Best Government Is Least Government

Given the statistics in this presentation, how did these government approved interventions come to pass:

Don't eat salt, don't eat fat, take statins to lower cholesterol, install stents to protect from heart disease, eat grains, and take blood pressure meds to lower blood pressure.  

Obamacare and Cost Control - Will The Two Ever Meet?

In reality, cost control is simple.  Everyone knows how to do it: Austerity and incentives.  Government needs to spend less, and stop using regulation to discourage frugality.  Alas, these realistic solutions are extremely unpopular.  Gruber is too technocratic to go full populist and say, "We should spend as much as it takes to give the best possible health care to every American."  But in the end, that's the philosophy behind Obamacare: Do whatever it takes to cover everyone, and hope the American public one day sees the wisdom of austerity and incentives.
http://econlog.econlib.org/archives/2012/01/sins_of_omissio.html

Quite simply, it would be hard to get a better summary of what is wrong with health care and why all the talking heads you generally hear have no idea what they are saying.

Krugman Hates Choice, Believes Coercive Authority Is More Noble

Krugman well describes the dilemna of publicly funded health care - it's not possible to pay for all the health care that could be purchased.  Rationing is a requirement.  The question he can't get to because of his ideology is: who should choose the rationing?  He never asks this question, he just thinks government should ration and that's the end of it.

Here's a bit of Krugman's logic, if you want to call it that:  How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.
What has gone wrong with us?
Does he think all health care has nothing to do with patient choice?  I think it is about 99% about choice, the exception being only care of those not conscious or rational enough to choose. 

All  of Krugman's complaints are ineluctible concerns resulting from government's intrusion into the health care process, but it sometimes seems as if he's never considered them before.

As the Cafe puts it: 
If consumer choice isn’t the ultimate driver of health-care supply, however, what – or who – will be its ultimate driver?  Health-care suppliers?  Congress?  Government bureaucrats?  Princeton dons?
Admittedly, the politically engineered wedge separating the receipt of health-care services from the responsibility for paying for these services creates problems.  But the best way to address these problems is to remove the wedge rather than to arrogantly suggest that some mysterious transcendent force will more reliably look after individuals’ health-care needs than will those individuals themselves as they operate in markets in which insurers and physicians must compete for consumer dollars.
 

Medicare/Medicaid Efficient?

http://nalert.blogspot.com/2011/07/south-florida-psychiatrist-pleads.html

This gives the lie to the "Medicare/Medicaid have a 1% administrative cost" distortion - distortion in that anyone could have administrative expenses that low if they didn't have to collect payments in the current, government distorted system.

Brooks' Assumptionland

We’ll probably need a mixture of these approaches to figure out what works. Instead, Republicans decry the technocratic rationing model as “death panels.” Democrats have gone into demagogic overdrive calling premium support ideas “privatization” or “the end of Medicare.”
Let’s be clear about the effect of this mendacity: We’re locking in the nation’s wealth into the Medicare program and closing off any possibility that we might do something significant to reinvigorate the missing fifth. Next time you see a politician demagoguing Medicare, ask this: Should we be using our resources in the manner of a nation in decline or one still committed to stoking the energy of its people and continuing its rise?
http://www.nytimes.com/2011/05/10/opinion/10brooks.html?_r=2
"Figure out what works?"  Fifty years of failed government health care isn't long enough to figure out it won't work?  Of course the politicians are mendacious - that's what they are good at.  What a comic approach.  This man is glad politicians are gaining control of the payment and distribution of health care, but surprised that their primary tool of their trade is to avoid truth, thus being able to say they are everything to everyone.

Mr. Brooks' closing paragraph is noteworthy.  I agree that locking the nation's wealth into a failing Medicare system is an absurdity - if the original idea was "we must do something to ensure that people can still get care while they are old and we can at least pay for some of that via the coercive power of the state", the truth now is we could be spending every penny the government has to throw at the problem and we still won't be able to pay for all the care that could be bought.  And yes, the death panels are an inevitability - once we've given the government the power to tax us to pay for our health care, we have also ceded control over how much we get to spend when in decline, and how heroic the efforts will be to save us.  When it comes down to keeping the dying alive or healing the young, the bureaucrats will choose the later.  It's only logical.  It's also soulless and anyone who fights this bureaucratization of health care is fully justified.

