Cobb

One Hundred Forty Six Cheap Drugs From Walmart

It was 2005 when Walmart began it's low cost plan to cover generic prescription drugs. The following is the original list. You can get a 90 day supply of any of these for ten bucks.

Giving Unto Casarean

There's something very weird going on that I need some women's perspective in understanding. I just happened across a statistic that informs me that in 2005, about 35% of American women delivered via Cesarean Section. 30 years earlier the rate was about 5%.

WHY?

I have no clue as to why American women are increasingly having c-sections, but my instinct tells me that it's related to the sexual revolution, a set of social changes I find increasingly dubious. So I'm poking around and here is what I find. 

Canada

Nearly half of obstetricians in Canada say a woman should have the right to choose a caesarean section when there is no medical reason to warrant one.

The finding comes from a nationwide survey of maternity care providers that found many obstetricians appear to support the wide use of technology, despite a push by their own professional body to "normalize" childbirth and reduce Canada's rising C-section rate.

Forty years ago in Canada, five per cent of babies were delivered by caesarean. Today the rate is 28 per cent nationally, and more than 30 per cent in B.C. and P.E.I. More than 78,000 C-sections were performed in Canada last year.

Childbirth.org

What are some reasons that would mean I would need a cesarean?

Prolapsed cord (where the cord comes down before the baby), placenta abruptio (where the placenta separates before the birth), placenta previa (where the placenta partially or completely covers the cervix), fetal malpresentation (transverse lie, breech (breech can sometimes be managed by External Version, exercises or a vaginal breech birth), or asynclitic position), cephalopelvic disproportion (CPD, meaning that the head is too large to fit through the pelvis. This can also be over diagnosed, it can be caused by maternal positioning either from restraint to bed, lack of mobility or anesthetics.), maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc. (please note that these conditions do not ALWAYS mean a cesarean.)), fetal distress (This is a hot topic with the recent studies indicating that continuous electronic fetal monitoring increases the cesarean rate and does not show a relative increase in better outcomes. Discuss with your care provider how they define fetal distress and what steps are used to remedy the situation before a cesarean.), maternal exhaustion, and repeat cesarean, these are the main reasons for cesareans.

Katherine Beckett

This article uses the US debate over elective Cesarean section to re-consider some of the more contentious issues raised in feminist debates about childbirth. Three waves of feminist commentary and critique in the United States are analysed in light of the ongoing debate over whether women should be able to choose Cesarean for non-medical reasons. I argue that the alternative birth movement's essentialist and occasionally moralistic rhetoric is problematic, and the idea that some women's preference for high-tech obstetrics is the result of a passive 'socialization' into 'dominant values' is theoretically inadequate. On the other hand, the invocation of women's choice and appreciation of high-tech childbirth serves as a weak foundation for a feminist perspective on childbirth. By limiting their analysis to the rhetorical and discursive nature and functions of 'the medical' and 'the natural', poststructuralist critics of the alternative birth movement obscure the connection of these discourses to practices that have very different consequences for maternal and infant health and, most importantly, for the consumption of health care resources.

Matthews & Zadak

The alternative birth movement is a consumer reaction to paternalistic and mechanistic medical obstetrical practices which developed in the United States early in this century. Alternative birth settings developed as single labor-delivery-recovery rooms in the hospital or as free-standing birth centers. Both alternatives offer family-centered, home-like, low technological maternity care. In order to overcome physician resistance to non-traditional maternity care, alternative birth center policies eliminate all women who are expected to have a complicated pregnancy or delivery. Physician resistance to alternative birthing is publicly based on the issue of maternal and infant safety. Additional issues, however, are that physicians fear economic competition and resist loss of control over obstetric practice. This paper (1) traces the historical antecedents and social factors leading to the alternative birth movement, (2) describes the types of alternative birthing methods, and (3) describes ways in which the obstetrical community has maintained and rationalized dominance over the birthing process.

The best answer I could find comes from Childbirthconnection.org which I artlessly reproduce in full:

Reasons for the Rising Cesarean Section Rate

The following interconnected factors appear to be pushing the cesarean rate upward.

Low priority of enhancing women's own abilities to give birth
Care that supports physiologic labor, such as providing continuous support during labor through a doula or other companion and using hands-to-belly movements to turn a breech (buttocks- or feet-first) baby to a head-first position, reduces the likelihood of a cesarean section. The decision to switch to cesarean is often made when caregivers could use watchful waiting, positioning and movement, comfort measures, oral nourishment and other approaches to facilitating labor progress. The cesarean section rate could be greatly lowered through such care.

Side effects of common labor interventions
Current research suggests that some labor interventions make a c-section more likely. For example, labor induction among first-time mothers when the cervix is not soft and ready to open appears to increase the likelihood of cesarean birth. Continuous electronic fetal monitoring has been associated with greater likelihood of a cesarean. Having an epidural early in labor or without a high-dose boost of synthetic oxytocin ("Pitocin") seems to increase the likelihood of a c-section.

Refusal to offer the informed choice of vaginal birth
Many health professionals and/or hospitals are unwilling to offer the informed choice of vaginal birth to women in certain circumstances. The Listening to Mothers survey found that many women with a previous cesarean would have liked the option of a vaginal birth after cesarean (VBAC) but did not have it because health professionals and/or hospitals were unwilling (Declercq et al. 2006a). Nine out of ten women with a previous cesarean section are having repeat cesareans in the current environment. Similarly, few women with a fetus in a breech position have the option to plan a vaginal birth.

