Thursday, September 10, 2009

DoctoRx Comments on the President's Healthcare Speech and Goes Where Few Politicians Have Gone Before

The President has addressed Congress and the American people on health care reform; click HERE for the text of his speech. Also, you may click to see the Republican response (given by a heart surgeon).

One thought I have is on the following quote from the speech:

The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies – subsidies that do everything to pad their profits and nothing to improve your care. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.

Fraud and waste are not easy to eliminate, and "waste" is not even easy to define. These should be addressed ASAP and need not be part of sweeping health care reform. Medicare's famously low overhead administrative costs are part and parcel of not requiring pre-approval for tests or alleged surgeries, thus allowing fraud to exist on a significant scale. In my part of the country, Miami, Medicare fraud is a major industry. Eliminating it would put a lot of people on the dole!

So far as reducing subsidies to managed care companies: go for it! But once again, legislation on that issue could already have passed Congress. Despite being thwarted on broad healthcare reform, President Clinton moved successfully against Medicare HMOs, saving the taxpayer muchos dineros. Medicare HMOs are parasitic creatures, as are essentially all HMOs. If they are really so efficient, let them prove it by asking for no subsidy.

Regarding "preventive care": This term is often misused. A mammogram is a form of cancer screening; an abnormal mammogram is not designed to prevent cancer but rather to catch it early. In any case, I believe that early detection of cancer, diabetes, high blood pressure, etc., is a very good thing; but I also believe that it is expensive. Long ago, it was taught that long-term treatment of mild high blood pressure added but one year to a person's expected life span. Is this a good thing? Yes. Does it cost more money than it saves? Presumably, yes. I do not believe that the President has been accurately advised when he insists that preventive care is, say, revenue-neutral. I for one would much rather see my government have spent money on preventive health care than huge sums saving stockholders and bondholders of giant financial conglomerates from losses, but you can't always get what you want, and the good things that this President wants to do for the uninsured simply cost money. One reason for skepticism of his plan in certain quarters is the recollection that Medicare was supposed to cost small potatoes when it was created. Whoops!

Whether it's a social program or a war in the Middle East, people remember who promised wrongly at the outset, no matter whether or not the promise was made in good faith.

Now to the main event. Believe it or not, there are more important health care fish to fry than fiddling with insurance plans. Here goes:

The single most important thing that the Administration can do right now in the field of health is to create, support and enhance programs to combat the obesity and overweight problem in this country. The next most important thing is to stamp out cigarette smoking. Perhaps the President will lead the way in that regard. Mr. Obama should use the bully pulpit to aggressively promote health habits that will actually prevent heart disease, smoking-related cancer and lung disease, and the like. If he wants to really get with the DoctoRx program, the President will promote vegetarianism (or modified forms thereof) as part of a program both to achieve/maintain good health and to promote environmental greenness.

None of these initiatives requires a 4-year waiting period. There are numerous specific things that can be done by executive order, legislatively, and rhetorically to fight the good fight to get the pot bellies off Americans, prevent children from growing big bellies, and make cigarettes obsolete.

Those are just some initial goals. What about even tougher laws against drunk driving? What about persuading Hollywood to present getting drunk as unfunny and worse? Etc. and so on.

Where all sides in this debate have missed the main point is that a large portion of the ills that American flesh is now heir to are preventable by life-style improvements that cost both the individuals and the taxpayer less than nothing, but rather pay for themselves financially many times over. Can this unhealthy society change?

Yes. It. Can.

But. It's. Not. Easy.

Fitness first.

Copyright (C) Long Lake LLC 2009


  1. To the Middle class and Poor, that Surgeon is just another rich person who wants more money...No one trusts him...and it's dumb to put a surgeon on TV after that, seeing thats the guy giving us expensive bills that the insurance companies treat us like crap for. The Douche.. All you guys trying to filibuster the REAL American people are tearing this country up from within, and making us look bad the (needs to be replaced) congressman who shouted during the elected leader's address to the REAL American people.

  2. I was having the same conversation with someone who is a health care policy consultant here in Washington DC about two weeks ago. You want to save a ton of money on health care; get rid of the BS food pyramid from the FDA with a real one that has fruits and vegetables at the bottom and enriched grains, dairy and red meat at the very top. Also, give a tax credit for gym memberships.

  3. How about eliminating class action lawsuits and malpractice lawsuits except for gross negligence? How about stopping pharmaceutical advertising except to the medical profession? I have never seen an ANALYSIS of health care costs to see what categories are rising faster. I am an engineer and I would never dream of creating a system without an analysis of what currently exists in order to understand the cost and risk factors.

  4. Fraud has to some extent already been addressed - Obama has tasked Lanny Davis at the Crim Division with hiring a new head for the Fraud Section, and hiring around 20 new trial attorneys who will focus on Medicare/Medicaid fraud. I think they have already increased the Fraud Section's budget to reflect these priorities.

  5. Re: obesity - THANK YOU! Nobody seems to be discussing the PWC report that estimated obesity costs at $150 billion. They could easily levy taxes on unhealthy foods/beverages the way they do cigarettes and alcohol. But taking on both the food lobby and insurance lobby at the same time? Methinks many dems will discover their inner 'moderate'

  6. There are further levels of complexity in all aspects of health care, but I agree with the idea we should change such public policy that is within the purview of government, such as influence over public education. Physical fitness in public schools could easily become a new priority.

