View From a Height

That seems to be the Democrats' favorite game this year. In Ohio, the Democratic Secretary of State has persuaded the Supreme Court to overturn a lower court requirement that registrations actually be validated by election day. While the Supreme Court - possibly correctly - argued jurisdictional issues, Secretary of State Jennifer Brunner was claiming that it wasn't necessary to validate up to 200,000 registrations with irregularities. I say, "possibly," because I'm pretty sure that a Colorado state court ruled on certain aspects of HAVA four years ago, but it's possible that the issues at stake here are different, and non-justiciable by a state court.

Secretary of State Brunner has already allowed up to 3000 questionable registrants to vote electronically early, making it impossible to retrieve their votes should there turn out to be fraud. But Let's Pretend all those votes should count.

ACORN's been very active in Ohio, registering individuals, both existent and non-, multiple times. But since it'll be hard to make sure all these voters are entitled to the franchise, Let's Pretend there's no problem here, nothing to see here, move along, move along. By dodging the problem now, the Court has set itself up for a much bigger headache later on.

Likewise, my Democratic opponent, Lois Court, on Tuesday, defended the notion of Single-Payer Mandatory Universal Health Care (abbreviated backwards, that's "CHUMPS") by claiming that "I define 'public good' to mean something that's good for the public."

Never mind that that's not what it means, either word-by-word or as a phrase. Let's Pretend that it is. Let's pretend that the only cost is the cost of delivery, not the cost of the product itself.

The problem with Let's Pretend is that sooner or later Mom, or as she's known in this case, The Real World, calls you in to get cleaned up for dinner.

The other side likes to style itself as, "Progressives." They are. They're Progressively More Expensive, Progressively More Intrusive, and Progressively More Restrictive.

Posted by Joshua Sharf at 01:31 PM | Permalink | Comments (1) | TrackBacks (0)

In fact, it's not even what you make, it's who you know:

An ailing Democratic fundraiser has obtained an experimental cancer-fighting drug through the Mayo Clinic, according to his son, despite the drug maker's refusal to sanction the treatment.

Fred Baron, a prominent political donor linked to the John Edwards mistress scandal, received the drug Tysabri after a "legal basis" for its use was found, his son Andrew Baron said in an e-mail to The Associated Press. He didn't elaborate.

Baron has described Tysabri as a "last chance effort for life" in his 61-year-old father's battle with late-stage multiple myeloma. Doctors last week gave Fred Baron only days to live, his son said.

Tysabri is approved for people with multiple sclerosis or Crohn's disease, but is only in the early clinical trial stage for multiple myeloma.

Patients can seek to use drugs outside the authorized use under what the Food and Drug Administration calls single-patient investigations. But permission must ultimatelyBiogen Idec Inc., which manufactures Tysabri, didn't grant permission to treat Fred Baron with the drug, company spokeswoman Naomi Aoki said late Thursday. Biogen has maintained the regulatory risks of giving him special access to Tysabri are too great.

The company stood by its decision despite appeals from such prominent figures as former President Bill Clinton and cyclist Lance Armstrong.

Andrew Baron said the Mayo Clinic, working with the FDA, found a legal basis for using Tysabri on his father.
come from the drug manufacturer, said Judy Leon, an FDA spokeswoman.

Look, I have nothing against Fred Baron. I hope the treatment helps and I hope he lives. But this article contains an entire critique of our treatment of drugs, and another critique of the economics of health care.

A company has developed a treatment that has the potential to save a man's life. He's likely going to die, anyway. Why on earth should the company be held liable for its effects on him, if doctors say there's a chance it will help, and he's requesting the treatment? Let him sign a waiver, and maybe he will live. And maybe we'll discover something about the drug, or the disease, that will save lives down the line.

More broadly, doesn't this show that medicine is a scarce resource, not a "public good?" Medicine, in extremis, like any other product, will have to be rationed. Right now, we ration it through the ability to pay, either directly or through insurance. The result of a socialized system will be bureaucrats making the decisions about who's "deserving" of care.

