Kurt Harris MD

An Archevore is someone who eats based on essential principles, and also someone who hungers for essential principles. Take your pick.

Exploring these principles is one of my interests, but not the only one.

So you may find commentary here about other issues in medicine, health, other sciences, or just about anything.

Feed The Archevore

Archevore is written, produced, and directed by me. I am an independent science writer with no outside sponsorship from any private firm, NGO or, Zeus forbid, government agency. Donations are greatly appreciated. 


In addition to buying from the book list, you can also support Archevore by making all of your Amazon purchases for any item through the Amazon Portal below.

Amazon Portal

 

 

Buy gold online - quickly, safely and at low prices

 

« Do you believe in magic? | Main | Reader Ben on why carbs deserve a presumption of guilt »
Friday
Nov062009

KILL THIS BILL

The PaNu blog started simply as a way for patients and friends to access my ideas about nutrition without my physical presence. I have a lot of ideas about a lot of different subjects, some of which I am just as passionate about as diet and medical science. My decision to keep them off the blog has solely been a pragmatic one. My time and energy are finite, and once you are in the second half of your life, you tend to try to use both effectively. It’s easy enough to be subject to diffusion with a topic as broad as nutrition and so much more were I to add more topics.

Hell, I haven’t even had time to post food pictures yet. I have some; they are just still on the flash card of my Canon.

Tonight I am making an exception. The blog as a whole lately has been running about 15,000 unique visitors and over 70,000 page views a month. This is from 0 in all categories 5 months ago. I know this is small potatoes compared to mainstream media outlets, but you can see it makes more sense for me to post something here than spam the 18 people on my email list.

If you think this is off topic, I assure you it is not. You can read anti-heathcare reform editorials anywhere.

I will give you my view of the big picture and show you how it relates to paleonutrition and taking charge of your own health.

Imagine the following. You are a thoughtful person. You find life challenging in a positive sense. You may or may not be college educated, but you read a lot, and you feel like the internet and the availability of books is a godsend. You can access primary sources of information that were opaque to almost everyone outside of privileged or highly specialized positions until the last decade of the 20th century.

You are an agent, a human who feels the power of knowledge, including self-knowledge, and with it a responsibility to make the most of your time on this earth.

Acting with agency as opposed to merely existing means actualizing your life, sorting out needs from wants, coming to terms with which of these are good and worthy of desire, and which of these might be based on fantasies or lies.

Ultimately it becomes a condition where you say:

“I want to know the truth, no matter what it is.”

“I want to discover this truth for myself.”

“I have found that not all sources can be relied upon and not everything is as it seems. I want to decide which authority besides my own reason I will appeal to. I don’t want this decision made for me.”

You realize that “science” is not a privileged sphere of inquiry. It is not special.

You see that scientists are not priests and doctors are not demi-gods.

With your new knowledge, often outside the mainstream or even considered heretical, you feel it is important to make your own decisions about how to allocate your time and energy. You want to allocate that precious time and energy (and money) in accord with your values.

It starts to bother you if others appropriate your wealth (your energy) for foreign wars of empire, to prop up a parasitical financial oligarchy that has been sucking the real economy dry for 30 years, or to pay for things you don’t approve of. You realize that both the “left” and the “right” want to control you and use you to expand their own power.

Most of all, you don’t want others to tell you what your priorities should be. Because you realize how hard it is be enlightened yourself, you cannot imagine a central authority that could direct anyone without doing violence to everyone.

You acquire this attitude early in life, or maybe only over decades.

At some point you start to learn about medical science and nutrition. You are amazed at the lack of consensus. You are amazed that expert advice can differ so much. If you went to medical school, maybe you are amazed at how much of what you were taught proves to be useless or dangerous.

It starts to become obvious to you that there are diseases that serve as the substrate for the biological analogue to Dwight Eisenhower’s military-industrial complex. Diseases that, were they to disappear, whole portions of the world’s largest economy would have to be mothballed like the USS Iowa. There are whole systems of modern iron lungs ready to become future curiosities. They exist for today’s dietary polio.

Cancer

Diabetes

Obesity

A suite of degenerative diseases

You realize that there is very good, if sometimes obscure, evidence from both modern medical science and the study of non-neolithic human cultures that most of what is being spent on healthcare in the world’s largest economy is going to treat these diseases of civilization. When you learn of how ineffective these efforts are, and then how cheaply and simply they could simply be avoided, you are dismayed.

You may start to educate your family and friends about how absurdly simple it might be to reduce your risk of diabetes, Alzheimer dementia, the most common cancers, osteoporosis and autoimmune disorders. You may have luck educating your own physician and stimulating her curiosity.

Eventually, you realize that entrenched interests are a powerful impediment to changing things at a societal level. You may or may not have read “The Birth of the Clinic” or “Discipline and Punish” by Michelle Foucalt. You are certainly not a Marxist, but you see that the method of the deconstructionists can be used to find the interests behind what is held to be the truth by force.

A federal government that, cloaked in a supercially left-right polarity and using the fraudulent tool of “democracy” exists for nothing but to arrogate more power to itself. No aspect of your life is too trivial to avoid a probing tentacle of this leviathan.

The uneasy and opportunistic partners of our government, privileged rent-seeking corporations that don’t need to flout the law because it is created solely to benefit them in the first place: the agriculture lobby, the manufacturers of artificial commodity “foods” like archer-daniels midland, the subsidized ethanol makers, the big pharmaceutical companies  - economic tapeworms that never profit more than when the host is not killed but kept just sick enough to continuously need the juice.

Massive “insurance” companies that ostensibly hate a patchwork of regulation and oversight, but would be competed into oblivion if there were no regulations against selling across state lines, the way computers or bicycles or electric guitars are. Companies who, if they were not protected by the gross asymmetry of the tax deductibility of employer provided insurance and ever-expanding mandates and government micromanagement, would not stand a chance in hell of selling a single policy for $20,000 per year.

Having every dollar of health care spending run through government or a private company between you and your doctor and calling it “insurance” is not insurance. It is already an insane sort of privatized socialism. Can you imagine sending $600 per month to your “grocery insurer” and having to get pre-authorization for your pastured butter and grass-fed beef?

You encounter these things. They soon become obvious to you. They become facts.

You see that a bloated 16% of the American economy is essentially a fascist partnership between privileged and entrenched commercial interests and the overweening government that pretends to discipline them.

You may have read “The structure of scientific revolutions” by Thomas Kuhn. You begin to think that the reigning scientific paradigm, what Kuhn called “normal science” is the ideology that keeps these powerful interests powerful. The same way “the red menace” and the “war on terror”  justify the empire and a military budget that is more than half that for the entire world. It seems the “normal science” of diet and health will be maintained until it is forcibly displaced, or at worst when enough of the priests that maintain it have, simply, died.

You reckon that the freedom of individuals to make their own decisions offers some hope. You know that, despite entrenched interests, agency and the urge among some to create and take risks in hope of profit are a spontaneous force that could challenge the “health care system” and the normal science that props it up.

You decide to wait. You wait for a new system to arise.

A system where the physicians and scientists who think like you do, like agents, combine with the entrepreneurs who always exist, never snuffed out completely by the leviathan, and use their certainty that a new system can work to begin to create it.

A system that recognizes the diseases of civilization for being the nearly optional scourge that they are.

A system that has the morality, enforced by the logic and self interest of both buyers and sellers, to say that your 80 year old grandmother’s new knee is not as worthy as your daughter’s chemotherapy for easily curable Hodgkin lymphoma.

A system that, without subsidies and mandates, doesn’t insure anything that has no scientific evidence for its efficacy, unless people want to pay extra for it a la carte.

A system that sees that rare events that are unavoidable are the logical and most profitable thing to ensure, and avoids the mandates of central planning that increase cost.

A system that realizes that the profit motive and removal of distorting government regulations and subsidies, would allow people to choose what they want to be insured for and for what price.

A system that empowers people to make their own decisions about what kind of medical provider they wish to see, and recognizes the right of individuals to work with their insurer to determine what level of training should be required.

