. Universal coverage. Individual and employer mandates. Guaranteed Issue and Community rating. Expansion of public programs. Standardized benefits, including minimum benefit requirement. Diagnosis and treatment, preventive dental care, vision and hearing services, mental health, substance abuse, cancer screenings and other chronic disease screenings, rehab services, non-emergent medical transportation and other appropriate services.
Creates the Stakeholder Oversight Commission to supervise 3 advisory committees – health care quality, rural health and health disparities. Private insurance includes all state mandated benefits and two or three enhanced plans that include vision and dental benefits. Tax assessment on employers with tax credit for those who provide health insurance. Mandate all residents to purchase insurance.
#6 – A Phased Approach to Achieving Universal Health Coverage in Colorado proposed by Kaiser Permanente.
Expand Medicaid programs to children with premium assistance. Individual mandates such that an individual must have coverage through their employer, individually private coverage or through a public program. There will be a tax and surcharge on those who remain uninsured. Guaranteed issue, community rating. Would increase and encourage the use of HMOs. A medical home or primary physician essential. Evidence based guidelines. Statewide medical records database.
Uses voluntary HMOs and providers; but also a statewide managed indemnity plan mandated for those not in HMO. Individuals in indemnity plan must choose primary care physician – a medical home. Reimbursement rate is 100% of medicare for non-HMO providers, HMO rates are reimbursed on a capitated basis and determined at the state level. Individuals eligible for group plan must use that plan. Basic or comprehensive plan with a deductible (0, $2000 or $10,000).
#4 – Comprehensive Health Care Plan for Colorado proposed by CLUB 20. Individual mandates for tier 1 coverage – basic benefits using appropriate associated reimbursement rates using Oregon as model. Providers mandated to participate in quality improvement efforts and meet quality standards.
It would create Colorado Health Commission to coordinate and direct new overarching elements of health care reform. Also would create the Colorado Care Connector to assume role of current medical and efficiently provide Tier 1 coverage to those who can’t afford it. Promote concept of medical home with primary care provider. Can purchase Tier 2 coverage – which allows for unlimited health care options.
#2 – Better Health Care for Colorado proposed by Service Employees International Union. This plan is a bit vague but seeks to create a path for universal health coverage. It doesn't appear to have mandates, but I'm not sure how universal coverage is to be enforced without mandates.
It would create a new quasi-public entity to provide access to private insurance specifically tailored for "target" populations. The exchange would coordinate health care financing from multiple sources, and offer products to subsidized uninsured and non-subsidized small businesses. Would offer limited health plan of $25,000 to $35,000 annual benefit; pre-paid plan; more comprehensive coverage such as in the State Employee Health Insurance Plan, and other plans for indigent or high risks. Managed care approach. Would have employer-sponsored insurance with an opt-out provision.
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| Tuesday, May 01, 2007 |
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Update on "Infuriated Socialists"
By Paul Hsieh @ 12:37 PM
The Denver Post did publish my response to the Jim Spencer column in today's edition:Jim Spencer called my April 25 letter "crazy" and accused me of violating my oath as a physician because I argued that health care is not a right.
The exact opposite is true. My moral responsibility to my patients requires that I oppose socialized medicine. When countries like Canada attempt to guarantee a "right" to health care, it inevitably leads to rationing of vital medical services. Under their "single payer" system, Canadian patients routinely wait for months before government bureaucrats allow them to get MRI scans or surgeries that are immediately available in the U.S. Doctors cannot practice good medicine when handcuffed by such a system - and many will quit medicine rather than work under those conditions. (For more information, see www.WeStandFIRM.org.)
Trying to create a universal "right" to health care turns patients into pieces of meat and turns doctors into slaves. Neither is right for Colorado.
Paul Hsieh, M.D., Sedalia The other letter they published at the same time was also good:Jim Spencer refers to a letter from a physician regarding the "right" to health care as the craziest he has read in some time. Plainly, Mr. Spencer has no idea what a "right" is.
A "right" refers to a freedom of action that an individual possesses. For example, "the pursuit of happiness." It does not refer to a sanctioned or legalized gain of unearned goods or services, nor does it involve the violation of others' rights. These are more properly termed "theft" or "slavery," and are obviously immoral.
A "right" to health care necessarily involves enslavement of health care workers (Canadian physicians have no right to private contracts) and confiscation and redistribution of tax monies.
If it were so easy to provide health care as a "right" by simple legislative fiat, as Mr. Spencer implies, then I cannot understand why we do not end hunger by passing a similar law forcing restaurants to provide food.
The health care problems we have now would best be addressed by reintroduction of the concept of personal responsibility, re-establishment of a free market and the rewarding of charity care. Only then will "rights" truly be respected. (They left his name off the online version, but the print version lists him as "Michael K. Stahl, M.D., Carbondale".)
