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Free Market Healthcare By Travis Snyder OMSIII SOMA National Director Of Political Affairs AMSA/SOMA Health Policy Week Touro University Nevada 4/8/08.

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Presentation on theme: "Free Market Healthcare By Travis Snyder OMSIII SOMA National Director Of Political Affairs AMSA/SOMA Health Policy Week Touro University Nevada 4/8/08."— Presentation transcript:

1 Free Market Healthcare By Travis Snyder OMSIII SOMA National Director Of Political Affairs AMSA/SOMA Health Policy Week Touro University Nevada 4/8/08

2 Healthcare is not academic, ‘per se’ but political There is no universal agreed upon ‘right answer’. Too many variables. Like religion. The importance of economics. Tendency towards emotionalism. Base reasoning on logic and reason. Never question intentions. ‘Lies, damn lies, and statistics’. Refute the ‘other side’.

3 Health = Wealth 5% of world’s population 20.8% of world’s wealth Historically unmatched in world history Pax Americana Why?

4 We created Wealth Wealth is created. Example: Microsoft and windows. Microsoft didn’t steal $$$ from anyone! They received all their profit from voluntary consent of their customers who also profited. Currency backs up things of value. As Americans create goods and services Congress prints money.

5 Why do we create so much wealth in the United States? Freedom! –from taxes –regulations –to contract Rule of law and respect of private property. “Some animals are not more equal than others.” Minority rights. Divine law of Europe, in US remove the middle man between man and God. King of your castle.

6 “The poorest man may in his cottage bid defiance to all the forces of the Crown. It may be frail, its roof may shake; the wind may blow through it; the storm may enter, the rain may enter -- but the King of England cannot enter; all his force dares not cross the threshold of the ruined tenement!” -William Pitt, the Elder (speech to the British Parliament describing a basic American principle [Every man a king] that would become ingrained in our Constitution)

7 Wealth = Health Wealthy countries have better healthcare. Good healthcare is created the same way wealth is. United States has the best healthcare in the world. Despite moving away from the principles of our foundings.

8 Comparing countries on Health outcomes

9 Comparing Countries on wait times

10 United States scientists received 171 or 55% of the 309 Nobel Prizes in Science awarded from 1951 to 2000.Nobel Prizes

11 Research Papers and Journals Language and country preponderance trends in MEDLINE and its causesLanguage and country preponderance trends in MEDLINE and its causes In 2000, 68% of all papers (Medline) were published in the 8 Anglo countries and 90% were written in English.

12 Big Pharma! Top twenty: 12/20 US US companies spend over $50 billion a year in research.

13 Other categories US leads Medical device development Radiologic/Diagnostic advances Surgical/Procedural Advances Transplants Just about any other ‘new advance’.

14 Brain Drain! According to INS statistics, 28,947 doctors and 60,618 nurses were admitted as immigrants between 1990 and 1996 — in both cases already surpassing the total numbers admitted during the 1980s.

15 Brain Drain /6 th British medical school grads went overseas Pub Med.Pub Med In in 9 Canadian born physicians practiced in the United States Canadian Medical AssociationCanadian Medical Association 25% of total US physicians are foreign born (India = highest) Stealing From the Poor to Care for the Rich (NYT)Stealing From the Poor to Care for the Rich

16 Questions to Ponder How many lives have been saved by US medical doctors and scientists over the past 50 years? How many lives have been saved by US drug companies in the past 50 years? Why is the US ahead in every category? For the same reason we lead every category in wealth creation: freedom.

17 Total healthcare spending per capita

18 Per capita healthcare spending as percent of GDP

19 Private healthcare funding per capita (most recent) by country

20 Per capita public healthcare spending as a % of GDP

21 Criticisms of American Healthcare We have the best healthcare, but… not all can access it.

22 45 million uninsured? Are 45 million really uninsured? April 26th LA Times Four government surveys attempt to estimate the number of Americans who are without coverage for a full year, a potentially harmful gap. The results range from a high of 45 million in the Current Population Survey to a low of 19 million in the less-known Survey of Income and Program Participation, also by the Census Bureau. Why do we pick the 45 million number?

23 Who are the million? (transitional workers) 2003 study by the Congressional Budget Office: about 45 percent will have health insurance within four months. It is estimated that 25% of the uninsured make 5 times the poverty limit.estimated 9.2 million of the uninsured are not citizens of the United States. Q. When is 45 million not 45 million?