And finally, a system that recognizes that not only does it make medical insurance more affordable to allow entrepreneurs to exclude those with unhealthy behavior, it may be the most powerful weapon we have to actually make people healthier, instead of keeping them alive to feed the tapeworm.

You speculate, with good reason and perhaps a pencil and pocket calculator, that even if the removal of subsidies and mandates does nothing for medical prices, within a generation health care costs could be reduced by ½ or 2/3 with the focus on sophisticated care for trauma non- dietary cancers and infectious diseases. You reason that in every other area of the economy, the simple removal of subsidies and tax advantage will force prices down even futher.

Why should an insurance premium for a medical event be tax deductible when food and your apartment are not? Do we want people to have insurance more than food?

You wait for the day, perhaps a few years off, perhaps longer, when you can buy health insurance based on your behavior – when you are rewarded for choices you know to be healthy by entreprenuers and their actuaries who are also convinced. They will offer to insure you at deeply discounted prices if you don’t smoke, if you eat real food, and if you avoid gluten grains, excess vegetable oils and fructose. You are willing to get blood tests every year to confirm that you are sticking to a diet that mimics a Paleolithic metabolism.

If the “health care reform” bill under consideration by the US House of Representatives is voted on Saturday and passes, you will wait forever.

THE HOUSE BILL

The Wall Street Journal calls it “the worst bill proposed by congress since the Roosevelt administration”.

I agree.

The bill will create a Frankenstein’s monster of an entitlement that will likely have a real cost of over $2 trillion on top of our country’s already unpayable $50 trillion in unfunded liabilities.

This new entitlement, the first in our history to force the individual purchase of a service from private corporations, will eliminate the only surviving competitive option to the loathsome private insurance system, which is the option to purchase nothing at all. The cost for this Mussolini-inspired product will skyrocket.

The ban on exclusion from coverage sounds “fair”, but will permanently eliminate the possibility of ever buying insurance that rewards you for healthy behavior. Even without new taxes and income transfers through subsidies to buy insurance, you will be forced to be in the same risk pool as your obese neighbor on avandia who eats chips and bread all day and his kids who are already nearsighted from hyperinsulinemia, themselves just two decades away from insulin injections.

Mandates will eliminate the possibility of choosing not to be insured for things you don’t wish to pay for, and minimum benefit packages will force even those who prefer high deductibles to pay for first dollar coverage they don’t want. Premiums for the self-employed will triple based on this alone.

The possibility of anything as radical as choosing to pool yourself with individuals with lower risk of disease based on your diet will disappear and likely never return. A few years after this passes, it will become another part of the “third rail”  - no one will touch the idea as it will be considered unfair, and the insurance companies need the healthy in the risk pool in order to be profitable. All these efforts to keep the prudent/ and or healthy in the pool with the unhealthy will be done under the rubric of “fairness”.

So now you have my argument. You can see, I hope, that it is anything but support for the status quo. “Health care reform” as proposed is nothing but a permanent and unrepealable entrenchment of the status quo you are disgusted with.

So I am asking you as a favor, if any of this concerns you, email, fax and phone your congressmen and senators tomorrow and let them know how you feel.

If you like and you agree, you can also tell them you favor:

1)   Complete elimination of the deductibility of employer sponsored health insurance

2)   Removal of all federal barriers to selling health care insurance across state lines

3)   Elimination of all federal mandates in the provision of health insurance

4)   Replacement of Medicare and Medicaid with individual need -based grants to enable recipients to purchase insurance that meets their own needs.

Thanks for your attention. The rest is up to you. I have done what I could.

 

CONTACT YOUR REPRESENTATIVE

 

Empire of Debt

Daily Reckoning

itulip

Von Mises Institute

Cato Institute

 

PrintView Printer Friendly Version

EmailEmail Article to Friend

Reader Comments (67)

My entrepreneurial response to operationalize these insights is to form the Ancestral Fitness Anti-Health Insurance Co-Op:

http://www.brentpottenger.com/Epistemocrat/An_Anti-Health_Insurance_Co-Op_for_the_AFE.html

http://epistemocrat.blogspot.com/2009/10/ancestral-fitness-anti-health-insurance.html

Reverse risk pool. Healthy people opt in. Health insurance like Vibrams. Physiological economics for healthcare.

I would love to make it happen--demonstrate from the bottom up that ancestral/paleo/evolutionary/primal lifestyles (diets, in particular) empower people to achieve health while reducing medical costs, creating a vibrant community of agents (and self-experimenters) who help each other restore, maintain, and enhance their health states together.

Everything starts somewhere; somewhere small.

That's my dream.

Cheers,

Brent

November 6, 2009 | Unregistered Commenterepistemocrat

@Kurt

I am largely in agreement with what you have written. I have had similar thoughts and have come to similar conclusions --- however, the irony is that even with well-intentioned folks who may be sympathetic to the structure of your/our argument simply don't get it. Paleo that is.

For example, from John Mackey's now famous op-ed:

http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html

contains a lot of what I think you and I would agree with -- but then ends with this missive:

"Recent scientific and medical evidence shows that a diet consisting of foods that

>>>>>>are plant-based, nutrient dense and low-fat<<<<<<<

will help prevent and often reverse most degenerative diseases
that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years of age."

My reaction: Noooooooooooooooooooooooooo!!!!!!!!!!!!!!!!!!!

My cholesterol levels (seen here http://freetheanimal.com/2009/03/nmr-lipoprofile.html since Richard of Free the Animal) was kind enough to interpret them, if shown to an "insurance" company in order to ascertain my health and offer me premiums based on their interpretation of my health would be sky-high.

Yet I am crazy enough to think that my cholesterol levels signal that I am eating what I am meant to eat.

C'est la f*****g vie.

November 6, 2009 | Unregistered CommenterPatrik

This post makes me wish I could subscribe to this blog twice.

I'm not a member of the body politic. If someone orders me to buy insurance, my only response will be to refuse, and deal with the consequences as best I can.

November 6, 2009 | Unregistered Commenterdamaged justice

Viva la revolution!

I didn't know you were an Anarcho-Capitalist/Libertarian, Dr. Harris! But it all makes sense. We always subconsciously mingle with like-minded people.

Agreed on all counts. I live in Germany, and we have had a public health care system for a while now. It absolutely stinks. I was at the doctors yesterday and heard one of the nurses CRY in her room because of the stress and chaos and how the system prevented her from helping the patients.

There is of course private insurance - but only for rich people. Yes, that's right, you can only get private insurance in Germany if you make over 52.000€ per year, about 77.000$ US. By law. Why? So people don't bug out of public insurance and make the whole system collapse.

The whole thing is very simple really: why can't I decide what I want to do with my life? If I don't like insurance, my bad. If I don't want to eat healthy, I'll get sick. If I don't want to fasten my seatbelt, who cares? I'm the only one suffering the consequences, so I'm the only one who can make these decisions.

Sincerely,
Bleicke, who respects Dr. Harris even more all of a sudden

November 6, 2009 | Unregistered CommenterBleicke

I'm not touched directly by the Health Bill as I don't live in the states, but I wish that all of you could make a difference. It still amazes me to see that the majority of Americans are not all obese, ignorant people that follow what they're told without questioning. (It's a gross over generalisation, but this stereotype of the American red neck tourist exists here in Europe.) Significant resistance and free thinkers can be found where you least expect them, or maybe the principles of the often called 'the founding fathers' have not been forgotten and a change is going to come from there again.
I voted against the Lisbon Treaty because I understood it to mean a loss of sovereignty for the state and because misinformed and gullible people were being scared into voting for a Constitution that was already rejected by other referendums before and was repackaged with the help of some cosmetic changes and more confusing legalese. It went through the second time.

Thank you for your posts.
Must have been a typo. Michel.

November 6, 2009 | Unregistered Commentersimona

Fantastic post, Kurt. Spot-on.

November 6, 2009 | Unregistered CommenterKeith Norris

Kurt,

"Removal of all federal barriers to selling health care insurance across state lines"

250 million was spent by the insurance industry lobby to make sure those barriers stay in place. I just heard someone quote a certain senator that said, "the insurance lobby has the ability to walk in the sand and not leave footprints!"