After reading the Spencer column and my reply, one of my partners also e-mailed me:Amazing. Absolutely amazing. While reading Spencer's article, the "looters" from Atlas Shrugged kept coming to mind. Keep fighting the good fight. I had no idea that he had any familiarity with either Atlas Shrugged or Ayn Rand, so that was a pleasant surprise!Labels: Health Care
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| Monday, April 30, 2007 |
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Problems With Maine's Socialized Medical System
By Paul Hsieh @ 4:55 PM
The state of Maine has also attempted to provide "universal coverage" for its residents for many years, with predictably poor results. According to this recent NY Times article, instead of saving money, the program costs continue to explode, and the state officials are considering what sort of cutbacks to implement. Rationing is just one short step away.
Interestingly enough, one of the supporters of the plan is quite explicit about the central problem. She states, "This program needs healthy people who don't get subsidized so it can prosper." In other words, it needs a massive forced redistribution of wealth from one group of citizens to pay for the health care of another group of citizens who otherwise couldn't pay for it themselves.
Yet for some reason, supporters of "universal health care" refuse to call these systems by their real name -- "socialized medicine"! (Via Jason Spears.)
(Also crossposted to the FIRM weblog.)Labels: Health Care
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| Friday, April 27, 2007 |
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Infuriated Socialists
By Diana Hsieh @ 10:13 AM
A few days ago, Paul published this letter to the editor in the Denver Post:
Health care is not a right, and it is not the proper role of government to provide health care for all citizens. Instead, this should be left to the free market. It is precisely the attempts of the governments of countries like Canada (or states like Tennessee) to attempt to mandate universal coverage which have led to the rationing and waiting lists for vital medical services. Similar problems are already starting to develop in the Massachusetts plan as well. Any plan of government-mandated "universal coverage" is nothing more than socialized medicine, and would be a disaster for Colorado.
Paul S. Hsieh, M.D., Sedalia In response, Denver Post staff columnist Jim Spencer attacked Paul (without identifying him by name) in his column "Reforming the health of our care":
The craziest letter to the editor that I've read in some time came from a physician who claimed that Coloradans have no right to health care.
Seems the guy not only forgot his Hippocratic oath but also the law.
If you're sick enough or badly injured, they have to treat you at the emergency room regardless of your ability to pay.
The doctor aimed his editorial rant against socialized medicine. But he wrote it because a state blue-ribbon commission is now cobbling together a plan for medical treatment and prescription drugs for Coloradans. The column then discusses the supposedly noble work of the 208 Commission in determining the proper "private/public mix in the provision of health care."
I'm tickled pink to see Paul causing such a stir. It shows the power that physicians have when they speak out against socialized medicine.
For more information about the fight against socialized medicine in Colorado, visit FIRM: Freedom and Individual Rights in Medicine. For Paul's more detailed case against socialized medicine in Colorado, read Socialized Medicine in Colorado - An Open Letter to Colorado Physicians.Labels: Health Care
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| Friday, April 13, 2007 |
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Daily Health Check
By Diana Hsieh @ 7:48 AM
This NY Times article "Lessons of Heart Disease, Learned and Ignored" has some really valuable information on the common confusions about heart attacks that lull people into complacency, such that they don't avail themselves of the proper treatment options. It's well-worth reading, particularly if you have family history of heart disease, as I do.
A few days ago, Paul told me of a woman who failed to check out chronic belly pain for months until it became unbearable. At that point, the CT and MRI scans showed colon cancer, already spread to the liver. That's not good: a friend of ours died about 18 months after a similar diagnosis. (She suffered no symptoms until she fainted on the subway.)
On hearing the story, I suddenly struck by an indirect health benefit of my daily course of vigorous exercise: I would never endure such pain for more than a few days (if that) -- not just due to general worry about the cause of the pain but also due to very specific annoyance with my inability to exercise as usual. The same is true of the fatigue that often comes with heart attack mentioned in article above: the problem surely wouldn't be quite so clear or so pressing to me if I were a couch potato.
In other words, exercise doesn't promote health merely by making the body more fit; it's also an important daily test of one's health. That's kinda cool, I think.
P.S. Happy Friday the 13th! It's my lucky day... I was born on Friday, December 13th, 1974.Labels: Health Care
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| Wednesday, April 11, 2007 |
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Socialized Medicine in Colorado -- An Open Letter to Colorado Physicians
By Paul Hsieh @ 12:01 AM
Socialized Medicine in Colorado -- An Open Letter to Colorado Physicians
by Paul S. Hsieh, MD; paulhsiehmd@gmail.com
Dear Colleagues:
My name is Dr. Paul Hsieh, and I am a physician practicing in the south Denver metro area.
I am deeply concerned that socialized medicine may be imposed on Colorado by our state legislature within the next year or so under the guise of "comprehensive health care reform". I'm morally opposed to this because I believe it would be destructive to our medical practices and harmful to our patients. I'd like your help now in speaking out against this ominous prospect.
