Post Mortem

The immigration bill seems dead — although you never know in Washington. I didn’t think it was a bad bill. Some realistic border enforcement (no expensive useless pork projects walls) and perhaps a two-year window for illegals to get their act in shape before serious enforcement begins: it would have gone through.

What surprised me was the viciousness of the Right. Illegal aliens became the new gays; nothing was too vile to say about them. The Daily Show had a panoply of “conservatives” saying illegals were bringing TB and leprosy while molesting our kids and robbing our banks. All of this was crap, of course.

I think what happened was that the conservatives finally lost it. This wasn’t really about the illegals. They were simply caught in the crossfire of a Republican conniption fit. Bush’s supporters — his few remaining supporters — had seen him trample over states’ rights, limited government, individual liberty, federal restraint and any other true conservative principle you can nominate. And they finally lost it. Now that he’s a lame duck, they felt free to let go of the frustration that’s been building for six years.

Well that and that Bush’s supporters — his few remaining supporters — are the most extreme wing of the party.

A Sicko Liberal Media

CNN does their fact checking on Sicko. It precisely illustrates why the stupid liberal media is both stupid and liberal.

Like Moore, we also found that more money does not equal better care. Both the French and Canadian systems rank in the Top 10 of the world’s best health-care systems, according to the World Health Organization. The United States comes in at No. 37. The rankings are based on general health of the population, access, patient satisfaction and how the care’s paid for.

Read those last words. “How the care is paid for”, i.e., the US system is ranked low partly because it’s not socialized. And as I’ve noted many times, “general health of the population” contains no corrections of America’s high rates of obesity, violence, car crashes and drug abuse. And by the way, those things are high because Americans are making stupid choices, not because their healthcare system has failed them.

So, if Americans are paying so much and they’re not getting as good or as much care, where is all the money going? “Overhead for most private health insurance plans range between 10 percent to 30 percent,” says Deloitte health-care analyst Paul Keckley. Overhead includes profit and administrative costs.

“Compare that to Medicare, which only has an overhead rate of 1 percent. Medicare is an extremely efficient health-care delivery system,” says Mark Meaney, a health-care ethicist for the National Institute for Patient Rights.

This is quoted a lot. And it is utter total BS. It is absolute mendacious deception. Yes, Medicare only spends 1% of its budget on it’s administration. The only problem here is that Medicare doesn’t administer Medicare. Medicare is administered by private insurance companies, which spend enormous amounts of money on paperwork and Administration. 1% is what Medicare spends administering the administration.

When I worked in medicine we were constantly in paperwork wars with Medicare. The appeals system was backed up for years. Talking to the Aetna people led me to believe that their administrative overhead was far greater for Medicare than non-Medicare (30-40% was the figure they would give me). This is somewhat exaggerated because Medicare pays very little — they haven’t significantly raised their fees in about 25 years. So the ratio of administration to pay-outs is a bit inflated. But they also provide more care.

Still. 1%? What kind of lazy media take that figure for gospel? Jumping Jesus, does anyone out there think anymore?

Moore focuses on the private insurance companies and makes no mention of the U.S. government-funded health-care systems such as Medicare, Medicaid, the State Children’s Health Insurance Program and the Veterans Affairs health-care systems. About 50 percent of all health-care dollars spent in the United States flows through these government systems.

Hmm. Do you think there’s a reason he doesn’t talk about them? Like the rat-infested VAArmy hospitals? Or the crummy payments made by Medicare and Medicaid that cause us to cost-shift to people with private insurance?

That’s no surprise given the number of U.S. specialists. In U.S. medical schools, students training to become primary-care physicians have dwindled to 10 percent. The overwhelming majority choose far more profitable specialties in the medical field. In other countries, more than one out of three aspiring doctors chooses primary care in part because there’s less of an income gap with specialists. In those nations, becoming a specialist means making 30 percent more than a primary-care physician. In the United States, the gap is around 300 percent, according to Keckley.

And yet almost every healthcare reform plan — and the current structure of Medicare and Medicaid — is designed to screw the family doctor even more.

There’s a reason specialists in this country make so much: their services are not being rationed.

