When Saul of Tarsus set out on his journey to Damascus the whole of the known world lay in bondage. . . . Then, of a sudden, there was a light in the world, and a man from Galilee saying, Render unto Caesar the things which are Caesar's and unto God the things that are God's.
And the voice from Galilee, which would defy Caesar, offered a new Kingdom in which each man could walk upright and bow to none but his God. Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me. And he sent this gospel of the Kingdom of Man into the uttermost ends of the earth.
So the light came into the world and the men who lived in darkness were afraid, and they tried to lower a curtain so that man would still believe salvation lay with the leaders.
But it came to pass for a while in divers places that the truth did set man free, although the men of darkness were offended and they tried to put out the light. The voice said, Haste ye. Walk while you have the light, lest darkness come upon you, for he that walketh in darkness knoweth not whither he goeth. . . .
Published December 24, 1949, and every year since.
Posted by: Mike ||
12/24/2008 06:53 ||
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President-elect Barack Obama has nominated former Sen. Tom Daschle (D-S.D.) to become the new Secretary of the Department of Health and Human Services--a.ka., the new "health care czar." Since losing his Senate seat 2004, Daschle has been promoting health care reform proposals. His most comprehensive plan is outlined in his new book Critical: What We Can Do About the Health Crisis.
One of Daschle's more ambitious proposals is the creation of a Federal Health Board (Fed Health) modeled loosely on the Federal Reserve Board. Like the Federal Reserve, Daschle's Fed Health "would be composed of highly independent experts insulated from politics."
That's worked so well for our economy ...
One of the central goals of Fed Health would be to compare the effectiveness of various medical procedures and drugs. Daschle asserts that such research into comparative effectiveness would produce substantial cuts in health care costs.
It's not a bad idea in theory: the NIH already is sponsoring some comparative trials and much more could be done. I just don't trust Daschle to get it right and keep it 'insulated' from politics ...
For example, in Critical, Daschle argues that Fed Health "could help define evidence-based health benefits and lower overall spending by determining which medicines, treatments, and procedures are most effective--and identifying those that do not justify their high price tags."
Sounds like the Oregon plan a few years back, which made decisions on peoples lives based strictly on dollars. Of course that's what you expect from the progressive community -- you certainly won't get any compassion.
Daschle adds, "We won't be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost effective. That means taking a harder look at the real costs and benefits of new drugs and procedures."
Notice that Daschle is conflating two kinds of comparisons--clinical effectiveness and cost effectiveness. Determining clinical effectiveness--that is, comparing different treatments to find out which ones work better--is certainly an appealing idea. After all, no patient would want an inferior treatment when a better one is available. However, determining cost-effectiveness is a much more fraught activity. How much is an extra few months of life worth? How much more should be spent on treatments that have fewer nasty side effects? Much more at the link. I wouldn't buy Tom Daschle's book but your local library may have a copy. This is the Blueprint for "National Health Care".
Posted by: Deacon Blues ||
12/24/2008 00:00 ||
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#1
This is all bull. The only thing that will reduce health care costs is increased supply. That means doubling the number of nurses, nurse practitioners and doctors graduated from our colleges for the next decade or two. That we import medical professionals is absurd, and degrades other nation's health care systems.
#2
Well, rammer, you're definitely at least half right - supply, as in supply and demand, holds the key, as almost always. But I think the supply of trained personnel is not the key driver of the excess cost increases.
Health is not a public good, but a private good. Supply and demand rule in creation, pricing, and allocation of private goods. Departures from outcomes driven by supply/demand almost always create distortions and imbalances (robust ones, that, by definition, are not unwound by market action). In "health care", the three greatest distortions seem to be lack of competition, subsidies, and administrative inefficiency. Each of these is a direct result of non-market interference/intervention.
Trim here, tweak there, reform dis and dat, and see a tiny return. Allow common sense and market dynamics to drive the cost of, and demand for, "health care", and witness what's happened in every other situation in human history (without exception) where private goods were at issue.
#4
This is how health rationing is justified here in Canada, and probably elsewhere too. If a treatment is twice as good, but three times more expensive, you're not allowed to get it.
And I literally mean "not allowed", unless you fly to the US and pay cash. Either your drug/treatment is on the list, or it isn't. Private care is illegal, although some provinces have been fighting that battle (citing human rights legislation) for years now, with limited success.
"socialised health care" AKA state treatment rationing is always the nationalisation of the whole countries bodies, the complete antithesis to self ownership (the basis of civilisation).
#9
It's an immortality crisis not a health care crisis. Look back fifty years ago and see what medical care the wealthiest could afford. Most of the procedures, protocols, and pharmaceuticals we the average enjoy as common practice couldn't be had by any of them - because they didn't exist. Look at the Census data, every decade for the last hundred years, we as a people are living longer and longer. We probably have the single largest population of people over 80, 90, and even 100. There is no real health care crisis, but a perception that we're entitled to immortality. Like the Pharaohs trying to obtain immortality, we'll consume the GDP of an entire civilization playing that game.
