My initial reaction to your comment is to disagree with it for this reason: The most significant reason that insurance companies deny an individual insurance policy to people today is that the government has required them to provide so much coverage to anyone who is insured, and with regard to group policies, mandated that they accept everyone who applies and in some cases, what those people can pay for such coverage. This means that individual policy insurers have to be very careful about whom they insure because the claims tend to exceed the premiums.

For example, yesterday at a luncheon, I met a woman who is in favor of mental health treatment, and she herself has had a fair amount of treatment for depression, which was paid for by health insurance. She indicated that she cannot buy an individual policy without mental health coverage, and that she and her husband therefore was barred from starting their own business, because they need medical coverage through his employer. However, the reason she cannot get a medical plan with a mental health coverage exclusion (which she admitted she wanted and would be willing to purchase) is that the governments (federal and Colorado) mandate that benefit on insurance policies. So, the government in its push to expand insurance coverage for more benefits, has actually restricted the ability of people to choose their own policies and benefits. This woman is willing to pay out of pocket for her mental health treatment, wants to buy a policy that does not provide mental health benefits, but the government won't let her spend her money in the way she chooses. So, she is stuck, and her husband is stuck working in a job to keep their insurance policy.

In her case, she has a pre-existing condition of depression, and most insurance companies would want to exclude that benefit -- for either a certain period or perhaps entirely -- because depression tends to be a recurring condition. But, they can't exclude it, and she can't get individual policies because they can't exclude the benefit.

Insurance today would still be a very good model if it were designed only for major medical, and not for routine diagnosis and treatment -- even for chronic illnesses such as diabetes, high blood pressure, high cholesterol and mental health conditions such as depression. These are illnesses or conditions that most people could plan for and pay for out of pocket -- especially if they weren't paying such high premiums for insurance that covered those very benefits. For example, four years ago, I paid $445 a month for health insurance, plus co-pays, which insurance did not include eye exams, eyeglasses, or dental care. Now I have a high deductible insurance policy, which costs me $245 a month. I can therefore afford to budget another $100 a month to pay for my annual exam, mammography, blood tests, eye exam and glasses, and dental care. This current policy saves me at least $100 a month more than I paid 4 years ago even though I must pay for all routine care!

The problem for many Americans is that they have pre-existing conditions that the carriers cannot exclude, and so these Americans cannot get this kind of savings. For most Americans, government has made insurance more expensive and less available by requiring that insurance companies must include broad benefits that cannot be excluded under any circumstances. They have also made group insurance more expensive by requiring that all insurers accept any group that applies, or that all customers of a certain age and location must pay the same rate. Government has made it extremely difficult to pay for their own routine care or their own uninsurable conditions and to obtain insurance only for catastrophic problems.

At some point, health insurance may not be viable as it currently exists because of scientific advancements and medical technology. But, I don't think that day has come at this point. Health insurance today for many people today is not viable ONLY because of government regulation and intervention. That is the area that needs to be changed.

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Dear Sir,
I agree that health care insurance and health care provision need free market reforms.

Keep in mind, however, that insurance developed in a time when risk was spread among the insured population randomly. The state of technology, or lack thereof, made it impractical to single out expensive beneficiaries. The whole idea of insurance is based on what has now become a fiction due to computerization. Insurance companies and pools of beneficiaries used to participate in a level playing field of mutual uncertainty, but now that uncertainty has been largely removed from the insurance market, bargaining power has dramatically shifted in favor of insurance companies. The insurance consuming public has not, by and large, caught up with this fact.

In the age of computerization, the insurance paradigm is no longer a fair market. I would appreciate you spending some mental energy on what a fair market replacement for insurance might look like. I'll admit, I don't have the answer.

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This nurses' strike is very interesting and deserves more attention. One of the stories I found indicates that some of the nurses are being called selfish for wanting more money, while not looking out for the patient welfare. When there is no free market, this is one of the consequences.

I plan to blog about this. Thanks, JW for the tip.

