Health reform should save people, not kill them

By John in Oregon

When we have a limited budget for medical care, who gets that care? For Statists only so much medical care exists in the world. Your gain is my loss. Older people spend a lot more on doctors than younger people. Should the elderly be prevented from spending their money on staying healthy? If you spend your money on health care, does that subtract from the medical care of a younger person? President Obama’s statements and the Democrat health care plan are based on the belief that it does.

Dr. Ezekiel Emanuel a health policy adviser in the Office of Management and Budget and brother of White House Chief of Staff Rahm Emanuel, gives voice that American Health Care is too expensive, misdirects resources and it stinks. The use of services, nurses, technicians, medical tests, and the use of expensive technology must be cut. “The President’s top medical advisers are quite frank about this. Dr. Emanuel has chided Americans for the expense of their ‘being enamored with technology.'”

Dr Peter Singer makes this point directly in his NYT Magazine article Why We Must Ration Health Care. Dr Singer opens his article with;

“You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?”

Singer then goes on to make the case that limited health care resources should be directed to more effective treatments for more productive individuals. He states “Health care is a scarce resource, and all scarce resources are rationed in one way or another.”

But is Singer correct? Is heath care scarce or limited? Consider Singer’s scenario with a drug we know more about.

You have advanced breast cancer. It will kill you, probably in the next year or two. A drug called Taxol slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

In the late 80s and early 90s Taxol was hideously expensive. It was worth 10 to 100 times its own weight in gold. Lets follow a sampling of the headlines through the years.

– Taxol Slows Advanced Breast Cancer
– Taxol Effective For Early Breast Cancer
– Weekly Taxol Best For Followup Breast Cancer Care
– Taxol Benefits HER2-Positive Breast Cancer
– Taxol Investigated As Breast Cancer Preventative

Taxol was initially used for advanced cancer, them became a drug that is used for early and preventative breast cancer treatment. In other words over the years we learned Taxol was effective and when best to use it. During those same years the cost of the drug plummeted. Fewer women experience advanced breast cancer. The drug is now responsible for a large reduction in the social and health care cost of disease.

Will Sutent be the same kind of drug for Kidney and other Cancers? We don’t know yet. It could be, but if we follow Dr. Singers recommendation we will never know because, for Dr. Singer, Sutent is a wasted resource.

In mid 1960s the odds of dying immediately after a heart attack was 30 to 40 percent. In 1975, it was 27 percent. In 1984, it was 19 percent. In 1994, it was about 10 percent. Today, it’s about 6 percent. Many small steps along the way to fight the nations number one killer.

Within the last 6 weeks on PBS a spokesman for the Democrat health care bill highlighted the waste of angiograms for heart patients. Surviving the heart attack was no better with an angiogram than without he said. Access to expensive angiograms should be restricted as a wasted and unnecessary treatment.

Yet last December 6th (2008) an article by Nathan Seppa in Science News reported “People who show up at a hospital with mild heart attack symptoms, but only ambiguous scores on medical tests, might still warrant emergency treatment, according to research presented at a meeting of the American Heart Association.” “¦ “patients who had gotten early catheterization [angeogram with catheter treatment] were 70 percent less likely to have repeat coronary blockage”¦”

That’s a large reduction in future heart attacks. A huge savings of the social and health costs of heart disease.

The common theme in Washington DC is that health care is a zero sum game. Dr. Emanuel, Science advisor John Holdren, Dr Peter Singer, President Obama, and the architects of the health care bill believe your use of the health care system is someone else’s loss. When you consume wealth, someone else has less.

This point of view holds that Sutent and Taxol are an expense. Angeograms, CTs, and MRIs are an expense. The sanitary sewer system, a large contributor to health, is an expense. Indeed the patient and the doctor are an expense. All expense and no benefit.

Jay Leno once joked about the commercial, “Eat all you want… we’ll make more!” But, they stopped making Nacho Cheese Doritos. Now you must buy Nacho CHEESIER Doritos.

In 1798 Thomas Malthus was wrong. Just as those in 2009 who believe that wealth, resources and health care are limited are wrong. New wealth and health care are created by people. Use the health care you need, we can make more.

I will take the new and improved product any day.