The political process which could lead to socialized medicine is already underway, but most working physicians I've spoken with have been unaware of it. Hence, I want to sound the alarm before it's too late.
As some of you may know, in June 2006 the Colorado state legislature authorized a special 24-person Commission (called the "208 Commission" after Senate bill SB208) to generate proposals to restructure the health care system in Colorado, and submit them for legislative approval. The Commissioners were chosen by politicians from both political parties. Currently, there are only two doctors on the 208 Commission; the other 22 are representatives of various special interest groups.
The basic premise of the 208 Commission is that the government must guarantee health care for all Coloradoans. During their public meetings, a significant number of the Commissioners have expressed support for some form of socialized medicine. Although they frequently use euphemisms such as "single payer" or "universal mandatory coverage", similar language has been used in other US states and in other countries to justify massive government control of medicine.
Simultaneously, the Colorado Medical Society (CMS) has developed an official position in which they urged that health care in Colorado should be "universal, continuous, portable, and mandatory".
On January 25, 2007, the CMS submitted those "Guiding Principles" to the 208 Commission, portraying them as the consensus of the doctors of Colorado. They have also stated that the "CMS believes, after extensive vetting and a unanimous vote at the 2006 House of Delegates, that the Guiding Principles represent a compelling consensus of Colorado physicians".
When I first learned of this, I was angered and appalled, because that position does not reflect my views or the views of many other physicians that I've spoken with. The CMS does not speak for me on this issue, and I am not part of this "compelling consensus".
I completely oppose any form of socialized medicine, regardless of whether it is called "single payer", "mandatory universal coverage", or anything else, because I believe it would be bad for both patients and doctors. Years of experience in the US and other countries have shown that these programs will hurt patients and even cause their deaths. As costs inevitably spiral upward, bureaucrats will ration medical services. Eventually, physicians will be forced to practice against their best medical judgment. This is a violation of the fundamental rights of both doctors and patients.
As a result, in states like Tennessee (which in 1994 implemented its own version of mandatory universal coverage called TennCare), many doctors find the practice climate intolerable and are either leaving the state or quitting medicine entirely. I do not want that to happen in Colorado. States like Massachusetts and California, which are also attempting to guarantee universal health care for their residents, will soon face similar problems.
Although I agree that there are genuine problems with the current system, more government interference in medicine can only make things worse. One basic principle we all learned in medical school was, "First, do no harm". This applies as well to politics as it does to clinical practice. Most of the problems of the current system have been the result of bad government policies. Adding more government bureaucrats to the mix will only make things worse.
In my opinion, it is not the government's role to guarantee health care for all Coloradoans, any more than it is the government's job to guarantee all citizens a car or a job. It is morally wrong and economically unsustainable. Doctors and patients ought to be able to freely contract for medical services to their mutual benefit without interference from the government. It is precisely the attempts by the governments in Canada and Great Britain (or states like Tennessee) to guarantee universal "cradle-to-grave" coverage that has led to the runaway costs and rapidly deteriorating health care in those places.
I recognize that not everyone will agree with me here, and this is part of my point. This is a very contentious issue amongst doctors. Based on my discussions with numerous physicians, I don't think one can accurately say that there is a "compelling consensus" of the doctors of Colorado.
So if you oppose socialized medicine on the grounds of medical conscience (as I do), then please contact the Colorado Medical Society and the 208 Commission, and let them know where you stand.
Even a one line e-mail like, "I oppose universal, mandatory coverage or any other form of socialized medicine, because it will be bad for me and my patients", could have a tremendous impact.
To contact the relevant members of the CMS and the 208 Commission go to: http://tinyurl.com/2y9t4f or send mail to 208Commission@coloradofoundation.org.
The CMS is speaking in your name on this issue, so if you disagree with their position (or if you believe that their position should not be portrayed as the physician "consensus"), then they need to know. The CMS has requested feedback from doctors including those who disagree with their current position, so I urge you to take them up on this.
The 208 Commission is a public body, and has also asked for input from all citizens of Colorado. So if you want to protect your right to practice good medicine and protect your patients' best interests, they need to hear from you before they submit their proposals to the state legislature for a vote.
For further information about this issue, one excellent resource is the website www.WeStandFIRM.org, a non-profit group of Coloradoans devoted to freedom and individual rights in medicine. I especially recommend their article, "Health Care is Not a Right" by Dr. Leonard Peikoff. If you wish to stay informed on this topic, I also encourage you to sign up for their mailing list or read their blog.
Also, please feel free to forward this open letter to any other Colorado physicians that may be interested. A copy of this letter is also available online at: http://www.WeStandFIRM.org/docs/Hsieh-01.html.
Sincerely,
Paul S. Hsieh, MD
E-mail: paulhsiehmd@gmail.com
Disclaimer: I am neither a Republican nor a Democrat, but an independent voter. My objections to socialized medicine are unrelated to party politics.