Casual attitudes about surgery and cesarean sections in particular
Our society is more tolerant than ever of surgical procedures, even when not medically needed. This is reflected in the comfort level that many health professionals, insurance plans, hospital administrators and women themselves have with cesarean trends.

Limited awareness of harms that are more likely with cesarean section
Cesarean section is a major surgical procedure that increases the likelihood of many types of harm for mothers and babies in comparison with vaginal birth. Short-term harms for mothers include increased risk of infection, surgical injury, blood clots, emergency hysterectomy, intense and longer-lasting pain, going back into the hospital and poor overall functioning. Babies born by cesarean section are more likely to have surgical cuts, breathing problems, difficulty getting breastfeeding going, and asthma in childhood and beyond. Perhaps due to the common surgical side effect of "adhesion" formation, cesarean mothers are more likely to have ongoing pelvic pain, to experience bowel blockage, to be injured during future surgery, and to have future infertility. Of special concern after cesarean are various serious conditions for mothers and babies that are more likely in future pregnancies, including ectopic pregnancy, placenta previa, placenta accreta, placental abruption, and uterine rupture (Childbirth Connection 2006).

Providers' fears of malpractice claims and lawsuits
Given the way that our legal, liability insurance, and health insurance systems work, caregivers may feel that performing a cesarean reduces their risk of being sued or losing a lawsuit, even when vaginal birth is optimal care.

Incentives to practice in a manner that is efficient for providers
Many health professionals are feeling squeezed by tightened payments for services and increasing practice expenses. The flat "global fee" method of paying for childbirth does not provide any extra pay for providers who patiently support a longer vaginal birth. Some payment schedules pay more for cesarean than vaginal birth. A planned cesarean section is an especially efficient way for professionals to organize hospital work, office work and personal life. Average hospital charges are much greater for cesarean than vaginal birth, and may offer hospitals greater scope for profit. 

All of these factors contribute to a current national cesarean section rate of over 30%, despite evidence that a rate of 5% to 10% would be optimal. 

Astounding!

Are American women that stupid? Given this information, the decline of marriage and the rise of abortions since the American sexual revolution, I would say that on the whole our nation has radically degenerated on the very basics of human survival. Good Lord!

But let us never forget in these days of 'health care debate' the final paragraph. The incentives that encourage this surgical procedure increase its market share. Here is something I think all conservatives should make an absolute stand on. Defund elective Cesareans.

A Conservative View of Health Care

A thoughtful reader sent along a Progressive view. I respond interactively. His piece is indented, my responses are in italics. My bottom line is this:

Whatever happens in Washington after the machinations, rich people like Michael Jackson will try to buy doctors to help them live against impossible odds, and they will die. Poor people will try to afford doctors to help them live against impossible odds, and they will die. And everybody that lives will take life for granted and try to tell the sick to live like the well, and Death will not be impressed at all.

http://www.nytimes.com/2009/09/03/health/policy/03care.html

Makes sense, but the left (correctly I believe) is getting suspicious of the gov supplements to lower HC costs for the poor.  They will amount, in the end, to cash payments to those who are driving costs up in the first place, namely the health insurers and drug companies, in exchange for promises to provide “savings” based on their own estimates of what the costs would normally be. 

This reminds me of saving the banking industry, driven over a cliff by greed, by giving them cash on the hope that they will perform so well and responsibly that they will pay the money back with a profit.  That was followed by an urgent need to reign in executive compensation in light of the awful political realities around bailout cash going to crazy executive bonuses.  And of course we “saved” the auto industry, driven over a cliff by incompetent leadership (whoever signed off on job banks was an idiot), by giving that same leadership tons of money on the hope that they will perform so well and make such great decisions that they will pay the money back.  Gm responded by shedding 4 brands (including some profitable ones), and then “reducing” their number of models from 48 to 34.  And of course Fannie Mae and Freddie Mac, whose function in the economy was risk management, failed to see the concentration of risks around mortgage backed securities and associated derivatives, and required a government bailout that is counting on them to make enough great decisions to turn the housing market around so we can get the money back.  So far, no good.

This is called throwing good money after bad. But it is the inevitable consequence of industrial policy. Once you decide to bailout an industry, you bail it out unselectively. You cannot enforce any law or priority that will ever be more thorough, exacting and fair than the law of supply and demand. You merely stimulate artificial supply or artificial demand, then sit back and admire your ability to juice the system. It doesn't change the people involved - it doesn't make them better businessmen, it only proves that they respond to incentives. In other words, you substitute one sort of greed for another. And in this case it is the greed for money provided by politics instead of the money provided by private enterprise. It's Obama money and those that get, get.

What is troubling about all of this, when looked at in aggregate, is that it smacks of Reaganism.  I hated Ronald Reagan.  Sure, he offered some entertainment value, but I thought his ideas were whack.  He delivered them so well, that he emboldened an army of whack thinkers who still threaten our political stability with their stubborn refusal to use reason to navigate our way through tough issues.  It is very hard for Sarah Palin to use reason.  Sarah Palin is, by choice, unreasonable.  Faced with a series of nation-threatening scenarios, her and her band of angry Appalachian dwellers have united with Rush Limbaugh to fight for the right to do nothing.  As much as I hate Ronald Reagan, at least he had the decency to surround himself with smart people.  Jim Baker earned my respect, as did Frank Carlucci and a number of other Reaganites.  But his ideological legacy is Sarah Palin, and that alone is grounds for an ass whoopin.  His political/economic legacy is the trickledown theory.  And that is what we are practicing right now, in spades.

