The Real Cause of Our Health Care Problems (Or: How Bureaucrats Destroy Industries)
Steven Brill just published a long article called Bitter Pill: Why Medical Bills Are Killing Us. It’s a good article and worth reading, despite being far too long at 11 pages. There’s so much repetition that it probably could have been 5 pages instead, and it’d be a better piece for it.
It’s surprising to me, though, that the author fails to identify (or at least, fails to state) what is the clear cause of the outrageously expensive medical bills that he details in the article’s several anecdotes.
He spends a lot of time pointing out exactly how much profit is being accumulated by many "non-profit" hospitals, and how much they are paying to their executives and administrators. It’s the same as the situation with "non-profit" colleges and universities: the term non-profit is purely a marketing term, and a deceptive one at that, since hospitals, colleges, and universities are among the richest organizations in the country. They are making tons of profit -- tens of millions of dollars per year in many cases -- they just aren’t structured in a way that it gets distributed to shareholders.
The problem is that medical bills are insanely inflated, and the implication seems to be that the cause is these rich fatcats running the hospitals -- or at the very least, those rich fatcats are evil even if they aren’t actually the cause.
The author correctly identifies chargemaster prices as part of the problem. He gives many examples of chargemaster highway robbery, such as pills or alcohol wipes that cost several dollars each in the hospital even though their actual price in the free market is pennies each. And he recounts how administrator after administrator was unable to explain to him exactly where the chargemaster prices come from or why they’re so high.
He also goes into detail about Medicare and private insurance and their strengths and weaknesses, including how a lot of insurance is limited to a few thousand dollars of coverage while medical bills routinely reach tens of thousands, even hundreds of thousands.
Despite all the good reporting and detail provided on these many aspects of our health care system, nowhere does the author state the simple economic fact that is at the root of the problem: the decoupling of the customer from the payment. In other words, the person receiving the service is not the person who pays the bill.
Whenever you insert a third party between a buyer and a seller, whether that third party is an insurer or the government, the result is an interruption of the price signal and a distortion of the market. In many cases this leads to a bubble, as we’ve seen in housing and higher education. When "someone else" is paying the bill, the buyer has no incentive to care about the price, which means that the seller -- whose goal is profit, after all -- will raise prices.
So when the government pumps billions of dollars into the housing market to "make housing affordable", the actual result is that prices skyrocket until the market is destroyed. When the government pumps billions of dollars into higher ed to "make college affordable", the actual result is, again, skyrocketing prices as the bubble inflates. And "making health care affordable", as Obamacare purports to do, by making it "free" for many people, outlawing copays, etc, will again in fact cause the opposite to occur: it will get more expensive.
There are many problems in the U.S. health care system, but none are more important or more fundamental than this one. Hospitals, drug companies, and medical device makers can only charge outrageous prices because patients don’t pay them directly. Further decoupling the patients from the prices will exacerbate the problem, not solve it.
The failure of politicians to understand this most basic economic principle has led to massive damage and suffering in our health care, housing, and education markets.
Why You Can't Trust the Media for Accurate Health Information
A rather ridiculous Wall Street Journal article about weight gain carries this subtitle: "Study Challenges Idea That Varying Amounts of Fat, Protein and Carbohydrates Are Key to Weight Loss". It states:
Quoting Ron Winslow:
It isn’t so much what you eat, the study suggests, but how much you eat that counts when it comes to accumulating body fat.
The findings are the latest in a string of studies to challenge claims that the secret to healthy weight loss lies in adjusting the amount of nutritional components of a diet -- protein, fat and carbohydrates. [...]
25 young, healthy men and women were deliberately fed nearly 1,000 excess calories a day for 56 days, but with diets that varied in the amounts of protein and fat... body fat among participants in all three groups increased by about the same amount. [...]
"The body was confronted with excess calories, but it didn’t care where they came from," ... The findings suggest that it matters little whether a diet is high or low in fat, carbohydrates or protein, it’s calories that build body fat. [...]
"Weight gain depends primarily on excess calories, regardless of the composition of the meal."
