Category ►►► Doctor, Doctor
January 1, 2010
"VIP" Treatment Under Nationalized Health Care
A few days ago, my 77 year old father, who lives in Japan, fell and couldn't get up for more than an hour. He was taken to a hospital, where he still rests.
Last night my mother called to update me with a summary of his condition: He has a compressed disk, it seems (it's hard to translate from Japanese to English and from Mom-speak to ordinary human language). The condition is somewhat serious but not life threatening; he'll have to spend a few weeks in hospital. Too bad; New Year's is the biggest holiday season in Japan.
I'm sure everyone reading this post knows that Japan has socialized medicine (national health care, single-payer, however you want to call it). It's not as draconian as the NHS in the United Kingdom or the Canadian national and provincial health-care system; but it is universal -- everyone must pay for government insurance. Fortunately, those who are well off can also buy private insurance in addition... and they can use that instead of the government system (unlike in the UK or Canada).
In other words, Japan already has the system that proponents of ObamaCare eventually want to install here in America. So let's take a look at how it works in the real world.
After Mom reassured me about my father's condition, she started talking about last year around this time, when she had to have stomach surgery.
"Oh Sachi, the care I received was wonderful!" she said; "I stayed in a private room which was like in a nice hotel. It had a private bathroom. The nurses were nice. The doctors were wonderful. I spent nine days in the hospital and only paid ¥80,000!" [About 800 dollars]
"Really?" I asked; "government insurance actually covered all that?"
"Oh, of course not; I have three insurance policies," she proudly announced.
Before retirement, my father was a patent attorney. As a private business owner, he had to pay an exorbitant government insurance premium, both for himself and his three employees. But he always knew that would never be enough coverage, so he purchased two more private insurance policies. In other words, he spent more than twice as much on health insurance as a typical American spends now, pre-ObamaCare.
But even those extra policies wouldn't cover the VIP treatment my Mom got. I asked a few more questions, and she finally spilled the beans:
"I was supposed to be in a 4-person room. But I had a private room all to myself, thanks to your uncle."
Ah, my uncle the hospital administrator. I'd forgotten about him!
My mother's third or fourth youngest brother (I forget which) holds a high administrative position at a major university hospital. It seems he has a great deal of clout there, which has been a great help to our family in times of medical need.
My mother is quite the hypochondriac; she always complains about one ailment or another, usually imaginary. So whenever she is not satisfied with her general practitioner, she talks to my uncle. First thing you know, she's seeing a specialist -- skipping the long waiting list that those without such connections must endure under Japanese system.
On another occasion, Mom hurt her knee. My uncle "referred" his sister to a university hospital doctor who was Japan's most famous doctor for ligament tears. Patients from all over Kanto Plain (where Tokyo sits) would come to see him.
"He only takes 40 patients a day," mom said (only 40! Imagine that!) He doesn't accept appointments; so if you want to see him, you have to get there by 7:00 a.m, take a number, and... wait. And wait, and wait.
My mother strolled in at 9:00, the time the office officially opens; the waiting room was already full, and they had long stopped issuing any numbers. One lady told my mom that she had gotten up at four and had her daughter drive her for two hours to get to the hospital. She was lucky; she got number 38 and had waited three hours already. "There are no specialists in my city," the lady explained.
My mother-the-sister-of-one-of-the-nomenklatura presented her letter of introduction to the receptionist:
"Don’t worry, Ma'am, never mind the number. Just have a seat; we will call you."
My mother did not have to wait. The doctor was most courteous, a rarity in Japan, and he asked about my uncle. Then he gave Mom a thorough examination, spending far longer with her than other patients.
So my parents have the more expensive national health care for business owners (Dad pays higher taxes), Kokumin Hoken -- Citizens' Health Insurance; the lesser one is for ordinary salaryman, Shykai Hoken -- Society Health Insurance. In addition, they have not one but two private health insurance plans, a primary and a supplementary. On top of that, my mother's brother is a high-ranking official at a major hospital in Japan.
But Mom is not so foolish as to rely upon such insecure health-care planning as that; she has a back-up system that she also uses...
After such nice treatment as she got for her knee and her stomach, my mother never forgets to send "gifts," typically cash and premium liquor to the doctors, expensive chocolate to the nurses -- and of cours, something extra special to my uncle, her brother. She was laughing that after her hospitalization, she spent more money on gifts than the actual medical bill. That means over thousand dollars of, let's be honest, bribery.
