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Democrats vs. Your Health

Is Socialized Medicine really the answer?

The United States has the best healthcare system in the world. There is no dispute about that. The problem with our healthcare system is not the quality -- but the cost. But how do you bring down the cost?

Democrats believe they know the answer: Just get the government to take it over! But does that REALLY bring down the cost? Is our government -- who brought us the $435 hammer and the Bridge to Nowhere -- really the lowest cost provider for healthcare?

11/29/2007: Carolyn Rebholz: Rep. Ruud is wrong on health care 10/19/2006: Tim Goodyear 07/28/2006: Great Moments in Socialized Medicine (Part 2)
10/13/2007: Rep. Michele Bachmann: Why we must resist S-CHIP expansion 10/05/2006: Cullen vs Ruud: In Their Own Words 07/27/2006: Angela Erhard
CHART: Minnesota #2 in Healthcare Mandates 10/05/2006: Bonnie Gasper 07/26/2006: Katherine Kersten: Too Many Healtchare Mandates?
11/16/2006: Katherine Kersten: Pawlenty a conservative? Since when? 09/14/2006: Al Bode 07/20/2006: Claire O'Connor
11/14/2006: Response to Pawlenty Plan 08/31/2006: EP News "Correction" 06/13/2006: Canada says NO to Socialized Medicine (Part 2)
11/14/2006: Pawlenty Jumps Ship on Health Care 08/24/2006: Bill Cullen, Candidate 42A 02/23/2006: Canada says NO to Socialized Medicine (Part 1)
11/14/2006: Great Moments in Socialized Medicine (Part 4) 08/07/2006: Great Moments in Socialized Medicine (Part 3) 06/05/2005: Health Care Facts and Myths
10/24/2006: Latest Ruud Ads 08/03/2006: Maria Ruud, DFL-42A 02/01/2005: Great Moments in Socialized Medicine (Part 1)

  The following article is reprinted from the Eden Prairie News, Thursday, November 29, 2007:

Who Is Kidding Whom?
By: Carolyn Rebholz, Eden Prairie

Rep. Maria Ruud and Rep. John Benson of Minnetonka are proposing “Universal Health Care for all Minnesotans by 2011.” This is not the answer, and it is mediocrity at best.

In the past 18 months my husband has been hospitalized several times in two different facilities for surgical procedures for a life-threatening condition. His private health insurance was excellent. Upon his final exit interview after the last procedure on his way to better health, we visited various caregivers in that facility who had provided superb assistance. We wanted to thank them for everything. One response to my husband was “At your age [65] the lines to receive specialized care under Universal Health Care would have been so long, you’d likely be dead.” Thank goodness we have an opportunity for private health insurance.

The notion that Universal Health Care will provide “high quality affordable health care” is just another “sounds good” governmental ploy to control individual choice.

The following article is reprinted from the Minneapolis Star Tribune, Monday, October 13, 2007:

Here's why we must resist SCHIP expansion
By: Rep. Michele Bachmann (R-MN)

Congress is engaged in a debate about the future of health care in America and about what should have been a proposal to extend affordable coverage for low-income children.

The State Children's Health Insurance Program, or SCHIP, is set to expire soon. This decade-old program offers states federal funding to provide health insurance for children in households that do not qualify for Medicaid but cannot afford private coverage.

Unfortunately, the program has become politicized, and Congress recently passed legislation to expand SCHIP coverage beyond children, beyond U.S. citizens and beyond those who are truly in need, and, contrary to the Star Tribune's editorial (Oct. 5), that is where the problem lies.

According to the U.S. Census Bureau, several million SCHIP-eligible children are uninsured. Surely, children in need should have the health insurance promised to them before SCHIP is expanded further up the income ladder or before more of the program's limited resources are used for adults.

Here's my idea: Let's cover the kids first. Let's focus on children in need who don't have access to health insurance and fund SCHIP as it was meant to be. I've publicly supported legislation that would accomplish these goals and keep SCHIP moving forward to help those it was intended to help.

But some want to move SCHIP in the wrong direction. Under the bill passed by Congress and vetoed by the president, SCHIP dollars could be used to cover childless adults and more-affluent families -- in some cases, households earning up to $83,000 per year. It also changes current law to make it easier for illegal immigrants to get SCHIP funds.

A Congressional Budget Office study shows that more than 77 percent of children affected by this expansion already have personal, private health insurance. So why create an incentive that pushes kids out of private insurance into a government-run program, rather than focusing on low-income, uninsured children?

Worse, this legislation makes SCHIP financially unstable. In order to appear fiscally sound, it gives children health insurance for five years, then cuts SCHIP funding by nearly 80 percent -- a classic bait and switch that will cause millions of American children to lose their health coverage.

And what are the taxpayers getting in return? According to the CBO, the bill will lead to only 800,000 eligible-but-unenrolled children being enrolled in SCHIP by 2012. The sad fact is that it would be cheaper to give each of these kids $72,000 than it would be to enact this bill, and it would probably show healthier results.

Rather than playing politics with children's health or scoring points with radio and TV ads, Congress can show the American people that we are here to solve problems. I hope that House leaders will do the right thing and bring up a bill we can all support.
Michele Bachmann, R-Minn., serves in the U.S. House of Representatives.

2009 Healthcare Mandates By State
State Mandates
Rhode Island 70
Minnesota 68
Maryland 66
Virginia 60
New Mexico 57
Texas 57
Washington 57
U.S. Average 42.1
North Dakota 34
Wisconsin 34
South Dakota 30
Iowa 26
Michigan 25
Source: Council for Affordable Health Insurance

#2 IN
#2 IN

If you buy a car, you have a choice. You can buy an expensive car "fully loaded". Or, if you're on a tighter budget, you can buy a cheaper car without all the extras. It's your choice.

With Minnesota healthcare, you do not have a choice. Minnesota now has the second highest number of health insurance mandates in the nation -- more than 48 other states. Health coverage in Minnesota must now include everything from hearing aids to chiropractic care to hairpieces. The trouble is that, as you add more mandates, the cost goes up. Add enough mandates and health insurance becomes unaffordable for everyone.

Republicans believe that Minnesotans need choice in healthcare coverage. They believe the free market is the best way to hold down costs and offer people the greatest opportunity to select the health care coverage they want and need.

But the DFL wants to go the other way. They want to eliminate the free market and have the government totally take over our healthcare system. But will that really bring down costs?


The following article is reprinted from the Minneapolis Star Tribune, Thursday, November 16, 2006:

Governor Pawlenty's a conservative? Since when?
By Katherine Kersten, Star Tribune

If you think Gov. Tim Pawlenty has a conservative bone left in his body, read the news reports about his statements Tuesday at a Minneapolis health care conference.

Pawlenty announced that he would use the machinery of government -- and a "surplus" of taxpayer money -- to "start moving toward universal health coverage." How? First, by "covering the state's 70,000 to 90,000 uninsured children." He proposes either to expand MinnesotaCare, the state's publicly subsidized health coverage program, or create a brand new state program.

How will Pawlenty's proposed new health care entitlement avoid the pitfalls of other government-driven health care arrangements, which tend to cost more than expected, result in rationing, and be hobbled by assembly-line care?

