Interesting article about President Obama's healthcare proposals. It emanates from the Cato Institute.

Posted by James Bartholomew • Indexed in NHS

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Obama is moving on towards his reforms of American healthcare. The Cato Institute is mounting a carefully argued opposition to his reforms.

The existing US healthcare is, of course, bad in a number of respects. It is just less bad that British healthcare. One of the agreed faults of American healthcare is its ridiculous cost.

Here are a few ways in which the cost could, perhaps, be reduced:

1. All people could be allowed to buy the insurance they want instead of coverage dictated by their state. (See excerpt from Cato paper below.)

2. Break up the cartels that I suspect may exist in US healthcare such as accredition only by a very limited number of associations for doctors and nurses. This kind of cartel leads to many, expensive years of training which are an unnecessary expense if a practitioner is going to work exclusively, say, in in obstetrics. The customer pays for massive over-qualification. Competition in accreditation would bring down costs and allow innovative, lower-cost solutions.

3. Reduce the awards given by courts for medical malpractice. These big awards increase the cost of a doctor's insurance which, I gather, can be amazingly high. If the awards were lower, the doctor's insurance bill would be lower and the customer's bill would be lower. The laws on what constitute malpractice may well be worth revising, too.

I expect there are plenty more, major savings to be had. American healthcare could perhaps be half the price without sacrificing any quality at all.

Here is an excerpt from the Cato paper in which the policy proposals of Obama and also McCain were discussed. Here is the section on McCain's liberalising ideas:

Deregulation (mostly)

Whereas Senator Obama’s plan relies
heavily on new regulation, Senator McCain
generally calls for deregulation, particularly
in the area of insurance.
Most notably,McCain would allow people
to purchase health insurance across state lines,
a practice that is currently prohibited by state
laws. Since health insurance is largely regulated
at the state level, one of the major reasons
that costs differ so from state to state is
because of the varying regulations and mandates
that states have chosen to impose.

For example, New Jersey has imposed more than
40 mandated benefits, including in vitro fertilization,
contraceptives, chiropodists, and coverage
of children until they reach age 25.
The state has also adopted community rating
and guaranteed issue. In part as a result of this,
the cost of a standard health insurance policy
for a healthy 25-year-old man would average
$5,580 in the state. A similar policy in
Kentucky, which has far fewer mandates and
no community rating or guaranteed issue,
would cost the same man only $960 per
year. Unfortunately, consumers are more or
less held prisoner by their state’s regulatory
regime. It is illegal for that hypothetical New
Jersey resident to buy the cheaper health insurance
in Kentucky.

In contrast, if consumers were free to purchase
insurance in other states, they could in
effect “purchase” the regulations of that other
state. A consumer in New Jersey could avoid
the state’s regulatory costs and choose, say,
Kentucky, if that state’s regulations aligned
more closely with his or her preferences. Many
consumers would undoubtedly choose less
regulation. For example, young and healthy
individuals with low incomes may choose not
to buy coverage that forces them to subsidize
older, sicker (and generally wealthier) individuals.
For those risk-adverse individuals who
prefer greater regulatory protection, the cost
of those protections would be reflected in
higher premiums.

Senator McCain’s proposal would permit
this type of interstate competition. With millions
of American consumers balancing costs
and risks, states would be forced to evaluate
whether their regulations offered true value or
simply reflect the influence of special interests.
As McCain says, “nationwide insurance markets
that ensure broad and vigorous competition
will wring out excessive costs.”

McCain would also allow people to purchase
insurance through nontraditional groups. Today,
three types of organizations can offer group
insurance: employers,unions, and trade associations.
McCain would open this to other groups,
notably churches and professional organizations.

More problematically, he would also allow
small businesses to band together in “association
health plans” (AHPs) to gain benefits
from pooling their risks. That makes sense if
the AHPs can choose among competing state
regulations, but there are reasons to be concerned
over creating federally regulated
AHPs. Doing so would be a step toward
greater federalization of insurance regulation.
As costly and damaging as much insurance
regulation is today, it is at least somewhat
restrained by the fact that special
interests are forced to lobby in 50 state capitals.

Fundamental to McCain’s vision
of health care reform is
changing not just who pays for
health care, but how that health
care is paid for.Moving the locus of insurance regulation
to Washington would simply create a
“one-stop shopping” center for lobbyists.

On the supply side, McCain supports
“innovative delivery systems, such as clinics in
retail outlets and other ways that provide
greater market flexibility in permitting appropriate
roles for nurse practitioners, nurses, and
doctors.” His campaign speaks of healthcare
being offered through a variety of venues such
as “Minute Clinic, COSTCO, banks, investment
companies,hospital orhealthcompanies
such as Wellpoint, Humana or online services
such as Revolution Health, Google Health,
etc.,” with the government’s role limited to
establishing “some standards of transparency,
solvency, etc.”