Lastly, look at the assumptions in this absurd statement:
"Should we be using our resources in the manner of a nation in decline or one still committed to stoking the energy of its people and continuing its rise?"
Restated:  Should we continue to allow the political class to seize the results of our life energy and spend it on their re-election and political legacy, or should we respect property rights thereby allowing the citizenry to benefit from their own ingenuity and labor, and from the undeniable boost in wealth and productivity that results from cooperative trade amongst free men?  This author has a serious case of the fatal conceit.

The Five Percent Solution

About 5 percent of the population is responsible for almost half of all health care spending in the United States and for rising premium rates, according to a new report from the National Institute for Health Care Management Foundation.

U.S. health care spending has sharply increased over the past few years. Between 2005 and 2009, national health care spending rose by 23 percent from $2 billion to $2.5 billion, according to the NIHCM Foundation, a nonprofit, nonpartisan organization focused on health care. A foundation report that reviewed the 2008 Medical Expenditure Panel Survey found health care spending was concentrated among a small group of high-cost patients.

The report stated about half of the U.S. population accounted for only 3.1 percent of all expenditures. But 10 percent of the population hogged 63.6 percent of all health spending, the survey found.  The top 5  percent of the population accounted for 47.5 percent of all spending, and the top 1 percent accounted for 20.2 percent.

http://www.nationaljournal.com/healthcare/report-5-percent-of-people-account-for-half-of-u-s-health-care-spending-20110627?mrefid=mostViewed

Unfortunately, the article did not cover what might be done to reduce the cost of care for these 'expensive few'.  We know these folks must be the older part of the population, because about 25% of all spending is spent in the last year of life.  We also know, due to a later quote that half this highly treated population is diabetic or pre-diabetic, that many of these folks have eaten themselves sick - but like smokers, it is hard to discern whether they are more or less costly over their 'life cycle' because they have more illnesses, but live shorter lives.

Any way you slice it, pun intended, the public provision of health care is going to boil down to managing the shortages, and it will satisfy very few but still cost bundles of cash.   "What will the demand for health care if the cost at the point of sale is zero?"

Unintended But Still Rotten

A similar family earning $93,699 (400% of poverty) gets a subsidy of $14,799. But a family earning $1 more—$93,700—gets no subsidy.
Economists call large, discontinuous changes in program benefits like this "notches." Although notches might be administratively convenient, they have terrible incentive effects. As Prof. Raj Chetty of Harvard points out in a recent National Bureau of Economic Research working paper, prior research on notches show that they induce sharp reductions in labor supply. 
Consider a wife in a family with $90,000 in income. If she were to earn an additional $3,700, her family would lose the insurance subsidy and be more than $10,000 poorer. In addition, she would also pay more in income and Social Security taxes. Taken together, these policies impose a substantial punishment on work effort.
Notches also lead to unfairness. The principle that families of the same size with similar incomes should be treated similarly by tax law and transfer programs has deep philosophical roots and appeals to basic notions of equity. The notch turns this principle on its head. Next-door neighbors with virtually identical circumstances could receive very different levels of government assistance, depending on which side of the notch they happen to fall. This feature will justifiably increase public cynicism about the law and government in general.

Devil's In The Details

http://www.sbisvcs.com/Brochures/The%20Worst%20Study%20EVER%20by%20Scott%20W.%20Atlas.pdf
Does the US spend more than any other nation but get worse health care outcomes?  Is the US really ranked 37th in healthcare in the world?

That's what the World Health Organization said, and the data the WHO published has been used by the President to good effect in the battle over whether the government should run our health care via coercion, rather than allowing liberty and choice to decide how we get cared for.

Bottom line - it reminds one of the old saw about "lies, damned lies, and statistics."

Stand Up You Fools

If Republicans don't stand up this time, when will they?

How Bad Is It?

