Les Jones

Hawaii ends universal child healthcare after just seven months

Friday, October 17th, 2008 | Health Care | Permalink | 1 Comment |

AP - Hawaii ending universal child health care:

HONOLULU – Hawaii is dropping the only state universal child health care program in the country just seven months after it launched.

Gov. Linda Lingle’s administration cited budget shortfalls and other available health care options for eliminating funding for the program. A state official said families were dropping private coverage so their children would be eligible for the subsidized plan.

“People who were already able to afford health care began to stop paying for it so they could get it for free,” said Dr. Kenny Fink, the administrator for Med-QUEST at the Department of Human Services. “I don’t believe that was the intent of the program.”

Cheap Eyeglasses Online

Wednesday, April 2nd, 2008 | E-commerce, Health Care | Permalink | 4 Comments |

James Rummel posted a while back about a Web site selling eyeglasses for as little as $8 a pair. Now he links to Sevesteen’s review of that Web site. It sounds like the biggest challenge is knowing what frames to get that will look good on you:

I also got a pair of sunglasses with memory temples and bridge, semi-rimmed (the string type) for $15–Wore those while driving to work, and the prescription seems fine, as are the $13 hingeless stainless steel semi-rim. Finally, I bought a $10 semi-rimmed that I’m wearing now. Also fine.

I will probably order from them again, but if I get something beyond the basic lens, I’ll be more careful about width, and probably stick to a frame style I already have.

My wife tells me she worked part-time for an optometrist back in her twenties. She was shocked at the markup on eyeglasses. I believe it.

She and I got new glasses in December. The salesperson was happy to throw in anti-reflection coatings to our glasses, add polarization to my sunglasses, and even make new lenses for my old frames, all at no extra cost. This despite the fact that we were buying during a buy one pair get two pair free sale. We didn’t even drive a hard bargain - we just mentioned those things and she happily gave them to us gratis. I realized then how much profit margin that store has on eyeglasses. I can only imagine how much profit margin my optometrist makes on eyeglasses during his buy one get nothing free sale.

Our optical plan will cover new eyeglasses on January 1, 2009, so we may give Zenni a try then. Most of the eyeglasses are in the $25-50 range, which our deductible will more than cover.

Saving Lives and Reducing Healthcare Costs - with a Piece of Paper

Thursday, February 14th, 2008 | Health Care | Permalink | 2 Comments |

The New Yorker - If a new drug were as effective at saving lives as Peter Pronovost’s checklist, there would be a nationwide marketing campaign urging doctors to use it:

In December, 2006, the Keystone Initiative published its findings in a landmark article in The New England Journal of Medicine. Within the first three months of the project, the infection rate in Michigan’s I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero. Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative’s first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist.

Via Andrew Tobias.

See also:
- History of Obstetrics and the Apgar Score

Wal-Mart Drug Prices

Thursday, January 17th, 2008 | Health Care | Permalink | 4 Comments |

Just got back from Wal-Mart, where I picked up three prescriptions for my mother. Total cost for a month’s worth of three prescription drugs: $6.75 with tax.

When I told my wife she explained that she had shopped around. One of mom’s drugs is $40 at Walgreen’s, $20 at a local pharmacy chain, or $2 at Wal-Mart. It’s hard to believe how different prices can be. Way to go, wife.

I’d like Wal-Mart’s pharmacy even better if they had longer hours and a drive-through, but for those kind of savings I’ll adjust my schedule and walk a little.

U.S. Credit Rating Threatened by Medicare, SS, Debt Liabilities

Friday, January 11th, 2008 | Health Care, Social Security | Permalink | 10 Comments |

Financial Times - US’s triple-A credit rating ‘under threat’:

The US is at risk of losing its top-notch triple-A credit rating within a decade unless it takes radical action to curb soaring health care and social security spending, Moody’s, the credit rating agency, said yesterday.