I hate it when the media talk about healhcare. They are so pig-ignorant of how the business works, they just make the situation worse. I’ll never forget the NBC/ABC/CBS special with Koppel/Brokaw/Rather (I can’t remember which, I was so angry) in which they said a doctor was charging his patient $150 a day for poking his head in her hospital room for five minutes. Ignored in this finger-wagging maneuver:

  • The doctor would have been in the nurse’s station reviewing the chart, giving orders, talking to nurses and doctors and deciding her course for about 15-30 minutes.
  • Medicare probably paid about $75 for the visit, if they paid at all, no matter what the doctor charged. A lot of doctors charge their full price so they can keep track of just how badly Medicare is screwing them.
  • If anything bad had happened to the patient, the nurses would have called the doctor at home at 3 am to get orders. And most of the time, he’d give the right ones. For no extra charge. Try calling your auto mechanic at 3 am about your transmission.
  • Listen, media. Do you think you could do some fucking research? I don’t mean going to various liberal think-tanks so they can tell you Medicare only spends 1% of its money on administration — a claim so ludicrous, you’d think even our flunky media would see through it. Why don’t you send a reporter to work in a hospital or a doctor’s office, to fight with insurance companies and to watch the malpractice lawsuits stream in. Then you might do some actual reporting.

    Oh, that liberal media!


    I’ve been a parent for three weeks and I’m already hearing Those Words:

    “Well, now that you’re a parent, you’re going to be more progressive. You’ll want to provide for your daughter and protect her. I’ll see you at the next Hillary rally.”

    Um, no.

    Read this decade-old interview with Dave Barry and take home this quote — “Any parent that relies on any law to help him parent is an idiot.”

    I don’t want the state to provide for and protect my daughter. Because I know the state can’t. I want to provide for and protect her myself. I put her in an expensive car safety seat because I want to protect her, not because the law mandates it. I’m getting her vaccinated because I want her to be healthy, not because the law mandates it. If she stays away from drugs, it will be because I successfully explain to her how stupid they are, not because they are illegal.

    And I’m far more concerned about the tens of trillions of dollars in unfunded Medicare, Medicaid and Social Security liability that is going to come down on her like an anvil.

    Let me raise my daughter. I don’t need laws and handouts to do it. All I need is her.

    Not Gonna Happen

    It seems to me that this is a perfect way to get spending down in Washington.

    By our calculations, the OMB study, called Program Assessment Ratings Tool (PART), further reveals that on average more than half of all federal expenditure programs are falling about 50% short of their stated goals.

    This means that out of every dollar spent, 50 cents may possibly be accomplishing something worthwhile, but the remaining 50 cents might as well have been poured down a rat hole. In these cases alone, the cost of government incompetence is over $250 billion per year.

    Congress, however, is not the least bit interested in PART or any other attempt to evaluate federal spending on an efficiency or cost-benefit basis. For one thing, the results would be embarrassing. Too many federal expenditure programs made no sense to start with or are now outmoded and would be a waste even if performed efficiently.

    Furthermore, federal budgeting is not about spending as little as possible and trying to make certain that each $1 spent produces at least $1 of public benefit. Instead, it is about spending the maximum amount in the most politically efficacious way.

    So you establish a non-partisan committee to figure out which programs aren’t working. They come out with a way to slice $250 billion out of the budget and you don’t have to own up to it — just say “the commitee made me do it.”

    And Congress in uninterested.


    We need to stop electing these asswipes.

    The Answer

    This is fairly typical of those who would defend or at least seriously contemplate socialized medicine:

    I have little direct experience of government work, but both my parents have worked in state and local government (in a state energy office and a city welfare program) and I saw them working hard, being frugal in their work, making a lot happen with a little, accounting for every expense.

    No one has ever said . . . OK, no one who’s reasonable has ever said that government employees are evil. My experience has been that ineffecient, nasty and wasteful government employees are rare.

    No, the problem is fundamental. We have an education system full of nice, dedicated, hard-working people that is a disaster. A post-office filled with decent people that is incredibly expensive. And a military filled with good people that wastes billions.

    Hell, even most Congressmen aren’t bad people. But we’ve got $70 trillion in unfunded liabilities to show that it’s a bad idea to give them too much money and power.

