The NHS is now being instructed to turn its back on ‘alternative’ treatments such as homeopathy. This is a very good beginning… now all we need is for it to turn its back on non-alternative treatments too and Britain can start to allow a First World healthcare system to develop.
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The next step for the National Health ServiceMay 23rd, 2006 |
 69 comments to The next step for the National Health Service |
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Does this suggest that alternative treatments may soon be your best option in England?
The irony is that “alternative” treatments are pretty first-world here already. You ever seen those “doctor&herbs” chinese medicine shops? There’s one in every mall, and they’re as overtly businesslike as Boots or Tesco. Pure quackery, but a shining example of how an undistorted medical market could look.
Truth to tell, there’s been several times of low money I’ve been tempted to give them a try. They’re neither ruinous nor Stalinist, and you won’t catch MRSA. I have a suspicion though that all I’d end up with is the runs in addition to whatever I already had.
There is no First World. The original Cold War formulation was: East vs. West, with a “Third World” that is nonaligned.
Accusing the West of labeling itself the “First World” is a leftist slander.
Jeffrey… ‘accusing’? Get a grip. And maybe you need to travel more.
Is there any “first world” country with a true free market in healthcare? The US certainly does not have a free market.
But we in USA are told British Health Care is what we should pine for!
I just listened to Viggo Mortensen give address at my daughter’s graduation at St. Lawrence University this past weekend, He was all exercised about the awful state of US Health Care and lectured us on how good you Brits had it. He is a famous movie star and of course knows what he is talking about….. doesn’t he??
It is a matter of degree… the UK has a full blown socialist system of state funded heathcare rationing.
Jefferson Doesn’t Address Alleged Facts in Bribery Probe
yikes more corruption
Jefferson Doesn’t Address Alleged Facts in Bribery Probe
yikes more corruption
Jefferson Doesn’t Address Alleged Facts in Bribery Probe
yikes more corruption
Take a breath Trina. It’ll stop that stutter.
Wellll….
Rationing happens in every health care system. This is inevitable when demand (virtually infinite) meets supply (far from infinite, however you go about it)
The only valid question is, how you do the rationing?
— by queues or by price?
You pays your money (something you will do anyway, directly or through taxation) and takes your choice.
But whatever choice, there will be rationing.
Anyone got any good links for arguments against the NHS?
.
Except there is no choice. I cannot opt out of supporting the NHS. Even if I pay for my medical needed privately, I am still forced to pay for the NHS.
Of course you are right, as an individual.
I suppose I should I should have made it clear that by ‘you’ in this context, I meant all of us together, as a nation. And there there is a choice.
And my choice would be not to be subjected to an absurd command economy system for healthcare, thanks.
You are also incorrect as to what ‘rationing’ means. It is a method of restricting a market by allocating resources according to directives rather than price.
In USA at least, there seems to be no Car Insurance crisis. There are multiple providers and stiff competition (re; all the clever Geico gekko adds). It seems that a Car insurance model with medical savings accounts that accrued over one’s lifetime like a 401 k could fix most the present issues. But than again, that would make consumers independent and responsible …can’t have that now can we.
Have you all seen what the US state of Massachusetts is attempting here. I like the experimentation.
If JEM is right about “rationing,” this may be a good step. U.S. states should be laboratories for this kind of thing rather than having the federal government “pine” to be like Britain.
http://www.purplethink.com/epinion/HealthcareMass.asp
Uain, not that I am endorsing the NHS at all as an alternative. However, we should be aware of how people consider healthcare differently. Health is necessary for life whereas cars are not. We have a choice of having car insurance or not having a car at all (actually come to think of it, we should also have the choice of having a car without insurance). People tend to think that health is so important that it can’t be regulated by the market. It is trading in people’s lives. Hence, merely asserting an alternative system along the lines of commercial markets isn’t in itself going to be very persuasive.
Our best line is really:
1. Healthcare has to be regulated someway because it isn’t an infinite resource.
2. Some people blatently don’t have as much regard for their health as others, ergo they seem to place a lower value on it, and that would only be correctly reflected by a market system.
Personally, I would be tempted to go for a mixed system (at least for a while). Encourage people to take out private insurance but offer a state discount to private insurance for those whose premiums are abnormally high or are too poor to pay the whole thing for themselves. But go to lengths to produce a system that demonstrates that healthcare COSTS real money to everyone and so encourage people to be responsible for their own healthcare.
Sorry, no, it’s you who’s incorrect about the meaning of ‘rationing’.
According to the OED, rationing is allocation of a limited resource, such as food say — or in the case being considered here, health care — either by regulation or by price.
Just as I said: every country rations health case, one way or another. It is inevitable — like death and taxes.
Having this discussion on any other premise is simply fantasy.
Traditional chinese medicine(TCM) has its quirks, but in Singapore at least, we have no doubts about its effectiveness. If it was just the placebo effect, then shouldn’t western medicine work just as well?
Every Singaporean knows that when you get a sprain, you see a chinese sinseh, not a western doc. It’s cheaper and the treatment is faster(a few jerks here and there, a few massages, and voila!). The local sinsehs are also good enough to direct their patient to a doctor for X-rays if they suspect a fracture. My sister works at a hospital, and when she had a back problem when carrying heavy loads and had to quit her speciality, the hospital’s doctors recommended a chinese physician well known for treating back problems. She got cured, and her pregnancy did not give her any problems at all.
I had a friend who has asthma when he was a kid. Took damn near every type of western medicine to try to curb it, but no luck. His mom finally decided to toss the dice and sent him to see a chinese physician. Even without asking my friend about his ailment, the fellow took his pulse for all of two seconds, and without preamble proceeded to list out the symptoms of his asthma, as well as the asthma itself. He prescribed some expensive chinese drug, and my friend was cured. Permanently.
My parents had another incredible encounter of a similar sort. There was this TCM professor at the TCM clinic where all Singaporean tourists were obliged to visit on tours to China, and he offered to scan them. No western MRI, X-ray, or devices needed; just his fingers on their wrists and a keen eye. Without no way of knowing their prior medical background from Singapore hospital files, he was able to list out all their health problems, and wrote a prescription, albeit a very expensive one.
Whaddya know, they worked. My mum had too much ‘fluid’ in her legs and face, and her knees hurt. They don’t now.
So there is some validity to ‘alternative’ treatments. My own guess is that it works on some people and not on others, and of course there are some things you just have to rely on western medicine. The trick is finding out which is which, and that’s where research comes in. There’s going to be a local university course next year where students will learn both biomedical technology and TCM, hopefully enhancing the rigor of the field.
