National Center For Policy Analysis @ MindSay 
A culture of corruption exists in America that is both extensive and profoundly pervasive. It afflicts all of America’s institutions and is responsible for both the low esteem in which those institutions are held by the American people and this nation’s inability to solve its social and political problems. This culture is so entrenched that it considers itself invulnerable to criticism. When corruption is discovered and publicized, rarely is a mea culpa issued; the publication is usually ignored by the guilty who continue to act as though the discovery were never made. Oddly enough, the low esteem in which the institutions’ are held is rarely transferred to the individuals who manage those institutions; thus, although only 14 percent of the people approve of the Congress as a whole, the same individual Congressmen get elected over and over again and are still addressed and considered as honorable. While the members of a criminal institution are considered criminals, the members of corrupt public institutions are not generally considered to be corrupt even though an institution of any kind can only be corrupted by corrupting its individual members. That fact, perhaps, explains why corrupt public institutions endure and cannot be reformed, and perhaps the only way to reform such institutions is to begin calling the spades that comprise these institutions black.
There is one corrupt institution in America that has so far avoided this disapproval–America’s institutions of higher education, especially their post graduate, their Ph.D. granting, departments. The corruption of these departments is subtle; it is exposed only by the actions of their graduates who are rarely linked to the institutions that granted their degrees. Many of these graduates engage in careers that consist of publishing propaganda in the name of research, and even when their “research” is subjected to devastating critiques, these critiques are completely disregarded as though they never existed. Such disregard displays an almost total degree of intellectual dishonesty and a complete antipathy to truth, and academic institutions that do not instill a devotion to both intellectual honesty and truth in their post-graduate are corrupt to the core, for the traditional purpose of the Ph.D. degree is to educate people for the advancement of knowledge. Without a devotion to intellectual honesty and truth, such advancement is impossible.
I have been a devout critic of such people for some time, and I have not only posted my critiques for public examination, I have always sent courtesy copies to the individuals involved. All of these posts can be read in this blog (http://johnkozy.mindsay.com), but what recently provoked this reaction is an piece written by John C. Goodman (what a misnomer!) that was published in the Dallas Morning News on July 16, 2007 under the headline, “Film buffs may praise Moore’s ‘Sicko,’ but policy buffs can see all its defects.”
Now I am not a defender of Moore or his movie. I have not seen it, and since I’m not much of a movie-goer, I am not likely to see it. But one doesn’t need to see or even know anything about the movie to understand how nonsensical Mr. Goodman piece is. Right from the start, in the second paragraph to be exact, he locks himself into a contradiction. He writes, “Sicko isn’t a movie about health care and how to fix it. It is a one-sided attempt to drive a very specific agenda–single-payer, government-run health care.” But John, single-payer, government-run health care is proposed as a way of fixing our broken health care system. So if the movie is about single-payer, government-run health care, it is about health care and how to fix it; it can’t be any other way.
But it’s Mr. Goodman’s arrogance that is grating. He writes, “A majority of movie reviewers and columnists have praised Mr. Moore’s filmmaking and lauded him for “raising the important questions. The problem is, few of them can speak to the policy issues. . . .” And then, “Why . . . is national health insurance in other countries as popular as Mr. Moore says it is? One reason is that people do not realize how much they pay for it in taxes.” Now how could Mr. Goodman know that either of these statements is true? What evidence could he ever bring to bear to support them? Has he tested people on their knowledge of policy issues? Has he objectively surveyed the citizens of other countries to determine what their knowledge of where their tax contributions go? Of course not. Mr. Goodman’s claims are the claims of a scoundrel. He also writes, “If you have never tried to see a doctor in Britain or Canada, you might even believe it.” Well, how many times has Mr. Goodman tried to see a doctor in these countries? Is his knowledge of the national healthcare systems of these countries based on personal experience or hearsay? These statements and others are not only unsubstantiated claims, many of them are unsubstantiatable.