24 There is no ‘Healthcare Crisis’ Less than 3% of Americans are chronically uninsured for more than 2 years. - Kaiser Foundation. Furthermore, unfortunately: we have universal health care in America. Hospitals cannot turn patients away, emergency rooms cannot turn patients away, unfortunately. Additionally, private hospitals, charitable foundations, and churches cover those in need. 95% of Americans have access to drugs (WHO)

25 Doctor Consultations per year

26 In fact, is health ‘insurance’ really even insurance? Insurance –“A contract (policy) in which an individual or entity receives financial protection, or reimbursement, against losses from an insurance company, which pools client's risks to make payments more affordable, in exchange for a premium.” - investopedia Do we buy insurance for our groceries? Insurance normally pays for expensive things we don’t normally need and don’t expect to get. (Fire, flood, car accident)

27 What we choose to call “health insurance” is, in fact, a system of cost- shifting masquerading as a system of insurance. We treat a public, statist political system of health care as if it were a system of private health insurance purchased for the purpose of obtaining private medical care. - Thomas SzaszThomas Szasz Mandates – 47+ in NV! –A new analysis prepared for the National Center for Policy Analysis by the actuarial firm Milliman & Robertson estimates the costs of 12 of the most common mandates and finds that, collectively, they can increase the cost of insurance by as much as 30 percent. –According to a 1999 study conducted by the Health Insurance Association of America (now part of America's Health Insurance Plans), as many as one in four individuals who are without coverage are uninsured because of the cost of state health benefit mandates.

28 Mandates Provider Mandates — A provider mandate requires an insurer to cover specified providers such as chiropractors and podiatrists. Benefit Mandates — A benefit mandate requires insurers to cover a specific benefit, such as drug and alcohol abuse counseling or well-baby care. Employee Mandates – ‘Wal-Mart Laws’, require an employer of a certain size to provide some form of health insurance. Ownership Mandate – Non physicians can’t employ physicians, can’t own clinics. (but hospitals can)

29 Benefit Mandates Diabetic mandates Autism mandates Dependents mandates (up to age 30 in NJ) A mandated offer for medically necessary breast reduction and/or systematic varicose vein surgery (Maine) (not passed) Mental health mandates Whigs

30 Viagra! Wahoo! N.Y. Audit Shows Sex Offenders Get Viagra Scores of convicted rapists and other high-risk sex offenders in New York have been getting Viagra paid by Medicaid for the last five years, the state's comptroller said Sunday. Viagra Covered by Medicare

31 Provider Mandates Lobbyists of all different providers and specialties want to be mandated, give $$$ to state legislators.

32 Ownership Mandates Doctor organizations always support this. Unintended Consequences Touro University Nevada has been developing a clinical practice facility for faculty, staff, and students. We ran into a serious obstacle in February when we discovered that non- physician owned corporations could not provide patient care in Nevada. After extensive research, we discovered that many states with similar laws had enacted legislation or regulations to enable private not-for-profit medical schools to create clinical practices.

33 Employee Mandates ‘Wal-Mart bills’ Md. Legislature Overrides Veto on Wal-Mart BillMd. Legislature Overrides Veto on Wal-Mart Bill –The bill will require private companies with more than 10,000 employees in Maryland to spend at least 8 percent of their payroll on employee health benefits or make a contribution to the state's insurance program for the poor. Progressive Wal-Mart. Really.Progressive Wal-Mart. Really.

34 Publix to offer 7 popular prescription antibiotics for free 8/6/07 South Florida Sun-Sentinel Fourteen-day supplies of the seven drugs will be available at all 684 of the chain's pharmacies in five Southern states. "It can't be any more affordable than free," Crist said. With health care costs one of the biggest challenges facing many Americans, Crist said that the private sector's involvement in the solution was "a great trend." Wal-Mart last year started offering hundreds of prescription drugs of all different kinds, ranging from diabetes medication to high blood pressure drugs, for $4. Kmart, a unit of Sears Holding Corp., began last month offering a 90-day supply of generic drugs for $15. Now, more than 300 drugs are included in that program.

35 Corporate Welfare (General Motors wants your $$$) As government healthcare expands, companies shift burden to the state.

36 Why do we have employer sponsored healthcare? 62.4 percent of the nonelderly population — had health care coverage through employer- sponsored insurance in 2004 Corporations are people?