"Pawlenty didn't outline specifics for expanded children's coverage," according to the Star Tribune. How much will this new entitlement cost? Spokesman Brian McClung says there's "no cost estimate yet."

Pawlenty is vague about what he means by his new goal of "universal health coverage." But his remarks on Tuesday suggest that he envisions an expansion of government control over the financing and delivery of health care -- hardly a prescription for what ails us.

It's clear that health care policy needs reform in this country. The problem isn't quality of care. We've got the best in the world. The challenge is paying for that care and ensuring that coverage is as broad as possible.

The source of our current difficulty, in part, is that market forces, which produce the best product for the best price in other aspects of our lives, have largely been suspended when it comes to health care. Government piles requirements and regulations on the plans that can be offered, while a third-party-payer system insulates consumers from the real economic impact of their health care decisions.

If we want to substantially enhance consumer choice and competition, we'll probably have to rethink the entire health insurance industry.

The matter is extraordinarily complex, and anyone who claims to have the whole answer needs to visit a doctor. But an expansive new benefit, on the taxpayers' tab, will only make matters worse.

Pawlenty himself recognized this in July 2005 when he was resisting DFL legislators' attempts to relax controls on MinnesotaCare spending. Back then, he told me that Minnesota's state-subsidized health care programs, already among the most generous in the nation, faced projected cost increases that could break the bank in coming years. Left unchecked, he said, health care spending could require a doubling of state income-tax revenue every eight years to pay the bill.

Does Pawlenty now want to go down that road? We need details, Governor, and fast.

In another troubling sign, Pawlenty engaged on Tuesday in pseudo-populist bashing of private companies that are trying to wade through the current health care swamp. According to the Star Tribune, "The governor saved some sharp words for health maintenance organizations":

"'What is the health value of what they do?' he said. 'How have the outcomes improved? Are we less obese? Are we less diabetic? Do we have less heart disease? Do we have less cancer? Are our children more engaged and active? Do we have less mental health challenge?'"

While the answer to some of these questions is no, Americans are in fact living longer than ever. And you've got to have a utopian vision to believe that, without HMOs, we'd be "less obese" or that our children would be "more active and engaged."

I remember a Pawlenty who once would have talked for hours about parental responsibility for childhood obesity before mentioning a word about government. Now he seems a distant memory. (Disclosure: I served on Pawlenty's transition team in 2002.)

There's a lot of talk these days about him as a possible presidential running mate in 2008. I suggest that Rudy Giuliani or John McCain hurry up and make him an offer. Otherwise, Hillary Clinton may beat them to it.


Twila Brase of the Citizen’s Council on Health Care (CCHC) issued the following press release following the Governor’s speech (11-14-2006):

CCHC Responds to Today's Speech by Governor Tim Pawlenty

St. Paul, Minnesota -- Twila Brase, president of Citizens' Council on Health Care, provides the following comments-pro and con-to points made by Governor Tim Pawlenty in his speech at the Midwest States Health Reform Summit in Minneapolis. The forum focused on bringing the 2006 Massachusetts universal coverage law and in particular, its controversial health insurance mandate, to Minnesota.

Governor: We must chart a path toward universal coverage.

CCHC: Universal coverage is a government-directed initiative, not a consumer-driven initiative. The discussion should not be about coverage. Coverage is not care. Many people with insurance coverage, including the privately and publicly insured in the U.S. and the entitled in other countries, fight to receive care every day. Health plans and governments use restrictions, bureaucracy, and control of dollars to ration patient access to care.

Governor: I think we should move to universal coverage. We need to move in steps. We've been studying diligently the Massachusetts model. We need to start with covering all kids. That's the logical next step to universal coverage in Minnesota.

CCHC: A health insurance mandate is a boon for insurers, a a bad idea for citizens, and a big step to government-run health care. A mandate is also unconstitutional. Government forces citizens to transfer their hard-earned incomes to the pockets of health plans. In addition, a mandate will not create universal coverage. As the Governor himself said, Minnesota requires car insurance, yet 17% of the public has not complied with the law.

Governor: Television advertising for pharmaceuticals creates consumer-driven appetites and should be limited if not temporarily suspended.

CCHC: Government should not limit citizen access to information on medical treatments. This is a patient protection issue. Health plans and government agencies are building data monitoring systems to direct and control the practice of medicine. If drug and medical device companies are not allowed to advertise, how will citizens and patients ever learn about treatments governments and health plans do not want doctors to tell them about?

Governor: We need to get to the point where we don't need to be a Ph.D to figure out your medical bills.

CCHC: Agreed!

Governor: We need to incentivize or require everybody to go to e-prescriptions.

CCHC: Computerization is not problem-free. Several studies report that electronic prescribing increases medical errors. A study in the Journal of the American Medical Association found Computerized Physician Order Entry (CPOE) added twenty-two new medical errors.

Governor: We need to pay doctors according to how well they meet recognized standards of care. We won't use a stick approach. We'll use a carrot approach. We'll reward doctors who meet the standards. This system is only going to get more robust.

CCHC: We disagree. This is a big government stick approach. Anyone who is not "rewarded" is penalized. They get a stick. There are no carrots, and increasing robust means increasingly punitive. This approach also permits government to intrude in private medical records and interfere with private medical decisions.

Governor: The role of the HMOs is called into question. Are they just banks? Are they just underwriters of risk? Or are they true partners. What is the health value of what they do? If they are just glorified aggregators of risk that don't meaningfully improve health, we need to chart a different future.

CCHC: We concur. We have long said that HMOs are banks that don't have to give the money back. In fact, they are allowed to write their own definitions of "medical necessity" and deny care based on those definitions. It's time for citizens to "bank" their own dollars, protect their assets, and keep the dollars they need to get the health care they want.

Citizens' Council on Health Care is a non-profit, independent health care policy organization that supports free-market ideas in health care.



Goververnor Pawlenty has announed that he now SUPPORTS Socialized Medicine:

"The Republican governor said he was 'open to' a state law that would try to achieve universal coverage by requiring that all Minnesotans have insurance." (Star Tribune 11/15/06).

•Scott Johnson (Powerline) responds: "So much is wrong with this proposition. I recoil from the arrogance of such instruction from public servants who have forgotten their jobs."
•Ed Morrissey (Captain's Quarters) suggests that "Pawlenty has decided to drop all of the reasons Republicans voted for him and address all of the reasons Democrats did not."
•Lady Logician demands: "Governor Pawlenty, I WANT MY VOTE BACK!"

Great moments in Socialized Medicine (Part 4)
A London man fixed his own front tooth with SuperGlue after failing to find a National Health Service dentist to do the job

The following article is reprinted from the London Daily Mail, Tuesday, November 14, 2006:

   Gordon Cook with
   his superglue

Dentist shortage leads man to superglue own tooth

A man fixed his front tooth with superglue after failing to find an NHS dentist.

Gordon Cook, 55, has used the bizarre "DIY dentistry" technique on a loose crown for the last three years - with each fresh application of glue lasting around two months.

The father of seven, who was erased from his original dentist's register after moving to a new home in Tranmere, Merseyside, said he turned to glue after losing hope of finding a dentist. He said: "I tried to find a new dentist but they had all gone private.

