Way way way too little, way way way too late
It's the little things that count, but that's only if you're not nailing hookers on days of the week that end in "y".
"As shadowy moneymen in the terror underworld go, not many are as unsavory as Jamal Yousef, an ex-Syrian military man turned terrorist arms supplier. Three years ago in Honduras, undercover U.S. agents caught him trying to sell 100 AR-15 assault rifles, 100 M-16 assault rifles, 10 M-60 machine guns, C-4 explosives, 2,500 hand grenades, rocket-propelled grenades and as many as 18 surface-to-air missiles to Colombia's FARC Marxist narcoterrorists."There's just one problem -- they most likely have the wrong guy.
The talking heads on cable TV panned President Obama’s Wednesday press conference. You see, he didn’t offer a lot of folksy anecdotes.Right. There is a well known causative correlation between folksy anecdotes and cable TV punditary approval. Oh wait -- he's setting up his "Obama rulez Bush droolz" point for later.
Shame on them.Yeah -- shame on them for criticizing the President's lame performance and meandering, vague responses when he's working for the cause. Aren't you on board, commrades?
The health care system is in crisis. The fate of America’s middle class hangs in the balance.A crisis, and the very fate of the middle class you say? According to whom, and by what metric? In general, the word "crisis" connotes an impending disaster. And, while the Federally funded Medicare program certainly faces the result of its structural shortcomings a couple of decades from now, no portion of our nation's healthcare system can be said to be currently in "crisis." This is a buzzword used in the same way that used car salesmen tell you that it's urgent that you drive that car off the lot TODAY. So, any arguments that Krugman presses in the rest of this piece that are based on urgency fail, on their face.
And there on our TVs was a president with an impressive command of the issues, who truly understands the stakes. Mr. Obama was especially good when he talked about controlling medical costs.Hagiography. Irrelevant.
And there’s a crucial lesson there — namely, that when it comes to reforming health care, compassion and cost-effectiveness go hand in hand.Okay -- we're finally to his premise: "compassion and cost-effectiveness go hand in hand." Let's see how well he does supporting that postulate.
To see what I mean, compare what Mr. Obama has said and done about health care with the statements and actions of his predecessor. President Bush, you may remember, was notably unconcerned with the plight of the uninsured. “I mean, people have access to health care in America,” he once remarked. “After all, you just go to an emergency room.” Meanwhile, Mr. Bush claimed to be against excessive government expenditure. So what did he do to rein in the cost of Medicare, the biggest single item driving federal spending? Nothing. In fact, the 2003 Medicare Modernization Act drove costs up both by preventing bargaining over drug prices and by locking in subsidies to insurance companies.He's off to a piss poor start. First, President Obama hasn't actually done anything yet, so we can't really compare what he has "said and done" -- only what he has said. The quote from President Bush, while appalling to a certain group of people, is in fact accurate. And, while our previous President claimed to be against excessive government expenditure as Krugman notes, his actions in no way bore that out. If one is only familiar with liberals and liberal circles of friends (like, say, Krugman), one might not understand the fact that most conservatives and Republicans supported President Bush mostly on the basis of his foreign policy and were either ambivalent or openly hostile to his excessive domestic spending. Of course, one thing that Krugman decides to skip, because it shoots his argument in the ass, is the Medicare prescription drug program. This was a Bush initiative (bastard), and drastically increased Federal Medicare spending. From a liberal standpoint it was extremely compassionate -- hundreds of thousands of seniors could now "afford" drugs that they could not before. But where was the cost-effectiveness? It's no wonder Krugman chose to only mention it in the most tangential fashion.
Now President Obama is trying to provide every American with access to health insurance — and he’s also doing more to control health care costs than any previous president.To what kind of health insurance is President Obama trying to provide access? Is it going to be any good? Is it going to be as good as, say, service from PennDOT? Or the IRS? I can say that I want to provide everyone with access to a car, but if that car turns out to be a Ford Pinto it's not really that great of a goal, is it? So, by making an extremely broad statement, the President is able to let everyone write into it what they would like to imagine. And, when he shows up with a fleet of Pintos, be able to say "But this is what you asked for!" Beware the man who says that everyone can drive a BMW, and that it will only cost everyone half as much if we all do it.
