Monday, March 29, 2010

Rebuttal Rage

Why I generally don't read or listen to political viewpoints opposing mine :

I formerly held the same views arrived at by the same manner of thinking so I'm already familiar with the faulty logic.
Everyone with whom I'm on speaking terms, is liberal. Therefore in any political discussion I get involved, which is admittedly rare since I do try to avoid them, all I hear are leftist arguments.
There are only so many hours in a day and there's much intelligent commentary to digest, so there's little time left for extraneous inanities.
I'm irritated seeing deeply flawed liberal viewpoints appearing in mass media - a forum they don't deserve.
Conservative observers keep current with liberal commentary and often refer to it in theirs. They read it so I don't have to.
The MSM is so ubiquitous, there's no escaping leftist viewpoints anyway. CNN in airports is one example. Another is Weather Channel blather about "climate change". Yet another is Yahoo News which appears on my home page.

A digression - Since Obamacare passed, Yahoo, initiating its electoral campaign for Democratic members of Congress who voted for the bill, has been headlining its benefits. Conspicuously absent have been any headlines trumpeting the recent revelation of one of the bill's hidden unpleasantries - the rescission of the tax break for corporate retiree prescription plans. (Remember Ms. Pelosi saying we have to pass the bill to find out what's in it? We're finding out.) The potential results of this provision? Lower corporate earnings, writeoffs, lost jobs, increased premiums and retirees' loss of their prescription benefits (or if over 65, being shoved into Medicare. Not exactly a cost effective development). It took exactly one day for bad stuff to start happening. The MSM hasn't noticed.
(For a lucid and entertaining explanation of that one noxious Obamacare provision, as well as a typically scathing assessment of the bill's total noxiousness, see the Mark Steyn (NRO) column linked below).

Anyway back to the topic - why I avoid leftist commentary.
A final reason - Reading (or listening) to these compels me to respond, which I do occasionally in this blog. And the time and labor involved can be quite substantial. (I obssessed over a lengthy response to an op-ed written by George McGovern appearing in the WSJ last year. The effort was necessary in order to thoroughly counter all of his distortions, misconceptions and bad advice).

I should have heeded my self-imposed censorship. In the letters section of the WSJ Friday (3/26), mixed in with sensible critiques of the Obamacare bill were three voicing support. And, I read them. Now I'm driven to respond. First, I'll reproduce two of the letters which are similarly themed.

In response to your March 22 editorial "The Doctors of the House":

Americans will soon realize the important benefits of the health-care reform package. Insurance companies will no longer be able to deny coverage for pre-existing conditions. They won't be able to cancel anyone's health insurance when the policy holder gets sick. They won't be able to impose lifetime and annual caps on benefits.

Democrats made these things happen, without a single Republican vote, and they are bringing health insurance to tens of millions more Americans. Republicans fought these basic, common-sense goals every step of the way and now vow to repeal the whole thing if they regain power. Go on, Republicans, explain to the voters this fall why you want to take away their health care. I dare you to do it without lying.

Todd Belknap

The passage of health-care reform is a great day for America. We are blessed to have a leader like President Obama, who can turn on the charisma when he needs to, but whose greatest strength is intelligence, patience and self-confidence.

Democrats are able to claim full credit for passing a bill that has many popular provisions. Soon it will become illegal to deny children coverage for pre-existing conditions. Adults will have to wait until 2014 for that protection but will at least get access to new high-risk insurance pools until then. Children will be able to stay on their parent's insurance plans through age 26. Lifetime limits will disappear, and so will an insurer's ability to cancel your policy when you get sick. Starting Jan. 1, Medicare patients will qualify for free annual wellness visits. And insurers will be required to pay out at least 80% to 85% of premiums in actual health-care reimbursements. Customers of insurers who pay out less will get rebates.

Glen Gillette

William Buckley once said that conservatism is the politics of reality. A corollary is that liberalism is the politics of fantasy. To liberals all government giveaway programs are beneficial. There are no tradeoffs involved. We are "getting" "popular provisions" - gifts from caring Democrats - and evil, heartless Republicans are trying to deny them. "Republicans want to take away our health care", as Belknap puts it.

First, and it's ridiculous to have to make this point, but U.S. "health care" is already in abundant supply and it is readily available. Surprising as it may be to the two letter writers, the vast majority of Americans already have health insurance and polls consistently show that well over 80% are happy with the quality of their health care. (A June 2008 ABC News/USA Today/Kaiser Family Foundation survey put the number at 89%).

