My first wife, Renee, died of cancer in 1995. She was 42. I returned to the Winship Cancer Center in Atlanta to see what progress has been made in diagnosis and treatment.

Dr. Carl D’Orsi, head of radiology noted that we have a cure for cancer; early detection. Big advances are being made in imaging and diagnosis.  Dr. D’Orsi demonstrated a topographical mammogram.  This experimental machine can take a remarkably clear image of a tumor too small to be detected by a traditional mammogram . This same machine can also read a section more clearly that may look suspicious in a mammogram and see that there is no tumor, effectively avoiding unnecessary biopsies.

This machine will likely be able to increase the effectiveness of treatments by catching it earlier. But it is expensive, and it is experimental. Few places have them.   I saw other imaging systems that are also experimental and offer great hope.

I also saw huge laboratories involved in new techniques of delivering chemotherapies such as nanotech  targeting systems.

They have developed genetic testing that can  determine your odds of getting certain types of cancer. This aids the patient is selecting treatments that can dramatically reduce the chances of contracting cancer even in a high risk pool.  One of these tests costs $3,000.

Because of the costs of these treatments it is used selectively only for those whose risk profiles merits the extra expense. But the underlying point is that our health care system may be expensive because it is just so damn good. Anyone who has dealt with the fear and trauma of cancer know the value of these new developments; but we also must realize it is not cheap. Otherwise we risk never making these improvements available.

While the large insurance companies are commonly demonized, the reality is that their annual profits would not cover our health care bill for 48 hours.  The far more significant costs drivers are the quality of the technologies that deliver the best treatment systems in the world.

The cancer specialists at the Emory Winship Clinic were  troubled over the new government standards restricting mammograms for younger women. The committee establishing these new standards, which will likely be adapted by the insurance companies, did not have a single radiologist or oncologist on them.  Clearly these standards should rely more on individual case histories than simple age categories.

I would much rather trust my health and the health of my family to the professionals at the Winship Center and other advanced centers than to the government data crunching agencies that know nothing.  They may not be a death squad but such irresponsible regulations accomplish the same goal.

Perhaps it is not the end of the world if our health care system is expensive. Perhaps it is worth it.

An excellent article on the health care dilemma

‘A Wasted Opportunity‘
Wellpoint’s CEO on ObamaCare’s mistakes and how to pick up the political pieces.
by By JOSEPH RAGO in the Wall Street Journal

excerpts

Mrs. Braly says, when 85 cents out of every premium dollar or more “is paid out in the actual cost of care, doctors, hospitals, suppliers, drugs, devices.” Confiscating the 2009 profits of the entire insurance industry would pay for two days of U.S. health care.

“In Maine, where guaranteed issue went into effect in 1993, there were 11 carriers in the individual market, and now there are two: Us, and another company that would not be called in any circle an equivalent health insurance company.” In Kentucky, 45 insurers fled the state, with WellPoint the last one standing, until the state started in 1998 to repeal most of these regulations.

Depending on the plan, WellPoint’s monthly premium for a 20-year-old in Indianapolis, where the company is based, ranges from $53 to $202. But the same young adult looking for similar coverage in Albany would face costs anywhere between $832 and $1,047. Obviously health costs vary across the country, Mrs. Braly says, but these disparities are almost entirely due to New York’s regulatory mandates. In a state with 19 million people, 88 New Yorkers between the ages of 18 and 24—88!—have bought WellPoint’s best-selling individual insurance product because insurance laws make it perfectly rational not to acquire costly coverage until people need it.

As Mrs. Braly diagnoses the U.S. health-care system, its two main strengths are (a) choice and flexibility and (b) cutting-edge treatments and procedures. But while American medicine has been shaped by specialization, scientific advancements and major technological breakthroughs, it is paradoxically antiquated. The modern managerial and corporate practices for obtaining better productivity and quality that have revolutionized every other sector of the economy have largely passed over medicine.

Campaigns promise generalities but laws have to be specific. The health care disaster shows how difficult the road from promise to result is.