Sarah Palin is what people used to call a useful idiot, but more importantly, she is the most successful ruse imaginable. Palin doesn't have to lead, just like Jesse Jackson and Al Sharpton don't have to lead. She merely needs to keep all eyez on her and speak an occasional obvious truth. Nobody who discusses Sarah Palin is serious. Nobody.
 

I don’t think progressives sit around dreaming of ever increasing government influence over the economy and our lives.  Shoot, we pay taxes too.  It was the actions of George Bush (Ronald Reagan with no vision, no charisma and a much tougher opponent than Grenada or Daniel Ortega), that lead directly to where we are now, with no choice but government intervention on a major scale.  Progressives do dream of better living conditions for everyone.  We do sit around and dream of reducing the disparities between the rich and the poor, not by necessarily bringing down rich folks, but rather bringing up poor ones.  We recognize that we need a bit more of rich folks money to do so.  But up until recently, we tried to find ways to directly impact the communities that were suffering.  Those days appear to be over.

Progressive dreams are dreams deferred. There is a reason for that, which is that they defy the order of things for the conceit of any temporary ability to make the weak strong, the poor rich, the foolish wise, the uneducated brilliant, the common extraordinary. Progressives revel in achieving social inversions, to afflict the comfortable and to comfort the afflicted, and they do so from a perverted sense of obligation to achieve through politics what their souls are too thin and selfish to accomplish through Christian charity. It is not enough for the Progressive to take his own money to feed the hungry, he must take mine too, and it is only through this sort of unity that the Progressive achieves satisfaction. This is why Progressives are never silent and have nothing to be proud of. Their struggle is endless. It is the struggle to politically steamroll everyone into their perverse universe where the poor are always noble and deserving and the rich are always suspect and corrupted. I for one hope that Progressive dreams shrivel up like a raisin in the sun. Progressives always hope that it explodes.

One of the most successful government programs is Medicare, which directly impacts the lives of poor people.  One of the least successful was welfare, which was implemented wrongly and then decimated too suddenly.  The democratic party seems so shaken by the reality of the failure of welfare, that we have caved in to Reagan’s point of view.  Indeed, Obama the candidate upset the party with some almost nostalgic references to Reagan’s impact.   Perhaps that explains why every major solution to date has smacked of trickledownism.  While the administration is trumpeting the success of the stimulus plan (which admittedly included a few bucks directly to citizens), unemployment continues to increase right alongside corporate profits.  The tax rebates are spent, the cash for clunkers program (a whopping $2.4 billion…less than 1% of what we gave to B of A) is over, foreclosures are still skyrocketing, yet we still have billions set aside in case any other executives fall upon hard times.

Medicare will not defeat death. Every major solution must smack of trickledownism because that is the nature of hubris. Those that seek to achieve the impossible are always selling their plans to people dumb enough to believe. There are no solutions to be had from the top down. There is only what you do from the bottom up. The very act of asking for a solution makes you a sucker.

With that as a backdrop, we are engaged in a bitter struggle over absolutely necessary health care reform, and progressives are being asked to give up on a government run alternative to the ridiculously expensive private solutions.  The reason the status quo fears a government run health care alternative is that it will most certainly lower costs (and profits) by its very existence.  Managed Health Care is a commodity now.  There are no more important innovations outside of electronic records (drug, equipment, and treatment innovations are being developed in academia and in laboratories, not corporate suites).  You don’t need armies of overpriced executives to make awesome business decisions on how to give Johnny an immunity booster.  Managed Health Care executives are spending all of their time trying to figure out how to increase the size of their yachts.  Trust me, I know a few of these people.  They are mostly older men with a penchant for good drink.  They don’t deserve to profit so handsomely from the suffering of poor and middle class folks (the rich don’t need health insurance, they pay directly).  A government run option is the best way to fundamentally rein in costs, which is the most important component that needs to be reformed.  Trickle down won’t work in this instance.  All these other gimmicks, which fill a few thousand pages of dense legislation, amount to compromises that progressives are not impressed by.

Don't take Viagra. Don't buy Anacin. Deal with your headache. Study anatomy. Birth your baby at home. Whose fault is it that people who own human bodies understand more about how their cars and their iPods work than how their knees and their lungs work? You don't have a right to be stupid about your body. But just like crime funds a prison industrial complex, such stupidity funds a hospital industrial complex. What else could you possibly expect from the clever people who spend maybe five more years in their lives studying the human body except for them to exploit the fools who do not?

I still support Obama.  His health care sticker is on my business website because he asked me to put it there.  I cringe at the thought of a McCain/Palin administration.  But I hate the compromises Obama is making.  I am beginning to wonder if it even makes sense to reach across the aisle when you know that the folks on the other side enjoy playing with venomous snakes.  I am beginning to think that a strident, ideological left is just what the doctor ordered in these crazy times.  If you like Reagan’s impact, don’t copy his whack ideas, copy his swagger, his command of the stage, his conviction.  It will get the drama-addicted media back on our side, and with that, who knows what we can do.  Right now, we look like suckers.

Washington is the wrong direction to look. So long as your orientation is "I need Washington to do X for me to lead a happy life", then all you'll ever do is compete with people who want Y, and Z, and R, and D, and Q, and P. In the end you'll only get F'd.

Handle your own business. 