Stop writing...you get me too fired up ;-)
Have a great weekend.
Marc

November 6, 2009 | Unregistered CommenterMarc Feel Good Eating

Bleicke and Simona

It's great to get support from the UK and Germany, two countries with systems assumed to be perfect by american leftists. Thank you.

Brent

I have had the idea for several years. One would need a lot of capital and it may still be difficult on a state-by state basis. If these reform efforts fail, I plan to do it myself. If "reform" passes, it will become a dream.

Patrick

Mackey's editorial shows the flaw of all central planning - you can be 90% right and still not trusted to make all the decisions. The truth of paleonutrion will never become more general in an environment that enforces today's normal dietary science by government fiat.

Marc, Keith and dj,

Thank you

November 6, 2009 | Registered CommenterKurt G. Harris MD

I want off this grid.

KGH RESPONDS:

Pelosi and her ilk want to make sure your very flesh and the grid are one.

November 6, 2009 | Unregistered Commenterwes

As usual, Dr. Harris, you draw clarity out of nonsense succinctly yet eloquently. Multi-page rants I've read and written about government you have boiled down to a few thoughtful sentences. What a top-five university nursing education taught me and what 12 years as an RN made me realize that it had failed to teach me about health and healthcare is laid out in a couple of paragraphs. I doubt my sanity and judgment a lot less after this reading this post. I hope it finds a wide audience. I'll do what I can to make sure it does. Bravo.

KGH RESPONDS

The "internets" exist to share information and create communities with souls we may never meet.
Thank you very much for your support, Keto.

November 6, 2009 | Unregistered CommenterKetoWarrior

Definitely the best post on "universal healthcare" that I've read in a long time. You eloquently expressed what I've thought about healthcare costs for a long time in a way I haven't been able to articulate myself.

Commenter above on the Mackey article gets it. It's one reason I found it difficult to distribute that article. The right philosophical ideas, with a disastrous dietary approach. For the same reason, I it difficult to distribute free-market articles that presume that pharmaceuticals are the answer to all our healthcare problems and that we'll all die tomorrow without our drugs, so THAT is the reason we need free market healthcare.

I think you've struck the right balance here.

Honestly, people have no idea how a free market could solve the current cost/health issues. You stop funding the institutions, with OUR tax dollars, that are creating these problems, which includes in large part the NIH, CDC, USDA, etc. In fact, you abolish these institutions altogether. How much science they have ignored over the years is gobsmacking. And if people want to eat crap their entire lives, let THEM fund their cancer and heart disease research. I should have a choice to not pay for that.

You may also enjoy this site: http://www.westandfirm.org/

KGH RESPONDS:

Big pharma is not a free market, it is a rent -seeking cartel. The tonnage of illegal drugs sold is dwarfed by the damage caused by the legal pharmaceuticals.

If it were really a free market, you could buy any drug you wanted over the counter.

Feel free to link or propagate.

November 6, 2009 | Unregistered CommenterMonica Hughes

Bra-vo! A kindred spirit.

The crux is, "You acquire this attitude early in life, or maybe only over decades."

Unfortunately, the vast majority of people do not live long enough to acquire this attitude. Personally, I think that if lifespan were on the order of 1000 years, everyone would have this attitude. But cultural institutions are too powerful for most to overcome in such a short life. I wish there were a solution to this, but I fear there is not.

The founders did a wonderful job of limiting the power of government, but not quite good enough - they could not foresee the pernicious influence of corporatism on government and the freedom-threatening backlash that results. The tumor spreads throughout the nation, and calcifies, as tumors are wont to do, and will soon become inoperable, if it is not already...

Sadness and despair. Oh... what could have been!

KGH RESPONDS:

One way or another, resist.

November 6, 2009 | Unregistered Commenteranon

I find myself continually torn on this issue. On one hand my day job requires me to run a hospital that federal law requires to take all comers regardless of ability to pay. I have two thousand employees whose jobs depend on proper reimbursement for services rendered, even if the service needed could have been avoided by better life decisions on the part of the patient.
On the other hand I find myself personally sympathetic to Kurt's views having made the diet and exercise changes that led to my currently excellent 55 year old state of health.
Having said all that I agree that this House bill needs to be killed, and I would agree with Kurt's final 4 recommendations.
Meanwhile I have at least started the conversation in my own hospital and community about the right nutrition changes and have already seen some success. My job does give me a bit of a local bully pulpit and this seems like a great way to use it.

KGH RESPONDS:

Ken, thanks for sharing the views of a hospital administrator and avid cross-fitter. As you know, I own an imaging center along with my partner. In my scenario first dollar coverage would basically disappear. I would no longer be limited by law to charging medicare rates (which have shrunk 40% in 3 years) to 70-year-olds who arrive in a Mercedes S-class wearing a gold Rolex. My commercial reimbursement would go down, but that is OK. The aggregate volume of services in all communities would go down as well. That's OK, I am confident competing solely on quality service and price and not on insurance company and "network" steerage would only grow my business.

November 6, 2009 | Unregistered CommenterKen Smithmier

I lived by the Navajo Nation, and being half Navajo i would get free healthcare from the Hospitals, and Dental clinics on the reservations... I went twice, and it was garbage... my parents never took me back, and payed for the goods elsewhere. Lots of people don't understand what free healthcare is like.

troy

KGH RESPONDS:

It is like free anything -not costless, just totally disconnected from any incentive that woudl allow it to improve.

November 6, 2009 | Unregistered Commentertroy

Kurt:

As Krugman says, the prevailing view among economists is that applying "free market principals" to health care is a flawed paradigm doomed for failure.

Do you have anything to back your position that these steps will be effective in any way (and not extremely counterproductive)?

It seems one of the eminent economists of the 20th century (Nobel laurete, Clark Medal, von Neuman Prize) seems to have written a paper that more or less says your suggestions are ineffective and inappropriate.

KGH RESPONDS:

Invoking Nobel prize winners when Obama, Arafat and Gore are Nobel prize winners is an appeal to authority that that will get zero traction here.

Try Hayek. Krugman is a statist of the worst kind and totally incoherent. The "prevailing view" among economists has led to 1.8 T deficits and 10.2% unemployment.

The free market works for food and and computers. It used to work very well for shelter and automobiles.

It also works very well for dentistry and the fraction of medical services not intermediated as much by insurance and governments. Rates of growth in spending on dental services and increases in prices are lower than the increases in spending for healthcare in any country.

November 6, 2009 | Unregistered CommenterChris

It is funny how you can read a person's blog on a seeming neutral subject for some time, yet know for a certainty that one day you will read a post like this. Now I feel bold enough to put forward something I left out of the comments of another post - OT to health but as you live in Wisconsin (and like rifles), I wondered if you were familiar with the work of JPFO? If not, consider this an invitation (www.jpfo.org).

Back on topic to this post - what you write seems so clear and self evident, to me (and evidently a few others), yet there are so many who consistently reject the concept of individual freedom that must be the foundation to build our prosperity (including health) on, but there is no satisfactory explanation for the difference in philosophy. It is perhaps the most challenging of the nature v. nurture questions. And it begs - is Paleo eating the chicken? or the egg?

November 6, 2009 | Unregistered CommenterLucy

Amen! This brilliant piece exudes passion and provokes action. I'm going to be sharing this post with my friends and family.

November 6, 2009 | Unregistered CommenterSatya

Dr. Harris , BRAVO!

Alas, I fear that this country is fast becoming a nation of ignorant ,lazy and way too preoccupied with inane trivial things to understand what is going on right under their noses. I have read were 46% of people polled think that this health care bill is a good thing.

I wish I could be optimistic about the future of the west in general and the US in particular , but I am not. I see the decline in peoples health as economically catastrophic ,NO system can support the tsunami that is fast approaching.

