Health Care

To Vax or Not To Vax…

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That is indeed the question, and against all urging and advice, a fair number of Americans are saying ‘not’; for valid and wholly understandable reasons, after having made a carefully considered decision. Such be the case of the Daughter Unit and I. The Daughter Unit spent most of last year being pregnant and did not want to risk anything that would possibly damage Wee Jamie in utero. Her medical team did not do anything more than make a pro forma suggestion; that they did not mention it after she declined likely hints at their own doubts about the safety. We both had to get yearly flu shots when we were on active military duty, and honestly, I would routinely get sicker from the shot than I usually did from the flu itself. Towards the end of my active-duty time there was a great push to get all active duty to be vaccinated against anthrax, and I was in two minds over having to get that vaccine, before my retirement rendered the point moot. I remembered very well how so many of those deployed for the first Gulf War later developed serious health problems, problems that it was speculated, might have been because of the array of vaccinations they were given, in combination with exposure to various environmental hazards and contaminants. (I’ve always thought that the Gulf War Syndrome was a kind of multiple chemical sensitivity/allergy, caused by exposure to a range of triggering compounds or combinations, to which some people were more vulnerable than others. Not a medical or sciency-person; just my own opinion from what I have read and knowing veterans who were affected by deployment in that war. But that’s a whole ‘nother rabbit hole.) To get to the point, it was not entirely unknown for reluctant military personnel to be ordered to take vaccines, over their own doubts and objections.

Just this week, the Daughter Unit received a form letter from the Secretary of Veterans’ Affairs, addressed to Dear Veteran:

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“Follow the Science”: the Winning Political Slogan of 2020

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Voting in the 2020 American presidential election raised the question posed by Johnny Carson’s game show  “Who Do You Trust”  (1957-1963). Candidate Biden was chosen based on trust in his half century track record as a political centrist opposed to his Party’s left wing agenda to promote racial, economic and environmental justice. “Follow the Science” on the pandemic became a campaign theme to bolster trust because scientists – unlike lifetime politicians – are perceived as purveyors of truth. The campaign worked, then centrism was abandoned.

COVID 19 brought to the fore the differences between advocates of science-driven management – the premise of not just pandemic management but the entire Biden Administration agenda and competitive markets. How can producers and consumers stumble onto greater truths than scientists? Economist Adam Smith’s “invisible hand” explained how – almost a century before the naturalist, geologist and biologist Charles Darwin’s “origin”. Scientific investigations were historically the domain of idle rich like Smith and Darwin, because in addition to the need for peer review independent from political influence, they were expensive, time consuming and only infrequently produced interesting results.

Today almost-universal government funding either directly or indirectly has inevitably and irredeemable introduced bias (and sometimes worse)   into science, particularly the social sciences. Political narratives feed back  into the data, producing more noise .

To Tell The Truth, the Whole Truth and Nothing But the Truth

Panelists grilled witnesses on  “To Tell the Truth”  (1956-1968) to identify the real from fictitious characters. Economist Raj Chetty  notes:

“As is the case with epidemiologists, the fundamental challenge faced by economists — and a root cause of many disagreements in the field — is our limited ability to run experiments. If we could randomize policy decisions and then observe what happens to the economy and people’s lives, we would be able to get a precise understanding of how the economy works and how to improve policy. But the practical and ethical costs of such experiments preclude this sort of approach.”

Hence economists, like virologists, rely on limited models to make generalizations. Virologists study the cellular makeup of a virus to explain pandemics. Economists study discrimination to reach a generalized truth about systemic racism, or financial panics to understand contagion. Physicists search for sub-atomic Higgs Boson particles to explain the origins and workings of the universe(s).

Witnesses in American court rooms on  Perry Mason  (1957-1966) swore to tell “the whole truth and nothing but the truth”  under penalty of law.  Scientific truth is a building block. Economists can then apply their tools, e.g., cost benefit, present value, probability,  value of life, etc. to various alternatives to determine the whole truth and develop policies that are in the “public interest.”

But economists and politicians don’t take that oath.  95% of social scientists and historians identified as liberal/democratic, a bias toward progressive political action. The word “policy” derives from the Greek word for politics which is generally not aligned with the public interest.

