Ed Morrissey has blogged at Captain's Quarters since 2003, and has a daily radio show at BlogTalkRadio, where he serves as Political Director. Called "Captain Ed" by his readers, Ed is a father and grandfather living in the Twin Cities area of Minnesota, a native Californian who moved to the North Star State because of the weather.
Dr. McCoy To The Sidelines, Please
Star Trek fans remember the tricorder, the handy medical and scientific device that allowed both Dr. McCoy and Mr. Spock to make instant evaluations of injured crew members, hostile environments, and hurt Hortas. They were one of the ways in which plot lines could get speeded along without too much exposition, along with the "universal translator" that allowed everyone to speak in California English -- well, everyone! except! William! Shatner!
In a development that ST fans might appreciate, sports physicians may be able to use something similar now to check for concussions. A new hand-held brain-scan device promises to make a clear diagnosis that will eliminate guesswork and prevent permanent damage:
A startup called BrainScope is developing a tool that may help inform doctors about which injured players should stay on the sidelines—or be taken to a hospital. The Chesterfield (Mo.) company's handheld device determines the severity of concussions by reading the brain's electrical signals. The National Collegiate Athletic Assn. is planning a clinical trial later this year. Ira Casson, co-chair of the NFL's Mild Traumatic Brain Injury Committee, is eyeing the technology. "Today, you often have to use only your judgment" to gauge how serious a concussion is, Casson says. "If there were something more objective, that would be very useful." ...
The result was a tool that's cheap and simple enough to be used on the sidelines. Rather than producing hard-to-decipher squiggly lines, the BrainScope device displays a meter, which shows whether brain activity after an injury falls in or out of the danger zone. Built-in signal-processing technology picks up abnormal brain signals, while simultaneously canceling out electrical noise from blinking, breathing, and the like. The device calculates the severity of each injury by comparing brain wave readings to a database of 15,000 scans compiled at New York University's Brain Research Lab. "We're going about it exactly the way many doctors told us to go about it," says Causevic.
On Jan. 15, Causevic met with brain experts for the NCAA to design a pilot program. Before they roll out BrainScope, they'll measure the brain activity of 750 high school and college players. That will provide an additional comparison to validate BrainScope's accuracy after an on-field collision.
The device has applications outside of sports as well. If the price gets low enough, EMTs could carry this as a diagnostic device. Emergency rooms could use it in place of a more expensive EEG for triage. Most importantly, as Business Week notes, the military could use it in the wake of bomb attacks to determine whether troops need to be rotated out of combat assignments for recovery.
The technology still has to prove itself. It uses a scanning technique that has not had much validation in the past, despite 70 years of experimentation. The technique suffers from a reputation garnered by quacks using it for New Age enlightenment and for diagnostic purposes for which it was never intended or tested. BrainScope intends to provide the real-world test for the product that will prove the technology a boon or a bust in short order.
It's not quite the tricorder that Star Trek predicted, but it's a good start if it works. Does the device come with the lighted salt shaker accessory Dr. McCoy used, too?
When Government Runs The Health Care System....
... it gets to make choices about what -- and whom -- to cover. A survey of doctors in Britain's National Health Service show that a significant percentage of providers want government to cut off benefits to the elderly, the obese, smokers, and others:
Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives.
Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone.
Fertility treatment and "social" abortions are also on the list of procedures that many doctors say should not be funded by the state.
The findings of a survey conducted by Doctor magazine sparked a fierce row last night, with the British Medical Association and campaign groups describing the recommendations from family and hospital doctors as "outrageous" and "disgraceful".
On one hand, this makes sense. After all, the taxpayer has to foot the bill for these procedures and these patients. Why should some taxpayers have to subsidize bad behavior? If people choose to smoke, why should non-smoker taxes support the consequences of that habit, especially when it makes non-smokers wait longer for their own health care?
This exposes the fallacy of "free" health care. There is no such thing. Someone has to pay the bills, and it can either be the patients themselves, the insurers, taxpayers, or a combination of the three. No matter what happens, each of these payers will act in some way to ration care, especially regarding cost. The question is which kind of rationing allows for the best access for the individual, and which threatens the greatest intrusion on freedom and personal choice.
In a single-payer system, the government can extort individuals over their personal choices, and even have some rational support for that extortion. In the name of "fairness", they can determine that some people are too old to invest in their care. They can determine that others eat badly and therefore don't deserve to take resources away from people who eat better. At some point, that could translate into preferential treatment for vegetarians or against vegetarians, depending on the whims of the bureaucracy at the moment.
Do you want government to tell you that your mother or father are simply too old to matter anymore? Would you like to have that happen in a system where either the private care choices are out of reach because the government has removed all of the private insurers from the market, or they don't exist, as in Canada? Eventually, state run systems fall back to the bread line model, as they did in the Soviet Union, and someone has to start making choices about who gets the bread. (via Memeorandum)
Tobacco For Tots
A public service message on behalf of the children:
And remember, flu season's coming. No time like the present to start smoking and do your part for respiratory health.