Wonderful. The national health-care system works!
That's why my mother isn't worried about Dad's care; he's going to be treated better than anybody other than corporate CEOs and of course government officials. But even with that kind of influence, my father had to wait three days for his preliminary examination and to have X-rays taken. After all, it was a holiday week, the Emperor Akahito's birthday, and no doctor was willing to return to the hospital for anything other than a life or death situation. (And maybe not even then; how many extra private insurance plans is the fellow carrying?)
The day my father was taken to the hospital, the nurse told Mom to obtain several changes of clean pajamas, underwear, and towels for my father. Also soap, shampoo, and other toiletries, which were needed right away. Conveniently, the hospital has a kiosk that sells all kinds of items and is open 24 hours. Just a little markup over buying at a regular store, miles away... maybe 100% or so.
Oh, yes, I almost forgot, they told Mom to bring a thousand-dollar deposit. Cash.
My sister and mother take turns visiting Dad everyday. They have to pick up his dirty laundry, wash it and bring it back, because the hospital doesn't do that. But Dad's quite lucky that he stays in a nice hospital with three different insurance policies, under the auspices of his brother in law. My girlfriend’s father only had government insurance when he was hospitalized, and the hospital did not even turn on an air conditioner in the middle of August, with temperatures over a hundred degrees and humidity close to 100%.
My girlfriend visited her father as often as she could; she had to: Half the time, they didn't even empty his bedpan.
You see? National health care works great... so long as you're rich enough to afford the premium level of government insurance and to buy multiple additional private policies; so long as you have influential relatives; and so long as you're willing and able to brazenly bribe the doctors and bureaucrats who run the system.
"I am so glad we live in Japan," Mom said. "I worry about you in America, with no national health care!" Thanks, Mom, but I'm afraid "help" is on the way from President Barack H. Obama.
Are you looking forward to it as eagerly as I?
Cross-posted on Hot Air's rogues' gallery...
November 25, 2005
What's Flu With You?
Recently we have been hearing about this mysterious Bird Flu from Southeast Asia. Some prophets of doom say it has already spread to epidemic proportions in China, and that it will soon spread across the globe. Dire predictions warn of a worse pandemic than the Spanish Flu of 1918, which killed an estimated 50 million people worldwide.
But science reporter Michael Fumento challenges the conventional wisdom. “As of November 9, 125 cases and 64 deaths have been reported from avian flu since late 2003," Fumento writes; "all in Indonesia, Thailand, Vietnam, and Cambodia." So far, at least, the Avian Flu is a bust in the pandemic sweepstakes.
Scientists have determined that, like the 1918 flu, the virus in the current Bird Flu does jump from birds to humans. But what has not yet been seen is a single case where the new H5N1 influenza virus was transmitted from human to human... which was what made the World War I Spanish Flu so deadly. H5N1 (H5, for short) is very different from the Spanish Flu.
Sir John Skehel, a lead researcher of the National Institute for Medical Research team, which studied the 1918 strain in great detail, told BBC News Online:
"[O]ur research will not have an immediate impact on the situation currently unfolding in the Far East with the chicken flu known as H5, since, from our previous work, we know that the 1918 and the H5 Hemagglutinins are quite different."
I believe that the reason all reported cases of H5 in humans come from rural Asian communities is that in those places, birds ranchers practically live with the birds. Bloody, dripping birds are routinely sold in the street without any kind of refrigeration or sanitation. I remember a number of years ago, many Japanese restaurants had dead ducks, feathers and all, dangling from hooks on the outside walls. But in developed countries like the United States, we raise, slaughter, and store poultry quite differently (freezers are a wonderful invention); these sanitary procedures help prevent bird-to-human infection. So from what I've read, I believe that unless the virus mutates to transmit human-to-human, H5 will not cause a pandemic in the developed world.
That is not to say that H5 won't suddenly mutate, as the Spanish Flu did. So, what is wrong with warning the population? Shouldn't we err on the side of caution? There is plenty wrong, Fumento says.
What we can say with confidence is that there is never such a thing as helpful hysteria. And the line between informing the public and starting a panic is being crossed every day now by politicians, public health officials, and journalists.
