San Franciso May Lead the Way

San Francisco mayor Gavin Newsome is expected to announce plans for a system of univeral healthcare for the city at his "State of the City" address. The address is scheduled for Wednesday at San Francisco State University.

This story will be interesting to follow. Will the city lead the nation on this issue, as it has on so many others?

Past the Tipping Point

MSNBC's Sandra Lilly asks, "Are we at a tipping point on healthcare reform?"

Her non-technical analysis is highly recommended reading.

Her analysis substantively duplicates my own: out of control costs for employers and employees alike give both the workers and the owners common cause.

How long before Washington notices? My own suspicion is they will take note when elections are won on the issue. And that might be sooner than anyone anticipates.

DOJ Investigates Medical Business Practices

According to the New York Times, the Boston US attorney has subpoenaed information about possible kickback and fraud violations from three of the nation's biggest medical device makers.

In addition to the Boston US Attorney's investigation of possible barred payments made by Medtronic, Guidant and St. Jude Medical, the Minneapolis US Attorney has launched a separate investigation. The latter asked for information about Guidant's defibrillator and pacemaker. The devices were recalled several months ago.

In an ideal world, the free market would regulate the behavior of companies and investigations would be limited to contract enforcement. In the real world we live in, the pressure to make a quarterly profit can distort judgment and result in tragedy.

Here's hoping these investigations turn up empty handed.

MO Medicaid Cuts: What Not to Do

Missouri, a good model to avoid, cut payment for various Medicaid services recently. The short sighted politicians, in an effort to scrimp on the state budget, decided the state will no longer pay for in-home physical therapy.

As a result, patients who need the therapy to enable them to return to work, cannot get the required treatment at home. However, they can still get the therapy in the hospital.

Hospital stays for some patients in Missouri are now being extended to enable them to get physical therapy. The estimated cost of keeping the patient in the hospital for this treatment is triple the cost of providing the therapy at home.

Gentle readers, in a rational system, such craziness would not be tolerated. But when healthcare decisions are driven by politics and monopoly economics rather than medicine, such oddities are inevitable.

Patients Starved for Data

New Study Shows Patients Want Data on Cost and Quality of Care.

A study by non-for-profit Harvard Pilgram Healthcare shows what we've been saying all along; people do not have access to the kind of information that would make a healthcare market work more like a free market.

The study showed that both doctors and patients would use better information about costs and outcomes to make healthcare decisions.

In a free market, customers know the price of the goods they are getting, and also have a good idea of the quality of the product. In healthcare, prices and quality are normally closely guarded secrets.

Providers may not have the data, and have only powerful incentives to avoid getting it. A public showing of poor quality care would mean more than mere loss of business. Providers fear patients and lawyers would seize on data showing poor quality as an excuse to sue for malpractice.

Cost data is notoriously hard to come by. Providers and insurers like to play guessing games with each other. Providers fear actual data on real costs would be a tool in the hands of insurers used to hold down profits; insurers won't reveal compensation rates for fear providers will cut a better deal somewhere else.

This is not what Adam Smith had in mind.

The study was reported in the Boston Globe.

Fear, Politics & Health

As fear and avian flu creep across Asia and into Europe, leaders in the United States grope for solutions to the potential crises. The crazy patchwork quilt of state sponsored private monopolies that constitute the healthcare industry is totally unprepared for pandemic.

A political odd couple, conservative Kansas Senator Pat Roberts and New York Senator Hilary Clinton introduced legislation recently in a attempt to restore minimal US capacity to manufacture vaccines.

The president met with vaccine manufacturers to discuss the situation. Conservatives blame decades of government intervention for the destruction of domestic vaccine manufacturing capacity, and they are half right. The Bush adminstration and the manufacturers themselves blame the potential for lawsuits, as well as simple unprofitability. "You aren’t going to make a huge amount of money making vaccines." said John Clerici, a representative of a French vaccine maker.

Of course, in America, no one in healthcare makes any money until until people get sick.

Preventative care, such as public vaccination programs, generates no profit for businesses. With the high costs of medical care, poor people would never get shots without government intervention. By requiring immunization for children entering public school, we ensure, not only their health, but ours as well.

Without public, that is government subsidy, the poor would constitute a pool of culture media for communicable diseases such as polio, tuberculosios, measles and so forth. Our society would struggle with the afflictions we see in third world nations.

By relying on a mixed private monopoly and public sector for healthcare, the United States guarantees poor results at monopoly prices.

No wonder bird flu has the politicians worried.