"A lot of them said they would take me on as an NHS patient, but only if I agreed to have the loose crown fixed as a private patient, which would cost around £100.

"In the end, I just decided to take matters into my own hands. I had read somewhere that super glue was invented for medical use, to bond skin, so I gave it a go.

"I tried a few different brands but the one I use now, which is just called Industrial Super Glue, is the best.

"You can't really taste it but you do have to be careful not to use too much, in case you glue your mouth shut."

Mr Cook, a security manager, has now found an NHS dentist and hopes to have the crown fixed professionally.

Councillor Chris Blakeley, chairman of Wirral Council's social care and health overview and scrutiny committee, said: "Mr Cook's solution was rather extreme but he is not alone when it comes to dentistry horror stories.

" People are finding it extremely difficult to find an NHS dentist, and we are currently gathering evidence to assess the scale of the problem, which is not unique to this area."


The following Ruud mailings were sent out in late October. Once again, she is careful NOT to use the words "Universal Healthcare" or "Socialized Medicine" or "Single Payer". Nowhere in the ads does she tell you what the final COST of providing you with "free healthcare for all" will be. Nowhere in the ads does she tell you the DOWNSIDE of her plan -- government run, government controlled health care -- lack of choice, long lines, and rationing of care.

She personally called the Eden Prairie News in August and admitted that she supports "Universal Healthcare." But, yet, she carefully avoids using the term in her ads, in her website, in her letters to the editor. During the debates she failed to use the term even once. Why?

Why does Ruud continue to evade the issue? Ruud says healthcare is one of her TOP PRIORITIES but yet she has yet to be straight with the people of Eden Prairie and Minnetonka.

To see a larger version of the ads, click on each of the photos above.

Bill Cullen has a better plan. To see the many differences between Bill Cullen and his opponent, see Bill's website.

The following letter is reprinted from the Eden Prairie News Thursday, October 19, 2006:

Supports Cullen
By Tim Goodyear, Minnetonka

It was disappointing to learn that Rep. Maria Ruud has joined those who endorse a universal health care system.

I am afraid to even imagine how this type of system would dramatically increase the costs of all of our health care, as well as decrease quality due to government bureaucracy. While the government certainly should play a role in helping those who need assistance, the vast majority of consumers want more choice and control over their own health care.

The competition between Target, WalMart, Costco, and Kmart benefit us all with lower prices and more choices in consumer goods, and this high level of competition in the Minnesota health care market would help keep down costs as well. Profit and nonprofit companies alike should be allowed to compete in our state so that we, the consumers, have the most competitive choices available.

Free, open markets are the best way of providing health care services, especially when they aren't overly burdened with government mandates and red tape. Newer innovations like HSA accounts are great choices that encourage consumers to become cost conscious, compared to the outdated third party co-pay plans that have led to our current high costs.

More competition, freedom, and limited government will make Minnesota an even better place to live. This is another reason I heartily support Bill Cullen for the Minnesota House of Representatives and encourage you to join me.




The following are the e-mail responses from the candidates to a question asked by the Eden Prairie News (printed 10/5/2006). THE COMMENTS ARE ADDED AND ARE NOT THE OPINION OF THE CANDIDATE OR THE EDEN PRAIRIE NEWS:

Q: How would you address the health care needs of Minnesotans? What needs to be done to prevent further increase in cost?

Bill Cullen's Answer: “We must hold the line on exploding costs by encouraging the power of the private market. I have a four part plan.

First, we must increase competition by eliminating the laws that restrict the market to a few insurance providers.

Second, we must assure that pricing and quality metrics are available to consumers so you can make informed decisions.

Third, we must make health care savings accounts easily available to consumers.

Fourth, we need tort reform.

My opponent supports universal healthcare. That will not contain healthcare costs, it will just increase costs and cause rationing of care.”

Comment: Bill Cullen is asked a question and he answers it. How would you address healthcare and bring down the cost? Here's my four point plan. Boom, boom, boom, boom. And not only that, but here's why my opponent's plan is bad.

You learn more about Ruud's plan from Bill Cullen than you do from Ruud. Isn't that ridiculous?

Bill Cullen is asked for a solution and he delivers. Now read Ruud's evasive response . . . .

Maria Ruud's Answer: “Rising healthcare costs are the biggest economic threat facing Minnesota. Healthcare is also a major social concern for voters whose families are either getting squeezed out of adequate health coverage or losing their coverage completely.

Comment: Ruud wastes her first two sentences basically telling us “Yup, we've got a real problem here.”

Access to affordable healthcare for all residents must be our number one priority. This is not only the right thing to do but is also part of the economic package that can make us a much more competitive state.

Comment: This is the closest Ruud actually comes to an answer. Except it really isn't an answer. Who is going to pay for this? What kind of “economic package”? What the heck are you talking about, Maria?

Additionally, if the state doesn't aggressively control escalating health care costs, there won't be enough money left for education, public safety, transportation and other issues.”

Comment: Does Ruud ever answer the question? You decide.

How would she “answer the healthcare needs of Minnesotans”? We still don't know.

How would she “prevent further increase in cost”? We still don't know.

She won't talk about it because she knows socialized medicine is unpopular. She knows people don't want long lines, high taxes, fewer choices, and rationing of care.

She says healthcare is her #1 priority. Yet, when given the chance to tell us what she would do, she chooses to be evasive.

Eden Prairie and Minnetonka deserve straight answers to straight questions. Eden Prairie and Minnetonka deserve better than Maria Ruud.


The following letter is reprinted from the Eden Prairie News Thursday, October 5, 2006:

Questions Ruud
By Bonnie Gasper, Eden Prairie

Rep. Maria Ruud champions her work related to "children's mental health." She boasted about an award she received from a lobbyist organization called the National Alliance on Mental Illness (NAMI-MN) which supports Minnesota initiatives to screen "early and continuously" children birth to age 5 for mental illness.

Does Rep. Ruud know or care that NAMI has a serious conflict of interest? A large portion of its budget comes from drug companies. According to internal documents obtained by Mother Jones magazine; from 1996 to mid-1999, 18 large pharmaceutical firms gave NAMI a total of $12 million. NAMI's largest donor was Eli Lilly who delivered over $1 million in 1999 alone.

NAMI supports mental health screening of children (for the children, of course) and drug companies support NAMI because they stand to make billions of dollars pushing drug therapy on your children as a result of these screenings.

When the overall positive predictive value of a common screening tool is a mere 27 percent, you can be certain millions of children will be falsely diagnosed and recommended for treatment.

In 2005, Rep. Ron Paul of Texas introduced the "Parental Consent Act" - a bill forbidding federal funds being used for any mental-health screening of students without the express, written, voluntary and informed consent of their parents. The bill was supported by Minnesota Reps. Kennedy, Gutknecht and Kline.

NAMI, the organization that Ms. Ruud supports, worked to defeat this bill. They said that the bill would harm their "efforts" to screen schoolchildren for mental illness. As a result, the bill remains stalled in committee and has not been allowed to come to a vote.

