-Caveat Lector-
nessie wrote:
Not all of the "rest of the working class" CAN pay for
their own health care, at least not if they want to
also eat food, wear clothes and live indoors.
Keep their cell phones, two cars, beepers, credit cards ...
MJ:
Pfffffeeeeewwwhhhh <dusts off vital information>
Government has been involved in medicine since before any of
us were born. And over the past 30 years its involvement has
grown rapidly. Its policies are the cause of medical care's
high cost and the difficulty of obtaining health insurance
-- the two problems the politicians now propose to cure with
more government.
Here are 18 ways the state of your health, the quality of
medical service you receive, and the price you pay are affected
by federal or state government interference.
Physicians
1. Licensing: Government restricts your access to health
care by forbidding you to seek advice and treatment
from an unlicensed physician. And laws forbid nurses
and other experienced healthcare specialists from
performing many services -- even though they may be
qualified to do so and would charge less than a doctor.
So you MUST go to a licensed physician for almost any
care at all. If his fees seem high, it may be partly
because the government limits the competition he must
face, and partly because he has to charge you for the
costs he pays to stay in good standing with state and
federal regulators.
2. Restricted access to care: Today 'telemedicine' makes it
possible for your doctor to transmit tests and X-rays to
non-local physicians who have more experience or more
sophisticated equipment for analyzing a particular
problem. This increases your chance of being cured
-- and cured quickly. It also can be cheaper because
it bypasses trial-and-error treatment and eliminates
the need to travel long distances for consultation and
treatment. But many states prohibit you and your doctor
from consulting a doctor who is not licensed in your state.
3. Litigation costs: Government courts have fostered a
litigation explosion that makes malpractice insurance
extremely expensive for your doctor. To limit this
expense, many doctors will not take on new customers,
and some have left the profession altogether. This
reduces the supply of doctors and lifts medical costs
even higher. Doctors have to guard against any
possibility of a lawsuit. So your doctor may order
expensive tests for you -- to assure that later you
will not complain in court that he failed to explore
every possibility.
If you could agree in advance that you would not sue for
malpractice except in certain specified circumstances,
the doctor could afford to charge you less. And if he
could refuse to treat anyone who did not sign such an
agreement, he could charge you a lot less. Unfortunately,
government courts in most states refuse to honor such an
agreement. And physicians can be sued just for turning
down a patient.
Medicines & Medical Devices
4. FDA approval: Government keeps you from obtaining any
medicine that it has not yet approved. Getting a new drug
approved from the FDA (Food and Drug Administration) costs
a company on average $300 million -- and can take as long
as 10 years. By the time the drug finally gets approval,
it may have been available for years in other countries
-- while you were stuck with a less effective, more
expensive alternative.
5. Foreign products: And because drug companies in other
countries do not have to run the FDA gauntlet, medicines
often cost much less overseas -- and in some cases are
available only overseas. It would be nice if you could
order these medicines, which would save money and allow
you more choices. But you cannot, because the government
usually will not let you. And if you get caught trying,
they may even put you in jail -- even if the drug you were
buying is the only known cure for a fatal disease.
6. Cost in lives: The FDA claims to save lives by keeping
unsafe drugs off the market. But the drugs banned here
do not cause bodies to pile up in countries where the drugs
are legal. On the contrary, Americans die because the FDA
forcibly prevents them from taking the drugs they need.
For example, the FDA approved propranolol for limited use
in 1968, but refused to allow it to be used for angina or
hypertension. Then it reversed itself and approved the
drug for angina in 1973 -- and then for hypertension in
1976. A study by Arthur D. Little, Inc. estimated that
roughly 10,000 Americans died for lack of propranolol every
year the FDA prevented their doctors from treating them
with it. Dr. Mary J. Ruwart, a scientist with Upjohn Co.,
says more Americans may have been killed by being denied
access to this one drug than by the use of all unsafe drugs
in the 20th century.
Robert Goldberg (a senior research fellow at Brandeis
University's Gordon Public Policy Center) has pointed out
that, in the same way, "the FDA has sat on or rejected drugs
for depression, schizophrenia, kidney cancer, and epilepsy
-- not because they were unsafe, but because in the final
analysis the agency didn't think the drug was so important
or effective."