The warning over the future of the triple-A rating - granted to US government debt since it was first assessed in 1917 - reflects growing concerns over the country’s ability to retain its financial and economic supremacy.

People are willing to talk about the national debt (it was the centerpiece of Ross Perot’s 1992 presidential campaign, which led to some deficit reductions and even modest debt reductions in the ’90s). People are even willing to talk about Social Security shortfalls (which led to modest Social Security changes, such as changing retirement age from 65 to 67 for those of us born after 1959).

Few people are willing to talk about the truly massive unfunded obligations of Medicare and Medicaid ($33.4 trillion), which dwarfs unfunded Social Security obligations ($4.6 trillion) and the national debt ($10 trillion). The U.S. also has “$2.3 trillion unfunded liability for medical and disability benefits promised to civil servants and military personnel who retire.”

Social Security needs a few tweaks to stay viable. Removing the $85,000 ceiling for contributions and indexing payments to prices rather than wages would help. Reducing Social Security payments doesn’t seem like an option - the government has made express commitments of specific dollar amounts upon retirement. It would undermine credibility in the government to reduce those payments.

Medicare on the other hand doesn’t have the same type of specific obligations, and in general pays out much more than it takes in. Medicare represents our largest financial shortfall, so reform there is mandatory for our government to stay solvent.

This looming threat is one reason I do not want government-provided healthcare. The government has already shown it can’t provide a health care system with balanced books. My guess is that if we don’t get nationalized health care the next ten years it will be off the table. Once people realize how financially unstable the current government health care system is they won’t want another.

Massachusetts’ MittCare Over-enrolled and Overbudget

Monday, November 26th, 2007 | Health Care | Permalink | No Comments |

Boston.com Success could put health plan in the red

The state budgeted $472 million this fiscal year for the subsidized program, based on enrollment estimates made last winter. The program, called Commonwealth Care, provides comprehensive insurance to people without access to work-based coverage who earn less than 300 percent of the federal poverty level, or about $31,000 for an individual. The state money pays the full premium for the lowest-income residents and subsidizes the rest. Members are responsible for small copayments.

The connector began enrolling people in October 2006 and set a goal of 136,000 by June 30, 2008. Outreach has resulted in more than 133,000 people signing up. If enrollment reaches the high estimate of 178,280 by June 30, Holland said, the state cost could hit $619 million.

Also driving up the cost was a decision by the connector last winter to eliminate premiums for thousands more people than originally planned, in an effort to make insurance more affordable.

They had a sale on free money, and it sold better than they expected.

Why No Tax Break for Privately-purchased Insurance?

Monday, November 26th, 2007 | Health Care | Permalink | No Comments |

Romesh Ponnoru writing in Time:

During World War II, employers started giving workers health benefits to get around wartime wage controls. Since then, the government has continued to give a tax break for employer-provided health insurance; it isn’t taxed, the way wages are.

That’s how we ended up with the health-insurance system we have now, based on employers. You get a tax break if you get your insurance through your job. If you get a raise and use it to buy your own insurance instead, you have to pay taxes on that money. (Ditto if you use your raise to pay doctors directly.) Almost everyone takes the tax break. The market for insurance bought by individuals is, as a result, small and stunted, which is all the more reason to stay in the employer system.

[...]

In his State of the Union Address this year, President Bush proposed letting people who buy insurance for themselves qualify for the break too. The Congressional Budget Office estimates that his plan would help 7 million people who don’t have insurance get it. But its main point is to offer individuals more control over their health care–to make it possible, for example, for them to keep their policies when they switch jobs.

Makes sense to me.

About the 1 in 6 Americans without Health Insurance

Thursday, November 8th, 2007 | Health Care | Permalink | No Comments |

The New York Times - Beyond Those Health Care Numbers:

To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had national health insurance, they would probably not be covered.

The number also fails to take full account of Medicaid, the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.

The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.