He has also called for “different licensing
schemes for medical providers.” In particular,
McCain has suggested that some types of
care could be shifted to nurse practitioners
and other allied health personnel. “We need to
have flexibility in the delivery of care so physicians
can spend more time on the tasks they’re
suited for,” a McCain advisor explained.
Although most medical licensing and scope of
practice laws are a state, not a federal,
purview, there are some actions McCain could
take in this area, particularly in terms of federal
reimbursement policies.

Unfortunately, not all of Sen. McCain’s
proposals are free-market oriented.

Posted by James Bartholomew • Indexed in NHS

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Treatment of cancer in Britain frequently involves

- late diagnosis
- delayed investigation through scans and other tests
- tests using less than ideal equipment
- non-use of the latest drugs
- delayed treatment

The Daily Mail has pulled together a useful article describing some of the treatments and investigations which a cancer patient in Britain may not get.

Here is one section on PET scanners:

Positron Emission Tomography (PET) scans are immensely sophisticated, showing how body tissues are working. But they're expensive, so many surgeons have to rely on the results of a CT scan (computerised tomography) which is less detailed.

It means in some cases it is only when the surgeon begins operating that they realise a patient is not suitable for surgery, because there are tumours the CT scan hadn't spotted.

Dr Fox adds: 'The last thing a patient needs is an operation that's useless.'

An estimated 20 per cent of operations have to be aborted because of this.

Concerned patients can ask their specialist to refer them to a hospital with a PET scanner, says Dr Fox. However, they might not be granted their request.

I expect there are figures available on the number of PET scanners in Britain per million of population compared with the equivalent fitures for other countries. If anyone is willing to obtain and send me the figures, I will upload them.

Posted by James Bartholomew • Indexed in NHS

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Youtube now has an excerpt from the talk I gave at the Cato Institute in Washington.

Posted by James Bartholomew • Indexed in Welfare benefits

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"People like to be generous. They just don't like to be generous with their own money. They prefer to be generous with other people's money."

This is a remark, which I hope I have remembered pretty accurately, made to me by Professor Meir Kohn of Dartmouth University in America. I can't remember whether he was offering an explanation of why politicians like to spend or why electors vote for political parties that spend. The comment probably applies to both.

Posted by James Bartholomew • Indexed in Politics

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We were staying in San Gimignano, a pretty Tuscan village with slightly bizarre towers, when I was arrested by the local police. I had left my daughter, Alex, then aged ten I think, in a café while I went round the corner for ten minutes to collect our washing from the laundry. I had given her some maths questions to do while I was away. On my return, I found two policemen in the grand costumes they wear there. They asked me if I was my daughter’s father and then required me to bring my daughter and both our passports to the police station.

As I collected the passports from the flat where we had been staying for ten days - learning Italian, reading some Italian history, visiting Sienna and Florence, viewing and learning about Renaissance art as well as keeping up the maths and so on - I told myself to stay calm. Reason would surely prevail.

In the police station one of the officers was clearly in two minds as to whether to put me in handcuffs. I suppose it might have been the sight of poor Alex clinging tightly to my arm that persuaded him to think that, actually, he would be doing her no favour by taking me away from her and into a cell.

Hang on a minute, you may say. This has precious little to do with the government’s intention, announced yesterday, to inspect parents who educate their children at home and ensure they teach in an approved way. Yes, there is a difference in the quantity of state interference which I experienced in Italy and what is proposed here. But it is measured on the same scale. What is more, the state has form on this issue. When it started to get involved in education in the early 19th century, it merely offered financial help. Then it decided it had better inspect the schools it assisted. After that, it came to believe – incorrectly - that as many as five per cent of children were not being educated . So it pushed further ahead with state education and then wholly free state education. This free education crowded out most of the private and many of the religious schools. The state then bought up their school buildings on the cheap. At last, it was totally in control.

The same happened with universities. At first the state just wanted to ‘help’ again. No strings attached, honest. But after some years, strings were duly stitched on and our universities now have the independence of a toaster. So when proponents of state interference in home-schooling say, “we’re only here to support you” forgive me if decline to believe it. Even for a start, the government wants to send an inspector into the home of every parent who dares to teach his or her own child. This inspector will demand to know what and how the child is taught. He or she will then have the right to insist that you, the parent, step outside to a different room to in order that your child can be interviewed alone. What questions will your child be asked? It is not specified. Perhaps, how does your parent treat you? How much work do you do? Does your parent scold you? Do you ever cry? You can readily imagine how a ‘wrong’ answer could put you on a “cause of concern” list.

The government wants to insist, from the start, on its own educational theories - teaching according to its own idea of a “broad, balanced, relevant and differentiated” curriculum. In due course, no doubt, if the government believes that the earth is flat, you will be in trouble if you teach open-mindedness and willingness to consider that the earth may be round. Or to use a more current example, the government believes that global warming is happening and is created by mankind. It is in the curriculum. In due course, a home educator who teaches open-mindedness to evidence on the issue would have a mark against him or her. Many would-be home-educators will be discouraged by this domination by bureaucrats and not undertake it at all – which is against the interests of their children who would benefit from one-to-one tuition in the vast majority of cases.

