This is another in the health care discussion continuum. I am hearing a lot of ridiculous statements from politicians. Let’s look at some ways that would actually reduce health care costs and if we really want to go there.
I spent a lot of time discussing universal health care, the built in inefficiencies, and how it will lead to poorer quality physicians and care in an earlier entry. I am clearly convinced that universal government-run health care is a disaster and will make mediocre care available for everyone. As I said in that piece, 40 million Americans have poor care now but universal health care will make sure everyone does.
Rationing Care – We could do what the British and other socialized medicine care countries do. They don’t call it rationing. They call it an effective use of resources to deny care to significant portions of their population. The way they do it is with actuarial tables. For example, if the median age of death in the country is 74 and you are 76, no matter your medical health state, you are a bad investment for medical resources. If you prescribe to those statistical methods, you probably also believe that when you reach a certain age, you should just jump off a building or head on down to the Soylent Green plant for processing. Additionally, under mandatory universal health care, someone like Warren Buffet with a billion dollars earned, gets the same care as John Q. Suckerfish, who had lived his life on welfare. A system like this will set up generational war where the younger members of society will hoard the health care dollars despite having no where near the need for them. Do you really want to see your parents and grandparents denied care, even if they are in good health, based purely on an actuarial table? I don’t think we want to go there.
Improving efficiency – Everyone always talks about improving efficiency in health care. You might notice that they always do it in generalities. President Obama continually talks about the “billions of dollars we can save by improving efficiency in health care” but the only specific he ever mentions is electronic medical records. I have addressed the problems with those in an earlier post. When people talk about improving efficiency in generalities, it is a sure sign that they have no idea what they are talking about. It is a straw man. It is like saying “I am for better schools” or “I am for a strong defense”. Unless you have specific proposals, you reek of fecal matter from male cows when you discuss it.
Get Out of My Emergency Room – One method of reducing costs which has been widely recognized for years is moving people back to seeing their family primary care physicians and physician assistants. The same office visit which costs $75 at the family physician office costs $600 at the local emergency room. I have worked in many emergency rooms where every Sunday night, mothers bring in their children with minor complaints of colds, fevers, etc. to inquire whether their children should go to school tomorrow or not. It is major waste of health care dollars. If a family physician or pediatrician held office hours Sunday evening, the emergency room would only have half as many patients and the cost would be reduced by a factor of ten. The reasons that emergency rooms exist is because doctors historically did not want to have to work twenty four hours a day. Since internists and surgeons would be called in at all hours of the night to see patients, they came to hire physicians to man the medical facility at night. That eventually led to the creation of the emergency medicine specialty.
Many people now use the emergency room as their local clinic. Part of the reason for this is that emergency rooms are not allowed to turn away patients. Therefore, a person can choose not to pay for health insurance and just show up. Who picks up the cost? The taxpayers of the local area. In an analogous manner to the emergency room physician, why not have physicians or practitioners man clinics at night to allow primary care to be done at the clinic rate rather than the emergency room rate? If people use their existing health policies to make office visits instead of using the emergency room, huge savings are possible.
Private Health Insurance – Over the years, business interests have put in place laws which severely restrict which health care plans people can purchase. For example, in most places, you cannot buy a policy across a state line. If you live in Maryland, for example, you cannot buy a policy from a health insurance company in Utah. The system was set up by the local legislature after lobbying from the local health insurance company to set up a monopolistic system. The system guarantees no competition and therefore no reason to improve policies or reduce premiums. It is the same as universal health care in that the system is bloated and inefficient. To reduce costs almost immediately, those state line restrictions should be dropped. This must be done in combination with the next section to induce competition among health insurance providers. A family will buy the health insurance policy with the best benefit package and lowest premiums available if those plans are in competition.