But what’s even worse, the criticisms he levels at the healthcare systems of these countries apply even more so to the American system.
He says that in Britain, about 1,000,000 are on waiting lists, in Canada, more than 876,000, and in New Zealand, more than 90,000. But he neglects to point out that in America more than 47,000,000 can’t even put their names on a waiting list. Put these numbers in a list and compare them:
1,000,000
876,000
90,000
47,000,000
So even if his numbers are true, the criticism is absurd. And then he writes, “In fact, people in other countries often have to pay out of pocket for care that has been denied them by the government.” This claim may very well be true, but in America, the insured have to pay out of pocket even for insured procedures. Hasn’t Mr. Goodman ever heard of co-pays and partially covered procedures. An American with health insurance goes into a hospital for even a minor procedure and comes out owing thousands of dollars on top of what his insurance has paid. That never happens to a Canadian or Britain or a New Zealander.
The real “in fact” is that Mr. Goodman is a shill for a corrupt, inefficient, and mediocre healthcare system. Within the past year, the New England Journal of Medicine published a piece showing that Americans of all income levels are being subjected to sub-par medical care and we’re paying more for it, as much as one and a half times more, than the people in any of the countries whose healthcare systems Mr. Goodman criticizes.
And there is example in Mr. Goodman’s piece that utterly baffles me. , “Why . . . is national health insurance in other countries as popular as Mr. Moore says it is? . . . A third reason is that most people are healthy.” Why so, I wonder? Is it because they have better healthcare?
Finally, the worst thing about Mr. Goodman’s piece is that not an iota of it is original. Robert Weissman has a piece on the web at http://www.counterpunch.org/weissman07182007.html titled “More Humane and More Efficient National Health Insurance” which contains the following paragraphs:
“The health insurance industry and its allies have worked hard to respond to SiCKO by promulgating a series of deceptions. It's awfully hard to defend the current U.S. system, so their emphasis is on criticizing other countries' healthcare systems.
They have a lot of practice at this stuff. Get on a call with people like Sarah Berk of Health Care America and Sally Pipes and John Graham of the Pacific Research Institute, and they will compellingly recite three key misleading arguments:
* People in other countries have to suffer through long waiting periods before seeing a doctor or getting treatment.
* National health plans ration care.
"Government-controlled healthcare" or "government monopoly healthcare" is inherently of inferior quality.”
Mr. Goodman not only lacks a devotion to intellectual honesty and truth, he even has to copy other people’s stuff. He is a spade that surely should be called black.
© 2007 John Kozy, Jr.
The American Healthcare System—A Disaster in the Making
The collapse of the American Health Care Delivery System becomes more and more evident as each day passes. Consider what we know:
1. Americans pay more per capita for health care than the residents of any other nation and get less for it than the residents of many other nations. (These numbers are regularly published in the Economist.)
2. A recent study published in the New England Journal of Medicine reports that “U.S. patients receive proper medical care from doctors and nurses only 55 percent of the time, regardless of their race, income, education or insurance status.”
The upshot is that Americans are getting their pockets picked for inadequate health care. How the American medical profession can be complacent about this is difficult to understand. One would think that the AMA and other medical groups would be engulfed in shame and howling like coyotes baying at the moon. But except for an isolated voice here and there, the group is mostly silent.
This collapse of the health care system has been in progress for some time. Its continuous degradation has been fairly obvious; yet no major influential group seems to want to do anything about it. Politicians can’t because they are too easily influenced and beholden to heavy contributing special interest groups and fall prey to their lobbyists. The insurers won’t because their businesses are at risk if the system changes, but why the medical profession isn’t is a mystery.
What’s worse, however, is that the “ideas” that have been put forth as way to improve the system have all been spurious.
