Govt's Track Record Makes ObamaCare Scary

The following is circulating around the Net. Its analysis is simplistic but somehow does make me scared of ObamaCare, not to mention the even more government-centric proposals. What do you think?

To President Obama and all 535 voting members of the Legislature.

A. The U.S. Postal Service was established in 1775. You have had 236 years to get it right and it is broke.

B. Social Security was established in 1935. You have had 76 years to get it right and it is broke.

C. Fannie Mae was established in 1938. You have had 73 years to get it right and it is broke.

D. War on Poverty started in 1964. You have had 47 years to get it right; $1 trillion of our money is confiscated each year and transferred to "the poor" and they only want more.

E. Medicare and Medicaid were established in 1965. You have had 46 years to get it right and they are broke.

F. Freddie Mac was established in 1970. You have had 41 years to get it right and it is broke.

G. The Department of Energy was created in 1977 to lessen our dependence on foreign oil. It has ballooned to 16,000 employees with a budget of $24 billion a year and we import more oil than ever before. You had 34 years to get it right and it is an abysmal failure.

You have FAILED in every "government service" you have shoved down our throats while overspending our tax dollars. AND YOU WANT AMERICANS TO BELIEVE YOU CAN BE TRUSTED WITH A GOVERNMENT-RUN HEALTH CARE SYSTEM ??

The Stump Speech I'd Give if I Were Running for President

I'm not delusional enough to run for president, but drafting what would be my stump speech helps me refine and articulate my ideas on how to improve America. HERE is the text of that speech.

HERE is the link to my delivering that speech on my NPR-San Francisco radio show. Scroll down to the 05/08 show, labeled "stump speech." The speech is the first 20 minutes. Then I invited callers, the first one was supportive, then some assaults, and last, a good question.

FreedomCare: How I'd Do Health Care Reform

I believe that the following simple plan would be infinitely more helpful to patients than ObamaCare and challenge you to make a legitimate case why I'm wrong:

1. Per the post I just wrote, make health care provider training shorter and more practical. That would improve quality while reducing cost and increasing supply of providers.

2. Except for the truly indigent and for catastrophic health care, health care would be paid directly by the consumer. If consumers had most of the money at stake, 300 million Americans would be exerting the power of the invisible free hand of the market to drive down costs and improve quality. The good quality, cost-effective providers would succeed, the bad ones driven out of business.

3. To ensure that those consumers had the information needed to make smart choices of health care providers and procedures, there would be outstanding, easily accessible consumer information on all licensed doctors, nurses, hospitals, etc: for example, patient satisfaction (disaggregated by condition,) the provider's risk-adjusted success rates for different procedures, etc.

So what do you think of this plan?

The Unspoken Key Issue re Health Care Reform

The medical establishment already kills over 100,000 people every year as the result of medical errors. Countless more people stay sick longer or get sicker because of such errors. For example, someone just told me that because of an error in surgery, he became blind.

Under President Obama's health care proposal, we'll be providing health care for 45 million more people with the same number of doctors, nurses, hospitals, MRI machines, etc. That 45 million has greater-than-average health care needs while having lower average income, and thus will often get low-cost or free health care under the Obama plan. The result will be that even more of the people who do fully pay into the system will stay sicker longer, get sicker, or die.

From where I sit, the answer is a two-tier system: a basic level of care for everyone and a higher level of care for those who pay into the system. Alas, I doubt seriously whether the Democrats could ever support such a plan. Their core principle is that equality trumps merit.

My Plan for Reinventing Health Care

I'm scared. Yes I believe health care is a right but fear that extending that right to all U.S. residents could kill me.

Already, errors by doctors, nurses, etc., kill over 100,000 people a year who shouldn't have died. Countless more get sick or stay sicker longer because of medical errors. Some of that is caused by shortages of health care providers, especially highly qualified ones.

If President Obama keeps his promise to extend health care coverage to the 48,000,000 U.S. residents who don't have health coverage, many more people will become victims of medical errors and all of us will have to wait longer for care, perhaps for inferior care.

My liberal side says all people have the right to health care but my libertarian side says I worked hard so I could afford to pay the many thousands of dollars in health care premiums in hopes of living longer and healthier. So why should I be forced to pay even more tax dollars to subsidize 48,000,000 people getting health insurance, including 13,000,000 illegal immigrants, and millions of others who took welfare instead of a job or refused to delay gratification and took a part-time and/or low-paying job rather than getting a degree and then a full-time professional job so they could afford health insurance? Worse, my paying for them to get coverage will mean that I am at greater risk of morbidity and mortality because of medical errors and long waits, for example, for an MRI exam or to see a specialist.