The Rich Get Health Care
The British National Health Service has launched an entire new industry: surgical tourism. The Daily Mail reports that the numbers of Britons seeking an escape from the universal health-care system will exceed 70,000 this year and 200,000 by 2010, flying to all parts of the world to get medical attention, and better surgical conditions:
Record numbers of Britons are travelling abroad for medical treatment to escape the NHS - with 70,000 patients expected to fly out this year.
And by the end of the decade 200,000 "health tourists" will fly as far as Malaysa and South Africa for major surgery to avoid long waiting lists and the rising threat of superbugs, according to a new report.
The first survey of Britons opting for treatment overseas shows that fears of hospital infections and frustration of often waiting months for operations are fuelling the increasing trend. ...
India is the most popular destination for surgery, followed by Hungary, Turkey, Germany, Malaysia, Poland and Spain. But dozens more countries are attracting health tourists.
The European destinations seem understandable, given their proximity and easy access. The longer trips to India and Malaysia indicate a measure of desperation. The expense involved has a great deal of money flowing out of the country, and it shows that a free people find market-based solutions when possible.
India's popularity comes in part from their efforts to fight against antibiotic-resistant bacteria, something that the NHS has yet to do systematically. In fact, the DM says that surgical complications from Clostridium difficile have risen past the 55,000 cases known from the previous year, continuing a decade-long trend that has seen a 500% increase in such infections. Hungary's attraction comes from its access to dentists, while the NHS has seen most of its dentists flee the system.
And of course, what this shows is that those who have the money will have the resources to get medical care -- and they know better than to use the NHS. People who can afford the double hit of their taxes (which fund NHS) and private medical care manage to do so, and they don't stop at British private medical resources to get it. They have "globalized" medical care by shopping for services, using competition to drive down cost and improve delivery of services.
If Britain would allow those kinds of market forces to work in its health industry rather than impose the kind of top-down government management that NHS represents, they might keep that money in Britain. If the US wants to keep from creating its own surgical tourism industry as an export, we should learn this lesson, and quickly. (via Memeorandum)
The New S-CHIP, The Same Ram Job
The Democrats have introduced a new version of S-CHIP that they hope can garner enough Republican support to override a presidential veto. The changes in the details limits childless adults from accessing S-CHIP and it sets a lower ceiling of 300% of the poverty line for eligibility. However, it still contains the regressive smoking tax and still does not account for full funding of the program:
Just one week after failing to override President Bush's veto, House Democrats will put a new version of their $35 billion expansion of the State Children's Health Insurance Program to a vote today, hoping that minor changes will win enough Republicans to beat Bush this round.
The new version will underscore that illegal immigrants will not have access to the expanded program. It will ease adults off the program in one year, rather than the two in the vetoed version. And it establishes a firmer eligibility cap at 300 percent of the federal poverty line, just more than $60,000 for a family of four.
The move took Republican leaders by surprise. Bush administration officials yesterday voiced conciliation, suggesting the president could accept legislation that would expand the program by about $20 billion over five years, far bigger than the $5 billion expansion that Bush initially proposed. At the same time, Health and Human Services Secretary Mike Leavitt has been meeting with House and Senate Republicans, urging them to hold the line against an even larger bill. And Bush continues to oppose the tobacco tax increase that Democrats want to fund the measure.
House Majority Leader Steny H. Hoyer (D-Md.) has been meeting all week with some of the 45 House Republicans who voted for the first bill, looking for ways to win the dozen or so votes that supporters needed to override another veto. But Democratic leaders have yet to reach out to the Republicans who voted against the measure.
"When they need my vote, they don't even have the courage to ask me for it," complained Rep. Ric Keller (R-Fla.), who has suffered through a barrage of advertisements from Democratic allies accusing him of forsaking children.
That's not the only place in which they lack the courage of their rhetoric. After years of complaining about Republican majority practices (which followed Republican complaints of Democratic majority practices before 1994), Nancy Pelosi promised open debate and reasonable access for the minority. In a well-documented initiative that's on her Speaker web site, Pelosi promised that "Bills should generally come to the floor under a procedure that allows open, full, and fair debate consisting of a full amendment process that grants the Minority the right to offer its alternatives, including a substitute.” She also promised that “Members should have at least 24 hours to examine bill and conference report text prior to floor consideration. Rules governing floor debate must be reported before 10 p.m. for a bill to be considered the following day.”
So what happened today? The debate on HR 3963 will occur under a "closed rule" -- which means Republicans can't offer amendments. The GOP Whip claims that this is the 40th time that rule has been invoked by the majority. Also, the bill got filed last night at 11:25 pm, almost a midnight run, and the House started debating it at 11:20 this morning, just shy of 12 hours after publicizing the text. Most of the people debating this bill havenh't even read it yet.