James

November 6, 2009 | Unregistered Commenterketojim

The co-op model that would work for now--and skirt regulations, red tape, etc.--would be to form a 501(c)(3) and pool resources to pay for non-catastrophic health services. That is, each member of the Ancestral Fitness Anti-Health Insurance Co-Op would purchase a high-deductible plan in their individual states for catastrophic coverage, lowering their premiums as much as possible, and then this Co-Op community of lifestyle-based healthcare financing would bear the risk of payments up to these deductibles. The Co-Op would negotiate payments with providers, pay for most of these costs out of capital on hand from premiums, and then would also float out part of the bills incurred to members for voluntary payment. This would create a community of individuals of kindred spirit invested in each other's health, sharing ideas for restoring, maintaining, and enhancing health while also advocating for each other financially with the medical system to navigate the maze and avoid negative Black Swan hits.

Thoughts on this approach?

November 6, 2009 | Unregistered Commenterepistemocrat

I hope that you post this, as I think you're a very thoughtful and intelligent person, though I do strongly disagree with you on this issue.

Yes, when it comes to you, sir, and your personal Superman project, your concerns are valid, legitimate, honorable, and even virtuous. The problem is there are 300,000,000 of us, and we're all entitled to eat how we like, think how we like, do (for the most part) as we like. If you, personally, would like to ride your llama into the sunset with John Zerzan and live in your own isolated bubble of primitive cool, that's your prerogative. But the rest of us have to simmer in this extremely imperfect soup with our sick relatives who need meds, with our coworkers who eat candy for breakfast and smoke cigarrettes for lunch, with the clinical homeless, with aging parents who will no sooner believe that butter is better for them than margarine than they will believe that pigs fly (they do!)...

Healthcare as now delivered in this country is a national embarrassment. No system is perfect. I gave up on being a utopian when I was but a pantywaist. The House bill is certainly not perfect, but in this imperfect nation, governed by extremely imperfect humans, it's an improvement over the status quo. (gratuitous name calling part deleted here- Ed)


KGH RESPONDS:

Firstly, your second paragraph is totally at odds with your third. The fact that I don't want to be in a risk pool soup with 300,000,000 people who insist on smoking and eating their way to ill health is precisely the point. You may do so voluntarily

The house bill is indeed no small thing. It is an "improvement" to the status quo all right - if an increase to the breathtaking level of intrusiveness and inefficiency that already exists is your idea of an improvement.

Your view reminds me of a physician who would give a drug , any drug, just so they have "done something" even if it accelerates the patient's demise.

Yes, I deleted the part of your post with the name- calling. Too bad.

November 6, 2009 | Unregistered CommenterEl Fug

Kurt:

"Criticizing an argument for "appeal to authority", and then citing winners of the peace prize in the 1990's (different prize, different times, Arrow won it in 1972 for Economics) is just as much of a logical fallacy."

KGH: You made the appeal to authority, not me. I bought up Hayek (who won it for economics) to show how trivial it was to make such appeals. I think what you mean is inconsistency, not logical fallacy.

"Attacking Krugman for being a "statist" and "incoherent" is an ad hominem fallacy and irrelevant."

KGH: It's my claim and I am sticking to it. Your characterizatin of my opinion is irrelevant to me.

"Anyways, if you read Arrows paper "Uncertainty and the Welfare Economics of Medical Care", he specifically addresses why free markets work for food and things like computers, but not health care.

I was hoping to have a discussion where you referenced an actual paper Hayek wrote, or maybe an article where he explained why free market economics work for health care, and maybe a refutation of Arrow's conclusion."

KGH: I am not going to write you a dissertation. If you are that interested in Hayek you can read his books, as well as Von Mises and Rothbard as I have. I am enough of an empiricist to take the real world examples of dental care and elective medical care over the musings of any economist any way, especially "professional" ones.

Health care is not special. It needs to compete for scarce resources the same way any other valuable good or service does. We don't have food and shelter "insurance" and they are much more essential.

"You usually back up your opinions with research and science, where here all I see is hand waving, I am disappointed."

KGH: Sorry to disappoint you. Belief in my own value as a human and in the idea of private property has nothing whatever to do with science. It is in fact based on lack of faith in statism and socialism, which if you can't see it, can only be because you don't want to. Somehow I doubt if you really want the evidence you seek. Start by reading Murray Rothbard, then come back and tell me the flaws if you like.

November 6, 2009 | Unregistered CommenterChris

Kurt,

I agree with your take on the "reform" measures being contemplated in congress, but for a different reason.

Two years ago, my elderly mother suffered a rupture of an aneurysm that had formed on her basilar artery while visiting relatives in very rural Saskatchewan, Canada. The doctor at the clinic at her sister's hamlet thought she had a migraine when she complained about a severe headache so he gave her a shot, Health Canada charged $50 cash and sent her to her sister's home to bed. She eventually became unresponsive and they moved her to the ramshackle Moose Jaw Union Hospital via ambulance. I caught up with her there in the ICU. The MJU ICU doc ordered a CT scan and both the radiologist and he thought she had suffered a stroke, but not a bleed, so they put her on Heparin. She became worse - close to death in fact. They moved her to Regina General. There she was correctly diagnosed with a SAH (from the MJU CT scan, no less). They stopped the Heparin(!) and installed a shunt to relieve the cranial pressure. From there she was flown by an air ambulance to the US, where the rupture was fixed by coiling. She survived and recovered fully.

Some observations:

-The clinic in the hamlet was staffed by a very green doctor who did not do any follow-up. This almost killed her.
-The ICU doc and radiologist at Moose Jaw Union almost killed her again by misreading her CT and prescribing a blood thinner whilst she was bleeding into her brain.
-The neurologist, neurosurgeon and ICU personnel at Regina General were highly competent and her treatment was excellent, as was the infrastructure she experienced.
-Her treatment at OHSU in the US, where she was coiled, was also first-rate.
-The total cost was about USD $330K with insurance picking up all but USD $14K (for the plane ride).
-The RG ICU charge nurse lent me his office to negotiate with the insurance company and air ambulance company at 3AM after my mother survived the shunt installation. The ICU staff's compassion during this process was something I will never forget and I will also remember their comments that nobody should be expected to deal with a negotiation like that in the midst of a health crisis of a loved one - a sentiment I can certainly endorse.
-It took my sister and I about one year to process the paperwork and get everyone paid. Her insurance folder ended up about as thick as a big city phone book.
-The bills from Health Canada were about 1/2 to 1/3 the price for similar procedures at OHSU.
-Every doc we dealt with in Canada was an immigrant. The bad ones and the good ones. Her neurologist and surgeon at Regina were Iranian and South African, respectively.
-I made choices about my mother's care every step of the way here in the US. Everything required coordination with the insurance company. This was the equivalent of a full-time job for about three months, until she was in an assisted living facility. In this case, having to make all of these choices was not particularly a good thing.

OK, so why am I boring everyone with this screed? Simply because my mother's ordeal touches on most aspects of the "reform" argument, including the so-called death panel.

My own opinion based on that experience and subsequent reflection: those of us not making our income in the medical system would be *decisively* better off without a profit incentive anywhere in that system.

My Canadian relatives may bitch about HC, but they recoil in disgust at what we put up with and mandates mixed with private, for-profit insurance companies have every chance of making the health care experience in the US for less than the seriously wealthy a true horror show. Who will insure the uninsurable? Should they be left to die in the street because they over-indulged in fast food or have bad genes. And what about those of us who are insured? As my mother's case illustrates, even those of us with excellent coverage from reputable companies (i.e. with no rescission policies) can incur massive, unexpected costs that can and have put people on the street due to health care cost-related bankruptcy.

Let's change our system, but for god's sake let's objectively pick the best the world has to offer and implement that. If the US government can't run it, perhaps we can outsource the administration to Health Canada or to the French.

KGH:

Your whole post is bit of a non-sequiter. I honestly thought your point would be that despite the hassle, the US system has high quality (I think it does by many measures) I will let everyone else decide, but it reads like a perfect argument against the canadian system.

She was misdiagnosed and nearly killed by being given heparin for SAH where?

And had the aneurysm defninitively treated with a GDC coil in which country?

November 6, 2009 | Unregistered CommenterMark

"Firstly, your second paragraph is totally at odds with your third."