After going on and on with comments like that, the author sticks the following sentence in at the end of the article, in a paragraph all by itself, without any commentary whatsoever:
Quoting Ron Winslow:
Carbohydrates were held steady at about 41% to 42% of calories while fat levels varied with the protein regimen.
Huh?? So: people were overfed by 1000 calories, they all ate the same amount of carbohydrates, and they all gained the same amount of body fat. Conclusion: adjusting carb intake won’t help you lose weight!
How does this kind of thing get past editors, or the original author for that matter? It’s hard to avoid the conclusion that either a) they’re all liars, or b) they’re all fools.
Ricky Gervais: I Have No Balls
Here’s Ricky Gervais on the cover of some magazine, attempting to look jaded or tough or something, while mocking Christianity:
Scrawled across his chest are the words "I have no balls." Well, he thinks it says "Atheist." But considering that mocking Jesus is about the safest, most politically correct, and least original thing that anyone could do, it’s clear what the real message is. Yawn. Call us back when you grow a pair and start mocking Muhammad.
The Normal Condition of Man
Quoting Robert Heinlein:
Throughout history, poverty is the normal condition of man. Advances which permit this norm to be exceeded -- here and there, now and then -- are the work of an extremely small minority, frequently despised, often condemned, and almost always opposed by all right-thinking people. Whenever this tiny minority is kept from creating, or (as sometimes happens) is driven out of a society, the people then slip back into abject poverty.
This is known as "bad luck."
This is worth remembering, as president Obama continues his foolish and dangerous class-warfare rhetoric about how "the rich" aren’t doing their fair share.
Love the Sun, Ditch the Sunburn
Mom and I were talking the other day about getting sunlight on your skin to make vitamin D, while not getting so much sun as to get a sunburn. Your body makes something like 10,000 IU of vitamin D from just 10 minutes of midday sun exposure -- assuming a decent amount of uncovered, non-sunblocked skin is exposed -- so it’s pretty easy to get enough D without getting burned. But then mom brought up an interesting question: why is it that, as kids, we were able to play outside in the sun all day with no sunblock and not get sunburned, whereas today, just an hour of sun will often cause a sunburn?
One theory is that ozone depletion, which has led to more ultraviolet light reaching Earth’s surface, is the cause of the increased sunburn incidence, but there doesn’t seem to be much solid evidence for that. It makes sense and I think it’s a factor, but probably not the whole story.
A few days after this conversation, Mark Sisson wrote a piece on natural sunburn prevention in his usual thorough and well-referenced style. It turns out that avoiding the sun, avoiding saturated fat, and loading up on omega-6 fats (e.g. vegetable oils) all increase the likelihood of getting a sunburn when you do get a rare bit of sun exposure. Of course those three things are all recommended by the US government, and by now I’m well beyond the point where I’m surprised that US government recommendations actually cause harm rather than helping.
I didn’t realize this until I read Mark’s article, but since I switched to a more primal/paleo diet earlier this year, I’ve been able to get a lot more sun exposure without getting sunburned. Last year, after hearing Steve Gibson’s comments on vitamin D and then deciding to go out and get some midday sun a few times per week, I could only get about 20 minutes before starting to burn, as I discovered one day when I tried to push it up to 30 minutes. But this year, although I again started at 20 minutes, I have since pushed it up to about 45 minutes and I’m not getting burned at all. The only difference is that this year, with my new way of eating, I’m consuming much less "frankenfood" like vegetable oil and much more natural saturated fat.
Be sure to read Mark’s whole article on the topic for more natural ways to prevent sunburn, and don’t miss the comments, which are full of people reporting a complete lack of sunburn since having gone primal.
What the Government is Really Feeding Us
By now you’ve probably seen the "improved" version of the government food pyramid, which is the food plate:
Of course, it’s the same old scientifically-discredited message: load up on fruit (sugar) and grains (more sugar) and avoid fat. And what do you get when you follow the government’s advice? All of this can be yours:
The solution is painfully obvious to anyone with half a brain: just eat real food. Eat the foods that people have ALWAYS eaten, for the vast majority of human history, instead of the grains, vegetable oils, and other processed foods that modern man has invented. In other words:
(Images via @robbwolf’s Twitter feed.)