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Just thought I'd drop by with the current top headline from Sweden:

"Strike all over the country"
"At present 7 000 nurses are on strike" (same per capita figure in the U.S. would mean 0.2 million nurses on strike)
"Public opinion is crucial says DN analyst"

www.dn.se

Nice to have your salary dependent on "public opinion"...

Also, I read a scary piece about how non-unionized nurses are forced not to work if their particular department is selected for the strike. And as non-unionized nurses they don't get any money from the unions. But they do get the "opportunity" to become members of the union just before the strike and thereby get a strike-salary. When one nurse had to do this the union representative said, with a smirk on his face, something like: "Well, it's okay to become a member now, huh?"

If I'm not misinformed there has been a major strike among nurses in Denmark as well recently.

Viva la "single-payer".

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The altruist ethics and collectivist politics behind moves like this are taught as if they are unchallenged -- almost obvious -- notions. For a good example, consider how Harvard professor and author of two books on "health system ethics", Jim Sabin, <http://healthcareorganizationalethics.blogspot.com/2008/04/how-us-rations-specialty-drugs.html>approaches the so-called "specialty drugs". Altruistic and collectivist politics are so ingrained, that the good professor takes them as premises with which reasonable people would surely agree... as if only the details need to be worked out.

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The number of patients waiting for treatment is irrelevant; what matters is how long they wait. Three quarters of a million people waiting a month is less of a problem than 100,000 waiting a year. Worse still is a situation where people who need treatment can't even get on a waiting list. Rationing is always necessary in health care. In a free market rationing is by price. Other systems suggest you form an orderly line. An ER beset by a plane crash will ration by triage.

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Before any reader can take "FIRM" seriously, they need to disclose the sources that provide funding for FIRM . Note to readers in CO: if FIRM refuses to disclose this information, this financial data is publicly available and can be obtained from your state Attorney General's Division of Public Charities that collects required financial reporting data on all non-profit 501(c)3's in the state.

I look forward to checking back to review this most pertinent information about FIRM's funders. Thank you in advance.

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But the death certificates will always list the disease as cause of death -- not the system.

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I have to say, after a recent stint with my uninsured fellow at the local emergency room (paired with the flood of very unclear invoices afterwards), I LOVE this concept.

It would have been much better to simply pay cash that very night and not have to navigate through bills from four different "service providers" and their seemingly purposefully vague charges.

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That's a nicely phrased summation.
Under number 1, don't forget that according to the US Census Bureau that the number of uninsured as a percentage of the total population has been flat at between 14 and 16 percent for close to two decades. The myth of the "growing" crisis of the uninsured.
I've got an interesting story about the uninsured non-citizens that I'll share once it has played out completely.

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An insurance-based healthcare system does not eliminate bureaucracy either. The American taxpayer actually pays more per head of population for healthcare than does the British one. In the UK patients can opt out of the NHS and use an insurance-based system or even pay out of their (taxed) income. The government-funded health system in the US which comprises Medicare, Medicaid, VA, tax-breaks etc already limits the freedom that many doctors seek, and insurers can be restrictive in their cover. As medicine gets more costly, rationing becomes inevitable - whether by waiting lists or ability to pay bills. An example of the irrationality of UK rationing, a few years ago the total NHS bill for cancer chemotherapy was $330 million per year. But the cost of treating indigestion was $4 billion. This at a time when Helicobacter counld be diagnosed and H2-inhibitors were available without prescription in pharmacies. Guidance is necessary for patients. It seems to me that the best guides are primary care physicians rather than bureaucrats. The UK NHS provides a primary care physician for every citizen at taxpayers' expense. They make $200,000 a year and are independent contractors not salaried staff. That looks to me to be a better way of spending money than squandering it on hospital ER rooms where patients inappropriately stand in line with minor ailments.

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Thanks for calling attention to this. Living in Massachusetts, I've become desensitized to talk about the mandatory insurance law (quasi-universal healthcare), and missed this particular article.

I did some looking into the Cambridge Health Alliance and I was unable to find many hard numbers for where all of its funding comes from, but it is clear that it is publicly funded by both state and federal (medicare) money.