If someone dies from taking an FDA-approved drug, Congress
holds lengthy hearings to see how FDA approval can be made
even more difficult. But if thousands of people die while
the FDA strings along the pharmaceutical companies, there
are no hearings, no TV soundbites, no one-liners for the
press, no grim-faced TV anchormen, no outraged editorials,
no attention whatsoever -- just a lot of prematurely dead
people whose families have no political pull. If you were
an FDA decision-maker, which way would you lean?
7. Prescriptions: Even after the FDA approves a drug, you cannot
buy it without written permission from a government-licensed
doctor -- even if you have used it many times before. And
because government has made it so easy to sue a doctor -- and
collect -- many doctors will not approve prescription refills
without an office visit. The drug itself may cost only $20,
but it might cost you $120 to get it.
8. Non-prescriptions: Some ailments can be treated effectively,
and sometimes more cheaply, by non-prescription means -- such
as over-the-counter medicines, vitamins, selected foods, and
even red wine (in the case of potential heart conditions).
But despite the First Amendment, the FDA will not let the
sellers of many of these products advertise their health
benefits -- even those that are widely accepted in the medical
profession. The FDA has actually conducted armed attacks on
health-food stores to confiscate offending vitamins and other
nutrients.
Even aspirin makers are forbidden to tell you that almost all
doctors and heart specialists believe a daily aspirin reduces
the chance of your having a heart attack. How many deaths and
expensive bypass surgeries would be avoided if more people
knew about the preventive power of aspirin?
The government's own Center for Disease Control has asserted
that folic acid supplements help pregnant women prevent spina
bifida and other birth defects, but the FDA forbids vitamin
makers from putting this information on their labels.
9. Litigation: Government courts also have driven many surgical
devices off the market. Ingredients such as Teflon and
silicone are disappearing from the market because of lawsuits
against chemical companies. Du Pont, for example, decided to
stop selling polyester for medical devices. Total annual
sales of polyester amount to only $200,000 for Du Pont, but
potential lawsuits can run into the millions, so the reward
is not worth the risk. This trend will make it harder to
obtain such things as heart pacemakers, artificial grafts,
and other devices.
Hospitals
10. Non-payers: Federal law dictates that all private or government
hospitals that receive any payments from Medicare must treat
anyone who shows up at their emergency rooms. This affects
almost every hospital in the U.S. because each one has at least
one patient covered by Medicare. If the patient cannot pay,
you and other paying patients have to make up the difference.
Research
11. Political influence: Government subsidies keep researchers busy
on projects chosen by politicians for their most-favored
backers -- even if more lives could be saved with other projects.
12. Loss of medicines: Research on rare diseases has come almost to
a halt because the demand for potential drugs will not be large
enough to recoup the enormous cost of getting them through the
FDA. [even with efforts to circumvent this reality]
Insurance
13. Tax policy: You cannot deduct medical expenses from your taxable
income unless you are self-employed, in which case you can
deduct only a small part of them.
But an employer can deduct all the cost of the medical benefits
he provides for employees. So your employer pays you less and
provides health insurance instead -- which is tax-free for you.
Further, the tax incentives encourage your employer to reward
you with additional fringe benefits rather than raises. So he
is likely to provide 'first dollar' insurance -- wherein all
medical expenses are covered, rather than just catastrophic
illnesses or accidents.
Since you do not have to pay any of the bills, you have no
incentive to economize. Neither do the millions of others
with similar plans. Together, they push up the demand for
medical services -- and its cost.
In a true free market, rising costs discourage demand for a
product -- allowing prices to ease back down. But the tax
system has separated the consumer from the price -- the patient
from the cost -- so demand continues to rise, even as prices
are rising.
14. State mandates: Almost every state has laws that force insurance
companies to cover certain conditions and procedures in every
medical policy -- regardless of the consumer's needs. These
add-ons include such things as psychiatric care, birth services,
teeth-whitening, abortions, toupees, chiropractic services,
cosmetic surgery, alcohol and drug rehabilitation, sex therapy,
acupuncture, and marriage counseling.
