Category Archives: Health

Save the Ta-Tas

October is breast cancer awareness month – as you must know, unless you are color blind. The Indiana Hoosiers went down to defeat yesterday, trimmed in the hot pink of the awareness campaign. The World Health Organization, however, is not a believer. See their chart, below. No cancer at all is in the top ten, let alone breast cancer.

WHO ChartAccording to the World Health Organization, cardiovascular disease is by far the world’s biggest killer. Stroke and heart disease account for three out of ten deaths. So, where is the black ribbon of heart attack month?

Of course, people respond emotionally to disease. If someone you know suffers from, say, Multiple Sclerosis, then for you that is the world’s worst disease. Public policy, however, must be informed by the numbers. Here is the WHO again:

Cause-of-death statistics help health authorities determine their focus for public health actions. A country where deaths from heart disease and diabetes rapidly rise over a period of a few years, for example, has a strong interest … to help prevent these illnesses.

The breast cancer campaign is a lot of fun. The pink ribbons are fun, the slogans are fun, and the ads feature … healthy breasts! If it were just about getting more women to have mammograms, it would all be good fun. Even early detection is discredited, however. See Our Feel Good War on Breast Cancer.

For every 2,000 women screened annually over 10 years, one life is prolonged but 10 healthy women are given diagnoses of breast cancer and unnecessarily treated, often with therapies that themselves have life-threatening side effects.

This emotional response to health policy is emblematic of what’s wrong with all policy in America today, from identity politics to economic policy. No one makes an effort to think critically. We just climb aboard the bandwagon with the ribbons and the celebrities.

See also: My Disease Isn’t a Cutesy Slogan

Update:  Now trending on Twitter is #NoBraDay, which embodies everything tacky and offensive about the campaign.

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No Country for Old Men

Today we heard a story on NPR about how old ladies who are poor don’t live as well, or as long, as old ladies who are rich. This insight, supported by two anecdotes, was the sole content of the story. We kept waiting for some analysis, a policy prescription, or even some statistics.

The story went like this. Old poor lady is cheery and upbeat, but has a chronic illness and no health care, so her life sucks. Meanwhile, old rich lady is drinking carrot juice and having a massage. Her life is good. This was ostensibly a story about health, but – what about old men?

We kept waiting for the host to ask what ought to be done about this, or whose fault it is, or what percentage of poor people are also old. Crickets.

This is what Jeremiah calls a “so sad” story. It leaves you feeling that something ought to be done, and no idea what that might be. This being NPR, though, we’re pretty sure it means more power for the federal government. Maybe they can confiscate some of the rich old lady’s health and give to the poor old lady.

Seriously, though, you would want to do a root cause analysis first, and then design a policy prescription that would actually help someone – and you would need more facts than just two lousy interviews.

Jeremiah would like NPR to collect anecdotes about other demographic groups, like young men. Down the street, here, are some strapping young men who play basketball all day long. Being out of work actually seems to enhance their health. Then, NPR could follow the one young fellow who works two jobs and spends four hours a day on the bus. He’s looking rather tired.

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Eating the Seed Corn

Jeremiah is not superstitious about genetically modified crops.  He understands the science, and he is aware that farmers have been modifying food crops since the dawn of farming – first through selective breeding, then hybridization, and now with molecular genetics.

Corn Crib

When Jeremiah was a boy, we would put up some of each year’s corn as seed for the next year.  A crib full of seed corn, drying in the sun, is an ancient store of wealth.  This is why we display dried ears of corn at Thanksgiving.  Thanks for this year’s bounty is coupled with hope for the next planting.

No one does that anymore.  Seed is bought new every Spring, from Syngenta, or Dekalb, or Monsanto.  In fact, it’s illegal to put up this corn, because the genotype is patented.  It is even possible, in theory, to make GMO corn sterile.

City slickers may have heard the expression, “eating the seed corn.”  In business, this means depleting an asset that you can’t renew – diluting your brand, for example.  What worries Jeremiah about GMO crops is not the science.  It is the concentration of power over our food supply.

Farming, by its nature, means self-sufficiency.  A narrow supply chain makes the food supply vulnerable to disruption.  Jeremiah is not superstitious about GMO, but he is terrified of empty corn cribs.

See also:  Top Five Myths of Genetically Modified Seeds

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Ironies Abound

This year’s budget impasse centers on the Affordable Care Act, a.k.a. Obamacare.  Defunding, delaying, or otherwise sabotaging the Act was the original goal of Tea Party Republicans.  Meanwhile, we read that implementing Obamacare is a disaster, from website to database.  If the Republicans were smart, they would sit back and watch it fail.

“It wasn’t designed well, it wasn’t implemented well, and it looks like nobody tested it,” said Luke Chung, an online database programmer.

If you’re responsible for this system, the impasse is a gift from God.  The president can “compromise,” buying you an extra year to fix it – and he can look statesmanlike in the process.  In fairness to the programmers, the Act is large, complex, and unsettled.