Looking at the Public Option

One of the smartest and most successful guys I've had the privilege of knowing is engaging in our attempt at a non-partisan debate about the politically charged subject of healthcare reform. Snatching the discussion from Facebook to Cobb, we started with First Things, where the philosophy of rights and goods was, I thing a very good jumping off point about getting into the essential difference between the way the public sector rations goods and the way the private sector rations goods.

We start here with the following:

It’s a mistake to think of health care as a right. It is not a right; it is a good. Freedom of speech, by contrast, is a right, as is freedom of religious belief. They are privileges that inure to individuals as a consequence of the primordial right, free will. That is why we see them as inalienable. The exercise of these rights does not depend on any action of government, but rather on its inaction. Government may not legitimately interfere with their exercise, but nothing mandates that the government provide us with printing press or chapel.

Health care is different. It is more akin to the other goods which sustain life: food, clothing, and shelter. A well-ordered society exists to protect its members from the unlawful taking of life, and is structured to facilitate its members’ acquisition of these goods.

But health care differs from these other goods: First, health care is not absolutely essential for all people on a daily basis; second, there is an insufficient supply in this world to meet the demand of those who would have it. There is enough food in the world to feed everyone. Hunger and famine are the result of its inadequate distribution, not its absolute dearth. There are enough garments in the world to clothe everyone, and enough roofs to protect all from the rain. Health care, in contrast, is a far scarcer resource. Descartes once remarked that common sense is the most equitably distributed attribute in the world, because we never see anybody who feels he doesn’t have enough. Health care is not like common sense. We often see people who feel they don’t have enough, or at least can’t get enough at a price they’re willing or able to pay.

And then our debate ensued with I think these key important points:

@Kevin - Neither quotes from various democrats nor isolated historical examples fit my definition of a logical, data-driven argument (and your "bureacracy" and "socialist elite" labels come dangerously close to crossing my no name-calling or ideology line). If a mere existence proof was sufficient evidence of the flaw in the "public option to government takeover is inevitable" position, I would point out that the public option in higher education has been singularly unsuccessful in putting the private providers out of business. I'm not taking a side here ... I am just looking for a cogent, logical argument.

@Gary as the doctor in the article clearly describes how they make a decision to cover a procedure, medicine or treatment, in that decision they always factor in the loss of that customer' business, be it an individual or business and the potential for litigation if they don't approve something as medically "necessay". The gov't is subject to no ..such pressure and therefore if we go down that path rationing in whatever form will become less "rational". Whether it is simply a public option or evolves to single payer. I know I'm not addressing your exact question, but I hope you recognize the concern many of us have about the public option. If the gov't plan excludes some procedure, medicine or treatment, private insurance may choose to use that as rationale for exclusion and thereby negate the powerful market forces the good doc describes. Either way, the poor who may only have the public option, will suffer. I hope this makes some sense and you will take this as a sincere attempt.

The Bill HR 3200 in question can be found at OpenCongress: 

This is the House Democrats' big health care reform bill. Broadly, it seeks to expand health care coverage to the approximately 40 million Americans who are currently uninsured by lowering the cost of health care and making the system more efficient. To that end, it includes a new government-run insurance plan (a.k.a. a public option) to compete with the private companies, a requirement that all Americans have health insurance, a prohibition on denying coverage because of pre-existing conditions and, to pay for it all, a surtax on households with an income above $350,000. A more detailed summary of the bill by the House Committee on Education and Labor can be read here (four-page .pdf).

The New Health Care

I got a twitter about why people go to chiropractors for menstrual pain even though it doesn't work. The same reason people go to chiropractors at all, because they're friendly, they help and you like coming back. Nobody wants to go to the hospital. So I'm thinking....

The new health care is something you go to all the time, like once a month. And you like to go because the building is new and clean and there are young people there and people are having fun. And the lobby is airy and the people at reception are cheery and you go and your doctor knows you. But he's not just a doctor, he's a young person and you see the young people most of the time because most of the time there's nothing  seriously wrong with you. And there's no co-pay unless you miss three months in a row.

It's a pharmacy and a health spa and an urgent care facility and a spine center and a homeopathic joint and there are circles of wellness and you are in the outer circle where you are never too far from serious doctors, surgeons and specialists who work the inner circles. The entire place is built like the Pentagon, except its more like a capital G with concentric circles plus a way to get quickly to the middle if your problem is that serious.

The point is that you don't mind going and you are in constant contact with people who can quickly form teams to handle your case. Everybody is longitudinal.

--

Blackfive has tweets from a conference;

An Affirmative Action Health Care Plan

I realize that no Republican expects Obama to do much good for the country and that he will be experimenting and doing this and that to appease his constituencies, from the hopeful center to the manic left. But it just occured to me that there is something he could do to please me. That is to demonstrate his brilliance in the place he has unquestionable authority.

If Obama can revolutionize health care for the US Armed Forces, then maybe we in the private sector will stand up and take notice.

The current news isn't good of course, but it only makes it easier for him to prove that he can do the right thing.

Personnel costs represent the second largest "piece" of the budgetary pie; DoD plans to allocate $125 billion for personnel this year, roughly 20% more than it will spend on acquisition. 

While increased pay and bonuses account for some of that increase, the real growth has been on the health care side. According to Michael Fabey of Aviation Week, the Pentagon's health care budget has grown 144% since 2001. As you might expect, a portion of that growth reflects combat medical costs in Afghanistan and Iraq. But according to defense analyst Loren Thompson of the Lexington Institute, most of the increase can be traced to "the constantly escalating costs of routine medical services." 