“The Humanitarian with the Guillotine”

Monday, November 5th, 2007 | Health Care, Political Survival Kit | Permalink | No Comments |

A 1943 essay by Isabel Paterson, via Smallest Minority:

When a humanitarian wishes to see to it that everyone has a quart of milk, it is evident that he hasn’t got the milk, and cannot produce it himself, or why should he be merely wishing? Further, if he did have a sufficient quantity of milk to bestow a quart on everyone, as long as his proposed beneficiaries can and do produce milk for themselves, they would say no, thank you. Then how is the humanitarian to contrive that he shall have all the milk to distribute, and that everyone else shall be in want of milk?

There is only one way, and that is by the use of the political power in its fullest extension. Hence the humanitarian feels the utmost gratification when he visits or hears of a country in which everyone is restricted to ration cards. Where subsistence is doled out, the desideratum has been achieved, of general want and a superior power to “relieve” it. The humanitarian in theory is the terrorist in action.

When it was written the massacres in Germany and the USSR were well underway, and would later be expanded on in China, Cambodia, and elsewhere.

There’s been a discussion over at Instapundit’s about a subset of professional humanitarians who want to save the world (by their definition) and be well paid for it. Paterson has something interesting to say about that:

The great religions, which are also great intellectual systems, have always recognized the conditions of the natural order. They enjoin charity, benevolence, as a moral obligation, to be met out of the producer’s surplus. That is, they make it secondary to production, for the inescapable reason that without production there could be nothing to give. Consequently they prescribe the most severe rule, to be embraced only voluntarily, for those who wish to devote their lives wholly to works of charity, from contributions. Always this is regarded as a special vocation, because it could not be a general way of life. Since the almoner must obtain the funds or goods he distributes from the producers, he has no authority to command; he must ask. When he subtracts his own livelihood from such alms, he must take no more than bare subsistence. In proof of his vocation, he must even forego the happiness of family life, if he were to receive the formal religious sanction. Never was he to derive comfort for himself from the misery of others.

Report: 70,000 Britons to go Overseas for Healthcare in 2007

Friday, November 2nd, 2007 | Health Care | Permalink | No Comments |

The news from the universal healthcare paradise of jolly ole:

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. Patients needing major heart surgery, hip operations and cataracts are using the internet to book operations to be carried out thousands of miles away.

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.

Here’s a crazy idea: the U.S. should grant work visas with aggressive citizenships paths to medical professionals in all of the countries listed above. Hat tip to Kim du Toit.

Brits Pulling Teeth at Home for Lack of State Dentists

Wednesday, October 17th, 2007 | Health Care | Permalink | 2 Comments |

AFP - English ‘pull own teeth’ as dental service decays:

LONDON (AFP) - Falling numbers of state dentists in England has led to some people taking extreme measures, including extracting their own teeth, according to a new study released Monday.

Falling numbers of state dentists in England has led to some people taking extreme measures, including extracting their own teeth, according to a new study released Monday. Others have used superglue to stick crowns back on, rather than stumping up for private treatment, said the study. One person spoke of carrying out 14 separate extractions on himself with pliers.

More typically, a lack of publicly-funded dentists means that growing numbers go private: 78 percent of private patients said they were there because they could not find a National Health Service (NHS) dentist, and only 15 percent because of better treatment.

Paying your medical professionals low wages’ll do that. I’d love to see the U.S. offer fast track immigration to foreign doctors seeking a better life.

Speaking of foreign countries with big government health care plans: Wait times for Canadians needing surgery hit an all time high of more than 18 weeks in 2007. I’ve heard anecdotal stories about Canadian doctors moving to the U.S., but I don’t have any data.

Canadian Premies Being Brought to U.S.

Monday, October 15th, 2007 | Health Care | Permalink | No Comments |

Fox News via Jim Miller.