Those policy features mentioned in the two letters - children's coverage to age 26, no lifetime limits, no annual caps on benefits, free annual wellness visits - are all common in employer provided policies and are all available to those purchasers of insurance policies who want them. That these policies may be prohibitively expensive to some is in large part caused by, again, government created restrictions and distortions in the health care market. (The mention of a cancellation due to illness provision is laughable. That's like a life insurance policy that expires a moment before a policyholder's death. No insurance company would long survive engaging in such scandalously illegal practices. If a policy contained such a provision, then its terms would have to be clearly stated. And anyone who would buy such a policy or was given one by an employer and wasn't aware of those terms, has only himself to blame).

The goal of health care reform should be to make quality health care affordable and accessible to as many people as possible. The goal is not to mandate universal health insurance coverage. Or - as will be the eventual result of Obamacare - universal coverage by a single payer, the government. (Monopolies are bad. Those operated by the ruling entity are especially so). These mandates do not "give people health care". They do not increase the supply of health care. They do increase the demand for it. Increased demand + static supply = increased cost.

Belknap and Gillette recite a fantasy. A childish one at that. Profligacy without repercussions; indulgence without consequences. And Belknap expresses indignation that, to this, there is resistance. The reality is that resources "given" to some must be taken from others. And, contrary to liberal mythology, Washington is not nearly smart enough to manage such a transaction in something as complex and immense as U.S. health care. Conservatives understand this and can anticipate the collateral damage such an undertaking would produce. I expanded below Mark Steyn's original list* of potential Obamacare ramifications, most of which are quite likely. (The final two, especially the last one, being more speculative, may take some time).

Longer wait times*, fewer doctors*, bankrupt hospitals, stifled innovation, fewer medical breakthroughs, more bureaucracy*, loss of privacy, higher taxation, massive IRS expansion*, bankrupt states burdened by Medicaid, explosive debt*, persistent unemployment, the end of the Pax Americana*, and global Armageddon*.

Republicans don't want to "take away our health care", Mr. Belknap. They want to make health care as affordable to as many as possible. Democrats want to compel citizens to adhere to arbitrary mandates put in place by politicians and unelected bureaucrats. Republicans favor allowing citizens free rein to exploit an open market unencumbered by government restrictions. Instead of shifting resources around, Republicans seek to grow resources. They want to take advantage of the great wealth creation machine that is capitalism. Republicans are not averse to income based government subsidies. But fostering economic growth is essential. Obamacare's failure is ensured more than anything by its hinderance of economic growth.

In today's NRO, Jay Nordlinger makes a salient point about the very term, "health care system".

I think this is one difference between liberal Democrats and conservative Republicans: They want a “system”; we don’t want any system at all. We just want . . . life. Healthy, democratic, free-market life.
To my knowledge, we don’t have a housing system, or a food system, or a clothing system, or a car system (although we have some government ownership of auto manufacturing). We just have — what? An economy. An open, American economy, in which people meet other people’s needs as they arise.

Nordlinger goes on to say that "system" is a word that central planners use. Like the ones who ran the former Soviet Union.

One other point. Gillette's letter credits Obama's persuasive powers for turning the tide. For allegedly convincing the American people to support the bill which in turn convinced reluctant legislators to vote for passage. In reality it was a only series of blatantly corrupt deals that bought just enough votes to allow passage by a slim margin. This was necessary, and the process took over a year, despite huge Democratic majorities in the House and Senate and a compliant press. Obama's "charisma" was not a factor. Since the health care debate began, he's given roughly 60 speeches on health care and support for the plan consistently declined.

Now to the third letter which works a different angle - the miserable state of American health care.

Your editorial concludes that "we fought this bill so vigorously because we have studied governmental health care in other countries, and the results include much higher taxes, slower economic growth and worse medical care." I, too, have studied health care in other countries. The dominant feature in which the U.S. is clearly superior is the cost of care, which runs about twice the cost of care in countries such as France, Germany, Canada and the U.K., which have varying systems of universal medical coverage. For this extra care the U.S. ranks 38th in the world in life expectancy, behind Cuba as well as the above four countries; we rank 29th in infant mortality, and well behind most European countries in survival of dialysis patients. It is challenging to find a desirable health-care statistic besides cost in which our care significantly exceeds that of our peers.