Universal mental health screening simply has no place in a free or decent society. The notion of federal bureaucrats screening then ordering potentially millions of youngsters to take psychotropic drugs strikes an emotional chord with American parents, who are sick of relinquishing more and more parental control to government.

The government does not own our kids, and it has no constitutional authority to interfere in our family's intimate health matters. Psychiatric diagnoses are inherently subjective, and the drugs regularly prescribed can produce serious side effects; especially in developing children. The bottom line is that the government is out of its jurisdiction here.

I don't know a single parent who supports governmental screening and drugging of children. Ruud shares no "common ground" on this one.


The following letter is reprinted from the Eden Prairie News Thursday, September 14, 2006:

Questions Ruud's health-care plan
By Allen Bode, Eden Prairie

I'd like to thank the Eden Prairie News for clarifying Maria Ruud's position on health care. As the paper explained in a correction on Aug. 31, 2006,

"Ruud supports universal health care."

If government forces employers to pay for universal health care, it will negatively impact wages and take-home pay. Consumers will feel the pinch as the price of goods and services rise to cover these new costs. Small businesses will be hit especially hard.

If the government were to simply take over health care, we only need to look at the medical systems in Canada, Europe and the former Soviet Union. They're outdated, inefficient and costly, with many procedures frequently rationed.

As a recent survivor of major spinal surgery, I was most fortunate to have been able to select the neurologist, surgeon and hospital of my choice such that I can again walk and care for my new granddaughters.

Universal healthcare is not just another costly, feel good, big government program that doesn't work; it won't cure what ails our health care system and will ultimately lead us to join our Canadian friends who frequently need to leave their country to find quality physicians and timely treatment for their serious ailments.

When Hillary Clinton tried to impose universal healthcare on America, the only good that came out of it was the public rebuke. Americans knew then, this plan wasn't good for them, for patients or their doctors ... and the citizens of Eden Prairie and Minnetonka know that it isn't good for them now.
(Editor's note: Bode is vice chair of the Senate District 42 Republican Party.)


The following refers to a "correction" printed on the editorial page of the Eden Prairie News Thursday, August 31, 2006:

The August 31 Eden Prairie News contained a curious “correction”:

Ruud supports universal healthcare.

We have discovered that it was Maria Ruud herself who called the paper and demanded the correction.

Curious fact #1: Maria Ruud lists Healthcare as one of her three priorities (along with Education and the Environment). But nowhere on her campaign website does the word "Universal" appear. She calls the paper demanding a correction of her position, yet the term she uses does not appear even once in her literature. She demands that her position not be mischaracterized, yet she never mentions it during her debates. Why is that?

This is one of her three priorities and yet she will not tell us where she stands. What is Maria hiding?

Curious fact #2: Regardless of the term she uses -- Universal, Single Payer -- it's still basically the same thing. Government dictated, government controlled, government mandated medicine. Maria Ruud wants to socialize our healthcare system. And that is bad news for Eden Prairie and Minnetonka families!

The following letter is reprinted from the Eden Prairie News Thursday, August 24, 2006:

The 21st Century Healthcare System
By Bill Cullen, Minnetonka resident and candidate for Representative, House District 42A

There has been a lot of discussion about the health-care crisis on these pages. This crisis is really a crisis of cost as the care we receive is outstanding and the vast majority of Minnesotans have coverage. Today health-care costs consume 16.2 percent of our gross domestic product, which is twice the rate of any other country. Health-care costs continue to grow at almost three times the rate of inflation. In other words, the problem is huge and getting worse. Our solution must contain costs without losing (preferably improving) quality.

The DFL, and my opponent, [Rep.] Maria Ruud, want tax-supported, single-payer healthcare. This only makes sense if you believe our government is a low-cost, high-quality provider capable of providing personalized care. Other single payer systems have resulted in the government hiding escalating costs in tax rolls and rationing services. Do you believe that more government bloat and control is the prescription for health care?

I believe government should reform our health-care market to be consumer driven. All HMO providers should be allowed to sell in Minnesota so we have more competition. Health savings accounts should be more readily available. The fees and quality of our providers must be transparent to the consumer. When consumers are in control of their own health care, they will make financially wise choices with regard to procedures, insurance and behaviors.

We should strive to limit government and maximize individual choices.


Great moments in Socialized Medicine (Part 3)
Miminum waiting times in Great Britain

The following article is reprinted from the Vodka Pundit , Monday, August 7, 2006:

Single-Payer, Multi-Waiter
Posted by Will Collier  ·   7 August 2006

With Hillary Clinton a sure thing to run for President, it's a very safe bet that we'll be hearing plenty of calls in 2008 for socialized medicine, except it'll be euphemized as "single payer" government health insurance. Check out this story from the UK on how well that's working out for the Brits:

Hospitals across the country are imposing minimum waiting times - delaying the treatment of thousands of patients.

After years of Government targets pushing them to cut waiting lists, staff are now being warned against "over-performing" by treating patients too quickly. The Sunday Telegraph has learned that at least six trusts have imposed the minimum times.

In March, Patricia Hewitt, the Secretary of State for Health, offered her apparent blessing for the minimum waiting times by announcing they would be "appropriate" in some cases. Amid fears about £1.27 billion of NHS debts, she expressed concern that some hospitals were so productive "they actually got ahead of what the NHS could afford".

The Sunday Telegraph has learned of five further minimum-waiting-time directives. In May, Staffordshire Moorlands PCT, which funds services at two hospitals and is more than £5 million in the red, introduced a 19-week minimum wait for in-patients and 10 weeks for out-patients. A spokesman said: "These were the least worst cuts we could make." In March, Eastbourne Downs PCT, expected to overspend by £7 million this year, ordered a six-month minimum wait for non-urgent operations. Also in March, it was revealed that Medway PCT, with a deficit of £12.4 million, brought in a nine-week wait for out-patient appointments and 20 weeks for non-urgent operations.

Doctors are also resigning. One gynæcologist said that he spent more time doing sudoku puzzles than treating patients because of the measures. Since January, West Hertfordshire NHS Trust, with a deficit of £41 million, has used a 10-week minimum wait for routine GP referrals to hospital. Watford and Three Rivers PCT, £13.2 million in the red, has introduced "demand management": no in-patient or day case is admitted before five months.

Oh, yeah, sign me up for that.


The following letter is reprinted from the Eden Prairie News Thursday, August 3, 2006:

Ruud sponsored health-care measures
By Maria Ruud,

I would like to thank Angela Erhard for her letter to the editor in the July 20 Eden Prairie News regarding affordable health care in Minnesota. I appreciate her concern about this issue, and agree with her that this is a worthwhile goal to work toward.

Ms. Erhard specifically inquired about measures I sponsored to control health care costs in Minnesota. I was pleased to co-author House File 1635, legislation that would have allowed individuals and small employers to purchase affordable health care coverage by joining existing groups of purchasers. This approach, if enacted, would have saved small businesses as much as 31 percent on the cost of health care coverage. No state subsidies would be involved because the businesses and individuals would pay full cost, yet still be able to access lower premiums as part of a larger pool. In addition, I supported House File 588, a new law that permits health insurers to sell lower cost policies that are not subject to burdensome state health insurance mandates which increase premiums. I look forward to continuing work on health-care cost containment efforts next session.