    Everyone who encountered a socialized medical system will tell you that the people within are nice. People tend to be when they’re spending other’s money. I’m sure many of the people who ran the Soviet farm program that starved millions to death were just trying to do their best. And I don’t know a public school teacher who doesn’t work her butt off.

    No, the problem is not bad people. The problem is that collectivism doesn’t work and never has and never will. We hear excuse-makers using this all the time — the idea that good people will make the system work. And it fails to happen every single time.

    My own brief experience in consulting was, by contrast, one of huge amounts of waste: high-priced plane tickets bought at the last minute for no reason other than laziness, luxury hotel rooms, excessive quantities of staff, lavishly paid for by giant corporations and all to give them messages they wouldn’t act on, but needed to have hired in to check a box or cover their asses.

    Don’t get me started on consulting. But in many ways, this is precisely the point. One of the biggest problems with health care today is that the consumer is too far removed from the process. Most people have no idea how much their insurance is shelling out. Most people have no idea how much their insurance costs. So decisions on cost are made on the corporate level, not the consumer level.

    The solution to this is not to get the consumer further removed from the process.

    HMOs — and remember that Hillary in 1993 wanted all of us to be in HMOs — are the worst of all possible worlds. The consumer has no power at all. The business makes all the decisions. And people are forced by their employer to stick with their HMO, no matter how crappy they are. And so the HMO employees get, to quote this reader, luxury hotel rooms and first class tickets, while some poor shmuck with cancer suffers.

    All this suggests to me that much of the difference between efficiency and inefficiency, or smart and dumb decisions, in any given sector is cultural, dependent on local group and individual choices, on access and accountability, rather than a necessary structural effect of the profit status of the enterprise.

    So the solution is to impose a uniform culture on everyone? We’ve seen what happens when you do that to education (thank you, NCLB). Or farming. Or culture war issues.

    With socialized medicine, we will get the worst of all possible worlds. Inefficiency? Medicare wanted us to discharge patients after a breast biopsy and bring them back weeks later for mastectomy, rather than doing both at the same time. Dumb decisions? I will never forget Medicare telling us that removing a bowel obstruction wasn’t medically necessary.

    No one is going to claim that a privatized consumer-oriented healthcare system is going to be perfect. But we can’t let the perfect be the enemy of the good. You think healthcare is expensive and inefficient now? You just wait until it’s free.

    Wednesday Linkorama

  • National Review on “universal health care”.

    The health-care debate has centered on the uninsured. That so many people do not have health insurance is a consequence of foolish government policies: regulations that raise the price of insurance, and a tax code that ensures that most people get their insurance through their employer. If you don’t work for a company that provides health insurance, you’re out of luck. People locked out of the insurance system still have access to health care. But they often end up in emergency rooms because they did not receive preventive care.

    In several states in this country, it is against the law to buy health insurance that doesn’t have aromatherapy coverage.

  • The Justice Department is prosecuting accountants who find legal loopholes to save their clients money. Tell me again how Bush is a conservative?
  • The immense wave of regulation from Washington has only gotten stronger under Bush. Tell me again how Bush is a conservative?
  • Americans are the most charitable people on the planet.

    Gaudiani said Americans give twice as much as the next most charitable country, according to a November 2006 comparison done by the Charities Aid Foundation. In philanthropic giving as a percentage of gross domestic product, the U.S. ranked first at 1.7%. No. 2 Britain gave 0.73%, while France, with a 0.14% rate, trailed such countries as South Africa, Singapore, Turkey and Germany.

    Throw this in some euro-weenie’s face next time he talks about how greedy and uncaring Americans are.

  • Bam!

    John Stossel tears David Brooks a new one:

    Now David Brooks is a bright guy, so I wonder how he can blame the free market for failing in this way. He continues, “Despite all the incentives, 30 percent of kids drop out of high school and the college graduation rate has been flat for a generation.”

    Excuse me, but why is that the market’s fault? Government dominates education in America. K-12 education is a coercive, often rigidly unionized government virtual monopoly that fights every attempt to experiment with free-market competition.

    Read it.


    I’m sure the Right will go on and on about how the kids that gave the President a letter on torture are “young know-it-all twerps”. Boortz in particular likes to go on about how young people think they know everything. And he’s not wrong in that regard.