This is the New Direction for America promised by the Democrats. They issue bills in the dark of night, refuse to allow real debate and compromise, and force votes on massive spending initiatives without allowing for reasonable review first. That direction leads to irresponsible legislation and hefty bills for taxpayers, regardless of the value of the initiative. If this new S-CHIP proposal has any merit, why are Democrats afraid of real debate and bipartisan effort?
Questionable Assumptions From A Questionable Poll
The Los Angeles Times reports today that their polling demonstrates that more Americans agree with the Democrats than the Republicans on how to reform health care. A slender majority want government mandates for people to carry health insurance, and a larger majority supported a mandate for employers to offer it. However, the polling sample has much more to do with the results than the Times acknowledges:
Two of the main proposals advanced by Democrats received majority support in the poll.
Sixty-two percent said they supported requiring large employers to help pay for coverage whereas 31% opposed it. And 51% said they favored a mandate that individuals purchase health insurance, much as drivers are required to carry auto coverage; 39% disagreed.
Tax breaks to make insurance more affordable -- a leading Republican idea -- more closely divided the public, with 44% backing that approach and 45% opposing it.
In one of the most politically significant results, the poll finds that independents and moderates were generally lining up with Democrats in the healthcare debate.
Just as with the CBS polls, the LAT/Bloomberg poll delivers results that favor Democrats -- because the pollsters oversampled them. A sample of 1039 registered voters contained a split of party identity of 46% Democrats, 36% Republicans, and 18% independents. Newsweek's last survey of party identification puts the split at 34%/30%/36%, which gives a much different perspective on the questions.
Yesterday, I warned about this at Heading Right and predicted that policy questions would give necessarily skewed results. It isn't hard to imagine that a poll with 46% Democrats would come up with 51% supporting the Democratic Party's policies. It might be a little more surprising that Republicans could pick up eight points for its own approach to health care with so few independents represented. In fact, the 8-to-5 point pickup might indicate that the Republican policy has more appeal to independents.
The intraparty results certainly have some value, but any questions regarding the overall policy preferences in such a poor sample are simply unreliable. I also note that the PDF of the polling done by the Times does not include the questions for the health care analysis which they report today. The questions are critical to know how the pollsters framed the issue and whether they pushed for a certain response. The lack of this data in their methodology makes the results even more suspect.
S-CHIP Override Debate: Live Blog
The debate has just begun for the S-CHIP expansion veto override in the House. At the moment, the House is not expected to override the veto; vote counters have the Democrats coming up short.
10:00 am - John Dingell has gone on about how this is "health care for America's children". It's about health insurance subsidies for middle-class children. No one proposed shutting down S-CHIP, or even curtailing it. The White House wanted a modest expansion, but not the vast expansion the Democrats want.
10:02 - Nathan Deal (R-GA) says that federal money should be limited to actual children, not childless adults. The states should fund those adults through Medicaid. He also wants the limit to go up to 250% of the federal poverty level, and that an asset cap of $1 million should be implemented.
10:04 - Charles Rangel, "in the spirit of bipartisanship, especially to my Republican colleagues", says Bush will be on the ranch in 2008, not at the polls -- so why uphold his veto now? I guess that qualifies as "bipartisanship" in Rangel's mind.
10:07 - Jim McCrery (R-LA): This expansion uses a "budget gimmick" that will not provide the necessary funding. The bill assumes 6.5 million children will drop off of S-CHIP in the second five years, leaving only 1.3 million in 2017. The President's plan would fund 2.9 million children in 2017.
10:10 - Frank Pallone (D-NJ) says the tobacco tax is a "good way" to pay for the expansion. He also says that "most" of the children are in working families. "Most"? Even families making $83,000 are working families -- no one doubts that. And a tobacco tax is terribly regressive, something Pallone doesn't mention.
10:13 - Steve King (R-IA) says S-CHIP stands for Socialized Clinton-style Hillarycare for Illegals and their Parents. It's a Trojan horse for socialized medicine. Dingell objects strenuously to the poster. "It doesn't even look like the Hillarycare proposal!"
10:15 - Pete Stark says that the Republicans will find enough money to fund the war and "kill kids". Nice. I can see in the Constitution where military resources and war fall under Constitutional responsibilities -- can Stark point out where it covers health care?
10:17 - "Bush just likes to blow things up." That gets an admonition from the Chair to Stark, and Kevin Brady (R-TX) calls Stark's comments "beneath contempt". Brady notes that Republicans created and support S-CHIP, but not federal subsidies to the middle-class. The Republicans paid for the entire ten years when they passed it -- the Democrats have not paid for it.
10:26 - Heather Wilson (R-NM), who wants to run for the GOP's open Senate seat, argues to override the Bush veto on the S-CHIP expansion. I suspect her primary challenger, Steven Pearce, will argue against the expansion of a block grant program into a middle-class entitlement.
10:32 - I'm seeing a pattern in these speakers. The Republicans, with the exception of King, use real data and the text of the legislation. The Democrats use hyperbole and at least on three occasions the Iraq war to argue for the expansion. They have mischaracterized the GOP position as intending to eliminate the program.
