Ron Paul: dead, uninsured staffer didn't need government help

Rep. Ron Paul, sticking to his guns, told TPM that government should stay out of health care:

Ron Paul told TPM on Wednesday that even if there’s a “case or two” that makes Americans uncomfortable, the government should stay out of the health care business. Even if one of the cases in question is his former campaign manager, Kent Snyder, who died with $400,000 in unpaid medical bills after being unable to secure health insurance due to a pre-existing condition. 

The staffer's friends and family took up a collection, which yielded $38,000 dollars.  I guess doctors are and hospitals are supposed to randomly absorb these losses rather than violate liberarian principles by having mandatory comprehensive health insurance.

 

A plain blog about politics: Worst Argument Ever

Jonathan Bernstein takes down Robert Reich's hysteria. - GWC

A plain blog about politics: Worst Argument Ever:

"Robert Reich tweets:
Ds can no longer campaign on R's desire to Medicare and Soc Security, now that O has agreed it
Just utter foolishness. I've already written a How To post on running against the Ryan budget after the grand bargain, so let's try another way of thinking about it:"

Health reform: One way capitalism can make health care worse and more expensive | The Economist

This post illustrates Jonathan Chait's point that being a west coast blogger is easy because all you have to do is wait til 9 PM Pacific Time when NY Times op-eds are published then point out for the umpteenth time what an airhead David Brooks is. Here's one more piece of evidence on Brooks' latest lament that government insurance can't deliver health care efficiently.

Health reform: One way capitalism can make health care worse and more expensive | The Economist: "Why do we think that a system in which ads for Claritin are all over the subways will generate better overall health results than one where a national review board determines whether Claritin delivers treatment outcomes for some populations sufficiently superior to justify its added expense over similar generics? What do we expect from a system in which, as ProPublica reports today, body imaging companies hire telemarketers to sell random people CT scans over the phone?"

In defense of Canada | The Incidental Economist

Just to be clear: read this post. Canada's single payer system delivers health care more efficiently than does our system. Medicare is a single payer system. It works. do costs need to be managed? yes. Do we need to replace it with a subsidy for you to buy private health insurance? No. /t Paul Krugman

In defense of Canada | The Incidental Economist

Paul Ryan: The GOP Path to Prosperity - WSJ.com

Get rid of Medicare.
Goodbye "Great Society"
Goodbye "War on Poverty"
Paul Ryan: The GOP Path to Prosperity - WSJ.com

Government covers over half of health care costs

More than half of health care costs are borne by government

h/t Ezra Klein via  Paul Krugman  If we want to be more effective in health care delivery we need to use the biggest wedge: government expenditures and controls.  And BTW - caps on victims of medical malpractice is an unjust way to do it.  And turning medical malpractice adjudications over to "experts" like doctors is undemocratic and untrustworthy.  Obama ought to rethink that sop to the right.

Medicare it ain't but it is the biggest progressive win since Reagan was elected

I remember the passage of Medicare.  I was in college and little concerned with public matters.  That would come with the draft and escalation of the war in Vietnam by Lyndon Baines Johnson.  Johnson was a great President who made a fatal error - inability to think his way out of war in Vietnam.  The civil rights bill, the War on Poverty, and Medicare were his great accomplishments.


Since Reagan principally, public debate has been dominated by the conservative attacks on "entitlements".  It wasn't always so: the Department now known as HHS (Health and Human Services( was then known as HEW (Health Education & Welfare).  This relentless ideological assault on the modest social democracy of the Democratic Party has shaped public debate - so that we end up with a private insurance program - rather than the expansion of Medicare and single-payer plan that I, like most progressives, would have preferred.  Important  as this is, it is not Social Security, not Medicare.  But it IS the biggest progressive victory in Congress since Ronald Reagan was elected in 1980.  And it is Obama's victory.  Gives us Hope.

Medicare hell-holes and Medical Liability Reform in Federal Health Care Reform

`Is there a role for medical malpractice reform in health care reform ?' Medical-legal policy specialists Michelle Mello and Troyen Brennan at Harvard School of Public Health, writing in the New England Journal of Medicine, say a definite maybe.

They identify three options: Disclosure and offer programs (a kind of Offer to take judgment-cum apology), Administrative or Specialised Tribunals (with "neutral experts or neutral adjudicators"), and Safe Harbors" (legal defenses for adherence to evidence-based practices).

Would these measures accomplish much? No, but Mello and Brennan recommend doing it anyway. Why? Because health care reform "will entail changes in the payer mix that are unfavorable for providers and exert continued downward pressure on reimbursment rates."

The connection? Reformers should offer MD's a "quid pro quo". Malpractice reform would be welcome because "most physicians find the litigation system unfair, financially and psychologically burdensome, and unhelpful in promoting safety and quality. They would welcome relief of some sort."

This is sincere but unpersuasive advice. If medical malpractice reform is to be enacted it should be on the merits, e.g.

- the proposed reform improves deterrence of poor care, or

- increases rates of compensation of the negligently injured, or

- decreases costs while preserving other values.

A medical malpractice reform bone is unlikely to win much support from skeptical physicians. Physicians' attitudes are driven by ideology and anecdote, not data - as Tom Baker has demonstrated in The Medical Malpractice Myth (2005). Mello and Brennan know this from their own research - such as their demonstration that flu vaccines generate only negligible amounts of litigation, contrary to what many consider common knowlege. See Mello and Brennan, Legal Concerns and the Vaccine Shortage, JAMA, October 12, 2005—Vol 294, No. 14.

Medicare hell-holes

Since we spend 6 - 7% more of GDP on health care than other advanced countries of similar levels of public health we need to look beyond myth. Atul Gawande in the New Yorker has done just that. In The Cost Conundrum he discusses what a Texas town can teach us about health care. Hidalgo County, south Texas, is a "Medicare hell-hole". Costs are not driven by Tex-Mex cuisine, but by gorging on tests and procedures ordered by unsalaried doctors who get paid by the procedure and are subject to no significant institutional controls.

Gawande concludes that unlike procedure-driven pricing at Doctors Hospital at Renaissance in Edinburg Texas, we should adopt the salaried physician and medical management approaches demonstrated by the Mayo Clinic in Minnesota. "If we brought the cost curve in the expensive places down to their level, Medicare’s problems (indeed, almost all the federal government’s budget problems for the next fifty years) would be solved", he argues.

This is the approach taken by President Obama, who lauded Mayo Clinic in his recent address before meeting with Senate Democrats.

Image: Doctor's Hospital at Renaissance, Edinburg, Texas