Headlines like "Flu Pandemic Could Kill 150 Million, U.N. Warns" (Reuters) certainly haven't helped. Never mind that the figure was tossed off by a single official who provided a range of "5 million to 150 million." (Translation: "We haven't the foggiest.") Similarly, the media have generally morphed the federal government's estimate of 200,000 to 1.9 million deaths to simply "1.9 million deaths." Also not helping is the media propensity to seek out the most alarmist "experts." [Emphasis added here and below]
But, how likely is it that a mutated virus will start to infect the human population? Fumento again:
There are no pat formulas, such as the chances of shooting snake eyes or drawing a royal flush. Nor is it just a matter of time. Indeed, one of the arguments against a human outbreak of H5N1 is that sick birds have been mixing with humans for years now without producing a pandemic.
It's practically a state secret that the discovery of H5N1 in poultry dates back not to 1997 but rather to 1959, when it was identified in Scottish chickens. Perhaps haggis had a protective effect on the farmers, but there was a terrible outbreak of the related H5N2 among both chickens and turkeys in Pennsylvania in 1983-85 (17 million birds were destroyed) that appears to have originated as H5N1 in seagulls. So H5N1 has been flying around the globe for over four decades and hasn't done a number on us yet. That doesn't mean it won't ever; but there's absolutely no reason to think it will pick this year or next.
However, just because it hasn’t happened yet doesn't mean it never will. This is hardly reassuring. Can’t we do something to help prevent a repeat of 1918?
The simplest prophylactic action would be to vaccinate all domestic birds. But considering the vast numbers of the bird population and the difficulty catching them to give them shots, it's highly doubtful this could be done. A more practical program is to minimize the contacts between birds and humans.
- Developing countries should adopt the procedures used by developed countries to raise domesticated poultry.
But what about mutations? If the flu mutates into a human-to-human infection, that will spread much faster than Bird Flu spreads today; most people have no contact with potentially infected birds... but everybody has contact with other humans.
In fact there is something we can do to minimize the possibility of mutation. There are two ways that the virus can mutate. The first is simply by random chance; but this is unlikely to produce a particular mutation -- human-to-human contagion, in this case.
But the other route to mutation is by contact with another strain of the virus. If a human who is already infected with any other human flu that spreads by human-to-human contact also contracts the H5N1, the two viruses can merge and form a completely different, so-called hybrid flu. The hybrid can combine the symptoms of H5 with the human-to-human contagion of the other flu.
- So to avoid hybrid flu, vaccinate as many humans as possible. We can do this without getting into a panic mode.
We can also minimize the spread of flu, even if a mutation occurs and H5 actually starts to transmit between humans. It makes perfect sense to take the same precautions we already take for any other flu.
- If you contract the flu, take medication that “reduces the duration and severity of acute human influenza” and stay in bed, away from other people.
As Michael Fumento notes,
Both Tamiflu and Relenza should be taken as soon as flu symptoms become evident, preferably within two days, although at least one animal study showed Tamiflu was still helpful long after what's normally considered the "window of opportunity." It's also okay to take them if it's known that avian flu is truly on the wing.
Of course if the flu is as lethal as they say it is (some claim a 50% mortality rate), none of these measures would be enough. But is it? Fumento argues that the lethality of this flu is exaggerated:
We do know, however, that there are millions of Asian farmers in constant contact with the saliva and feces of countless birds where the virus has been prevalent. Indeed, blood samples collected from rural Chinese in 1992 indicate that millions had already been infected with H5N1, yet there was no reported outbreak of human disease. An analysis was also conducted after an H7N7 avian flu outbreak in the Netherlands two years ago. It found infections among half of persons who either had contact with the birds or were family members. Were something like that rate to hold true for Southeast Asia, H5N1's mortality rate among infected humans would turn out to be no higher than for human flu.
The 50% lethality rate assumes that the 125 known cases are the only ones that have actually occurred; 64 deaths divided by 125 cases equals 51.2% mortality. But what if there have been hundreds or even thousands of other infections -- and the victims simply got over it? How would we know that they had H5, rather than a normal flu? Typically, doctors only know a person has Avian Flu if he is admitted to a hospital or other health-care center; but that would only happen if the infection became very dire indeed (rural farmers in the Third World don't go to hospital unless they're very, very sick for a very long time). So the H5 infections we hear about are exactly those that are so severe that death is not surprising. We would never hear about the milder cases.