Global Warming Nuts Take a Page From The Anti-Fat Fanatics' Playbook
When you’re wrong on the science, don’t despair; you can always turn to the government to force your views on the public. Hey, it worked for the anti-fat fanatics.
Quoting Roger E. Sowell:
A group of attorneys using children and young adults as plaintiffs plans to file legal actions in every state and the District of Columbia on Wednesday in an effort to force government intervention on climate change. [...]
The second point, regarding the harm being fairly traceable to the defendant’s actions, is a great sticking point. Here, plaintiffs must show that increases in CO2 are causing and will cause the dire events that are predicted. "Fairly traceable" means that there is a direct cause-and-effect that can be discerned. This will be where the fun begins, as each side trots out their experts and makes their case. The fact that CO2 has risen over the past 50 years, yet none of the dire events have occurred, surely will not be overlooked by the defense attorneys. The facts that CO2 continues to rise, and the global and regional temperatures are falling, and the ocean levels are falling, and the ocean temperatures are falling, also will surely be emphasized by the defense attorneys.
Why The USDA Dietary Guidelines Are So Screwed Up
Nice piece by Tom Naughton (the creator of the Fat Head DVD) on one of the many failures of big government:
Quoting Tom Naughton:
When government steps in, spontaneous order and the wisdom of crowds is replaced with centralized control. Imagine what would happen if we were all required by law to shop at Uncle Sam’s Grocery Emporium. Since space is limited even in the largest stores, there would be endless battles over what Uncle Sam’s should put on the shelves. The vegans would demand more plants-only foods. The Weston A. Price fans would demand more grass-fed meats and dairy. The organic crowd would want organic produce, while the cost-conscious shoppers would protest that organic foods are too expensive. Lobbyists would make a killing trying to influence Uncle Sam’s management.
That’s essentially what’s happening with the USDA Dietary Guidelines now. The Weston A. Price Foundation is angry because the USDA warns us to avoid saturated fats. The vegan wackos at The Physicians Committee For Responsible Medicine are suing the USDA for warning us about saturated without also (I’m not kidding here) telling us specifically to stop eating meat, eggs and dairy products.
Nobody’s happy, and nobody’s going to win. The battle will go on forever, when it shouldn’t have been fought at all. But now we have to fight, because the USDA has taken it upon itself to tell my daughters’ school it can only serve 1% or skim milk. We were even instructed to include a grain food in the lunch my younger daughter brought from home on the day the government inspectors were visiting her preschool.
Pretty please, stop and think about that for a second: a little group of experts in Washington, D.C. is telling a preschool in Franklin, Tennessee what foods the parents must put in their children’s lunches if the school wants to stay out of trouble. If that doesn’t blow your mind (and scare you just a little), something’s wrong.
Obama's Foremost Goal for NASA
What do you suppose President Obama would specify as the foremost goal of NASA? Something related to space, perhaps? Don’t be silly.
Quoting NASA Administrator Charles Bolden:
When I became the NASA administrator -- or before I became the NASA administrator -- [Obama] charged me with three things ... perhaps foremost, he wanted me to find a way to reach out to the Muslim world and engage much more with dominantly Muslim nations to help them feel good about their historic contribution to science...
Obviously, what NASA really needs to do is find ways to boost the self-esteem of Muslim nations.
Is it too much to ask for junior-senators-turned-presidents to know what NASA actually is?
Gulf disaster on level of Three Mile Island
Well that’s certainly the absurd headline of the day. The TMI partial meltdown resulted in no deaths, no injuries, and no significant release of radiation; it was about the best possible outcome you could hope for in the event of a nuclear meltdown. So how exactly is the Deepwater Horizon disaster "on the level of" TMI, considering that it’s killed 11 people and leaked several million gallons of oil into the gulf?