#10
Agree completely, P2K. It is an interesting time of year to contemplate why, when so many have so much health care there should be an immortality crisis.
What human agency formerly dealt with immortality? What happened to it? What seeks to supercede it? Why?
And while we're thinking about the immortality crisis it might be useful to consider what relationship it has to the immorality crisis that threatens us even more so.
What human agency formerly dealt with immorality? What happened to it? What seeks to supercede it? Why?
Since Aricept is for the elderly I'm not surprised. For decades the UK has rationed dialysis for kidney patients and simply did not provide them for people over 65 (if I remember the age correctly - corrections welcome on the number).
#13
You know it'll be _real_ cost effective if people over 8580 75 simply were -er- taken care of (permanently - as in euthanasia). Unless of course they are important like congresscritters or [the right kind of] journalists.
After all the elderly really doesn't contribute to society anymore and consume an awful lot of healthcare. They are a drain on a precious resource.
#14
Let's address the canard of administrative costs as a driver of heathcare expenses. Administrative costs are only 3% of the healthcare dollar. What really drives costs are medical/technology advances and people "living too long." In the U.S. we foster medical advances and engage in medical "heroics" to keep gramma alive -- and that's a problem for the socialized medicine crowd.
Posted by: regular joe ||
12/24/2008 9:54 Comments ||
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#15
Agree Joe up to a point.
A major driver of cost is insurance.
We do NOT have a health care crisis we have a health care COST crisis.
The amounts awarded for malpractice suits have driven the cost of insurance through the roof and even driven many doctor's out of business. The whole malpractice / tort system has to be reworked.
#16
Verlaine, you may be right but miss my point. Supply and demand set the price for any good freely traded. With health care the demand side of the equation can not be regulated downwards. People are going to avoid being sick or dead with great intensity. Thus the only side of the problem that can be affected by policy is the supply side.
Buying health care is no different from buying a haircut. The primary reason that health care visits cost more is because there are many fewer trained nurses than beauticians.
A smaller but not negligible additional cost is the cost of capital that pays for the more expensive tools that health care workers use, x-ray machines or pharmaceuticals for example verses scissors and combs. These costs are real
but are shared across all the customers and goes asymtotically to zero over time.
Insurance costs are also higher in medicine than cosmetology. But the total cost of insurance is simply the sum of the cost of mistakes. Much like automotive insurance is priced based on the expected number of thefts or accidents in the population, so is medical insurance priced by expected costs of mistakes. If we don't want to pay those costs, then we can regulate what is defined to be a mistake or cap how expensive mistakes are judged to be, which is what we are doing now. Or we can better train medical professionals so they make fewer mistakes, which brings me back to my initial point.
Health care costs can best be managed by investing in our medical educational system to make more supply and get government off our backs.
#17
In a free market, extreme health care for the elderly (imitation immortality) would only be available to the very wealthy, and it would serve as a means of transferring that wealth back to the society at large. Everyone else would reap the benefit of sharing (a few years later) in the medical advances paid for by the immortality-seeking super-wealthy. (Sort of like how only a few years ago only rich fools would buy the big flat screen tvs, and now they are all that is available, even in WalMart.)
The philosphical questions then become: Is everyone entitled to extreme health care, and if so, is it even possible for society to pay for it? If everyone is not entitled, or it is not possible to pay for everyone, then who gets to choose the lucky recipients? And how? Auction? Lottery? Political connections? Enlightened bureaucrats?
#18
Just for my own edification....let's say that Obamacare is instituted around 2010. Some treatment that I want/need is not covered, but has a reasonable chance of working the way I would like to ameliorate/cure some condition. I can somehow scrape up some dollars to pay for a treatment....somewhere.
Anyone know anywhere to go once that happens with a decent health care system?
(Sorry, I don't think Cuba's an option but are there other places the more medically minded here might recommend as backups?)
#19
regular joe, I'm not intending to promote a canard. My point about administrative costs was based entirely on two personal experieces; these may be aberations, or they may not be properly termed "administrative" costs in the system. I received a 40% reduction in charges from a major medical care outfit (FORTY), got about the same from a small-group specialist - for paying up-front w/ credit card vs. the insurance billing dance. I am indeed taking enormous license to just deem that administrative burden - but what else explains such a gigantic discount, unlike anything encountered in any other kind of transaction in my entire life? I don't claim to understand just how such an enormous mysterious cost element enters the picture - I do claim that it has nothing to do with actual medical care, or even with actual administration thereof.