I certainly agree with your basic stance against any sort of government-funded healthcare for a whole host of reasons. But in this particular case I can't help but see it as ironic that one government program is cannibalizing the funding of another government program. Yes, the Cambridge Health Alliance also gets private donations (including a major affiliation with Harvard) but the point is that the CHA is held up as an example institution in publicly funded care.

With that context, I don't see this as a clear example in damnation of universal healthcare when the victim in this case is another government program. Or perhaps I'm not correctly interpreting your point? If you are mostly focusing on the coming catastrophic failure of the new MA system, and this case as one of many examples along that path of how corrupt an idea it is, then I completely agree.

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Congrats -- great visibility!

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Ha ha. I just read that in order to cut costs Swedish hospitals have developed a new unisex underwear. The reporter who wrote the article asked: "but don't men nead more "support"" and the woman answered that it's not were important because patients mostly lie down... Soviet here we come...

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[Here's a copy of my letters to each of the legislators listed in the post. -- PSH]

Subject: I support HB 08-1327, "Affordable Health Insurance"

Dear XXX:

My name is Dr. Paul Hsieh. I am a resident of Sedalia, CO, and a practicing physician in the South Denver metro area.

I'd like to speak out in strong support of HB 08-1327, "Affordable Health Insurance", because it would be good for my patients as well as my colleagues.

This bill is good because it gives Colorado residents greater choice in selecting health insurance products both from within the state and out of the state, without being subject to some of the onerous insurance mandates which have made quality health insurance too costly for many hard-working families.

It gives people the right to more freely contract with insurers for the goods and services that they genuinely need, using the proven power of the free market to help bring down costs and improve quality.

Arvada attorney Lin Zinser and I have written an article entitled, "Moral Health Care vs. 'Universal Health Care'", which has recently appeared in the national journal, "The Objective Standard".

We argue that the current crisis in American health care is the result of decades of government interference and violations of individual rights in health insurance and medicine. Hence the solution to the problem is not more government controls but instead to gradually and systematically transition to a rights-respecting, fully free market in those industries.

The full text of the article is available online for free at: <http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universal-health-care.asp> or <http://tinyurl.com/25zffu>.

HB 08-1327 would be a good step in the right direction towards allowing a much-needed free market in health insurance.

Thank you,

Paul Hsieh, MD
6586 W Rainbow Creek Rd.
Sedalia, CO 80135
E-mail:
Freedom and Individual Rights in Medicine: <http://www.WeStandFIRM.org>

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Martin Buchanan asked me to put this on the Comment side of this post -- it is his letter to the state representatives.

Dear State Representatives:

On Monday 18 February you will hold hearings in the Business Affairs and Labor Committee on House Bill 1327, allowing Coloradans to freely buy health insurance issued in other states. As a working man, I'm unable to attend the hearings and testify. I've taken the last couple of hours writing this emailed letter to you all, including my own Rep. Ferrandino, to express my strong and reasoned support for this bill.

1. We need this bill to cut the Gordian knot of 49 Colorado state health insurance mandates in current law. See the Council for Affordable Health Insurance (http://www.cahi.org) and their just released report on Health Insurance Mandates in the States 2008. These mandates increase health insurance costs by 50% or more.

2. Individual rights are the foundation of American government and Colorado's Constitution. Article II of Colorado's Constitution describes inalienable rights to our lives, property, and pursuing ("seeking") happiness, along with free exercise of religion and many other rights. Like the U.S. Constitution, Colorado's Constitution indicates that the enumeration of certain rights does not deny or disparage others retained by the people. HB1327 goes a long way towards restoring individual rights currently violated by health care mandates:

A. Our natural right to buy and sell freely, so long as we violate no other person's rights. HB1327 simply allows us to buy health insurance policies from other states, just as we already buy books from Amazon.com in Washington state and computers from Dell.com in Texas.

B. Our natural right to choose the features we want in the goods and services we buy. It would be insane to force me to buy a Cadillac if all I need is Kia. It is equally nuts to force me to buy health coverage I don't want for services that I don't need.