“I’m a born-bred Canadian, as well as my daughter and son, and I’m ashamed,” Jill Irvine told FOX News. Irvine’s daughter, Carri Ash, is one of at least 40 mothers or their babies who’ve been airlifted from British Columbia to the U.S. this year because Canadian hospitals didn’t have room for the preemies in their neonatal units.

“It’s a big number and bigger than the previous capacity of the system to deal with it,” said Adrian Dix, a British Columbia legislator, told FOXNews.com. “So when that happens, you can’t have a waiting list for a mother having the baby. She just has the baby.”

“The Canadian healthcare system has used the United States as a safety net for years,” said Michael Turner of the Cato Institute. “In fact, overall about one out of every seven Canadian physicians sends someone to the United States every year for treatment.”

And from Sky News:

Bliss’s new study - Too Little Too Late - Are We Ensuring The Best Start For Babies Born Too Soon? - was based on surveys of 195 neonatal units across the UK.

It found that units were forced to refuse new admissions for an average total of two weeks out of a six-month period. And 10% closed their doors to new admissions for eight weeks or more over six months. The study also found that most units were operating above the 70% average occupancy level recommended by experts.

Although some new nurses have been recruited, the service is still 2,600 nurses short of the recommended number, the study said.

Unpaid Medical Bills Only Responsible for 3% of Healthcare Costs

Thursday, October 11th, 2007 | Health Care | Permalink | 1 Comment |

Business Week:

But how big is the free-rider problem, really? According to an Urban Institute study released in 2003, uncompen- sated care for the uninsured constitutes less than 3% of all health expenditures. Even if the individual mandate works exactly as planned, that’s the effective upper boundary on the mandate’s impact.

So even a 100% solution to that problem wouldn’t make much of a dent in healthcare costs.

Canadian MP Travels to U.S. for Cancer Treatment

Thursday, September 20th, 2007 | Health Care | Permalink | 5 Comments |

Uncle reminded me of this story: Stronach travels to U.S. for cancer treatment:

OTTAWA–Belinda Stronach, the MP for Newmarket-Aurora and former cabinet minister, travelled outside Canada’s health-care system to California for some of her breast cancer treatment earlier this year.

Stronach, diagnosed in the spring with a type of breast cancer that required a mastectomy and breast reconstruction, went to California in June at her Toronto doctor’s suggestion, a spokesperson confirmed.

Stronach’s people vigorously deny that she went to the U.S because of waiting times in Canada, but don’t seem to have a good explanation otherwise. According to these Ontario healthcare stats, 90% of cancer patients receive surgery within 84 days. Not sure how that compares to the U.S.

“Health care for nothin’ and your docs for free”

Monday, September 17th, 2007 | Health Care | Permalink | 1 Comment |

Hillarycare now has a theme song:

I shoulda learned to play th’ Class War
I shoulda learned to court them bums
Look at that mama, she gonna promise free insurance
Votes? That’s gonna get some.
And she’s up there, whats that? Socialist noises?
Bangin’ on the wealthy like Noam Chomsky
That ain’t campaignin’, that’s the way you do it
Health care for nothin’ and your docs for free.

Myths of European Healthcare

Thursday, September 13th, 2007 | Health Care | Permalink | 1 Comment |

Sarah Berk exposes some mistaken ideas about European healthcare in a rebuttal to Michael Moore’s “Sicko”:

Michael Moore ends the movie “Sicko” with a lie. It may not be an intentional lie, but it is a falsehood, nonetheless. Michael Moore ends the movie saying that every European country offers “free” health coverage to their citizens and every European country provides such coverage through a “single payer” system.

Both statements are untrue. It is a sad commentary on the pathetically, uninformed state of the health care policy debate in America that health care journalists and American political leaders do not simply know that both of the statements are untrue and that they have not responded clearly and quickly to correct the error.