Yet another argument for market economics.
You are also incorrect as to what ‘rationing’ means. It is a method of restricting a market by allocating resources according to directives rather than price.
That’s an odd error for an expert in “free market economics” to make. Rationing is in fact what the price mechanism does. Market fundamentals, 101.
I cannot opt out of supporting the NHS
Yes you can. You could use a bit of labour mobility and move to Somalia. I believe they have a pretty freewheelin’ healthcare market there.
In economics, it is often common to use the word “rationing” to refer to one of the roles that prices play in markets, while rationing (as the word is usually used) is called “non-price rationing.” Wikipedia
Is everyone clear on that?
If it was just the placebo effect, then shouldn’t western medicine work just as well?
No, because different kinds of placebo affect people differently. You have to believe in the placebo. There was an interesting trial done, where a doctor gave two groups of patients a placebo. But the doctor thought that one group was getting a real drug. The placebo worked better when given by a doctor who thought it was a real drug, than when given by a doctor who knew it was a placebo but told the patient it was a real drug.
Freaky, eh?
I don’t think health insurance is analogous to car insurance.
By and large, we have far more control over the health of our car than the health of our body. Luck plays a relatively small role (in cash terms) in car insurance – most of it is down to driver skill and common sense. We all have about the same luck on the road. But luck is by far the biggest factor in health insurance payments. We have fastly different individual luck in health terms.
There’s a well recognised system in place for determining fault, if any, when your car is damaged. But there is no system, nor any obvious concievable one, for doing the same with health problems.
Some people, quite early in life, become obviously uninsurable – by which I mean they develop health problems such that the cost of treatment obviously outweighs their entire remaining lifetime earnings. There is no premium you could charge them that would make it worth insuring them. It’s hard to see how such people would fare in a truly free insurance market. If I get multiple sclerosis at 25, no-one is going to insure me unless they are forced to.
A 20 year old who writes off 3 cars in as many months, may become a better driver (or at least a luckier one) in the future. A man who develops bowel cancer at 20 isn’t going to become any healthier. Even periods of remission merely prolong the insurance payouts in that case.
And it’s getting easier and easier to predict who will be expensive to keep alive. There are already genetic tests that indicate such high probabilities of serious illness, that those people would be uninsurable under a free insurance system. Either society would have to ban insurance companies from using those tests, or accept a relatively large number of people dying of chronic conditions with no health insurance.
It’s quite funny when Western doctors pop up to tell us acupuncture doesn’t work. What they really mean is that they can’t work out how or why it works for those 1.3 billion Chinese. It is, after all, an extremely annoying afront to the Western mind that we’ve not yet discovered how it does what it does. Maybe all those Chinese are just very very suggestible (this to some of the most practically-oriented people that have every walked the earth.) When I first started using it (in Hong Kong), I was, of course, utterly sceptical about the guy taking my chi-pulse, and explaining how the chi had got blocked along one of my meridians. All BS as far as I was concerned. On the other hand. . . . it worked exactly as advertised.
Same thing for homeopathy. I took Claritine for years, every day, to ward off rampant and disabling dust-mite allergy. When, as an after-thought, my naturalist/dietician offered to get rid of this allergy via homeopathy, I asked him, joshingly, if he really thought this kind of BS worked. “Well,” he said, “I’ve tried it with about 5,000 people now, and it’s worked, say, 95% of the time.” And it did.
No, I can’t understand how either of them work. But acupuncture clearly does, and homeopathy seems to some of the time.
Still, I suppose we’ll all have to keep paying for the Claritine. . . .
People pay “National Insurance”. Lets see it do what it says on the tin and actually become a National Insurance scheme.
Cut the umbilical chord between our payments, NI, and the NHS Trusts and have the NHS Trusts compete for business from the NI for our healthcare.
Further along the road we can examine how people can opt out of the NI mechanism.
In all this, I see direct funding from the State for A&E, but it should be able to ban unruly and violent individuals who abuse the system.
There is no health “experiment” going on in Mass. The Republican Governor (supported by the Democrat State Leglislature) has just introduced another tax on business enterprises – oh they can get out of it if they provide health cover (which would cost them more than the new tax). Of course big corps who already provide health cover (which can only be paid for by lower wages than would otherwise be the case) will not be hit by the new tax.
So it is just a cover for a tax increase. No wonder the mainstream media and academia think it is wonderful.
As for Britain – the National Health Service already opts out of many established treatments.
The normal line is to make you wait for treatment. You may die waiting, or you may get the treatment when it is too late to do much good.
And it is quite likely to be the wrong treatment (due to various regulations and cost concerns) in any case.
I am still forced to pay for the NHS
This is such a strawman as arguments go.
You’re forced to pay for many many things, many of which are more odious than Universal Healthcare. In general, for access to low cost pescriptions, visits to a GP and a range of relatively instant access services the NHS is a good deal – at least in my direct experience of US healthcare.
On a business trip last week, a US co-worker, covered by what I am assured is our top notch health insurance, was taken ill. He was rushed to the ER where he waited for 5 hours before they got an IV into him and treated him.
His experience and the attitude of the staff, in what I was assured was a “fine” hospital, were certainly on par with the dear old NHS at its best.
The best I’ve seen was in Germany, of course, another “non-free” healthcare system, but a trip to A&E took half an hour for a dozen stiches, tetenus and a course of anti-biotics.
I’m moving to the US later in the year, and, based on my experiences last time I lived there, the one thing I’m not looking forward to doing is finding a Doctor.
“It’s quite funny when Western doctors pop up to tell us acupuncture doesn’t work. What they really mean is that they can’t work out how or why it works for those 1.3 billion Chinese.”
I was under the impression it wasn’t so much that the treatments work but we don’t know how they work, more that it does work but not any better than a placebo. Same with St John’s Wort and depression. If you give people the impression they are being looked after, then they feel better. And feeling better is part of recovering anyway.
Not really. If I could, I would allocate that money to a private insurance policy but I do not get that choice. Moreover the existance of the NHS crowds out and grossly distorts the market for private healthcare, making it harder for those who want to finhd their own way.
And I tend to oppose those too.
Treatments such as homeopathy and acupuncture are very effective at stopping cravings in treating addiction patients. I’ve been very interested in it, as my oldest friend and her mother have both struggled with alcoholism. They were both very, very sceptical when their counsellor first proposed acupuncture as a method of treatment, but they figured “what have we got to lose?!” and went along for a couple of sessions.