But we always come back to the Spanish Flu. It did kill about 50 million people. How can Fumento be so confident that will not happen again? We have more people in the world. We have better and faster transportation (which spreads the disease quicker). If H5 spreads anything like the Spanish Flu did, the result would be much worse today. Or would it?
Odds are that the Spanish Flu would not have become a pandemic if it happened today. In 1918, the world was in the midst of WWI. Millions of young people from all over the world, many from rural areas with very little immunity to urban disease, gathered into congested military bases, then were shipped to faraway countries. You can almost track the epidemic in lockstep with the movements of American and English troops. Soldiers were stuck in trenches without adequate access to medical treatment and in daily intimate contact with all the other soldiers... a laboratory-perfect prescription for spreading disease. But none of these conditions exists now.
Avian Flu or any other kind of flu should not be treated lightly. But we have means to deal with this disease. Running around like “infected” chickens with their heads cut off is not one of them.
November 19, 2005
I work for the United States Navy as a civilian engineer. What I do requires me to be on ships a lot, but most of the time, I simply visit the ship at a port or shipyard. In fact, in four years of my Navy career, I never had to go underway untill this fiscal year started, and I joined a new project team.
When I thought of riding a ship, the first thing that worried me was seasickness. I am prone to some types of motion sickenss: I get car sick, air sick, and even a Disneyland ride can make me sick. I heard horror stories from my co-workers, some of whom said they carried around "barf bags" everywhere they went. Some guys were sick even before the ship left the harbor, and one guy was actually helpless with seasickness while the ship was still tied to the pier!
One of my co-workers got so dehydrated, he had to be treated with an IV drip. Needless to say, this job is not particularly popular amongst many of the engineers... and I think some of them use their weakness as a weapon: since they get seasick, they don't have to go underway for weeks at a time, without even being able to call home, like I have to.
The problem with getting sick on a Navy ship is that, for obvious reasons, you can't get off the boat. If the ship is not too far from land, they can helo you out; but otherwise, you're just stuck. And the on-board medical personnel cannot do much for a civilian; they're not authorized to give you anything much more than aspirin, unless it's a medical emergency.
The first time I went underway, I was really worried about being seasick. I brought enough Bonine pills to last for two weeks and took them religiously for the first week. Although Bonine is not supposed to make you drowsy, I felt like I was half asleep all the time. Every time I sat down, with the combination of the Bonine and the rocking motion of the ship, I was out like a light... and the Navy takes a dark view of people falling asleep on watch, military or civilian.
I finally had to give up and stop taking the pills -- and then it turend out that I don't get seasick at all! Even in a rough ocean, when some of the sailors themselves were down on the floor holding their heads, I was perfectly fine. At one meeting, a young officer was giving a presentation. Suddenly he stopped in the middle and fled to the bathroom. (What do you do if you find out you're prone to seasickness after you enlist in the Navy?)
Dafydd tells me ginger pills work well, according to Adam and Jamie on the show Mythbusters: they were the only non-pharmaceutical cure that actually worked for Adam Savage, who has a terrible problem with seasickness. I should recommend that to my coworkers. That way, they will have no more excuses for not going underway, and I won't have to go so often.
October 21, 2005
It's Morning in Medicaid
How did this manage to slide by unnoticed? (Warning, you have to click past the advert.)
U.S. Gives Florida a Sweeping Right to Curb Medicaid
By Robert Pear
Published: October 20, 2005
WASHINGTON, Oct. 19 - The Bush administration approved a sweeping Medicaid plan for Florida on Wednesday that limits spending for many of the 2.2 million beneficiaries there and gives private health plans new freedom to limit benefits.
The Florida program, likely to be a model for many other states, shifts from the traditional Medicaid "defined benefit" plan to a "defined contribution" plan, under which the state sets a ceiling on spending for each recipient.
Children under the age of 21 and pregnant women will be exempt from the limits.
Medicaid is, of course, the federal/state system for insuring the poor (Medicare insures the aged and the disabled). Traditional Medicaid is a classic "defined benefits" plan, where the state decides on the benefits and then shops for the cheapest way to pay for them; when such plans run into financial trouble, their only alternatives are to cut benefits or raise taxes, neither of which is politicall palatable.
