Could National Health Care Be Behind Britain's Anti-Drinking Campaign?
Ronald Bailey | June 15, 2007, 2:41pm
My friend Jonah Goldberg thinks it might be and explains why you should care. To wit:
The British government recently unveiled plans for a massive crackdown on “excessive drinking,” particularly among the middle class. It will include all of the familiar tactics of public health officials: dire new warnings on wine bottles, public-awareness campaigns, scolding from men and women in lab coats...
Britain still subscribes to a system where health care is for the most part socialized. When the bureaucrat-priesthood of the National Health Service decides that a certain behavior is unacceptable, the consequences potentially involve more than scolding. For example, in 2005, Britain’s health service started refusing certain surgeries for fat people. An official behind the decision conceded that one of the considerations was cost. Fat people would benefit from the surgery less, and so they deserved it less. As Tony Harrison, a British health-care expert, explained to the Toronto Sun at the time, “Rationing is a reality when funding is limited.”
But it’s impossible to distinguish such cost-cutting judgments from moral ones. The reasoning is obvious: Fat people, smokers and — soon — drinkers deserve less health care because they bring their problems on themselves. In short, they deserve it. This is a perfectly logical perspective, and if I were in charge of everybody’s health care, I would probably resort to similar logic.
But I’m not in charge of everybody’s health care. Nor should anyone else be. In a free-market system, bad behavior will still have high costs personally and financially, but those costs are more likely to borne by you and you alone. The more you socialize the costs of personal liberty, the more license you give others to regulate it.
Universal health care, once again all the rage in the United States, is an invitation for scolds to become nannies. I think many Brits understand this all too well, which is one reason why they want to fight the scolds here and now.
You think it can't happen here? Reason explains how wrong you are here and here. Whole Goldberg column here .
jh | June 15, 2007, 6:06pm | #
Chicago Tom, asks: "So is the implication that doctors are treating Medicare/Medicaid patients worse or giving them worse care? How exactly are the people with socialized coverage getting "worse care"?
Or is your point that less and less doctors are accepting medicare to the point that only the worse doctors are accepting it or that there is a shortage of doctors who take medicare. If this is what you meant I suppose some citation would be in order to prove that this is actually happening."
My wife is an orthopedic surgeon. She's one of the best on our island, so she's insanely busy. As her practice built up, she started shedding the socialized medicine patients -- first the Medicaid and related stuff, then Medicare. Unless you have private insurance, or go into the emergency room while she's on call, or are a personal friend, you have to go to a less capable doctor. And while you still have some doctor selection with Medicare albeit not the best ones, if you have the crappy Medicaid or Quest plans, you're likely to get someone pretty scary.
I was diagnosed with metastatic melanoma a few years ago. The first doctor I had screwed things up -- misdiagnosed it, dinked around for a few months, then when he finally realized what I had, he tried surgery and bailed out halfway through when he realized nerve endings were involved and he didn't have the expertise to save my right arm. And this was someone covered by private insurance, not some socialized medicine only doctor. Then, I had the best surgeon in the state remove a lump of cancer the size of your fist. To get that doctor's services, I had to go non-par, which means he charged the price he wanted and I had to pay the difference between that and what my private insurance paid. I'd probably be dead or lost the use of my right arm if I went to a lesser doctor.
You combine the restriction in choice of doctors with the less generous insurance in Medicare and especially Medicaid, and yeah, socialized medicine results in worse outcomes.
If you prefer statistical studies over real life anecdotes, try googling it.
eat drink and be | June 15, 2007, 11:31pm | #
Why would the average person below 30 want to have health insurance? Self insure, pay out of pocket for the little care you need, and invest your money in your ventures. If you go get big time sick, let the state take what little you have and get the best of care until you get well, if you do.
Once YOU take on the responsibility of another you naturally assume some control over their behavior. All lose some of their freedom. Don't ride your bike without a helmet. Wear your seat belt. Don't, don't, don't, and do, do, do.
We are letting people starve and thirst to death in Africa, die from lack of resources, every day all my life. We do a little, but not enough. We spend more on clothes, dog food, fun, and extras than we do on 'those unfortunate people.'
No one in our house, our family, our neighborhood, our city, our state, our country, is really starving to death. Get the camera put it on youtube.com.
