Author: Isaac

Categories
medical politics

A deep breath, healthcare reform, and the 10th amendment

I don’t want to give the wrong impression, but it may already be too late. If you read enough, you’ll see that people in countries that have various forms of nationalized healthcare, or at least nationalized healthcare coverage are mostly happy with it. People deal with whatever they have to work with. In other words, if something were to be passed, and it worked overall, I don’t think it would be the end of the world. That doesn’t mean I’m not worried what is hidden in those 1000 pages, but I’m not going to get crazy if it does get passed.

I am getting frustrated at people scoffing and ridiculing others for being worried about the federal government involvement in things that it doesn’t have any jurisdiction over. Calling them “unamerican” like our speaker of the house did is unexcusable. Whatever you may think of those people, they do have an argument that has some force, it’s called the 10th amendment. The 10th amendment (the last of the original bill of rights) is the key difference between our government and all of the other governments out there.

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

It is a clear limitation on the extent of the powers and scope of the federal government. Granted, the people yelling at the meetings are not citing the 10th amendment, but their sentiment is the effectively the same. Like it or not, it is there and we shouldn’t ignore it, or the people that share the sentiment.

Of course, the 10th amendment has all but been ignored for all of the 20th century. The supreme court has twisted itself into knots using the commerce clause in order justify all sorts of federal involvements that are not in the constitution. I do wish that we would remember what the federal government is supposed to do, it is very clearly spelled out in the constitution. The 10th amendment was put in there to prevent the federal government from emulating a monarchy. You have to have limits to prevent that, an the 10th is it. On the other hand, the proper use of the commerce clause could in fact help out this issue and the government could stay within its prescribed bounds. SIGH, I guess it’s too much to ask for that to happen…

Categories
economics medical

Just for the record, I do think things are screwed up

I have posted many times before on how screwed up the medical industry is. Insurance companies are sheltered from competition, providers can’t tell you how much anything costs, and there is an enormous amount of confusion about costs in medicine. it should be much more straightforward. If people are unaware what things cost, how will we ever get prices lower? If we don’t get prices lower, how will we ever expand availability in a way that doesn’t kill us?

So what are my ideas for correcting things? I would like to start with stripping away the layers that protect the insurance companies. Make them compete on a national level. I would like to see providers be more transparent on the costs of procedures. I would like to see more competition for care in the same way you see competition among dentists, corrective eye surgery, and plastic surgery.

All of these things could be done without additional tax burdens. Who knows, maybe they wouldn’t be enough for the people that are so eager to reform, but they would certainly make a difference. I want the lawmakers to go after the low hanging fruit before trying incredibly expensive and large programs. Shouldn’t that be the way things work on a normal basis? What’s wrong with doing the easy thing first?

Categories
freedom of choice medical politics

"It’s not a single payer system, so what’s the big deal?"

That’s a response I got to my last post. It’s true, I don’t know of anyone seriously promoting that, but it can still do what I said in my previous post. Why? It all has to do with the fact that it is a federal program.

Imagine that you have kids and live in an area with lousy public schools. You really don’t want to send your kids to neighborhood school, what to do? Sure, you have a choice, you don’t have to choose to use the state’s school, there are plenty of private schools to choose from. Here’s the thing, even if you choose to not use the public school you still have to pay for it. Your choice to not use the school does not help you out at all. You have to come up with the money for both the public and the private school. On top of that, the public school doesn’t really care if your children don’t go, they won’t change what they do at all.

Facing that decision, most parents go ahead and send their kids to the public school. If they are really committed, they will agitate to improve the school. Of course, if anything ever does come of that agitation, it will only be long after their kids are through that school.

It’s a similar thing with a federal health insurance “option.” It will be optional to use the services, but it will not be optional to pay for it. Faced with that decision, most people will go ahead and use it. Using what you are charged for is the rational thing to do, even if that thing is substandard. The cost of using something else is just too much for most people. This is the mechanism that will cause the federal program to squeeze out the private ones.

Keep in mind that this holds even if you can opt out of the premiums. This is because the inevitable cost over runs and/or cost underestimates will still be the responsibility of the federal government. Without any real reason to worry about profitability, there will be both. It will be like Fannie mae and Freddie Mac, political promises with no incentive to rein in costs or risks. In other words, a disaster waiting to happen.

Categories
freedom of choice medical politics

My thoughts on health care reform

I have had several people say to me that I must be excited about the effort to reform the medical world what with my MS and all. Despite what some people would see as an advantage to me, I don’t really see much upside in my circumstance.

It probably doesn’t come as any surprise that I just don’t trust reform coming from DC that involves more federal activity. The political process is not conducive to doing that well. Even if they managed to set the ideal system up, how long would it last? Special interest groups will be rewarded for their contributions and we will get mission creep like all other federal programs. The bill in the house is a prime example. It is currently over 1000 pages long, it isn’t a stretch of the truth to say that nobody can understand the thing in its entirety. The most recent concession involves an ethanol program for a lawmaker in Illinois. Perhaps there should be a law stating that new laws can be a maximum of 5 pages long…

A bigger worry is that with more government involvement we will get far fewer innovations in the medical world. Say what you want about the US healthcare industry, but there’s no question that it is responsible for the vast majority of medical innovations in the world. This is especially true when it comes to drugs. It is the quest for profit that drives inventions like MRIs, laser scalpels, heart valves, etc. Of course those new treatments are one of the reasons that costs keep going up.