10:37 - Poster family alert! Rahm Emanuel trots out the Sweeneys -- but they already qualify for S-CHIP! Once again, the Democrats obfuscate the isse of S-CHIP expansion.
11:08 - Heath Schuler says his children pray for all kids -- so then why limit it to 400% of poverty level? It's an argument for exactly what the Republicans have accused the Democrats of doing -- establishing a precedent for universal government health coverage.
11:11 - Pete Stark continues his lunacy -- "You don't want to talk about spending $200 billion to kill innocent Iraqis." What an idiot.
11:13 - Kenny Hulsof (R-MO) - "I don't need to be lectured to by someone who didn't even support the original program."
11:20 - Want to see the Stark comments? Here they are:
11:22 - Stark started his personal attacks on President Bush again, and got shut down by the Chair ... finally. Republicans called the point of order, noting that it was the third offense.
11:32 - Stark said, "Under the Republican plan by 2017, we probably will have killed 20,000 soldiers in Iraq ..." Joe Barton demanded a point of order, and if the Chair rules Stark out of order, he can't speak in the House the rest of the day.
11:35 - The Chair doesn't rule Stark out of order. The Republicans had a better case on the first instance. (I edited the quote for accuracy since the last update.)
11:37 - "This bill does not cover adults." Really? Why are over 70% of Michigan's S-CHIP recipients childless adults?
11:43 - Finally coming to the end of this debate. John Boehner just finished by urging Congress to focus on poor children. Nancy Pelosi argues that we should follow every other industrialized nation in providing government coverage for all children -- once again revealing the real agenda behind this S-CHIP expansion.
11:50 - Pelosi, still speaking, does a bait-and-switch. She says that the Republicans are wrong about the expansion covering people at 400% of the poverty level -- by showing current statistics of S-CHIP. This isn't about who's on now, it's about who gets put on after the expansion. Talk about intellectual dishonesty!
11:56 - Voting begins. They need 2/3rds to override, which comes to 290 votes. If the GOP gets 144 or more, the veto gets upheld.
12:13 - Pending the final tally, the Democrats failed to overturn the veto. I don't think they even picked up 5 votes since they passed the bill.
12:16 - House fails to override, 273-156. The Democrats picked up 8 votes, and I believe the Republicans gained 11. This means that Congress will have to act quickly to maintain S-CHIP benefits to current qualifiers -- and that means some horse trading with the White House.
Nationalized Health Care Is Like Pulling Teeth -- Your Own
The British have had a nationalized health care system for decades, and almost as long a list of examples why it doesn't work. Three years ago, we discovered that hospitals in the UK threw out viable kidneys for lack of physicians qualified to transplant them. Now we find out that a shortage of dentists has led Britons to perform free-lance extractions to avoid an excruciating wait:
A shortage of National Health Service dentists in England has led some people to pull out their own teeth — or use super glue to stick crowns back on, a study says.
Many dentists abandoned Britain's publicly funded health care system after reforms backfired, leaving a growing number of Britons without access to affordable care.
"I was not surprised to hear those horror stories," said Celestine Bridgeman, 41, of London. "Trying to find good NHS dentists is like trying to hit the lottery because the service is underfunded."
The National Health Service provides care to the vast majority of Britain's people, often for free. Unlike doctors who work for the health service, dentists work on a contract basis and can leave whenever they wish.
The situation shows what happens when government crowds out the private market, even when it allows some private participation. Most Britons, whose tax dollars fund the NHS, cannot afford to add private dental services on top of the burden. Thanks to so-called reforms, almost half of Britain's dentists won't take NHS patients, and the rest have either long waits or work too far away from the patients who need them.
In a free market, the compensation for dentists would be set by market forces. Shortages would not long exist, because any shortage would make dental services more valuable and would incentivize more students to pursue that specialty. As with the transplant surgeons, shortages occur because government caps compensation and removes the incentive to specialize at all -- and with dentists, who can opt out of the NHS system unlike their physician colleagues, the private market becomes exclusive to only those who can afford both the tax burden of NHS and the fees for dental work.
What happens then? The rich get dental work. The poor buy pliers and Super Glue. Actually, I could be wrong. The poor might borrow the pliers.
Six percent of the survey sample treated themselves out of frustration, including one man who extracted 14 of his own teeth. Twenty percent of the sample could not afford dental services. An additional 35% blamed their lack of dental care on a lack of NHS options close enough to them. That means a majority of Britons have no practical access to dental care, thanks to their government-run health care system.
Poll: S-CHIP Should Remain Focused On The Poor
USA Today has polled Americans on the Democratic proposal to extend S-CHIP subsidies to middle-class families -- and the results bode ill for the bill's proponents. A majority of Americans support George Bush's veto, and an even larger majority believes it will undermine private health insurance altogether:
A majority of Americans trust Democrats to handle the issue of children's health insurance more than President Bush, but they agree with the president that government aid should not go to middle-income families or those with private insurance, a new USA TODAY/Gallup Poll shows.