Or perhaps by "on the level of" he means that it will result in a decades-long stagnation of another vital energy industry within the US, while other countries move ahead with the technology?
But this article’s stupidity isn’t limited to its headline:
"Creating an independent blue-ribbon panel on this oil spill will help provide the recommendations to ensure that similar disasters do not happen again," said Rep. Ed Markey, D-Mass.
No, it won’t. Anyone with half a brain knows it won’t. You can’t prevent accidents; all you can do is plan better responses to them. And since the federal government has proven that it cannot or will not respond effectively to these kinds of issues -- from Katrina to Deepwater Horizon to the southern border -- it’s clear that relying on any such federal response is a recipe for further disaster.
How to Fix the IRS: Nuke it From Orbit
While doing my taxes, I read something about the "EITC". I wondered what that was, so I looked it up. I arrived at the IRS website, on a helpful page that purported to tell me whether I’m eligible for this tax credit.
Ten minutes and several pages of questions later, I finally got to a page containing questions like these:
"Are you or your spouse younger than your relative?"
"Did you file only to claim a refund and neither spouse was required to file a refund?"
That’s where I gave up.
Comcast: We're Not Happy Until You're Not Happy
Comcast’s TV and internet service is pretty good. I mean it hardly ever goes down, and it’s pretty fast. It’s such a stark contrast with their customer service.
Yesterday I called Comcast to ask them to come out and replace my old modem with a DOCSIS 3 modem. Their website explicitly states that there is no cost for this upgrade (other than the modem rental fee I’m already paying every month). But the woman on the phone insisted that I’d need to upgrade my service to a more expensive package to get the new modem.
So I hung up and called back. It’s impossible to talk to the same person twice at a giant monopoly like Comcast, so I knew I’d get a different person, and I assumed the next person would be a little less dense. It turned out that he was indeed a little less dense. He immediately said yeah, no problem, there’s no cost and we’ll send someone out tomorrow, how’s 7-9 AM? I said that was fine.
So today, 9 AM comes and goes with no sign of Comcast. I call them at 9:15. They tell me my appointment is for 11 AM to 1 PM. I tell them that’s wrong, but it’s no use. We reschedule it for later in the week.
A few hours later, around 1:15 PM, I get a call from a Comcast technician. He’s just calling to confirm our appointment and he’s about 5 minutes away.
So, to recap: the first person attempted to extort higher payments out of me based on a lie about DOCSIS 3 modems. The second person told me my appointment was at one time, but scheduled it for a different time. And the third person rescheduled my appointment (or so she said) but didn’t bother telling the technician in the field about it.
You’d think that in this kind of bad economy, companies could afford to fire people who are incompetent, and replace them with intelligent people, from the vast pool of unemployed workers. But apparently not.
Right-Wing Nuts Plot Attacks Against Cops
Quoting Joshua Rhett Miller:
Nine suspects associated with Hutaree, which is purportedly a Christian-based militia group, have been charged with conspiring to kill police officers and then attack a funeral in hopes of killing more law enforcement officials, federal prosecutors said Monday. U.S. Attorney Barbara McQuade said agents moved on the group because the militia members were planning an attack sometime in April.
Cue the left-wing nuts in the media and online, frothing at the mouth with their gleeful comments about this, claiming it proves that Christians are dangerous extremists. The nuts don’t care about facts, but reasonable people realize that these kinds of isolated incidents are exceptions, and that these conspirators are not typical Christians, nor do they represent what Christianity is about. As a Christian, I condemn the attacks that these conspirators were evidently planning, and most other Christians would too.
The NOW Response to the Tebow Superbowl Ad
Here’s the response from Terry O’Neill, president of the National Organization for Wild Women:
What I saw was a pro-violence-against-women message... The ad connects the idea of male happiness with violating -- committing violence -- against a woman... It’s really a disturbing message when you think about it.
That’s in response to an ad showing a quarterback who pretends to tackle his mom -- while she’s in the middle of talking about him affectionately -- and after which he gets up and gives her a hug. The ad is so sweet it almost makes you gag.