Curtis J. Krock, M.D.
Clinical Associate Professor of Medicine
University of Illinois College of Medicine at Urbana-Champaign

Before I get into the particulars of Dr. Krock's letter, and there aren't many, I want to reiterate a couple of points I keep making. First, Krock is enamored of countries that provide universal health care. Every American ally that does this, does it without the concurrent burden of providing for the bulk of its defense. We provide that service free of charge. There is no present model to predict the effect on those nations' economies, not to mention on their survivability, should the U.S. adopt an extravagant nationalized health care system, significantly decrease our military spending, and withdraw our defense umbrella. Those nations would then be forced to spend from their own budgets for protection from bad players like Russia, China, North Korea and Iran, for keeping sea lanes open for commerce, to support the international community's rare combat ventures to prevent mass slaughter, for transport and logistical capabilities for humanitarian relief efforts, etc, etc, etc. National Review had good reason to suggest that the U.S. military should be awarded the Nobel Peace Prize every year by default.

Second, I agree that our health care isn't as good as it can be. Its shortcomings are caused by government restrictions on the free market. Strengthening those restrictions will make it worse. The WSJ likened the progressive approach to the old Marx Brothers' joke - "The soup is terrible - And such small portions".

Krock correctly identifies the problem in the U.S. being the overall cost of health care. A problem that Obamacare will only intensify. What he doesn't mention is the cost to patients. This is from an article by Fred Barnes that I referenced last year.

A little-known fact: Out-of-pocket expenses by American patients amounted to 12.6 percent of total national health spending ($2.24 trillion) in 2007.
That's one of the lowest percentages of private out-of-pocket spending among the world's advanced countries--lower than Germany, Japan, Canada, and most countries in Europe, including those with government-run health care systems. Why do Americans get more and pay less? Because their insurance policies provide broader coverage than most government plans, says Tom Miller of the American Enterprise Institute.
(My emphasis).

This advantage to American consumers is the primary driver of high health care cost since people are unaware of just how much they're spending and don't take steps to control it. But it is an advantage. Our health care costs more because we get more.

Krock is very discriminating in his choice of supporting data, selecting only those that he thinks help his case. (And he doesn't provide much). He introduces a redundancy right at the start, by including both life expectancy and infant mortality, the latter being a major factor in the former. Krock, (as do all those trying to make the case for socialized medicine) overemphasizes the importance of life expectancy statistics. Those numbers are influenced by several variables other than health care including lifestyle, diet, culture, climate, genetic makeup, diversity of population and size of population. (Of the countries ranked above the U.S. in LE, none is even remotely as large. Japan with 127 million is second to the U.S with 309 million. Japan has a nearly homogeneous population and a better diet which helps explain its number 1 ranking with an LE of 82.6). And ranking the countries doesn't say much about their absolute values. For instance, the U.S. ranks 38th with an LE of 78.2. France with an LE of 80.7 ranks 10th. 2.5 years is worth 28 places. The fact is, most countries that are not desperately poor have closely bunched life expectancies. To get below a 70 year LE you need to go down to 116th place. (Trinidad and Tobago - A strange name for a country I've always thought. How about a country named "East Anglia and Vanatu with a little Morocco thrown in").

The culture factor includes the subfactor of teenage birth rates. With a rate of 41.9 per 1000 births, the U.S. is by far the leader in this category. For comparison, the U.K is at 26.1, Canada at 13.7, France at 11.7, and Germany at 10.0. The high U.S. teenage birthrate undoubtedly contributes to its infant mortality figures. As does its method of counting births. The following is from the Wikipedia entry on infant mortality.

The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR (Infant Mortality Rate) numbers somewhat lower and raises their rates of perinatal mortality. 2009, the US CDC issued a report which stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries and which outlines the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.

So if life expectancy isn't a good indicator of the quality of a country's health care, what is?

Survival rates for serious illness.

Dr. Krock cites just one example of this - survival of dialysis patients. Well, actually he cites no examples. Dialysis is a treatment, not a disease. Its success rate says nothing without information about who is getting treatment and why they're getting it.

The following is from a report on the website.

The U.S. has the highest rate of new (hemodialysis) treatment for ESRD (End Stage Renal Disease) among reporting registries worldwide. The U.S. accepts double the number (per million population) than does Europe, 40% more than Canada and 20 % more than does Japan.

Giving a specific treatment to substantially more high risk patients will necessarily increase its failure rate.