Independent experts have shown that the cost of health insurance will rise faster than it would have without the law. The Congressional Budget Office expects the price of a family policy in the individual market to be $2,100 higher by 2016 than it would have been had the law not passed. In at least 20 states, it's now impossible to buy child-only health insurance because of Ms. Sebelius's onerous new rules.
• Seniors are at risk of losing access to physicians and medical care. Medicare actuaries say that the cuts built into the law will force as many as 40% of providers to eventually stop seeing Medicare patients or go bankrupt.
• Many thousands of people are already losing the health insurance they have now as companies are exiting markets for individual, small group and Medicare Advantage coverage.

So far so good, eh?

Bailey Notes Chait's Blinding Partisan Blinders

The following is posted in it's entirity for a glimpse of an interesting tale.  It's a great read for a numbers angles, but most significant to me is how wrong someone could get it in support of their partisan angle whilst sustaining credibility on the partisan stage.  I thought perhaps only Krugman could be so wrong for so long and still have an audience.
_______________________

I was amused yesterday to find out that Matthew Yglesias over at the left-leaning Center for American Progress has stumbled across my 2004 article "Mandatory Health Insurance Now!" and sent out this tweet to his fans:

"Excellent defense of the individual health care mandate from @Reason: http://ygl.as/iaydWc"

Excellent defense? Well, not really a "defense" but an alternative to really bad ideas like a single payer plan. But thanks, I guess.
Not suprisingly, The New Republic's chief left-wing ideologue Jonathan Chait picked up the ball tossed by Yglesias and ran with it. He quotes a bit of it and then writes:

The article proposes a plan centered around an individual mandate as a private insurance alternative to the "creeping socialism" proposed by John Kerry, who was then running for president. Now, of course, Reason considers an individual mandate a massive imposition upon freedom and even unconstitutional. (Indeed, Roger Vinson's ruling that the individual mandate was unconstitutional cites a segment on Reason TV.) Now, the plan as a whole is far from identical to the Affordable Care Act. But its defense of the individual mandate is virtually identical to the case liberals have been making, and which conservatives and libertarians have been angrily dismissing.

Far from identical to ObamaCare? Well, yes.
ObamaCare involves a massive expansion of Medicaid; does not promote health savings accounts as a way encourage consumers put price pressure on health care providers; continues to link health insurance to employers; punishes companies for not covering employees; enforces the mandate by means of levying tax penalties on citizens; and will eventually attempt to restrain spending by turning insurance companies into utilities by bureaucratically setting their rates.
BaileyCare would enable all Americans to purchase health insurance in a national competitive private market. It would completely eliminate Medicaid and S-CHIP (and possibly even Medicare) and use those funds to provide vouchers to poor Americans helping them to buy private insurance in a competitive market. It also would completely delink insurance from employment; it is a consumer-driven plan that combines high-deductible catastrophic insurance with health savings accounts with the aim of using market competition to rein in health care expenses. Vouchers also mean that there would be no need for tax penalties to force people to buy insurance.
So why did I offer BaileyCare as an alternative to what eventually evolved into the economically and medically absurd mishmash that is Obama's Affordable Care Act? As I wrote:

I want to stress that mandatory health insurance is a second-best proposal. A totally free market system would be preferable; it's just not likely politically. Mandatory health insurance is a way to stop creeping socialization and preserve private medicine.

In any case, the intellectually blinkered Chait goes on to declare:

In any event, watching the right decide a policy it once advocated is not only unwise but a threat to freedom itself is a fascinating episode of ideological hysteria.

Right? Advocate? Never mind that political and intellectual subtleties are lost on uber-partisan Chait. Clearly, what I did not attempt to do in my 2004 article was offer any sort of analysis of the constitutional or legal status of a national health insurance mandate. Fortunately, Chait links to just such analysis done by my colleagues at Reason.tv. For excellent analyses of the flaws in ObamaCare I heartily recommend the work of my colleague Peter Suderman. For further analyses of the legal and constitutional aspects of ObamaCare please see numerous articles by my Reason colleagues here.
In the meantime, as we wait to see how the federal courts rule on the constitutionality of a health insurance mandate, I hope that I can count on the Center for American Progress and The New Republic to advocate the repeal of ObamaCare and support the adoption of the BaileyCare private health insurance plan.

The costs of doing drug business?

