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Gerald

Astute reader, eh? Down below you rather bluntly misinterpreted what I said. My position is that rather that increasing the money spent in the medical system, some of the enormous wastes of it need to be curtailed. Randomly giving out millions with regular 'highway robbery' settlements doesn't help matters.

One of my points is that the market, while a powerful force, can easily waste money just as readily as the government. For instance, the advertising shouting wars. For the most part, the money on advertising is as wasted as government largesse on expensive aircraft parts (such as screws). Or, the countless medical 'treatments' that are either useless or pointless in the given situation. (from drugs that don't really work well enough to be worth the cost or side effects to of course hail mary end of life stuff to of course nearly all 'alternative medicine').

The market likes 'alternative medicine'. If you want to be paid more fairly and to see real medicine prosper, the market cannot be allowed to blow countless billions on treatments that don't work. I don't see how colon cleansing, fake vitamin tablets, or accupuncture is really any different than Vegas Casinos.

Think for a minute on this, good sir. You seem to believe that cutting back on regulations will somehow allow the 'free market' to transfer money to where it is needed : more pay and better equipment for people such as yourself (I assume it isn't just personal income that is at issue, I would imagine the latest in imaging equipment becomes exponentially more expensive) and more research on stuff that probably actually works (monoclonal antibodies).

Yet it is this very market that can be deluded into spending a large chunk of their money on completely spurious crap, from believing they need the latest most expensive drug thanks to advertising to of course AM.

CBB MD

So as not to avail myself to the charge of misinterpretation, let me address what you say, and try to punctuate this with reality, and my opinions.


“My position is that rather that increasing the money spent in the medical system, some of the enormous wastes of it need to be curtailed”

Short of a deific mind, there is no one who is smart enough to define well enough what is waste in the system and what isn’t. You believe that drug advertising is a waste. I tried to point out to you that drug makers advertise because it works. They advertise because it makes them money. Otherwise they wouldn’t do it. Therefore, if you curtail their advertising, they need to raise prices to compensate for lost profits.

It’s the unintended consequences that always ruin the good intentions of liberals and market meddlers. Don’t lose sight of the accomplishment of this drug industry that has taken us from the primitive application of molds, just sixty years ago, to genetically engineered, mass manufactured monoclonal antibodies that will cure your cancer. There may be waste in the system, but on balance they have worked miracles. Why would you want to risk meddling with their success?

My point is that if we start with a health care system that is the best in the world (and it has been) and provides the best health care in the world (which it does – if you subtract out the social and behavioral problems and issues that people constantly saddle it with), then we need to institute or enact systems or policies that leave the health care system intact and let the reforms evolve in a natural way. The reason the stock market is ultimately efficient is because it is the accumulation of millions of pieces of knowledge data applied constantly to the price of a stock, which, if left alone long enough in the market system eventually acts to set the price where it belongs. No single person or group of people is smart enough to consistently predict where a stock price is going because only the market (i.e. the accumulated knowledge and experience of millions of people and institutions acting on the market) can do this. And no single person or group of people is smart enough to set rules on the health care system defining what is wasteful (and so not allowed) and what isn’t for the same reason. The system is too big; it’s too complex; and, in this case, the risk of unintended consequences includes undermining or destroying the best health care system in the world.

So the risk of big, top-down reforms –- in my mind – is too great.


“One of my points is that the market, while a powerful force, can easily waste money just as readily as the government”

The difference is that the market is an always-changing, dynamic force that results in evolution. What is wasteful today will be weeded out tomorrow. The government is a glacial force. Regulations and legislations are not amenable to easy or fluid reform. Usually changes are only made by amending existing legislation leading to bureaucratic morass.

"Or, the countless medical 'treatments' that are either useless or pointless in the given situation. (from drugs that don't really work well enough to be worth the cost or side effects to of course hail mary end of life stuff to of course nearly all 'alternative medicine')."