So what makes these statements untrue? Reality. Most European countries directly charge their citizens for their health coverage. It is not “free” anywhere. Some nations require people to buy coverage from health insurance companies that look very much like American health insurance companies. Other countries use a payroll tax on everyone’s paycheck to pay for health coverage. In those countries, each citizen pays a portion of their weekly paycheck for health insurance - - just like our Social Security payroll deduction. In Germany, each employee pays 7 percent of each paycheck for health care and each employer matches that 7 percent. People also can spend additional money to buy better coverage.

[...]

Each country in Europe has found its own unique path to universal coverage. Switzerland has no government health program at all. Everyone in Switzerland is required to purchase from one of nearly 100 competing insurance companies. (The Swiss government pays for coverage for the poor.)

What about France - - a country Michael Moore described as Eden in “Sicko?” The government uses a sales tax approach and uses that money to buy a basic (not comprehensive) package of coverage for about 80 percent of the French people. The basic government benefit coverage is somewhat incomplete, however, so 92 percent of the people in France now purchase additional private insurance to fill in the 20 - 40 percent gap in various parts of their government benefits. About 20 percent of the French people skip the government program completely and purchase only private coverage. In either case, the coverage isn’t free and is not handled through a Canadian single-payer model.

I actually knew that France’s system wasn’t single-payer, but some of the other information in that article was new to me. And in general Europe isn’t the monolith that many people assume it to be. It’s a big place with a lot of different people and governments.

Tonight’s 20/20: Inside Cuba’s Healthcare System

Friday, September 7th, 2007 | Health Care | Permalink | 2 Comments |

Soon to be playing on my TiVo:

ABC 20/20 will have a segment this Friday about healthcare that regular Cubans receive. It will be a “Give me a break” segment hosted by John Stossel.

It probably will be the last segment on that particular show.

20/20 airs at 10 PM EST and it lasts one hour.

George of The Real Cuba was interviewed as part of this program.

You will be able to see for the first time EVER on U.S. television, photos and videos taken inside Cuban hospitals, WITHOUT GOVERNMENT PERMISSION.

Should be interesting. I’m always amazed at the people who are willing to swallow Cuba’s official government healthcare statistics hook, line, and sinker. Cuba is run by a Communist dictatorship that imprisons reporters and librarians. They control the people to the extent that they hand everyone their food ration every month. There’s no reason on Earth to give any credence whatsoever to Cuba’s government statistics.

Edwards: Universal Health Care Means Mandatory Doctor’s Visits

Sunday, September 2nd, 2007 | Health Care | Permalink | 3 Comments |

From the AP:

Democratic presidential hopeful John Edwards said on Sunday that his universal health care proposal would require that Americans go to the doctor for preventive care.
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“It requires that everybody be covered. It requires that everybody get preventive care,” he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. “If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”

He noted, for example, that women would be required to have regular mammograms in an effort to find and treat “the first trace of problem.”

Regular mammograms: Under Edwards they won’t be just a good idea. They’ll be the law.

SEPTEMBER 3 UPDATE

Commentors at Protein Wisdom:

Consider the implications of that as far as treatments and prescriptions go. Will the patient have the right of refusal?

All those times I bemoaned “I don’t want the Feds any further up my ass” I never thought they’d be the ones deciding I got a colonoscopy…

For the people who say “keep your government off my body” with regards to abortion (and I’m one of those people, for the most part), how do you feel about Edwards plan?

In comments at Ann Althouse some folks take the line that if there’s government healthcare they do want this, because they don’t want to have to pay for someone else’s neglect of their own health.

I can understand the reasoning, but at the same time what are the odds that anyone will get a choice about whether they participate in the system. Hell, what are the odds the system will even come up for a popular vote? If socialized healthcare comes about, Congress will vote on it, the president will sign it into law, and from here on out you and your children will be paying for it whether you like it or not. And odds are it will be just as much of a bankrupting liability as Medicare and Medicaid.

This whole thing reminds me of that Gerald Ford quote, “If the government is big enough to give you everything you want, it is big enough to take away everything you have.”

Cancer Survival Rates - USA! USA!