C, the mother, hasn’t had a drink in eighteen months now; her daughter hasn’t had a drink in sixteen months. Before that, the longest either of them had gone without a drink was five months and one month respectively. For the first time in a decade, they have futures. I call that a success story. C knows other people who didn’t think it would help them and were surprised when it did.
Our local NHS trust is stopping acupuncture for alcoholics, but continuing to make it available to those addicted to illegal drugs. I’m not usually a conspiracy theorist (I usually roll my eyes at them) but that certainly seems suspicious to me … alcohol, after all, is taxed, whereas illegal drugs clearly aren’t.
I am hardly mainstream, and feel this characterization of what is happening in Massachusetts is narrowly focused on the negative. As a libertarian, I am no fan of increased taxes, but this tax is not to increase the wealth and power of government. Rather, employers that choose not to offer health insurance will assist in offsetting the costs associated with taxpayers subsidizing the uninsured/underinsured.
The $295/employee expense doesn’t even come close to covering the projected shortfall that the state will still need to absorb atthe expense of taxapyers. I hardly find that “cover for a tax increase.”
Bottom line, if it fails, we still learn without imposing an American NHS. I would rather one state experience the failure than all of us.
Let’s get this clear – we are talking about medical care here, not healthcare. They are not the same thing.
If we were investing for health (whether in a free market or state monopoly system) putting your money into medical care gives about the worst return for your money and time. Th public has been conned (perhaps willingly) into thinking that medical care is a prime or major determinant of health. Not true for most people – sanitation and lifestyle (diet, exercise, etc.) has by far the biggest effect. The biggest beneficial effect of medical care comes from simple and cheap treatments in the majority of cases.
If there were a true free market, I suspect most people would come to understand this. Paying (largely – I don’t want to imply that there should be no support for the genuinely unfortunate few) out of of your own pocket would concentrate the mind of most people wonderfully when it comes to the best way to preserve their health.
Yes! Health insurance works when it is for catastrophic care – everything else is a disincentive to maintenance one’s self. This is why I am hopeful that the Mass. law may enable the re-emergence of catastrophic health insurance as a bare-bones minimum requirement to be legally covered. Then, as you state, the populace will be more inclined to care for themselves.
I would allocate that money to a private insurance policy
That assumes that you can obtain private insurance for a cost which is comparable or less than your NI contribution and can maintain that level.
The reality is, of course, that while as a healthy male in your 30s you certainly can, the chances are that you won’t be able to maintain cover over your lifetime and will fall out of the system.
Even the US has to have a seemingly insanely expensive system for covering the health of elders who are frankly uninsurable under a private system – after all, insurance is a business and has to make money.
Moreover the existance of the NHS crowds out and grossly distorts the market for private healthcare, making it harder for those who want to finhd their own way.
Sorry, but that’s more of a feature than a bug. Certainly the UK has a bad deal with the NHS, but I don’t think the US is getting a much better one – certainly not in my experience of it, even with insurance. If given the choice of the two, I think I’d rather have a system of payment and compulsory insurance like Germany, France or other industrial countries.
The public, in much of the world, want 100% coverage, it’s a fight that Libertarians will not win. The question is how to make the systems as “free” as possible and most effective.
Surely it would be better to fight battles that can be won rather than tilting at unpopular Windmills?
Nic,
I honestly don’t accept that accupuncture is nothing more than a placebo: the results are (can be) too obvious and startling for that to be an explanation. A quarter of the world’s population accept it with just the certainty you have in western medicine. I don’t claim it’ll work for anything – who does? how could I? – but I know it works for some conditions. Yes, it is tremendously challenging that we don’t understand how, but that shouldn’t blind you to the fact that it can and does (not the same thing, I accept).
I think in these circs a little cultural humility, and a large dose of curiosity is called for.
First I have been amused by the efforts to redefine the word “rationing” by some people above (supported by internet sources and other ways of trying to prove that black is white).
If the new meaning the word takes hold history books will have to be rewritten.
For example, instead of saying “rationing was introduced in Britain at the start of World War II” one would have to write “rationing was introduced in this island when the first humans arrived here”, “that will be five handaxes for this bear skin”, “I see you are rationing bear skins by asking for handaxes for them”.
On the quality of American health care – I think rather more people go from Canada and Britian to the United States for operations than go from th United States to Canada and Britian.
On cost. I totally oppose the various ways costs have been forced up – such as the F.D.A. (and the various changes to the F.D.A. over the years) which have driven the time and cost of drug development through the roof. And doctor licensing in the various States.
If an A.M.A. doctor than someone the A.M.A. has not admitted then he should advertise his membership of the A.M.A. – not make it a back door closed shop by controlling the medical schools (a good example is how the number of people failing medical courses went up in the late 1930’s so that doctors fleely the Nazis would not force down medical fees).
The old fraternities (mutual aid societies – not college fraternities) were non profit ways of keeping medical bills under control (hence the regulation attacks on them).
However, for profit medical care has a better record of cost control than establisment controlled Blue Cross and Blue Shield (which were NON PROFIT).
Of course the most important reason for the explostion of medical costs (one that leaves even tort legal actions in the shade) is Medicare and Medicaid.
These programs cost 5 billion Dollars (both of them – not each) when they started out. Have a look at how many hundreds of billions of Dollars they cost now (many, many times the rate of inflation).
The “knock on” effect on costs of these Federal interventions is very great. They force costs up.
“Before Medicare and Medicaid came alone the old and poor were denied medical treatment” – simply not true (as Ronald Reagan was fond of pointing out).
Some people claimed that the “free list” that various doctors and hospitals ran did not offer as good medical treatment as the treatment available to people who paid top Dollar – but people on Medicaid do not tend to get top quality medical treatment now anyway.
Lots of typos above. “of the word” (I missed out “of”), “if an A.M.A. doctor is better than”….” I missed out is better.
And “along” not “alone”.
And so on.
Still, I hope, the meaning is still clear.
“Let’s get this clear – we are talking about medical care here, not healthcare. They are not the same thing.”
Too true.
…think rather more people go from Canada and Britian to the United States for operations than go from th United States to Canada and Britian
Paul, that’s a Strawman. I could equally say that I think rather more people stay in the UK and Canada to see a GP or go to an ER.
Besides, based on the news last time I was in Seattle, there are a lot of people going North of the Border in Washington state to take advantage of lower pescription costs in Vancouver. More than were making the other trip.
There is no question that if you have the cash to pay for treatment, the US is going to be the best bet for you.
The problem isn’t for the people who have nothing wrong or can afford to pay irrespective of price. The problem for Health and Medical care providers is at the edges.