Are you an expert in this? Do you know exactly to what you are referring in treatments that are useless or pointless (I mean can you delineate any but those that are most obvious to you – and are you therefore aware of how extensive or not or how clear-cut or fuzzy a problem this is)? I think the answers are both no. As medicine evolves – being the science it is– from the teleological approach of the past to a completely empirical discipline (as it will eventually be), useless and pointless treatments will become fewer, by dint of science; and, hopefully, by the natural winnowing created through market forces. But, as an expert in these matters, I can definitively tell you that it is supremely difficult to make these discriminations (useless versus not so useless versus marginally helpful versus sometimes any of the above –sometimes not). However, in a market-based system, if someone wants to pursue a marginally helpful alternative, it will be by their own choice and at some level, by their own expense. What will happen then? Really useless treatments will disappear.


"The market likes 'alternative medicine'. If you want to be paid more fairly and to see real medicine prosper, the market cannot be allowed to blow countless billions on treatments that don't work. I don't see how colon cleansing, fake vitamin tablets, or accupuncture is really any different than Vegas Casinos."

As for alternative medicine, the jury isn’t yet completely in – but reckoning will come if we let people become informed about their health (as they are informed about their mortgages and car loans and the odds of rolling a hard eight) and more responsible for the costs of their health care. When they have to decide on paying for phrenology versus paying for an MRI – phrenology will go away real fast.

People choose these options because they are uninformed. Part of any health care reform system I would support would be money spent on public education and awareness. MADD is a perfect example, as is much of the anti-smoking work. We don’t need prohibition to stop drunk driving; we need people to understand the consequences, make decisions based on facts, and to pay – in some way -- for the outcomes of their choices.

The problem with slot machines (not all of Vegas gambling), is that people to whom you give money specifically for health care (via Medicare and Medicaid) are taking that money and giving to Steve Wynn and who knows who else for no product and no benefit (it’s worse than spending food stamps on alcohol – at least whiskey is a product). People are bundling up your dollar bills and burning them, exactly because of what you advocate -- government stepping into the market place with top-down legislation that removes people from personal responsibility and enables them to waste your money.


"Think for a minute on this, good sir. You seem to believe that cutting back on regulations will somehow allow the 'free market' to transfer money to where it is needed : more pay and better equipment for people such as yourself (I assume it isn't just personal income that is at issue, I would imagine the latest in imaging equipment becomes exponentially more expensive) and more research on stuff that probably actually works (monoclonal antibodies).
Yet it is this very market that can be deluded into spending a large chunk of their money on completely spurious crap, from believing they need the latest most expensive drug thanks to advertising to of course AM."

You know, I would settle for no new regulations instead of trying to cut back on what the government has already done (remember the glacier?), as reversing health care legislation is almost impossible and certainly not worth the frustration, time and money, and hate mail. What I worry about is Hillary Clinton (or John Kerry or George Bush for that matter) stepping into the White House and pushing through a top-down systemic reform that creates a huge single-payer system for health care –leaving us dead in the water, like Canada. If that happens you will see the last great machine (The United States) of meteoric improvement in health care research and application, leading to better diagnostics and more effective treatments, go dark.

The answer is; instead, restore some of the lost market to this system. The ideas of Health Savings Plans and sliding tax credits for use in purchasing health insurance are good places to start. Certainly all Medicare patients need to be means tested so that Medicare is still available, but those who can afford to help defray the cost of their care are made at least partially responsible for those costs. Health insurance plans need to be dragged out of the workplace and into the marketplace so they can become more tailored and flexible to individual’s needs. Insurance needs to become less all-encompassing and more geared towards catastrophic and high-cost outcomes.

If I thought regulation was the answer or that more governmental meddling would work, or that legislators are smarter than the market, then I would advocate those actions as reforms. But they don’t work, and they won’t work, and everyone will pay much more – in more than wages or income -- if we let the system get fouled-up any further by wrong-headed governmental reform.

Gerald

The visual imagery you created by describing the actions of a free market is quite astounding. I imagine a vast swarm of insects that interact in evolving, temporary patterns that over time create quite impressive results.