O’Neill’s comment is stupid beyond words. It’s hard to believe that just a few weeks into 2010 we already have such a strong contender for the dumbest statement of the year.
Congress makes job creation top 2010 priority
I’m of two minds about this. My first reaction is, where have these clowns been for the past 2 years? NOW they’ll make job creation a priority?
But my second reaction is: great, with congress getting involved, we can wave goodbye to any hope we might have had about job creation happening soon.
Mass insanity in Copenhagen
Lorrie Goldstein nails it on Copenhagen:
It has everything to do with some of the world’s most corrupt dictators and regimes extorting billions upon billions of dollars from the developed world -- us -- which they will then spend not on reducing their own greenhouse gas emissions (GHG), but in any way they please.
The science is far from settled and the "fix" won’t fix a darn thing.
Who Designs This Crap?
This is the "tight corners" type attachment for our vacuum:
Notice anything strange?
Why are there 20 holes near the end that attaches to the hose?
Is it worse to think that they intentionally decreased the suction power, or that they failed to realize that’s what the holes would do?
Senator Coburn Threatening to Read Health Care Bill
Sen. Tom Coburn, the Oklahoma Republican who developed a close friendship with President Obama when they served together in the Senate, is threatening to have the entire health care bill read on the Senate floor.
More government stupidity -- the stupidity being the fact that they aren’t required to read the bills they pass in the first place, and that the bill-creation process itself has been so perverted, its products rendered so absurdly unwieldy and unreadable, that actually reading them can be used as a threat.
Here are two depressing and disturbing stories I read this week:
Congressional leaders fight against posting bills online:
Quoting Washington Examiner:
At town hall meetings across the country this past summer, the main topic was health care, but there was a strong undercurrent of anger over the way Congress rushed through passage of the stimulus, global warming and bank bailout bills without seeming to understand the consequences. The stimulus bill, for example, was 1,100 pages long and made available to Congress and the public just 13 hours before lawmakers voted on it. The bill has failed to provide the promised help to the job market, and there was outrage when it was discovered that the legislation included an amendment allowing American International Group, a bailout recipient, to give out millions in employee bonuses.
Quoting Washington Times:
Robert C. Scott, Virginia Democrat, and ranking member Louie Gohmert, Texas Republican, conducted a truly bipartisan hearing (a D.C. rarity this year).
These two leaders have begun giving voice to the increasing number of experts who worry about "overcriminalization." Astronomical numbers of federal criminal laws lack specifics, can apply to almost anyone and fail to protect innocents by requiring substantial proof that an accused person acted with actual criminal intent.
Mr. Norris ended up spending almost two years in prison because he didn’t have the proper paperwork for some of the many orchids he imported. The orchids were all legal - but Mr. Norris and the overseas shippers who had packaged the flowers had failed to properly navigate the many, often irrational, paperwork requirements the U.S. imposed when it implemented an arcane international treaty’s new restrictions on trade in flowers and other flora.
These issues infuriate me. There’s something seriously screwed up about a system that not only can, but does routinely imprison people for accidental and trivial issues while simultaneously letting rapists and child molesters go free with merely probation -- and which is constantly passing new laws that the lawmakers themselves haven’t even read, much less given the public a chance to see.
Windows 7 Launch Party
This can’t be real, can it? Ridiculous doesn’t begin to describe it. It’s actually embarrassing. It’s nearly painful to watch.
It's Not the Party, It's the System
Cringely has a medical malpractice post that I don’t find terribly compelling, but here’s one of the comments on it:
Government trying to do anything for us is always bloated and inefficient because there are no checks and balances to keep costs down. None. Private business (up until the bailouts) must keep costs in check. Government doesn’t care about that. Why should they? So when costs go out of control they either tax us at higher rates and/or print more money.
It’s not the party that’s in power, it’s the system that it has evolved into. Have we not figured that out by now?
You might say that’s overly cynical but it seems about right to me. I’m certainly no fan of insurance companies; I think insurance in general is just about the biggest scam that there is. But I don’t consider it an improvement to replace [insurance system] or [other broken part of health-care system] with [corrupt politicians] or [additional layers of bureaucracy].