The current mess simply tried to do too much. There are two main problems in health care: cost and coverage.

85% of Americans have coverage that they are reasonably happy with. Costs are high for many reasons. We want short waiting times and high quality. We have some the best outcomes for most major diseases and access to wondrous new drugs and technology. Part of the reason health care is expensive is because we value it so much.

Yes there are administrative inefficiencies, but the cost shift from underpayment from government programs drives up costs much more. If one wanted to help drive costs down we would discuss tort reform, allow insurance companies to cross state lines, promote health savings accounts, promote final directives, and stem Medicaid fraud.

But rather than address the problems of the 85% they sought to address the 15%. Yet those without coverage are not without health care. And a case can be made that those 15% are closer to 5% when you exclude prisoners, those already qualified for government programs, illegal aliens, and those able to buy health coverage who choose not to.

But the difficulty comes when you require medical underwriting without pre-existing conditions. This sounds great but there are still two critical problems. Without forcing everyone to buy insurance people would simply wait until they needed it and the claims experience would drive costs sky high.  Without compressing the difference in premiums based on age, the older American’s would just get guaranteed coverage that they could not afford.

Both of these place an undue burden on the young.  Yet If we want to get health insurance into individual hands then we need some assurance that individuals can get reasonably priced insurance.

We could treat health insurance like a life insurance contract.  The younger you are the cheaper it is. You could lock into a plan period with restrictions on increases.  This is essentially an HSA.  When you are young with few claims you can build ‘cash value’ that can be tapped when you are older. This can be encouraged with individual tax credits for individuals to buy their own health care.

We tend to treat health insurance like auto insurance except that we file a claim for every oil change and flat tire. No wonder administration costs are high.

The problem is that the government wants to provide a benefit but not incur the cost. This leads to more cost shifting , some form of rationing, or lower quality care.  Proponets of more government involvement in health care contend that market forces do not work in the health care field.  I disagree; it responds to market forces too well.

This may be anecdotal, but I keep hearing doctors becoming outraged over the greater intrusion of government into the healthcare delivery. Some threaten to retire early, work less, refuse Medicare patients, or otherwise adjust to the interference.

Doctors already face bureaucratic insurance representatives with no medical training dictating medical procedures, and they fear irrational lawsuits that drive up their malpractice claims. Adding the government distortion from the new health care bill may be a critical tipping point that leads to a critical shortage of doctors.

If the new health care bill discourages existing doctors from staying in the field and new doctors from entering, while adding millions to the insured roles we will face waits and delays the Americans will not tolerate well.

We are an impatient people.

Mark Constantian writes in the Wall Street Journal Where U.S. Health Care Ranks Number One (1/7/09)

excerpts

The WHO believes that we could have done better because we do not have universal coverage. What apparently does not matter is that our population has universal access because most physicians treat indigent patients without charge and accept Medicare and Medicaid payments, which do not even cover overhead expenses. The WHO does rank the U.S. No. 1 of 191 countries for “responsiveness to the needs and choices of the individual patient.” Isn’t responsiveness what health care is all about?

The Nobel Prizes in medicine and physiology have been awarded to more Americans than to researchers in all other countries combined. Eight of the 10 top-selling drugs in the world were developed by U.S. companies. The U.S. has some of the highest breast, colon and prostate cancer survival rates in the world. And our country ranks first or second in the world in kidney transplants, liver transplants, heart transplants, total knee replacements, coronary artery bypass, and percutaneous coronary interventions.

We have the shortest waiting time for nonemergency surgery in the world; England has one of the longest. In Canada, a country of 35 million citizens, 1 million patients now wait for surgery and another million wait to see specialists.

So what does this money buy? Certainly some goes to inefficiencies, corporate profits, and costs that should be lowered by professional liability reform and national, free-market insurance access by allowing for competition across state lines. But the majority goes to a long list of advantages that American citizens now expect: the easiest access, the shortest waiting times the widest choice of physicians and hospitals, and constant availability of health care to elderly Americans. What we need now is insurance and liability reform—not health-care reform.