Rammer, I don't think I miss your point, and I agree with most of your observations. But by supply-demand I don't mean reducing people's health care needs, but making it more likely people will judge such needs more seriously (e.g., not "going to the doctor" when "you don't feel well" - what % of that widespread behavior could/should be almost entirely eliminated?) To the extent American "health care" has become more like typical consumption - I think a significant extent - pricing can and would reduce demand, i.e. medical intervention for true needs.
But the larger effect would come from competition and pricing effects within the system, between the various players/suppliers/specialists/insurers. I'm talking the whole gamut. Specialists in cities 500 miles apart can't compete, but insurance companies can ..... and in time, groups of specialists with branches in cities 500 miles apart can. When a private good is being produced, there simply is no mechanism nearly as cost-effective and free competition in producing and providing it (even though there are usually market segments where it is less effective than others). And so on.
Increasing the supply of doctors and nurses is fine, but I don't think that would be a major cost-reducer for some time, nor would it wring most of the excess costs out of the system. Getting more competition between the current players would, and faster. Both are good, they're not mutually exclusive.
As to insurance and mistakes, I take it you are referring to the liability component of providers' insurance, not health care insurance? If so, your model is the legitimate one, not the actual one (in any area of liability): providers must insure against a predicted level of shake-downs, not just against actual mistakes. The problem here lies in the law, and the courts (as gatekeepers), well outside the health care cost area.
As commented above we have a health care COST crisis, nothing else. That's why I've focused just on cost-generating and cost-controlling elements, almost all of which in all cases are amenable to market amelioration through proper incentives and choice.
But I'm truly just stumbling around fairly blindly here, applying principles known to be reliable and some dribs and drabs of data from personal experience or observation. Sort of the analytical level we typically get about national security issues from, say, Beltway politicians and pundits, goofy academics, arrogant activists, and too many intel community "professionals". But, I hope, not all of it THAT bad!
Merry Christmas (and good health!) to all 'burgers, and thanks for your collective wisdom and insights and humor.
#20
Malpractice insurance and the CYA redundant and/or unnecessary procedures malpractice threats cause also contribute to costs, but not as much as end-of-life treatments.
Here's how it works: politicians cut or curtail Medicare increases, by say, 10%. Physicians and hospitals then tack on 10% or more to every non-Medicare procedure.
The pols then pat themselves on the back for containing Medicare costs and deplore greedy insurers for increasing premiums so that physicians can make up for the shortfall.
As far as shellgames go, Maddaff has nothing on our healthcare system.
Posted by: regular joe ||
12/24/2008 12:14 Comments ||
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#21
NS nails it. We have an immortality crisis. The demographic meltdown in Europe and East Asia is based on somewhat realistic expectations that immortality is at hand. That's the point that Spengler, Wretchard, Steyn and all of the other commentators on the issue miss. NS nails it a second time by tying the demographic piece to the spiritual piece. Well done... An immortal doesn't need God. He is a god.
There have been innumerable communal riots in India, nearly all of them in States ruled by the Congress at the time of the violence, yet everybody loves to pretend that blood was shed in the name of religion for the first time in Gujarat in 2002 and that the BJP Government headed by Mr Narendra Modi must bear the burden of the cross.
Similarly, nobody remembers the various incidents of Indian Airlines aircraft being hijacked when the Congress was in power at the Centre, the deals that were struck to rescue the hostages, and the compromises that were made at the expense of India's dignity and honour. But everybody remembers the hijacking of IC 814 and nearly a decade after the incident, many people still hold the BJP-led NDA Government responsible for the 'shameful' denouement.
Continued on Page 49
Posted by: john frum ||
12/24/2008 00:00 ||
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Even after 29 days of the Mumbai carnage, the Government is shadow-boxing with Pakistan, unable to forge a face-saving strategy that will assuage the anger of the people, not impair its electoral prospects next year on the charge of being soft on terror, and most of all force Pakistan to act against cross-border terrorism. The challenge lies in preventing the next attack.
Since the attack on Parliament House on December 13, 2001, on five occasions Pakistan has given solemn commitments not to allow use of its soil, including Pakistan-occupied Kashmir, for attacks against India. Two of these assurances were extracted by the United States in 2002 from former President Pervez Musharraf; the second was secured by US Deputy Undersecretary of State Richard Armitage -- that Islamabad would end cross-border terrorism permanently, visibly, irreversibly and to the satisfaction of India. It was erroneously assumed that the Pakistani pledges of good behaviour were underwritten by the Americans. In September 2008, President Asif Ali Zardari's reaffirmation of these commitments to Prime Minister Manmohan Singh on the sidelines of the UN General Assembly in New York revived the post-Kabul 'strained' peace process.
Continued on Page 49
Posted by: john frum ||
12/24/2008 00:00 ||
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#1
What took some people so long to conclude the obvious?