An article recently published in the Dallas Morning News (Sunday March 26, 2006) states that “In recent years insurance, government and employer groups have praised health plans that transfer more of the costs to patients. The theory is that if consumers have financial skin in the game, they'll make better health care choices that ultimately will decrease overall costs to employers and the government.” And John Goodman, President and founder of the National Center for Policy Analysis claims that “When people are managing their own health dollars, they cut down on unnecessary doctor visits, reduce unnecessary purchases of drugs and switch to generic drugs. In short people make common sense adjustments when they get to enjoy the rewards from more efficient purchasing of health care.”
Now I don’t know what evidence Mr. Goodman has to support this view; I suspect he has none, because I know that people do not act as he suggests when they purchase automobiles or groceries. Although it has often been proven that store brands are as good as and sometimes better than brand named items, a situation which is exactly analogous to brand named and generic drugs, most people buy brand named products. Why would anyone expect people to act differently when it comes to medical care?
But even if they were willing to act as Mr. Goodman suggests, few patients have the option of selecting the kind of medical care they receive. Physicians decide what drugs to prescribe, and most have been prescribing generics for some time now. Physicians also decide what tests to have performed. And has anyone ever seen a price list posted in a physician’s office or hospital, so that people could make comparisons?
And what’s this stuff about unnecessary visits to the doctor? The only people I know who do this are hypochondriacs, and they are not likely to change their practices under any conditions. Most of the people I know hate going to the doctor, often put it off far too long when ill, and attempt to carry on their ordinary lives while spewing germs in the faces of everyone they meet, a practice which I am certain sends more people to physicians than having gone to the doctor in a timely manner would have.
But there is one class of unnecessary trips to physicians that Mr. Goodman seems to be unaware of. An absolutely wasteful category that is imposed by medical insurers. People with chronic conditions who are apt to have to take the same or similar drugs for the rest of their lives are required to visit their physicians at least four times a year to get prescription refills, regardless of whether they have some other ailment that needs attention, for these prescriptions are written for three month periods only. These are the only unnecessary trips to the doctor that I am aware of.
So this whole idea of patients making their own medical choices is not only a red herring, it is a rancid one.
The other idea in the article mentioned above, the idea that insurance, government and employer groups have praised health plans that transfer more of the costs to patients is even more insidious.
Patients and their cohorts in group medical plans have always not only paid all of their health costs, they have in fact paid more, for they have financed the overhead and profits of insurers. It is true that physicians and hospitals do provide some pro bono care, but they provide it to those indigent patients who have no insurance and little income. This care is not provided to insured persons or persons who can partially pay. Neither hospitals, physicians, nor insurers have a charitable fund from which patients can draw the difference between what they can pay and what is charged. Employers have no such fund either. The idea that employers help employees pay their health care bills has no foundation whatsoever. Yes, employers do make contributions to their employees’ health care plans, but it is not charity. An employer’s benefits package is part of an employee’s compensation package which the employee earns. Some companies regularly send employees summaries of what their true compensation is when the benefits they receive is converted into dollars. So how can one transfer more to those who already pay all unless you are out to pick their pockets?
Certainly, employers would like to reduce these contributions, but not out of a desire to improve medical care. These employers will jump at any opportunity to reduce employee compensation whether it involves health care or not.
Mr. Goodman and others suggest that as employers reduce their contributions to benefit plans, they have more to spend on wages. Mr. Goodman says, the “employer is likely to pay more in wages and let employees buy their own insurance,” for instance.
But this makes no sense. If an employer reduces has contributions to a benefit plan by so many dollars and then increases wages commensurately, the employer’s costs are a wash. All that has taken place is a bookkeeping change. Of course, this then belies Mr. Goodman’s claim that the employer is likely to pay more in wages. What in the world would make it more likely? The employer’s costs are the same either way.
There is one more spurious idea, which, as I understand it, is Mr. Goodman’s own bad seed brain child—the Healthcare Spending Account. He says, “We developed the concept because many families live paycheck to paycheck and do not have extra money to pay a doctor.” True enough! Perhaps too true! But if these families do not have any extra money to pay a doctor, where do they get the money to put in a Healthcare Spending Account? Mr. Goodman doesn’t seem to see this contradiction. He then says that “HSAs make sure the funds are there when the need arises?” But how does it ensure this? How much money would a person have to have in a HSA to ensure that he could always cover his/her medical expenses? How long would it take a person to accumulate that amount? And what does he/she use to pay medical expenses in the meantime. I don’t know what the answer is; I don’t believe anyone does. As a matter of fact, I don’t believe that there is such a sum.