Third Party Payers – This section goes hand in hand with the prior one. Companies always complain about runaway health care costs as the reason they are unable to make a profit. It many cases, it is true. No one who has company-provided health care cares what it costs because they never see the premiums. As long as you can get care for your family and keep your job, there is no reason to care about the premiums. I believe one answer is to get rid of third party payers. If your employer gives you, as part of your pay and benefits package, money to buy health insurance instead of providing a policy, you then have a vested interest in knowing what it costs and finding the best policy available for the best price. A system like that would provide a lot of flexibility. It would be like automobile insurance in some ways. If you are a young healthy person, you could opt for low premiums with higher co-pays (deductibles) because the likelihood of having a serious illness in your twenties or thirties is fairly low. As you age, you can adjust your policy for higher premiums with lower co-pays because the likelihood of your needing medical care increases. If you have an individual or family policy that you own personally, you can take it with you if you change employers. Since you would buy the policy while you are young, you would not run into the problem of changing jobs in your late forties and finding the new premiums prohibitively expensive. If any policy anywhere in the country was available, people would shop for the best policy around. Insurance carriers would then be forced to compete with better benefits and lower premiums in order to attract customers. This is the way that free markets always improve services for customers.
Did you ever notice that when you buy a slice of pizza in New York City that it is really good? There is nothing genetic about the people in New York that makes them better cooks and the ingredients are the same as everywhere else. Why is that? It is because if you don’t make a good pizza slice, there are three more places down the street that do and you go out of business. That is the way competition works. If competition in the health insurance industry is opened, policies will improve and prices will improve. People will be able to maintain their policies no matter where they move and if they change their job. The market will fix the problem if we let it. For those unable to purchase policies due to physical or mental disabilities, the government can help them. No one has a problem with that. The prices will be less expensive to the government because of the competition in the industry and it will cost less in tax dollars. I should point out that I do have a problem with providing tax money for health care to able-bodied people who choose not to work or buy a policy. They have chosen their own fate as people in the United States are free to do.
Tort Reform – Many physicians are now required to practice what is known in the sector as “defensive medicine”. What that amounts to is getting your ducks in a row before the inevitable frivolous lawsuit. Extra expensive radiology studies, laboratory tests, and follow up visits are the norm to prevent litigation. In the obstetrics field, there are two kinds of baby births: perfect and lawsuit. It doesn’t matter if the birth mother is a crack-smoking alcoholic who performed as a professional wrestler while eight months pregnant, if the baby isn’t perfect, the Ob/Gyn is getting sued. That is because there are law firms that do nothing else but sue physicians and hospitals. In Pennsylvania, the same malpractice insurance policy for a general surgeon that costs $37,000 a year in premiums in Virginia, costs $135,000. Why is that? Are surgeons that much worse in Pennsylvania? No, it is because the tort laws in Pennsylvania are set up for lawyers to make money. You will find this to be true in every Democratic state. Since the Trial Lawyers Association is the biggest single contributor to the Democratic Party, you will never see tort reform in one of those states. About 36% of the general surgeons in Pennsylvania have left the state. They cannot afford to practice there. They have to make $135,000 before they make a penny to keep. The does not include paying office staff, leases for offices, supplies, administrative costs, licenses, continuing medical education or any of the other routine costs of running a practice. Therefore, they move or stop practicing. Pennsylvania screws itself. Of course, that won’t stop the legislators from complaining about the situation, even though they caused it. It is a lot like Christopher Dodd and Barney Frank talking about the housing crisis. Next time you think medical care is too expensive; go to see your lawyer to get that coronary artery bypass surgery. I’m sure he can hook you up.
In summary, there are a number of ways to reduce health care costs which are far preferable to government-run universal health care. I have pointed out a few but not all. I am sure I will visit this subject again.
Showing posts with label public funding. Show all posts
Showing posts with label public funding. Show all posts
Saturday, March 7, 2009
Tuesday, January 6, 2009
Art and Public Funding
There is always an ongoing debate about public funding, as in tax money, being used to give grants to art projects through the national Endowment for the Arts (NEA) and other public mechanisms. I have had the same debate a number of times over the years and today I was reminded of it so I thought I would make an entry about this subject.