This is not so. I understand YOUR not wanting to be in the risk pool. That's perfectly natural, though in my opinion it's somewhat selfish. I don't want to live in a country that abandons its citizens because they smoke, because they drink, because they do whatever. Obviously education is important. But when it comes to health, as the readers here know only too well, there is not what I would call any real consensus --- quite the contrary.

There are certain projects that are best undertaken collectively, and that indeed belong in the public realm. You're entitled to disagree, but health care --- along with road upkeep, libraries, education, police forces, fire stations, national parks, to name but a few --- is one of these things.

[ Calling the KKK racist is not name-calling ;) ]

KGH RESPONDS:

You didn't "call the KKK racist" - it's easy to tell if you're using insulting language -if you mean it to be insultig - it is insulting.

You telling me I am "selfish" because you want to force me into the risk pool, and I resist your efforts, is called coercion.

I don't like to be coerced, do you? Leftists always have a thousand reasons to justify why force should be used in the service of what they value.

I am done arguing with you. You have made your points, I think.

November 6, 2009 | Unregistered CommenterEl Fug

Brent

I'll respond via email when I get some time

Kurt

November 6, 2009 | Registered CommenterKurt G. Harris MD

"While I agree wholeheartedly with your dietary recommendations, and follow them myself, I find the rest of your argument both appealing and appalling. I don't want to go into a long list of why I don't agree with much of what you have said, but I do want to specifically address one aspect: allowing insurance companies to sell insurance across state lines. Another writer sums it up better than I:"

"It's not just that it allows insurers to cluster in whichever state has the loosest regulations and sell policies that only accord with those minimal standards (which is the dynamic that brought you a credit card industry based almost entirely out of South Dakota). It also allows them to use the Virgin Islands, Guam, American Samoa and the Northern Marianas for the same purpose. All those territories are poorer, and would have even more incentive to give insurers whatever regulatory concessions they wanted in return for the jobs and tax revenue that would come from Wellpoint opening offices in Guam." (http://tinyurl.com/yjwc2b7)

KGH: What you have just quoted is the very mechanism by which costs will come down. It's the mandates. Have you seen massachusetts? - go to Cato's website and see what a disaster that has been.

"You have every right to not like large risk pools that make healthcare more affordable for everyone. But this particular suggestion just makes no sense, and will make existing insurance options even worse than they already are."

KGH: It is the large risk pools and the diffusion of responsibility and lack of ability to form new ones voluntarily that makes it unaffordable. There is no financial incentive to minimize expenses or improve your health, and this perverse incentive is magnified by low deductibles and first dollar coverage.

Medicaid patients in my state have a three dollar co-pay - you read that right, $3 US. Guess how often they use medical services?

"My general position is that the healthier the community is, the more economically successful that community has the potential of being. And if people can't afford basic care, and end up in the emergency rooms because something that could have been taken care of easily has progressed to something more serious, that's not a good thing. And having lived and worked in the inner city, and seen low income folks use the ER as their only source of primary care, I know that is what happens, and I worked to develop alternatives, such as school-based health clinics. But again, I start from a different philosophical and value paradigm than you, (note that I say "different" and not "better"), so I have no doubt we will never agree on the solution to that, or even that there needs to be one. I do, however, greatly respect your approach to health, if not your approach to healthcare."

This is fantasy. I wish it were true that preventive care was cost effective, but there is little evidence that it even works, unfortunately. The "cover everyone to save money" idea is attractive but supported by evidence.

KGH:

Do you believe conventional medicine is effective on a population basis against metabolic syndrome and cancer? Are you a regular reader of paleo blogs? If so, how can you have so much faith that "health care" as presently constituted is so valuable? These are expensive wars of attrition analogous to vietnam and afghanistan. Body counts and drone attacks with no recognition of the core causes or what real prevention might mean.

November 6, 2009 | Unregistered CommenterCharles

How the Freedom to Contract Protects Insurability
http://www.theobjectivestandard.com/issues/2009-fall/freedom-to-contract-protects-insurability.asp

KGH:

Excellent paper - thank you for the link

November 6, 2009 | Unregistered CommenterMarnee

El Fug

Well,if you had started off with the same compliment as in your private message, I might have been gentler :)

In future, click on about me and there is an email box on the right.

November 6, 2009 | Unregistered CommenterEl Fug

"If it were really a free market, you could buy any drug you wanted over the counter."

Agreed. I think we're on the same page and you may have seen the sentence with "pharmaceuticals" in it and erroneously thought that that is my position? I know many people with that viewpoint who hold it intellectually honestly, but I'm not one of them. Drugs have their place, it just isn't in the 90% of chronic disease treatment/prevention sphere. Of course, in a free market, if people did have those views it would be inconsequential to people like us because they would have to pay for the research to create those drugs and pay for the cost of them to boot. (FYI, liked your post on acetominophen.)

I've written CME for physicians and needs assessments for such, so I understand the issue. We all know it's basically driven to promote pharmaceuticals. Which, of course, is a good reason I don't do it anymore. I made good $, but it was very unfulfilling.

KGH:

I think we are in complete agreement.

November 6, 2009 | Unregistered CommenterMonica Hughes

Some great stuff here!

One quibble with your responses to Chris is that you mention free markets in other things, most notably food, as if they actually exist. Huh?!? What free markets?

There are no free markets, anywhere. Especially not in food. Ever wonder why highly processed crap shipped from 100s or 1000s of miles away is cheaper than real food, not processed, from local sources? Ever wonder why most farmland is devoted to corn and soy rather than fruits and healthy veggies? Ever wonder why CAFOs are considered more "efficient" than pastured farm operations? Markets for food and agriculture have been incredibly distorted by myriad coercive interventions. Heck, such interventions are a major reason why Americans consume such a sad and sorry diet.

This is one reason why I personally prefer the term freeD markets. It distinguishes what I advocated from the status quo's distorted markets, letting folks know that I'm not a status quo apologist and that the real harms people observe can't be blamed on "free markets" as such markets don't actually exist, and never really have existed historically. Markets freed from rent-seeking and corporate cartelization would be radically different from existing pseudo-markets.

KGH:

All excellent points- Food and computers markets are free on a relative basis. Just how transgressive do you expect me to be, anyway? Next you'll tell me the whole federal edifice is unconstitutional and we should have stuck with the articles of confederation! (Both of which I might agree with)

November 6, 2009 | Unregistered Commenterfreeman

Great point, freeman. Not to spam your blog, Dr. Kurt, but I wrote an article on just this subject of free market ag. awhile back. It may interest you and some of your readers.

http://theobjectivestandard.com/issues/2009-summer/us-farm-policy.asp

Great stuff on this blog, by the way. I read all your posts in one evening and you're now in the feed reader. I'm very intrigued as to the way in which many in the "paleo" world seem to have converged on similar free market views. I don't think that's any coincidence.

KGH:

I think it is no coincidence - paleonutrition appeals to those who prefer to make their own choices and associate freely- I have printed every comment made. You can see the sympathy ratio is a bit higher than if it were the NYT.

November 6, 2009 | Unregistered CommenterMonica Hughes

Kurt:

Come on.

I referenced a paper specifically on the subject of health care and free markets, written by Arrow.

Your retort about the appeal to authority was on solid grounds, but attacking Krugman was suspicious. Why not simply disagree with his reading of Arrow and say you find the Austrian school of thought as evidence to the contrary?

If you are as well read in Hayek, Von Mises and Rothbard as you implied, why not quickly summarize their arguments as to why moral hazard, averse selection and asymmetric information in health care does not prevent free market principals from being sufficient.

I asked for a reference to a paper or an article, and you replied that you were not going to write a dissertation and referred me to the entire body of works of three authors and told me to "get back to you" ....

Somehow I doubt if you really want the evidence you seek.

Actually I do, and it would be appreciated if you would provide some degree of specificity. I have no particular experise in economics, after I read Arrow's paper I briefly discussed it with a colleague who works in the field, who relayed that his understanding was that Arrow's thesis was yet to be falsified.

Health care is not special. It needs to compete for scarce resources the same way any other valuable good or service does. We don't have food and shelter "insurance" and they are much more essential.