37 Employer-Sponsored Health Insurance in the United States — Origins and Implications Employer-Sponsored Health Insurance in the United States — Origins and Implications 2006 NEJM To control inflation in the overheated wartime economy, the federal government in 1942 limited employers' freedom to raise wages and thus to compete on the basis of pay for scarce workers. 4 However, the federal government allowed employers to expand benefits for workers, such as health insurance, which resulted in a rapid increase in employer-sponsored insurance , the Internal Revenue Service decided that the contributions that employers made to the purchase of health insurance for their employees were not taxable as income to workers. 4 By 2004, the tax benefit for employees had grown to $188.5 billion annually, 8 or about $1,180 for each American with employer-sponsored insurance. 4 8 Others – union rules and accounting rules

38 Conclusion Employer based health insurance exists in large part because of government interference in the market place. It distorts feedback loops by adding an extra degree of separation between consumer and health care provider. Employers want low cost healthcare, insurers want to make money – no feedback loops for patients to receive the product they want.

39 Socialized Medicine causes private companies to dump their employers on the government (Creating underclass)

40 Government created Underclass? Take away benefits if people make more money. Companies incentivized to pay less and people incentivized to work less and earn less. Feedback loops –Unconscious –Economics Seen in Welfare studies.Welfare studies –Another risk of expanding government care. –Do we hurt who we seek to help?

41 Welfare Reform State Reform took effect around and the National Bill was passed in 1996 % unmarried Mothers

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43 Child Mortality US News and World Report: –"First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.“

44 The perinatal mortality rate as an indicator of quality of care in international comparisons. The perinatal mortality rate as an indicator of quality of care in international comparisons. Med Care 1998 “For international comparison, the first step is to apply common definitions. The rate can vary by 50% depending on the definition used. Also, sources of registration bias need to be examined, because they differ considerably by country. Underregistration is known to be as high as 20% of perinatal deaths.”

45 Doctors in Miami are delaying the release of the world's most-premature baby, saying she will stay in hospital a few more days for checks.Doctors in Miami are delaying the release of the world's most-premature baby, saying she will stay in hospital a few more days for checks. (Feb 2007 BBC) Amillia's survival demonstrates the dramatic advances in neo-natal care in recent years, correspondents say. Amillia is believed to be the first baby to have survived following a gestation period of less than 22 weeks.

46 Conclusion So, in effect, by having among the best prenatal care in the world, we raise our infant mortality rate. Cuba vs United States Other factors involved in disparities within the US. Where would you send your family members to have a baby?

47 Life expectancy, a good measure of Healthcare?

48 US #44 in world 78 vs 83

49 Life expectancy Mirrors wealth. But only to a certain point. Diet, activities, cultural activities, genetics, make the differences past a certain point.

50 Where Americans live can affect how long they live Where Americans live can affect how long they live 9/12/06 AP Health disparities are widely considered an issue of minorities and the poor being unable to find or afford good medical care. But Murray's government-funded study shows the problem is far more complex, and that geography plays a crucial role. The longest-living whites were not the relatively wealthy, which Murray calls "Middle America." They are edged out, by a year, by low-income residents of the rural Northern Plains states in the Midwest, where the men tend to reach age 76 and the women 82. Murray was surprised to find that lack of health insurance explained only a small portion of those gaps. Instead, differences in alcohol and tobacco use, blood pressure, cholesterol and obesity seemed to drive death rates. Most important, he said, will be pinpointing geographically defined factors — such as shared ancestry, dietary customs, local industry, what regions are more or less prone to physical activity — that in turn influence those health risks.

51 FDA, a Pet Peeve

52 History 1906, President Theodore Roosevelt –Food and Drug Act (mislabeled substances) 1938 Food, Drug, and Cosmetic Act (FD&C Act) –The new law significantly increased federal regulatory authority over drugs by mandating a pre-market review of the safety of all new drugs, as well as banning false therapeutic claims in drug labeling without requiring that the FDA prove fraudulent intent Kefauver-Harris Amendment –Thalidomide incident –‘Revolutionary’ new powers. All new drug applications demonstrate "substantial evidence" of the drug's efficacy for a marketed indication, in addition to the existing requirement for pre-marketing demonstration of safety.

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54 SOMA Resolution WHEREAS, New pharmacological advances have resulted in major healthcare advances and enabled physicians to enhance patient care (4), WHEREAS, This year the FDA has so far approved only 7 NCE (new chemical entities), down 31% from last year (1), WHEREAS, It takes an average of years and $ billion to bring a new drug from lab to marketplace, in large part due to legal and current regulatory compliance (2), (3), WHEREAS, Generic drugs take over 20 months for approval, increasing cost and decreasing access (6), (7), (8), WHEREAS, Terminally ill patients are routinely denied opportunity to 21) try new or experimental drugs and therapies (5), (9), (10), (11),

55 News Stories A jab to halt Alzheimer's could be available within a few yearsA jab to halt Alzheimer's could be available within a few years 7/23/07 The Daily Mail When the jab was given to mice suffering from a disease similar to Alzheimer's, 80 per cent of the patches of amyloid protein were broken up. The jab, which is now being tested on patients, could be in widespread use in as little as six years.