In the real world, you need to clearly identify the problem before you implement the solution. But not in government. It drives me crazy that these politicians are insisting on speed at the expense of correctness. When Obama insists we must pass health care reform ASAP, it makes lots of people suspicious. When Arlen Specter says that we have to "make judgments very fast" on a 1000-page bill that hardly anybody has even read, the crowd reacts instantly and angrily -- and rightly so. What sane person thinks that it’s a good idea to make quick judgments rather than careful decisions on such huge and important matters? Only politicians think that.
I’m all for reforming things that are broken. But we need to clearly identify those things before we can fix them. Ramming through a 1000-page bill is not a solution, and a government that would do such a thing is in itself broken, in a far more serious way than the health-care system is.
Various tidbits seen over the past week or two:
From the Times Square Tea Party: "Do I look like a racist redneck teabagger to you?"
A hilarious Good Samaritan story by Scott Adams:
Luckily I did not have jumper cables, because if I did, I knew we would be late for the movie. I did my best to make a face that said, "I sure wish I could help," while being secretly gleeful that this was officially not my problem. I wondered if the young man thought I was lying about not having jumper cables. My fake sincerity face looks like a mime with an intestinal infection.
Joe Biden on rural broadband funding:
The bottom line is, you can’t function -- a nation can’t compete in the 21st century -- without an immediate, high-quality access for everything from streaming video to information overline.
I don’t know what I’d do without a high-quality access to information overline. In fact, I don’t even know what that means.
This article claims that wheat bread is no better than white bread. But what’s interesting is some of the detailed information about metabolic functions that it contains.
From amazon: Classic Live Lobster Combo for Two People. I don’t suppose it needs to be said that amazon rocks, this rocks, and "Lobsters-Online" rocks.
Ceiling cat. The photo of the cat looking down is great.
I don’t know exactly when all the TV news networks started referring to everything as an "ALERT", but now they do it all the time, and it’s annoying. When the installation of a statue into a statuary hall is a news alert, then it’s to the point where the word is devoid of any meaning at all. But sadly this is just another day in the life of the abused English language.
iTunes: Erring on the Side of Stupid
I love my iPhone. It’s the most amazing and useful device. Unfortunately to use it, you must also use iTunes, and iTunes is nothing short of an abomination of an application. Here’s just one recent example.
A week or so ago, iTunes started crashing about a minute after launching. I noticed that the crashes happened a few seconds after it started updating my podcasts. So I set it to stop auto-updating the podcasts. This is a bug, and it should be fixed, but it’s no big deal; bugs happen. And I can always use my iPhone’s built-in ability to update podcasts in the meantime.
But now I wanted to sync my iPhone to iTunes in order to get some new music. However, since my podcasts in iTunes are now a week out of date, I didn’t want it messing with the podcasts on my iPhone -- in particular which ones I’d already listened to and which ones I was partially into. So in iTunes, in the iPhone settings, I unchecked the "sync podcasts" checkbox.
Now what do you think a user means when he tells an app "don’t sync podcasts"? Seems pretty obvious to me. But I can tell you for darn sure what it DOESN’T mean: it sure as heck doesn’t mean PLEASE DELETE EVERY SINGLE ONE OF THE 2 GB OF PODCASTS ALREADY ON MY IPHONE.
I really wish iTunes were a person so I could strangle it to death.
How To Embarrass Yourself and Your Employer
During an hour-long press conference with Obama, during which only 13 questions were allowed, here’s the question that the New York Times came up with:
Quoting Jeff Zeleny, New York Times:
During these first 100 days, what has surprised you the most about this office, enchanted you the most about serving in this office, humbled you the most and troubled you the most?
Is this a press conference, or a third-grade field trip to meet the president?
There was a time when this would have been surprising, but not anymore. Now it’s just embarrassing and sad. It’s hard to believe there was a day when the New York Times -- now bankrupt in more ways than one -- actually mattered.