Grab Bag 2

Scorecards on state health care performance.
Not surprisingly, this shows that the south and Nevada are relatively bad at caring for their citizens. If the those states acted more like the best performing states, they would help a lot more of their people with better quality care at lower prices. They don't, though, because they have a predominant culture of blind belief in their superiority and refusal to engage in progressive change.

CT scans cause about 30,000 cancers per year, half of which will be fatal. This is not to say that we should never use CT scans. We do need to be more vigilant about the overprescription of tests and procedures, and this is a great example of that need. CT scans are typically overpriced and overprescribed because too many hospitals bought CT scanners by issuing debt and have to pay off those debts by increasing the prices to consumers and performing more tests than the population needs. Doctors with financial stakes in their clinics are especially prone to prescribing unnecessary tests and procedures because they profit from them. People will unnecessarily die early from expensively-treated cancer caused by unnecessary tests ordered for personal and hospital profit, as well as for the sake of defensive medicine. We need more oversight, more restrictions on the purchases of expensive equipment (some states restrict, but the outcomes are mixed because of the different standards used), and an absolute ban on doctors being in conflict-of-interest situations. "First, do no harm," right?

Speaking of defensive medicine, it is one component of the Congressional Budget Office's estimation that tort reform could effectively save America over $50,000,000,000 over ten years. The report suggests that the measures would also result in better health outcomes, perhaps due to a reduction in unnecessary tests and procedures that carry health consequences. Reform is of course heavily opposed by the deep, deep pockets of the lawyers who make piles of money no matter which side of the lawsuits they're on. Politicians are getting lobbied by the greedy lawyers who profit from the policies that hurt real people in our country.

Unsustainable Resource Allocation

Yesterday I wrote that our elderly are getting 2-4 times the money out of social services as they put in, as hard working taxpayers and their children are deprived of valuable services that would strengthen our country now and for the future. This recent MSNBC interview with crazy Betsy McCaughey gives the CBO citation and shows how the approximately 3:1 ratio was found.

There are two valid drivers for how we allocate money. The more deontological driver is to spend money to give people what they deserve. Benefits to soldiers, for example, or temporary unemployment benefits, or funds to support poor children. People who have a raw deal through no fault of their own, or who made sacrifices for the rest of us, deserve care. The more utilitarian driver is spend money on whatever will net the greatest good. What sets us up to have the best future? Military benefits are driven by this, also, as they are often calculated incentives to attract needed recruits so that we can even have a military. Public works projects that improve our infrastructure so we can continue trade and growth. Investing in research. Paying such vast amounts of money on social services to the elderly is more than they deserve and is not an investment in the future. At least McCaughey wants to raise the Medicare age to 70, even if she opposes making the system more efficient.

The major invalid driver of money allocation is greed. Special interests want their money. Politicians want votes and campaign contributions. Politicians make allocations (corn subsidies, no-bid contracts, F-22s, bridges to nowhere, etc...) that will get them votes and contributions, even though it hurts most people. Old people vote. Old people vote more often than young people. Politicians make policies that benefit old people at everyone else's (and the country's overall) expense. We are in a death spiral of increasing social security and Medicare expenses because politicians pacify the elderly now for votes instead of looking at the big picture and our country's needs for the future.

The interview also helpfully shows that a public option, or the public marketplace option that Obama talked about, would greatly reduce health care costs by eliminating the widespread occurance of localized insurance monopolies. I have two real choices for insurance provision in my area, and that is not competition that benefits consumers. When did Republicans start hating competition? Was it when insurance lobbyists handed them goodies, or are they just stubbornly trying to shoot down at any cost everything Obama tries to do?

Also, tort reform, which I've strongly advocated, seems to be a very low priority as far as cost controls go. It's still a good idea, and the special interest most opposed is the lawyers who take half the money, but it can go on the back burner.

No Public Option

The Senate Finance Committee excludes a public option. This really is no surprise. We know that Baucus is in the pockets of insurance companies instead of his constituents, as are many other politicians. It is also blatently apparent that the entire Republican party is united to prevent the Obama administration from accomplishing anything good for America. The Republicans want the Obama administration to fail at improving our country and serving its citizens, just so the Republicans can cite the failure while campaigning for the next elections.

What can we do?
Well, we obviously need some campaign finance reform, for starters. There is an organization working to accomplish this goal. Change-Congress.org, organized by the illustrious Lawrence Lessig, fights against the sway that special interest groups (insurance companies) have over our government. When there is more of an incentive for politicians to work for their constituents, and less of an incentive for them to pander to money-grubbing companies, we will see policy decisions that are better for this country.