I recently read, although I cannot put my finger on the source at this moment, that a person aged 65 would need $600,000 in such an account to ensure his/her ability to pay his medical bills. If one assumes that a person begins such an account at age 25, he/she has exactly 40 years in which to accumulate that amount. That comes to a monthly contribution of $1,250 a month. Of course, someone will point out that I am ignoring growth in the fund, which is true, but I’m also ignoring the fact that over these 40 years the person will have to make withdrawals from this fund for the medical expenses he/she has to cope with in the interim. How many people can afford to make such a contribution, which I would point out is in addition retirement account investments, medical insurance premiums, and many others. How would those who live from paycheck to paycheck ever be expected to accumulate enough in an HSA to “make sure the funds are there when the need arises,” to use Mr. Goodman’s own words? I do not believe it is possible and if I am correct, Mr. Goodman’s concept is a still birth when it comes to ameliorating the faults of the American healthcare delivery system. It’s a non-starter that will benefit no one who now has a hard time paying for medical care.
How can anyone with a brain larger than a gnat advocate such an idea? There are only two possible answers. Either the person is incredibly stupid or he is utterly dishonest intellectually.
Mr. Goodman rightly says that “There is enormous waste in our system,” but he is wrong in attributing it to patients. The system eats up money without providing any return to patients just as pandas eat bamboo. Insurance company profits and overhead, cumbersome and wasteful claims processing and payment systems, ridiculous salaries for company executives, and perhaps the most scurrilous the massive funds spent on lobbying—this is where the bulk of the waste is, except people like Mr. Goodman won’t admit it because it does not fit their predilections.
Someone has suggested that some new ideas are needed. But that’s the problem. There are no new ideas that will fix the system, and the longer we delay while seeking new ideas, the worse the system becomes.
There is only one solution to adequately financing the healthcare system. A way must be found to reduce its costs. No patchwork way of trying to find ways to pay current and future costs will ever fix the system, because costs grow faster than patient income. How to fix the problem of poor quality is another matter. But both of these problems can only be solved by the medical profession, and it seems reluctant to tackle the issue, (as a look at the AMA’s web site demonstrates) and I believe I know why.
Once upon a time, business, and medicine in America is a business, was motivated by a maxim. Build a better mouse trap and the world will flock to your door. Somewhere along the way, businessmen discovered that they could get the same result by merely making people think they had built a better mouse trap. People in America no longer go into business to provide a product or service; they go into business to make money. The product or service is merely a means, and once people discover that they can make as much money by pretending to provide a product and service, the motive to degrade the quality of both is evident.
This mania afflicts much more in America that the healthcare system. It is the reason we cannot manufacture anything anyone else in the world wants to buy, anything that even many Americans want to buy. It is the reason for our unbalanced balance of payments, for the decline of great American manufacturing companies such as our automobile industry, and the great decline has just begun. What passes a culture in America can best be described as a vulture.
You see, I am not optimistic. I don’t believe that we will fix the healthcare system any better than we have been able to fix the problems of illegal immigration or illegal drugs and many others. We won’t fix any of these because the problems are not what concern the groups that can bring about a fix; only making money does. Just as illegal immigration and illegal drugs make a lot of money for a lot of people, so too does the current healthcare system. The system does not exist for patients; we only pretend that it does.
Jesus said, “Ye cannot serve both God and mammon.” But the truth is, serving mammon precludes serving anything else.
©2006 John Kozy, Jr.
Medical Savings Plans, Portable Health Insurance, and other Idiocies.