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References:
I've listed some references for those who want more information. These are optional resources for those who want to learn more about these topics, but not required reading. (I do not necessarily endorse every item in full):
"Health Care is Not a Right" (HTML format or PDF format):
[Online essay] This brilliant essay was written by Dr. Leonard Peikoff, a philosophy PhD living in Colorado Springs. The original version was written in the 1990's after Hillary Clinton proposed her infamous national health care plan, and has been updated by Lin Zinser and Dr. Peikoff for 2007. He argues that a "right" to health care does not exist and that any attempt to create one necessarily leads to disaster, because it runs antithetical to the genuine rights that were recognized and codified in the Constitution by the American Founding Fathers.
"A Short Course in Brain Surgery":
[Video] This astounding 5-minute video tells the story of an Ontario man with a brain tumor who couldn't get the care he needed under the Canadian system because the waiting lists for an MRI scan and for a neurosurgeon were too long. Fortunately, he was able to get appropriate treatment in Buffalo, NY.
"Health Insurance in the United States"
[Online article] This informative article covers the development of the U.S. health insurance system and its growth in the twentieth century, including the development of Medicare and Medicaid. It also examines the role of government policy in setting the stage for nationalized health care.
"The History of Health Care Costs and Health Insurance":
[Online article] This report was written by Linda Gorman, who is a health-care economist at the Independence Institute in Golden, CO. In this article, she covers the history of spiraling health care costs and government control of medical care, and shows how bad laws and other government interference in medicine have led to the current problems. She also offers some positive market-based alternatives to socialized medicine which have been proven to simultaneously increase patient outcomes and decrease costs, including Health Savings Accounts (HSA's), insurance deregulations, etc.
"Your Doctor Is Not In: Healthy Skepticism About National Health Care":
[Book] This book by Jane Orient, MD, is an illuminating and provocative analysis of the immorality and impracticality of government interference in medicine in general, and single-payer systems in particular. Dr. Orient is the Executive Director of the Association of American Physicians and Surgeons.
"The Cure: How Capitalism Can Save American Health Care":
[Book] This book was written by Dr. David Gratzer, a physician who has practiced in both the US and Canada, and has first-hand experience with the pros and cons of both countries' medical systems. His documentation of the long waiting lists in Canada and the higher mortality rates for treatable conditions is chilling. He also provides excellent historical background on how health insurance became linked to employee benefits as a result of bad IRS policies, with all the resultant problems. His basic conclusion is that capitalism, not socialism, is the way to address the problems. He offers a number of practical, concrete proposals to fix our current problems, all of which are based on decreasing government interference in medicine.
Podcast interview of Dr. David Gratzer at Instapundit.com:
[Podcast] A 30 minute interview by Glenn Reynolds of Instapundit.com with Dr. Gratzer on the problems and solutions to America's health care problems.
"Universal Health Care -- Call It Socialized Medicine":
[Online essay] Lawrence Huntoon, MD, PhD, discusses why "universal health care" is synonymous with "socialized medicine". He also observes:Indeed, "universal coverage," nationalized health care, or socialized medicine, regardless of what you choose to call it, is not the same as medical care. All of the citizens of Canada, for instance, have "universal coverage." What they often don't have, however, is the medical care that they need when they need it. That is why we see Canadians crossing the border into the United States in droves to obtain the health care that they can't get when they need it in their own country. Their government rations access to health care and thus attempts to control costs by making MRI scans, radiation oncology, bypass surgeries and many other health services largely unavailable to their own people. Dr. Huntoon is a former president of the Association of American Physicians and Surgeons, and is a practicing neurologist in New York state.
"Universal Health Care's Dirty Little Secret":
[Online article] Trying to provide universal coverage doesn't actually result in better care, just rationing.
"No 'Crisis' of Uninsured":
[Online article] Rocky Mountain News columnist Mike Rosen debunks the myth that there is a "vast army of people... who are permanently unable to obtain health insurance".
"Why Are Health Costs Rising?":
[Online article] A nice short analysis on why health care costs have risen so much. Again, the basic problem is government interference in normal market mechanisms. As anyone who has bought a cell phone or a DVD player recently knows, the natural course of the marketplace is higher quality goods for lower prices over time. Even in the medical field, this has been the pattern in LASIK and cosmetic surgery, i.e., in the types of medical care where patients pay for themselves and are therefore incentivized to be prudent shoppers.
"Colorado Medical Socialism":
[Online article] A strong critique of the CMS position on universal mandatory health care by Boulder Weekly writer Ari Armstrong.
There is no health care crisis in Colorado:
From Lin Zinser's 3/28/2007, "Report on the 208 Commission" (scroll down to her "second point"). She notes, "According to Colorado voters there is no crisis of health care in Colorado. According to Colorado voters polled in December 2006 for the Denver-Metro Chamber of Commerce, 77% of Colorado voters believe their own health care is good or excellent and 60% believe the quality of health care in Colorado as a whole is good or excellent. More to the point, only 7% describe the situation in Colorado health care as a crisis."