The report that led to the government decision to legislate on home education was prompted most strongly by a supposed fear that home-educated children might be abused. The report, as it emerges, declares that actually there is no evidence of any such correlation. But of course, once the process of making a report gets going, there is something in-built which causes the author to find reasons to say that inspections should take place anyway. Mr Badman, in this report, is full of pseudo-liberal reasoning. I say ‘pseudo-liberal’ because it has nothing to with the spirit of freedom, which lies at the origin of the word ‘liberal’. This ‘liberal’ is in the new and opposite sense of ‘we, the elite, will make you do the right thing’. We hear a well-modulated, reasonable tone. Beneath is the harder reality: they will come to your home. You will do as they say.

When I was young, in the 1960s, it was not unusual to hear people say, “It’s a free country, innit!” People used to scoff at the Germans and the Swiss for the bossiness of their governments. Now we have less and less reason to boast of our freedom – less and less reason to be proud that in Britain, if nowhere else, the state is our servant, not our master.

Posted by James Bartholomew • Indexed in Home education

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1. If the state starts to inspect all home educators, it will soon start to dictate to them. It will tell them what to teach, when and how. This is an infringement of freedom and free speech.

2. The parent is the correct person to have primary responsibility for a child, not the state. The state should be the servant of the people, not the boss. The state already has the power to take a hand if it has reason to think a child is being abused or not getting an education. Anything more than that would mean the state was taking over the primary responsibility of the individual.

3. Through inspecting and then prescribing what should be taught and how, the state will reduce the diversity of home education. In doing this, it will damage home education. Some children are currently taught in ways that are a response to the individual problems and opportunities that exist in the particular situation. For one child, lots of confidence-building activities may be desirable after that child has been badly bullied at a school. For another, trips to China, Egypt and elsewhere in the world may be possible and highly desirable to give a world perspective. Freedom allows the ulitmate in individualised education.

4.Inspection followed by increasing prescription of what should be taught will deter an unknown proportion of parents from home educating. This will deprive their children of the benefit that they would otherwise have had from home education. The benefit includes plenty of on-to-one teaching and a great deal of parental contact. Already some local authorities are somewhat hostile to home education. Further powers to inspect and regulate will give those bureaucrats greater power to obstruct and discourage parents who would otherwise have home-schooled.

5. Mr Badman has apparently said that there is no apparent correlation between home education and child abuse. In admitting this, he has removed the main argument for automatic inspection.

One supporter of moves to inspect all home educators every year said on Radio 5 Live that "We want to know where children are" as though this was a clinching argument. It is an absurd argument. For the vast bulk of the time, the state has no idea where people are nor does it need to know nor is desirable that it should know. We, the people, should be free to live our lives under the law. The state should not be monitoring us or dictating to us. The idea of "we want to know where children are" is based either on the notion that "the state knows best and had better be in　control of everything" or else on some psychological problem which leads individual administrators or parties to want to control others. The first notion is wrong and the second is positively disturbing.

The whole history of the welfare state tells us one thing above all others: the state starts by inspecting, goes on to regulate and finishes by taking over. In the process, the state demoralises those who perform a service; it makes that service inferior to what it would otherwise have been; the bureaucrats dominate frontline providers; the numbers of bureaucrats increase and the cost of what it does escalates. So one ends up with an inferior service provided at great expense to the taxpayer. Both of these consequences in turn lead to damage to the economy and culture of a country.

Posted by James Bartholomew • Indexed in Home education

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A man called Arthur (I didn't catch his surname) was on Radio 5 Live this morning saying that the equipment for treating prostate cancer in Britain is antique. He had had a recurrence of cancer a few years ago and realised that he would need radiotherapy.

He went did some investigation using the internet. He found that the NHS had none of the latest machines available at that time. The only ones in Britain were at the Harley Street Clinic and Cromwell Hospital (both private). Even these were not the very latest models. For these, you had to go to America. There they had a machine which was far more precise in killing the cancer with far less damage to the surrounding area.

I am not sure in what year he did his research. I have not done any research to check his story. So I do not pass this on as evidence of any strength. I only mention it as a lead for inquiry and verification.

Posted by James Bartholomew • Indexed in NHS

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A disturbing account of deaths at an NHS hospital in Gosport. It presents concerns not only about the hospital, but about operations of the coroner's office. My own personal experience of a coroner's office in London was not good. These officials seems to be a law unto themselves.

The story does not appear to put the General Medical Council in a good light, either.

Posted by James Bartholomew • Indexed in NHS

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For anyone who feels that Gordon Brown should go, this clip on Youtube is pure pleasure. It is Dan Hannan MEP in good form.

Posted by James Bartholomew • Indexed in Politics

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