Incredible picture into how far south the prescription/insurance cycle has gone - this kind of system could only be sustained with government interference.  The lady's insurance should know far more about these supplements than Dr. Davis does; at least the new provider seems to be asserting SOME common sense.

Limited Government?

"The reality is that ObamaCare assigns HHS vast, undefined new powers that will mean whatever Ms. Sebelius and her team decides they will mean. The bill uses the phrase "the Secretary shall" or one of its variants more than a thousand times. Earlier this year, the Congressional Research Service found that ObamaCare created a "currently unknowable" number of new boards, commissions and offices, adding that "it is currently impossible to know how much influence they will ultimately have."
HHS is also not building this bureaucratic apparatus in a transparent way. Ten of the 12 new regulations that HHS has issued in the last six months have been "interim final rules" that are not open to the ordinary process of public comment."
http://online.wsj.com/article/SB10001424052748703794104575546052343243306.html?mod=WSJ_Opinion_AboveLEFTTop

Hate To Depend Upon Politicians, But ...

http://online.wsj.com/article/SB10001424052748703649004575437271015655924.html
This looks like a set of no lose propositions. If only republicans weren't politicians, I would almost feel hopeful ...

"
Here are six key strategies that a Republican Congress could employ to put on the brakes:
• Defund it. House Republican Leader John Boehner of Ohio has vowed to choke off funding for implementation of the legislation, starting with parts that are especially egregious such as the "army of new IRS agents" needed to police compliance.
While Republicans could target the most damaging provisions of the legislation and tie their defunding measures to appropriations legislation that the president wants and needs to sign, they'd better be ready for battles. When former House Speaker Newt Gingrich lost a stand-down with President Clinton over closing down the government in 1996, it was widely seen as a setback for GOP efforts to scale back big government.
• Dismantle it. To focus committee action and floor votes, Republicans can look for provisions in the law that Democrats are on record as opposing. For example, Senate Budget Committee Chairman Kent Conrad (D., N.D.) has said that the new federal program to fund long-term care—the Community Living Assistance Services and Supports Act, or CLASS Act—is "a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of." Mr. Conrad and five of his Democratic colleagues sent a letter to Senate Majority Leader Harry Reid (D., Nev.) before the legislation passed opposing the program and expressing "grave concerns" about its fiscal sustainability.
Other highly unpopular provisions include the requirement that all businesses must file 1099 forms with the IRS to report any purchases totaling more than $600 in a year. This is designed to raise about $17 billion over 10 years from tax cheats. Rep. Dan Lungren (R., Calif.) was the first to introduce legislation to repeal this gigantic paperwork burden. Many Democrats in vulnerable districts who voted for the health law are also anxious to repeal this provision, which the National Federation of Independent Business says will impact 40 million businesses.
• Delay it. Republicans can also vote to postpone cuts to the popular Medicare Advantage program, postpone mandates requiring that individuals and businesses purchase and provide health insurance, and delay imposition of the $500 billion in taxes required by the law. Mr. Obama wouldn't likely sign such legislation, but the debate would shine a light on problems that haven't received nearly enough attention.
• Disapprove regulations. The Congressional Review Act of 1996 (CRA) gives Congress the authority to overturn regulations issued by federal agencies if both houses approve, with a two-thirds majority needed to override a presidential veto. This would be difficult to pull off. But proposing a resolution of disapproval under the CRA gives Republicans a platform to express strong disagreement and bring attention to especially egregious rules.

The current congressional majority wants to gut the CRA, and the House passed a bill that would eliminate the requirement that federal agencies submit their rules to Congress before they can take effect. The Senate has not yet acted, but this measure should be on the Republicans' watch list for the rest of the year.
• Direct oversight and investigation. Other aspects of ObamaCare are ripe for public hearings. For example, rules dictating how much insurance companies must spend on direct medical benefits are already hugely controversial—even before they have been issued. Businesses are also aghast at the narrow openings they have to protect their current health plans from onerous federal regulation. Republicans could summon many witnesses to testify about the impact of this regulatory straightjacket."