56 Bionic eye restores sight to the blind 2/17/07 The Times An early version of the prosthetic retina has already been fitted to six patients with retinitis pigmentosa, a degenerative and incurable eye condition that affects 1 in 3,500 people. All have recovered the ability to detect light and motion, and even to make out large letters and to distinguish between objects such as a cup, a knife and a plate. The artificial retina has been cleared by US regulators to begin trials on between 50 and 75 people suffering from two of the most common causes of blindness, opening the way for millions more to benefit from similar implants in the future. The US Food and Drug Administration has insisted on older subjects as they have less to lose if the experiments go wrong.

57 Drug Helps Restore Sight: Relief for wet macular degeneration Drug Helps Restore Sight: Relief for wet macular degeneration 8/6/06 MonteryHerald.com After years of having to tell patients losing their eyesight to wet AMD that nothing could be done, doctors now can offer hope. On June 30, the U.S. Food and Drug Administration approved Lucentis to treat wet AMD, which strikes an estimated 155,000 people a year. The approval came seven years after the drug's maker, Genentech Inc., began the first test in humans, said Dawn Kalmar, a spokesperson for the company based in San Francisco. About 95 percent of patients regain their sight after treatment, and in some, vision gradually gets better than it was before the onset of the disease.

58 A Cancer Treatment You Can't Get Here China, with lower regulatory hurdles, is racing to a lead in gene therapyA Cancer Treatment You Can't Get Here China, with lower regulatory hurdles, is racing to a lead in gene therapy 3/1/06 Business Weekly

59 Court Fights! Court Backs Experimental Drugs for Dying PatientsCourt Backs Experimental Drugs for Dying Patients 5/3/06 Washington Post In its opposition to the challenge, the FDA had said that the agency already has programs that make potentially lifesaving drugs available before final approval. In addition, it said that allowing large numbers of patients to take unapproved drugs could put many at unacceptable risk, even if they are terminally ill.

60 Implantable Heart Device Receives F.D.A. ApprovalImplantable Heart Device Receives F.D.A. Approval 9/5/06 New York Times In June 2005, a panel of heart experts appointed to advise the F.D.A. voted, 7 to 6, against approving the Abiomed device, in part because of concern that the risks from complications like bleeding, strokes and infection outweighed the benefits. Some panel members expressed concern about whether patients would live long enough with an improved quality of life to justify the risks. Decision was Reversed! !Reversed!

61 Parkinson's Drug pulled From the Market 3/20/07 Seattle Post-Intelligencer –Temple said withdrawal was requested after two recent studies, published in The New England Journal of Medicine, indicated high rates of valve leakage - up to 20 percent - in patients taking the drug. –Temple said a few people may not be able to change to another drug and the agency is making arrangements to have pergolide available for them.

62 Breathless arrogance 2/9/06 East Valley Tribune Editorial An advisory panel to the U.S. Food and Drug Administration has recommended that an over- the-counter asthma inhaler sold as Primatene Mist be taken off the market. The stated reason is not that the product has harmed any asthma patients, but that the inhalers are propelled by chlorofluorocarbons (CFCs), the compounds that allegedly destroy the Earth’s ozone layer and have been banned for most other uses.

63 First Inhaled Insulin Approved 1/27/06 Forbes.com Exubera, the first inhaled insulin, has finally passed muster with the U.S. Food and Drug Administration after years of delays for Pfizer. From another story: But in June of last year, CNN/ Money reported that analysts were predicting that the FDA would spend two more years evaluating Exubera because of the lack of long-term tests establishing whether it would cause respiratory problems for smokers, as well as its effects on children.

64 Judge: Government must allow meatpackers' tests for mad cow 3/29/07 Mohave Daily News Judge: Government must allow meatpackers' tests for mad cow Creekstone Farms Premium Beef, a meatpacker based in Arkansas City, Kan., wants to test all of its cows for the disease, which can be fatal to humans who eat tainted beef. The Agriculture Department currently regulates the test and administers it to less than 1 percent of slaughtered cows. The department threatened Creekstone with prosecution if it tested all its animals.