I don’t know how many people understand the significance of Mr. Obama’s proposal to give MedPAC, the expert advisory board to Medicare, real power. But it’s a major step toward reducing the useless spending — the proliferation of procedures with no medical benefits — that bloats American health care costs.He's right. I don't understand the significance. However, Krugman doesn't explain it, which means one of several things. 1) He doesn't understand it himself (probably not the case). 2) He doesn't want to say because it is detrimental to the overall liberal goal of a de facto single payer system. 3) He was near his column's word count and had to cut something. So, since he's unwilling or unable to actually describe what makes it so awesome, asking us to take his word for it (argument from authority), we'll have to discard it.
And both the Obama administration and Congressional Democrats have also been emphasizing the importance of “comparative effectiveness research” — seeing which medical procedures actually work.This type of research is probably a good thing, but who do we want to have doing it? Do we really want a governing body that decides who can and can't have certain treatments? Once you get into that territory, you run a lot of risks. People start to game the evaluative procedures, lobby, play politics, etc. Personally, I would rather have innovative physicians -- physicians are the ones that come up with new treatments, by the way -- focused on actually coming up with great new medical techniques that might save or extend my life or the lives of my loved ones in the future, instead of, say, wondering how they can game their results to pass the cutoff of a top-level government panel. The truth is that almost all of the treatments we take for granted today began their existence as expensive, experimental procedures. Their effectiveness increased over time as doctors became more familiar with their ins and outs and more practiced in their delivery. Their costs fell as they became more common and eventually commoditized. Sit an effectiveness review board on top of a decreasingly privatized insurance system, and you can say goodbye to innovation.
Many health care experts believe that one main reason we spend far more on health than any other advanced nation, without better health outcomes,Bullshit. I'm assuming that Krugman is narrowly reading life expectancy statistics for this "without better outcomes claim." I've seen that before, and it's dishonest. If that's the case, and since he doesn't source his comment we'll just have to assume it is, he's implying that longevity is the single best way to measure the relative effectiveness of varying health care systems. Krugman makes the mistake of supposing that incremental gains in life expectancy once you've passed a certain level of basic civilization (antibiotics, handwashing, sewerage, etc.) is dependant on health care. There is no evidence that it is. What if aging and the eventual end that we all face at its hands is statistically consistent across populations? If so, then once the basics of civilization are achieved, longevity becomes an increasingly poor measure of health care. Better measures would be: length of wait to receive care, quality of life with illness, days lost to illness or injury after the decision to seek care is made, days ill/injured verus days well. If you really think that we don't have better outcomes, why don't you try getting breast or prostate cancer in these other "advanced nations" and see how you fare? Would you like a fifty percent lower survival rate (breast) or a four hundred percent lower rate (prostate)?
as is the fee-for-service system in which hospitals and doctors are paid for procedures, not results. As the president said Wednesday, this creates an incentive for health providers to do more tests, more operations, and so on, whether or not these procedures actually help patients.This is ridiculous. Does any health care provider (doctor, hospital) in the world get paid per outcome? Please show me where that is and how well it's working. Until then, I'd prefer that we don't gamble a significant portion of our economy -- not to mention our very lives -- on a completely untested approach that these geniuses think might be a good idea. Of course, the immediate flaw in fee for outcome that springs to mind is that doctors and hospitals will be significantly less likely to want to perform risky procedures, or even ones that don't pay off. Krugman's an economist so he should get this pretty easily. If you do x procedures a month, 85% of them succeed and you only get paid for successful procedures, what do you think happens? Do you think that perhaps the cost of performing those failed procedures, which is the same to the provider regardless of outcome, might get rolled into the bills of the successful procedures? Well, you say, we'd just make that illegal! Then you find yourself in a situation where doctors and hospitals will only perform the most certain procedures in their books. Well, you say, we'd just mandate that they perform them! You can keep going down that road until doctors work at the point of the government's gun. Now where have we seen that before? So, say goodbye to progress. On the other side, providers that choose to perform less-than-sure procedures will quickly find themselves out of business, because they can't charge for a significant portion of the work that they do. Either way, it's very very bad for everyone who needs health care, which is... every single one of us.