So, if I drink too much, you're going to say don't drive. No one should have a problem with that. But if I eat nothing but McDonald's #1 combo, go large, it isn't so easy to say I'm costing you anything. I might still outlive you and have one sudden heart attack that kills me. Where is the balance? Is it all or nothing?
Random Statist | June 16, 2007, 1:53am | #
"based on data gathered by Princeton Survey Research Associates from April through July 2001. Interviews were conducted with a random national sample of 3,457 adults age 19 and older.
In their report, Davis and coauthors find that elderly Medicare beneficiaries are more likely than enrollees in employer-sponsored plans to rate their health insurance as excellent (32% vs. 20%) and less likely to report negative experiences with their insurance plans (43% vs. 61%). Medicare beneficiaries are also less likely than those with private insurance to go without needed care owing to costs (18% vs. 22%). The survey also finds that elderly Medicare beneficiaries are more likely to report being very satisfied with the care they received compared with those with private insurance (62% vs. 51%).
As the chart below illustrates, private insurance holders are actually less satisfied with health care and more concerned about costs than Medicare beneficiaries. The fact that Medicare was systematically more likely than employer coverage to be rated as excellent across income and health status categories challenges the received wisdom that Medicare is "out of date," and should "catch up" with the private insurance model. "Would-be Medicare reformers need to be cautious if they want to make the program more like the private sector," the authors conclude. "
* Twenty-two percent of privately insured people found that their plan did not pay for care that they thought was covered, compared with 9 percent of elderly Medicare beneficiaries.
* Nine percent of privately insured people had difficulty getting a referral to a specialist, compared with 2 percent of elderly Medicare beneficiaries.
* Medicare beneficiaries were more likely to be very confident in their ability to get care in the future as those covered by employer plans (60% vs. 37%).
* Thirty-three percent of privately insured people were unable to pay their bills or had been contacted by a collection agency, compared with 18 percent of elderly Medicare beneficiaries.
Citation
"Medicare vs. Private Insurance: Rhetoric and Reality," Karen Davis, Cathy Schoen, Michelle Doty et al., Health Affairs Web Exclusive (October 9, 2002): W311–324
Random Statist | June 16, 2007, 1:58am | #
"The American Journal of Medicine
Volume 118, Issue 12, December 2005, Pages 1392-1400
Copyright © 2005 Elsevier Inc. All rights reserved.
Clinical research study
Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries
These results were presented at the Society for General Internal Medicine, 2003, Vancouver, BC.
Eric C. Schneider MD, MSca, Corresponding Author Contact Information, E-mail The Corresponding Author, Alan M. Zaslavsky PhDb and Arnold M. Epstein MD, MAa
aDepartment of Health Policy and Management, Harvard School of Public Health
bDepartment of Health Care Policy, Harvard Medical School, Boston, Mass
Received 13 January 2005; revised 4 May 2005; accepted 4 May 2005. Available online 25 December 2005.
Abstract
Background
For-profit health plans now enroll the majority of Medicare beneficiaries who select managed care. Prior research has produced conflicting results about whether for-profit health plans provide lower quality of care.
Objective
The objective was to compare the quality of care delivered by for-profit and not-for-profit health plans using Medicare Health Plan Employer Data and Information Set (HEDIS) clinical measures.
Research design
This was an observational study comparing HEDIS scores in for-profit and not-for-profit health plans that enrolled Medicare beneficiaries in the United States during 1997.
Outcome measures
Outcome measures included health plan quality scores on each of 4 clinical services assessed by HEDIS: breast cancer screening, diabetic eye examination, beta-blocker medication after myocardial infarction, and follow-up after hospitalization for mental illness.
Results
The quality of care was lower in for-profit health plans than not-for-profit health plans on all 4 of the HEDIS measures we studied (67.5% vs 74.8% for breast cancer screening, 43.7% vs 57.7% for diabetic eye examination, 63.1% vs 75.2% for beta-blocker medication after myocardial infarction, and 42.1% vs 60.4% for follow-up after hospitalization for mental illness). Adjustment for sociodemographic case-mix and health plan characteristics reduced but did not eliminate the differences, which remained statistically significant for 3 of the 4 measures (not beta-blocker medication after myocardial infarction). Different geographic locations of for-profit and not-for-profit health plans did not explain these differences.
Conclusion
By using standardized performance measures applied in a mandatory measurement program, we found that for-profit health plans provide lower quality of care than not-for-profit health plans. Special efforts to monitor and improve the quality of for-profit health plans may be warranted. "