Thanks to Rick Moran, James Lewis, and Christopher Chantrill of American Thinker and David Brown of the Washington Post, for background.
— Oregon Tax News

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Posted by at 05:55 | Posted in Measure 37 | 6 Comments |Email This Post Email This Post |Print This Post Print This Post
  • Bob Clark

    Fostering supply is a better tack than restricting demand. The former promotes creativity, enthusiasm, dynamism, and like drugs coming off patent, lower costs. The latter democratic party approach leads to slow service, escapism, and a general malaise. Restricting demand is so Orewellian, too. Look at U.S Representative Blumenauer’s proposal to have older people visit their doctor periodically to be told about doctor assisted suicide. Do you really think this wouldn’t be the first step towards speeding up the termination of the “unwanted.” Of course, the democrats usually are pro-death even when the baby is just about to come out of the womb. Some of them have even made allusions that abortion has helped rid society of certain bad elements. Blumenauer and his fellow democrat friend Speaker Pelosi are just plain creepy-like Orwellian.

    As a side note, Today’s Wall Street Journal reports France which has had Universal Healthcare is finding it too expensive, and is beginning to turn towards privatization.

  • Steve Buckstein

    Excellent analysis, John. The zero-sum game fallacy is bad enough when it’s believed by average folks; it’s positively dangerous when the power of the state turns it into public policy.

    To the point about the cost of care for the elderly, “…a study by Organization for Economic Cooperation and Development (OECD) economists in 1995 found that the higher utilization rates and greater numbers of the aged per se explained only 3 percent of the growth in health care spending in the U.S. between 1960 and 1990. The other 97 percent was the result of increases in demand (i.e., rising income and the inflationary effects of [the Medicare program that occur because those on the program perceive their care to be free or nearly free].”

    Source: “First do no harm”, Randall J. Pozdena, Ph.D., Cascade Policy Institute, October 2002.

  • Rupert in Springfield

    >When we have a limited budget for medical care, who gets that care? For Statists only so much medical care exists in the world. Your gain is my loss.

    You know, it used to bother me why the left always likes to frame things in terms of a zero sum game. Recently there was a discussion here where someone had the absurd notion that because homeowners were allowed to deduct mortgage interest, that meant that renters were taxed more. To him taxes were a zero game and he would not discuss it unless things were framed that way.

    So why is this?

    Well, for one thing a zero sum game will generally set up a situation where on group is pitted against the other. This is essential strategy for implementation of leftist policy. By definition leftist policy involves greater government involvement in peoples lives which by definition means less freedom. No one is going to take that sales pitch very willingly, “give up some of your freedom so we can run some of your life”.

    However if you can frame the debate in terms of “they have got it, you want it, we are going to take it from them and give it to your” that gets people riled up. People like that idea better, it plays upon the most base nature of humanity.

    This is why Obama wants to do nutty things like raise some taxes he knows will then bring in less revenue. Its not about the revenue, its about setting up a factionalized situation so he can be seen as the disburser of largess. Being seen that way is crucial, because as the government is seen more the granter of money rather than earning it through ones industry, one is more pliant to the idea of government providing ever more. Thus the image is more important to establish than actual revenue gains in the instance of some of Obama’s tax increases. That’s what he meant by it being a matter of justice to raise capitol gains. That meant government in its just position as wealth arbiter, not justice for the individual.

    The zero sum game with health care is on several levels. In one way it is being framed in this way of taking really expensive health care only old rich people can afford and giving it to the masses. I few old people are killed but thousands will get a flu shot or a cavity filled. Setting up this factionalized situation instills a sense of entitlement on the part of the would be recipients/thieves. This is why the language of “health care is a right” is promoted even though it is non sensical.

    The zero sum game accomplishes this factionalization and far more and thus its an important strategy. First of all if done right it sets the majority against the minority and thus helps promote the idea. Second, and perhaps most crucial, is that it sets up the construct of the idea being eminently possible financially and thus it becomes more real and less abstract in the persons mind. Funds for the idea don’t have to be obtained or spent at all since in a zero sum game the is simply shuffling of funds from one group to another. The third thing this strategy does is perhaps less subtle, but often quite necessary to left wing idealism. Permanent shut down of opposition. Take the case of health care. We constantly hear about taking the profit element out of insurance companies to use on health care, thus zero sum. Except then you have no insurance companies. The industry is dispensed with and thus opposition from them is no more. In the zero sum game they were zeroed out along with their money. The government is enriched and an opposition element is silenced by non existence.

    It’s all pretty scary stuff, but frankly that’s how one has to operate to shove ideas down peoples throats that they don’t want.

  • dartagnan

    The problem is not too many tests — the problem is too many UNNECESSARY tests that in too many cases are ordered simply so the clinic or hospital can make a few more bucks.

    True story: My own physician went into a hospital emergency room in another city with an attack of kidney stones. He had had these attacks before; he knew how to handle them. He told the emergency room docs: “Give me X liters of water (intravenously) and a shot of morphine for the pain and I’ll pass the stone.” As I said, he had been through this before; it was pretty routine for him. And as I also said, this man is a physician.