Historians are even more liberal than economists, but most object to the 1619 Project. It’s not the income inequality caused by market capitalism, but  government favoritism that’s unjust. Environmentalists use limited anti-capitalist models  to produce seriously sub-optimal policy recommendations. This science isn’t “the whole truth and nothing but.”

Scientific certainties spanning decades or even centuries are often proven wrong with better methods and larger samples or  metadata.  The federal government has for a half century  warned  against animal fats in favor of margarine even though metadata disproved the theory in 2018. Just as virology models assume contagion due to irrational public behavior, economic models of “financial panic” assume uninformed individuals irrationally run on solvent banks; in actual fact depositors  acted perfectly rational, queuing only at insolvent banks that were paying out at face value on a first come, first served basis. Large scale economic models that suffer from the bias  of small scale models tend to over-estimate the benefits of political intervention and under-estimate the unseen “unintended” but predictable indirect costs.

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Single Payer rears its ugly head again.

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A fellow I’ve known slightly for many years is editor of the Alpha Omega Alpha medical honorary society magazine, The Pharos. He has a lead editorial in The current issue It is titled “Now is the time to enact a US Healthcare System.

Now, don’t get me wrong. Dick has had a more successful career than I have. Many years ago I knew him and he read his acceptance letter to USC medical school in my apartment. He did well in medical school, almost as well as I did, but his wife agreed to go to New York for a high status internship and residency, setting him on a path to great success. He became a Professor of Medicine and eventually President of the University of Colorado. I have not seen him in years and suspect very little of his time has been spent in the delivery of primary health care “in the trenches” so to speak.

My wife refused to leave Los Angeles and I have, as a result, had a less prestigious career but satisfactory as anyone who has read my Memoir will see. I did harbor some resentment and the marriage ended in divorce after 18 years.

Now let us consider what this academic authority proposes. First, we are now ten years after Obamacare and some level of practicality has crept in.

The “federalism” response to the COVID-19 pandemic, medicine, health care, and the profession of medicine is not working well and needs to change. A serious societal and public review and plan of action for change is needed with regard to why and how the U.S. must improve overall health care and create a new health care system for all Americans. The U.S. is the only developed country in the world that has not determined that health care is a fundamental human right. Universal health care should be considered by all as a social good and a national priority.

There is, of course, no such promise in the US Constitution of a “right” to healthcare although we do have an Amendment forbidding involuntary servitude. Section 1

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

Shall the federal government have the right to compel doctors and healthcare providers to provide services ? Right now Medicare pays about 13% of billed charges. This produces ridiculous fees on paper but what is the uninsured to do ? Pay 87% higher prices ? At my last understanding, a doctor may not offer a service for less than his/her/xir Medicare price. Anyway, let us see what is proposed.

The long-standing federalism approach to health care is associated with a lack of leadership, the absence of a solid plan, setup, or organization to manage our national health care. Also it is slow to respond to national and international issues. It has not worked well and leaves the country’s health care system disjointed, confusing, and expensive. The federalism approach, in which all 50 states and five territories each have their own rules, regulations, and financing, has been a barrier to providing health care for every U.S. citizen, regardless of where they reside.

I frankly don’t see the Federalism handicap but suspect nationalization appeals to some. Those darned Red States again.

One option that is often discussed is a single payor system in which the government is the only payor through tax and other revenues and manages health care as a public and social good. Currently in the U.S., the Military Health Care System, Indian Health Services, Veterans Health Administration, and Medicare are all government single payor systems. Medicaid and the Child Health Insurance Program (CHIP) are jointly funded by the federal govern-ment and state governments. All totaled, these government funded programs provide health care coverage for nearly 50 percent of the U.S. population.4

The success of the VA and the Indian Health Service is doubted by many. Both have seen repeated scandals.

The other half of the population is covered under their employer-sponsored health plan; is self-insured; or receives coverage through individual market health plans, including ACA-compliant plans; or completely lack any type of health insurance. Through the private health insurance programs, private insurance companies are re-sponsible for paying claims for their members. Hospitals, physicians, pharmacies, and other health care providers each file claims independently. Obamacare is responsible for a significant segment of the uninsured as small group plans were devastated by Obamacare.