Florida's new system is a "defined contribution" plan, joining a number of other states that have gotten federal wavers to shift from defined benefits to defined contributions or otherwise reform their broken Medicaid programs.
"Defined contribution" has long been considered the Holy Grail for libertarian and conservative analysts of programs like Medicare, urged by both the Cato Institute and the Heritage Foundation; it relies upon consumer choice to keep costs down. Cato writes:
Under the traditional defined benefits approach, an institutional purchaser such as an employer determines what range of services it will cover, then seeks or creates a plan that will provide those services for an acceptable price. It has become increasingly difficult to sustain a defined benefit system. A steady stream of emerging technologies requires an equally steady stream of decisions about which ones will be covered by the plan. Moreover, it has become nearly impossible to provide such benefits economically, in the face of rising health care inflation and increasingly impotent cost-cutting tools.
In contrast, under defined contribution, the employer determines up front how much it will spend for health care, then typically provides an array of options from which beneficiaries can choose (Wye River Group on Healthcare et al., Parrish 2001, Blumenthal 2001). Those options can assume various forms. In the oldest, most familiar version, the contribution essentially represents a voucher for a conventional health plan. The employer assembles a collection of plans from which employees can choose, and then defines its own contribution according to the least expensive of those plans.
Unlike a defined-benefits plan, under the new system, recipients will be able to select more expensive health-care plans than the state is willing to pay for, so long as the recipient picks up the rest of the tab. The recipient gets an expensive plan for little of his own money, and the state keeps its own costs down.
Florida is not the first state to make the transition, of course; but I believe they are the biggest. And while states like Vermont have pilot programs, Florida is actually implementing the changes system wide.
The new Florida plan also incorporates private medical care into the state Medicaid program:
Joan C. Alker, a senior researcher at the Health Policy Institute of Georgetown University, said: "Florida's proposal is one of the most far-reaching and radical proposals we've seen to restructure Medicaid. The federal government and the states now decide which benefits people get. Under the Florida plan, many of those decisions will be made by private health plans, out of public view"....
For each beneficiary, Florida will pay a monthly premium to a private plan. Insurance plans will be allowed to limit "the amount, duration and scope" of services in ways that current law does not permit.
The Florida plan includes many of the very same features that President Bush has proposed for national Medicaid. From the New York Times article:
- Recipients must select a private health-care "Medicaid" plan. If they do not, the state will automatically enroll them in a private plan of the state's choosing.
- Recipients can choose to completely opt out of the Medicaid system; in that case, Medicaid will partially subsidize the employee share of an employer-sponsored health-insurance program (the article doesn't say how this works with the self-employed). Such persons will still pay the same co-payments, and they will have the same deductables as other members of that same employer-sponsored health insurance.
- Recipients who enroll in weight-loss or stop-smoking programs will receive Medicaid subsidies to help pay for them.
- The state and feds will pool money to spend up to $1 billion per year on hospitals that treat a large number of indigent or uninsured patients.
President Bush has been flogging Medicaid reform since his first days in office, at least since August, 2001. But the administration has finally begun to focus like a laser beam (as Clinton used to say) on presenting a fleshed-out proposal... which likely will look a lot like the Florida program.
We certainly could do worse; we're doing worse right now! But with these reforms, most of the projections of massive future liabilities will melt away, because market forces will actually hold costs down -- for the same reason that Cadillacs don't cost a million dollars: too much competition. Perhaps a successful program in the fourth largest state in the United States will spur Congress finally to enact such reforms nationwide and encourage other states to follow suit.
Then Medicare could be reformed the same way; and the public-private partnerships in Medicare/Medicaid could remove some of the terror on the Left, allowing meaningful Social Security privatization before the entire system crashes and burns. Although privatization of "entitlement" programs is inherently conservative, it is not inherently anti-Leftist. They're only against it because conservatives favor it.
I expect only two of these (probably Medicaid and Medicare) to be enacted during Bush's presidency; but that in itself would be a stunning conservative domestic legacy, especially coupled with his tax cuts, with the Patriot Act and other criminal justice reforms, and (I still hope) general tort reform. As we begin to see the benefits of a free market in what was previously thought to be sanctified to dictatorial bureaucracy, anything could happen.
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