Problems with Tennessee's universal health care system, TennCare [online articles]:
"The Price of Seduction"
(A devastating criticism of TennCare from family practice physician, Dr. Sydney Smith.)
"Tennessee: Lesson for California"
"TennCare: A model for how American socialized medicine will fail"
Problems with Massachusetts' universal health care system [online articles] :
"Universal Healthcare Boondoggle"
"Universal Health Care: Proceed with Caution"
"Intensive Care for RomneyCare"
"Bad Medicine: What's Wrong With RomneyCare"
Problems with California's proposed universal health care system [online articles] :
"One Step Forward, Ten Steps Back: How California Will Make Health Care Much More Expensive"
"Schwarzenegger's Folly"
(Analysis by John Stossel, co-anchor of ABC News' "20/20".)
Freedom and Individual Rights in Medicine:
[Organization] From their website:Freedom and Individual Rights in Medicine (FIRM) promotes the philosophy of individual rights, personal responsibility, and free market economics in health care. FIRM holds that the only moral and practical way to obtain medical care is that of individuals choosing and paying for their own medical care in a capitalist free market. Federal and state regulations and entitlements, we maintain, are the two most important factors in driving up medical costs. They have created the crisis we face today. I encourage all physicians interested in staying informed on these issues to sign up for their mailing list. FIRM also runs a weblog.
The Colorado Medical Society and some key officers:
Alfred Gilchrist (Executive Director): Alfred_Gilchrist@cms.org
Chet Seward (Director of Health Care Policy): Chet_Seward@cms.org
Lynn Parry, MD (President): nurvdr@mac.com
David Downs, MD (President-Elect): David_Downs@cms.org
Mark Laitos, MD: mlaitos@comcast.net
Ben Vernon, MD: wbvernon@qwest.net
The 208 Commission official website:
The full list of the 208 Commissioners and the publicly available e-mail addresses:
William N. Lindsay III, Chairman: 208Commission@coloradofoundation.org
Erik Ammidown: erik.ammidown@qwest.com
Elisabeth Arenales: earenales@cclponline.org
Clarke Becker: unknown
Carrie Besnette: cbesnette@gmail.com
David Downs, MD: David_Downs@cms.org
Steve Erkenbrack: unknown
Lisa Esgar: lisa.esgar@state.co.us
Linda Gorman: Linda@i2i.org
Julia Greene: jgreene@seiu105.org
Allan Jensen: allanjensen@earthlink.net
Grant Jones: grant@caahealth.org
Donna Marshall: cbghealth@aol.com
Pam Nicholson: pamnicholson@centura.org
Ralph Pollock: ralph@apaccess.com
David Rivera: unknown
Arnold Salazar: Arnolds@chnpartners.com
Mark Simon: mbsimon@juno.com
Dan Stenersen: unknown
Steven Summer: steven.summer@cha.com
Mark Wallace: unknown
Joan Weber: unknown
Barbara Yondorf: byondorf@rcfdenver.org
Peg Burnette: peg.burnette@dhha.org
Donald Kortz: dkortz@fullercompany.com
Lynn Westberg: lynn@sjbhd.org
[This letter was slightly edited on 4/17/2007. -- PSH]Labels: Health Care
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| Tuesday, March 27, 2007 |
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FIRM: Freedom and Individual Rights in Medicine
By Diana Hsieh @ 11:00 PM
Colorado's political machine is poised to institute socialized medicine in the state in the next year or so. Lin Zinser is fighting that ominous prospect with FIRM, a new organization devoted to promoting Freedom and Individual Rights in Medicine. FIRM's statement of principles reads:
We stand for Freedom and Individual Rights in Medicine.
America was founded on the principles of freedom and individual rights. Applied to medicine, the law must respect the individual rights of doctors and other providers, allowing them the freedom to practice medicine. This includes the right to choose their patients, to determine the best treatment for their patients, and to bill their patients accordingly. In the same manner, the law must respect the individual rights of patients, allowing them the freedom to seek out the best doctors and treatment they can afford.
Freedom and Individual Rights in Medicine (FIRM) promotes the philosophy of individual rights, personal responsibility, and free market economics in health care. FIRM holds that the only moral and practical way to obtain medical care is that of individuals choosing and paying for their own medical care in a capitalist free market. Federal and state regulations and entitlements, we maintain, are the two most important factors in driving up medical costs. They have created the crisis we face today.
What does FIRM do?
researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes of rising costs of health care and health insurance.
sponsors and holds public educational programs, lectures and town hall meetings on issues regarding the causes of the crises in health care and health insurance, and on the morality and economic costs of various health care programs and proposals.
makes speakers available for radio and television interviews, for professional conferences or symposiums, and for local, private or public meetings and talks in Colorado.
FIRM provides you with information about how to protect freedom and individual rights in medicine, and you decide how to use it.
