The Left Behind

Probably he just had enough of government and the limitations of a $143,500 salary, so Mark McClellan, announced his will leave his post as administrator of the Centers for Medicare and Medicaid Services. An economist and a physician, and someone who understands the value of evidence in making policy decisions, McClellan may well be missed, given the administration’s penchant for putting loyalty above competence.

If truly valuing evidence over politics, McClellan might not have been so enthusiastic about the Medicare drug benefit that could have worked so much better if the drug industry hadn’t written the law creating it. And he might have approved the Plan B oral contraceptive years earlier. But, hey, what can you expect when his predecessor at the agency represented the administration in talks with Congress about the shape of the drug benefit bill while he was negotiating to go directly onto the payroll of a drug industry lobbyist?

In a related safety net development, for the first time since 1999, the number of uninsured children in America has gone up, likely as a result of states cutting back on benefits in order to make sure no tax cuts are left behind.

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5 thoughts on “The Left Behind”

  1. Pretty soon you won’t be able to smoke in any hotel room. That isn’t the government’s doing. It’s the market. Travelers don’t want to smell other people’s smoke.

    Good idea, but what else might Marriott want to ban in hotel rooms?

    Ira R. Allen

  2. The Marriott ban smoking in all its hotel rooms? You can’t even smoke in a private room that you payed for all by yourself anymore?
    Anyway, I read somewhere that medical costs were the number one reason for bankruptcy in America. No one should have to pay for medical costs that they don’t have a chance to pay. Its not that I’m a socialist, I just don’t get a Darwinian kick out of medical costs destroying someone’s family. I may get a disease or get in an accident at any moment, and I don’t look forward to being sent to the poor house just because I needed to take out several loans to stay alive.
    Paying taxes for medical service is just as important as paying taxes for national defense. Sure there may be the case of the free-rider economics problem, where someone who can easily afford to pay his medical costs won’t have to spend a dime, but that is more than worth it in order to keep the population safe.

  3. Anonymous may understand a little about economics but apparently less about drug pricing and a lot less about human behavior.

    If an entity as large and powerful as the federal government decides to buy drugs for senior citizens, obviously more drugs will be sold — to the benefit of drug companies. But any other entity with that kind of power would negotiate — or force — price reductions. There is some economic term or other for this phenomenon of getting a discount for volume. But,no, the Republican party had to guarantee its lackeys in Big Pharma continued price protection available only to defense contractors. It isn’t government that produces inefficiency but outright corruption, whereby partisans protect their contributors.

    Anonymous is correct, as far as he/she goes regarding the importance of individuals acting in their own best economic and medical interest.
    Yet as complicated a thing as human behavior is, the solution Anonymous arrives at is to blame the victim.

    While we haven’t yet found one sure way help people change troublesome behavior — other than repeated boring, frustrating attempts that only sometimes work — we do know what doesn’t work: hectoring and blaming.

    After Congress loosened Medicaid rules, West Virginia plans to reduce Medicaid benefits to the unhealthy and Kansas is considering charging state employees who adopt healthy lifestyles less for their insurance and charging prevention-compliant Medicaid recipients a lower co-pay.

    The unfairness is obvious: The fat bureaucrat can afford to pay higher premiums, but the single mother working at one or two jobs at marginal pay may not have the time, energy or skills it takes to get healthy.

    If policy makers know anything, it is how to read public opinion. So it is not surprising that victim-blaming has gained traction, even among the victims. A recent Wall Street Journal-Harris poll found that in just three years, the percentage of people who want to make the unhealthy pay more for insurance jumped from 37 percent to 53 percent. Paradoxically, the same poll showed that a majority of Americans believe the poor and unemployed should get the same quality of health care as people who have jobs and pay taxes.

    How can it be that about the same percentage of respondents believe that everyone is entitled to the same level of health care but that the poor have to pay more if they are unhealthier?

    It does make a kind of perverse sense only if the penalties are imposed on the “unworthy” unhealthy, not the good-character people like you and me who only occasionally travel down the Rocky Road of excess. It may make sense from a moral perspective, but it’s lousy public policy because blaming the victims will neither improve their health nor keep health care costs down.

    Healthier living is not just a matter of “personal responsibility;” it requires persistent and inescapable cues from public interest campaigns, government regulations, inner strength and peer pressure to inform, encourage and reinforce the value of good health for individuals and their families. And it works. People of all moral and political beliefs have changed their behavior in many ways in recent years. They wear motorcycle helmets and seat belts, they designate themselves as drivers of the drunk and they demand that Marriott ban smoking in all its hotel rooms.

    Mass behavior change can happen relatively quickly, as anyone surgically attached to a cell phone can text you. The motivation has to come, first, from within. But sometimes, a regulatory carrot or a 2×4 can get your attention, too.

    Ira R. Allen

  4. It seems evident that /you/ don’t understand the economics of health care.

    For example:

    The best thing to do about the prescription drug benefit package would have been to never pass it. Doing so has guaranteed that prescription drug costs skyrocket even faster, just as every single socialized health care package has helped increase the rate at which health care costs in general go through the roof.

    When the government spends money on something, it warps the ratio of dollars offered versus service or product available. In other words, government spending is a subsidy, and drives prices up. If the Feds decided to spend fifty billion dollars per year on apples, the price of apples would end up increasing tenfold. This is how prescriptions drugs will be effected by the new plan…and this would have been true even if the drug industry were not apparently involved in its writing.

    Likewise, insurance and socialism both eliminate the only real, healthy price control; consumer responsibility. When people are paying for something themselves, they are able to judge and control the cost, and the consumption as well. They decide what they’d be willing to pay, and whether to get it at all.

    Socialism and insurance both strip this power away; today people pay less than 5% of their own health care bills…so it’s not surprising that health care costs up to twenty times what it should. You’d never tolerate paying ten bucks for an aspirin out of your pocket, but when your insurance company or government is paying that much for your aspirin during a hospital stay, you don’t even bother to find out.

    What this guy should have been doing, instead of imposing another huge entitlement, is fighting to deregulate the existing prescription drug situation, which includes returning patents to something closer to what the Constitution was meant to provide…in other words, much weaker patent laws covering fewer things, including less of a monopoly for a company on a new drug.

    Ironically, patents as currently implemented are anti-capitalist. They create an artificial monopoly over new drugs (and new inventions, and new computer algorithms, and gene sequences, and similarly invalid stuff), creating artificially high prices, along with the price boosts caused by insurance and socialism.

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