On a less grand scale, I also worry about people losing options that lay outside of the medical mainstream. MS is a case in point. The approved drugs are expensive, don’t have a great track record as far as effectiveness goes, and of course have various side effects. There are some other drugs that have been approved for other conditions that seem to help a lot of people with MS. They are much cheaper, have no significant side effects, and seem to have at least a similar amount of success as the approved drugs. Right now, I can get a doctor to prescribe these for me, but will I have that option if the feds are much more involved? Would I be able to get drugs that are not approved by the FDA for my condition?

So unless the lawmakers can get their act together and draft a law that anyone can read and figure out (If no one else reads it and understands it, at least they should be able to) I am firmly against this current legislation. It may have some good stuff in there, but how can anyone know?

Categories
politics

Vegas, and a modest proposal

Gambling was a blast the first time I went to Vegas. I hung out at the Roulette table and had a pretty long run. Eventually, I ran out of chips and the thought “I need more chips” crossed my mind. It took several minutes to remember that those chips were actually money. That isn’t by accident, the casinos know exactly what they are doing.

In the same vein, I’m getting sick and tired of hearing “The federal government” will pay for program x, y, and z. I would like a law passed that would require all government employees to substitute the phrase “The American taxpayers” for “The federal government.” It sounds like a minor thing but I think that it would have some significant effects. Instead of hearing senators say “The federal government will provide a subsidy of $4500 for older cars,” we would have “The American taxpayer will provide a subsidy of $4500 for older cars.” That does sound different, doesn’t it? I want politicians, members of the press, and political hacks on all sides to stop deceiving themselves and others. I want them to stop playing games when it comes to spending money. Be truthful when talking about spending our money!

Categories
economics freedom

Money isn’t the problem, people are

This is something else that came up with my kidney post. it’s from a friend of mine and I think it’s a fairly common outlook.

I guess in my ideal world, Isaac, we stop our worship to the god Money, who rules over us now, and puts himself between people and life, fun, love, education, food, nature, etc, etc, etc. It seems as people make more money, and create new and better avenues to money, they also create bigger needs for regulation and protection to control the greed produced in its wake.

Wow, where to start? How about this, the greed doesn’t come from the money. People have unlimited desires, we always want more. Of course in order to satisfy all of those wants, this world would need to be unlimited as would our lifespans. This is a limited world. We are limited.

When economists say that there’s no such thing as a free lunch (TNSTASAFL), they aren’t really taking about money. What they mean is that something has to be given up. There is labor, and time spent on lunch. Now, we could incur that cost ourselves, or we could get someone else to incur it for us. Of course, if they do that for us, they expect something in return.

Ultimately, we are all engaging in barter. I exchange my labor for someone else’s labor. Some people make sandwiches, some people sell cameras, other people do other things. But barter is really unwieldily. If I sell cameras and I want a sandwich, I would have to find someone that makes sandwiches AND wants a camera. So instead of doing direct barter, we use money instead. We exchange out labor for money and then exchange the money instead of labor directly.

Peoples’ desires for more is always what is at the root of what people blame on money. Those desires would still be around even if money were to disappear tomorrow. Of course, a world without that unit of exchange would suck. We should all be thankful for the existence of money, it makes life much easier. People’s desires, or if you prefer, greed, has always been around and always will be. What we have to do is learn how to deal with other people’s and our own and stop blaming other things for what we see as wrong in the world.

As far as the government being the best thing in order to protect us from greed, I’ll just say this; the government is made up of people too. They aren’t special people, they aren’t above anyone else. They too, are subject to the same types of desires and greed as anyone else. The difference is that the people in government are able to wield quite a bit more power than the average person. Entrusting other people with that kind of power is asking for trouble, and boy have we ever gotten it. At best, I would say that the government’s efforts have not helped at all with the issue of greed. Of course they have done that at great cost, and I really do think that they’ve made things worse anyway. Inevitably, when government “protects” us from something, they give more power to some corporation or at least give them more money. Keeping a level playing field is best accomplished without government interference and it allows us the maximum amount of freedom to determine our response to other’s greed.

Categories
freedom of choice medical

More on selling kidneys

I’ve had a little exchange with a friend on facebook over my ideas on selling kidneys. I’m sure that other people have similar fears, so here are my responses.

First off, it must be remembered that if selling and buying kidney were legal, things would not be the same as they are now. Issues relating to variable quality, obtaining kidneys from unsavory sources, the cost, and the potential violence of harvesting from unwilling people would be solved by the ability to go to a local clinic or hospital to have the procedure done. Imagine that kidney clinics were as common as fertility clinics, or dialysis clinics… There is no reason to think that kidney transplantation would be much different than it is now when it comes to safety. Selling would be done at the same places.

