I'm an agnostic when it comes to heath care policy. As a closet libertarian, I inherently distrust big government solutions. Cartels and monopolies are bad ideas no matter who is running them. And bureaucrats don't have the spirit of God descend upon them when they enter government service.

All bureaucracies behave like bureaucracies. The bigger they are, the badder. That they're not "doing it for the money" is even scarier, because money can be tracked, taxed and audited. The serpentine corridors of power aren't so easily navigated (unless the Feds happen to be bugging your phone).

And doing it for the ideological idealism of it all turns government into a religion. With the police and IRS at its disposal.

But Christian Lander is exactly right that I'm one of those artsy-fartsy types who's going to rake in a ton more benefits from whatever socialized system we end up than I'll pay out. I may just be old enough to clean up on Social Security and Medicare before they go totally broke too.

The secret reason why all white people love socialized medicine is that they all love the idea of receiving health care without having a full-time job. This would allow them to work as a freelance [artist or writer] without having to worry about a benefits package.

I really am a freelance writer.

The best solution would be to tax benefits as income and provide a tax deduction at the median amount to balance that out, and then greatly expand high-deductible health savings accounts. Then at the low end of the income scale, salt the HSAs with EIC-type funds to cover the deductible.

Both health care providers and insurance companies should be required to publish a price list for all common medical procedures, and provide them to all comers. Oh, and an electronic medical record system is definitely a must (though I don't see why legislation is required to do that).

And then there's the most egregiously disingenuous part of the whole debate: that the government must provide a "public option" to spur competition when it was the government that curtailed competition in the first place by not allowing insurance companies to compete across state lines.

Auto, home and life insurance companies don't work under those restrictions. And not surprisingly, nobody is calling for an auto, home and life insurance "public option." Why can't that cute Australian gecko hawk health insurance in all fifty state too?

In any case, we could import the Swiss system (a network of private non-profits probably closest to the current U.S. system) pretty much whole. Why reinvent the wheel? The best "worst" solution would be to either expand Medicaid out or expand Medicare down. No need to start from scratch.

But here's the one thing I don't understand. Why are the big unions officially so in favor of single-payer, and so rabidly party-line and anti-private insurance? These unions have the best health insurance benefits on the planet. I thought only populist proles from Kansas lobbied against self-interest.

Well, the health care labor unions will certainly clean up. But when it comes to the rest, I'm a living example, having grown a beneficiary of what we actually referred to as "Generous Electric." My father was white-collar (R&D), but white-collar benefits were based on the union-negotiated package.

And as the unions spent about half their time striking for better benefits, that package was very nice. (Then Jack Welch showed up and bared his fangs and they struck themselves right out of a job.)

Even as bad as things have gotten in the auto industry of late, and with all the concessions, the GM auto worker benefits package remains better than anything I could have dreamed of back when I had a "real" job.

Active United Auto Workers members make no monthly contribution and pay no deductible for their health insurance coverage. They face no co-insurance costs for in-network physician services and an annual out-of-pocket maximum of just $500 per family for out-of-network doctors[.]

In short, there is no freaking way that a single-payer or nationalized health care system could deliver that level of benefits. The system will inevitably regress to the mean. Though maybe that wouldn't be a bad thing.

We've either got to admit that we really want to spend tons of money on health care, or grow the stones to piss off powerful interest groups--not just trial lawyers and PhRMA--try convincing the AMA to increase the supply of doctors and drive down physician incomes to European levels (i.e., cut them in half).

Or simply admit that we don't live in Lake Wobegon and everybody can't be above average when it comes to their health care benefits.

Oh, and my last "real job" insurer? IHC, which the president has called out specifically as an exemplary health care provider. It was okay. No complaints about the care provided (the paperwork was a nightmare). But it ain't Generous Electric. No standalone insurer--including the government--can afford to be.

On the other hand, if we simply can't decide what to do, there's always this idea.