HKO comment- If I have learned anything over the years it is to get the whole story. Unfortunately  unwarranted criticisms, incomplete and slanted data, and inappropriate statistics are repeated by a compliant media and morons like Michale Moore so much that an unsuspecting public becomes overwhelmed with half truths and misinformation. If our heath care is so bad then why do so many people oppose the reform that is passing through our Congress?

There hasn’t  been much I have agreed with in the swamp of health care proposals, but I did hear one idea that made sense; a surtax on the Cadillac plans.

This addresses one of the problems of our system. Due to the tax deduction afforded businesses to buy health insurance ( and the lack of this deduction to individuals) we are actually over insured for many Americans.  If we used car insurance the way we use health insurance, we would file a claim for a flat tire, an oil change, a tune up and other routine maintenance.

Insurance should be used to avoid catastrophic claims, not to avoid all risks and all claims. Small claims should be paid by the insured, or if necessary small credit lines.

By inserting insurance into the most menial claims we have further removed consumer accountability from health care pricing.  HSA’s should be far more widely used.

I would prefer to see businesses just get completely out of the health insurance business and let individuals buy their own coverage the way they currently buy auto, home owners, and life insurance. I would certainly like to see less government involvement in our health care system, not more.

But this idea does at least acknowledge that over insurance is a problem, even if their motivation is questionable.

“A crisis is the rallying cry of the tyrant.” James Madison

Is health care a crisis?  Bruce Walker gives a great answer at American Thinker.

August 24, 2009

Infatuation with Crisis

By Bruce Walker

read the entire article here

Excerpt

If there is anything that should send fear down your spine about greater government involvement in health care it would be the words of Dr. Ezekiel Emanuel, brother of White house Chief of Staff Rahm Emanuel, and health advisor to President Barak Obama. Dr Emanuel has been appointed as health policy advisor to the Office of Management and Budget and to the Federal Counsel of Comparative Effectiveness Research.

Betsy McCaughey writes in the Wall Street Journal in “Obama’s Health Care Rationer in Chief.”  Read the entire article here.

Dr. Emanuel believes the Hippocratic Oath, the moral center of our health care system since … well since Hippocrates, is obsolete.  Doctors, in his view, should be as concerned for the overall benefit to society as they should be for the outcomes of a single patient. Doctors in his judgment should be more focused on providing “socially sustainable cost effective care.”

The doctor advocates redefining doctors’ ethical obligations. He even developed “a complete lives system” for allocating scarce resources.  Life and death are reduced to mathematical models, i.e. the graph above. The very young and the very old become more expendable to provide better care to the more productive or valuable segment of society (my emphasis).

If we cannot prevent automobile dealers from gaming the system, begging their congressmen for special dispensation (see this video), can you imagine the cronyism and corruption when life and death lay in the hands of favor dispensing government officials and bureaucrats?  Would Ted Kennedy have been denied expensive chemotherapy that may have added only a few months to his life at age 77?

I doubt it.

As McCaughey also appropriately noted, such decisions are not often clear; would we be willing to sacrifice three seventy year olds to save one  thirty year old? What about an educated valuable active teacher who is 70 verses a thirty year old drug addict or criminal?  Would we value Mother Teresa less in her senior years than a multi- millionaire athlete in his prime?  Do we really want mindless mathematical models and government bureaucrats allocating health care?

There are many myths about our health care system. It is expensive, but the quality is far better than many policy critics and advocates insist.  And no nation develops more life saving drugs and procedures than we do.  We have one of the highest cancer survival rates in the world.

But in the name of cost control should we be willing to do to our health care system what Dr. Kevorkian was only willing to do to individuals?

Obama’s claim that a government option will somehow keep the private health insurance carriers honest is either disingenuous or incredibly ignorant of basic economics.

