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)

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.
10:39 – Michelle Malkin is also live-blogging. Robert Bluey reports that Republicans have finally begun supporting the White House alternative. (via Memeorandum)
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.