Health By Bureaucracy

Just a quick one today.  I'm sure you've heard the news about the Federally appointed task force that decided that the current breast cancer screening procedures are too thorough sighting the high cost of each test and individual turmoil caused due to false positives (detecting breast cancer where there isn't any).  Thankfully the Obama Administration won't change their existing policy on this go-around... its like they have a critical bill moving through the Senate that is trying to give them control over what type of medical treatment is really necessary or something.


Seriously, though:  a government task force appointed to come up with the balance between cost, your own personal feelings, and your health?  Isn't this just like the government telling me what is healthy instead of me talking it over with my doctor?  I thought this was something only evil corporations were capable of: identifying what sort of treatments or preventative measures I need by a calculated cost-benefit analysis.  Why would you fight for something like this?


Here is my chance to poke a few more holes in the FDA, also.  Have you heard the story about the FDA looking to take action against highly caffeinated alcoholic beverages?  First off, who hasn't tried a Vodka with Red Bull - secondly, what is the point of making pre-mixed drinks illegal when the whole fashion was started with people mixing their own drinks?  If MillerCoors isn't allowed to sell their Sparks because it is dangerous, what is to keep people from mixing their own again?  Is the FDA going to go into a house party and arrest people for mixing drinks?  Which is really dangerous - the alcohol or the caffeine or both?  If everything is dangerous, let's just bring back prohibition and add caffeine to the list of banned substances!


It is impossible to implement enough laws to protect people from their own ignorance.  If it is dangerous to mix alcohol and caffeine, then education is the way to solve it (remember that party saying, "beer before liquor, never sicker - liquor before beer, in the clear").  It is the same with preventative health measures - these issues should be solved between a patient and their doctor.  These are the two most qualified parties that poses the most relevant information - not some bureaucratic task force.

Statistics: Who's side are you on, anyway?

There are a lot of statistics flying around regarding health care, and I thought it would be interesting to see what the numbers are really saying.  The thing that gets me is that statistics can me massaged to say just about anything you want them to say.  In this post I am going to focus on three statistics that stand out in my mind when health care is debated: The percentage of Americans without health care, the number of Americans without health care, and the life expectancy of Americans compared with other countries in the world.

These stand out to me because the number and percentage of Americans stated to be without health care doesn't seem to correlate with my impression of the number of Americans in existence, and I have heard some statistics that put the US as #1 for life expectancy when things like car accidents and murders are removed from the equation.  My biggest problems with throwing numbers around is the lack of information regarding the source of the data so that I can go look it up for myself.  That is an immediate red-flag in my mind that someone is trying to conceal something or manipulate the data to make their claims seem more important.

On to the amount of Americans without health care.  According to the National Coalition on Health Care fact sheet:

Several studies estimate the number of uninsured Americans. According to the U.S. Census Bureau, nearly 47 million Americans, or 20 percent of the population under the age of 65, were without health insurance in 2008, their latest data available.

~NCHC Fact Sheet

I am a little skeptical about that number.  First off, let's see how many people under the age of 65 the census bureau thought there was in 2008.  Using this data from the 2008 1-Year estimate, I have calculated  that 87.3% of the population is under the age of 65.  If there are 304,059,728 people in the United States, and 87.3% of them are under the age of 65, then there are 265,444,142 (rounding the .544 off to make a whole number) people in the US under the age of 65.  Assuming for a second that there really are 20% of those people uninsured, that would give us 53,088,828 (nearly 53 million) uninsured Americans - not the "nearly" 47,000,000 cited by the NCHC.

Now if we assume the NCHC number is correct (nearly 47 million uninsured Americans under the age of 65 are without health insurance), what percentage would that really give us?  Using my number from before (265,444,142 Americans under the age of 65), then 47 million is only 17.706% of all Americans under the age of 65 without health insurance. I'll grant that these numbers are still depressing, but why the inflation? Why isn't the truth good enough? Lucky for me, the NCHC included their referenced material in their footnotes:

DeNavas-Walt, C.B. Proctor, and J. Smith.  Income, Poverty, and Health Insurance Coverage in the United States: 2008.  U.S. Census Bureau., September 2009.

