It has been a busy week and I don't want these two posts to be buried beneath the rubble:
From Bayou Renaissance Man:
Selective Denial or "rationing" of health care?
The author explores one tunnel through the mountain of Status Quo medicine. Under the banner of improving outcomes the Federal Government starts denying reimbursement to providers who fail to pass certain hurdles. Lets say the bottom 10% of surgeons have a success rate below 75%. Simply refusing to reimburse those surgeons for ANY surgery would have the effect of improving outcomes.
Sounds humane, right?
But the net effect is that all surgeons will refuse to accept high-risk patients. Immune system deficiency? ...go fish. Body Mass Index over 30? ...go fish. Diabetic?...go fish. Over seventy years of age? ...go fish.
The next step will be to deny reimbursements to any facility that has sub-par performance. That will leave huge amounts of "fixed costs" stranded on the beach as the tide runs out. This will be a painful for investors but is necessary for the economy. We have too much fixed cost! And as long as a hospital's fixed costs gets serviced it will be increased. Think of it as fasting for better economic health.
The only way to get ahead of fixed costs is to kill it on the vine.
One minor quibble I have with the author is that he thinks that large groups like those with Type II diabetes will be exempted due to their political clout, i.e. large numbers. I disagree because the only way to deal with our bloating health care costs is to deal with large numbers, to use a chainsaw to cut off major limbs of the tree. Snipping twigs may look good but it will never remove enough cost.
Another minor quibble involves medical tourism. Folks with $50,000 can still go to Mexico, the Caribbean, India or a host of other countries for surgery even if they are over seventy, diabetic or have immune system issues.
The take-home is that the only way to game the health care system is to never need it. Stay fit. Stay as slim as you can. Eat well. Take your vitamins. Keep up-to-date on your immunizations. Remain monogamous. Never inject crap into your body. Avoid crazy people.
From Charles Hugh Smith
Mr Smith covers three topics:
- He wrote briefly of poverty. It is a racket, of course. Over 96% of Americans in "poverty" have at least one TVs, 98% have refrigerators, 83% have air conditioning, +81% have cell phones, and 60% have computers. How many families in the most affluent communities could make the same claim in 1990? Poverty becomes an unsolvable problem when it is posed as relative differences in wealth.
- He wrote about Universal Basic Income. Proponents of UBI claim that it will usher in the second Renaissance. Mr Smith points to people on disability (guaranteed check, almost the same as UBI) and notes that recipients watch more TV and take more prescription drugs. So far none have written any music to rival Saint-Saens or Rachmaninoff
- He wrote about Medicare for All.