Obviously, the add-ons run up the cost of your policy -- and the
state will not let you buy a cheaper one, even if you want to.
So it is not surprising that many people feel health insurance is
too expensive, and choose to go without it.
15. Community rating: Some states force insurance companies to set
premium rates that do not 'discriminate' by age, gender, or other
factors. Since the cost of insuring a healthy 25-year-old is
about one third of that for a normal 60-year-old, the single,
one-size-fits-all mandated rates make insurance prohibitive for
most young people. Not surprisingly, a lot of them join the
ranks of the 'uninsured' -- the folks the politicians believe
the free market has failed.
Government Insurance (Do not Call It Socialized Medicine)
16. Medicare & Medicaid: The tremendous runup in health-care costs
started in 1965 when Congress created Medicare -- which put the
government squarely in the health insurance business -- and
Medicaid.
Medicare is a health insurance program for the elderly, with
compulsory 'premiums'. Medicaid is a program by which state
governments use federal money to pay for health care for
low-income people.
When Medicare was passed in 1965, Congress projected its costs
into the future, and estimated it would cost $3 billion for 1990,
the equivalent (after adjusting for inflation) of $12 billion in
1990 dollars. The actual cost in 1990 was $98 billion -- further
evidence that no government program stands still.
The payroll tax in 1967 was a modest 0.9% (divided between
employer and employee). It has risen steadily and is now 2.9%.
And the amount of your earnings that can be taxed has risen as
well. In 1993 Congress removed the ceiling entirely, so that all
earnings are taxed now.
But despite these tax increases, Medicare will be bankrupt by the
year 2002 if the tax is not raised further. The program's
actuaries project that the rate has to rise to 4.3% by 2000.
But, of course, any projection will be revised upward before its
target date arrives.
Because the politicians consistently underestimate Medicare's
costs (refusing to recognize that coercion distorts supply and
demand), Medicare tax increases never catch up with ever-rising
expenses, and so the tax increases just keep coming.
Every year or two, with great fanfare Congress passes a 5-year
or 7-year deficit-reduction package that includes large cuts
in Medicare and Medicaid spending. Always the actual cuts
are scheduled for the later years of the plan, with the
details to be worked out by some future Congress. Meanwhile,
the current Congress holds a press conference and congratulates
itself for cutting spending and reducing the deficit.
But when the later years arrive, there are no cuts -- just more
increases. The big tax increase and deficit-reduction package in
1990, for example, assumed that Medicare cuts would save $60
billion over five years. Instead, additional Medicare
spending over the next five years amounted to $166 billion.
In the mid-1980s, Congress introduced a series of cost-control
provisions in Medicare. But since then, costs have risen at twice
the rate of health-care costs in general.
The pattern is virtually the same for Medicaid. When Congress
passed it in 1965, it cost $1 billion per year. By 1993 it was
up to $76 billion per year. In the 1980s alone, Congress expanded
Medicaid services 24 times -- adding about $20 billion per year to
its cost.
Because these programs impose so many requirements, the health-care
system now has far more administrators per patient and far fewer
doctors and nurses per patient. Those big medical bills are not
paying your doctor's country club dues; they are financing a bigger
and bigger health-care bureaucracy.
17. Shifting costs to you: Medicare often pays only a third or so
of the actual cost of a hospital stay. The American Hospital
Association estimates that hospitals lose an average of $900
on every Medicare patient treated, amounting to $9 billion a
year in losses. Hospitals have to pass the unpaid remainder
on to you, other paying patients, and insurance
companies -- making hospital stays and insurance more expensive
than they should be.
18. Government driving health care: By 1992, Medicare and Medicaid
accounted for 31% of all medical spending in the U.S. Health care
can hardly be called a 'free market'.
More money is spent on medical care now by governments than by
all private companies and individuals.
Regard$,
--MJ
Poverty is not a mortgage on the labor of others - misfortune
is not a mortgage on achievement - failure is not a mortgage
on success - suffering is not a claim check, and its relief
is not the goal of existence - man is not a sacrificial
animal on anyone's altar nor for anyone's cause - life is
not one huge hospital. -- Alyssa Rosenbaum
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