65 F.D.A. to Weigh At-Home Testing for AIDS Virus F.D.A. to Weigh At-Home Testing for AIDS Virus (18 years) A application for an at-home AIDS test kit led to years of controversy. At the time, AIDS advocates and public health officials predicted that such a test would cause widespread suicides, panic and a rush to public health clinics. At hearings, AIDS advocates handed out copies of an obituary of a San Francisco man who jumped off the Golden Gate Bridge after discovering that he was infected with HIV. An official for the Centers for Disease Control and Prevention told the F.D.A. that such tests could lead to "a sudden increase in referrals to already overburdened health clinics," according to an F.D.A. document. Federal regulators stalled the application for nine years, and at- home AIDS testing never caught on.

66 Personal Story

67 Conclusion (FDA review.org) –"penalties imposed by the marketplace on sellers of ineffective drugs … left little room for improvement by a regulatory agency." –Noble intentions aside, any reasonable concept of safety is at best relative. The safe use of a drug is dependant on innumerable particulars, unique to the individual. By attempting to create a safety standard for something as variable as physiology, the FDA imposes onto the marketplace a rule that is at once clumsy and constricting. (Medical socialism) – Consumers are protected by a dynamic mixture of expert consultation, individual experimentation, independent and industry certification and the tort system.

68 Resources Criticism of the Food and Drug AdministrationCriticism of the Food and Drug Administration FDA Tyranny FDAreview.org (Is the FDA Safe and effective? )FDAreview.org Abigail Alliance

69 Licensing: Yesterday In the early to Mid 1900s, Osteopaths were licensed out of almost every state in the county. In CA they ‘became MDs’. "I don't know as I cared much about these osteopaths until I heard you were going to drive them out of the state, but since I heard that I haven's been able to sleep.“ –Mark Twain who testified before the New York General Assembly

70 Licensing: Today The Missouri Association of Osteopathic Physicians and Surgeons (MAOPS) is advocating to remain one of the only states requiring direct on-site physician supervision of physician assistants. Nov. 2, The American Osteopathic Association (AOA), representing more than 54,000 osteopathic physicians (D.O.s) across the United States including thousands of ophthalmologists, was shocked to learn of Oklahoma Governor Brad Henry's decision to allow optometrists to perform surgery.Nov. 2, 2004 ‘Minute clinics’ Patient Care = turf wars. Would you Refer patients to an unlicensed physician or surgeon?

71 Doctors have monopolies on healthcare Why do you need a doc to get a prescription? Go to doc and ask for prescription, you’ll mostly get whatever you want. (why pharm advertisements work) (good health messages)

72 Medical Education Medical Education in Nevada: A Tale of Two Medical Schools Two schools, MD, DO, public, private Nevada Taxpayers, UNR: $519,000 per student, 52 students Touro U – 135 students (millions invested), 50 PAs, nursing, OT, education What about the old ‘guild’ system? Medical schools? Why do we need to learn biochemical pathways to become surgeons? Why do we need to learn surgical procedures to become psychiatrists? Conclusion : Much of medical school learning is done to fulfill requirements and attain prized residency spots. ‘Filtering out’ Same as College, same as highschool? Did we ever use any of those physics or chemistry? Process over substance. Residencies and specialists restricting spots. Why Derm so sought after? Never let your schooling interfere with your education. –Mark Twain

73 Taxpayers pay for docs to practice elsewhere Pennsylvania, with its high medical liability insurance premiums, is another state looking to improve resident retention. In 2004, 7.8% of Pennsylvania doctors-in-training stayed after completing residency, down from 50.5% in 1994, according to the Pennsylvania Medical Society. (46) in Haiti it was documented that at one point out of 264 medical doctors who graduated from a Haitian medical school all but three left the country, mostly for the United States.

74 Scientific or self interest? The Doctor Glut Revisited Feb 2001 PostGraduate Medicine More evidence of Doctors attempting to limit their numbers in order to raise their salaries: Of its [Pew Health Professionals Commission] recommendations, three were key:Pew Health Professionals Commission Shut down enough medical schools to trim at least 20% of first-year slots by 2005 Limit the number of residency positions to the number of US medical school graduates plus 10% Tighten visa restrictions on IMGs to encourage them to return to their native lands

75 The Future: Improving US Healthcare What direction should we move in? Socialized Medicine? –(We already have socialized medicine) How have countries fared that have socialized Medicine to a greater extent than we do? –Canada, Britain?