In other words, the Pentagon is paying more to operate its own medical facilities and for TriCare, the DoD-sponsored health insurance program for military personnel, retirees and their dependents. That should come as no surprise, since other, government-run medical programs have experienced similar increases over the same period.

The health of the Army is said to be a high priority matter for Obama, and did manage to got everybody jumping up and down over his choice of Shinseki to head the VA. So here is an opportunity, fruaght with possibilities, that he can make the health care standards of the US Army a beacon of light to the world. The countdown starts today. If he can do it with that percentage of Americans who live to defend us, then he can do it for ordinary folks.

We tend to forget that there are certain times when innovation for the whole of society comes from the organizational principles of national armies. That includes command and control and a host of other beneficial concepts. It is a little known fact, for example, that malaria was destroyed in France by Americans because of the necessity of saving the lives of Allied troops during WW2. These are precisely the areas where the President has full reign and Obama should exercise his power in this way.

Just as Affirmative Action through the integration of the Armed Forces made huge changes in the way our civil society operated, social engineering of health care from the Pentagon is the President's prerogative. Let that trickle down.

Michael Porter, Strategic Thinking & Bundled Payments

Some cat named Michael Porter who teaches at Harvard said one of the first utterly comprehensible things I've heard about the problem with American health care delivery. It's piecework.

Essentially the problem is this, the business model of healthcare incents doctors and specialists to become more specialized. A patient is not a patient, so much as a target of a set of procedures that are delivered by a group (not a team) of various professionals who all want to get their piece in. A patient is not a project whose success or failure matters in terms of on-time, to spec and under budget. Such concepts are not applied to patients.

The next time you see a television show or movie in which the doctor comes to the patient and reads the chart extensively, think about it this way. They have no idea who that patient is nor have they spoken to the other people who does. They see the chart and the chart dictates a plan of action - which means the doctor has to think up a new leg on their trip through the system.

"OK we're going to run some tests". Which means, I think I can make a referral to this other kind of specialist who heretofore has had nothing to do with you, but I can only get his attention of we give him the results from this new branch of treatment I'm going to queue you up for. You pay for the tests and you wait for the specialist to pay attention. You cannot, ever, get two doctors in the room looking at the same patient at the same time, unless it's surgery. The business model does not support a customer focused organization.

Bundled Payments means, pay a team for patient outcomes. Here's 40 thousand dollars and 12 days. The six of you get together and figure out how to get Sally healthy again. Put your heads together. If you get her out in six days, there's a bonus. If you don't spend all of the money, you can roll it over into a reserve account and use it when you get a more complicated patient.

It's about the insurance, sure, but it should be about patient outcomes, and right now hospitals in America are running off a system of incentives that are not about patient outcomes.

Single Payer: Why?

One of the reputedly smartest guys I know who teaches at this little place called Harvard Medical School suggested to me the other night that one of the things we ought to seriously consider is a Single Payer system of health care financing. I'm trying to figure out why. As I look at the Wiki entry, it says what it sorta is and what it sorta is not, but it doesn't give me any indication why it is supposed to work other than to show that other countries do it, sorta.

What is fundamentally different about health care that makes it difficult to insure? I mean, nobody suggests that we have a single payer automobile insurance system or single payer home insurance. I think that's a relatively easy question. I think it's because single payer is an attempt to standardize pricing or otherwise force all the parties involved to work from the same set of assumptions.

One of the things I would like to see is a more transparent pricing mechanism and some standards, but I would rather see those standards evolve in the market. Part of the problem is that I'm not sure that insuruers or providers have any incentive to standardize.

If you're like me, you deal with this open enrollement & election benefits period once a year, in the fall. Then you probably never change your coverage unless and until you change employers. Which means you probably buy cars more often then insurance. We all understand that we can get taken if we're not accustomed to shopping for cars. So shopping insurance, being a rare thing, is something we cannot get a good sense of as consumers - not like other more frequently purchased goods. Again, I think this fact plays to the insurers resistence to standards.

I also understand that there are factors that make doctors more or less likely to practice in a state and that this plays into the quality of health care available.

Is it possible to have a Single Payer system without government monopoly control of the entire process, or are they tantamount to the same thing? Have all Single Payer proponents despaired of a private solution?

McCain: Health Care

from the McCain08 Site:

Reforming Health Care for All Americans. Real reform will put families in the driver's seat of our health care system. The road to reform does not lead through Washington and a hugely expensive, bureaucratic, government-controlled system. John McCain will harness competition to offer more affordable insurance options for as many Americans as possible, leveraging the innovation and cost-effectiveness of our nation's firms to put an end to existing rigid, unfriendly bureaucracies. He will build a national market where insurance is more available, portable, and accessible across state lines; in which patients' rights are respected and their information under their control; and one in which people may save more in tax-exempt Health Savings Accounts. He will assist those who need help in getting private insurance.

John McCain will provide incentives for a national market - including the reimportation of pharmaceuticals - that offer greater transparency about effective patient care, options for preventative care and therapies, and prices so that competition makes it easier for families to navigate toward quality and low cost. He will demand reform to medical malpractice laws to curb abusive lawsuits that squeeze doctors, prevent innovation, and drive up the cost of health care. We need more transparency of prices and quality measures so that patients can make informed choices.

John McCain is willing to address the fundamental problem: the rapidly rising cost of U.S. health care. 