Can the government honestly be expected to both regulate and compete with private insurance carriers? When a private carrier cannot recoup or control its costs,  it loses money and goes out of business; a government insurance provider can be subsidized by the tax payer indefinitely.  Think Post Office and Amtrak.

But why does Obama think that a market with thousands of insurance companies competing needs to be kept honest by anyone?  Do we also need the federal government to enter  the auto or life insurance markets to keep them honest or is only health insurance in need of such government supervision?

Do the greedy oil companies need a state owned oil company to keep them honest? Should we have government owned grocers and farms to keep food costs down?

Some argue that the government would not have to earn a profit. But it is the desire to make a profit that attracts competition into a market and drives costs down. It is the desire for profit that drives efficiency to reduce costs. Medicare is fraught with fraud costing over $70 billion a year.  In New York State alone it is estimated to be 10% of their cost.  They have no profit incentive to control that cost.

If we depend on the government to keep private providers honest, who do we depend on to keep government providers honest?

In 1991 our company received a letter from the EPA that we were a ‘PRP’ which stands for a ‘Potentially Responsible Party’ for an environmental cleanup near Tampa, Florida. In 1980 Congress passed the act which created the Superfund, which was a pool of funds administered by a new bureaucracy.

This new bureaucracy decided that since we had sold lead batteries to a lead recycling firm that, according to the new law, we were therefore responsible for their downstream liability.  The recycler disposed of the lead acid improperly, causing water pollution in a nearby swamp.

But we sold the batteries two years before the law was enacted. Didn’t matter; we were held retroactively liable.  We could not explain our innocence to a jury because there was no jury; just a ruling from the Department of Justice.  We were directed to participate in the cleanup or face fines of $25,000 per day.  My daughter then a new born would be held liable as a descendent of a targeted business.

We were one of thousands of scrap yards that sent batteries to the site; but one of a few dozen that were actually viable enough to fund a cleanup. We were held jointly and severally liable for the cleanup, so if one of the other PRPs went bankrupt we had to cover their share.

When we found out that an environmental remediation company had damaged the site prior to our involvement we sought to sue them for their liability only to find out that they had worked for the EPA and were indemnified for their negligence and incompetence. This meant that even if we proved their negligence in court that the cost of their action would be charged back to US as an ongoing site expense.

Over the next 15 years our ‘cleanup group’ spent more on legal bills than we spend on the cleanup. An entire industry of environmental lawyers grew to respond to the Kafkaesque world created by the EPA and Superfund.  As one of the other PRPs noted, ” Our grandparents left countries because of laws like this.”

When the Superfund bill was passed it enjoyed widespread support from both parties to address the very real concern over the funding to clean up about 1400 identified sites.  But like other such ‘comprehensive’ laws the details are rarely identified in the bill itself.  The details are written and enforced by a bureaucracy that writes rules that our elected representatives never see, that are never debated at town hall meetings, that are never joked about by John Stewart or Bill Maher, that never hear the scorn from Bill O’Reily or Glenn Beck or Rush Limbaugh, and are too complicated to be addressed by the great unwashed sending in their letter to the editors.

This is why the details and hot points about the still to be seen Health Care Bill are irrelevant and distracting.  Once the government is able to establish a bureaucracy to write the rules and govern the use of our health care system the real damage will be beyond the scope of the Tea Parties, Twitterers, and even our own legislators.  This is the real truth about how the laws work in this country, especially when we seek ‘comprehensive ‘reform.   ”Comprehensive reforms” create bureaucracies that are unaccountable and indestructible.  They relegate our basic systems of justice to the dustbins of history.

Instead of trying to recreate an entire system we should identify the broken parts and fix them, one at a time if necessary. It would be much easier to get a bipartisan agreement and actually get something passed.  We agree that there are parts of the system that need change, but in our rush to ‘do something’ we attempt to do everything and end up with nothing.

But amidst the arguments and controversies this bill will be compromised at any cost as long as the end result is the establishment of a government bureaucracy to control our health care system. That is when the real damage will be done.