Wednesday, August 22nd, 2007 | Health Care | Permalink | 18 Comments |

Waiting for Cancer Treatment in Scotland

Tuesday, August 21st, 2007 | Health Care | Permalink | 3 Comments |

The (UK) Daily Record:

CANCER patients are still waiting up to seven months for treatment.

Patients are supposed to be treated within 62 days of urgent referral.

But figures out yesterday showed only three areas in Scotland were meeting those targets every time.

In the worst cases, sufferers were kept hanging on for 220 days.

The figures, for the first three months of the year, show 85.4 per cent of patients across Scotland were seen within 62 days.

The target set two years ago is 95 per cent.

And that 62 day goal is for urgent referrals. If you can’t regulate demand through prices, you have to regulate demand through rationing or waiting lists.

Wisconsin’s Universal Healthcare Plan

Thursday, August 9th, 2007 | Health Care | Permalink | No Comments |

From John Stossel via Q and O:

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.”

And, of course, down the road it will cost much more than that. Even the $15 billion is based on the usual Pollyannaish assumptions such as millions in savings “from putting more emphasis on primary care.”

Good luck with that, Wisconsin.

Canadian ER Wait Times

Tuesday, August 7th, 2007 | Health Care | Permalink | 1 Comment |

Canadian Broadcasting Corporation via Colby Cosh:

Quebec’s emergency rooms are bursting at the seams, especially in Montreal and the Outaouais, despite some $60 million spent last year by the Liberal government to relieve pressure on hospitals’ front lines, according to an annual report on health care.

For the second year in a row, Montreal newspaper La Presse rated admission times at Quebec hospitals and found the average time to be admitted to hospital through an emergency room is 16 hours and 18 minutes, about 30 minutes longer than two years ago.

The average exceeds Quebec’s target wait time of 12 hours, established by Jean Charest’s Liberal government in its last mandate.

and this:

Some Montreal hospitals are closing their emergency rooms on a regular basis to discourage people from coming in to seek treatment.

That’ll fix that pesky supply and demand problem!

Word of the Day - Baumol’s Cost Disease

Monday, January 8th, 2007 | Economics, Health Care, Word of the Day | Permalink | 2 Comments |

Here’s a simple example from Wikipedia:

Baumol’s cost disease (also known as the Baumol Effect) is a phenomenon described by William J. Baumol and William G. Bowen in the 1960s. The original study was conducted for the performing arts sector. Baumol and Bowen pointed out that the same number of musicians are needed to play a Beethoven string quartet today as were needed in the 1800’s; that is, the productivity of Classical music performance has not increased.

In a range of businesses, such as the car manufacturing sector and the retail sector, workers are continually getting more productive due to technological innovations to their tools and equipment. In contrast, in some labor-intensive sectors that rely heavily on human interaction or activities, such as nursing, education, or the performing arts there is little or no growth in productivity over time. As with the string quartet example, it takes nurses the same amount of time to change a bandage, or college professors the same amount of time to mark an essay, in 2006 as it did in 1966.

Baumol’s cost disease is often used to describe the lack of growth in productivity in public services such as public hospitals and state colleges. Since many public administration activities are heavily labor-intensive and have a limited desirable provider-customer ratio, there is little growth in productivity over time. As a result, the costs of the bureaucracy will inflate quicker than the growth in the GDP.

From The New Yorker:

There are really two American economies: one that’s getting more productive and one that’s not. In the first—the economy of Dell, Toyota, and Wal-Mart—consumers have grown accustomed to paying less for more. In the second—the economy of Harvard, the Yankees, and Bob’s Body Shop—they pay more for the same. The first economy has policymakers worried about deflation. The second has consumers worried about paying their bills.