76 Canada Patients suing province over wait times (Canadians flee to US for care)Patients suing province over wait times (Canadians flee to US for care) 9/6/07 Toronto Star The Best Treatment Money Can Buy 6/10/05 The Globe and Mail TORONTO -- Barbara Hogan would be dead today if she hadn't gone to a private U.S. clinic for treatment of her breast cancer.

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78 Access Denied: Canada's Healthcare System Turns Patients Into Victims Access Denied: Canada's Healthcare System Turns Patients Into Victims 12/03 Frontiers of Freedom Institute About 10,000 doctors left Canada during the 1990s. Results based on information are: total waiting time between referral from a general practitioner (GP) and treatment was 16.5 weeks; Saskatchewan had the longest wait at 32.6 weeks; and wait to see a radiation oncologist was 8.5 weeks (an eternity for those with a brain tumor or Hodgkin’s Disease.)12 Diagnostic waits were: 5.2 weeks for a CT Scan 12.4 weeks for an MRI 3.2 weeks for an ultrasound.13

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80 Borderline Care 6/13/05 Investors Business Daily –In one 12-month period, according to an article in the Canadian Medical Association Journal, 71 patients in Ontario died while on the waiting list for heart-bypass surgery. Another 121 lost their places in line because waiting made them too sick to survive surgery. Literally, condemned to death by waiting.

81 Man Gets 3 years for Toronto Shooting Spree Hoax 6/1/05 CTV.caMan Gets 3 years for Toronto Shooting Spree Hoax A New Brunswick man who told police that a friendly dog scuttled his plan for a bloody shooting rampage was sentenced Wednesday to three years in prison after admitting it was all a ploy to get life-saving surgery while in jail.

82 Canadians Face Long Waitlists for Health Care 3/19/05 Associated Press TORONTO - A letter from the Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: "If the person named on this computer- generated letter is deceased, please accept our sincere apologies." Another watershed lawsuit was filed last year against 12 Quebec hospitals on behalf of 10,000 breast-cancer patients in Quebec who had to wait more than eight weeks for radiation therapy during a period dating to October 1997.

83 Supreme Court Strikes Down Quebec Medical Law 6/9/05 CTV NewsSupreme Court Strikes Down Quebec Medical Law Canada's Private Clinics Surge as Public System Falters 2/28/06 New York TimesCanada's Private Clinics Surge as Public System Falters "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.“

84 Doctors Eying the U.S.: Canada Is Sick About It 10/19/03 Windsor Journal The two surgeons are sharply critical of Canada's health care system, which is driven by government-financed insurance for all but increasingly rations service because of various technological and personnel shortages. Both doctors said they were fed up with a two-tier medical system in which those with connections go to the head of the line for surgery. There was a net migration of 49 neurosurgeons from Canada from 1996 to 2002, according to the Canadian Institute for Health Information, a large loss given that there are only 241 neurosurgeons in the country.

85 NATIONAL CENTER FOR POLICY ANALYSIS A recent analysis of surgical waiting lists in British Columbia concluded that "nearly 80 percent of queue jumping is not on the basis of emergency but on the basis of physician/surgeon preferences, requests from senior Ministry of Health officials and sometimes from members of the legislature."29 Members of the federal Parliament and 4,364 high-ranking federal bureaucrats can avoid waiting lists because they have access to the National Defense Medical Center. In 1990, the Canadian Auditor General reported that 61 percent of the center’s in-patient days were for nonmilitary patients

86 Stronach went to U.S. for cancer treatment: report 8/14/07 ctv.ca Liberal MP Belinda Stronach, who is battling breast cancer, travelled to California last June for an operation that was recommended as part of her treatment, says a report. Spanish Surgeon rushed to treat Castro 12/24/06 Reuters Jose Luis Garcia Sabrido, an intestinal specialist, traveled to the Caribbean island on Thursday aboard an aircraft chartered by the Cuban government, according to Spain's left-leaning El Periodico de Catalunya newspaper. The plane carried medical equipment not available in Cuba in case the leader needs further surgery due to his progressively failing health, the newspaper reported.

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89 Britain

90 Cancer Lottery 11/25/07 News of the WorldCancer Lottery CANCER patients across Britain are facing a life-or-death postcode lottery which decides whether they get vital drugs and treatment. EACH cancer sufferer in bottom-of-the-table Oxfordshire is allotted just £5,182 a year—while in top-ranking Nottingham the spending is TREBLE that at £17,028. PATIENTS in high-spending areas such as Birmingham or Knowsley, Liverpool, have a 20 PER CENT better chance of surviving than those in low-spending Dorset or parts of Yorkshire. EVEN neighbouring towns differ wildly, with Hounslow (£11,726) in the Home Counties spending almost DOUBLE Ealing's £6,650; and Solihull (£6,405) in the Midlands being OUTSTRIPPED by Wolverhampton (£10,797).