So where in America is there serious consideration of moving away from fee-for-service to a more comprehensive, integrated approach to health care? The answer is: Massachusetts — which introduced a health-care plan three years ago that was, in some respects, a dress rehearsal for national health reform, and is now looking for ways to help control costs.Massachusetts' plan is a disaster. It meets the liberal goal of universal coverage though, so people like Krugman will happily gloss over it. And of course it's now looking for ways to control costs. What is wrong with these supposedly intelligent people who don't understand that when you present something that is obviously valuable (health care) as though it were free or seriously discounted (universal coverage, government plans like Medicare, etc.) people will hoard it. In the case of a service like health care, hoarding behavior shows up as over use. Unnecessary use. And, when you have people overusing a limited a resource, what happens to its price? It goes up. Do I even need to say "Duh" here? More on this at the end.
Why does meaningful action on medical costs go along with compassion? One answer is that compassion means not closing your eyes to the human consequences of rising costs. When health insurance premiums doubled during the Bush years, our health care system “controlled costs” by dropping coverage for many workers — but as far as the Bush administration was concerned, that wasn’t a problem. If you believe in universal coverage, on the other hand, it is a problem, and demands a solution.Dropping coverage, while tough for individuals, is the system's way of controlling the balance between supply and demand. No one has ever said that markets were compassionate. On the other hand, any attempt by the government to inject compassion into the equation -- especially in the form of universal coverage -- will quickly get a lesson in basics economics when costs begin to rise even more quickly than before. It's compassionate for a little while, until the system collapses under the weight of its fundamental flaws. After that, everyone's screwed. Funny, that sounds like another system that was touted to be compassionate, caring about the little guys, etc., for quite a while. And then it went to shit and crushed everyone in it's path. What was that called? Was it... communism? Yeah. It was. The same bunch is pushing for this, apparently because they understand neither history nor basic economics.
Beyond that, I’d suggest that would-be health reformers won’t have the moral authority to confront our system’s inefficiency unless they’re also prepared to end its cruelty. If President Bush had tried to rein in Medicare spending, he would have been accused, with considerable justice, of cutting benefits so that he could give the wealthy even more tax cuts. President Obama, by contrast, can link Medicare reform with the goal of protecting less fortunate Americans and making the middle class more secure.Ah, just has to throw in the most wonderful leftist class warfare "tax cuts for the wealthy" turd, doesn't he? When treatments are new and very expensive, who gets them? Who pays cash for them? The... wealthy? What happens to those treatments over time? If they prove effective in the field, they become more popular, and their cost goes down. Eventually, it becomes something routine like angioplasty. Who do we have to thank for routine miracles like that? Who essentially funded them in their infancy? It couldn't be the wealthy, could it? Because, like, they're evil or something.
As a practical, political matter, then, controlling health care costs and expanding health care access aren’t opposing alternatives — you have to do both, or neither.Just a restatement of his premise, which is clearly lacking.
At one point in his remarks Mr. Obama talked about a red pill and a blue pill. I suspect, though I’m not sure, that he was alluding to the scene in the movie “The Matrix” in which one pill brings ignorance and the other knowledge. Well, in the case of health care, one pill means continuing on our current path — a path along which health care premiums will continue to soar, the number of uninsured Americans will skyrocket and Medicare costs will break the federal budget. The other pill means reforming our system, guaranteeing health care for all Americans at the same time we make medicine more cost-effective. Which pill would you choose?I really hope he wasn't referring to The Matrix. If he was, he's an idiot. The President recommended the "blue pill" in his speech, which in the movie was the path to ignorance. The Red Pill, though certainly the less compassionate road, was the eventual road to knowledge and self-actualization. Oh wait -- maybe he did get the reference correct after all.