C. Our natural right to life. Because mandates make health insurance unaffordable for many Coloradans who otherwise could afford it, those people then go without health insurance and often without health care, risking their lives, because of the mandates that raise prices.

D. Our freedom of religion and conscientous belief. For example, abstaining from alcohol is a tenet of the Mormon faith, the Muslim faith, and many others. Yet currently Colorado law compels anyone buying health insurance to buy alcoholism coverage. Scientologists object to the modern mental health profession, but are compelled to buy mental health coverage. Some people consider chiropractic to be quackery, but the law compels them to pay for that coverage.

3. If you do not care about individual rights, then consider the utilitarian advantages of passing HB 1327:

A. Reducing health insurance costs by up to one third when Coloradans choose less expensive policies from other states with fewer and less onerous mandates.

B. Increasing competition among health insurers, who must now compete with out of state providers as well as in-state providers.

C. As a corollary of (A) and (B), reducing the number of uninsured Coloradans.

D. By reducing the number of uninsured Coloradans, reducing uncompensated medical care costs incurred by hospital emergency rooms and other medical providers.

E. Reducing the number of uninsured Coloradans is an important goal for the current governor and the 208 commission. More freedom is a much better way to accomplish this goal than more taxes and mandates.

F. You know that many of the existing mandates were created due to special interest group lobbying, not because of any pressing public need. HB 1327 gives us a way to reduce the negative impact of these mandates without yet going through the more difficult exercise of repealing these mandates one by one.

Sincerely,

[ writing for myself, not my employer ]

Martin L. Buchanan, MCSD

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And thank *you*, Lin, for driving all around the state giving talks, appearing on radio and TV, attending all the 208 Commission meetings, and talking with state legislators. We couldn't have done all this without you!

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It's been an interesting year. I remain curious to see what proponents of "incremental steps" toward single-payer will do now. My guess would be that if the Colorado legislature decides to take no action, things will stay pretty quiet until after the presidential elections, hoping for a Hillary win, at which point the issue will almost certainly rear its ugly head again. Continued vigilance and willingness to play "Whack-A-Mole" everytime it pops its head up will be needed.
Some of the comments I heard during the 208 process were mind boggling. I think the most outlandish was from a doctor here in Grand Junction testifying in front of the Commission members at public hearing: "The majority of health care spending takes place during the final three months of life." I guess the implication was that we all have the obligation to die quickly when we get sick, in order to avoid burdening the system!! We could have a great health care system if it wasn't for all those inconvenient sick people!
At any rate, good luck to us all.

Jim Schroeder, MD

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If you what to put this on your blog, you're welcome. If you want to correct grammatical errors that's perfectly fine too. But maybe it's not that big of a deal. This piece of news was published today (16 Jan) at the website of the second largest newspaper in Sweden:

Hastily translated (and shortened) by JW:

Article in Swedish at http://www.svd.se/stockholm/nyheter/artikel_778549.svd

Two men died after not getting adequate care in Sweden

In the spring of 2006 a 60-year-old man sought care in Saint Gorans Hospital. He was among other things suffering from a lung disease, auricular fibrillation and prostate tumor. The staff tried to contact the thoracic clinic at the Karolinska Hospital eleven times in order to get an appointment for him where they would decide if he could get a surgery or not. He died after eight days of waiting. The National [Swedish] Board of Health and Welfare says it is "very unfortunate" that he had to wait that long.

In May of 2006 a man in his 50s died after having been removed from the intensive care ward (in the University Hospital in Huddinge) despite his suffering from a spinal marrow damage he had gotten recently from falling in a flight of stairs. He died during the evening when he was not night watched on which he would have been in the intensive care ward. He was removed from the intensive care ward because of lack of beds there, and he was considered to be "the least" in need to be in the intensive care ward.

When we don't have enough room we have to remove the ones "least" in need and this is a very difficult decisions to make for the nurses and the doctors, says Sigridur Kalman, at the University Hospital in Huddinge

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Thanks! I saw a list of innovations in general (not medicine in particular) a wile back and it was staggering how so many of them were created in the US, since around the 1800th.

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