The first problem with the system is that art, by its very nature, is so subjective that the difficulties in determining which projects should be funded are problematic. It will always be left up to the interpretation of the leaders of the NEA what constitutes worthwhile projects. Inevitably, there will be public disagreement about whether a project is worthy. A large part of this is that the very people chosen to be a part of the NEA are not going to be in the mainstream of American education or values. Anyone who believes that a crucifix in a jar of urine is not offensive and is worthy of public funding is clearly outside the mainstream of public opinion. The art community will, of course, argue that the very nature of art is to be provocative. While that may be true, it in no way obligates the use of tax funding to subsidize the making of such projects.
My older brother, who is one of the smartest people I have ever known, once told me that a project like that was art because it “evoked an emotional response”. I argued in response to him that if someone was to make a bowel movement on the hood of my car, it would certainly evoke an emotional response in me and I wouldn’t consider it art. Additionally, what I would do to that person would certainly evoke an emotional response from him/her and that person, while traveling to the medical facility, would not consider my response performance art. It would, however, be nice if the police said no charges could be filed because I was just doing some “art”.
After the conversation with my brother, the analytical side of me reared its head and I decided I needed some objective criteria for what I considered art. So, here are a few that I came up with in a short time:
1) If I can do it, it isn’t good. I am absolutely terrible at painting anything other than a wall in a house. If art work consists of randomly throwing something at a canvas, scribbling nonsensical figures, pouring something to have it splatter, dropping something out of a flying plane, or especially, using bodily fluids, it sucks because I can do that. I am not sure who decided that three I-beams stacked up and painted orange is art but you see that same crappy thing in front of buildings everywhere. Once again, I can do it, so it sucks.
2) If you have to explain it to me, it isn’t good. Quality pieces of art have some intrinsic beauty or force that allows one to just know it has merit when seen. If I have to listen to some long-winded explanation about how it represents mans constant struggle to revive the extinct Dodo bird, the artist is not an artist, he is a bullshit artist. I can look at anything Rembrandt painted and just be awed by the lighting and mastery contained in the painting. Anyone can look at a Michelangelo statue and have no question of the mastery in his hands. I don’t need Rembrandt or Michelangelo to come back from the dead and explain it to me.
3) If you can’t sell it, art is your hobby, not your job. I play the guitar pretty well and sing while I am playing. That does not make me a professional musician. I do not expect the United States government to fund my upcoming CD costs. I don’t believe that Brad Paisley, Josh Groban, or the Rolling Stones expect funding for their recordings, either. If no one likes what you are producing enough to purchase it, you should at least consider the idea that your art work is not good. There are thousands of “actors” in Los Angeles who have never made dime from the entertainment industry. If you are making your living bussing tables, you are a potential actor but not a professional one. In fact, you are a bus boy. A struggling artist is a pseudonym for someone who can’t make a living from art. My previously mentioned brother is a very successful writer but he always had a job in addition to writing and didn’t expect taxpayers to subsidize his work.
4) Funding for art education is a legitimate use of tax dollars. The idea of having a broad educational experience for children in public schools, including art and music is a good thing. When you consider the current state of commercial television and the pop recording industry, it is clearly in the interest of all people in the country to have kids exposed to some quality. Classical music, jazz, poetry, classical literature, and art all deserve a place in education. I will also add that they should be in addition to, not in place of, reading, mathematics and science. I would much prefer kids to know the story behind the 1812 Overture than what “I’m gonna do with all the junk in my trunk”.
5) Good art and literature stays good. Charles Dickens books are still good all these years after he has departed. Leonardo DaVinci's works still inspire awe despite the hundreds of years since he produced them. He is another one who doesn't have to come back and explain them. Anything that is trendy and doesn't stand the test of time exposes itself for what is is... bad.
When the outlay of public funds for art projects is left in the hands of a small group of people chosen because of their out of the mainstream radical views, it is inevitable that curious and outrageous decisions will be the result. Their response is the typical left response of “You just don’t get it” because anyone who disagrees with them must be stupid. Recognizing trash when you see it is not one of the prerequisites for stupidity, however, not recognizing it certainly is.
