Health Care Reform Lite

Because I believe in comparative advantage, I blog about the few things I know something about and leave other topics in more capable hands. On those other topics I feel free to use shortcuts to form my tentative opinions since I won’t be inflicting them on others. Over the years, for example, WWFT (what would Friedman think) has been a useful timesaver.

One area of absolute and comparative disadvantage for me is health-care economics. That’s okay because the National Center for Policy Analysis for whom I work has several experts on health care economics. John Goodman, the founder and president, for example, is considered by many to be the father of Health Savings Accounts. He and Jeanette Goodman recently conducted an online petition drive against a government takeover of health care that collected a record 1.3 million signatures. My only contribution to that was to sign the petition. 

I do know enough about the health-care debate in Washington to be strongly opposed to the proposed reforms, but, because of the comparative advantage of my colleagues in that area, I haven’t immersed myself in it. Instead two or three simple facts tell me all I need to know.

If the reformers were really serious about reducing the cost and increasing the availability of health care, they wouldn’t pass up the low hanging fruit. An obvious place to start–both in terms of impact and low cost–is medical lawsuit reform. Win-the-lottery lawsuits raise the cost of necessary malpractice insurance for doctors and cause doctors to practice defensive medicine that also raises cost dramatically. If the reformers won’t go there, it means they have higher priorities than better, cheaper health care. They are clearly placing the financial interests of plaintiff lawyers above the health-care goals they claim to pursue. No doubt they will be substantially rewarded in campaign dollars.

Another example passing up low-hanging fruit is the failure to do anything to increase the number of doctors or to remove obstacles such as the caps they have placed on the number of medical residencies for medical students. We are expected to believe that we can add tremendously to the demand for medical services while limiting the supply and have costs fall. They don’t have a high opinion of our intelligence, do they?

Here at the end of 2009 we are reading about dying patients and the families of patients on life support trying to hang on a few more days or hours to 2010 when the death tax declines to zero. They shouldn’t hang on too long, however, because in 2011 the death-tax rate goes back up and the exempt amount goes back down.

Let’s see now, Congress lowered the death-tax burden for a few years, eliminated it for one year, and are raising it back to its original high level the following year. With decisions like that, how can they expect us to take them seriously? At least they are sparing me the trouble of digging deeper into the details. Don’t forget that the death tax taxes wealth that came from income that was already taxed, probably more than once.

On a slightly different topic, on Christmas Day, all that kept an airliner with over 300 passengers from being blown up over Detroit was a malfunctioning bomb fuse or detonator.  It was pure dumb luck. Yet, the head of homeland security says our security procedures had worked. Then the TSA announces new security measures that have nothing to do with the nature of the new threat. They would be laughable if they weren’t so inconvenient.

My personal favorite is a new requirement to remain seated for an hour prior to landing on international flights. I don’t know about you, but nothing makes me want to go to the bathroom more than being told I can’t go. For some time after 9/11, they enforced a 30 minute sit-down rule on flights into Washington D.C. I found that that was about my limit, and I’m about eight years older now. I think most people are.

Comments (5)

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  1. JustOne says:

    Didn’t Art Laffer and others in the Reagan era establish beyond a reasonable doubt that a supply side approach to lowering costs works better than price regulation? Perhaps I just forgot, but the Congress has had years to apply those theories to medical and medical insurance practices. That would have been “low hanging” in my mind for either Republicans or Democrats.

    Makes me wonder where all the initiatives and programs to fund more medical education went. There must have been some bills that would have encouraged the training of more nurses, doctors and medical technicians before the costs began to spiral up. Wouldn’t a few more doctors and clinics increase competition and lower costs?

    There could have been plans to increase the availability and lower the barriers for access to at least some classes of “prescription” medications. After all, many that were originally available only by prescription became “over the counter” a few years later.

    How dangerous could it be to allow a nurse to stitch up minor cuts, administer steroids for poison ivy or take cultures and prescribe antibiotics when bacterial infections are confirmed. Couldn’t nurse practitioners dispense a lot of commonly used meds for at least a little while without a doctors written approval. Couldn’t the FDA administer a few classes of drugs between over the counter and prescription?

    But now that it is a “crisis” I guess the low hanging fruit has been knocked down and trampled by the emergency response team. But then what else is new.

    Enjoy It … Whatever It Is.

  2. T Le says:

    Nurse Practitioners and physician assistants are doing stitches, assisting surgeries and prescribing all the medicines that doctors are doing under a doctor’s “supervision.” In many communities, there are more NP/PAs caring for patients than there are MDs. A doctor can have up to 2 nurse practitioners under his supervision in New York state. Over 50% of the time, the doctor does not really review what the NP is doing unless the patient gets really sick and needs to be hospitalized.
    Medicare allows a NP to charge at the same rate as a MD as long as the doctor is in the same building as the NP. A doctor can make a nice profit paying a NP’s salary and getting 100% reimbursement from medicare and private health insurance companies.
    As an doctor, I believe that the only way to decrease health care cost in the US is to have more educated patients.

  3. John B says:

    Anesthesiologists use nurse anesthetists who earn $75K-100K a year or about a third of what an Anesthesiologist makes. Yet reimbursement per unit is identical. Doctors have to be forced into controlling healthcare costs. There is no other way.

  4. I always make sure that my family gets Health Insurance from very reputable companies. health insurance is very important these days.`-“

  5. Muhammad says:

    Almost 50 million are unnseurid. The exact thing predicted by insurance people on this format and elsewhere, a couple of years ago, is happening: The Health Reform Act as written by our congress and senate, is making MORE people unnseurid. It will continue to drive the cost of insurance up, and encourage employers to discontinue health insurance coverage for their employers (by making it cheaper to pay the fine, than buy the required coverage). Source: CNN, quoting the CDC.