• Bringing costs under control is the only way to stop the erosion of affordable health insurance, save Medicare and Medicaid, protect private health benefits for retirees, and allow our companies to effectively compete around the world.
• Families should be in charge of their health care dollars and have more control over their care. We can improve health and spend less, while promoting competition on the cost and quality of care, taking better care of our citizens with chronic illness, and promoting prevention that will keep millions of others from ever developing deadly and debilitating disease.
• While we reform the system and maintain quality, we can and must provide access to health care for all our citizens - whether temporarily or chronically uninsured, whether living in rural areas with limited services, or whether residing in inner cities where access to physicians is often limited.
• America's veterans have fought for our freedom. We should give them freedom to choose to carry their VA dollars to a provider that gives them the timely care at high quality and in the best location.
• Controlling health care costs will take fundamental change - nothing short of a complete reform of the culture of our health system and the way we pay for it will suffice. Reforms to federal policy and programs should focus on enhancing quality while controlling costs:
• Promote competition throughout the health care system - between providers and among alternative treatments.
• Make patients the center of care and give them a larger role in both prevention and care, putting more decisions and responsibility in their hands.
• Make public more information on treatment options and require transparency by providers regarding medical outcomes, quality of care, costs, and prices.
• Facilitate the development of national standards for measuring and recording treatments and outcomes.
• Reform the payment systems in Medicare to compensate providers for diagnosis, prevention, and care coordination. Medicare should not pay for preventable medical errors or mismanagement.
• Dedicate federal research on the basis of sound science resulting in greater focus on care and cure of chronic disease
• Give states the flexibility to, and encourage them to experiment with: alternative forms of access; risk-adjusted payments per episode covered under Medicaid; use of private insurance in Medicaid; alternative insurance policies and insurance providers; and, different licensing schemes for medical providers.
• Build genuine national markets by permitting providers to practice nationwide. 
• Promote rapid deployment of 21st century information systems.
• Support innovative delivery systems, such as clinics in retail outlets and other ways that provide greater market flexibility in permitting appropriate roles for nurse practitioners, nurses, and doctors.
• Where cost-effective, employ telemedicine, and community and mental health clinics in areas where services and providers are limited.
• Foster the development of routes for safe, cheaper generic versions of drugs and biologic pharmaceuticals. Develop safety protocols that permit re-importation to keep competition vigorous.
• Pass tort reform to eliminate frivolous lawsuits and excessive damage awards. Provide a safe harbor for doctors that follow clinical guidelines and adhere to patient safety protocols.
• Protect the health care consumer through vigorous enforcement of federal protections against collusion, unfair business actions, and deceptive consumer practices.

John McCain believes that insurance reforms should increase the variety and affordability of insurance coverage available to American families by fostering competition and innovation.

• Reform the tax code to eliminate the bias toward employer-sponsored health insurance, and provide all individuals with a $2,500 tax credit ($5,000 for families) to increase incentives for insurance coverage. Individuals owning innovative multi-year policies that cost less than the full credit can deposit remainder in expanded health savings accounts.
• Families should be able to purchase health insurance nationwide, across state lines, to maximize their choices, and heighten competition for their business that will eliminate excess overhead, administrative, and excessive compensation costs from the system.
• Insurance should be innovative, moving from job to home, job to job, and providing multi-year coverage.
• Require any state receiving Medicaid to develop a financial "risk adjustment" bonus to high-cost and low-income families to supplement tax credits and Medicaid funds.
• Allow individuals to get insurance through any organization or association that they choose: employers, individual purchases, churches, professional association, and so forth. These policies will be available to small businesses and the self-employed, will be portable across all jobs, and will automatically bridge the time between retirement and Medicare eligibility. These plans would have to meet rigorous standards and certification.

John McCain Believes in Personal Responsibility

• We must do more to take care of ourselves to prevent chronic diseases when possible, and do more to adhere to treatment after we are diagnosed with an illness.
• Childhood obesity, diabetes and high blood pressure are all on the rise. We must again teach our children about health, nutrition and exercise - vital life information.
• Public health initiatives must be undertaken with all our citizens to stem the growing epidemic of obesity and diabetes, and to deter smoking.

Two Tidbits About Health Care

Buckley says that it's rather foolish to suffer the delusion that health is free. Health is not free. But the very idea that it is permeates American society. And I think it is because of this illusion that health can be free, that Americans believe that good health and consequently good health care can be gotten cheap.

Secondly, with respect to the health care industry itself, I cannot think of one great leader. Not in the history of America have we had anyone who stood as a captain of that industry to which we all looked upon with admiration.

It is with these two notions that I will pursue the question of health care in the upcoming week.

A Middle Class Squeeze

There's a family of five who cannot afford healthcare insurance. Who cares?

Here are the details. Dad works. Mom stays at home. Dad pulls 70k per year. Healthcare insurance costs $500 a month. They have a negative amortization loan on a half-million dollar house in Orange County California, one of the wealthiest counties in America. Their son can't play football. Too much risk of injury.

There is a government program for which they cannot qualify because their income is too high. And yet they scrimp and live simply just to afford their mortgage payment. They have been without health insurance for over a year.

Is this a problem?

The Frayser Plan

Dr. Louis Frayser is a family friend and a great man. He's one of those incredible old guys who remembers his great grandparents, which in his case means people born in the mid 1800s. His family is from Macon Georgia, and generally speaking he knows a thing or two. He's just what you would expect from an old country doctor who makes housecalls, a heart of gold. He can be an irascible old coot, but what I love about Dr Lou the most is his insatiable curiosity and willingness to be philosophical. We've had some really fascinating theological discussions - he's one of those people for whom you can't wait to find their considered opinion.