Anecdotal evidence is unscientific, but I'll include the following because it helps to illustrate the point. A few years ago, my father-in-law was hospitalized with (among other things) ESRD. He waited too long to be treated, for reasons other than economics or lack of due diligence on the part of his doctors. Though doctors believed it would be futile, he was put on dialysis anyway. He died shortly after and became another contribution to the low dialysis patient survival rate in the U.S. Chances are, in Europe or Canada or Japan, the treatment would not have been initiated. Tort lawyers have less influence on those countries' doctors' medical decisions.

Dr. Krock attempts to indict the entire U.S. health care establishment by citing only one disease criterion and it's a fallacious one at that. This is misleading and dishonest.

Then he adds, "It is challenging to find a desirable health-care statistic besides cost in which our care significantly exceeds that of our peers".

I'll ignore the hedging terms, "challenging" and "significantly exceeds", and just remark, Oh, really? (This is a family friendly site, otherwise I might have responded with something along the lines of, hogwash).

Here's some more of Barnes' article where he makes the case that the U.S. is unequalled, much less unsurpassed in the treatment of our most deadly afflictions, cancer and heart disease.

Private insurance, Medicare, and Medicaid cover most of the high cost of treating critical illnesses such as cancer and heart disease. And those are the ones in which the survival rates in the United States are significantly higher than in Europe or other countries. There are clinical data substantiating this. Two major studies (EUROCARE-4 and a study by the National Center for Epidemiology, Health Surveillance, and Promotion, in Rome, both published in the September 2007 issue of Lancet Oncology) were used to compare five-year survival rates for Americans and Europeans diagnosed with cancer.
For all cancers, 66.3 percent of American men and 63.9 percent of women survived. In Europe, 47.3 percent of men and 55.8 percent of women survived five years. Those are statistically important gaps.
And the survival rates were higher in the United States for the most common cancers as well. More than 99 percent of men with prostate cancer had survived in the United States after five years, 77.5 percent in Europe. Those with colon or rectal cancer survived at a 65.5 percent rate here and 56.2 percent in Europe. The rates for breast cancer showed a similar difference, 90.1 percent for Americans, 79 percent for Europeans.
Dr. Atlas cites a different set of results that underscore the same point: Your chances of living longer are better with treatment here. "Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom," he reports (see "Here's a Second Opinion," Hoover Digest online). "Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher."
Canada, whose single-payer health system is admired by many liberals, fared better but still trailed the United States. "Breast cancer mortality in Canada is 9 percent higher than in the United States, prostate cancer is 184 percent higher, and colon cancer among men is about 10 percent higher," according to Dr. Atlas.

In treating heart disease, Americans have far more access to statin drugs that reduce cholesterol. "Some 56 percent of Americans who could benefit from statin drugs .  .  . are taking them," Dr. Atlas wrote. "By comparison .  .  . only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them."

"Wildly successful" is the way David Brown of the Washington Post has characterized the transformation of heart treatment. "Today, someone having a heart attack who gets to a hospital in time is likely to get cardiac catheterization, angioplasty, the placement of a medicated stent, therapy with four anticoagulant drugs and, on discharge, a handful of lifetime prescriptions," he wrote. These are innovations over the past half-century.
The results are in.
"In the 1960s, the chance of dying in the days immediately after a heart attack was 30 to 40 percent," Brown wrote. "In 1975, it was 27 percent. In 1984, it was 19 percent. In 1994, it was about 10 percent. Today, it's about 6 percent."
These results are matched by the success in dealing with all heart disease. "In 1970, the death rate from coronary heart disease was 448 per 100,000 people," according to Brown. "In 1980, it was 345. In 1990, it was 250. In 2000, it was 187. In 2006, it was 135."

Cold numbers don't capture the breathtaking drama of what's happened. The transformation of heart care "has saved the lives of millions of Americans," Brown wrote. ".  .  . It is safe to say that almost everybody who has a heart attack wants the best treatment available. Nobody wants to turn back the clock." Nor should they, despite higher costs.
(My emphasis).

Dr. Krock claims to "have studied health care in other countries". Study it some more doc. You'll see that it falls short of ours.

All this just to respond to three measly letters. And measly is "le mot juste" as Mark Steyn would say.

And, bear with me. Just one more thing, speaking of Mark Steyn. I had to include this gem from his column linked below. (There are others included therein).

Incidentally, has the CBO ever run the numbers for projected savings if the entire CBO were laid off and replaced by a children’s magician with an assistant in spangled tights from whose cleavage he plucked entirely random numbers? Just a thought.

Barnes article


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