FIRM is a non-profit, non-partisan educational organization; it does not endorse any health care treatment, product, provider, or organization. Membership levels begin at $35 per year and are tax-deductible, as provided by law. On the FIRM web site, you can sign up to the "News" and/or "Activists" list. You might also want to read the updated version of Leonard Peikoff's essay "Health Care is Not a Right" and Linda Gorman' informative report "The History of Health Care Costs and Health Insurance."
Also, don't miss FIRM's blog: We Stand FIRM. (If you have a blog, please add that to your blogroll.)
Please help me spread the word about FIRM! In speaking to ordinary people, I've found strong opposition to socialized medicine, but little knowledge of the already-in-motion plans to institute that in Colorado and other states. So please encourage people to write letters to their state and federal representatives opposing socialized medicine, including its modern incarnations in euphemisms: single-payer, comprehensive, universal, and/or mandatory healthcare. If you live in Colorado, you should also write the 208 Commission, i.e. the body charged with soliciting and evaluating proposals for comprehensive healthcare reform.
It is possible to stop the spread of socialized medicine, I think. Now's the time to do it. If you wait now, you'll be waiting much more in the future... in lines for your substandard medical treatment, that is.Labels: Health Care
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| Tuesday, February 06, 2007 |
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Letter to the Editor on Health Care
By Diana Hsieh @ 6:53 AM
Last week, I wrote a letter to the editor for the Rocky Mountain News responding to Paul Campos' column on "myths" about American healthcare. It was published in full on the web, albeit apparently not in the print version. Here it is:
Paul Campos ("Our Sickly Healthcare," Jan 30) notes the enormous influence of the government on America's ailing market for medical care. Yet he misses the obvious: government meddling is the fundamental source of those ills. His proposal for more government-controlled medicine--for socialized medicine--would be a disaster for medical providers and patients alike.
Already, government bureaucrats set prices by arbitrary fiat via the Medicare system, then overwhelm doctors with paperwork and regulations. Already, consumers are encouraged to pursue medical care without regard for cost, thanks to tax laws encouraging employers to provide medical insurance for even routine expenses. Already, taxpayers are burdened with the cost of ever-growing medical entitlement programs. Already, FDA regulations drive up the cost of life-saving drugs and prevent doctors from prescribing drugs known to be safe. The result of that government meddling is an expensive bureaucratic labyrinth that prevents healthcare providers--doctors, nurses, drug companies, hospitals, clinics--from providing the best medical care for the patient's dollar.
The solution to these problems is not more paternalistic government regulations, bureaucracy, and entitlements. It is to allow--and require--people to take personal responsibility for their own health by separating medicine and state.
Diana Hsieh
Sedalia I was pretty pleased with the letter, particularly with the fact that it didn't take me too long to write. (RMN allows comments on letters; so please post away!)
The forces of socialism are gearing up to impose government-controlled medicine on Colorado, so I expect to be writing more on this topic over the next year and a half. (I'll say more about all that later.)Labels: Health Care
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| Sunday, August 06, 2006 |
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Tasteless Medical Slang
By Paul Hsieh @ 8:20 PM
After a busy weekend on call at our Level 1 Trauma Center, I thought I'd post some examples of classic medical slang. Here's a related list, with a more UK flavor. And of course, there's a Wikipedia entry. Most of these terms are never used in front of patients, for obvious reasons.Angel lust: a male corpse with an erection (not uncommon). Is also sometimes used to mean death that occurred during intercourse.
BFH: Brat From Hell, usually accompanied by PFH, i.e., Parent(s) from Hell
Bobbing for apples: unblocking a badly constipated patient with one's finger
Bury the Hatchet: accidently leave a surgical instrument inside a patient.
Code brown: Incontinence-related emergency
DBI: Dirtbag index, which is calculated by the number of tattoos on the body multiplied by number of recentmissing teeth, to estimate days without a bath
Donorcycle: motorbike, the biggest cause of donated organs!
FTF: Failure to fly, for attempted suicide victims
GPO: Good for Parts Only
Journal Of Anecdotal Medicine: The source to quote for less than evidence-based medical facts
N=1 trial: Polite term for experimenting on a patient
Neuro-fecal Syndrome: S**t for brains
Organ recital: A hypochondriac's medical history
O-sign: Found on the very sick patient who lies with mouth open. Precedes Q-sign
Q-sign: Following the O-sign, it's when the terminal patient's tongue hangs out of their open mouth
Rule of five: If more than five orifices are obscured by plastic tubing then the patient's condition is critical
TFBUNDY: Totally f*cked but unfortunately not dead yet. Best avoided in the medical notes
TUBE: Totally unnecessary breast examination
UBI: Unexplained beer injury, for all those hungover people on Sunday mornings with black eyes or swollen knees and no idea how they'd got them
Whopper with cheese: Fat woman with yeast infection Although this sounds suspiciously like an urban legend, there is a supposedly true story of one doctor who had scribbled TTFO ("Told To F*** Off") in a patient's chart. When the case later went to trial, the doctor was asked by the judge what the acronym meant, and luckily for him he had the presence of mind to say: "To take fluids orally".Labels: Health Care
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| Friday, September 16, 2005 |
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The Hippocratic Oath
By Diana Hsieh @ 2:00 AM
It is commonly thought that doctors swear the Hippocratic Oath. However, Paul never swore to anything like this:
I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.
