Author: cmh

What McCain Could Do About Taxes – Ben Stein NYTimes.com


Even Ben Stein concedes the point! Finally.

[Sorry that this is off-blog-topic, but I have to put these somewhere.]

“All politicians campaign on the promise to cut federal spending by identifying hitherto unfound waste, fraud and corruption. None of them ever do so in a meaningful way. Total federal spending has not once fallen noticeably since 1954, no matter the party or the promises of the incoming chief executive.

That is the first thing you need to know. The next thing is that the Republican Party (my party and yours) has for the last 30 years or so been operating under a demonstrably false and misleading premise: that tax cuts pay for themselves by generating so much economic growth that they replace the sums lost by tax cutting.

This would be a lovely thing if true, and the best of all ideas, the “something for nothing” idea. In fact, tax cuts lower federal revenue and generate federal deficits. It is also true that they do stimulate the economy and after a long period of years, federal tax receipts go back to where they were before the tax cuts.

For example, when President Bush enacted his tax cuts in the early 2000s, income tax receipts fell dramatically. It took almost six years for them to reach the level they had been in the last year of the Clinton administration, while G.D.P. in that period rose by roughly 30 percent. In the eight years Ronald Reagan was president (and I love and worship him), tax receipts did not fall anywhere near as much, but they rose more slowly, on a percentage basis, than they did in any other comparable eight-year period after World War II.

In other words, tax cuts do not pay for themselves, at least not on any basis I can see. Certainly, they are not worthless. They make taxpayers feel good and they generate growth. But basically, they shift the tax burden from us to our progeny and add immense amounts of interest expense to the federal budget. At this point, taxpayers shell out about $1 billion a day just for that item. “

And there’s even more! Ben Stein finds his inner Keynes. Or Krugman?

Crooks and Liars » 60 Minutes: Charity Trying To Make Up For Failing U.S. Health Care System

Crooks and Liars » 60 Minutes: Charity Trying To Make Up For Failing U.S. Health Care System

“If you’re looking for a story that shows the abysmal state of health care in America, look no further. 60 Minutes traveled to Knoxville, TN to film a free clinic set up by a charity group called Remote Area Medical Volunteer Corps, or RAM. The charity was initially started in the 90’s by it’s founder, Stan Brock, former co-star of Wild Kingdom, to give health care relief to remote areas of Latin America, but after watching this segment it’s clear that America’s health care system doesn’t look too much different than that of a third world country.”

The video of the 60 Minutes story is available for viewing at the C&L site and it is definitely worth watching, if only to count the thousands of anecdotes available for those who like that sort of thing.

In a related anecdote, a patient I saw today with (now) advanced lung cancer, who had this gem in his history and physical: “He developed severe, unremitting left sided chest pain beneath his clavicle and along his left anterior chest about 4 to 5 months ago. He did not seek medical attention due to lack of health insurance.”

Most Minnesota doctors like single-payer health care, academic study finds | Twin Cities Daily Planet | Minneapolis – St. Paul

Most Minnesota doctors like single-payer health care, academic study finds Twin Cities Daily Planet Minneapolis – St. Paul:

“In his years as a physician, he has seen a sharp change in how physicians look at health care. “Having lunch with other doctors used to mean listening to conservatives griping about the government. Now lunchroom talk is that single-payer would be a good idea,” said Adair.

A recent survey through the University of Minnesota and St. Olaf College found that 64 percent of Minnesota’s physicians support a single-payer system much like the Minnesota Health Plan. Another 25 percent said that health savings accounts were the way to go, and only 12 percent thought that the current system of managed care was adequate.

“I personally feel very angry and frustrated when I know my patients are not getting the care that they deserve,” said Dr. Elizabeth Frost, a supporter of the Minnesota Health Plan. “I hate saying to people, ‘you need this test or this study,’ all the while knowing they don’t have insurance and likely don’t have a lot of savings either.”

Of the reasons that a single-payer system is so attractive to the majority of physicians in Minnesota is that the current multi-payer, managed-care system often gets in the way of physicians’ ability to provide the care that they swore an oath to provide.”

The following point is also made:

“Because of [these] barriers people often under-use the system, “as opposed to the overuse that people erroneously cite as a significant problem in the current system,” said Settgast. “This under-use leads to unnecessary human suffering and also financial waste because the cost of caring for a patient with a stroke far exceeds the cost of effectively managing someone’s high blood pressure.”