Arrow specifically addresses this issue in his paper, and explicitly states the opposite.

The above statement gives the impression you have not read Arrow's paper, and are dismissing it without considering the merit of his arguments.

Perhaps you are very well read in economics, and such an excellent empiricist that your observations outclass those of Kenneth Arrow.

How about this, you suggest a book or paper by Murray Rothbard which I will read, and you actually read Arrow's paper and we have a real discussion.

KGH

I did not solicit your opinion, you came here voluntarily and read mine. You disagree and that's fine. Don't call your congressman. Not a problem. I am not posting this in order to solicit alternative opinions, frankly. It's an opinion piece.

Your impression is correct - I have not read Arrrow's paper as I am guessing you have read little of what I recommended.

I assure you I have read plenty of arguments about how health insurance is "different".

What I wrote is an opinion piece, not a work of science. Had I referenced it like a paper of similar length, it would never have been written.

November 6, 2009 | Unregistered CommenterChris

Dr. Harris,

You inspired me to get off my behind and call. I work in government, so I know they've already made up their mind, but like voting, you may not win, but you must try. Thanks for sharing your valuable mind and being a scientific source for those of us who are not scientists.

KGH:

Thank you for your support!

November 6, 2009 | Unregistered Commenterpjr

"Your whole post is bit of a non-sequiter. I honestly thought your point would be that despite the hassle, the US system has high quality (I think it does by many measures) I will let everyone else decide, but it reads like a perfect argument against the canadian system."

I guess I could have left out a few details to emphasize my point, but her situation, like our present dilemma, was complicated and painted in shades of gray. My personal conclusion was that overall, the Canadian system has its warts, but based on my experience and those of my relatives in BC, Sask and Alberta, I would greatly prefer what they have to what we have and what I see being proposed for the future.

Succinctly: If we can have universal coverage at lower overall costs with better overall outcomes (as measured by WHO methodology, for instance) at the expense of some reduction in quality (like increased wait times or small increases in poor outcomes for outlier cases) that seems to make sense to me. Yeah, we'll be paying for somebody else's sins, but we already are anyway, indirectly.

"She was misdiagnosed and nearly killed by being given heparin for SAH where?"

Twice, in fact. But I live way out on the Oregon coast and our small community hospitals will sometimes kill you just as fast. Interestingly, the Heparin was Baxter and possibly contaminated, so that could have killed her in a different way!

"And had the aneurysm defninitively treated with a GDC coil in which country?"

The options were to treat her in Calgary or Toronto or OHSU. Considering the high possibility of a "negative" outcome and then having to deal with all of the fallout 1,000 miles from home, I opted for the much more expensive transport to OHSU. Dunno if those centers would have done the same excellent job as OHSU, but I have nothing to base a negative opinion on. My impression was that if you get to a specialist center in the Canadian system, you'll be OK. It's surviving the intermediaries that can be a bit tricky. Similar to here where you need the "referral" and insurance approval.

Anyway, that's all I want to say on the subject except to remind you that I agree with your take on the mess currently coming out of congress.

Thanks very much for running such an open-minded and intelligent corner of the web.

KGH:

Thanks for the follow up - I only meant to emphasize the way we interpret the evidence depends on what we value.

When you say:

"If we can have universal coverage at lower overall costs with better overall outcomes (as measured by WHO methodology, for instance) at the expense of some reduction in quality (like increased wait times or small increases in poor outcomes for outlier cases) that seems to make sense to me.

That sounds to me like you are making a prescription for everyone to accept lower quality for lower cost - I advocate a system that stands a chance of letting you do that for your family without forcing me (coercion) to participate in it. I advocate no single system but the possibility of many systems.

November 7, 2009 | Unregistered CommenterMark

Nicely written. I don't think you could have mirrored my thoughts more exactly. I will be posting a link to this on my FB and Twitter.

November 7, 2009 | Unregistered Commenterlbd

"I find this post very disappointing and totally disagree. I don't want to be rewarded with lowers costs for insurance or health care because I am smart, interested in nutrition, and proactive."

KGH: Who is saying you have to be? Join the regular risk pool and I am sure they will be happy to have someone healthy.

"Good health, if I am so lucky as to keep it (there's a history in my family of several health issues, but none of them are 'chronic diseases of civilization'), will be enough."'

KGH: OK..

"Other people should have proper health coverage and not be charged more than someone who makes healthy choices - even if they are willfully ignorant, eat 200 lbs of sugar per year (and are overweight, diabetic, and have heart disease because of it), smoke cigarettes, drink to excess, and are assholes besides."

KGH: My translation - You want insurance for other people to cost more than it might other wise. If no one can be charged more for costing the system more, the insurance company should be forced to lose money (theft) or you want other people who are insured (not just you) to be forced to pay more (via taxes or regulation...more theft)

"I take great care of my body now by PaNu standards, and am very healthy as per tests. I was still healthy (and weighed the same) when I ate nothing but flour and sugar. I'm damn lucky, is all. Diet and lifestyle does make a difference, but it doesn't seem at all certain to me how much. We all know of hale 90-year-olds who are fat, eat like crap, and have smoked packs a day for 80 years."

KGH: Even if it were all genetics the reason health care is expensive is because so much of it is useless or inefficient, whatever the cause of the disease. Even if diet cannot change a thing, a non-subsidized system not built to benefit corporations and entrenched interests would still cost far less than what we have - even if everyone had the same risk and we could not change it - the idea of market forces with the ability to not be forced to buy insurance is just part of it.

November 7, 2009 | Unregistered CommenterBonnie

Kurt:

Sure, this is an opinion piece, we disagree, whatever.

Don't read Kenneth Arrow's paper, not a problem. Keep up the intellectual rigor.

I could not be more entertained by the dichotomy between our discussion here, and it's contrast with the discussions that normally take place on this blog.

I look forward to the next time someone posts a comment with a paper which disagrees with what you've blogged about, and you respond with character attacks on the paper's author/proponent and wave you hands about having read other authors in the relevant field.

Oh, and when they ask you to recommend a particular work of any of the authors mention, replying without a recommendation, and accuse the other person of not having read what you've suggested when they have made no claims otherwise.

Top notch, just what I've come to expect from the blog I recommend to people as an excellent source of perspective on evidence based approaches to improving your health.

KGH:

OK, I think you are about done complaining now. You can stop recommending my blog because I won't read a paper. I'll just wait on the the 40 or so medical papers I'd prefer to read so I can shore up this opinion piece for you! As if my refusal to read an economics paper means I lack intellectual rigor! That, by the way, is certainly an ad hominim remark.

I don't write my blog for you personally, and unless I missed the check, you don't pay me to write it.

Recommending a blog so you can later "call in your chips" and get the author to read an economics paper seems a pretty stupid motivation.

November 7, 2009 | Unregistered CommenterChris

Great post Kurt. From a distance it would appear that the US health system is designed to be as complex as the any tax system around the world to shield it from challenge and revolt.

Here in Australia it is evident that government policy is designed to favour the health funds and keep them in the game so to speak. In fact it has been that if you earn so much a year, you are taxed more if you are not in the health fund. The problem i always had was that the covered options in the "health plans" only provided limited options and greatly ignored alternative therapies like acupuncture, massage and the like.

I am very grateful that i can opt out of the system, take charge of my health, but still have access to emergency care when i need it. There have been times that i felt like a leper because i was not in health fund, however common sense tells me that i shouldn't insure myself for something that might happen, when i can take positive steps to let the human body be the precision machine it can be.

I'm afraid i find it hard to have sympathy for those who are unwilling to take responsibility. You can make choices, look after yourself or let others do it for you.

You will always get what you deserve.. if you are informed you can protect yourself. If you are not informed, you risk debt, dependancy and at worst premature death. I choose life and a good one on MY terms

November 7, 2009 | Unregistered CommenterGlenn

From you: "Do you believe conventional medicine is effective on a population basis against metabolic syndrome and cancer? Are you a regular reader of paleo blogs? If so, how can you have so much faith that "health care" as presently constituted is so valuable?"