In addition, during my first term in the Minnesota House I was honored to co-author many health-related pieces of legislation. Some of the topics these bills dealt with included children's mental health, breast and cervical cancer treatment, organ donation, lead poisoning screening, mental health parity in insurance coverage, prescription drug bulk purchasing, a statewide smoking ban, MinnesotaCare coverage, and the nursing shortage. Also, I am proud to be a founding member of the Mental Health Legislative Caucus which was named Legislator of the Year for 2005 by the Minnesota Chapter of the National Alliance of Mental Illness in Minnesota (NAMI-MN).

As a nurse practitioner, I witness on a daily basis the crucial importance of affordable, quality health care, and I will continue to support legislative efforts to see that all Minnesotans receive it.
Ruud represents Minnetonka and part of Eden Prairie and is seeking re-election.

COMMENTS: Ms Ruud says she is proud to be a member of the Mental Health Legislative Caucus. This caucus is the Minnesota chapter of the national organization National Alliance on Mental Illness. This organization strives to add mental illness as another mandated coverage for all states. Minnesota currently has 62 required mandates -- more than any other state in the union. Mandated coverage is another big government solution which will drive up health care costs.

Ms. Ruud wants government run healthcare. Her own website says:

“My 20 years in health care have shown me that health care should be a right, not a privilege.

Yes, yes. In other words, government run, government rationed healthcare.

The DFL Platform is even less ambiguous:

“(We support) Nationally funded, community-based comprehensive and affordable health care for all.

Ms. Ruud is also a member of an organization called League of Women Voters. Among the League's many Left-leaning action items: They support ILLEGAL immigration, they oppose requiring a photo ID to help stop voter fraud, they want to take away your right to conceal and carry a firearm, they support abortion . . . and they are STRONG advocates of socialized medicine:

“The League favors a national health insurance plan financed through general taxes in place of individual insurance premiums [and] is opposed to a strictly private market-based model of financing the health care system. ”Source: League of Women Voters MN Capitol Letter, May 12, 2006

Socialized medicine, Single payer medicine, Universal healthcare -- whatever you want to call it -- it's all the same. Think Hillary Clinton. Think long lines, long waits, rationed healthcare, lack of choice, lack of competition, and poor quality for all.

Again, from Ms. Ruud's campaign website:

“I supported the Minnesota Children's Health Security Act.

This is legislation which will put all Minnesota children into a new, Universal HealthCare system (ie. Socialized Medicine). This is the classic first step in bringing socialized medicine to the general population -- start with children then get the rest of us into it. Make no mistake about it, this is Universal Healthcare -- it is a benefits package that does not require families to pay premiums, co-pays or deductibles. Who pays for it then?

Once more from her website:

“Affordable, high quality health care will keep our families healthy, our businesses competitive and our communities strong.”

How does Ms. Ruud plan to make health care “affordable”? By creating a huge new government bureaucracy? By taking it out of the private sector? That doesn't make it affordable. That only passes on the costs to someone else.


Great moments in Socialized Medicine (Part 2)
In Canada a baby dies because there aren't enough hospital beds

The following article is reprinted from the CBC News , Friday, July 28, 2006:

Waiting-room miscarriage sparks call for resignations

Alberta 's Liberal leader is calling on the head of the Calgary Health Region to resign because of what he calls continuing problems in emergency departments, including a recent miscarriage in a hospital waiting room.

CEO Jack Davis should resign because emergency rooms are still overcrowded and not providing the level of care they should, Kevin Taft said Friday. 

"These issues are not getting solved. This is not getting better," Taft said.

The opposition leader also wants a public inquiry to be held into hospital operations.

Rose Lundy went to the emergency room at the Peter Lougheed Centre with abdominal pain last week. Three months pregnant, she suffered a miscarriage in the waiting room after staff told her there was a shortage of beds and she would have to wait.

The Calgary Health Region said it is investigating Lundy's case, but will not comment on Taft's call for changes.

"Remember this is not a single incident. This is a pattern that's repeated time and again," Taft said. "If things aren't corrected, if steps aren't taken, if new management isn't put in place, it's going happen again."

Board chair David Tuer should also consider resigning, Taft said.

Health Minister Iris Evans was not available for comment Friday.


The following letter is reprinted from the Eden Prairie News Thursday, July 27, 2006:

Solutions Needed for “Healthcare Crisis”
Angela Erhard

In the July 20 edition [letters] of the Eden Prairie News, Claire O'Connor spoke of the healthcare crisis and how Rep. [Maria] Ruud is working for high quality and affordable healthcare for all Minnesotans. However, I am confused. I have not seen one piece of legislation that Rep. Ruud has authored that will reduce the cost of healthcare. Though she proclaims a "healthcare crisis," Rep. Ruud, a registered nurse and healthcare professional, has no answer or vision to solve this problem.

Indeed, the DFL party, to which Rep. Ruud belongs, has voted for restricting commerce and for-profit insurance companies from doing business in this state. Competition is what is going to bring healthcare costs down. How does restricting the commercial environment (and these nonprofits paying outrageous executive compensation) reduce healthcare costs?

O'Connor seems to imply that the solution is for the government to provide our healthcare. Since when has the government been a low-cost and efficient provider of anything? Isn't it better to select our own health care from a competitive market with a wide array of options?

Angela Erhard is an Eden Prairie resident


Are there too many healthcare mandates?
According to the Council for Affordable Health Insurance, Minnesota now has more health insurance mandates than any other state. Health coverage in Minnesota must now include everything from hearing aids to chiropractic care to hairpieces. Kathy Kersten suggests that, if we want to get control of health care costs, we need to start offering choice in health insurance.

The following article is reprinted from the Minneapolis Star-Tribune, Wednesday, July 26, 2006:

Mandates push health insurance rates up and up
Katherine Kersten, Star Tribune

Amy Klobuchar's U.S. Senate campaign has just launched a new TV ad. In it, she laments that when her daughter was born, her health care provider had the nerve to make her leave the hospital after 24 hours, although the baby was sick and had to stay longer.

That was about 10 years ago. The ad shows that Klobuchar's daughter is just fine now, and, taking after her mom, is becoming a bright and spirited young woman.

Klobuchar didn't just sit and fret over her short hospital stay, according to the ad. She testified before the Minnesota Legislature and "got one of the first laws in the country passed guaranteeing new moms and their babies a 48-hour hospital stay."

Her story hit home with me. I, too, benefited from a 48-hour hospital stay after one of my children was born. I won't deny that I was pleased that my health insurance covered it.

Over the years, our Legislature has heard hundreds of moving stories like Klobuchar's. As a result, Minnesota now has more health insurance mandates than almost any other state -- over 60 and counting. An insurer selling health coverage to an employer or individual in Minnesota must now include everything from hearing aids to chiropractic care to hairpieces.

But there's a catch. While candidate Klobuchar trumpets her success in creating a health care mandate, she also frequently decries the high cost of health care in Minnesota. Could success on the mandate front compound the cost problem?

The fact is, the cost of all these mandates adds up. In recent decades we've created a standardized roster of benefits -- some quite expensive -- that everyone covered by the mandates must buy, regardless of whether they need them or want to pay for them. A sizable number of people are being priced out of the health care market.