But...there's a problem. These 'bugs', or individual people, have limits on them. The perceived value is just that - perceived, and so the actions of the free market have ALSO led to some ruinously destructive industries. One obvious one is in food. The most competitive food products are the ones that taste the best. Taste is a finely tuned sense for nutrition - but the products of the past couple decades pretty much hack that, with products that turn people into sick cows tasting the best.

Tobacco is another one.

So is gambling - it's the same reason. Most individuals DON'T understand odds or statistics, and addicted gamblers really DO believe the 'big score' IS 'overdue' and that their gambling is in fact going to 'pay off'.

Education? Yeah, right. That doesn't work for the vast majority of the population. We don't know of a way to make adults learn, or people who are addicted to a product. This is a sweeping statement...but for the general sense, it is true.

What WOULD work is obvious, sweeping regulation that is simple at it's heart. Scientific data on food needs to be collected that establishes some nutrient : calorie ratio and some sort of metric for measuring how well it satisfies appetite per calorie. Food below some minimum cannot be legally manufactured or imported into the country. Get caught smuggling, heavy fines are possible. (absolutely no possibility of imprisonment, however)

Same thing for tobacco products. As of some date, all tobacco products that contain anything else but nicotine and stabilizing and delivery agents conclusively shown to be non-carcinogenic would be banned. Same rules apply to smuggling. (get caught smuggling smokes, your car could be seized but you cannot be thrown in the pokey)

For drug companies, no spending more than some threshold (say 10%) advertising a patented drug. Think of it like a town fair : if none of the speakers are allowed to use megaphones, then no electricity is wasted as they try to out-shout each other.

Simple, effective rules are the name of the game here. No bureacracy, and you can do anything you want on the correct side of the legal line, and only face financial sanctions on the wrong side of it. This isn't government control, the free market is free to act the purpose is to keep the bees who are stupid from eating, smoking, and so forth poisons they can't perceive.

As for whether we "know" something to be true : can you in all honesty tell me there is ANY significant possibility that the above changes would break a productive sector of the economy?

CBB MD

You didn't address the magnitude of the advances achieved by the drug industry. That's a given.

Imposing "sweeping regulation" (the visual imagery you created of a cleaning lady is depressing) introduces an unknown -- and I am not willing to take a chance that you will get it right; because, as I said before, I don't think you or me or any group of people are smart enough to construct regulations that will trim the fat, mold the industry, and create good for all. The concept was tried in the USSR and it led to a generational tragedy. Europe has been over regulating their drug industries for the last ten years, and the result has been a deterioration of the drug pipelines and emigration of the industries to more hospitable shores – that’s a fact (see John E. Calfee’s testimony to the Senate Committee on Finance, of 4/27/2004).

Your suggestions are all highly theoretical and rather overarching and, I might add, completely impractical. I offered real, practical solutions that we could actually put into work next week (“The ideas of Health Savings Plans and sliding tax credits for use in purchasing health insurance are good places to start. Certainly all Medicare patients need to be means tested so that Medicare is still available, but those who can afford to help defray the cost of their care are made at least partially responsible for those costs. Health insurance plans need to be dragged out of the workplace and into the marketplace so they can become more tailored and flexible to individual’s needs. Insurance needs to become less all-encompassing and more geared towards catastrophic and high-cost outcomes.”).

This may be a generalization, but I have always been perplexed by the intellectual leadership of the left’s disparagement of the common man’s intelligence. By my reckoning, almost 84% of people are within or above one standard deviation of the mean in intelligence which means, to me, they are educable on many levels about almost anything. It is my opinion that considering people uneducable (or bovine) connotes a profound cynicism – the influence of which leads to the huge ethical and economical error of attempting to legislate good behavior rather than helping people understand risks and benefits -- then letting the people decide.

Did you know that on the television show “Who Wants to Be a Millionaire?” there is a part of the game where stumped contestants are allowed to ask the audience to choose the right answer, out of four choices, of a usually esoteric or arcane nature? The audience gets it right something like 95% of the time.

Markets have, at their base, people inputting individual opinions, data, and experiences. I’m not saying every outcome is always perfect, but it relies on an essential humanitarian principle, and it works – that’s proven.

paula

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