Well, yes, I am a regular reader of paleo blogs. And I've been eating pretty close to paleo since I was 15 (in 1966), cut out all starches and sugars on my own (my parents thought I was crazy), ate pretty much only meat and milk and nuts, and lost 30 lbs. over a summer vacation. That was more than 40 years ago, and while I've experimented with a lot of dietary approaches, paleo has been my default for four decades, and is how I eat now. So I speak from some experience.

I'd be an idiot not to agree with the argument that most of our chronic health issues are not caused by a lack of drugs, but an incredibly stupid diet, unsuited to our biology. And yes, if everyone cut out grains, sweeteners, and industrial oils, most of the chronic diseases we see like cancer, diabetes, heart disease and high blood pressure would be significantly reduced if not pretty much disappear.

But I've also worked in the trenches, with people who can't afford basic medical care, and watched their lives deteriorate. I've seen kids who don't get vaccinated get whooping cough and spread it throughout a community (just last year in fact). Or young women without access to reproductive services get pregnant at 14 and basically kiss their lives away. Or other folks who have some fairly minor disease turn into something major that either ends them up in the ER, or kills them. That doesn't make for a healthy, functioning, productive community.

So I totally agree that the chronic disease issue won't be dealt with at all by the health care reforms being considered. But basic medical care will be. And I see that as a positive. That's the way every other industrialized country does things--with variations, of course--and their health outcomes are either no worse or better than ours, while spending significantly less money, and by and large they are happier with their systems than we are with ours. That's not opinion, that's fact.

Are the incentives screwed up in general? Absolutely. And that has to be dealt with. And it will, or we will go bankrupt. But the political process moves slowly, and sometimes you take what you can get and improve it as you go. If we at least stop some of the thousands of people dying each year because they don't have insurance at all, and thus have no access to care, I'm fine with that.

So yeah, I absolutely subscribe to Paleo concepts, and have preached them to the masses for a long time. And I respect your position, and share many of the same concerns and values. In this case, however, we disagree.


KGH:

Apart from the fact that my reading of the evidence is that much preventive care, whether for rich or for poor, is of little proven benefit, none of these sad facts you invoke requires the government to take money from us against our will. Statists have no faith in private associations, charities and individuals to remedy anything, it seems, even though the balance of human misery has never benefited more from the parasitical state than the private sector it depends on.

The basic medical care you speak of has little evidence for efficacy - if you are talking about walk in clinics and free pap smears - why not through private means? Perhaps you could devote yourself to such and then contact me to see if I might help you with your imaging needs in the interest of the community. Freed from the burden of the state, I might then have the resources to do so.

In any case, no problem perceived by you justifies stealing from others to help achieve. Who decides? You? As long as 6 want to command the resources of 4 that justifies it? It does not, in my view.

I don't want to steal from you. I am only asking you not to steal from me.

Advocacy of statism in any form is nothing but advocacy of legal theft. The ends do not justify the means.

By the way, if it were a really a fact and not just your opinion, you wouldn't need to say so, would you ;)

November 7, 2009 | Unregistered CommenterCharles

we are [likely] all familiar with a system in which we are forced to purchase insurance: auto insurance. [yes, i know you may choose not to own a car.] and in that system of coerced purchase of private insurance, the companies may decline to insure those who have a history of accidents or traffic violations, who are in a demographic group with a known proclivity for having accidents [youngsters], and so on. and there is, i believe, in each state a risk pool with high rates for those unable to purchase insurance privately.

the theory behind the coercion, of course, is that drivers who have accidents impose their costs on their victims as much as themselves. similarly, as long as hospitals are forced to service all comers, the costs of the uninsured will be passed on to the rest of use in one fashion or another. thus the uninsured impose externalities on the insured. similarly, the unhealthy impose externalities on the healthy.

a system partially modeled on the auto insurance market might be more palatable all around. the difference would have to be that your health insurer shouldn't be able to drop you the moment you get sick. one problem with your model of a healthy-persons' insurance company is the foreseeable efforts of such a company to prove that the newly ill member had somehow deviated from the prescribed health practices, mimicking some of the worst practices of our current insurers. i'd like to see that banned. this is different in principle from the forced acceptance of pre-existing conditions- those could be rated, like an accident history. but someone who becomes sick, having previously held insurance, should be allowed to keep that policy going forward, indefinitely.

i can't say i've thought this through; it's just a thought that occurred to me, and it won't happen anyway, so i'm reluctant to put more time into it. but i think it points out a bit of problem in your approach.

KGH

Hello Jeff, and thank you for your comments. As a practical matter I could see having some level of publicly financed catastrophic insurance that covers the real medical disasters we all fear - not as any kind of ideal but as an alternative that I could live with. The problem is who decides what should be included. I would settle for knee MRIs having to be paid out of pocket, would you accept it for simple phobias? That is the kind of thing I envision - if we could get agreement on what is fair to cover publicly that is rare and not anyone's fault - I could deal with that. It just seems insane that we use an insurance model for things like births - that is not any more medical than an addition to your kitchen if there are no complications. So public financing and perhaps subsides to make sure everyone has coverage for leukemia or Glioblastoma, fine, sports injuries in vitro therapy and marriage counseling, that seems insane to me. But such a true insurance model will never happen either.

Where we may (or may not) differ is that I think that so much of what gets paid for is not really any less elective than rhinoplasty, not because it's not directed at real suffering, but because it is largely an illusion that it even works. Think of how many of the surgeries that get done in the typical hospital in a typical day have real evidence to back them up, or of what percentage of the amount spent on drugs goes to applications that really work. My jaded view is that the folks I know that stay the hell away from doctors and hospitals if they can at all help it are generally none the worse for it. Much of the analysis of the benefits of screening supports my view.

By the way, I object to the car insurance metaphor - you must prove that you are insured for liablity to others, not for collision damage to your own car. Also, driving is optional, being alive is not, (if you want to be alive). The metaphor is not apt, I think.

The liability to others for uncompensated care is estimated at about 2-3% -hardly enough to warrant coercion into participation for those who want out, and this is a byproduct of the law that is not analogous to the real risk of running into other cars or pedestrians with your vehicles. If that is the concern, why does the bill not allow waivers so I can put up a bond and self-insure?

I also have no problem with providing services at different tiers - not everyone gets to eat the same food or live in identical neighborhoods - I think so called "health care" services are much less a determinant of life quality than these goods, which most accept as being unequally distributed. Of course those who want the bulldozer of egalitarianism will get no argument here - I can't convince you there is no God either.

The problem of externalities is not unique to health care and does not destroy the case for more market oriented solutions being better than centrally planned ones, even if the externalities do not go away. Pollution is a perfect example of that.

November 7, 2009 | Unregistered Commenterjeff klugman

I'm so glad I live in the UK and have the National Health Service.

Why ? Because it means that if I'm knocked down by a car or have some other serious emergency I will get seen to immediately in any accident and emergency department at any hospital with no questions asked about whether I can afford the medical costs.

Why ? Because if I were a new born baby, born with serious health issues I would be treated with no questions asked as to my parents' income. The US has the highest infant mortality in the West which I find totally astonishing.

Why ? Because I will always been seen by my family doctor the same day I need to see him, though if it's the weekend I would probably get a locum who might not be so good....however, in an emergency I'd get seen straight away as above in an accident and emergency department at any hospital.

Why ? Because I never pay more than £7.20 per prescription, whether the medicine costs £1, £7 or £100. And actually, having diabetes (not due to bad lifestyle choices) entitles me to totally free prescriptions...as all children under 18 and all adults over 60 get.

Why ? Because the pharmaceutical companies don't overcharge the National Health Service quite as badly as they do American citizens - example: I'm prescribed Omacor (Lovaza) which costs the National Health Service £50 for 100 capsules, ie 50p per capsule whereas according to Dr William Davis of the heartscanblog, Lovaza costs $4.33 per capsule or £433 for 100 capsules: http://heartscanblog.blogspot.com/2009/08/fish-oil-for-780-per-bottle.html - same medicine in both countries but the pharmaceutical company charges vastly different amounts.