~NCHC Fact Sheet

I dropped that into a Google search which produced this document.  If you pop on over to page 27 of that PDF document, you'll be at the section relating to health insurance.  This is the very first paragraph in that section:

The percentage of people without health insurance in 2008 was not statistically different from 2007 at 15.4 percent. The number of uninsured increased to 46.3 million in 2008, from 45.7 million in 2007 (Table 7 and Figure 6).

~U.S. Census Bureau

REALLY!?  Even the high number (46.3 million) which includes people over the age of 65 doesn't equal the NCHC number of nearly 47 million people without health insurance.  What numbers are they even looking at?  According to this report (which is cited by the NCHC), there are 301,483,000 people in the US of which there are 46,340,000 people uninsured (about 15.4%).  There are 263,695,000 people under the age of 65 in the US and 44,692,000 (nearly 45 million) of them are uninsured, about 16.95%.  Again, I'm not trying to say that this isn't a lot of people; I'm just making the point that someone is not being truthful about there numbers and that seems a little suspicious.

Now my favorite: Life expectancy.  Life expectancy is one of those really difficult things to calculate because there are so many variables.  What are the chances of you getting struck by lightning or getting depressed and committing suicide or having a house fall out of a tornado and landing on top of you or being attacked by pirates on the high seas or... I think you are getting my point.  None of those examples have anything at all to do with your health at the time of the incident that ends your life... unless you are trying to imply that having health insurance will protect you from the killer asteroid in Armageddon.

The most popular statistic sighted is that the US has the lowest life expectancy rating among developed nations... just above Cuba.  Wolfram|Alpha is really useful for doing statistical analysis, so I asked it to show me data relating to life expectancy.  It tells me that the United States is ranked 50th in the world with an average life expectancy of 78.11 years which beats out Cuba's expectancy of 77.45 years (ranked 57th).  That sure beats Swaziland (ranked 227th) with an average expected life of 31.88 years!  All of this data includes unnatural causes of death including car accidents and homicide.  So what are the leading causes of death in the US?  I found a World Health Organization database here that lists mortality statistics for all over the world, but it is friggin' huge and I don't remember access well enough to make use of the data.  Luckily, as is often times the case on the internet, someone else has done the work for me.  Scroll on down to the dynamic table and check out the description.  When you remove fatal accidents from the equation of life expectancy (like car accidents, homicide, etc), the US all of a sudden is ranked #1 in life expectancy.  You may also note that the data is from an older database (1999), but based on the data I've been sifting through from the WHO, this trend still seems to hold true (If you want to volunteer to sift through the latest access data, be my guest!).

The bottom line is this: the truth is absolutely more powerful the any other variation of data.  As soon as it is picked up that the data you are using has been exaggerated in any way, your entire argument is suddenly no longer sound.  If you are modifying this data, what else have you not told me?  Why is the data being altered?  Why are people lying to me over something as important as my own health?  So much for private corporations being the ones we can't trust.

The Gloves Come Off

First I want to start out by apologizing for the end of my last post. It went a little out of control with my rant which didn't add anything meaningful to my argument. I will strive to never let that happen again.

Let's have a discussion regarding life sustaining care for Medicare and Medicaid. Back in the sixties when these plans were created, they originated as universal government health care plans. There wasn't enough country-wide support for them in that form, so they evolved into plans primarily for the elderly (surprise - the elderly at the time didn't have to pay into the program with their tax money because they either already qualified for the program, or were not far from it... and the elderly make up the highest percentage of the voting public).

Since this is a very sensitive subject for a lot of people, I'll give you a little personal background to convince you that I am not totally disconnected from the real world. Firstly, no one is suggesting that the country should go cold turkey with these programs - this would cause irreparable harm to people that depend on the care these programs provide. Additionally that would represent a breach in trust between the government that has made a promise to people deeply invested in these programs (not that the government hasn't broken promises before - just that I'm not advocating breaking any more than they already have). My own grandmother depends on these programs ever since the day I took her to the hospital after a stroke. It is with this in mind that I would like to propose a road map to a better system for the entire country.