Massachusets Health Care

http://online.wsj.com/article/SB10001424052748704324304575306861120760580.html
President Obama said earlier this year that the health-care bill that Congress passed three months ago is "essentially identical" to the Massachusetts universal coverage plan that then-Gov. Mitt Romney signed into law in 2006. No one but Mr. Romney disagrees.
As events are now unfolding, the Massachusetts plan couldn't be a more damning indictment of ObamaCare. The state's universal health-care prototype is growing more dysfunctional by the day, which is the inevitable result of a health system dominated by politics.
In the first good news in months, a state appeals board has reversed some of the price controls on the insurance industry that Gov. Deval Patrick imposed earlier this year. Late last month, the panel ruled that the action had no legal basis and ignored "economic realties."
In April, Mr. Patrick's insurance commissioner had rejected 235 of 274 premium increases state insurers had submitted for approval for individuals and small businesses. The carriers said these increases were necessary to cover their expected claims over the coming year, as underlying state health costs continue to rise at 8% annually. By inventing an arbitrary rate cap, the administration was in effect ordering the carriers to sell their products at a loss.
Mr. Patrick has promised to appeal the panel's decision and find some other reason to cap rates. Yet a raft of internal documents recently leaked to the press shows this squeeze play was opposed even within his own administration.
In an April message to his staff, Robert Dynan, a career insurance commissioner responsible for ensuring the solvency of state carriers, wrote that his superiors "implemented artificial price caps on HMO rates. The rates, by design, have no actuarial support. This action was taken against my objections and without including me in the conversation."

Mitt Romney signs health-care reform into law as Ted Kennedy (third from right) looks on, April 2006.
Mr. Dynan added that "The current course . . . has the potential for catastrophic consequences including irreversible damage to our non-profit health care system" and that "there most likely will be a train wreck (or perhaps several train wrecks)."
Sure enough, the five major state insurers have so far collectively lost $116 million due to the rate cap. Three of them are now under administrative oversight because of concerns about their financial viability. Perhaps Mr. Patrick felt he could be so reckless because health-care demagoguery is the strategy for his fall re-election bid against a former insurance CEO.
The deeper problem is that price controls seem to be the only way the political class can salvage a program that was supposed to reduce spending and manifestly has not. Massachusetts now has the highest average premiums in the nation.
In a new paper, Stanford economists John Cogan and Dan Kessler and Glenn Hubbard of Columbia find that the Massachusetts plan increased private employer-sponsored premiums by about 6%. Another study released last week by the state found that the number of people gaming the "individual mandate"-buying insurance only when they are about to incur major medical costs, then dumping coverage-has quadrupled since 2006. State regulators estimate that this amounts to a de facto 1% tax on insurance premiums for everyone else in the individual market and recommend a limited enrollment period to discourage such abuses. (This will be illegal under ObamaCare.)
Liberals write off such consequences as unimportant under the revisionist history that the plan was never meant to reduce costs but only to cover the uninsured. Yet Mr. Romney wrote in these pages shortly after his plan became law that every resident "will soon have affordable health insurance and the costs of health care will be reduced."
One junior senator from Illinois agreed. In a February 2006 interview on NBC, Mr. Obama praised the "bold initiative" in Massachusetts, arguing that it would "reduce costs and expand coverage." A Romney spokesman said at the time that "It's gratifying that national figures from both sides of the aisle recognize the potential of this plan to transform our health-care system."
An entitlement sold as a way to reduce costs was bound to fundamentally change the system. The larger question-for Massachusetts, and now for the nation-is whether that was really the plan all along.
"If you're going to do health-care cost containment, it has to be stealth," said Jon Kingsdale, speaking at a conference sponsored by the New Republic magazine last October. "It has to be unsuspected by any of the key players to actually have an effect." Mr. Kingsdale is the former director of the Massachusetts "connector," the beta version of ObamaCare's insurance "exchanges," and is now widely expected to serve as an ObamaCare regulator.
He went on to explain that universal coverage was "fundamentally a political strategy question"-a way of finding a "significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less.' And that's the challenge, how to do it. It's like we're waiting for a chain reaction but there's no catalyst, there's nothing to start it."
In other words, health reform was a classic bait and switch: Sell a virtually unrepealable entitlement on utterly unrealistic premises and then the political class will eventually be forced to control spending. The likes of Mr. Kingsdale would say cost control is only a matter of technocratic judgement, but the raw dirigisme of Mr. Patrick's price controls is a better indicator of what happens when health care is in the custody of elected officials rather than a market.
Naturally, Mr. Patrick wants to export the rate review beyond the insurers to hospitals, physician groups and specialty providers-presumably to set medical prices as well as insurance prices. Last month, his administration also announced it would use the existing state "determination of need" process to restrict the diffusion of expensive medical technologies like MRI machines and linear accelerator radiation therapy.
Meanwhile, Richard Moore, a state senator from Uxbridge and an architect of the 2006 plan, has introduced a new bill that will make physician participation in government health programs a condition of medical licensure. This would essentially convert all Massachusetts doctors into public employees.
All of this is merely a prelude to far more aggressive restructuring of the state's health-care markets-and a preview of what awaits the rest of the country.
Mr. Rago is a senior editorial writer at the Journal.