Of course I pay for all of this in my taxes....nothing is really free. And of course there are problems with the National Health Service - it can be slow for patients needing referrals to specialists for non urgent conditions. However, my husband's work give us private health insurance as part of his pay, many employers in the UK do this, which means that we always have very quick access to see specialists....much quicker than my American penpal who even with terminal cancer and even with good medical insurance waits weeks to see a specialist :( Before she dies she will be destitute - I find that simply immoral.

Of course I'd rather a system such as that in France....that's even better than the UK and it is still a state run healthcare system with top up private insurance and is one of the most efficient and effective health care systems I have experienced.

KGH says:

Anne

You seem to perceive the system there is a good deal for you. I am sure it is. You are reassured that certain services are available, how many of these had you had to use so far? Have you had cancer or a brain aneurysm?

A system where other's money is take from them without their consent (taxes) and used to buy things for you. In the meantime, you are wealthy enough to have access to a separate private system as a backup in case the public system does not meet you needs.

As far as the quality in the NHS, maybe it depends on your expectations. I have heard as many anecdotal stories of understaffing and slow service.

But my favorite is how if you are getting treatment for cancer, and choose to pay out of your own pocket for a drug of treatment the NHS does not supply, they deny you further service as punishment - deny you services you and others have paid for for the cancer you are dying of. Try suing them and see how far that gets you. Look for the same freedom- restricting shotgun approach to cost control here in a few years.

All that said, I do not deny that a single payer system would be far better cost wise, and as long as you stay as healthy as most people, convenience-wise to our current horribly fascist (private profits with public subsidies) system in the US. Socialism in Britain in the post-war period was better than the regime of Hitler, but choosing a better socialism is neither the only nor the best solution.

November 8, 2009 | Unregistered CommenterAnne

I'm just getting into the Paleo diet... and when I came here this morning, the first thing I saw was this editorial in the anarcho-capitalist/Libertarian vein. I think I've found home.

Well-said, sir. Well-said except for one thing: you presume that the people in Congress actually represent us, or give a damn about our interests. Entrenched interests (and their money) were what got these people elected in the first place.

Ever seen how much ADM and Monsanto and Kaiser and their ilk spend on politicians? I'm afraid "Write to your Congressman" is a non-starter.

KGH:

I am totally sympathetic to that point of view, actually. Murray Rothbard himself alternated between cooperating with anti-statist elements in electoral politics and advocating not voting - a higher turnout can give the appearance of legitimy to the system. Nevertheless, attempting to influence your oppressors need not be an acknowldgement of thier legitimacy.

November 8, 2009 | Unregistered CommenterCharlotte

Hi Kurt,

Yes there are anecdotal stories of how slow the NHS is and of understaffing which are dreadful - problem is I've heard worse from my American penpal with cancer who pays a lot for her health insurance and has hefty co-pays - she has had some same kinds of procedures as I have and she pays many times the price I my insurance company pays (I see my private insurance settlements) - if she got a good, fast, service that would be one thing, but her service seems to be very bad with very little continuity of care too.

I've not had to use the emergency services of the NHS but when my brother was younger he was knocked down by a car whilst just standing on a pavement and his skull was fractured. He was rushed to hospital where he got top work done by a neurosurgeon, was unconcious for three weeks and now has a 'plate' in his skull where the bone was shattered. I can't praise the NHS enough for that.

I'm definitely not wealthy ! The company my husband works for gives all it's employees, from the post room boy to the managing director, the same private health cover. It wouldn't give us extra cancer drugs that the NHS won't pay for...that is a big failing of the NHS I agree, and it has been addressed as Parliament changed that rule a few months ago. I don't think any country, or individual, will have a limitless budget for medicines though - isn't it up to the pharmaceutical companies to make affordable medicines ?

Regarding taxes I, or other people, pay for things other people use, well that's the same as our taxes for education. I homeschooled my son but I still have to pay taxes for schools ! It seems unfair but that's the way a country is run....even if you don't have children you still pay taxes for other people's children who go to school.

Anne

That is entirely the problem, that is indeed the way a statist, centrally planned country is run. I am as opposed to socialism in education as in any sphere. Appropriating resources by force to pay for anything is immoral and I am absolutely opposed to it.

To those raised in a collectivist mileiu, my ideas may sound as crazy as my dietary ones do to those raised on the healthy whole grains culture - I assure you I have spent as much time and consideration in arriving at these opinions as my opinions on diet and medicine. Don't forget, I am a health care insider, not just a consumer.

I, for one, would rather have no health insurance than submit to the orwellian level of surveillance that exists in the UK - not fond of the idea of renditions in the US either.

I might add, the fiscal condition of the UK is even worse than the appalling condition of the US.
Hardly a model for much of anything. Love the people, though, and part English myself, as my surname might suggest.

November 8, 2009 | Unregistered CommenterAnne

Hi Kurt,

You wrote:

"Love the people, though, and part English myself, as my surname might suggest."

I wondered that ! My maiden name is Harris :-)

Anne

November 8, 2009 | Unregistered CommenterAnne

Btw, I quite appreciate your ideals, but I don't see how they can ever happen when we live in such large scale communities (countries). If we were still in hunter gatherer groups it would be perfectly feasible, which is why I go with the next best thing which I think is the most moral...ie the state looks after it's most vulnerable citizens.

I don't think state education, or private education, is good for children. To me homeschooling, and only homeschooling in an autonomous learning style, is the very best way for children to learn...but how many parents want that level of responsibility or want to give their children that level of freedom ?

Anne

November 8, 2009 | Unregistered CommenterAnne

Anne

You don't think private education or state education is good for your children. Why not give everyone the same choice you have made without taking their money to fund an educational regime they don't prefer?

November 8, 2009 | Registered CommenterKurt G. Harris MD

Excellent post. Just shared it through every medium I could. Thanks for posting it

-Anthony

ps- did you get my e-mail?

Anthony - thanks!

Yes I got your email, sorry, reply delayed due to being a bit busy.

November 8, 2009 | Unregistered CommenterAnthony

Wow, Kurt.

Mark Sisson has people in his comments who deny evolution and you have cheerleaders for theft.

Right now, I've only a vegan troll or two. :)

KGH RESPONDS:

HaHa

Now I see why you got out of the libertarian blogging business.

Saturated Fat

Private Property

Two old ideas that may come back yet.

November 8, 2009 | Unregistered CommenterRichard Nikoley

Kurt: An excellent editorial. I will be sure and share it with others. I am glad that you said it the way it is! You have guts and you are 100% on target!

November 8, 2009 | Unregistered CommenterAndy

Here is the Austrian rebuttal to Arrow's and Krugman's statist musings on health care "being different" than others goods and services that individuals . As always, they are blind to the dynamism and spontaneous order of voluntary emergent human action. Whenever markets are freed, they tend to breed variety - and evolution.

http://blog.mises.org/archives/010358.asp

And here's how government "fixed" the "problem" the first time (back in the 1920s)
http://libertariannation.org/a/f12l3.html

And finally, George Reisman's health care white paper (from mid 90's, but nothing has changed really)
http://mises.org/story/3613

I'll be promoting this blog in the libertarian community.

KGH:

thank you!

thanks for the links - I've read both of those but not bothered to link to them specifically as I have the von mises link there already - I've learned that most people who challenge you on the evils of the state or wheat are not going to read it anyway

November 9, 2009 | Unregistered CommenterJack

Hi Kurt,

You wrote:

"You don't think private education or state education is good for your children. Why not give everyone the same choice you have made without taking their money to fund an educational regime they don't prefer?"

Absolutely agree - and, thankgoodness, everyone does have that choice to homeschool their children ! The US and UK governments haven't taken that right away yet. In an ideal world it would be best that people would not be taxed to fund state education for other people's children, but in the days before state education many children were simply neglected educationally by their parents and that isn't fair on the children imho.

KGH:

In California, the teacher's unions got a law passed that said you have to have a teachiing certificate to home-school. Don't know if that got signed or repealed. Britain has freer education than the states, actually.

November 9, 2009 | Unregistered CommenterAnne
Comments for this entry have been disabled. Additional comments may not be added to this entry at this time.