Imagine my surprise when he told me last Sunday that he started a blog and has put together a proposal for Universal Health Care, among other things.

Well it turns out that his blog isn't exactly bloggy, but it is on the web and his proposal is a rather massive piece. Not blog length at all, but rather comprehensive. So I have promised to pub him up and give him the benefit of my ear and popularity. Moreover since I'm trying to figure out the whole thing, I've decided to take pieces of his thesis apart for analysis and discussion. To that end, and towards a new direction at Cobb, I'm adding the category of Health Care.

I put the entire proposal up at the Conservative Brotherhood site, and Frayser will be my first expert to help me digest this entire subject.  You can't help but love the audacity of his plan:

It is almost common knowledge that our health care system is in a state of chaos. Dominated by governmental bureaucracies and the bureaucratic maze created by the various mega health maintenance organizations, insurance companies and a supporting cast of hospitals, pharmaceutical companies and laboratories. Costs spiral and our federal deficit swells. Worse yet, those needing and seeking health care are often put off, delayed or denied the needed care. The bean counters in the various bureaucracies decide who gets care and, if they get care, what care consumers (patients) get. Medicare and Medicaid costs, including pharmaceutical costs, are like a runaway train. These costs comprise the lions� share of the federal deficit. This has been well documented in many writings published in the New York Times and other major papers and by television money reports. Efforts to positively, definitively, and permanently correct the health care problem have failed. To date, changes in the system proposed by politicians and others have been little more than Band-Aids applied to a wound hemorrhaging money. As a result, the taxpayer is drowning in red ink. China, who floats a huge piece of our deficit, has a choke hold on our economy.

The purpose of this proposal is to offer a completely new approach to health care in our country. This system rests upon the following principles:

A. The principle of competition and right to choose, are central to American capitalism and central to this proposed health care system.

    B.    The concept of �free care/free medicines� is completely and permanently eliminated from this system.

C. Revision of present methods of reimbursements that will result in a major, major reduction in health care costs and hence a major, major reduction in the federal deficit.

D. We can provide universal health care for every American citizen. However, to date very little discussion has been offered regarding the role of universal health care in the reduction of health care costs. I propose to do so.

E.    Relieve private industry of a significant portion of health care costs for employees.

F. We should support an existing mechanism, community clinics, for providing comprehensive health for everyone including those indigent persons who don�t qualify for universal health care.

It is my belief that this proposal, which rests on the principles cited, will remove the costly nightmare that is today�s health care system. The specifics of the system now follow.

And so, beginning next week, I'll start talking about health care and setting up a framework for analysis and understanding.

After All, It's Only Money

If you believe the Beatles, then all you need is love. If you ask the New York Times, all you need is money. Somewhere out there is 1.3 Trillion dollars just floating around. All we need to do is take it from the bad people and give it to the good people and we can solve all of our problems.  Aren't we fortunate to have the genius of the Democrats to tell us exactly which pockets to pick in order to deliver utopia? Vote for Hillary!

The problem is, of course, we already voted for the Clintons and they didn't deliver the first time around.

Universal health care is a great idea. I like it, seriously. But we obviously have to deal with the people who are in the business of delivering it today. They're not in Iraq. One thing has nothing to do with the other, but who knows, maybe that's what Obama or Christopher Dodd or Edwards might promise. We'll just convert Martin Marrietta into a health insurance company, right?

Putting the annual cost of war in perspective means evaluating the cost of not making war on your enemies, period. How about some honesty around here people?

Freak Accidents & Municipal Budgets

It's almost an axiom that wherever you find tornados, you find trailer parks. And every time we see that poor white woman tell us in her twang that "it sounded like a train coming" we secretly laugh at her foolishness just for living there. Some of us laugh more openly, but the same harsh question persists.

Why do people in Malibu live on the edge of the mountain if they know there are mudslides?

Why do people in the Oklahoma panhandle live there if they know that tornados are going to hit?

Why do people on the Florida coast put up with hurricanes year after year.

Why do people live in California at all, much less in high rise buildings when they know that the Big One is going to come?

Hell, why are any of us living outside of Alaska when we know global warming is coming? That's a question I ask of all tree huggers, and sometimes I wish I could buy them the plane ticket.

We've seen this before. You and I still remember the movie, now out on DVD called 'The Day After Tomorrow'. There is nothing quite so arrogant as a lone scientist who bets his career on a once in a lifetime event. That's the whole Michael Moorian point dramatized via the swell-headed actor who gets to blame the Administration for not paying attention to science.

Last night I heard the most hate-filled screed against the 'Bush Crime Family' on the radio. This jerk wanted nothing more than the full wrath of a hurricane to land directly on the head of Michael Chertoff. It was an astoundingly furious tirade. You could just imagine that if he could control the weather, he'd order a Category Five to order. Except it can't be done. And we all know it.

Ask yourself right now, how much money are you spending on insurance. Do you have flood insurance? Earthquake insurance? Tornado insurance?  People are rational aren't they? Then how is it that people who have no health insurance spend money on a car and car insurance when a car is more likely to kill them than anything else they own?

People take risks.

Furthermore taxpayers make priorities. And the priority is clear. We Americans don't save money for a rainy day. We don't take our municipal budgets and spend them on infrastructure. We don't think that the work of the Army Corps of Engineers is glamorous or deserving of our political attention.

I don't have to tell you that there are people who would like to conjure up genies and spend money in retrospect. It's not going to happen. The people have voted with their feet.