91 Daughter Dies while waiting for a Scan 8/8/07 Norwhich Evening News A woman who had complained to her GP of severe headaches for almost a year collapsed and died of an undiagnosed brain tumour. Jennifer Bell, 22, had been told she was suffering from stress but after months of illness had finally been referred to a neurologist. She then faced a 13-week wait before a 'relatively urgent' MRI scan could be carried out. Three days before the longawaited appointment she collapsed at home and died later in hospital. Yesterday at an inquest in Norwich, Coroner William Armstrong agreed that an early scan would have led to much faster intervention.

92 I won't let Daddy die: Girl of six raises £4,000 for life-saving drugs the NHS won't provideI won't let Daddy die: Girl of six raises £4,000 for life-saving drugs the NHS won't provide 10/26/07 The Daily Mail (UK) The drug Mr Hill needs is called Tarceva. It is available for free in Scotland but not in England, as the National Institute for Health and Clinical Excellence found it was not "an effective use of NHS resources".

93 Sex health crisis swamps clinics 4/3/05 The Observer. The true scale of Britain's sexual health crisis is revealed today in a report showing that two-thirds of clinics are turning away patients because they cannot cope with demand for treatment.

94 Doctors opt to have private operations 3/26/06 Times Online More news from the socialized medical system of Britain: HOSPITAL consultants are spurning the National Health Service by paying for medical insurance so they can be treated privately if they become ill. A survey of 500 consultants, commissioned by Bupa, the health insurer, found that 41% of senior hospital doctors have invested in private health cover. More than 90% of the consultants surveyed have posts within the NHS. All of those surveyed also worked in private hospitals.

95 Experts push NHS to use US-style cancer care 8/26/07 Telegraph (UK) LIKE many other British cancer sufferers before him, Rob Ellert travelled to one of America’s leading hospitals to give himself a better chance of survival. Anni Matthews, 53, who is fighting breast cancer, was told by British doctors in February 2003 that she would be lucky to live until the Christmas of that year. Matthews, a former property company director, increased her chances of survival by travelling to the Dana-Farber Cancer Institute in Boston, Massachu-setts, where her treatment was helped by new “wonder drugs”.

96 English Dentistry NHS funding for kids' braces slashed by 20 per cent 12/17/06 The Daily MailNHS funding for kids' braces slashed by 20 per cent English Pull Own Teeth Due To Poor Dental Services 10/15/07 AFP In a Dentist Shortage, British Do It Themselves 5/7/06 New York Times I pulled out my own teeth 3/31/05 The Mirror (and Sun) Last March 3,000 people queued for a new NHS dentist in the town. NHS dentists play as patients wait 3/30/08 London Times

97 Perverse Incentives Broken feedback loops In Hospice Care, Longer Lives means money lost 11/27/07 NYT Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected. Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.

98 "Before 2000, freestanding children’s teaching hospitals received yearly an average $374 per resident in GME funds from Medicare, whereas nonchildren’s teaching hospitals received an average $87,034 per resident. This disparity in the level of federal funding for freestanding pediatric versus nonpediatric teaching hospitals is attributable to few Medicare patients being cared for in children’s hospitals."." (italics added) (19)

99 Top down, not bottom up, leads to distortion of the market Dem Eyes Breast Test 'Wait Woe' 7/22/07 New York Post Mammography centers in New York City are closing at an "alarming" rate, causing a 171 percent increase in wait times for the cancer-detecting procedure, according to a study by Rep. Anthony Weiner. Since 1999, 67 mammography sites, more than a quarter of the city's supply, have closed, the Brooklyn Democrat found. The problem is that Medicare pays only $83 for a procedure that costs $125 to provide, said Weiner, who will introduce legislation to increase payments.

100 Fix Medicare - Not Prices Fix Medicare - Not Prices 10/10/06 Cato The Medicare bureaucracy is somehow supposed to divine the correct prices for more than 7,000 distinct physician services in each of Medicare's 89 physician-payment regions (yep, some 623,000 separate prices). And - unlike market prices - these price controls don't automatically adjust to reflect the value of goods and services. As a result, quality suffers. It is tempting to think that Medicare's payment system exists to benefit physicians who know how to play the game. But few physicians enjoy having their practices thrown into turmoil by payment changes uttlerly unrelated to the value they provide. A more plausible explanation is that Medicare's pricing system exists to serve Washington's political class. Politicians can use the perennial threat of payment cuts to shake down wealthy physicians for political contributions. Organizations that lobby on behalf of physicians - like the AMA and the AAFP - rake in membership fees as well.