Please click on “Moral Hazard” (along the right of this blog) to see more about that last point. But the bigger point is true in my expereince too: physicians are tired of this “system” we now have and are ready to take a chance on change. It would make an interesting poll for the AMA to undertake…

UPDATE: The findings section of the paper, from Minnesota Medicine.
Findings A majority of respondents (72%) were male with a median medical school graduation year of 1979. Nearly half (46%) practiced primary medicine, followed by medical specialty (35%), surgical specialty (12%), and general surgery (6%). More than three-quarters (79%) worked in a metropolitan setting, and nearly two-thirds (65%) practiced in a clinic.
Of the 390 respondents who answered the question about which financing system would offer the best health care to the greatest number of people for a fixed amount of money, 64% said they favor a single-payer financing system, 25% preferred HSAs, and only 12% preferred managed care (Figure 1). Figures 2, 3 and 4 offer a closer look at who prefers those financing structures by sex, geographic location, specialty, and type of practice.
A single-payer system was favored by women physicians over men (female, 76%; male, 59%; p=.003); more male physicians than female preferred HSAs (male, 30%; female, 16%; p=.004). The percentage of male respondents who favored the current managed care system slightly exceeded that of female physicians (12% versus 9%; p=.553).
Geographic setting was also significantly associated across the 3 choices. Urban physicians favored a single-payer system over their rural and suburban colleagues (71%, 60%, and 54%, respectively; p=.009). Rural physicians preferred HSAs over suburban and urban physicians (34%, 32%, 17%; p=.002). Managed care garnered less than 15% support overall, with 14% of suburban physicians, 12% of urban doctors, and 6% of rural respondents favoring it; p=.217). Thus, urban physicians had the most support for a single-payer system and the least for managed care. Rural physicians were relatively enthusiastic for HSAs but least supportive of managed care.
When looking at physicians’ responses across medical specialty, those practicing primary medicine most favored a single-payer system (74%); general surgeons least favored such a system (36%). Conversely, general surgeons most favored HSAs (55%), and primary medicine physicians least favored them (20%). Managed care found greatest support among physicians who practiced a medical or surgical specialty (17% each) and the least among those who practiced primary medicine (6%). Of those who favored managed care, the significant split was specialists over generalists (17% and 7%; p=.001).
Physicians also were asked who should be responsible for providing access to health care. Nearly all (86%) believed it is the responsibility of society through government to ensure access to good medical care for all, regardless of ability to pay. Only 41% held that the private insurance industry should continue to play a major role in medical care financing and delivery.
Using a regression model, we found that physicians who agreed that it is the government’s responsibility to ensure access to medical care were significantly more likely to favor a single-payer financing system (OR 13.51; CI 2.85, 64.15; p=.001). Those who believed the private insurance industry should continue to play a major role in financing medical care were significantly less likely to favor a government-run system (OR 3.45; CI 1.35, 8.33; p=.009

Capitol Hill Watch | Four Medical Device Companies Made $800M in Illegitimate Payments to Physicians Over Four Years, HHS OIG Official Says – Kaisernetwork.org

Capitol Hill Watch Four Medical Device Companies Made $800M in Illegitimate Payments to Physicians Over Four Years, HHS OIG Official Says – Kaisernetwork.org:

“Four companies that manufacture artificial hips and knees paid physicians more than $800 million in royalties and fees over four years to influence them to use their products, Gregory Demske, assistant inspector general of legal Affairs at the HHS Office of Inspector General said during a Senate Special Committee on Aging hearing on Wednesday, Bloomberg/Washington Post reports (Goldstein, Bloomberg/Washington Post, 2/28).

Demske said, ‘Although most physicians believe that free lunches, subsidized trips or gifts have no effect on their medical judgment, the research has shown that these types of perquisites can affect, often unconsciously, how humans act’ (Cooley, CQ HealthBeat, 2/27). He added that illegitimate payments to physicians have led to increased use of lower-quality medical devices.”

Health Net ordered to pay $9 million after canceling cancer patient’s policy – Los Angeles Times

Health Net ordered to pay $9 million after canceling cancer patient’s policy – Los Angeles Times:

“Calling Woodland Hills-based Health Net’s actions ‘egregious,’ Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, ruled that the company broke state laws and acted in bad faith.

‘Health Net was primarily concerned with and considered its own financial interests and gave little, if any, consideration and concern for the interests of the insured,’ Cianchetti wrote in a 21-page ruling.

Patsy Bates, a 52-year-old grandmother, was at work at the Gardena hair salon she owns when her lawyer William Shernoff called with the news. Bates said she screamed and thanked the lawyer.

Then, ‘I thanked God,’ she said. ‘I praised the Lord.’

Bates called the arbitration judge ‘an angel . . . a real stand-up kind of judge.’

When Health Net dropped her in January 2004, Bates was stuck with more than $129,000 in medical bills and was forced to stop chemotherapy for several months until she found a charity to pay for it.

Health Net Chief Executive Jay Gellert ordered an immediate halt to cancellations and told The Times that the company would be changing its coverage applications and retraining its sales force.

At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved.”It’s difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive,” the judge wrote.”

Of course, this will get reduced substantially on appeal, but at least this tort case got the attention of the insurer to improve policy (for the time being, anyway).

Britain’s health care amounts to malpractice – BostonHerald.com

Britain’s health care amounts to malpractice – BostonHerald.com

I don’t know of a person who advocates for universal health care in the US who advocates for a nationalized system such as Britain’s that the author holds up as his bogeyman. The discussion is about which type of single payer system or universal insurance coverage scheme we should adapt to the US. As Michael Moore has stated, we aren’t talking about blindly adopting another contry’s system wholesale, we are talking about having a policy discussion and creating a uniquely American system, emphasizing our strengths and remedying our weaknesses.

But what really prompted me to write this were a couple of absurd statements by the author.