Health Insurance or Health Care

A commenter "on this post http://cafehayek.com/2010/08/monopoly-taxation.html, writes:
How or why would private insurance companies insure anyone over the age of 65? I think any system private or governmental would require younger participants to support retirees.
I've heard this point made many times and it's half or maybe a quarter right. Private insurance for old people in the absence of government intervention is unlikely. The reason is that old people are likely to get sick. The premiums that would make coverage profitable would probably be very high. Would people pay that premium? Probably not. The point of insurance is to insure against the unexpected. You are willing to pay a premium, literally, to avoid a large unpredictable expense. But no one wants to pay a premium for an expected, predictable expense. And when you're old, getting sick is predictable and expected. So when you're old, you'd be unlikely to buy private insurance.
[EDIT: Should have made it clear (as some commenters have correctly pointed out), that I meant private insurance that pays for everything, lifesaving (bypass surgery) and the simply pleasant (a better knee). Yes, even old people might want catastrophic coverage, but that too would be very expensive because it is likely. But as I point out in the next paragraph, it's the health care that's the issue, not the insurance. Health care is going to cost the elderly more. That is the problem not some problem in the insurance market. The expense of health care for the elderly is made worse by the fact that EVERYTHING is paid for by someone else other than the consumer and not just care that is most valued.]
But it isn't health insurance that keeps you healthy. It's health care. Would old people be able to buy health care? Sure. It just wouldn't be free. That would be unpleasant in some dimensions, but pleasant in others. One of the benefits would be that health care would be cheaper because some procedures would be skipped. Another would be not forcing others to pay for your health care. For people who are poor or whose families are poor, we might expect to see private charity or even government assistance such as medicaid. But universal health insurance for the elderly, rich or poor, is a bad idea."
www.cafehayek.com

Anticipating Obamacare

But surely there MUST be some way that humankind, master of space and nearly of time, can contrive a system in which we can control all the variables, and deliver health care to everyone, effectively and with compassion for all?
Yes, but that method would require LESS political control and more market control and it would allow self rationing and it would include incentives to take care of oneself (it will still be expensive to get sick). The plan termed "obama care" is based on an already failed model - see below:
"All this anticipates Obamacare. Even if its modest measures to restrain costs succeed -- which seems unlikely -- the effect on overall spending would be slight. The system's fundamental incentives won't change. The lesson from Massachusetts is that genuine cost control is avoided because it's so politically difficult. It means curbing the incomes of doctors, hospitals and other providers. They object. To encourage "accountable care organizations" would limit consumer choice of doctors and hospitals. That's unpopular. Spending restrictions, whether imposed by regulation or "global payments," raise the specter of essential care denied. Also unpopular."
http://www.realclearpolitics.com/articles/2010/07/19/obamacares_future_foretold_106358.html

Market Distortions - From Which Vectors?

http://mjperry.blogspot.com/2010/06/colonoscopy-in-us-9000-costa-rica-350.html
"Video segment about a retired Detroit meteorologist, with a high deductible for his health insurance, who turned to medical tourism in Costa Rica for a common procedure. Quotes for a routine colonoscopy in the U.S. were as high as $9,000, but only $350 in Costa Rica."


What factors drive costs THIS MUCH HIGHER IN THE US?!?!