Three days before the Democratic-controlled House attempts to override Bush's veto of a five-year, $35 billion expansion of the State Children's Health Insurance Program (SCHIP), the poll shows that Americans' opinions on the issue are mixed.
Of those polled, 52% said they have more confidence in Democrats to deal with the issue, compared with 32% for Bush. But majorities also supported two positions at the core of the president's opposition:
Democrats have gone on a full-court press to get this legislation passed, and then to get the veto overridden. They have used two families as fronts for the expansion, even though the children of both families qualified for S-CHIP prior to their expansion. They are running ads even now, showing toddlers with large, staring eyes, that claim "George Bush vetoed Susie," and so on.
And they have lost the argument. Despite Bush's low polling numbers and their political advantage on domestic policy, the Democrats have not convinced Americans to subsidize health insurance for middle-class families. In fact, the USA Today poll used the less-outrageous annual income limit of $62,000 for the description of the expansion (some have it at $83,000), and Democrats still lose, 52%-40%. It isn't even close.
The Democrats will attempt to override Bush's veto later this week, but this should put the final nail in the coffin for S-CHIP. Nancy Pelosi and Harry Reid intended on pressuring Republicans into voting for override by threatening them with targeted attacks in the 2008 election on the issue. Now it looks like the Republicans have an issue somewhat akin to HillaryCare, a vast overreach on health insurance with which they can batter Democrats as fiscally irresponsible and pandering. With numbers like these, the Democrats will have trouble holding onto the Republicans they had in the first place, let alone picking up any converts.
UPDATE: Bruce Kesler notices the failure of the Democrats, too.
Walberg Rejects The Smear
Tim Walberg, the staunch fiscal conservative and freshman Republican Representative from Michigan, writes about the deceitful campaign waged by Democrats on behalf of the S-CHIP expansion. From country music parodies to hiding behind 12-year-old boys, the Democrats want to paint opponents as heartless Scrooges who want to see kids go without health care. Walberg writes about the way S-CHIP gets applied in Michigan, and we find out that it's not just about kids, or even primarily about them:
I support renewing S-CHIP to provide health care to children in low-income families, but I also believe we need to ensure that the children’s health program is available for children who need it, and not for adults, people who enter the country illegally, or families who already have private insurance.
The Democratic legislation takes a program originally meant for children of low-income families and expands it to cover some families earning up to $83,000 and illegal immigrants, while moving millions of children from private health insurance to government programs.
In 2006, 118,501 children and 101,919 adults in Michigan received health care from the S-CHIP program. Incredibly, this means that 46 percent of Michigan’s funding allotment intended to give poor children health insurance actually went to cover adults.
The Wall Street Journal further described this problem in its August 9 editorial: “The bill goes so far as to offer increasing ‘bonus payments’ to states as they enroll more people in their SCHIP programs. To grease the way, the bill re-labels children’ as anyone under 25, and ‘low income’ as up to… $82,600 for a family of four.”
That split tells a large story about S-CHIP and its upper limit of 25, far beyond what anyone considers childhood. If 46% of S-CHIP payouts went to subsidize health insurance for adults before the expansion, what will be the percentage afterwards? Even without this expansion, the S-CHIP program has already suffered from a serious case of mission creep.
The federal government should not be subsidizing health insurance for adults, let alone middle-class children. Adults can make their own choices, as can families who own commercial property and have over $400,000 in home equity. Walberg wants to renew the program as it was initially designed, not as another government entitlement that will trap the government into more non-discretionary spending while we still can't solve the economic consequences of the entitlement spending to which we are already committed.
This stopped being about poor kids when the Democrats tried to expand the program into the middle class. It stopped being about kids altogether when almost half of the subsidies went to adults rather than children. It's clear that S-CHIP needs more control, not more expansion, and that the Democrats want to use it to make people more dependent on the dole.
Malpractice Awards Increasing?
In an earlier thread, a debate broke out about whether malpractice awards have increased so rapidly as to contribute to the rise in health care costs. I decided to take the evening to research the topic while I watched an excellent History Channel documentary on Christopher Columbus' last voyage. It turns out that the data isn't that easy to find. I spent quite a while doing Internet searches and coming up with plenty of commentary but little hard data.
Finally, I came across the National Practitioner Data Bank, which takes in all reports of malpractice payouts. Since 1991, the government has directed all such payouts to be reported into a database that allows healthcare providers and patients to research physicians, nurses, and other caregiver types to see what actions have been taken against them. They have historical data prior to that year, but it's not comprehensive. It also doesn't list actions that don't result in payouts, which create legal costs that also do not appear in the data.
Their website has its limitations. The data only comes in a large text file, which takes a lot of manipulation in Microsoft Access to use. I spent a couple of hours working the data into tables and building the first few queries. By the time I finished, I had a good idea why the data is so hard to find.