What astounds me is that the US gets such a bad deal for the huge amounts of cash spent in the medical industry.
this is from an article in the Times today
Alex – the incidence of illness will be more due to lifestyle/diet and genetics than the amount of money they spend on healthcare, though, won’t it. After all, you spend money to treat the problems you have.
That’s not what is reported:
QUOTE:
A fascinating study published in the Journal of the American Medical Association this month found that white, middle-aged Americans, even though they spend more than twice as much on healthcare as their English counterparts, have far higher rates of diabetes, heart disease, strokes, lung disease and cancer than we[*] do.
It’s not just that they are fatter than we are (though they are), as the results hold even when the sample is adjusted for obesity. We drink more than they do but are still healthier. It’s not that we all have free treatment on the NHS: the study found that even the wealthiest Americans, all of whom have health insurance, are as unhealthy as the poorest English. And it is not that America’s large proportion of ethnic minorities skews the result, as the research focused only on non-Hispanic whites.
“It was a bit of a big shock,” confessed Dr Michael Marmot, one of the study’s authors. “Everybody should be discussing it: why isn’t the richest country in the world the healthiest country in the world?” One of the Americans who worked with him on the research said that, at first, no one wanted to believe the data. But the results are clear. The only question is, why?
END QUOTE
[*] That is, we here, getting by on the NHS
I don’t know why, either.
But I suggest it shows that the idea that a market-led health system is better than a state-run one is just not true, on the evidence. And also, that there is a very poor correletion between money spent and health outcome.
I would add, I don’t see how a market-driven health system can possibly work effectively as very very few ‘customers’ know what they really need or what it’s worth or if it will work. In other words, they are too ignorant of the market to be able to use it in any meaningful way. It’s a 100% sellers market, which is the main reason why the US system is about twice as expensive as the NHS yet delivers no better results — or, according to this repost at least, actualy worse results.
Markets can only work when both buyers and sellers know enough to ‘play’ it in a meaningful way. This is probably always going to be impossible for health.
JEM,
First of all, let’s be clear that we are talking about medical care, not healthcare.
You can make some comparisons of medical care between countries by concentrating on some specific outcomes – for example the number of people that survive common cancers. On most such measures, the NHS scores poorly compared to other western countries, including the US.
More Americans may get certain ailments in the first place, but this is healthcare issue, not a medical care one. It may be that their lifestyle (present or past) increases incidence of various ailments. The article you quote doesn’t analyse this – it just says it doesn’t obviously seem related to current obesity. You can have a generally good diet, be reasonably fit and be obese or you can be unfit, eat cake all day and be obese. The fact of the obesity does not mean that both lifestyes are equivalent health wise.
So it’s not reasonable to cite US medical care as worse value (or plain worse) than the NHS. It is reasonable to assert (as you do) that extra spending on medical care isn’t a big factor in health (in any system) and is therefore a poor investment. In any case, the costs of the US system is hugely inflated by all sorts of producer interests – it is not a particularly free market system.
Well, I am one of those pitiful Americans stranded without national health insurance. I am 40 and just had a second treatment for the second cancer I’ve had in my life. I pay $11.50 per paycheck for my health insurance, and I have not had to pay a red cent for my expensive diagnostic tests, surgery, hospitalization, and treatments. All I have had to pay is a $10 specialist co-pay, three times, to see a world-class specialist oncologist, who is so damn good that people come from all over the world to see him. (The retail price of his clinic appointment is over $400.) That and some prescription co-pays, all manageable and paid with pre-tax dollars from my health care flexible spending account. This cancer was detected by an excellent ENT that I see quarterly to monitor some unusual ear problems I have, for which surgery will someday probably be necessary. He did the cancer surgery and did a damn good job. In my HMO, I don’t need to see my excellent primary care provider before seeing any specialist. I routinely see an ENT, an oncologist, and an ob-gyn without seeing my GP for a referral first.
The po’ folks around here get top quality care on Medicaid, with no copays. Actually, there’s a $1 copay on prescription meds now. They also get dental and vision for free.
The working po’ go to public and charitable free clinics, staffed pro bono by the volunteer hours of the same excellent quality doctors that I see as a paying client.
No one is turned away for treatment in American ERs. There’s a lot of po’ folks and illegal immigrants who don’t bother signing up for Medicaid, even when the hospital social workers beg them to, because they don’t need it. Hospitals have multimilliondollar charitable waiver programs. So even the “uninsured” get top care.
That giant sucking sound is what we pay to maintain Cadillac care for the elderly, regardless of means, in Medicare. They are incredibly expensive. I can see why other countries ration care for the elderly. I think poorer, younger, working families paying high taxes for better care for the elderly than what they get for their families, will revolt politically at some point. Still, we are attached to the idea of saving granny at any cost (to others, not ourselves), that I think the idea of rationing care for the elderly will be abhorrent. Besides, it’s the seniors who are incredibly well organized politically, and the Baby Boomers are retiring now, it’s a numbers thing in politics. They’ll patch the donut hole in Part D and bill us younger folks for it.
At least in Canadian and British NHS, you can seek private paid care. That would have been illegal under Hillarycare, early 90s version, with heavy fines and jail time for both the patient and the doctor.
Free market American medical care exists, and it is the only place where costs have fallen due to increased competition. To whit: cosmetic surgery, LASIK, new unapproved procedures…like my two dental implants. The second one was cheaper than the first (market forces). Both were clearly worth it, and much less destructive to healthy teeth than the procedures that would have been covered by insurance. My choice.
I am considering saving my pennies for a bellyectomy LOL…surgically slimming the midsection bits I can’t seem to diet/exercise away with midlife descending upon me relentlessly. Merely for orthopedic and athletic performance reasons, not vanity. The only reason why I care is because it would improve my rowing stroke and speed in the boat. I even have a rowing friend who is a plastic surgeon willing to cut me a deal.
NHS style health care scares me!!!!
1. Break the NHS into regional health providers. Abolish the NHS moniker.
2. End national pay negotiation / rates.
3. Freeze pay outside London and the SE for 5 years.
4. Split health ‘Insurance’ from service ‘Provision’ (e.g. Oxon Health Insurance versus Oxon Hospitals). Set-up simple contracts between Insurers and Providers, a daily hotel rate plus theatre time.
5. The Insurers to employ GPs directly on vastly reduced salaries. Encourage investment in expert systems to speed diagnosis and prescription. Charge a small fee on a rising scale to discourage time wasters.
6. Make basic Insurance free (paid by the state) and encourage people to opt out.
7. Sell the Providers, the hospitals.
8. Encourage the Insurers to offer paid for top-up policies.
9. Sell the Insurers.
10. Control healthcare cost inflation by restricting what the Insurers get from the government for the basic free care, adjusted by regional costs of living.