Herzlinger writes about this phenomenon in "Who Killed Healthcare."  Her explanation, which is compelling ... Government. 

A Duty To Die

A "Duty to Die"?
By Thomas Sowell
One of the many fashionable notions that have caught on among some of the intelligentsia is that old people have "a duty to die," rather than become a burden to others.
This is more than just an idea discussed around a seminar table. Already the government-run medical system in Britain is restricting what medications or treatments it will authorize for the elderly. Moreover, it seems almost certain that similar attempts to contain runaway costs will lead to similar policies when American medical care is taken over by the government.
Make no mistake about it, letting old people die is a lot cheaper than spending the kind of money required to keep them alive and well. If a government-run medical system is going to save any serious amount of money, it is almost certain to do so by sacrificing the elderly.
There was a time-- fortunately, now long past-- when some desperately poor societies had to abandon old people to their fate, because there was just not enough margin for everyone to survive. Sometimes the elderly themselves would simply go off from their family and community to face their fate alone.
But is that where we are today?
Talk about "a duty to die" made me think back to my early childhood in the South, during the Great Depression of the 1930s. One day, I was told that an older lady-- a relative of ours-- was going to come and stay with us for a while, and I was told how to be polite and considerate towards her.
She was called "Aunt Nance Ann," but I don't know what her official name was or what her actual biological relationship to us was. Aunt Nance Ann had no home of her own. But she moved around from relative to relative, not spending enough time in any one home to be a real burden.
At that time, we didn't have things like electricity or central heating or hot running water. But we had a roof over our heads and food on the table-- and Aunt Nance Ann was welcome to both.
Poor as we were, I never heard anybody say, or even intimate, that Aunt Nance Ann had "a duty to die."
I only began to hear that kind of talk decades later, from highly educated people in an affluent age, when even most families living below the official poverty level owned a car or truck and had air-conditioning.
It is today, in an age when homes have flat-panelled TVs, and most families eat in restaurants regularly or have pizzas and other meals delivered to their homes, that the elites-- rather than the masses-- have begun talking about "a duty to die."
Back in the days of Aunt Nance Ann, nobody in our family had ever gone to college. Indeed, none had gone beyond elementary school. Apparently you need a lot of expensive education, sometimes including courses on ethics, before you can start talking about "a duty to die."
Many years later, while going through a divorce, I told a friend that I was considering contesting child custody. She immediately urged me not to do it. Why? Because raising a child would interfere with my career.
But my son didn't have a career. He was just a child who needed someone who understood him. I ended up with custody of my son and, although he was not a demanding child, raising him could not help impeding my career a little. But do you just abandon a child when it is inconvenient to raise him?
The lady who gave me this advice had a degree from the Harvard Law School. She had more years of education than my whole family had, back in the days of Aunt Nance Ann.
Much of what is taught in our schools and colleges today seeks to break down traditional values, and replace them with more fancy and fashionable notions, of which "a duty to die" is just one.
These efforts at changing values used to be called "values clarification," though the name has had to be changed repeatedly over the years, as more and more parents caught on to what was going on and objected. The values that supposedly needed "clarification" had been clear enough to last for generations and nobody asked the schools and colleges for this "clarification."
Nor are we better people because of it.
http://www.realclearpolitics.com/articles/2010/05/11/a_duty_to_die_105521.html

Obama Care Failing Already

"Already, businesses small and large are warning of the ill effects of the law's changes to the tax code. In order to generate the nearly $1 trillion necessary to pay for the law, its authors scoured the tax code looking to squeeze out more money whereever possible. And sure enough, within a few days of its passage, a handful of big companies took tax write downs in response to changes in the tax treatment of an existing drug subsidy. An estimate by Credit Suisse puts the total damage across the economy at around $4.5 billion—with $1 billion coming from AT&T alone.

The change involved the tax treatment of a subsidy that never should have existed, but it suggests the extent to which America's health care system is already reliant on government meddling, and how costly expanding the government's role in the system can be. And, perhaps more importantly, a planned investigation into the write-downs revealed that many big corporations are considering dropping their health care coverage and dumping employees onto the public dole."

http://reason.com/archives/2010/05/14/the-cure-is-worse-than-the-dis