Many factors affect the cost of health insurance, but mandates are one cost-driver.

Merrill Mathews, director of the Council for Affordable Health Insurance, describes the problem this way: "Coverage with lots of mandates is like a Cadillac with options," he says. "It's great if you want it and can afford it. But if you can't, you have to walk."

State Sen. Brian LeClair, a member of the Senate Health and Human Services Budget Committee, builds on the automobile analogy. "We should mandate seat belts. But should we mandate leather upholstery and four-wheel drive? When it comes to health care, many people would find that a standard Buick works for them. What we need in this state is health insurance flexibility and choice."

Take the case of a healthy young single man, just out of school. He may not want maternity coverage, mental health benefits or a hearing aid. But in Minnesota, if he wants health insurance, he has to pay for all these and more. As a result, he may decide not to buy health insurance at all.

Small businesses, which employ a significant part of our state's workforce, are especially hard hit by Minnesota's mandates.

"Mandates -- especially mental health, chemical dependency and maternity coverage -- may add close to 20 percent to the cost of health insurance here," says Mike Hickey, state director of the National Federation of Independent Business. "Small employers won't offer health insurance if it threatens their financial stability."

Hickey thinks reform is long past due. "We need to stop three decades of costly mandates," he says. "Our goal now should be to make health insurance more affordable."


A Ruud supporter says we NEED MariaCare
Maria's appeal, as with many on the Left, is primarily emotion, not logic. Just get government do it! Let's let the government take over our health care system. But is that really the answer? Ruud supporter Claire O'Connor seems to think so . . .

The following is reprinted from the Eden Prairie News, Thursday, July 20, 2006

Looking For My Candidate
Claire O'Connor

I am an active, healthy, maturing adult. I've worked all my life, paid my share of taxes (of course), contributed to the economy and to society. Though recently retired, my contributions continue through taxes and through volunteer work in my community. Now, it seems, I have to worry about health care for me, my children and grandchildren. Will it be there when we need it and will we be able to afford it?

With elections coming up, I wondered which of the candidates for state representative share my concerns about health care. Minnesota Republicans' solution (as I understand it) is to reduce government's role in protecting health care for me and my family. I don't know about you, but it seems strange to ask me to vote for someone who wants not to do the job. Does that also mean they will take a smaller salary?

[Rep.] Maria Ruud, current representative for my district, knocked on my door recently. So I asked her how hard she works to protect health care.

I found out that she is a registered nurse and nurse practitioner who is very aware of many of the problems with our health care system. She told me that her experience has taught her that Minnesotans of all ages must be able to get the highest quality affordable health care when they need it. As an elected government representative she works to rein in costs, improve care for those with mental illness, help small employers provide health benefits, ensure protection for children and reduce the nursing shortage. Maria Ruud gets my vote.

Claire O'Connor is an Eden Prairie resident

Analysis: Claire O'Connor shares one thing in common with many Maria Ruud supporters: She's a Bush-hating Leftist. To read about her many other misguided views, see the following links:

Healthcare NOW! -- Claire announces that, after living in Canada, “I know first hand that single payer tax supported health care is the only way.”Healthcare Now is an organization pushing for a government takeover of medicine.
Irish anti-War Movement -- Claire goes on an anti-Israel, anti-Bush rant.
CRM Vet -- Claire declares that with Colin Powell and General Schwartzkopf in charge, “we will never have elections again.”Yikes!
December Designs -- Claire whines that in 2000 her “vote didn't count.”This is the classic “selected, not elected”myth pushed by many on the extreme Left. Even though every major news outlet that studied the ballots later agreed that Bush was indeed the winner, don't confuse Claire's mind with the facts.

This is who Maria counts as her supporters?

Socialized medicine . . . government controlled medicine . . . rationed medicine. Is that really “the only way?”

Canada moving AWAY from Socialized Medicine (Part 2)
When George Zeliotis of Quebec was told in 1997 that he would have to wait a year for a replacement for his painful, arthritic hip, he did what every Canadian who's been put on a waiting list does: He got mad.

The following article is reprinted from the Wall Street Journal , Monday, June 13, 2005:

Unsocialized Medicine
A landmark ruling exposes Canada's health-care inequity

Let's hope Hillary Clinton and Ted Kennedy were sitting down when they heard the news of the latest bombshell Supreme Court ruling. From the Supreme Court of Canada, that is. That high court issued an opinion last Thursday saying, in effect, that Canada's vaunted public health-care system produces intolerable inequality.

Call it the hip that changed health-care history. When George Zeliotis of Quebec was told in 1997 that he would have to wait a year for a replacement for his painful, arthritic hip, he did what every Canadian who's been put on a waiting list does: He got mad. He got even madder when he learned it was against the law to pay for a replacement privately. But instead of heading south to a hospital in Boston or Cleveland, as many Canadians already do, he teamed up to file a lawsuit with Jacques Chaoulli, a Montreal doctor. The duo lost in two provincial courts before their win last week.

The court's decision strikes down a Quebec law banning private medical insurance and is bound to upend similar laws in other provinces. Canada is the only nation other than Cuba and North Korea that bans private health insurance, according to Sally Pipes, head of the Pacific Research Institute in San Francisco and author of a recent book on Canada's health-care system.

"Access to a waiting list is not access to health care," wrote Chief Justice Beverly McLachlin for the 4-3 Court last week. Canadians wait an average of 17.9 weeks for surgery and other therapeutic treatments, according the Vancouver-based Fraser Institute. The waits would be even longer if Canadians didn't have access to the U.S. as a medical-care safety valve. Or, in the case of fortunate elites such as Prime Minister Paul Martin, if they didn't have access to a small private market in some non-core medical services. Mr. Martin's use of a private clinic for his annual checkup set off a political firestorm last year.


The ruling stops short of declaring the national health-care system unconstitutional; only three of the seven judges wanted to go all the way.

But it does say in effect: Deliver better care or permit the development of a private system. "The prohibition on obtaining private health insurance might be constitutional in circumstances where health-care services are reasonable as to both quality and timeliness," the ruling reads, but it "is not constitutional where the public system fails to deliver reasonable services." The Justices who sit on Canada's Supreme Court, by the way, aren't a bunch of Scalias of the North. This is the same court that last year unanimously declared gay marriage constitutional.

The Canadian ruling ought to be an eye-opener for the U.S., where "single-payer," government-run health care is still a holy grail on the political left and even for some in business (such as the automakers). This month the California Senate passed a bill that would create a state-run system of single-payer universal health care. The Assembly is expected to follow suit. Someone should make sure the Canadian Supreme Court's ruling is on Governor Arnold Schwarzenegger's reading list before he makes a veto decision.

The larger lesson here is that health care isn't immune from the laws of economics. Politicians can't wave a wand and provide equal coverage for all merely by declaring medical care to be a "right," in the word that is currently popular on the American left.

There are only two ways to allocate any good or service: through prices, as is done in a market economy, or lines dictated by government, as in Canada's system. The socialist claim is that a single-payer system is more equal than one based on prices, but last week's court decision reveals that as an illusion. Or, to put it another way, Canadian health care is equal only in its shared scarcity.