Heartache

I spent the entire morning and half of the afternoon in the Emergency Room over in Torrance today. I'm fine, but I sure was mad this morning.

I spent last evening rushing around to put together a slide show for this Sunday's after service coffee hour in commemoration for my recently departed grandfather. Pops came by with his DLP for the slideshow and I'd only put in about 60 pictures out of the 150 that I need for the powerpoint. So I'm grumbling around trying to get that done when I start getting these zaps through my chest.

I'm not saying anything about it, but they hurt. It's like somebody sticking a voodoo needle in and around my heart. It's real sharp for a second and then it disappears. Several times this happens. The kids are being complete pests. Everyone is getting on my nerves. I can't wait until I get them all in bed so I can relax. Brother, the stress is finally getting to me.

So finally the spousal unit gets home (we are back to being a two entrepreneur family, god help us) and we're ready to crash on the sofa and watch The Sheild. Ouch. It happens again. About six times that hour. After the show, I google up chest pains. Now I'm convinced its Angina.

My wife's father dropped dead of a heart attack when she was a young teen. I ain't going out like that, but all evening I'm trying to think whether or not I should go to the emergency room. I'm not exercising. I'm not short of breath. The pain doesn't go to my arm or my neck. I can handle the pain. In fact, this is what bothers me the most. What if I've already had a mild heart attack and I'm walking around on 80% heart muscle? I cannot afford to be sick. I cannot afford to drop dead.

I go to sleep without speaking.

Wrench in the Wal-Mart Theory

Reader Frank had this to say about the supermarket strike:

However, what we've found through our discussions with industry experts, and by examining the data of countless chains, is that customers traditionally won't travel much more than a three mile radius to get their mainstream groceries.  This is the traditional geographic market division for supermarkets.  Sometimes freeways, rivers and railroads make the geographic boundaries.

This presents a serious challenge for Wal-Mart. Indeed Frank went on to inform me that it's a standing challenge for Target Greatland as well. These big box format stores need lots of real-estate. So geographically in Southern California, there aren't a lot of locations amenable to the format, especially in Los Angeles. I can attest to this fact as we are Costco shoppers; it requires a bit of discipline when we go for those items once a month several miles out of the way.

In strike news there are no talks or negotiations underway. Safeway (Vons) is taking the hardline and saying there will never be a better offer on the table. City Councilmen are taking sides. The LATimes comments on the benefit package:

The strike was called over employer proposals to cut health care and pension benefits and create a substantially lower tier of wages and benefits for new hires. The proposed contract � rejected by 97% of voting union members � also would allow stores to shift union work to outside vendors and to open nonunion stores.

Top wages for store employees range from $7.40 for baggers to $18.19 for meat cutters. Union officials say the average is about $12 an hour and that most workers are part time.

All employees receive fully paid family health benefits. The grocery chains say workers must start shouldering some of these costs, citing escalating health insurance expenses and competition from nonunion stores. Under the proposal, workers would among other things have to contribute to premiums, paying at least $780 a year for family coverage.

That's a very reasonable figure, but I suspect it may not characterize the median expense.

Other stores are doubling their reciepts, especially the upscale stores like Bristol Farms and Whole Foods. On the discount end, Costco saw a 10% jump in sales Monday. As for our family, we've been learning about the discounts for quite some time now. There's a surprising lot of shopping that can be done at the 99 Cent store. Everyone is talking about Trader Joe's as a first among alternatives, and there is always 7-11 for staples.

Sister mentioned that when the Detroit Free-Press went on strike, customers seeking alternatives didn't return and the paper has never been the same. Likewise speculation as to where customer loyalties will go is in the air. Most people I talk to expect that prices will be higher at the affected stores (almost 800) when this mess is all over.

Right now there is no end in sight, and so now this weekend more and more people are going to be personally affected. Decisions are being made. We're relying more on our alternatives, but as I said, we're in a tight money situation and haven't been going to Von's (our regular) for quite a while. It's tough all over.

Bitchfest '03

I'd say that Cruz Bustamante got in the best barb, but that's only because I was reading. I had other things to do rather than watch a televised debate, if that's what you'd call it.

BUSTAMANTE: You're one to talk about photo ops, Arnold.

There's really not much to say here. I like that Bustamante condescended to AS, and I'm rather surprised that Arnold was only barely above literate on the issues. It might not have showed up on camera but when you read the transcript it's amazing how many time he says 'I don't know what you're talking about.'

Huffington proved herself to be little better than an excellent analyst and provocateur. I wouldn't follow her lead into a grocery store.

Camejo made a good showing, and a fine command of the issues and of himself. Too bad he really believes in the loony toons lefty reactionary stuff. I think he did an admirable job of not showing how much he hates capitalism. His words on taxation were the best of all of them.

Bustamante should have been talking down to everyone, and he could have portrayed himself as leadership material. Nobody pinned Gray Davis on him like they should have and he squeaked out of it, but he didn't really capitalize.

McClintock was entirely predictable but I think he did better than he deserved to do. So the Republicans are in a really big stew now, because Arnold stunk up the joint with his diversionary tactics.

All of them got bogged down on health insurance. Camejo won that one for clarity. Arnolds tangents were really sloppy and didn't succeed in print in bringing up new issues that the others couldn't reject. I'm for kids, just doesn't cut it.

I predict that Bustamante goes up, Camejo goes up, McClintock goes up, Huffington falls off, and Arnold loses points. Republicans tear out their hair, and the State of California slouches towards armageddon. Bill Simon must be kicking himself bigtime.