 “We have to pass the [health care] bill so that you can find out what’s in it.”

It’s hard to write code when nobody knows for sure what the system is supposed to do – which brings us to another irony.  According to The Economist, the law is a shambles because Ted Kennedy’s death forced the House to pass a draft bill that wasn’t quite ready.  This is cruel fate.  Not only did the liberal lion not live to see his dream fulfilled, but his very passing maimed the nascent reform.

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What Did You Expect?

Each side has its lunatic fringe.  We debunked a rightist one last month.  Here is an article from Bloomberg which traces the anti-Obamacare movement back to – wait for it – the Confederacy.  This is a clumsy  appeal to racism, and the argument is stretched so thin it actually ends up supporting the other theory of the civil war.

“There were zero Republican votes, so they are stiffed at that level,” said Merle Black, a professor of political science at Emory University.

Jeremiah’s own position on Obamacare is an eclectic one.  He is for the individual mandate, and against both employer and government provided insurance.   See here.

So, where was Johnson’s race card, when he pushed through Medicare and Medicaid?  The answer is that Johnson did the work.  He knocked heads, sold favors, and built a coalition.  Along the way, there was debate and a grudging consensus.  If you are going to enact landmark social programs, you have to do the work.

Jeremiah warned, back in 2009, against passing Obamacare on a strict partisan vote.  Republicans can now disavow any responsibility for the law and its consequences.  They have nothing to lose, and much to gain, from sabotaging it at every turn.  No one should be surprised at this result.

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How To Control Health Costs

Early in Jeremiah’s career, he was introduced to “Medicare optimization.”  Hospitals hire these consultants to review their Medicare claims, and make sure they’re billing the legal maximum.   Today, most hospitals have specialist staff and computer systems for this.  A cynic might say the hospitals are gaming the system, but – their financial health is at stake.

He also had the opportunity to work with a major health insurer, where the gimlet-eyed “utilization review” team scrutinized their hospital bills.  Who do you think does a better job of controlling hospital fees – a government agency with a price list, or a private insurer with a profit motive?

Patients may prefer Medicare where  its coverage is more generous, but that’s only because the government has “unlimited” money to spend.  Tax-funded generosity only encourages runaway spending.  This is the root cause of the housing bubble, the college tuition bubble, and the health care bubble.

But Jeremiah, you ask, won’t the hospitals just reduce their quality of care?  Won’t the insurers just pass on their rising costs?  Won’t the patient, at the bottom of this hierarchy, still get the shaft?  Not if the patient is also the customer.

All the pundits want somebody else to pay for your health insurance, whether it’s your employer or the government , but this is a scam.  The money still comes out of your pocket – or your grandkids’ – one way or another.   The scam is that you’re not calling the shots.  You can’t fire your insurer if they give you lousy service or skimpy coverage.  You can’t shop around for better rates, as you can with every other kind of insurance.

A few more reforms are needed to create a free market in health care:

  • End the tax deduction for employer-paid health insurance, so that everyone is shopping in the same market.  You pay for this “savings” in your taxes, anyway.
  • Reform the tort system, so that hospitals aren’t the prey of specialist lawyers.
  • Require everyone to buy health insurance.  This has recently been approved by the Supreme Court.
  • Allow insurers to consider your health when issuing a policy, just as life insurers do.  Competition with other insurers will limit the up charge for your smoking habit.
  • Allow insurers to compete nationally across state lines.
  • Allow prescription drugs to be re-imported, if they’re cheaper in Canada.

Finally, we should subsidize premiums for the poor and the sick.  This allows us to help them without distorting the market.

Competition will spur innovation and drive down costs in health care, as it has in every other industry.  Health care is only expensive because it is glutted with phony savings, perverse incentives, and special interests.  Insert “sclerosis” metaphor here.

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On The Pill

Pictured left is Sandra Fluke.  Ms. Fluke recently testified before Congress, insisting on her right to have birth control pills supplied free by her university, Georgetown Law.  The university doesn’t want to pay, because they are Catholic, and the Church does not condone birth control.

This line of reasoning is controversial, pitting women’s rights against religious freedom.  Jeremiah has a better line of reasoning.  It’s $125 a pack!  That’s what Ms. Fluke said in her testimony.  Is she crazy? There is a Planned Parenthood three stops away on the Metro.  They have the pill for $15.

There is a very good reason health insurance does not cover birth control.  It is not an “insurable risk.”  It’s a fixed cost – a certainty.  If you run a business and you ask your agent to cover the pill, he will simply tack the $15 – or more – onto your premium.

Ms. Fluke’s testimony is thoughtful and compelling with regard to women’s health issues.  The non sequitur is that someone else should pay.  If this were Jeremiah’s daughter, she could ride down to Planned Parenthood and pay for her own birth control like everybody else.  We also note that tuition at Georgetown is $47,000 a year, and that young lawyers like Ms. Fluke typically graduate into six-figure jobs.

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