KARACHI - The attack on Mumbai on November 26 by Pakistan-linked militants opens a similar opportunity for India to what happened to Washington after the September 11, 2001, attacks on the United States. The US was able to further its regional designs with global support and was able to coerce Islamabad into cracking down on its own strategic partner, the Taliban in Afghanistan.
New Delhi also now has the international community on its side, but Pakistan is in a very different position from where it was seven years ago, and the new political and military leaders are not in a position to take similar steps to those of their predecessors.
Continued on Page 49
This article starring:
Dawood Ibrahim
Maulana Masood Azhar
Zakiur Rahman
Posted by: Steve White ||
12/24/2008 00:00 ||
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#1
The military is gun shy because the terrorists are their own action arm.
#2
I sympathise with Pakistan, it must be tough to run a country full of well-armed medieval idiots.
They tried the Saudi plan of sending the craziest off to fight Holy wars and die (thus making the host country look Holier in the process) but they picked areas that are far to close to Pakistan. Much better ot have sent their Jihadi to the Philipines or Sudan or something rather than Kashmir/India/Afghanistan where it is easy to get back to the homeland with a head full of crazy ideas and enough skill to do damage.
NEW YORK -- He was a distinguished investor who traced his lineage to the French aristocracy, hobnobbed with members of European high society and sailed around the world on fancy yachts.
But after losing more than $1 billion of his clients' money to Bernard Madoff, Rene-Thierry Magon de la Villehuchet had enough. He locked the door of his Madison Avenue office and apparently swallowed sleeping pills and slashed his wrists with a box cutter, police said. A security guard found his body Tuesday morning, next to a garbage can placed to catch the blood.
The bloody scene marked a grisly turn in the Madoff scandal in which money managers and investors were ensnared in an alleged $50 billion Ponzi scheme. De la Villehuchet is believed to have lost about $1.4 billion to Madoff. No suicide note was found, said NYPD spokesman Paul Browne.
De la Villehuchet, 65, was an esteemed financier who tapped his upper-crust European connections to attract clients. It was not immediately clear how he knew Madoff or who his clients were.
He grew increasingly subdued after the Madoff scandal broke, drawing suspicion among janitors at his office Monday night when he demanded that they be out of there by 7 p.m. Less than 13 hours later, his body was found.
His death came as swindled investors began looking for ways to recoup their losses. Funds that lost big to Madoff are also facing investor lawsuits and backlash for failing to properly vet Madoff and overlooking red flags that could have steered them away. It's not immediately known what kind of scrutiny de la Villehuchet was facing over his losses.
De la Villehuchet (pronounced veel-ou-SHAY) comes from rich French lineage, with the Magon part of his name referring to one of France's most powerful families. The Magon name is even listed on the Arc de Triomphe in Paris, a monument commissioned by Napoleon in 1806. "He's irreproachable," said Bill Rapavy, who was Access International's chief operating officer before founding his own firm in 2007.
De la Villehuchet's firm enlisted intermediaries with links to wealthy Europeans to garner investors. Among them was Philippe Junot, a French businessman and friend who is the former husband of Princess Caroline of Monaco, and Prince Michel of Yugoslavia.
De la Villehuchet, the former chairman and chief executive of Credit Lyonnais Securities USA, was also known as a keen sailor who regularly participated in regattas and was a member of the New York Yacht Club. He lived in an affluent suburb in Westchester County with his wife, Claudine. They have no children. There was no answer Tuesday at the family's two-story house. Phone calls to the home and de la Villehuchet's office went unanswered.
Guy Gurney, a British photographer living in Connecticut, was friends with de la Villehuchet. The two often sailed together and competed in a regatta in France in November. "He was a very honorable man," Gurney said. "He was extraordinarily generous. He was an aristocrat but not a snob. He was a real person. When he was sailing, he was one of the boys."
The two were supposed to have dinner last Friday but Gurney called the day before to cancel because of the weather. But during the call, de la Villehuchet revealed he had been ensnared in Madoff scandal.
"He sounded very subdued," Gurney said.
Gurney said de la Villehuchet was happily married to his wife. "I can't imagine what it's like for her now," he said.
A multi-volume chronology and reference guide set detailing three years of the Mexican Drug War between 2010 and 2012.
Rantburg.com and borderlandbeat.com correspondent and author Chris Covert presents his first non-fiction work detailing
the drug and gang related violence in Mexico.
Chris gives us Mexican press dispatches of drug and gang war violence
over three years, presented in a multi volume set intended to chronicle the death, violence and mayhem which has
dominated Mexico for six years.
Rantburg was assembled from recycled algorithms in the United States of America. No
trees were destroyed in the production of this weblog. We did hurt some, though. Sorry.