According to Jerry Bonenberger of Babb Insurance in Pittsburgh Pennsylvania, “small employer groups with less than 50 full-time employees are experiencing an extraordinary increase in their insurance premiums for 2015. In one case, a professional services firm with 42 full-time employees received an 87% increase in their premiums for next year.”

Through the development of the quasi-independent, apolitical National Health Reserve System (NHRS) pro-posed in the Summer 2020 issue of The Pharos,(1) the U.S. would have a health care system modeled after the Federal Reserve System, allowing for government funded care for half, and private insurance for half. The role of the NHRS would be to govern, integrate, coordinate, and manage a nationwide system of health care, both private and governmental. It would be far more extensive operationally than the Federal Reserve and would be governed and managed by experts, including physicians, health professionals, and others using data, experience, evidence, and planning to operate a national health care system independently with transparency and quasi- independence from politics.

Does anyone really believe that ? At least he wants to get rid of Obamacare although it is too late, as I have repeatedly pointed out. Doctors are no longer small business people but employees with the psychology of employees. Those that are opting out to go to a cash practice are a small minority but that seems the only realistic option. I submitted a rebuttal letter to the journal but doubt it will see the light of day. In it I suggested some reforms on the lines of the French system that I described in multiple blog posts ten years ago. I think the French system would have been a better reform but I doubt that will appeal to the academics who want control. When I was at Dartmouth in 1994-95 I met many of the people who designed Hillarycare, and they were also all academics. Pelosi and Reid who wrote Obamacare (I doubt Obama had anything to do with it) at least learned to include the insurance companies in their plan. In fact, I am sure it was written by insurance lobbyists and 25 year old staff lawyers.

The abysmal implementation of Obamacare suggests that big national scale programming projects are not the federal government’s strong suit. The federalism that my former friend, Dr Byyny, opposes allows for incremental reform and some level of experimentation. A national one-fits-all program failed spectacularly. Another one is likely to fail, as well.

That was 2015.

Medicine and Obama’s Third Term.

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Obamacare changed American Medicine forever. I am becoming convinced that was a major purpose. Since 1978, Medicine and doctors have become the most regulated sector of the American economy.

Five years ago, I predicted one consequence. A doctor shortage. Why ?

A few years ago, it was reported that 10,000 doctors were leaving UK every year. How has the NHS dealt with this shortage?

By importing third world doctors.

The UK’s National Health Service (NHS) will soon begin a major campaign to recruit health workers from other countries to meet growing staff shortages.

Reports suggest a strategy has been drawn up to target a number of countries around the world, including poorer nations outside Europe.

One estimate in March this year said the NHS will need 5,000 extra nurses every year – three times the figure it currently recruits annually.

But what about the countries that it will recruit from – what impact will it have on them?

Where do non-UK staff come from?
The NHS already recruits globally to meet its staffing needs.

More than 12% of the workforce reported their nationality as not British, according to a report published last year.

How are we dealing with our doctor shortage ? By adding “Practitioners” instead of doctors.

How did this begin? In 1978, a new federal program was created called “Professional Standards Review Organizations.”

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The Completion of a New Project

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So and aside from the outage at Chicagoboyz which deep-sixed the site for the best part of a week, I myself was also sidelined at about the same time by another issue: the completion of a project. That is, the eight months-long project to brew up another human being; this one being my Grandson Unit, currently known as Wee Jamie. He had to be delivered a week ago Thursday, through the medium of a hastily scheduled C-section, as an intermittent constriction of the umbilical cord, which delivered all nourishment and oxygen to him in the womb-without-a-view had occurred yet again. The perinatal experts at the clinic where the Daughter Unit was being seen decided that better deliver now than risk problems later. This was six days short of the day that the Daughter Unit’s OB-Gyn had initially decided should be Wee Jamie’s Date of Delivery (again somewhat short of her 40-week human gestational period, which would have been at the end of the first week in June) … well, all of that was rescheduled because of that concern. The Daughter Unit is 41, so a degree of concern was justifiably merited.

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