Monday, November 09, 2009

Eureka! Health care is now free!


Richard offers a stunning insight into the sheer economic illiteracy of the current Democrat Party. Exhibit A: Jan Schakowsky (Marxist-IL):

In the debate on the health care bill in the house, Democrat Jan Schakowsky made a revealing comment. Asked about the abortion restrictions placed in the bill (the Stupak amendment), she responded that the bill was overall good for women.

Now there would be free breast cancer screenings for women.

Did you hear that? Free. Nobody pays. Do the doctors get paid? By whom?

Will this new "free service" add to insurance premiums? This is not the Congresswoman's concern. If the price of anything is free, there will be more of the service delivered of course. But remember, whatever the volume, Shakowsky thinks it is free, because the consumer does not pay at the point of service.

That, of course, is one of the reasons why American healthcare costs so much. Almost everyone thinks that the service is free at the point of service. When people pay out of pocket for things -- flat screen TVs, cellular phone service, etc. -- they are good consumers.

When they think something is free at the point of service, they are terrible consumers, using more of whatever is "free".

Someone else pays of course: government, their employer, insurance companies, your children and grandchildren... all future taxpayers. Barack Obama made a similar comment about colonoscopies in his last prime time news conference on health care reform.

Everyone should have a colonoscopy and it should be free (no deductibles, or co-pays). These, for the record, are not inexpensive procedures, and involve the use of anesthesia, which is always a risk factor for any procedure.

But if insurers are now mandated to provide free colonoscopies, there will be many more of them performed. It will be the gastroenterologists' full employment act. Many who are not at risk (family history, over age 50) will have the procedure done

Costs will go much higher. But, hey, it is free. And isn't that a good thing? In microcosm, this is the bill the Democrats have passed: lots of goodies, and the piper will be paid later. Kick the can down the road.

Fiscal responsibility? Why worry? Do you think this bill will actually cost only $1.2 trillion over ten years? If volume is higher than estimated by the CBO, then the premiums for insurance will rise whether in a private insurance or public plan, and so will the subsidies paid under this bill.

Those subsidies do not just cover the poor. Families with incomes up to $88,000 get subsides to buy insurance in the House bill. Are these poor folks, needing a handout? I think not. The purpose of this bill is to create a new middle class entitlement. Make these people think they owe their "free" health care to the government and the party of big government.

The reality is that less care often means higher quality than more care. The New York Times has an article in the Sunday magazine on the Intermountain system in Utah. This is the system run by those horrible Mormons, who voted against gay marriage.

Intermountain happens to have the best health care system in America. Books have been written about this system. They don't prescribe treatment protocols from up high, but actually look to see what works at their hospitals.

Hospitals from around the country are coming to Utah to learn what they do. While Mayo and Cleveland Clinic have models of collaborative care among MDs who are salaried (and hence do not directly benefit from fee for service over utilization), Intermountain achieves its results with measurement.

There are models of low cost quality care in America. But Obamacare or PelosiCare have a one-size-fits-all model that will lead to even higher levels of over-utilization than already exists. When the country starts going broke, we will see rationing from up high, not the Intermountain model or the Mayo model.

The Obama team trusts bureaucrats and politicians, not doctors.



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