First, “No one can complain that the NHS is underfinanced. This year’s budget is $210 billion – about $1.05 trillion if adjusted to match America’s population.” Really, no one? The Internets have this thing called “Google” and if you search for “NHS underfunded” you might find out that at least a few people (Tony Blair, for one) who believe it is underfunded. But more importantly, is there anyone who doesn’t get that we spend roughly twice as much per person on healthcare and get terribly shaky outcomes for it? Specifically, is there anyone writing a piece for a major newspaper who doesn’t know this?

And this: “A September 2007 Lancet Oncology article found 66.3 percent of American men alive five years after cancer diagnosis. Only 44.8 percent of Englishmen survived after five years. Across the European Union, 20.1 females per 100,000 under 65 died prematurely of circulatory disease. Among British women, that number was 23.6.”

Here’s an interesting table from that study, showing the UK NHS as the worst, except for Slovenia, Iceland, Poland and the Czech Republic. And I’ll say it again, nobody wants to replicate the British system here. And for more comparisons on US versus other countries healthcare outcomes, go here.

And, finally, my favorite, “Within this maze, patient needs often yield to the wants of pols and medicrats.” Go see Sicko, man! Are you kidding? You think we don’t have pols in the hands of Pharma and the health insurance and health care industries and “medicrats” at our insurers? Who do you think draws those multi-million dollar salaries at the Blues and Aetna and the rest?
Aren’t these people getting tired of flogging this dead dog? Probably not, because apparently that dog still hunts in the imaginations of some.

Cheers,

Boston herald:

I don’t know of a person who advocates for universal health care in the US who advocates for a nationalized system such as Britain’s that the author holds up as his bogeyman. The discussion is about which type of single payer system or universal insurance coverage scheme we should adapt to the US. As Michael Moore has stated, we aren’t talking about blindly adopting another contry’s system wholesale, we are talking about having a policy discussion and creating a uniquely American system, emphasizing our strengths and remedying our weaknesses.
But what really prompted me to write this were a couple of absurd statements by the author.
First, “No one can complain that the NHS is underfinanced. This year’s budget is $210 billion – about $1.05 trillion if adjusted to match America’s population.” Really, no one? The Internets have this thing called “Google” and if you search for “NHS underfunded” you might find out that at least a few people (Tony Blair, for one) who believe it is underfunded. But more importantly, is there anyone who doesn’t get that we spend roughly twice as much per person on healthcare and get terribly shaky outcomes for it? Specifically, is there anyone writing a piece for a major newspaper who doesn’t know this?
And this: “A September 2007 Lancet Oncology article found 66.3 percent of American men alive five years after cancer diagnosis. Only 44.8 percent of Englishmen survived after five years. Across the European Union, 20.1 females per 100,000 under 65 died prematurely of circulatory disease. Among British women, that number was 23.6.”
Here’s an interesting table from that study, showing the UK NHS as the worst, except for Slovenia, Iceland, Poland and the Czech Republic. And I’ll say it again, nobody wants to replicate the British system here. And for more comparisons on US versus other countries healthcare outcomes, go here.
And, finally, my favorite, “Within this maze, patient needs often yield to the wants of pols and medicrats.” Go see Sicko, man! Are you kidding? You think we don’t have pols in the hands of Pharma and the health insurance and health care industries and “medicrats” at our insurers? Who do you think draws those multi-million dollar salaries at the Blues and Aetna and the rest?
Aren’t these people getting tired of flogging this dead dog? Probably not, because apparently that dog still hunts in the imaginations of some.
Cheers,

heritage foundation – Moral costs of socializedmedicine

Vindy.com News – Youngstown, Ohio – Moral costs of socializedmedicine:

“Anyone who considers Canada’s health system a role model for the U.S. should consider the case of Samuel Golubchuk. His case shows the inevitable collision course between government-controlled health care and the rights of private conscience.”

Typical hack rubbish. My comments are on the Vindy web site below the article…

Quebec commission makes recommendations

Quebec commission makes recommendations:

“Quebec – The Castonguay task force on health care proposes a $25 charge for every visit to a doctor and an increase up to one percentage point in the Quebec sales tax to help pay for medicare.

Claude Castonguay, the chair of the task force, notes that health care, as a share of the provincial budget is growing 5.8 per cent a year, while total government spending increases 3.9 per cent annually.

He proposes capping health spending at 3.9 per cent and making up for the shortfall with a new health-stability fund, financed by the $25 doctor’s charge and the sales-tax increase.

Extra billing for health care is currently illegal under the Canada Health Act, which Castonguay concludes ‘hampers the evolution of the provincial public health systems.'”

In keeping with the “warts and all” approach to comparing helathcare systems…

The feedback to the story was mostly negative.

Jeff Weintraub: Teddy Roosevelt & Adam Smith on inheritance taxes (Susan Dunn & Sam Fleischacker)

Again, I’m off topic here, but I just love to collect interesting pieces on economics and this one is very interesting: thoughts from TR, Adam Smith and the founders on the inheritance of wealth.

Jeff Weintraub: Teddy Roosevelt & Adam Smith on inheritance taxes (Susan Dunn & Sam Fleischacker)