    But just because college-age kids spout a lot of stupid crap does not mean they aren’t occasionally right. And it’s amazing to see these kids show more courage than the entire Congress combined.


    Why would I never join a union?

    Shit like this.

    Amicus, Britain’s second-largest trade union, boasting 1.3 million members, has voted to throw its support behind the increasingly authoritarian government of Hugo Chavez, proclaiming that “International solidarity with the people of Venezuela is vital if the revolution is to survive.”

    Christ on a Crutch, what is wrong with these people?


    Sullivan has some great comments.

    Like Sullivan, I’m pessimistic about our future in health care. I feel that we are likely to get some form of socialized medicine. And it will only be after it’s too late to go back that Americans will realize what they’ve lost. The sob stories in Michael Moore’s movies will change from people being denied healthcare by HMOs to *everyone* being denied healthcare by a faceless government agency. Experimental procedures won’t bankrupt you, they just won’t exist.

    But my biggest point is on the innovation-killing aspects of “universal health care”. In many ways, the movement to socialize medicine is another of the “fuck the future” policies that are driving me crazy. Budget deficits, open-ended foreign wars, unfunded liabilities. It’s apparently not enought to rob the unborn of all their money. Now, in an effort to get cheap healthcare today, we are going to stifle innovation and invention. At least when our grandchildren are dying of drug-resistant typhoid, we can be grateful that we got numerous erections and lowered cholesterol.

    There is no cost in the world greater than opportunity cost. People in socialized medicine systems see the great state apparatus — they do not see the privatized system that could be in its place. People in this country see the great Medicare. They do not see the system of private insurance which would be infinitely superior.

    The biggest cost of socialized medicine and price-controlled drugs will be the innovations we *won’t* get, the things that *won’t* be there for our children and grandchildren. Cures to cancer and Alzheimer’s; perfect asepsis; technology to slow or even stop aging; surgeries that are less invasive and painful.

    If we stick with the system we have now — perhaps with reforms to get the consumer closer to the spending, rather than futher away — our grandchildren will look back on our present healthcare the way we look at leeches and hacksaws from the 19th century. But socialism will gobble that bright future up. It will stagnate innovation and progress.

    Is our healthcare so good right now that we’re ready to stick a fork in it?

    I’ve said it before and I’ll say it again: the biggest reality on healthcare is how spoiled rotten the American people are. I heard the repugnant Richard Roeper reviewing “Sicko” the other night and he pronounced our healthcare system “a disaster”. Try telling that to people like Sullivan, who are alive because of expensive innovation — or my wife who is controlling her MS with expensive meds.

    We spend more money on our cars than we do on our bodies. A history and physical is less than a year’s maintenance on a typical car. You will pay less out-of-pocket for life-saving surgery than you will for a high-end automobile. But it’s still too much for most people.

    Whenever people complain about the cost of healthcare (and our insurance just laid out ten grand to bring our daughter into this world), I’m forced to ask:

    How much is your life worth?

    Oh, Come On!

    Isn’t there anything better to do with research money? I have a rejected NSF proposal that could do better.

    Their paper, published yesterday in The Archives of Internal Medicine, involved 100 primary-care doctors in the Rochester area. As part of a study on patient care and outcomes, the doctors agreed to allow two people trained to act as patients come to their offices sometime over the course of a year. The test patients would surreptitiously make an audio recording of the encounter. The investigators analyzed recordings of 113 of those office visits, excluding situations when the doctors figured out that the patient was fake.

    To their surprise, the researchers discovered that doctors talked about themselves in a third of the audio recordings and that there was no evidence that any of the doctors’ disclosures about themselves helped patients or established rapport.

    First, anyone who has hung around doctors is not surprised that they talk about themselves all the time. I don’t think you can be a doctor without having an ego – it comes with the whole “saving people’s lives” thing.

    Second . . . come the fuck on! Are Doctor unique in this? I live in Texas and practically can’t drive through a damned McDonald’s without hearing the cashier’s life story. Professional people chat with customers. That’s the way the world works.

    Jesus Christ. We needed a group of researchers to figure out, after a year of study, that doctors are chatty? Stand by for new studies showing that plumbers often unveil their butt crack and waiters occasionally hit on customers (and vice-versa).