Did you know that there was a time when doctors advertised their prices? They even had sales in order to bring in new business. There was also a time when it was economical to fund research into new medical technologies in an effort to provide better services at a reduced cost. Doctors and Hospitals would compete for your business by striving to offer you the most advanced care in the nicest facilities with the most thoughtful staff. This was back in the time when the cost of health care meant something other than "its too high." Why don't you try this exercise: How much do you pay for your medical insurance? How much did that last prescription cost (not the co-pay - the actual per-pill cost)? How much does it cost for a physical at your doctor's office? What about a routine vaccination? Did you know the answer to any of these questions off the top of your head? If the answer is no, then you must either be super rich to the point that you don't have to worry about money or that you rely so much on someone else to watch over your medical care that the money doesn't matter. My guess is the latter over the former... but if that is the case, then why is the cost of health care so important to people now?

The simple solution to this problem is to put you back in the loop regarding the direct costs of your health care. If suddenly you had the choice to go to two identical doctor's offices where one charged you $35 for a check-up and the other charged you $50, then you could make a conscious choice as to which would be best for you. When the $50 guy sees his business drop, then he will find ways to get his costs down to compete with the $35 office. This model is called the Free Market. The problem with today's market is the government has come in and said that if you get Medicare, you won't have to see the cost to visit the doctor. So if you no longer care about cost (because the government is picking up the tab), why would the first office keep their prices at $35 when the guy down the road is doing the same thing and getting paid $50? And not only do the lower cost facilities get paid at the higher rate, the only thing they have to do in order to get your business is to be put on the "approved doctor" list. Anything else (like a comfortable waiting area, courteous staff, timely service, advances in efficiency) are unnecessary because the doctor's office no longer needs to compete for your service.

Now, to make this a good argument, I'll give you some an example. Back in 2004, Dr. Robert Barry was invited to testify in front of the Joint Economic Committee of Congress regarding a revolutionary type of clinic he had opened (here is his full testimony). In 2001 he left his practice as an ER doctor so that he could help the less fortunate in his community. His clinic began to attract people that were "political exiles within our healthcare system". I'll allow you to read the whole thing at your own pace, I just want to quote Dr. Barry's findings:

It seems that centralized bureaucracies simply cannot manage healthcare. Medical decisions are much too complex and personal to entrust to distant bureaucrats many of whom lack basic medical knowledge. The most efficient and humane solution is to allow ordinary Americans to manage their own care by giving them control over their healthcare dollars. It is, after all, their money and their health. They should control both.

The simple truth is this: there is no competition with the government. If the government gives a favorable deal to anything short of every health care provider, then those providers outside of the system suffer because people can't afford to pay the taxes required to sustain the government program AND to pay for the care they really want. Here is the road map:

1. End the tax benefit for employer health plans.
2. Begin to allow young people to opt-out of Medicare and Medicaid taxes (with the understanding that they will not be applicable for the programs in the future).
3. Begin a phase out government support for treatment of uninsured patient care.
4. Reimburse the people of the United States for the costs of these programs in the form of lower taxes.
5. Return freedom to the people.

Finally, just to hammer home the point that I am not crazy in my thinking that the government can't force people to be charitable, check out this article about the Christian duty to "actively seek the demise of all government welfare programs."

What Does The Country Want?

It isn't a mystery - the health care system in America is Broken: Prices are high, customer satisfaction is low, insurance premiums are unfordable, medical students don't want to become primary care physicians because they aren't able to afford their school loans, and medical malpractice suits are rampant. But you don't need me to tell you this - every where you turn there are people shouting for change from our terrible health care system. So what do people want to happen? Gallop had a poll back in July 2009 that asked people if they wanted health care reform.
95% of those poled want congress to do something. I noticed immediately that the questions posed wasn't "Pass the new healthcare reform law..." but rather "Pass a new healthcare reform law..." If you do a little more snooping around on the Gallup site you can find a much more interesting poll regarding health care reform.
If everyone is so upset at the cost of their health care, why then would they encourage their representatives to vote for a bill that they feel would increase the cost of health care even further? Does this make sense to anyone? Maybe they are okay with it because they feel the quality of health care they would get would increase, right?
This Gallup poll says that those polled felt that their own personal health care quality was more likely to WORSEN because of a new government health care reform bill.

So let me summarize: people in the US want health care reform, they expect that the country as a whole will pay more for health care, and they expect that the quality of their personal health care will worsen. Does this sound logical to anyone? Why would you vote for something like this?