Still, it gives enough data to see trend lines, and the numbers look fairly oppressive -- but stable. In the past 16 years of complete data, can see that the malpractice numbers went steadily upwards in both awards and amounts. In 1991, the NPDB shows 17,964 malpractice awards paid for a total of $2.3 billion. Ten years later, in 2001, malpractice awards peak at 20,425 awards totaling $4.823 billion, over double what it was in 1991. While the number of awards start declining, the amount of the awards remains high, peaking in 2003 at $4.859 billion.
The steady increase has come in dollars per award. In 1991, when the data first became complete, the average payout for a malpractice award was $163,192. It has increased in every year since, except in 2005 when it dropped slightly before exceeding 2004's level in 2006. In those fifteen years, the average award went to $269,227. In 2007, with six months data on the books, the average award jumped significantly to $288,445.
Has there been an explosion in malpractice awards? No, but the awards have become much more lucrative in the last fifteen years. Last year, the number of awards paid dropped to the lowest level in the 15-year period -- but it resulted in $4.259 billion in payouts, higher than the amount paid in the year with the second-highest number of awards. In those 15 years, insurers and practitioners have had to pay almost $60 billion just in awards, apart from legal fees and the like.
I'll be playing with this database a little more. I'd like to analyze trends for states with malpractice caps, for example, to see whether that affects the number of awards. In the meantime, this data should start an interesting discussion in the comment thread.
S-CHIP Battle Moves To Vetoland, Population: 3
The Senate passed the expansion of the S-CHIP program yesterday with a veto-proof majority, 67-29, which sets up a standoff between Congress and the White House over the renewal of the politically sensitive program. The Bush administration favored renewing S-CHIP and even expanding it to a small degree, but the large expansion and the cigarette tax it uses has the White House talking veto. If Bush vetoes it, it may set up a standoff between Bush and Republicans looking towards tough re-election fights:
The Senate, with an overwhelming bipartisan vote yesterday, sent President Bush a $35 billion expansion of the State Children's Health Insurance Program, setting up the biggest domestic policy clash of his presidency and launching a fight that will reverberate into the 2008 elections.
Bush has vowed to veto the measure, but he has faced strong criticism from many fellow Republicans reluctant to turn away from a popular measure that would renew and expand an effective program aimed at low-income children. Democratic leaders, while still as many as two dozen votes short in the House, are campaigning hard for the first veto override of Bush's presidency.
They secured a veto-proof majority last night in the Senate, with the 67 to 29 tally including "yes" votes from 18 of the 49 Republicans, including some of the president's most stalwart allies, such as Christopher S. Bond (Mo.), Kay Bailey Hutchison (Tex.) and Ted Stevens (Alaska). Democratic leaders are likely to send the measure to the White House next week, giving advocates a few more days to pressure Bush to sign it.
For Republicans, the issue is politically perilous. Every Senate Republican facing a difficult reelection bid bolted from Bush yesterday. Most House Republicans in swing districts abandoned him Tuesday when the House approved the bill 265 to 159. Those Republicans "took the vote that was easiest to explain," said House Minority Whip Roy Blunt (R-Mo.).
The legislation that passed the Senate limits the S-CHIP application to households that earn 300% of the federal poverty line. This is an apparent change from earlier versions that had the limit at 400%, and that can be found in Section 110 (a)(8)(a) -- except that 110 (a)(8)(b) allows states to make exceptions that could force the government to provide grants to others as well. At 2007 poverty levels, a family of three could make up to $52,000 per year and still be eligible in 2007, and in 2008 that number would likely go to $54,000 or more as the poverty level gets indexed to inflation. In Alaska, that number goes to $64,000.
Even with the reduction in application, this still moves money from primarily poorer people with the sharply regressive cigarette tax and gives it to the middle class. It also undermines the market for private insurance, which has better coverage than the government Medicaid coverage that will crowd out the free-market solutions. The expansion beyond the S-CHIP's original intent to assist poor children dilutes the program and adds to entitlement programs that are already threatening to bankrupt the nation.
Will the President veto the legislation? He has only issued three vetoes in almost seven years, and two of those protected embryos. He has not vetoed an entitlement expansion, especially not the prescription program for Medicare that he championed. A veto on S-CHIP will put enormous pressure on a handful of Republicans who stuck to fiscal responsibility and who face tough re-election campaigns already in the House. It may also create some pressure on Senators who gave the bill a thin veto-proofing that the House failed to achieve in its bipartisan vote.
I don't believe the President will veto the bill, although he should. He will probably want to save his political capital for Iraq and the appropriations bills that he will almost certainly veto in the next month or two. Those will require continuing legislation that will create a lot of contentiousness, and the gains from vetoing the S-CHIP expansion will be minimal among his base. His presidency has not been an exemplar of spending control as it is.
If he surprises and follows through on his veto threat, the pressure on Republicans will be enormous. It could set leadership on Republicans from safe seats to reverse their support for the expansion as written, hopefully by presenting the tax-break package that the GOP developed belatedly to combat this version of S-CHIP. That would keep incumbents in tough races from having to explain a vote against the original, while forcing Congress to do the right thing.