    I'd like to help inform one bit of the health care picture you briefly address though:

    "I do not believe that the President has been accurately advised when he insists that preventive care is, say, revenue-neutral."

    This question isn't a matter of speculation. There is research, and surveys of research.

    In short, for net medical costs (alone) over time, about 20% of "preventive" care is "cost-saving", that is it reduces net medical expenditures over time. Of course, medical expenditures alone are not the entire cost picture of illnesses, which include such further real costs as lost work days, and even such as disability payments.

    But in medical costs alone about 20% of preventive care is 'cost-saving.'

    Another significant portion of "preventive" care buys life-years at relatively low cost compared to average medical treatment costs per life-year gained.

    And, of course a significant, large portion of "preventive" care increases net medical cost significantly or has relatively high cost per life-year gained.

    But...if we created incentives for the types of preventive care already proven to reduce costs, and further incentives for the portion of preventive care that buys life-years at relatively low cost, and did not incentivize the remaining, expensive preventive care, then one could say accurately, backed up with data and proven experience, that this new incentive structure for preventive care would be "cost effective."

    Its an interesting subject.

    Here's my analysis of the CBO letter on this question:

  7. Thanks for a thoughtful post.

    "The single most important thing that the Administration can do right now in the field of health is to create, support and enhance programs to combat the obesity and overweight problem in this country."

    I was recently on a panel with a group of health care professionals, and when I (the economist) suggested that a major cause of our health care problems was that we're a nation of slackers with poor diets, I got a surprising (to me) amount of push-back. It wasn't that they denied the role of individual behavior in obesity. Their point was that programs aimed solely at changing individual behaviors (including the bully pulpit) have limited results. Subsidizing gym memberships? Is the commentator implying that the reason so many people drop into and out of aerobics programs is because of cost?

    It seems to be much more than that. For example, there are many low-income neighborhoods in this country that do not a grocery store with fresh produce, while mini-marts with cigs and snacks abound. For example, the study of the British civil service that showed that, after controlling for all the variables, folks at higher status levels were in better health than folks at lower status levels. Dealing with inequities due to income and race is a huge piece of becoming a healthier nation.

    Smoking rates have dropped because of increased taxes on cigs, because of laws against smoking indoors, and because of huge publicity. Taking on bad eating habits is much more complex. Getting people to exercise more may be even tougher. It means changing the way neighborhoods are designed to encourage biking and walking. It means increasing school funding to bring back recess, and increasing PE from one year to four years in high school (exempting competitive athletes). It means changing the work week here in the U.S. where we work more hours per year than almost any industrialized nation.

    In comparison, a little reform in health care financing seems like a snap.

  8. Wonderful! Yes, that's just what I want. More nagging, this time enabled by the Federal Government and perhaps using their full force of coercion to make me drink less, stop smoking and eat a partially vegetarian diet!

    The forces of coercive collectivism know no bounds, but it's for our own good, doncha know! Maybe we should have mandatory callesthenics on every street at 6:00 AM.

  9. "...a partially vegetarian diet!"

    So you currently eat, what...not even carrots? - an occasional pickle?

  10. You present a number of good ideas, but I wonder if this grab-bag of measures will really work as a long-term solution. There are steps the government can take to reduce obesity, for example, but can the government do much to significantly reduce it? Given that people in society already have numberless disincentives towards obesity, I doubt one more government action would do the trick. And making obesity, smoking, or similar lifestyle choices illegal would probably require too much government involvement in people's everyday lives.

    Even policies with short term effectiveness might quickly go out of date. Let's say the government encourages eating chicken rather than beef. However, as part of other social trends, as well as government incentives, people start eating less beef, cooking steak twice a week and vegetarian meals the rest of the time. Suddenly, it is eating sausage and fried chicken that's the problem!

    Some of the president's claims were not particularly credible, but I am going to wait before there is a more concrete proposal to worry about costs and the like. Personally, I think a proposal that reigned in costs but increased the deficit in the short term would be palatable, but you could see Dems scratching their heads when Obama said he would not approve any program that raised the deficit by more than a cent.

  11. I concur with Zeke. We are arguing over something the Fed Gov has no business to be involved. I can not see anywhere in the Constitution, where medicine is listed.

  12. Early detection of mildly high blood pressure is expensive? How? Mine has been treated for twenty years with a single pill daily--the kind that Wal-Mart sells for $4 a month.

    Solve obseity? Not unless you can get rid of fast-food franchises. Not unless we can earn enough money to buy fresh food. Ever see what's on sale at the supermarket? American cheese, soda, bacon, frankfurters...and crap made with high fructose corn syrup and gentically modified frankenfood. A few less Republican ignoramuses at the FDA might help, along with a living wage.

    Oh, and most people I know cannot afford health insurance. My preventative care is tons of vitamins and minerals, none of which, by the way, is covered by Medicare.

  13. Michael Pollan has a great editorial in the New York Times about our unhealthy food policy. The best thing would be to eliminate subsidies for agri-business (which go directly to fast food).
    PE in schools is useless. Much better to promote walking and biking.