Cost disease isn’t anyone’s fault. (That’s why it’s called a disease.) It’s just endemic to businesses that are labor-intensive. Colleges, for example, could do many things more efficiently, but, since their biggest expense is labor, the only way to reduce costs is either to increase the number of students each professor teaches or to outsource the work to poorly paid adjuncts. The same goes for health care: you can control drug costs and limit expensive new procedures, but, when it comes to, say, hospital care and doctor visits, the only way to improve productivity is to shrink the size of the staff and have doctors spend less time with patients (or treat several patients at once). Thus the Hobson’s choice: to lower prices you have to lower quality.

Interesting. It seems that it’s the very sectors of the economy - such as education and healthcare - where government is being asked to step in that are the very ones vulnerable to Baumol’s cost disease. And once government steps in to subsidize it, the prices are going nowhere but up - as the cost decreases due to subsidy, the utilization and demand increases. (Demand doesn’t really increase, because there’s more or less unlimited demand for education and healthcare, but effective demand increases.)

It’s well-known that healthcare costs and edcuation costs are rising faster than the rate of overall inflation. Is that simply a function of Baumol’s cost disease, or is it caused by government subsidy, or some of both? I don’t know the answer, but in either case it may suggest limits on government intervention. In the latter case, subsidy creates demand, and in the former case government is attempting to solve a problem that is to some degree insoluble. Or am I reading this wrong? Tell me in comments.

See also:
- Why Are U.S. Healthcare Costs So High?

Previous WOTD - Dysgeusia

Medicare Accounts Costs vs. the Private Sector

Friday, September 1st, 2006 | Health Care | Permalink | No Comments |

You always hear that Medicare has lower accounting costs than the private sector. Megan McCardle thinks she knows why.

For starters, the private sector–whether they be charities or corporations–has to collect and track the money they spend. So does the government–but unlike the private sector, that figure doesn’t get charged off against, say, Medicare; it gets charged to the auditor’s office, the IRS, the Treasury, the justice department, and so forth. (Social security does track the money you send them, but the IRS, not their legal department, is the enforcer.)

Also, it is often very, very hard to tell what something costs a government agency. They don’t pay cash prices for a lot of the services they get, and they don’t do normal corporate things like accruing their pension liabilities, so it’s hard to know what their true compensation costs are.

Government agencies also–obviously–don’t have big finance sections to tell them how much they need to pay in taxes. That doesn’t mean they’re more efficient at delivering services; it just means that they don’t pay taxes. We could achieve the same “efficiency”–and many others besides–by eliminating the corporate income tax.

Apparently (I haven’t read the studies myself) when you add in those sorts of costs, the government’s administrative costs are higher than the private sector’s.

And with Sorbanes-Oxley, publicly-traded companies face even more accounting costs.

UK’s Minimum Waiting Time for Healthcare

Thursday, August 10th, 2006 | Health Care | Permalink | No Comments |

From the (UK) Telegraph via Will Collier.

The Sunday Telegraph has learned of five further minimum-waiting-time directives. In May, Staffordshire Moorlands PCT, which funds services at two hospitals and is more than £5 million in the red, introduced a 19-week minimum wait for in-patients and 10 weeks for out-patients. A spokesman said: “These were the least worst cuts we could make.” In March, Eastbourne Downs PCT, expected to overspend by £7 million this year, ordered a six-month minimum wait for non-urgent operations. Also in March, it was revealed that Medway PCT, with a deficit of £12.4 million, brought in a nine-week wait for out-patient appointments and 20 weeks for non-urgent operations.

Doctors are also resigning. One gynæcologist said that he spent more time doing sudoku puzzles than treating patients because of the measures. Since January, West Hertfordshire NHS Trust, with a deficit of £41 million, has used a 10-week minimum wait for routine GP referrals to hospital. Watford and Three Rivers PCT, £13.2 million in the red, has introduced “demand management”: no in-patient or day case is admitted before five months.

There is no evidence that in any of these cases, emergency treatment or cancer care was delayed.

Elsewhere, serious financial tensions are emerging between hospitals and the PCTs paying them.