Did we need a public option?
Well, the CBO says that various plans proposed would cut the US deficit by tens of billions of dollars over the next ten years, while providing health care to tens of millions of American citizens who currently have no insurance. I've seen other organizations estimate that the deficit would drop by even more, since the CBO did not look at every related variable. There are different plans, though, and different ideas of what the public option would look like. So, there are proposals that include public options that would help many Americans and save our country money, which are both outcomes we need. There are other ways to get these outcomes, such as a single-payer system (HR676, Medicare for All, has hardly been mentioned) or extremely tight regulation on insurance companies, but a public option was the most likely to make it through congress. It just isn't likely enough.

I am confident saying that any politician currently opposing/stalling efforts to increase the government's involvement in health care, either through a public option, marketplace, expanding Medicare, or more strictly controlling private insurance companies, is motivated only by the drive for personal power. These politicians enjoy their campaign contributions and visits from lobbyists, and the Republicans know that sticking with the party line ensures they will keep getting support in future elections. The politicians who are fighting for the health of our citizens are the ones who care about their constituents.

Conservatives for Patients' Rights - Fearmongering Liars

I'm really busy this month with a big project, but I will take a minute to remark on the commercials being run by CPR. They've been on CNN during pieces about health care reform. These commercials use scare tactics to raise a fervor against a public health insurance plan. These commercials are misleading.

The one that comes to mind warns people that a public plan would put government bureaucrats between them and their doctors.
A) So what? That's better than having insurance company bureaucrats between people and their doctors. Insurance company bureaucrats do what they can to deny treatments. The government is proposing a public plan to increase the availability of care.
B) Good! As I've discussed before, doctors don't always follow best practices, and too often make uninformed, biased, ignorant decisions that could be prevented by informed oversight.
C) 47,000,000 Americans don't even get to see doctors right now, and the public plan would fix that. What stands between these people and their doctor is the absence of government involvement.
D) NO ONE IS FORCING ANYONE TO SIGN UP FOR THE PROPOSED PUBLIC PLAN. IT IS VOLUNTARY. IF YOU DON'T WANT IT, DON'T JOIN IT. There is no reason to oppose its creation.

The commercials also claim that the government would be financially wasteful, and cites other examples of government waste. This completely ignores the fact that the government-run health payers we already have (Medicare and Medicaid) are the least wasteful health payers, and are extremely efficient. In fact, many other corporate stoog... I mean Republicans are opposing a public insurance plan on the grounds that it would be so financially efficient that people would flock to it and private insurance companies would lose too much business. You can't have it both ways, conservatives. Stop with the obvious lies and misleading claims. Stop trying to convince the public to oppose what's good for the whole country just so you can keep collecting contributions from the insurance companies. Stop blindly believing that capitalism will make everything good, and start looking at the real world.

Insurance Industry Buys Politicians - Probably

FiveThirtyEight.com has a great post with a pretty graph about the likely effects of the amounts of money the insurance industry spends on politicians. The largest receiver of bri... contributions is Baucus, the guy leading the health care reform decisions, and who is opposed to a public insurance option.

FiveThirtyEight continues to be clear and responsible, pointing out that it did not take into account counter-lobbying from unions and other pro-public-option factions, and also that it is hard to tell if "perhaps senators receive a lot of money from the insurance industry because they hold conservative positions on health care, rather than the other way around. Although I believe that accounting for ideology should correct for most of this".

National Center for Complementary and Alternative Medicine

USA Today had an article on the progress of the NCCAM over the last ten years. The federal agency funds research into the effectiveness of complementary and alternative medicines. The conclusion: $2.5 billion of research shows us that almost none of that stuff works better than placebo.

The tone of the article suggests that NCCAM is bad for spending so much of our money studying stuff that doesn't work. Really, it is only partly bad, and that is due to the agency's implementation. It is important to know what works and what does not work. If no one else is going to do the research (because there is no incentive, because CAM is underregulated), then it is good that NCCAM is picking up the slack.

Where NCCAM falls short is in telling us all that these things do not work. With a board loaded with CAM supporters, the conflicts of interests are apparently too strong to allow the agency to work the way it was intended. It is not spreading the message that bogus "supplements" and "remedies" are bunk, and there is no regulatory authority to ban these misleading products and treatments that take advantage of the ignorant.

It also falls short in that it continues to research absolutely ridiculous things, such as distance healing and energy fields. It wasn't good when the military looked into psychic detection of enemy submarines, and it's not good to waste money on this complete malarky now. Until someone gets James Randi's prize, the feds should stop wasting tax money in these directions. There are a lot of things we already know don't work.

Double-blind, placebo-controlled, randomized study is the standard when possible. Never trust someone who is trying to sell you something. Our country would be better off if our government protected people who just don't know better from snake-oil salesmen.