101 The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design. - Friedrich A. Hayek

102 Medical care subsidized like farmers. Reminiscent of government attempts to regulate and subsidize agriculture and pay farmers not to grow crops: "In an unorthodox bid to ease a growing glut of physicians, the federal government has agreed to pay hospitals around the country hundreds of millions of dollars not to train doctors. Farmers rediscover allure of tobacco No longer subsidized, crop gains acres in U.S.Farmers rediscover allure of tobacco No longer subsidized, crop gains acres in U.S. 9/19/07 Wall Street Journal Three years after the federal government stopped subsidizing it, the leafy crop is gaining new popularity among U.S. farmers. Cheaper U.S. tobacco has become competitive as an export, and China, Russia and Mexico, where cigarette sales continue to grow, are eager to buy. Since 2005, U.S. tobacco acreage has risen 20 percent. Fields are now filled with it in places like southern Illinois, which hasn't grown any substantial amounts since the end of World War I. Analogy: Breast and plastic surgery, elective procedures, cosmetics, most profitable for doctors and low waits for patients.

103 AMA advocating tax increase (another link here)AMA advocating tax increasehere 6/14/06 Chicago Sun Times Millions of upper-income Americans refuse to buy health insurance because they're young and healthy and figure they don't need it. But now the American Medical Association wants to force them to buy coverage. The AOA represents the interests of doctors, not patients (unconscious bias). (SCHIP, Medicare, Medicaid)

104 Rhetoric of Politicians Hospital Disputes Clinton Story About Uninsured Pregnant Woman FoxNews.com ^ | 04/05/08 | Aaron BrunsHospital Disputes Clinton Story About Uninsured Pregnant Woman FoxNews.com ^ “It hurts me that in our country, as rich and good of a country as we are, this young woman and her baby died because she couldn’t come up with $100 to see the doctor.” –-Senator Clinton Bryan Holman, had played host to Mrs. Clinton in his home before the Ohio primary. Deputy Holman said in a telephone interview that a conversation about health care led him to relate the story of Ms. Bachtel. Deputy Holman knew Ms. Bachtel’s story only secondhand, having learned it from close relatives of the woman. Ms. Bachtel’s relatives did not return phone calls Friday.

105 But not all politicians… Ron Paul interview on HealthCareRon Paul interview on HealthCare (Kaiser)

106 Recommendations Abolish employer based insurance government incentives Allow interstate/national purchases of insurance Remove insurance mandates Abolish the FDA Eliminate licensing requirements Eliminate doctor ownership requirements Phase out Medicare and Medicaid Phase out government research grants and funding of Medical Schools and residencies

107 Conclusions Government control of Medicine doesn’t work. Despite overburdened with regulations, American healthcare is exceptional and excellent. British, Canadian, and other single payer systems. suffer many problems. Uninsurance ‘crisis’ is over exaggerated. 3 rd party employer based healthcare was encouraged by government regulations and has resulted in harm. Infant Mortality statistics are false. Life expectancy statistics are misleading. FDA harms more Americans than it helps. Government control of Medical education is harmful. Licensing laws and other regulations (mandates) are harmful.

108 Final Conclusions We don’t pretend to know what system of Healthcare is ‘best’. Employee based, HMO, disaster insurance, Health Savings Accounts, or any combination thereof. We are confident the market will find the best choice, through trial and error, provided government get out of the way and allow private individuals to contract with each others and control their own bodies. The future is optimistic, the internet is facilitating information exchange and exposure to new ideas and theories not presented before.

109 Further Links US Government Health Canadian Health Care British Health Care –Above three from neoperspectives.com, source of most information in this presentation. This ppt presentation will be uploaded there. Political Virus / Why there's only one drug to fight avian flu. 10/22/05 Wall Street Journal EditorialPolitical Virus / Why there's only one drug to fight avian flu. Governor Schwarzenegger Should Go to Nashville 1/17/06 American ThinkerGovernor Schwarzenegger Should Go to Nashville How to Cure Health Care Nov 2001 Hoover Institute Milton Friedman Fix Medicare - Not Prices 10/10/06 Cato Mdsalaries.blgosort.com

110 “Just because you don’t take an interest in politics doesn’t mean politics won’t take an interest in you.” - Pericles

111 Questions, Comments?


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