Labels: health care, politics

I'm old enough to remember when Ronald Reagan was going to wring waste, fraud & abuse out of the welfare system, and every speech on the subject was accompanied by an infuriating anecdote about a "welfare queen" who was ripping off the rest of us honest taxpayers. As much as I liked Ronald Reagan, it was nonsense.

That kind of rhetoric works well in the righteous indignation department. But the only way to make government more efficient is to make it smaller, which is what Clinton-era welfare reform did, in no small part by instituting "death panels" that decided who really deserved benefits and who got the boot.

But (with apologies to Jonathan Swift), I believe I have a better solution. The Japanese are the longest-lived people in the world, yet Japan spends half what the U.S. does on health care. Oh, and Japan does very few organ transplants, though for an average of $300,000, a Japanese citizen can line up for a new heart in the U.S.

The Japan Times reports that some Japanese patients have paid as much as $1.63 million. So providing organ transplants doesn't correlate well with overall life expectancy, but it certainly can bring in boatloads of cash! That's how we'll finance free health care for all. Everybody gets a lollipop and a pony too!

Labels: health care, japan, politics

The interminably hospitalized or ailing characters in Air, Clannad and Kanon (both of which have two) remind me of the dying heroines in operas like La Boheme, who manage to expire while everybody's singing up a storm. "Mimi! Mimi!"

The "dying kid" theme shows up a lot in Japanese melodrama. A large part of it is dramatic convenience, but there's actually a medical reason behind it. Despite having the world's longest lifespans and some of the most modern medical technology in the world, Japan does very few cadaverous organ transplants.

Most transplants are live-donor organs such as kidneys, and weighted for population, Japan does less than a tenth as many as the U.S. Only eleven heart transplants were performed in 2008. This has led to "organ transplant tourism," such as the three yakuza lieutenants and a yakuza oyabun who received liver transplants at UCLA.

EU countries have long complained about this, and only U.S. hospitals still place Japanese nationals on heart transplant lists. Cadaverous organ transplantation was formally legalized in 1997. A bill passed the Lower House in June 2009 intended to bring Japan's medical ethics laws into line with World Health Organization guidelines.

This doesn't really "solve" the problem, as the definitions of "brain death" and the legal concept of "consent" remain far from settled in the public mind. As the Mainichi Shimbun opined about the bill:

It doesn't appear that thorough deliberation of the various proposals has taken place, nor does it seem that Diet members and the public have reached a real understanding of the issues.

What makes this all the more interesting is that abortion is legal in Japan and is little debated. Japan is one of the few developed countries besides the U.S. that has a death penalty and regularly uses it. It is also little debated.

When it comes to surveys showing how "atheistic" Japanese are, it should be remembered that a belief in a Judeo-Christian deity says little about people's beliefs when it comes to life-and-death matters such as transplantation and cancer. Japanese doctors still regularly (as high as 70 percent) hide diagnoses of cancer from patients.

They do so even in the face of studies showing that the decision to conceal the "true diagnosis was not related to the presence of psychiatric disorders in Japanese cancer patients" (informed patients had a lower rate). Doctors are acting upon religious and cultural beliefs, not science.

I believe that at the heart of the matter is the firm hold Buddhism still maintains over all aspects of funerary culture in Japan, including Obon, the second most important holiday after New Year's. (On the other hand, faux Christian marriage ceremonies have become more popular than the traditional Shinto rites.)

In fact, after I wrote the above paragraph, the aforementioned bill passed the Upper House (13 July 2009). This is a "sea change," explains Mari Yamaguchi of the AP, "because of Buddhist beliefs [that] consider the body sacred and reject its desecration."

So the languishing patient remains a very believable possibility in Japanese melodrama. Another good example is My Hime, in which Mai's little brother languishes away for the entire series before going to the U.S. for a heart transplant in the happy ending.

Labels: anime, buddhism, health care, japan, jun maeda, politics, religion, shinto, yakuza