NHS style health care scares me!!!!
I’m not entirely sure why. You certainly have excellent treatment, good for you! However, I’ve other USian friends who’ve had the exact opposite experience, fortunately not with Cancer but certainly with other conditions where they’ve ended up with huge bills and a lowered standard of living because their HMO won’t cover them.
I understand that everybody is treated in the ER and can get incredible and often heroic treatment there. But that, in itself, is a huge problem.
Without a mechanism for preventative care, people will naturally put things off and potentially by the time they present in ER, a simple low cost treatment could be really expensive.
Of course, you could argue that that could be their own fault for putting something off – but the reality is, that is exactly how people behave.
kentuckyliz,
I regularly race my coach (he taught me to scull) and I tend to beat him these days despite the fact that he is much more technically skilled than me (we’re about the same age and size). I put my wins down to the fact that he has a bigger stomach than me which shortens the finish of his stroke!
So although the thought of non-vital surgey scares me, you may well be right about the benefit to rowing performance.
It is the cost of proscription drugs in the United States compared with Canada that is the “straw man” Daveon.
One either supports patents or not (I am not going to argue the matter either way) but you have not said “I do not support patents”.
By the way if there are going to be no patents (so that drug costs can be lower in the United States) you would have to (in justice) abolish the F.D.A. (which massively increases the cost of developing treatments) and you have not written a word (that I know of) about the need to abolish the F.D.A. – which is also (of course) responsible for tens of thousands of deaths by the delays that it puts into the development and the distrubution of new treatments.
People who are very ill should be allowed to take risks.
As for the N.H.S. I know this system well (one of my relatives works in it).
Here is a typical example of the N.H.S. – my mother (a firm supporter of the N.H.S. who refused point blank to consider any other option) died of cancer – the treatment provided? “They made me a nice cup of tea Paul – in a real china cup”.
Although you are clearly a statist I certainly do NOT hope you get cancer Daveon – but if you do it would be interesting to see how long your support for the N.H.S. lasts.
Certainly there still is a sense of service (although it is in decline) – but that is a hold over from the old pre N.H.S. days.
I used to guard a hospital in London (I have guarded hospitals in various parts of Britain) and I found old rotting copies of the history of the hospital in the basement – a story of free service provided over many decades by dedicated people (long before the N.H.S existed).
If you go to a British hospital keep a sharp eye out – one can still sometimes find signs that money and time were provided long before 1948.
The system is falling apart (as even the health service managers, let alone the doctors and nurses, will admit) – to defend it is to do the people of Britain great harm. The longer they are told that they do not need to make provision for either their own health or that of the poor – because “the government will do it” the more people die who could have been saved.
As for the idea of spreading the N.H.S. to the United States – I believe that was tried in the State of Louisiana (look up what happened).
It disgusts me that people are still prepared to defend the absurd idea of government health care.
Especially in the United States where even government financed health care (Medicare and Medicaid) has been a total mess – an explosion of costs that have not just inflated the programs themselves but have spilled over into general health provision as well.
“Why is American health care so expensive” from the same people who support Medicare and Medicaid. The hypocrisy is almost beyond belief.
The effects of these (and other – such as the licensing laws) government interventions are used as an excuse for yet more government interventions.
It reminds me of the people who tried to redefine the word “rationing” so they could claim that nations like Canada always had rationing (before government health care).
The Russian saying springs to mind. “They smash your face in and then they say you were always ugly”.
I should have said that even health service managers will admit IN PRIVATE that the system is falling apart (in public they are the government’s strongest supporters).
I know the private opinions of N.H.S. managers from first hand conversations with them.
I should have also (in fairness) have stated that my mother’s cancer was cut out by an N.H.S. operation. However, as she been waiting a very long time indeed, the cancer had spread.
I might as well get the other family history done with.
First me “he is a hopeless case, he will never be able to do his own shoelaces up or anything like that” – this was not said to me, but it was said in my presence (when I was child). My father did not give up on me and I can do quite a few things (including tie my own shoelaces).
My father himself. I once had to go to Kettering General to help him leave.
I admit that I never got the full details, but he was convinced till his dying day (many years later) that had he remained in that hospital he would have died (and he was not a man given to fear).
The reason I had to come was because he was in a very poor state, and the staff were getting in his way. I was careful not make a direct threat of physical violence (that is a criminal offence), but to make it clear (by facial expression and body language) that physical violence would occur if they got my way.
My bluff (although I do not know whether it was a bluff or not) was not called.
My Aunt (a person of very modest means) has had to have private medical treatment on several occasions. If she had waited for N.H.S. treatment she would be dead.
“not TO make a direct threat” and “to make IT clear” (etc).
Oh well those N.H.S. people may have had a point when they said I was hopeless case.
Although you are clearly a statist I certainly do NOT hope you get cancer Daveon – but if you do it would be interesting to see how long your support for the N.H.S. lasts.
Ok Paul, I’m assuming that you’ve a number of personal issues here otherwise my response to your rambling diatribe would be a lot more Anglo-Saxon.
I was quite clear that I have private coverage, I work hard, I can afford to pay for things and have paid for myself to see doctors and specialists in my own time because I did not want to wait for the NHS.
There is that choice and I am able to make it because I’m pretty well off.
A lot of other people don’t have that choice.
I’m perfectly happy to pay for them, I don’t see it as a burden and morally any alteranative is utterly repugnant to me. Even care for you Paul.
As it happens my nearest and dearest have had experience of the NHS. My father had cancer and made a full recovery, my mother recently had surgery – she’s made a full recovery and was in fact out canvassing within 2 days of the operation.
As I also said, I don’t think the UK nor the US are particularly good models – there are much better services out there which are also universal and seem to provide much better value for money.
Clearly you have a reading problem Daveon, as I said that I hoped you did NOT get cancer – not that I hoped that you did.
I also notice that you have not replied to my points about the F.D.A. or about doctor licensing, or about Medicare and Medicaid (or indeed about anything).
All you have done is insult me, “rambling diatribe” and so on.
As for your desire to pay for the medical treatment of the poor.
Good for you!
Please do so (most people used to give money for exactly this purpose).
However, that has nothing to do with the N.H.S.
The N.H.S. is not about giving – it is about the government taking.
Also the N.H.S. is open to all.
And it is the well connected middle classes (not the poor) who stand a chance of getting good treatment.
If you think the poor tend to get timely and good medical treatment from the N.H.S. you know nothing about the subject.