When asked whether he was worried about being known as the man who helped bring down his country's universal health-care system, Mr. Zeliotis told the Toronto Star, "No way. I'm the guy saving it." If the Canadian ruling can open American eyes to the limitations of government-run health care, Mr. Zeliotis's hip just might end up saving the U.S. system too.


Canada moving AWAY from Socialized Medicine (Part 1)
Long waits and lack of choice. As U.S. politicians continue to sing the praises of "Universal Healthcare", Canada is beginning to discover that socialized medicine doesn't work

The following article is reprinted from the NY Times , Thursday, February 23, 2006:

As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging
By: Clifford Krauss

VANCOUVER , British Columbia: The Cambie Surgery Center, Canada's most prominent private hospital, may be considered a rogue enterprise.

Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years in discomfort before receiving treatment.

But no one is about to arrest Dr. Brian Day, who is president and medical director of the center, or any of the 120 doctors who work there. Public hospitals are sending him growing numbers of patients they are too busy to treat, and his center is advertising that patients do not have to wait to replace their aching knees.

The country's publicly financed health insurance system frequently described as the third rail of its political system and a core value of its national identity is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine.

Dr. Day, for instance, is planning to open more private hospitals, first in Toronto and Ottawa, then in Montreal, Calgary and Edmonton. Ontario provincial officials are already threatening stiff fines. Dr. Day says he is eager to see them in court.

"We've taken the position that the law is illegal," Dr. Day, 59, says. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

Dr. Day may be a rebel (he keeps a photograph of himself with Fidel Castro behind his desk), but he appears to be on top of a new wave in Canada's health care future. He is poised to become the president of the Canadian Medical Association next year, and his profitable Vancouver hospital is serving as a model for medical entrepreneurs in several provinces.

Canada remains the only industrialized country that outlaws privately financed purchases of core medical services. Prime Minister Stephen Harper and other politicians remain reluctant to openly propose sweeping changes even though costs for the national and provincial governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment.

But a Supreme Court ruling last June it found that a Quebec provincial ban on private health insurance was unconstitutional when patients were suffering and even dying on waiting lists appears to have become a turning point for the entire country.

"The prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services," the court ruled.

In response, the Quebec premier, Jean Charest, proposed this month to allow private hospitals to subcontract hip, knee and cataract surgery to private clinics when patients are unable to be treated quickly enough under the public system. The premiers of British Columbia and Alberta have suggested they will go much further to encourage private health services and insurance in legislation they plan to propose in the next few months.

Private doctors across the country are not waiting for changes in the law, figuring provincial governments will not try to stop them only to face more test cases in the Supreme Court.

One Vancouver-based company launched a large for-profit family medical clinic specializing in screening and preventive medicine here last November. It is planning to set up three similar clinics in Toronto, Ottawa and London, Ontario next summer and nine more in several other cities by the end of 2007. Private diagnostic clinics offering MRI tests are opening around the country.

Canadian leaders continue to reject the largely market-driven American system, with its powerful private insurance companies and 40 million people left uninsured, as they look to European mixed public-private health insurance and delivery systems.

"Why are we so afraid to look at mixed health care delivery models when other states in Europe and around the world have used them to produce better results for patients at a lower cost to taxpayers?" the premier of British Columbia, Gordon Campbell, asked in a speech two weeks ago.

While proponents of private clinics say they will shorten waiting lists and quicken service at public institutions, critics warn that they will drain the public system of doctors and nurses. Canada has a national doctor shortage already, with 1.4 million people in the province of Ontario alone without the services of a family doctor.

"If anesthetists go to work in a private clinic," Manitoba's health minister, Tim Sale, argued recently, "the work that they were doing in the public sector is spread among fewer and fewer people."

But most Canadians agree that current wait times are not acceptable.

The median wait time between a referral by a family doctor and an appointment with a specialist has increased to 8.3 weeks last year from 3.7 weeks in 1993, according to a recent study by The Fraser Institute, a conservative research group. Meanwhile the median wait between appointment with a specialist and treatment has increased to 9.4 weeks from 5.6 weeks over the same period.

Average wait times between referral by a family doctor and treatment range from 5.5 weeks for oncology to 40 weeks for orthopedic surgery, according to the study.

Last December, provincial health ministers unveiled new targets for cutting wait times, including four weeks for radiation therapy for cancer patients beginning when doctors consider them ready for treatment and 26 weeks for hip replacements.

But few experts think that will stop the trend toward privatization.

Dr. Day's hospital here opened in 1996 with 30 doctors and three operating rooms, treating mostly police officers, members of the military and worker's compensation clients, who are still allowed to seek treatment outside the public insurance system. It took several years to turn a profit.

Today the center is twice its original size and has yearly revenue of more than $8 million, mostly from perfectly legal procedures.

Over the last 18 months, the hospital has been under contract by overburdened local hospitals to perform knee, spine and gynecological operations on more than 1,000 patients. Since the Supreme Court ruling in June, it began treating patients unwilling to wait on waiting lists and willing to pay their own money.

Now Dr. Day says he is considering building a full-service private hospital somewhere in Canada with a private medical school attached to it.

"In a free and democratic society where you can spend money on gambling and alcohol and tobacco," Dr. Day said, "the state has no business preventing you and me from spending our own money on health care."


Healthcare facts and myths
One of the most persistent myths about the U.S. health care system is that it does not provide for the poor. Not so, according to this article by Arnold Kling.

The following article is reprinted from the TCS Daily , Thursday, May 5, 2005:

Poverty and Spending on Health Care
By Arnold Kling

One of the most persistent myths about the U.S. health care system is that poor people lack access. While we allegedly provide luxury health care for the rich, we do much less than other countries for those in poverty. However, the data tell a different story.

The government's Medical Expenditure Panel Survey (MEPS) tabulates health care spending for a sample of over 35,000 Americans. One of the variables included in the survey is household income relative to the poverty line.

When the data for 2002 (the latest survey year available) are extrapolated to the full noninstitutional population, one obtains these results for persons below the poverty line:

Number of Persons: 35.6 million

Total Spending: $106.3 billion

Per Capita Spending: $2,986

Next, look at data on per capita spending on health care in various countries, as compiled by the OECD. In 2002, per capita spending in Canada was $2,931, in France it was $2,736, in Germany it was $2,817, and in the United Kingdom it was $2,160. The United States spends more on the average poor person than those countries spend on the average person.

In fact, the MEPS data understate spending in the United States, in part, as it is limited to the noninstitutional population. Therefore, it excludes nursing home expenditures. When those are added in, the per capita spending in the United States on those in poverty will turn out to be higher.

Still, people who are above the poverty line receive much more medical care in the United States, right? Wrong. In the MEPS data, the per capita spending rate for people above the poverty line is $2,789, essentially the same as the rate for poor people. (Again, the MEPS data excludes spending on nursing homes, research and development, and other categories that show up in countries' national income accounts.)


As with all aggregate health care data, these statistics were not designed to answer the most penetrating questions. Some issues that come to mind are:

1. Do other countries spend much more per capita on their poor than they do on the average person?

2. Do poor people in the United States consume too much of the "wrong" health care resources -- too much acute care and not enough preventive care?

