Saturday, June 13, 2009

The Voice of the GOP

The moronic Rush Limbaugh spouts off here on how "exercise freaks" are driving up healthcare costs with all their "knee injuries and sprains". Portly souls like himself, who keep in reasonable shape on their own, don't even need to see a doctor. It's the joggers and bikers and treadmillers and swimmers and the Haagen Daz-lite crowd who are the true villains. That socialist Obama is waging war on his obese brethren!

Mm-hmm, strong work from the current Leader of America's only opposition Party. Next week he'll be blaming the financial crisis on all those solvent homeowners with their "miserly saving and fiscal prudence".


Anonymous said...

"President Obama challenged Republican critics Thursday to offer alternative plans for overhauling US health care, saying he's 'happy to steal steal people's ideas' but doing noting about out-of-reach costs and uninsured Americans is not an option." - A.P. report

"Socialist Obama" - socialism, that's a Cold War era (and modern day McCarthyism) term.

Isn't it?

Anonymous said...

"McCarthyism is the politically motivated practice of making accusations of disloyalty, subversion, or treason without proper regard for evidence."

It's a simple but dirty tactics used all too often to characterize current administration's policies. At the term of last century, it's more or less synonymous with the term "witch-hunt."

MissFifi said...

Rush is a flea of a man and I have not heard portly used in so long that it made me laugh out loud. thanks for all your terrific posts!

Anonymous said...

Rush has always been a joke. I honestly use to think his program (that my husband) loved was a comedy. When I found out it wasn't and he was serious about all this stuff, I had to admit he was an asshole, and so was my husband. I got a divorce and stopped watching TV.

Andrew_M_Garland said...

Lack of Competition in Health Care Insurance

It is the lack of competition in healthcare insurance and government intervention that is increasing health care prices, ironically driving the call for further government control.

According to David C. Rose, Professor of Economics at the University of Missouri-St. Louis [edited excerpt]:

Medicare is a good deal partly because the government drives a hard bargain with health care providers by offering artificially low payments. In a competitive market of many insurers, no one insurer could do this.

Artificially low payments don't cover the full cost of procedures, so health care providers shift costs to everyone else. In other words, the lack of competition in today's market leads to higher insurance costs for people who aren't old enough to qualify for Medicare. Extending Medicare-like insurance to everyone won't work, because no one will remain to pay the shifted costs.

[ The same applies to emergency room (hospital emergency department) prices. The law EMTALA forces ER's to treat all patients equally regardless of ability to pay. They must shift these costs onto those who can pay. This produces the amazing $10 ER aspirin. -ag ]

In a competitive market, driving such hard bargains is impossible, so prices reflect actual costs. The Obama administration plan will give us the worst of both worlds.

-- Artificially low premiums will drive most private insurance out of business.
-- There will be no place to shift costs.
-- Shortly, we will have no reduction in cost from cost shifting.
-- We will have substantially less competition.
-- Less competition will result in higher actual costs.

This has been the experience in countries with nationalized health care. Many have an even worse looming entitlement problem than the United States.

Travis said...

Andrew M. Garland - gee, thanks for the astroturfing comment, a totally irrelevant comment only related to the original post by keywords. Subtle.

Rush is an national embarrassment.

Andrew_M_Garland said...

(ohio surgery)
To Travis,
Sorry. I thought part of the discussion related to what actually was causing higher healthcare and insurance costs.

You think the only discussion is whether Limbaugh is wrong. I think he is mostly wrong.

I see this question within Limbaugh's rant. What is the best approach for remaining fit while avoiding disability and high health care costs?

Does it reduce overal medical costs to encourage skiing for better fitness, and pay to fix resulting ski injuries? Why should the fun and benefits of skiing be personal, while some of the costs are spread to the community? Possibly, medical plans should be priced according to activities, and the prices would show which activities pay off in greater health and lowered overall cost.

If that seems picky, then why is it not picky when applied to smokers? Smokers are enjoying themselves while damaging their health, so it seems right to charge them more for health insurance. Yet, there is a possibility that smokers generate lower healthcare costs overall because they die younger.

What if skiers are enjoying themselves while improving their health, while also creating health care costs. It might be right to charge them for any overall increased costs for their healthcare.

Travis said...