    But would the hospital listen to him? Hell no. They INSISTED he have a CT scan (cost approx. $500) to determine that he, in fact, had a kidney stone. They wouldn’t treat him unless he agreed to it. So they did the CT scan to find out if he had a kidney stone and, sure enough, he did. They then treated him as he initially suggested and he was fine.

    Now, if this sort of thing happens to doctors, what do you think happens to ordinary slobs every day?

    Another personal example: A few weeks ago I went to the local urgent care center because I had severe lower abdominal pain. They did a bunch of urine tests and blood tests and a thorough physical exam and couldn’t find anything wrong. So they wanted me to have a CT scan to see if I had diverticulitis. I knew I had no other symptoms of diverticulitis (diarrhea or constipation, nausea and vomiting, fever, rectal bleeding) so I was more than a little skeptical. “I’m not spending $500 on a CT scan because I have a bellyache,” I said. “If it’s not better in two days I’ll come back and you can scan me.”

    It’s easy to see how somebody who was less well informed or in worse pain and maybe not thinking as clearly could have gotten panicky and been talked into a completely unnecessary CT scan. THESE are the kinds of abuses we need to stop if we are ever to get our ridiculous medical care costs under control. It’s not about “rationing”; it’s about plain old common sense — and medical ethics.

    • Rupert in Springfield

      I’m kind of mystified into how you arrive at the conclusions you do. Certainly the situations you describe are hardly new, a battery of expensive tests for a hang nail. However how you ascribe the motivation is beyond me. Unless you are going to some sort of hospital where the doctors or nurses are working on commission I fail to see their incentive to over prescribe. I just simply do not those in the urgent care section are making money from prescribing an unnecessary CT scan. How you reach that conclusion is not really indicated.

      I would suspect those people were prescribing the CT scan for a very simple reason, they have their name on the intake papers and if you suffered injury because of them not taking all precautions, you could sue and they would lose their jobs due to negligence.

      Frankly I think tort reform would do a lot to get rid of this.

      Sadly this is one of the common sense medical reforms that wouldn’t cost trillions that won’t happen any time soon. We all know who the trial lawyers association tends to give their money to.

      As an aside, I always wonder why there is all this hubub about prescribing unnecessary treatment when no one seems concerned about prescribing unnecessary health insurance. At least doctors are prescribing the unnecessary treatment. When it comes to insurance mandates, those are prescribed by special interest groups through the legislature. Getting down the cost of unnecessary insurance mandates is every bit a part of containing health care costs.

  • John in Oregon

    dartagnan you gave us a lot to consider. When you highlight unnecessary tests, my first reaction is to ask who decides a test is UNNECESSARY, and what are the circumstances which underlie the necessary / unnecessary decision?

    As I read your account of your doctors kidney stone I was astounded. Not by the actions of the ER attending but by your doctors attitude. In these days of patients trolling ERs for controlled substances I should think your doctor would understand why it is necessary to an attending to dot and cross Is and Ts for a controlled substance prescription. Your doctor is the first person I would expect to understand the ramification of laws governing access to controlled substances. That’s what I mean by circumstances.

    In any case why would we expect any attending to prescribe treatment without the basic diagnostic support?

    I really like your second example. You go in with belly pain and the Urgent Care attending doesn’t find anything alarming or abnormal. You spoke with the attending who suggested further diagnostic tests. At this point you acted like a consumer. You made a value judgment that the value of the test results did not justify the cost.

    This is exactly what free market conservatives would like to see. You consulted with your attending and made an informed purchasing decision.

    Far and away the best example to explore the issue of unnecessary tests is the angiogram scenario so often used as an example of the need for central planning. The details seem very clear. The UK fond that a patients odds of surviving the heart attack was no better with an angiogram than without. The UK then banned angiograms.

    Tom Daschle and the architects of the heath care legislation point out that when an angiogram finds a minor blockage the doctors treat it. It’s a powerful argument that unnecessary tests like angograms waste limited health care resources that could be directed to more effective treatments for more productive individuals.

    Now contrast with the study reported by Nathan Seppa in Science News. In that study half the ER heart patients received the normal standard of care. The others received extended care including catheterization.

    The study did not report improvement for the “current heart attack” which is consistent with previous studies. It did report a reduction in “future heart attacks”. The second heart attack that costs thousands to treat in the ER.

    It’s worth noting this study could never have been done in the UK. Not even if the health care rationing board had some how approved angiograms for the study. The facilities to do ER angiograms no longer exist in the UK.

    This in a microcosm is the issue. Limited health care resources that must be rationed by central authority or abundant resources allocated by consultation between doctor and patient.

    The context of deciding what is an unnecessary test has everything to do with it.

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