UPDATE: Rose asks about illegals using S-CHIP. I know that some have argued that S-CHIP would allow illegals to gain insurance for their children, but the text of the legislation makes it clear that children have to register by Social Security number, and that the state has to verify them with the federal government. Section 301, (dd)(1)(B), states clearly that children whose citizenship or legal residency cannot be verified must be disenrolled for the state to continue receiving S-CHIP grants.
There are good arguments to oppose S-CHIP, but this doesn't appear to be one of them.
Take From The Poor, Give To The Middle Class
Investors Business Daily looks at the S-CHIP expansion and recognizes the political dangers for Republicans opposing it. Any vote against expanding health insurance coverage to children will prompt critics to paint the GOP as the party of Fagins, taking medical attention away from poor sick kids. However, in this case, the kids aren't poor, although that's where the funding will originate:
As passed by the House, the State Children's Health Insurance Program, known as SCHIP, will create a major new middle-class entitlement even as we face looming national bankruptcy from our $50.5 trillion (yes, you read that number right) in planned spending under Social Security and Medicare.
Today, some 6.6 million kids are covered under SCHIP, at a cost of about $25 billion over five years. The new bill raises that to 9 million kids covered, at a cost of $60 billion. It pays for it with a 61-cent hike in the tobacco tax.
Sounds good, except that tax will hit the poor hardest. And those it helps are not poor. Under the new bill, families earning $83,000 a year could be eligible. If this bill were targeted at the poor, President Bush and the Republicans wouldn't oppose it. But it isn't. It's a new, radically expanded middle-class entitlement.
That, by the way, includes families like the Siravos of New Jersey, profiled recently by Bloomberg News. The Siravos earn $56,000 a year, own their own home and drive two used cars. They also pay $9,000 a year to send their only child to a private school.
Yes, things are a bit tight for the Siravos, as with many American families. But should the working poor subsidize health care for the Siravos and other middle-class families?
The tobacco tax represents a couple of problems to this program. First, as almost everyone recognizes, tobacco taxes are regressive. Because smoking tends to be more prevalent among lower economic strata, the funds raised for the S-CHIP expansion will come in large part from people already in the program. Not only that, but since taxes tend to act as a disincentive, the taxes will not produce the revenue projected by Congress based on current sales figures. And the people who quit will most likely come from middle- and upper-income brackets, according to the Cato Institute. This tax will therefore become even more regressive.
Next we have the problem with existing entitlement programs. Both Social Security and Medicare will start running up red ink in the next decade or less. Both will need serious reform to keep them from gobbling up more and more of the nation's GDP, and some of that reform will likely require means testing. Instead of applying that sensible approach to this entitlement -- more accurately, keeping means-testing in place -- we're about to expand it to cover kids in families making over $83,000 a year.
Many of the children this expansion covers already have private insurance, with better coverage. They do not need government assistance. For those without coverage in families making over $40,000, one has to wonder why the families have not made choices which include health insurance, and why those choices should be subsidized -- encouraged, even -- with funds disproportionately taken from the working poor.
The only explanation is that S-CHIP serves as a Trojan horse for nationalized health insurance. It's a particularly cynical method of forcing out private insurers by pushing government-controlled coverage onto children. It deserves a presidential veto, despite the inevitable demonization it will produce.
The Republicans have an alternative that uses tax incentives to level the playing field between those who get tax-sheltered employer-based insurance and those who have to pay for it directly. That approach may not be perfect, but it keeps entitlements from expanding when they should be contracting, and it provides assistance to the middle class without making the poor pay for it. That has to make more sense than this S-CHIP expansion.
Another National Health Care System Horror Story
The lack of facilities in a national health-care system has resulted in the death of a newborn. Japan, whose system has been cited as a model for the United States to consider, has few medical facilities in their rural areas, and the lack of obstetricians led one couple to be turned away from eight hospitals when the mother-to-be went into labor:
Japan's health minister has pledged to address the shortage of doctors in the country after a woman in labour was turned away by eight hospitals.
A ninth hospital refused to admit her even after she miscarried in an ambulance and her baby died.
The woman, who was in the sixth month of her pregnancy, lived just three minutes away from a hospital.
But she was forced to travel 70km (45 miles) by ambulance looking for a facility that would admit her.
Actually, the ninth hospital initially agreed to accept the case. However, the ambulance crashed on the way, and the woman miscarried and the baby died. After they found out what happened, that hospital then refused to admit her.
It's not the first time this has happened. Last year, a pregnant woman died under similar circumstances, only in that case twenty hospitals refused to admit her. None of them had bed space available, and Japan has a nationwide shortage of physicians, particularly in specialties such as obstetrics.