There's no perfect answer but if President Obama asked me (fat chance) to propose the ideal approach to reinventing health care in the U.S., here's what I'd propose:

1. Here's how I'd address the shortage of health care providers that would result from providing health care to all. Currently, training programs are unnecessarily long and expensive, largely because they're provided by university faculty, who want to teach their academic specialties (chemistry, calculus, etc.) Many a potentially good health care provider has been lost to the profession because of the training's unnecessary length and difficulty. Training should be shorter and based in hospitals, doctors' offices, homes, and other medical facilities, supplemented by a few courses taught at community colleges.

2. Everyone would, as a right of being human, get a basic-level single-payer health care--no paperwork required, no questions asked. "Basic-level" means, for example, that everyone would get exams and routine care not by a physician but by a physician assistant not of their choice,. They'd be entitled to receive cost-effective treatments administered by health care providers not of their choice. Wait times for non-emergency care would be moderate to long. That safety net of basic national health care would be funded as a surcharge on income tax--That would ensure progressivity.

2a. Individuals could purchase a higher level of health care on a fee-for-service basis or with private insurance. Those people could choose their doctor and other health care provider, have shorter wait times, and obtain less cost-effective treatments for example, an 80-year old who'd prefer bypass surgery over treatment with drugs.

3a. People with preexisting conditions would pay the same insurance premium as those without--It is wrong that a person already suffering with a condition should have to suffer additionally by having to pay more. However, insurance companies could add a surcharge for smokers and for people who abuse drugs or alcohol.

4. Health care providers would be incented to focus on primary prevention: weight, smoking/alcohol/drug prevention and cessation, teen pregnancy prevention. They would also be incented to focus on secondary prevention, for example, having medical assistants call patients to ensure they're taking their medication.

5. Health care providers would be paid a salary rather than piecework so there's no incentive to overtreat.

5a. Tort reform would limit physician liability, which would also reduce the expensive overtreatment and defensive medicine that is widespread.

6. Electronic medical records should yield improved medical care at lower cost. A patient's information, diagnoses, treatment, and outcomes are entered into a computer, using nationally adopted software. The results are aggregated anonymously, which provides health care providers with evidence-based data on the meaning of symptom clusters and on what treatments work best and most cost-effectively for what diagnoses. Of course, electronic medical records also benefit individual patients: records are readable (no physician scrawl) and instantly transferable to other health care providers. Patients would have access to efficacy data on individual health care providers, hospitals, and treatments--crucial to making informed choices.

Do you like my plan? Have a suggestion for improving it? Care to propose a totally different approach?

Canada's Single-Payer Health Care is Nothing to Emulate

Obama, before running for president, when he could be more candid, favored a Canadian-style single-payer, government-run health care system. Now, he's pulled back--at least until he's elected.

He might want to check on how the Canadian system is working. A new article reports that the chair of the committee that created Canada's single-payer system now says that the system has such serious deficiencies that no rationing of care or mass infusion of tax dollars can solve the problem. He now advocates replacing the system with a private one in which people have more choice. Another article presents another of those nightmare anecdotes in which a patient reports that the Canadian system is so overwhelmed that she couldn't get off the months-long waiting list even though she was losing her sight. And the average wait time to see a specialist is 18 weeks.

And that's in a country that is much easier to provide health care for than the U.S., which has many millions of new immigrants with extraordinary health care needs but with little money to pay into the system.

The Most Anti-Male Person in the World?

Following her book, "Are Men Necessary?" I shouldn't have been surprised at Maureen Dowd's most recent New York Times column.

Here are a couple of quotes from it:

"You simply operate on the assumption that no man matures after the age of 11."

“Most marriages that founder do so because of money — she’s thrifty, he’s on his 10th credit card."

That flips the reality on its head. American Demographic reports that women control consumer spending by a wide margin in nearly every consumer category. An Inc.com article states that women make "over 85% of the consumer purchases (in the United States) and influence over 95% of total goods and services."

The column listed criteria for a good husband and concluded that no men met the criteria.

This column is currently the #1 most-emailed New York Times column or article.

Would a major publication such as the New York Times publish something equally anti-woman, let alone anti-Black?

Tim Russert, Sudden Heart Attack, and Sexism Against Men

Tim Russert’s untimely death from a sudden heart attack reminded me of the dramatic 50+-year-long gender disparity against men in health care research and outreach.

Many more men than women die of sudden heart attack and at an earlier age than do women of breast cancer.

Indeed, sudden heart attack is the #1 cause of premature death among men over 40. Yet, more money per capita is spent on breast cancer research.