See, that’s the interesting thing. As an Amurrican, I see the NHS giving differential treatment based on social class, that the poor aren’t getting good medical treatment, and a lot of wealthier people resort to private pay arrangements outside the system….
And in the USA, we taxpayers pay for the medical care of the poor and aged/disabled (Medicaid and Medicare, respectively), and there are free public and charitable clinics for the uninsured and hospitals won’t turn anyone away and have huge charitable programs.
So why would the USA take on an NHS type system?
I think there should be tax advantaged MSA’s available to all, not just those who are self-employed/employed by a small business who have a catastrophic coverage policy. Why should I have to spend my health care flexible spending account (S125 plan) each year? Why shouldn’t it be a permanent account, allowed to accumulate and grow for the occasional catastrophe, or invested for later life care?
My Dad’s Medicare days ran out on his nursing home, and he’s waiting for an assisted living apartment to open up. He got the first bill, $5500 for less than a month. I have LTC insurance! Why shouldn’t we have tax advantaged savings/investment accounts?!
kentuckyliz,
I’m not going into details of my and my family’s experience. I have no wish to become a dartboard for idiots like daveon.
I have had the best insurance available and had ~18 reconstructive operations under it. I have been uninsured and sought medical care. There is no possible comparison to be made.
Please do not tell people how good medical care for the poor is in the US until you wake up one day (you personally) and find yourself un or under employed, uninsured and seeking medical care.
You will be billed at approximately 3 to 5 times the prices the insurance companies pay. If you want to use medicaid, you must have no assets that can be sold. One farmer I worked for lost his life savings, his house, and everything else when he had a heart attack. He now lives in an apartment in the city. I didn’t embarass him further by asking if it was ‘low income’ housing.
I suspect research would suggest it is difficult to get a truly honest diagnostic because whoever finds a major illness will get stuck treating it and having to either not get payed, or go through legal procedures to take someones life savings away.
Just my 2 cents.
Midwesterner: it did happen to me a few years ago. I was unemployed at the time, and uninsured when I collapsed and was rushed to the ER. The care was first class and I was seen immediately; within minutes I had an IV in and was sent for an MRI scan. This revealed a huge (12mm) kidney stone that had to be smashed by lithotripsy. I could not afford the $8,000 bill, but got the university hospital to write it off without anyone selling my house or car.
Paul, I suggest you go back and read your posts.
If you think the poor tend to get timely and good medical treatment from the N.H.S. you know nothing about the subject.
Actually, I don’t think the poor get particularly good medical treatment from the NHS – as I’ve said on this thread about 5 times now. Nor do the poor get particuarly good treatment under the US system.
Given that ultimately you end up with some form of universal coverage, because people generally don’t like to see people dying of things that can be treated, the question comes back to what is the most effective and efficient way of funding that coverage.
Several countries seem to have a good universal model – the UK is not, as I’ve said, one of them.
most people used to give money for exactly this purpose
Yes they did. In days when care was significantly cheaper and less effective than it is now. That’s why things changed – the majority of people didn’t
Midwesterner:
I have no wish to become a dartboard for idiots like daveon
Interesting “phrase” there, apart from the ad hominem, which I think was uncalled for, but par for the course around here.
Why on Earth should you end up as a dart board, unless you think it’s going to be easy for an “idiot” like I obviously am, to throw on target “darts”.
I don’t think the NHS is a good nor sensible model for any country and am getting tired of saying that.
I do think, however, that in an advanced, rich, industrial country in the early 21st century, that medical care should be universal.
As there are a lot of countries that seem to be able to manage it, that suggests that there are models between the US and the UK which can work.
So why would the USA take on an NHS type system?
I wouldn’t suggest it should, and regardless of what people are suggesting here, I’m not.
There are a couple of principle issues here. Firstly that around the world most people want/expect there to be unversal medical coverage, secondly that private insurance companies are businesses and need to make money to survive.
As there is a basic incompatability between these two aims.
Universal coverage for emergencies also has its problems because of people’s natural tendancy, if something will cost them, to put off seeing a Doctor. Simple blood pressure monitoring and medication is a hell of a lot cheaper than medical care for an MI or an emergency bypass.
I don’t think the UK has it right, nor, based on my own experience and that of insured friend’s living in CA and WA, do I think the US does.
I think that France, Germany, Japan, Scandavia and others, who, as a percentage of GDP pay more than the UK but less that the US, do have it better.
Actually, Midwesterner, I have had the experience of which you speak, and my sister and her family are farmers who have at times purchased catastrophic insurance, been uninsured, sought employment off the farm for insurance purposes, tried to apply for state children’s insurance for the working poor, and been forced to get family Medicaid because their income was too low. (They actually *wanted* to buy the state children’s insurance plan and were not allowed to.) This is ridiculous. They are wealthy multimillionaires in assets including stock holdings, and their income appears artificially low because of the business write-offs permitted to farmers.
I was laid off a year after having cancer the first time and going through a scare of metastasis, and my COBRA payments were higher than my unemployment payments or any income I could get working what I could until I found my next professional position FOURTEEN months later. I had to spend my dwindling savings on health insurance.
Any uninsured health care I have ever bought has been below market price, and below what the docs bill insurance companies. You don’t know how to negotiate! If you tell them you’re uninsured and a cash customer willing to pre-pay, you can get rock bottom medical bills because they don’t have the expense of having to deal with the insurance companies.
When my farming relatives were having babies, they were uninsured and sold cows to prepay their maternity and delivery costs. They negotiated as cash customers and shopped around the different hospitals and birthing clinics…and got the best deal. Of course, they were referred to social services and law enforcement for paying cash for their hospital bill, it triggers suspicion that they’re drug dealers or something.
Hospitals have charity programs and can be negotiated with.
For some reason, people think that their health and medical care isn’t something that they should spend their money on, but having a huge house and a fancy car and a big screen hi def TV are. ??? I think their priorities are whacked. When you see a doc or a hospital for medical care, you sign papers agreeing to pay whatever your insurance doesn’t. I don’t know why people think they should have the right to renege on their word.
Daveon asks me to go read my own posts – as he has still not dealt with the points I have made (about the F.D.A., about doctor licensing, indeed about anything) I would advise Daveon to go back and read them.
We now have an historical claim from Daveon. This claim is that “things changed” (i.e. the N.H.S. was created) because medical care became more effective and expensive.
Simply not true Daveon. The N.H.S. was not created because of some change in medical practice, it was created for the same reason that most such interventions occur – ideology.
One might as well as say that John (later Lord) Reith insisted the government take over the B.B.C. because of some technical broadcasting matter (of course, in his mind, “public broadcasting” had become fused with state owned broadcasting).