I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.
If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot. Paul vaguely remembers swearing to this modern version upon graduating medical school instead:I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. Boy, is that ever a snoozer! Surely it's no longer necessary for doctors to promise to forebear taking sexual advantage of the slaves in the houses of the patients they visit. (After all, what doctor makes house calls these days?!?) Still, an oath with a single inspirational purpose would be more appropriate than that disjointed list of nags.Labels: Health Care
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| Sunday, August 28, 2005 |
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Medical Education
By Paul Hsieh @ 10:15 PM
In the comments section, Marnie recently asked,What is Paul's specialty please? How many years out of school is he? Does he still recommend the business? [I start post-bac pre-med classes in 3 weeks.] In response to Marnie's questions:
1) My field is diagnostic radiology, with subspecialty interests in trauma/emergency radiology and orthopedic radiology.
2) My education consisted of 4-years college (i.e., pre-med), 4 years medical school, one year laboratory research at the NIH (National Institutes of Health) in Bethesda MD, 4 years residency in diagnostic radiology, and one year of additional clinical fellowship training in MRI (magnetic resonance imaging) with emphasis in advanced orthopedic radiology.
Since then, I've been in practice for 11 years, both as a faculty member at the Washington University School of Medicine in St. Louis (3 years) as well as 8 years of private practice (3 years in San Diego, and 5 years now in Denver.)
3) I still recommend the field provided that one finds the actual science and art of medicine interesting in their own right. In that case, the various b*llsh*t elements related to government regulations are tolerable, at least for the time being.
I personally find the field intellectually fascinating. Plus the technology is advancing at an exciting pace.
During my daily practice, I get to deal with people who are for the most part very rational (at least with respect to work), goal-directed, and efficacious. Most of my day is a constant use of reason (both induction and deduction), applied directly to issues of ultimate value, namely another person's life. In terms of job satisfaction, it's hard to beat this combination.
Since a lot of people don't know exactly what a modern radiologist does, I thought I'd explain in a little bit more detail what I do and what I like about my job.
There's nothing I enjoy more than solving a diagnostic mystery by taking a set of subtle and apparently disconnected findings from a patient's x-rays, CAT scans, and MRI's, and integrating them in order to arrive at a correct diagnosis.
Similarly, I enjoy performing invasive radiology procedures (so-called "interventional radiology") where I use real-time x-ray imaging to guide a needle to a target within a patient's body (avoiding all the critical nerves and blood vessels), in order to either perform a biopsy or deliver a dose of medication to exactly the right spot in as pain-free and safe a fashion as humanly possible.
Advances in imaging technology allow radiologists to perform procedures in the x-ray suite that 20 years ago would have required much riskier open surgery. Interventional radiology is like playing a video game, but where the stakes are much higher (as are the rewards).
Colorado is a very outdoors-oriented state, and hence a lot of people enjoy activities like skiing, snowboarding, mountain biking, rock-climing, etc. Hence, if you were to take a bad fall on the ski slopes at Aspen or Vail and hurt your knee, it would be me who would interpret your MRI scan and tell your orthopedic surgeon which structures were torn and which were ok.
Or if you were to get into a bad car accident in the middle of the night and were helicoptered to our Level 1 trauma hospital, it would be me who would read your emergency CAT scans and tell the trauma surgeons which organs were critically injured and needed immediate repair, which were less critically injured (and still needed attention, but not immediately), and which structures were ok.
I think I have one of the coolest jobs in the world. It was a long road to get to the point of being able to practice independently as full-fledged board-certified physician, but it was well worth it in the end.
Medicine is an extremely varied field, and there is a branch of medicine that should suit nearly any personality type. For instance, some people enjoy high-pressure specialities that require quick-decision making skills like trauma surgery, whereas other people like slower paced puzzle-solving fields like pediatric endocrinology. Some people enjoy fields with a lot of patient contact like family practice, others prefer fields with minimal patient contact like pathology. Hence, Marnie, you should be able find a field that suits your interests and temperament.
I wish you much success and happiness in your studies, Marnie. If you have any further questions about medical education, I'd be happy to answer them, either here or via e-mail.Labels: Health Care
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| Wednesday, August 24, 2005 |
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Killing Us Not-So-Softly
By Diana Hsieh @ 9:17 AM
I'm feeling a bit ill this morning. I'm not surprised, since I just read Malcolm Gladwell recent article advocating socialist medicine. Apparently, my husband should be sold into slavery so that a few idiots with rotting teeth can smile again.