And regarding outreach, there are a trivial number of prostate cancer ribbons compared with the number of pink ribbons against breast cancer. And have you ever seen even one ribbon against sudden heart attack?

More broadly, men die 5.3 years younger than women, and spend their last decade in worse health. There are more than four widows for every widower.

Yet when I searched PubMed, which indexes 3,000 medical journals over the past 58 years, I found 22,304 articles with the keywords “women’s health,” but only 586
with “men’s health.” That’s 39 articles related to women’s health for every one on men’s. A review of Charity Navigator, the leading database of nonprofits, finds that nearly all the gender-specific health-related nonprofits are on behalf of women.

If women suffer a deficit, for example, the “underrepresentation” of women in engineering, we typically see significant efforts at redress. Yet, when men have the deficit—even the ultimate deficit: they die younger—not only is there not redress, but the opposite occurs: disproportionate amounts of research and outreach are directed at women’s health.

I’ve heard these explanations to justify the double standard:
1. “It wouldn’t happen if, like women, men organized to protest.”
My response: Would you deny redress to women who are “underrepresented” if they hadn’t organized to protest?
2. “Men’s dying younger is their fault—if they’d only take better care of themselves.”
My response: The three major controllable causes of mortality and morbidity are obesity, smoking, and excessive drinking. Men have lower incidences of the first two. In any event, if women are “underrepresented” in engineering, would you deny them the redress by chastising them, “It’s your own fault. Do better in science and math.”?
3. “In the past, most health research was done on men. This only levels the playing field.”
My response: First, as cited, over the past 58 years—the period during which the greatest medical advances have been made—the opposite is true. And with regard to research that’s more than 58 years old, an underreported reason why women were often excluded from many experimental treatments was not lack of interest in women’s health but a concern that an experimental drug or treatment might damage a woman’s fetus.

And en toto, any deleterious effect that came from a smaller percentage of women being subjects in 58+-year-old medical research apparently was small: In, fact, the
life-expectancy gap in favor of women grew during every decade but one from 1900 through 1980.

The big question is why:
— Why do you think that, for the past 50+ years, the overwhelming majority of health care research has been on women’s health, despite men living shorter and in poorer last-decade health?
And consider these other male-death-related questions:
— Why do 92% of workplace deaths occur to men yet we rarely hear that statistic, while we frequently hear statistics such as, “Women earn 79 cents on the dollar compared with men?” (By the way, that statistic is misleading: Most current evidence suggests that for the same work, pay is, on average, roughly equal.)
— Why, still, must only men register with the U.S. military’s Selective Service?
— Why, still, are only men allowed to serve in direct combat? (resulting in the little-publicized fact that 99% of the Iraq War deaths have been men.)
— Why do the media emphasize when deaths occur to “women and children?”

I agree with men’s advocate Warren Farrell, who is the author of nine books including The Myth of Male Power and who has taught at Georgetown and the School of Medicine at U.C. San Diego. He believes the main reason is sexism: “Men are the disposable sex.”

Many of us have the opportunity to be gender-neutral or biased toward or against men in our professional lives.

For example, consider all the choices that higher educators can make:

— Which students to admit to your program
— Which readings to assign
— What content to present in class
— What research agenda to pursue
— Who to select as your research assistant
— What student thesis and dissertation topics to encourage
— Who to hire as a faculty member or administrator
— To whom to grant tenure
— Which studies to fund. (For example, should sudden heart attack studies be given higher priority?)

At this point in time, what do you think is the wisest stance for you, personally, to take?

Another Example of What Obama Will Be Like as President

Today, Barack Obama said, "We can't drive our SUVs and eat as much as we want and keep our homes on 72 degrees at all times ... and then just expect that other countries are going to say OK."

Obama's core principle is redistributive "justice." That means from those with the greatest ability to those with the greatest need---apparently even if it means we must go hungry and be too hot or too cold in our homes.

That of course, is signature Marxist philosophy. And indeed, some of Obama's closest relationships have been with Marxist sympathizers: Weatherman Underground bomber William Ayres, "Black Liberation Theologian" Rev. Jeremiah Wright, and Communist party leader Frank Marshall Davis. Obama's 's official blogger, Sam Graham-Felsen is a passionate devotee of hard-Left, America-hater Noam Chomsky. And of course, there's Obama's wife: Michelle Obama. Here is her most recent redistributive "justice" pronouncement: “The truth is, in order to get things like universal health care and a revamped education system, then someone is going to have to give up a piece of their pie so that someone else can have more.”