Unless you die with in the next few years you will live to see the final collapse of the Welfare States.
I would prefer to see the various “entitlement programs” in Brtitain, the United States, France, Germany (and so on) gradually reformed out of existance (which, I believe, is still technically possible even at this late stage – there is nothing inevitable about future economic collapse, it is being created by bad policy).
However, due to people such as yourself (who pretend that the only alternative to government control is “people dying in the streets”), this is not likely to happen.
If the welfare states are not scaled back they will collapse – and people like yourself will not allow any roll back.
Oddly enough there may actually be people dying in the streets (or, rather, more people dying in the streets as they are some people who do so already) – due to the economic chaos a general collapse of finances will bring with it.
But it is not people like me who will cause this Daveon -it is people like you.
People of your type have had victory after victory in preventing any control on the exploding costs of the Welfare State (which have been matched, of coure, by its declining effectivess), and you will live to see the results of your victories.
I repeat that none of this is inevitable. It is the result of bad policy – policy that (in theory at least) could be changed (even at this late stage).
But there is no political will to make this change. I see no possibility that the absurd idea that the government can take care of millions of people health, or their old age will be rejected (and proper reforms be put in place) before the whole house of cards comes down.
In private civil servants and politicians may accept that the present system can not last. But in public they say no such thing.
I had decided to leave my personal experience out of this. Beyond saying I don’t think it’s a matter of negotiating. Males in their thirties and forties without children and with some assets do not make very sympathetic ‘victims’ and are not cut any slack. And you need to forget about what doctors bill insurance companies, because that’s not what they are payed by them.
Doctors are free to bill the companies whatever they want. But the insurance companies will only pay whatever they choose to ‘negotiate’. Here is a sample bill(PDF). Notice even in the sample the amount of the ‘discount’. In reality it is usually much greater than even that. I just went to the file cabinet and pulled out one of my father’s bills. The provider billed $1,952.00 dollars. Of this, $353.80 was declared to be ineligible (and not billable). The insurance company ‘negotiated’ a $1,509.74 ‘discount’ on the remainder and agreed to a charge of $88.46! Of this, they paid 80% and my father’s portion was $17.70. Just in case you didn’t follow all that, the retail price of the procedure was $1952, the final amount paid was $88.46!
The farmer I had worked for was presumably trying to make the wisest possible choice in a devil’s decision. Millionaire!! Get real! He had worked approximately 16 hours seven day weeks on a share cropped dairy farm from around high school until maybe 40 years old. Being a share cropped farm, he couldn’t sell cows, he was a share cropper. Besides, telling a dairy farmer to sell cows is like telling a carpenter to sell his tools to buy medical care. With that kind of fore sight your should either be in academia or politics!! Due to his fathers health problems the farming operation stopped. He had paid off a small house worth approximately 35 to 50 thousand dollars. He probably had equal or more than that in savings. He got a job as a night clerk at a filling station. This was probably barely subsistence and almost certainly not enough to buy health insurance and still eat and drive to work.
So at age forty, the farmer at this point had some options. Assuming he kept the filling station job, he could,
a – spend down his savings buying insurance. He would probably have run out between 50 and 55 years of age leaving approximately ten years uninsured before Medicare kicked in. This leaves him with a house and no savings at ‘retirement’.
b – spend down his savings buying insurance (as above) then borrow against his house to pay the premiums until Medicare kicked in. This leaves him with no house and no savings at ‘retirement’.
c- gamble on his health in the near term and wait 10 – 15 years to buy health insurance. Then spend down his savings to pay for it until retirement. This leaves him with a house and no savings at retirement. But he is continuously covered from about age 50 to 55 on.
d- gamble on his health until Medicare kicks in and retire with his savings and his house.
To me, c seems a reasonable choice. Unfortunately he had a heart attack in his forties.
Post script, I am really curious what state gave Medicaid to your millionaire relatives. Every body I know has had to spend down their assets to a very low amount to qualify. Here is Wisconsin’s Medicaid information. There is a whole legal art to transferring assets to family members before the Medicaid retroconfiscation window closes. In our state, I think it’s at least two years and they’ll come after whoever you thought you transferred assets to and confiscate them.
And you are wrong. Cash customers scare the bejeepers out of medical providers precisely because they know there is almost certainly no more where that came from if anything goes wrong.
And my impression of charity is that it is for small change (like that 8000 dollars mentioned by another commentor) and for ‘evening news’-‘put it in an advertisement’ publicity cases. Everything else is referred to Medicaid.
Your last paragraph is too condescending to warrant a serious answer. I work 24/7 caring for a family member who’s social security check doesn’t even cover expenses. I get paid basically a token amount. Being extremely disabled, this person could be (miserable) in a nursing home costing taxpayers the $5500 a month you mention. My pay last year gross minus social security etc tax, with health insurance, and the taxes that I would have to pay on health insurance (but businesses don’t) would be somewhere near zero or negative. And you’ve got the bile to suggest that I’m the free loader.
The rising costs of private medical cover are a serious problem. Although (contrary to Hollywood, the media and academia) the costs of Medicare and Medicaid have risen much faster that that of private insurance.
It is quite possible that the old system of “Friendly Societies” in Britain and “Fraternities” in the United States (back in the days when a “fraternity” was something rather more than a student drinking society) was better than insurance companies – although different people are different situations.
The 80 plus per cent (and rising) of industrial workers who were in Friendly Socieites in 1911 had direct control over medical care costs (as the common practice was for doctors to be paid on a fixed contract basis by the society – rather than per treatment).
For profit (as opposed to non profit) H.M.O.s sometimes copy this system – although there less direct control by the patient over medical practice than there was under Fraternities.
The Blue Cross and Blue Shield non profit insurance companies were neither controlled by their members (as the fraternities had been) or interested in keeping costs down in order to produce a profit (as for profit H.M.O.s are).
Still we are where we are and a ways to reduce costs can be put in place.
1. The F.D.A. should be abolished. This would mean that drugs get to people years quicker and at a fraction of the cost (thus saving thousands of lives). It is not in the commercial interests of companies to kill their customers, and people should be allowed to take risks with new drugs (if that is their choice).
2. End regulations on both insurance companies and on H.M.O.s (apart from the old law of contract). Yes it would be really nice if everyone was offered lots of nice things in their plans. But some people can only afford basic cover – so the effect of demanding so many things be put in plans is that many people can afford no cover at all.