I'm quite serious about socialist medicine meaning the enslavement of doctors. If our government ever voted itself control over our health care, doctors would not be permitted to practice medicine except under the terms dictated by government bureaucrats. My husband would be told what treatments he could offer, what equipment he could buy, what fees he could charge, which patients he can or must accept, and so on. If any of his patients wanted to pay him more for some safe and effective treatment unacceptable to the government, he could not offer it. (He would be exploiting their need!) If too many doctors refuse to work under those conditions -- as I know Paul would -- the government could follow the lead of Pennsylvania by requiring doctors to ask for permission to quit, retire, or move to another state. Of course, some doctors would welcome socialist medicine, but such happy slaves are still slaves.
Given the well-known disasters of socialist medicine -- like ever-rising costs, long waits for diagnosis and treatment, substantial lags in technology, treatments not offered, and so on -- for an intellectual to pretend that "universal health care" would simply extend our high standard of medical care to all is inexcusable.
Certainly, much is wrong with our current health care system. Yet all the serious, chronic problems are rooted in our decades of government intervention. The government has substantially distorted the market with its massive regulatory schemes and ever-expanding welfare programs. For example, the unprecedented use of employer-provided health insurance to cover normal, expected medical expenses is a direct consequence of government wage freezes during World War II. For example, since insurance companies determine their payments based upon the arbitrary fee schedule of Medicare, doctors are paid very poorly for reading those all-important mammograms, even though they assume a huge malpractice risk in doing so. The solution to these kinds of problems is to eliminate the source government intervention, not to increase it.
My mood was slightly improved upon re-reading Leonard Peikoff's excellent essay "Health Care is Not a Right". Altruism, collectivism, and statism drive the engine of change for socialist medicine -- and so the battle must be fought in moral terms. Economic arguments about the practical effects of socialist medicine are a helpful adjunct, but by themselves, they lapse into absurd irrelevance.Labels: Health Care
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| Sunday, March 20, 2005 |
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Canadian Health Care
By Paul Hsieh @ 8:00 AM
This recent article on Canadian health care shows how badly things have deteriorated. Some choice excerpts:A letter from the Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: "If the person named on this computer-generated letter is deceased, please accept our sincere apologies." ...The patient wasn't dead, according to the doctor who showed the letter to The Associated Press on condition of anonymity.
Americans who flock to Canada for cheap flu shots often come away impressed at the free and first-class medical care available to Canadians, rich or poor. But tell that to hospital administrators constantly having to cut staff for lack of funds, or to the mother whose teenager was advised she would have to wait up to three years for surgery to repair a torn knee ligament.
"It's like somebody's telling you that you can buy this car, and you've paid for the car, but you can't have it right now," said Jane Pelton. Rather than leave daughter Emily in pain and a knee brace, the Ottawa family opted to pay $3,300 for arthroscopic surgery at a private clinic in Vancouver, with no help from the government. Defenders of the Canadian system call it the "most moral and most cost-effective health care system there is in the world". As proof of its morality, they make the argument that it's good because there's no contamination by self-interest. The website for this group, Friends of Medicare, is very explicit on this point in their FAQ:Why shouldn't I be permitted to buy medical treatment for myself and my family?
The Moral Answer
Let's turn the question around. If you can afford the treatment for your grandchild, but your neighbor cannot, what justification is there for denying your neighbor's grandchild timely treatment? Is your sick grandchild more deserving of help than your neighbor's grandchild? This gets to the heart of the moral question; and it gets to the heart of the basic value represented by our compassionate Canadian Medicare System. The basic principle is that a person has the right to the best medical care available regardless of ability to pay. As appalling as the answer is, at least they are totally clear on the moral underpinnings of their policies, as well as the practical consequence - you should not be able to buy better health care than your neighbor, since it goes against the moral value of egalitarianism. One obvious corollary would be an eventual ban on people buying better food their their neighbors even if they can afford to do so, because there's no justification for you to have something your neighbor can't. It may seem far-fetched now, but so would the current position of the "Friends of Medicare" just a generation ago. (The FAQ also glosses over the fact that buying something for oneself is not the same as "denying" the same thing for your neighbor - this is just another example of the "fixed pie" fallacy in action.)
The article also details a number of bizarre unintended consequences caused by the perverse incentive system of Canadian health care. For example:...That's one way the system discourages the spread of private medicine -- by limiting it to nonresidents. But it can have curious results, says [orthopedic surgeon Dr. Brian Day].
He tells of a patient who was informed by Ontario officials that since Ontario couldn't help him, they would spend $35,000 to send him to the United States for surgery.
Day said his Vancouver clinic could have done it for $12,000 but the Ontario officials "do not philosophically support sending an individual to a nongovernment clinic in Canada." The rest of the article describes various Canadians' desires to somehow reform the system, while retaining the egalitarian nature. Given the unsoundness of the underlying premise, all I can say is "Rotsa Ruck!"Labels: Health Care
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