3. Do poor people in other countries require less health care than poor people in America? Are they healthier to begin with?

I suspect that the answer to (1) is "no," but that the answers to (2) and (3) are "yes." People who tend to make bad choices about how to care for themselves and how to spend money also tend to be poor. Taking this propensity to make bad choices as given, the poor need to spend more to achieve a given level of health. I believe that this effect is stronger in the United States than it is in other countries.

I suspect that severe substance abuse plays a big role in poverty, poor health, and mortality. My guess is that if substance abusers were excluded from the international statistics on health outcomes, the standing of the United States would improve considerably. If this is true, it still begs the question of whether our public health policies are inferior to those of other countries in the area of substance abuse.

I think it would be foolish to conclude that the United States does as well or better than other countries in providing health care to the poor. What the data do suggest, however, is that poor people in America do not suffer from a lack of total health care resources.

No Easy Answers

If the United States does not lag in spending on health care for the poor, then this undermines one of the arguments for adopting a more European or Canadian style health care system. Our challenge is not to redirect resources toward the poor but to come up with better approaches for improving public health.

In Medicaid, we already have the sort of state-funded health care system for the poor that other countries provide for everyone. It is difficult to see how expanding that system to the middle class (as Howard Dean, among others, has proposed) will make the poor better off.

I believe that there are genuine problems with our health care system. Studies and anecdotal evidence suggest that the uninsured and the poor receive inferior care. But I do not believe that there are any easy answers. In particular, I fail to see how any fair-minded individual could conclude that we ought to increase government's role in health care finance. If the poor under Medicaid are not as well cared for as the rest of us under private systems, then government-funded health care would seem to be part of the problem, not the solution.


Great moments in Socialized Medicine (Part 1)
As British socialized medicine continues to fail, the demand for "health tourism" grows

The following article is reprinted from the UK Guardian, Tuesday, February 1, 2005:

   Heart patient George Marshall
   in hospital in India.

This UK patient avoided the NHS list and flew to India for a heart bypass.
Is health tourism the future?

By: Randeep Ramesh in Bangalore

Three months ago George Marshall fretted about the choice offered by his doctor in Britain. Diagnosed with coronary heart disease, the violin repairer from Bradford was told he could either wait up to six months for a heart bypass operation on the National Health Service or pay £19,000 to go under the scalpel immediately.

In the end, Mr Marshall chose to outsource his operation to India. Last month he flew 5,000 miles to the southern Indian city of Bangalore where surgeons at the Wockhardt hospital and heart institute took a piece of vein from his arm to repair the thinning arteries of his heart. The cost was £4,800, including the flight.

"Everyone's been really great here. I have been in the NHS and gone private in Britain in the past, but I can say that the care and facilities in India are easily comparable," says Mr Marshall, sitting in hospital-blue pyjamas. "I'd have no problem coming again."

The 73-year-old found the hospital in Bangalore after a few hours surfing the internet. Mr Marshall decided to come after an email conversation with Wockhardt's vice-president and a chat with other "medical tourists" from Britain who had undergone surgery in the hospital.

"Once I knew others had come I thought, why not? In Europe hospitals in Germany and Belgium would do the operation for less than doctors in Britain. But Europe was still more expensive than here. And the staff speak English in India."

With patients such as Mr Marshall willing to travel across the globe to get treatment sooner or more cheaply than they could at home, Indian hospital groups see a huge market for their services.

A study by the Confederation of Indian Industry (CII), and McKinsey consultants estimated "medical tourism" could be worth 100bn rupees (£1.21bn) by 2012. Last year some 150,000 foreigners visited India for treatment, with the number rising by 15% a year, says Zakariah Ahmed, an analyst who helped compile the report,

With a large pool of highly trained doctors and low treatment prices, healthcare aims to replicate the Indian software sector's success. Built on acres of land, often gifted to companies at peppercorn rents from Indian local authorities eager to promote business, the new, sleek medical centres of excellence offer developed world treatment at developing world prices.

A number of private hospitals also offer packages designed to attract wealthy foreign patients, with airport-to-hospital bed car service, in-room internet access and private chefs. Another trend is to combine surgery in India with a yoga holiday or trip to the Taj Mahal.

Many say that it is not just cost but competency that is India's selling point. Naresh Trehan, who earned $2m (£1.06m) a year as a heart surgeon in Manhattan but returned to start Escorts hospital group in India, said that his hospital in Delhi completed 4,200 heart operations last year.

"That is more than anyone else in the world. The death rate for coronary bypass patients at Escorts is 0.8% and the infection rate is 0.3%. This is well below the first-world averages of 1.2% for the death rate and 1% for infections," says Dr Trehan. "Nobody questions the capability of an Indian doctor, because there isn't a big hospital in the United States or Britain where there isn't an Indian doctor working."

Most foreign patients who come to the subcontinent are from other developing countries in Africa, south-east Asia and the Middle East where western-trained doctors and western-quality hospitals are either hard to find or prohibitively expensive.

Hospital administrators accept that many prospective patients from the west are put off because images of India tend to focus on poverty and on the less than hygienic living conditions of most people.

Mr Marshall had never visited the subcontinent before and only been out of Britain twice before, to Australia and Egypt, on holiday. He readily admits that he did not tell his daughter what he was planning to do until two days before coming, for fear of her "reaction".

What little Mr Marshall knew about the country was not favourable and at first he was shocked by the organised chaos of India. "There are so many people here. When I was in the car coming from the airport we got stuck in really heavy traffic. It was hot, there were horns going off and people shouting. I thought, 'Oh hell, I've made a mistake.'"

But once in his airconditioned room, with cable television and a personalised nursing service, the 73-year-old says that his stay has been "pretty relaxing. I go for a walk in the morning when it is cool but really I don't have to deal with what's outside".

How many patients will come from Britain ultimately will depend on the NHS, which has begun sending patients for treatment to Europe to cope with its backlog of cases. At present the NHS restricts referrals to hospitals within three hours' flying time - but Indian hospitals say this barrier will eventually be lifted.

"It is inevitable. In the west you have rising healthcare costs and an ageing population," says Habil Khoraiwallah, chairman of Wockhardt, who plans to open five hospitals in India next year, including a new 350-bed hospital in Bangalore. "People are already discovering the benefits themselves. Governments will follow."

But campaigners say while the private medical industry is getting tax breaks and other incentives, the public healthcare system in India is falling apart. The country has less than one hospital bed per 1,000 people, compared with more than seven in first world countries. There are just four doctors in India for every 10,000 people, compared with 18 in Britain.

"The poor in India have no access to healthcare because it is either too expensive or not available. We have doctors but they are busy treating the rich in India," says Ravi Duggal, a researcher at Cehat, a health thinktank based in Mumbai. "Now we have another trend. For years we have been providing doctors to the western world. Now they are coming back and serving foreign patients at home."

What treatment costs

Heart bypass UK: £15,000
France: £13,000
US: £13,250
India: £4,300

Hip replacement UK: £9,000
France: £7,600
US: £15,900
India: £3,180

Cataract operation UK: £2,900
France: £1,000
US: £2,120
India: £660

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