You have to keep in mind that you can’t just pop any old kidney into anyone else. There are compatibility issues. In addition, you don’t want any sort of nasties to be transmitted to the recipient, so proper screening is necessary. When dealing with a black market, you take some pretty big risks, but there’s no reason to in a legal market.

As far as the cost goes, it would still be expensive, but what major medical thing isn’t expensive? It’s hard to imagine that insurance companies wouldn’t cover the procedure since it would prove to be a great savings over dialysis costs and complications. Legalization also would end up lowering the costs since the supply would be dramatically increased.

My friend David summed it up like this, “Would selling organs open a Pandora’s box? Yes. Do I have the right to keep that box closed. No. Should I fight to make sure people aren’t exploited- absolutely.” I would never claim that legalizing this wouldn’t bring up some tricky issues or solve all of the problems out there but it would help a lot.

In the end, all of the positive results are very nice and good, but they are not the real reason to legalize the buying and selling of organs. The real reason is that people should be in charge of their own bodies. If ethical issues come up because of that, so be it. taking control away from people in regards to their own body is the real crime, everything else is a secondary effect.

Categories
medical

More on selling organs

That last post was really about kidneys. There are immediate and obvious benefits to allowing people to sell their kidneys to waiting patients. But think about this, what do you think would happen if people’s estates were paid for the organs that can be harvested after someone died?

Yes, more organs would be transplanted, and more people would be saved, but think about some of the possibilities. It could be a replacement for life insurance. If you could contract with a company to take your organs in case of an untimely death, your estate could benefit tremendously. Think about it, how much would a heart, kidneys, lungs, liver, corneas, etc. bring in? Now imagine that instead of paying for life insurance, you could simply contract for your organs? You could even take out a supplemental insurance policy in case the organs could not be harvested. I would imagine that policy would be quite a bit less expensive.

My point is that a lot of people could be made better off by simply getting rid of one law. Why do we continue to allow people to die?

Categories
medical

Why is selling kidneys illegal?

I was listening to “Talk of the Nation” today and I ended up being so mad I was yelling at the radio. The program was about the busting of an organ brokering service in NYC. All of the commentators had the assumption that this practice was dangerous, to whom I couldn’t tell. One guest even went so far as to try to stop people from traveling to the US to sell a kidney. Am I the only one that thinks that people traveling to the US TO SAVE LIVES is a good thing? I wish I could have asked her this; Are you telling me that if they spent money to come here and give their kidney to someone that would be OK but them being paid to do the same thing is immoral and dangerous?

Give me a break. There are two obvious critiques of the ban on organ selling. The first I’ve already alluded to. If you can do it for free, why can’t you get paid for it? A person is saved in any case. That leads to the other argument. Right now, every person in the process of organ transplantation benefits, except the donor. The recipient obviously gets their life back, perhaps even has it saved. the hospital, the surgeon, the transportation involved, they all get paid. So why is the donor left out? Why is it OK for everyone else to benefit and not the guy that is actually giving something up?

Instead of viewing those people that got busted as dangerous criminals, perhaps we should see them for what they are, life savers. Everyone was willing, it was done in the US for crying out loud, where’s the danger? I understand worrying about “exploiting” people, even if I don’t agree with it. What I don’t understand is why we don’t worry more about the people that are dying, dying from something that is easily solved.

Categories
odds and ends technology

An awful night’s sleep and an amazing dream

Man, last night was perhaps the most brutal night’s sleep I’ve ever had. I tossed and turned and woke up feeling like I got beat up. I ached all over and had a splitting headache.

The good news is that I had a rather vivid, pleasant dream. I was visiting a childhood friend and his family in Hong Kong, not that they have ever been there as far as I know. I also saw one of my college roommates there. I now realize that my completely truthful conversation with him sounds as weird as anything else in the dream. He asked me what I had been doing and I told him that I had been in Yemen, but that my MS has kind of grounded me recently…

Anyway, it was time to leave. I was going to take the train to the airport, here’s where it gets cool. I walked down the street and got into an elevator to take me up to the tracks. Strangely, the elevator got slightly smaller as it went up. Then it started moving sideways. Just as I started to freak out, a window revealed itself and my train tickets were printed up for me! I was on the track, on the way to the main train station. Pretty cool.

At the station, I was supposed to find the area to board my particular car. The cars were similar to the old fashioned cars on trains, or maybe a carriage. They were tall, with lots of glass, and there were two benches facing each other. Cars of a certain destination would cycle through a small eddy-like area and you were supposed to jump on as it came by. Well, mine came and went, it didn’t slow down or stop for me. So I got on another, figuring that they were going to the same place anyway. But then mine came back! So I jumped off and tried to get onto the correct one.

I ended up missing both, but not to worry. There was a keypad recessed in the wall with some instructions. I punched in the general direction I wanted to go and a small compartment opened up. As I punched in my specific destination, a closet opened up so I could store my luggage and we got underway. Once again, I was in my own train car. It was pretty small, people that are claustrophobic would probably freak out, especially with the car’s inclination to get smaller as you got underway. It was also good that I was by myself, no one else would have fit.

Anyway, I enjoyed that, I like trains, and having my own car was quite a treat. Who knows, maybe sometime in the future we’ll get to experience all that for real.