The Real Issue Behind Health Care

The most talked-about topic today is the battle over health care reform going on in the US House of Representatives. It is absolutely clear that this country needs to do something about the way it handles health care. Insurance Premiums, prescription drugs, emergency care service, and routine doctor visit costs are all the highest they have ever been. There are people on every side of the argument that are very passionate about their views. This all sounds like a perfect mess for me to jump into!

Here is my sticking point, right off the bat: our country has an established process for dealing with social issues of this magnitude. The country is split very passionately right down the middle with very few people residing in the gray area. What is worse is that the two opposing sides are so passionate about their views that instead of having a real debate, they are demonizing the opposition and spreading false information. This doesn't do anyone any good because it only acts to hide what is actually important: The real issue.

The real issue is whether or not the Congress has the power to enact a health care reform plan regardless of how you feel about health care. I am not a monster who wishes death and inadequate health care onto those less fortunate than myself - I am a person that volunteers my time to help out my community. I am not rich to the point that I don't worry about money, so clearly I am also in favor of affordable care. My biggest concern right now is that I am watching the government stick its fingers into places it has no right being and I don't want it to get any worse.

The process I alluded to previously is detailed in the US Constitution. Some people will argue that the buck stops here with regard to the Health Care Reform Bill because Article 1 Section 8 of the US Constitution states exactly the Powers of Congress. It is quite clear that congress has no authority when it comes to telling the citizens of the United States what they must and must not do with regards to their health care. For an issue like this, there are constitutional amendments. The constitutional amendment (which most people forget about) is used when the people want to change or add something in the Constitution (such as congress' power over health care). It is really simple to add an amendment to the constitution - the process is outlined in Article 5 of the Constitution. The one catch is that 3/4 of the house of representatives AND the senate must ratify the amendment. 75% of the population must be on the same page in order for it to happen. If health care was such a no-brainer, then it would be easy to get enough votes for an amendment.

Before I go too far, I have heard a surprising number of people present the question of whether the constitution is even a relevant point of argument. Examples are thrown up such as warrant-less wire tapping and suspension of habeas corpus. If a government is willing to commit such acts which go against current constitutional amendments, what makes me think they will care about this issue? The US constitution is the guiding light for the country - the one document that can always be looked to when the country is divided. I say that the people have let this country stray too far from this path. Our government is straying from the constitution because the people don't care and let them get away with it. Why else is it that so many public figures are found guilty of corruption and still get re-elected into office? The function of government is to serve its people. The function of the people is to tell the government what they need. It is similar to the argument of who is to blame when a dog attacks a person: the owner for not controlling their dog, or the dog for directly committing the act? The constitution is absolutely relevant, and it is our job to make the government fall in line. Moving on.

The foundations of the current health care bill seem to be rooted in this one pesky line in the Constitution. One of the powers granted to congress is...

To lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States;

-Article 1 Section 8, US Constitution

That part in there about collecting taxes for the "...general welfare of the United States" has been widely interpreted to mean all sorts of things from the government's responsibility to help educate US citizens to providing for all of their health care needs. To really understand this statement, we need to first remember that the founding fathers wanted us to think of the document as it applied at the time of ratification and not construct an interpretation for today's world. What I mean by this is the constitution isn't a living document in the sense that it was made so long ago that the meanings have changed but rather today's words have changed around the meaning of the constitution. The meaning of the constitution is the same now as it was back when it was ratified - we have to come up with words that make sense to fit those meanings. James Madison (the 4th President and the principal author of the US Constitution) once said...

Do not separate text from historical background. If you do, you will have perverted and subverted the Constitution, which can only end in a distorted, bastardized form of illegitimate government.

James Madison

In order to discover the intended meaning of the constitution, we have to look back at the people who actually wrote it. Madison spoke very clearly about the words "general welfare" in this section of the constitution. During Madison's time in office, congress had passed a bill that would provide federal funding for state improvements such as rural roads, bridges, and canals arguing that it would be in the general welfare of the people to have these improvements in their state.

With respect to the two words 'general welfare,' I have always regarded them as qualified by the detail of powers connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators.

James Madison

I'm sure there are some places to argue over interpretations in the Constitution, but this clearly isn't one of them. Based on the amount of controversy surrounding the current health reform bill, red flags should be going off in your head. Whatever your view is, I am certain you must be thinking that the other half of the country is insane for believing the opposite. Maybe we all need to take a breath, re-gain our bearings, and think logically. That is exactly what the constitution is for.