The first problem with the system is that art, by its very nature, is so subjective that the difficulties in determining which projects should be funded are problematic. It will always be left up to the interpretation of the leaders of the NEA what constitutes worthwhile projects. Inevitably, there will be public disagreement about whether a project is worthy. A large part of this is that the very people chosen to be a part of the NEA are not going to be in the mainstream of American education or values. Anyone who believes that a crucifix in a jar of urine is not offensive and is worthy of public funding is clearly outside the mainstream of public opinion. The art community will, of course, argue that the very nature of art is to be provocative. While that may be true, it in no way obligates the use of tax funding to subsidize the making of such projects.
My older brother, who is one of the smartest people I have ever known, once told me that a project like that was art because it “evoked an emotional response”. I argued in response to him that if someone was to make a bowel movement on the hood of my car, it would certainly evoke an emotional response in me and I wouldn’t consider it art. Additionally, what I would do to that person would certainly evoke an emotional response from him/her and that person, while traveling to the medical facility, would not consider my response performance art. It would, however, be nice if the police said no charges could be filed because I was just doing some “art”.
After the conversation with my brother, the analytical side of me reared its head and I decided I needed some objective criteria for what I considered art. So, here are a few that I came up with in a short time:
1) If I can do it, it isn’t good. I am absolutely terrible at painting anything other than a wall in a house. If art work consists of randomly throwing something at a canvas, scribbling nonsensical figures, pouring something to have it splatter, dropping something out of a flying plane, or especially, using bodily fluids, it sucks because I can do that. I am not sure who decided that three I-beams stacked up and painted orange is art but you see that same crappy thing in front of buildings everywhere. Once again, I can do it, so it sucks.
2) If you have to explain it to me, it isn’t good. Quality pieces of art have some intrinsic beauty or force that allows one to just know it has merit when seen. If I have to listen to some long-winded explanation about how it represents mans constant struggle to revive the extinct Dodo bird, the artist is not an artist, he is a bullshit artist. I can look at anything Rembrandt painted and just be awed by the lighting and mastery contained in the painting. Anyone can look at a Michelangelo statue and have no question of the mastery in his hands. I don’t need Rembrandt or Michelangelo to come back from the dead and explain it to me.
3) If you can’t sell it, art is your hobby, not your job. I play the guitar pretty well and sing while I am playing. That does not make me a professional musician. I do not expect the United States government to fund my upcoming CD costs. I don’t believe that Brad Paisley, Josh Groban, or the Rolling Stones expect funding for their recordings, either. If no one likes what you are producing enough to purchase it, you should at least consider the idea that your art work is not good. There are thousands of “actors” in Los Angeles who have never made dime from the entertainment industry. If you are making your living bussing tables, you are a potential actor but not a professional one. In fact, you are a bus boy. A struggling artist is a pseudonym for someone who can’t make a living from art. My previously mentioned brother is a very successful writer but he always had a job in addition to writing and didn’t expect taxpayers to subsidize his work.
4) Funding for art education is a legitimate use of tax dollars. The idea of having a broad educational experience for children in public schools, including art and music is a good thing. When you consider the current state of commercial television and the pop recording industry, it is clearly in the interest of all people in the country to have kids exposed to some quality. Classical music, jazz, poetry, classical literature, and art all deserve a place in education. I will also add that they should be in addition to, not in place of, reading, mathematics and science. I would much prefer kids to know the story behind the 1812 Overture than what “I’m gonna do with all the junk in my trunk”.
5) Good art and literature stays good. Charles Dickens books are still good all these years after he has departed. Leonardo DaVinci's works still inspire awe despite the hundreds of years since he produced them. He is another one who doesn't have to come back and explain them. Anything that is trendy and doesn't stand the test of time exposes itself for what is is... bad.
When the outlay of public funds for art projects is left in the hands of a small group of people chosen because of their out of the mainstream radical views, it is inevitable that curious and outrageous decisions will be the result. Their response is the typical left response of “You just don’t get it” because anyone who disagrees with them must be stupid. Recognizing trash when you see it is not one of the prerequisites for stupidity, however, not recognizing it certainly is.
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