Also “discrimination” is just another word for freedom. If a company wants to charge a higher rate to cover (say) homosexuals (because they calculate that such people are more likely to get A.I.D.S.) that is their business. Saying that everyone (regardles of “gender, sexual preferance, race…….”) must pay the same – just means that everyone pays a fortune. And yes I did write “race” – if a company (or non profit foundation) want to charge a person from one race more than someone from another race (or not cover them at all) that is their choice.
If New York Times readers do not like this they should set up their own company and charge less (after all such people are certainly rich enough to do this – if they would “put their money where their mouth is”).
It is not just the cost of the regulations. It is the vast cost of the admin work that goes with the regulations that pushes up costs.
3. An end to doctor licensing. This was a scam from day one. In State after State the A.M.A. insisted on licensing laws being put in place – as it knew that it could gain control of all “approved” medical schools and improve the income of its members.
Milton Firedman got his Ph.D expossing this scam more than sixty years ago, but nothing has been done to end it. If A.M.A. doctors are really better than other people in the health field they should advertise “A.M.A. approved” and let people flock to them. If they need the threat of government action to maintain their position there is something wrong with it.
4. Gradually get rid of Medicare and Medicaid. The costs of these programs are exploding so they will either be controlled – or they (and the rest of the Welfare State) will utterly destroy civil society. Also (of course) the cost explosion of Medicare and Medicaid has a “knock on” effect in (to some extent) dragging up private medical costs.
These programs should be turned over to the States with the money that the Federal government was going to spend on them in the current fiscal year – but with no increases in future years (indeed with Federal funding gradually being reduced).
As cost mounted, each State would find ways to reform programs that were now totally under their control. And the most successful States would be copied by others.
A more radical policy would involve selling off Federal assets (such as the one third of the country that the Federal government unconstitutionally claims to own and the interstate road system) and the money being used to set up a trust fund for the old and sick – so that they would have something to fall back on.
It is too late to tell (say) an 80 year old man “what a fool you were to trust the government – you should have being saving for such things as sickness and old age since you were 21”.
5. Tort law reform. Each State (Federal tort law reform raises Constitutional problems) should seek to reform tort law so that the old law negligence is restored. Not “a bad thing has happened so someone must pay” – but “we can prove, to a civil [not criminal] standard of proof that this person acted in a negligent way”.
In this way such things as legal insurance cover for doctors would come down, and medical practice itself would become more patient centered – not lawyer obsessed as it is now.
There are many other things that could be done.
Sadly the political chances of anything serious being done are very low.
The cost of the Welfare State (in nearly all Western countries) will continue to rise and its effectiveness will, of course, continue to fall – with more and more people “slipping through the net”.
Till, in the end, the Welfare States collapse and take civil society down with them.
It is unfortunate, and it could be avoided. But I see no sign that it will be avoided.
I have just written a fairly long comment. Mostly on practical things that could be done (I am trying to get away from pointless flame wars with statists). It has been hit by smite control (perhaps due to its length).
Hopefully it will appear in due course.
Paul,
Your knowledge of history as usual far exceeds mine. I agree with almost all of your suggestions with the following caveats.
Ending the FDA can only work if full disclosure of all research and who funded it is stipulated as good conduct business practice. If a manufacturer turns out to have withheld negative results or have been secretly the funder of favorable research, this is a violation of fully disclosing risk to potential patients/subjects/customers.
I’m right with you on the regulations covering what insurance may be written. Those mandates are absurdly destructive fantasies in the same way as minimum wage laws. They simply deny opportunities and choices to the victims they pretend to help.
AMA is nothing but a modern style trade union.
Might I add that it needs to be made clear that people own their own bodies and the medical records on them. No information may be withheld because the doctor doesn’t approve of releasing it to the patient.
Medicare and Medicaid will and are destroying the last vestiges of both affordability and quality of care throughout all of the medical industry. But like many extreme dependencies, withdrawal could be deadly. You recognize this in your example of the 80 year old man. Your idea of turning them completely back to the states, free of government funding or mandates is probably the safest route to go.
Here are two points on which we may disagree. First, I am not at all comfortable with the idea of privatizing the interstate highway system. Originally founded as the “National System of Interstate and Defense Highways” by the “Federal-Aid Highway Act of 1956”, every hurricane we have demonstrates its importance to national safety and security. I believe its functions are part and parcel of the preamble to the constitution. I am open to debate, but this is what I think now after substantial thought on the subject.
I am also thoroughly uncomfortable with the idea of selling collectively held assets and setting up a trust fund. Much as I detest any collectivism in government, I fear liquefying the assets while under the same controllers that have created these messes in the first place. Social security is vested in a government style trust fund. Need I say more?
Like many on Samizdata and probably you too, I am reaching the point of wondering if there is any margin yet to be had in salvaging this creature our government(s) have morphed into versus letting it/them fall in on itself. But I suppose that has the potential to be even worse.
I agree with Midwesterner that companies (and individuals) must be open to legal action for deception (i.e. fraud) – this is and should remain part of the criminal law.
I also agree that companies should be open to civil action (tort actions) – but I hold that the old rules of tort (i.e. proof that the party sued was actually at fault – if only proof to a civil [balance of probabilities] rather than a criminal [beyond all reasonable doubt] standard).
However, I would stress that it is not in the interests of a drug company to kill its customers – or to have its image destroyed by a media exposure that its new drug does not work.
Further I would say that people should have the right to risk a dangerious drug.
“drug X will most likely kill its user so we should ban it” – NO, someone should be allowed to use drug X (and people should be allowed to sell it) if they believe there is no other way – i.e. their sickness is even more likely to kill them.
On roads.
Yes Congress does have the right to build “post roads” under the Constitution of the United States (Article One, Section Eight).
However, what Congress has a RIGHT to do is still a matter of choice (they do not have to do it).
The environmental costs of road building (or rather of the things that run on the roads) are causeing increasing concern. Perhaps the old system of railroads (bankrupted, in part, by the “free” road system) was better.
Although, of course, private roads is not the same as no roads. As the old book “Uncle Sam Monopoly Man” makes clear, such things as light houses and roads do not have to be provided by government.
You are right that the Social Security “trust fund” is a total fraud. If the criminal law applied to private companies was applied to government every President from F.D.R. onwards would have been sent to prison.
How the tens of millions of people who have become dependent on government are to be saved is (I admit) a difficult question. However, the political class seems to have “solved” the question by deciding to do nothing at all – the system will carry on till it collapses (taking the people with it).
The Democrat Senator Bob Kerry (of Nebrasska) uses to warn of this. Now no Democrats and only a few Republicans (such as Ron Paul) do. I suppose politicians have come to the conculsion that the whole area of reform is a vote loser.