Mandatory Private Insurance - Why It's Stupid

The Washington Post has a very flattering article about Senator Baucus today. I am going to just focus on one sentence, though.

"Baucus is committed to delivering universal coverage and getting more and better care from health dollars, and he is seriously considering an individual mandate -- requiring adults to have health insurance -- and taxing employer-provided health insurance."

If he's considering an individual mandate, he is clearly not committed to getting more and better care from health dollars. This is very similar to McCain's proposal. Let's start with the setting. We have now about 50,000,000 people with no insurance, almost entirely because it is too expensive. We have tens of millions more people with inadequate insurance, who still go bankrupt if a major health complication occurs. We have companies offering less and less in the way of health benefits because prices are rising so much.

* Making health insurance mandatory for people who can't really afford it is going to require spending federal money on subsidies. It is flat out less efficient to give this federal money to private insurance companies with their high overhead than to just expand Medicare or Medicaid. This is just Congress's way of unnecessarily giving our tax dollars to insurance company stakeholders as a "thank you" for all the campaign contributions.

* Individual insurance customers have no negotiating leverage. Large employers get discounts on insurance prices because they can pool risk and threaten to take their big group contract to a competing insurer. Individuals can't negotiate to reduce insurer's profits, so they get gouged. Unless the government is going to really meddle with private insurance rates and practices, making private insurance mandatory is going to lead to an even higher percentage of health dollars going to profits instead of care. Depending on how the subsidies are worked out, this will either unnecessarily hurt the lower class, unnecessarily rip off taxpayers, or both.

* We will still have huge problems with underinsurance. Even with subsidies, even when it's mandatory, consumers with lower incomes are going to get the insurance plans with the lowest premiums. These plans may have high copays, high deductables, and poor coverage. We are still going to see bankruptcies due to medical costs. Unless the government meddles extensively with what insurance plans are offered, but that doesn't seem to be on the table.

* Regarding taxing health insurance from employers, that will result in a further reduction of coverage by employers, higher costs to individuals, poorer coverage overall, and further weakening of our ability to compete in the global market. What would eliminate all of these problems is a public, single-payer option, which would reduce everyone's costs, increase coverage, and let our industries be more competitive.

Health Insurance Reform - Conflicts of Interest

It's been in the news for a week now that Senator Baucus's Finance Committee hearings are a total sham. With 59% of Americans asking for a single-payer system, it is absurd that the Senate would only meet with representatives from the industries that profit from the existing, inefficient private system. How could Baucus overlook representatives from single-payer supporting groups? The unfortunate and obvious answer is money.

Baucus has received "... from the insurance industry, $1,170,313; from health professionals, $1,016,276; pharmaceuticals/health-products industry, $734,605; hospitals/nursing homes, $541,891; health services/HMOs, $439,700" over his career.

"According to the report, Senator Baucus received $183,750 from health insurance companies and $229,020 from drug companies in the last two election cycles."

Insurance companies and drug companies have lots of money to spend on lobbying and campaign contributions (legal bribes). People who cannot afford health insurance also cannot afford lobbying or campaign contributions. The only way to get representation in government decision-making processes is to pay the people who get to make the decisions.

But wait... where did those figures come from? Some searching on news.google.com has only given me more blogs and op/ed pieces that cite DemocracyNow! or the 13 protesters who were arrested, heavily biased sources of information. Where can I find something more legitimate? A few seconds with Google gives me OpenSecrets.org. Let's look up our friend Max Baucus.

Three of his top 5 contributing industries and their contributions since 2005:
Insurance - $545,225
Pharmaceuticals/Health Products - $493,313
Health Professionals - $492,641

Individual contributers include Aetna, Amgen, Blue Cross, and Kindred Healthcare. For the billions of dollars these companies have riding on Baucus's actions, they are getting a pretty sweet deal. Baucus isn't alone, though. These companies donate to pretty much everybody to make sure their interests are taken into account more than the citizens of this country who do not make large financial contributions.

Something else that is interesting is that pharmaceutical companies gave 2-3 times as much money to Republicans as to Democrats until 2008. This may just reflect that we had a Republican majority in Congress until recently, but also that the Republican party values big corporate profits more than social welfare, relative to the Democratic party. Big Pharma would want to finance Republican campaigns in closer elections, but resort to just getting some leverage with Democrats in a year in which more Democrats were going to win anyway. I would like to hear other ideas.

I am glad that organizations such as OpenSecrets help give us transparency, but why isn't this information in the mainstream media? When CNN runs a story with politicians giving their policy views, it could easily and briefly mention each politician's conflicts of interest. Most people just don't know what's out there unless it's given to them, and it is the media's responsibility in a democracy to give the public relevant information.