What is more "fair" about rationing it though political connections?

Posted by Joshua Sharf at 12:25 PM | Permalink | Comments (0) | TrackBacks (0)

If expanded markets in health care are going to work, then we need informed consumers. I can spend hours looking for the best tour package, comparing hotels, finding what airline will save me $10 on a seat if I walk down the ramp backwards flapping my arms. But if I had to pick which hospital to direct the ambulance to when I have my coronary bypass, I would probably have said, "Rose, Jeeves."

Silly me.

Markets only work if parties have real information to base their decisions on. Without feeling sorry for insurance companies, it's possible to admit that part of their premium comes from asymmetrical information: applicants lie. Likewise, it's tremendously difficult to act like health care consumers because we don't have the information that we have when we're buying vacations or melons.

Now, comes a Colorado company, HealthGrades, which seeks to provide just that information to health care consumers - outcomes for hospitals, comparisons for physicians and nursing homes. This is exactly the kind of company that, if allowed to pursue its business, can help change the world.

Right now, the revenue model seems a bit...muddled. It appears to be a combination of selling reports and selling Google ads. I'm sure they've done much more market research than I have, which is none, but it seems a bit steep to ask a consumer to pay for this sort of report, when they're already putting up money up front for an HSA and its deductibles. On the face of it, it seems that the best bet would be to seel licenses to insurance companies, who could then market access to the information as part of an HSA.

And note that the only government action required is to get out of the way.

Posted by Joshua Sharf at 11:03 PM | Permalink | Comments (0) | TrackBacks (0)

Proponents of Single-Payer health care have attempted to recast health care from a product into a "public good." In fact, the term, "public good" has a very specific meaning in economics. While certain elements of health care may meet the definition, most - and the most interesting for public policy - do not.

In order to be a public good, an item has to 1) be non-rival, i.e., if I take some, it doesn't mean any less for you, and 2) non-excludable, i.e., effectively, you can't keep me from taking as much as I want. Air is a good example (despite the appealing military term, "oxygen thief").

Almost no medical services meet these requirements. There is no reasonable way that a hospital room, or the attention of the nurses assigned to that floor, can be either non-rival or non-excludable. Even if you pack patients in as though hospitals were tenements, there's still a limit. And I had darned well better know who's in each room, otherwise delivering care of any kind is going to be a pretty dicey proposition.

One could make a case that routine medicines such as aspirin and penicillin might, as well as most common vaccines. Even in those cases, however, one assumes need. While we can all breathe as much as we like, if all of us were to wander through hospital dispensaries gathering up handfuls of band-aids and anti-inflammatories, the stocks wouldn't last very long.

So someone saying that health care is a "public good," either doesn't understand the term - indicating a level of economic illiteracy and muddled thinking typical of so much of what passes for health care debate - or they do know, in which case their proposals have devastating implications.

Posted by Joshua Sharf at 08:59 PM | Permalink | Comments (0) | TrackBacks (0)

The great appeal of Single Payer is its simplicity. Like the man said:

Your friends, they don't like you very much anymore. You force them to make too many decisions. With me, only one decision: do what I say.

The more extreme versions of Single Payer would even outlaw spending in supplemental insurance, under the delusion that health care should be completely independent of income or wealth. (For instance, the AARP has a sign on Colorado Blvd. claiming that it's time for "universal coverage and financial security for everyone." As though the two were the same, and either achievable.)

Despite pretensions to morality, this is in fact a deeply immoral vision of health care. It says that it's perfectly ok to spend your money to protect yourself from a home invader, but not from cancer or heart disease or a broken leg.

The notion derives directly from the definition (and abuse) of the concept of a "public good," but that's for another post.

Posted by Joshua Sharf at 11:50 PM | Permalink | Comments (0) | TrackBacks (0)