Andrew M. Garland - It's very hard to imagine having a rational conversation about health care that begins with Rush's irrational attack on exercise and its supposed effects on health care costs. I also don't trust you, since you started out by concluding that Obama's incomplete/unnegotiated health care will be a disaster. I'm concerned that you're either a crank or you're a paid astroturfer.

Having said that, I'll still make a case. First, your views on the sources of health care costs are strangely incomplete and weirdly focused on competition.

The bottom line is that the uninsured cost everyone money. Just one uninsured diabetic patient, for example, creates a whole cascade of budgetary effects down the line, many of which could have been avoided by proper medication, diet, and exercise counseling if it had been given months or years before the acute problems. Some patients in budgetary constraints right now are choosing between their meds, literally picking one or two not to take. Many can get away with that, but many cannot. They will sicken and die, incurring costs that all of us pay before they go. Doctors will also rationally move away from treating the uninsured, increasing the patient/doctor ratio for people in that group.

Better health care for all is cheaper health care, in the context of public policy. It's cheaper to avoid problems or to treat small problems in primary care offices than it is to use emergency rooms to treat the catastrophic problems they turn into. It's cheaper to have doctors treating patients using the best standard of care, instead of wondering if this treatment or that prescription will be permitted, or spending time fighting with insurance companies over a month's old bill.

In addition, who cares if insurance companies go out of business when competing against a public option? Will we miss their expensive ads? Their caring touch? Their free pens and note pads? As currently formulated, medical insurance companies exist to obtain premiums, then deny as much care as they can legally get away with, even if those acts lead directly to the death or suffering of patients. They force doctors everywhere to jump through meaningless hoops and repeatedly apply for reimbursement for procedures. Medical care is not a fucking game, and it should not be governed primarily by the profit motive. There's no "competition" worth the name that these leeches provide. They can all go out of business, and be damned.

Andrew_M_Garland said...

To Travis,
You don't have to trust me. I give some summaries, support arguments that seem right to me, and I include the reasoning and links.

I don't have a "solution" to healthcare, but I notice the areas where I think government policy is distorting how that care is currently delivered and priced. I read the posts and comments by people working in healthcare.

InsureBlog is a site by an insurance broker who offers insight into insurance. He criticises many insurers and praises others.

M.D.O.D. is a site by practicing doctors who deal with the current government regulation of health delivery. Of course, along with Buckeye Surgeon.

I like competition as a way to involve all interested and knowledgable people to discover over time the least costly or most effective ways of delivering products and services, including healthcare. It seems you believe that Obama's appointees will work out a better "incomplete /unnegotiated" plan for 1/8th of the economy by September. Then, they will make sure that there is no competition.

I agree that healthcare through emergency rooms is too expensive for the care delivered. I see the logic in the analysis by Prof. Rose (above) that this is partly cost shifting from Medicare onto insured patients. Why doesn't Medicare pay enough to keep its patients in doctors offices and out of emergency rooms? According to your view, that would be much cheaper overall.

It is a federal law (EMTALA) that forces emergency rooms to give full workups to everyone, including drug seekers who repeatedly make up symptoms. This drives costs way up. If government can't deal with the costs of this current policy, then how will it change this policy?

Government agencies do not deliver the "best standard of care". There are already "formularies" that specify the allowed drugs to be used in Medicare. Doctors must start with the cheapest ones for any given problem and work their way up, if needed. They can't specify from the start the drug that they think is best. The formularies differ by state. Whatever the government specifies will be the best standard of care, by definition.

Insurance can't be less expensive if actual health costs remain high. Providing subsidized insurance shifts this expense onto taxes in a formal way, rather than onto taxes in the current informal way. This makes little difference.

You believe from the start that insurance companies are leeches and should go out of business. Given that, the only possibility is the program proposed by the government. Why quibble about details? I don't look forward to the "caring touch" of a single government bureaucracy. When the government makes a mistake, who are you going to sue?

Travis said...

Sorry, dude, you're a troll or an paid astro-turfer. You don't really respond to any of my points, but you do have a ready stream of patter that includes buzzwords like competition. It's not convincing.

I don't believe in any public health care plan that doesn't stop evil crap like rescission. The status quo is simply unacceptable.

I'm not going to check this thread anymore.

Norma said...

When I was in rehab for my shoulder (work injury--I'm a librarian), everyone in there was an athlete, and fully intended to go back to damaging their bodies when well.

Jeffrey Parks MD FACS said...

That's a fantastic point! Rush would be proud of you trolling through my blog leaving such insightful comments....