Speaking of health care, redistributive "justice" will, of course, apply there--with frightening implications. Obama's health care plan will result in people with good health care (because they were good enough of an employee to be hired for a job with health insurance, had saved up enough money to buy their own, or on Medicare) having to give up that good health care and pay for health care for others', including, for example, lazy heroin addicts and illegal aliens. (No, they're not "undocumented immigrants"--that's another of those focus-group-tested phrases designed to elicit sympathy even if the term is inaccurate.) You cannot insure 47,000,000 more Americans with the same number of doctors and nurses without decimating the quality of our health care, especially since many of those 47,000,000 don't have the money to pay for health care.

In future years, the Obama plan is sure to degrade our health care even more because when foreigners see that-- as in 1986--amnesty was defacto granted to all illegals (which is what Obama promises to do as soon as he takes office--if it hasn't already been passed into law, which currently is being attempted) many millions more of the world's needy will sneak into the U.S. illegally. That will continue until U.S health care and other upsides of American life decline to the levels in their home country.

Ironically, Obama's core goal (for everyone in the world to live better and close to equally well) will be subverted by redistributing resources from those with the greatest potential to solve society's problems to those with the least.

Fortunately, the American system of government has checks and balances, so Obama's frighteningly extremist views (Remember that the nonpartisan National Journal rated him 100/100: the Senate's most liberal senator, moreso even than self-described socialist Bernie Sanders) an at-least-modestly more moderate Congress will keep him in check--hopefully.

Note that I am assuming Obama will be president. America's most powerful force is not the "military-industrial complex" but the ever more Leftist-biased media, and they want the most liberal candidate possible, hence Obama will be a shoo-in.

It will be an interesting eight years.

More Unfair Male Bashing

I was watching a PBS panel discussion among four women (nary a man) about why newly hired women scientists get strong evaluations yet half of women scientists stop working within the first few years. They offered only three explanations: machismo, sexual harassment, and employers not accommodating to employees' motherhood.

Why did none of the panel members mention any of these, which I have heard again and again from my women clients:

• Many women soon tire of the rigors and isolation of scientist work. Indeed recent research finds that women, on average, just aren't interested enough in science to make a long-term career out of it.
  
• They end up valuing being a mother more than working outside the home.
• They find it easier to be a stay-at-home mom.

As always in the mainstream (read "liberal") media, it's easier to just blame men.

The Most Deadly Double Standard

Men die far earlier from heart disease, indeed from all causes. Men live 5 1/2 years shorter than women and spend their last decade in worse health.

Yet the vast majority of gender-specific health research and education are for women. Think of the sea of pink ribbons for breast cancer research. Where are the ribbons for the many more men who die earlier of sudden heart attack?

It's sexist and unfair. Imagine that all literacy programs were aimed at whites, even though Blacks have a much higher illiteracy rate. It would never come to be, or if it did, would trigger national outrage and the program pulled. But when women are the beneficiary, there's no problem. Think about it.

The Deadly Downsides of Insuring Everyone

The soundbite "Health Insurance for All" generates widespread assent. But like most bumper-sticker rhetoric, closer analysis is required. Let me ask you a question:

It's well-acknowledged that the U.S. health care system is creaking under its weight. For example, over 120,000 people die annually as the result of healthcare-practitioner errors. Now, what do you think will happen when we ask our health care providers to add 47 million uninsured to their patient rolls, a group that has above-average health care needs but pays little taxes and will likely pay little into the new government-mandated system that will almost assuredly be enacted under a Democrat presidency?

Not only will more deaths result, but there will be long waits for health care, and refusal to provide care in such gray-area situations as a 75-year old male needing and wanting bypass surgery. Lest you think I'm making that assertion based only on the well-publicized nightmare experiences of some people in Canada who, for example, desperately needed surgery but couldn't get it, let me refer you to the U.S.'s current experiment in covering everyone: Massachusetts. And lest you think my source of information about the Massachusetts insurance-for-all system is some conservative rag, my source is the New York Times.

I do believe that basic health care is a right, but we cannot provide it for the whole world, including the 13 million and skyrocketing number of illegal immigrants. (And once we do, the number of illegal immigrants will accelerate further.) However we decide to reform health care, it is only right that there be tiers: basic health care for all, but, for moderate cost, other people should be covered for a wider range of procedures, allowed to choose their health care providers, and have faster access to them.

To increase the number of qualified health care providers, we need to realize that doctor, nurse, and allied-health practitioner training programs (currently designed primarily by academics rather than by top clinicians) can be significantly shortened with minimal impact on patient care. In fact, if those training programs were developed and taught by top clinicians instead of by academics, I'd predict that care quality would actually improve.