Why the shortage? Specialization costs more money, and in the Japanese system, the compensation does not make it worthwhile. Overall, compensation and malpractice costs have driven people away from studying to be physicians and surgeons. This is similar to the issues that Britain has had in the transplant specialties, first reported three years ago. Viable organ donations went to waste because the UK doesn't have enough transplant surgeons.
Japan has a somewhat different system than Britain or Canada. It allows for private insurers and facilities, but the government controls the market. It regulates prices, compensation, and the manner in which insurance operates. The effect is similar to that seen in other national health-care systems, which is that health care gets rationed through a mechanism other than patient choice. The NYU study claims that Japan has twice the beds per capita rate as the US, but that hardly explains these two instances of refusals. It also notes, probably more to the point, that Japan has one of the lowest physician per capita rates among industrialized nations, and that they spend less than seven minutes on an average for patient contacts (American doctors spend over 20 minutes).
Any system that allows a woman to die because 20 hospitals refused to treat her from lack of resources has serious problems. Any system that would refuse an emergency admission for a miscarriage in progress at nine separate facilities -- with an ambulance begging for assistance -- is not a model which we want to emulate here in the US.
No Free Lunches
Yesterday, I interviewed Dr. Ken Thorpe from the Partnership to Fight Chronic Disease on CQ Radio about the PFCD's efforts to fund preventive health care initiatives as a long-term cost saving initiative for Medicare and private insurance providers. The New York Times throws a dash of cold water on the underlying assumptions of the PFCD's claims today, claiming that preventive intervention will cost more in both the short and long run (via Memeorandum):
The current health care system doesn’t pay hospitals, doctors and nurses to keep people healthy; it pays for tests, surgeries and drugs. So Americans often get expensive invasive care of dubious medical benefit while missing out on sensible basic care. Millions of other people go without any care for chronic illnesses like heart disease and diabetes. If Medicare and private insurers paid for more preventive care, Americans would be healthier than they are today and live longer.
But the current presidential candidates go one step further. They don’t merely argue that preventive care delivers good bang for the buck. They argue that it delivers good bang for no bucks whatsoever. And this is where the candidates are overreaching.
No one really knows whether preventive medicine will save money in the long run, let alone free up the billions of dollars a year needed to help pay for universal health insurance. In fact, studies have shown that preventive care — be it cancer screening, smoking cessation or plain old checkups — usually ends up costing money. It makes people healthier, but it’s not free.
“It’s a nice thing to think, and it seems like it should be true, but I don’t know of any evidence that preventive care actually saves money,” said Jonathan Gruber, an M.I.T. economist who helped design the universal-coverage plan in Massachusetts.
This may be true -- as far as it goes. Even Dr Thorpe acknowledged that the plan relies on Americans to change their habits and take preventive steps themselves, even outside of medical supervision. Diabetics need to practice better dietary and exercise control, for instance, and all of the maintenance visits in the world won't help until they take those steps themselves -- and meanwhile, the maintenance visits cost more money.
The real solution to that problem is to expose the laggards to the costs of their decisions. Government-funded systems actually do this a little better than private insurance, which tends towards small co-pays, although that should encourage better use of preventive medicine. Unfortunately, how can a system be structured so that the costs of poor decisions gets borne by the decision-maker without making it seem punitive?
The best way to do that would be to encourage free-market health care rather than top-down management. In a free market, those decisions would lead directly to cost penalties or benefits. Insurance companies in a competitive market could structure costs based on the use of and adherence to preventive maintenance, and consumers could switch to insurers or providers that offered the best deal for the lifestyle they choose. It certainly would have less Big Brother implications than the government dictating cost for degrees of obesity, as an example.
The Wall Street Journal editorial-page editors are upset that Wisconsin's state Senate passed "Healthy Wisconsin", which will give health insurance to every person in the state. Of course, the Journal editors are right in saying that the plan is "openly hostile to market incentives that contain costs" and that the "Cheesehead nation could expect to attract health-care free-riders while losing productive workers who leave for less-taxing climes."
In addition, as the Journal put it, "Wow, is 'free' health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes." ...
Does it never occur to the progressives that the legislature's intrusion into private contracts is one reason health care and health insurance are expensive now? The average annual health-insurance premium for a family in Wisconsin is $4,462 partly because Wisconsin imposes 29 mandates on health insurers: Every policy must cover chiropractors, dentists, genetic testing, etc. Think chiropractors are quacks? Too bad. You still must pay them to treat people in your state.
Stossel's last point underscores what I wrote above. When government interferes in private markets through mandates, price-fixing, and/or competition with private enterprise, consumers pay more and get less. It also creates artificial shortages and distorts supply-demand equations in ways that create gaps for consumers. One of Dr. Thorpe's points was that primary-care physicians are underpaid and we have a shortage of care at that level. In a free market, rates would rise to correct the imbalance -- but because Medicare shortchanges primary-care efforts and that comprises a significant part of the compensation available, physicians tend to specialize to get better compensation.
I wish Wisconsin the best of luck -- and hope that their experiment ends at the St. Croix River.
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