When one considers the number of times that the American political establishment has enacted attempts to solve or even ameliorate problems with the American health care system, and then examines the reasons these attempts have failed miserably, one has to wonder if our Congressmen have the level of seriousness any solution requires. For if they claim to seriously want to reform the system but have been unable to do so, they are exposing themselves to a charge of incompetence, for the problems are not that difficult to solve, since other nations have long ago reformed their systems. Yet Americans still spend more on health care than the residents of any other country and get less in return.
A clue to why this has happened is to be found in certain completely idiotic ideas that have recently received journalistic notice.
We are being told, for instance, that we need to shop more carefully for the medical services we buy. An article I read recently in either the Dallas Morning News or the Dallas Business Journal, I don’t remember which, told the story of a person who upon not feeling well went through an extensive sequence of tests, all of which turned up nothing. He implied that he would have been smarter to decline further testing after the initial tests proved to be negative, and that if we all did that, the costs of medical care would decline.
Two things about this proposal mark it as idiotic. First, the decision advocated is one that is easy to make in hindsight but impossible to make in foresight. Would this person be making this proposal if the last battery of tests revealed a serious illness? I doubt it. Second, reducing testing is not likely to reduce medical costs. Laboratories cannot be eliminated, and their operation, even with reduced testing, must be paid for. So if the number of tests handled by these laboratories is reduced, the likely result would merely be a rise in the price of tests.
Two ideas put forth by John Goodman, the founder and president of the National Center for Policy Analysis in Dallas, TX. are also too idiotic to warrant any recognition. He is credited as being “the father of health savings accounts.” Yet it is difficult to see what such accounts would accomplish or how they could possibly be effective.
For example, isn’t it necessary to know how much money such a plan would have to contain to provide anyone with health-care security? What is the average hospital bill, for instance? And how long would it take a family contributing say a sum equal to its current health-insurance premiums to accumulate that amount? And what would happen if a single episode wiped out the plan? What would this family be expected to do between that event and the moment when the plan would again contain a sufficient sum to cover the family’s health costs? Go without medical care? That’s not a solution. And what of all those people who lack medical insurance merely because they cannot afford any premiums? How could they ever be expected to contribute to such medical savings accounts? How would medical savings accounts help them?
And now Mr. Goodman has proposed portable medical insurance. A fine idea for those employed by some firm that offers such insurance and who moves from one employer directly to another. But what about the person who goes unemployed? What good does it do him? The last thing a responsible individual would want to do to such a person is increase his basic living costs. Yet that is what Mr. Goodman is proposing.
In offering proposals for the improvement of the American health-care system, it is important to keep the problem firmly in mind, which is that too many people lack access to the system because its costs are too high. And neither of the three proposals described above affect this problem in the least. As a matter of fact they worsen it, since the person whose medical spending plan goes bust now has lost his access too. The first idea described above is entirely unworkable, and the astute proposal for portable medical insurance affects only those already insured.
Because of the conservative ideology that many Americans hold, and because that ideology has more than its share of proponents in the Congress, Americans may not be able to solve this problem under any of the current circumstances, because there is only one way to reduce the system’s costs—providers have to be made to realize that they must be willing to accept less.
Would that destroy any system of medical care?
We often hear that it would. We hear that fewer people would choose medicine as a profession and that pharmaceutical and medical equipment firms would cease to innovate. But those claims are dubious.
I don’t know exactly when physicians began to earn incomes considerably higher that those of the ordinary working population, but I know it was sometime during the last half century. In the 1930s and 40s, becoming a physician did not guarantee wealth; yet, people chose medicine as a profession. Nurses and schoolteachers have never had the promise of wealth, but people have continued to choose these as their professions. Yes, there are shortages now and then, but there has never been an absolute lack.
And what of the pharmaceutical and medical equipment firms? Would they stop developing new products? Well, what would happen if they did? The pharmaceutical firms would transform themselves into just so many more manufacturers of generic drugs, and the equipment firms would become manufacturers of equipment on whose patents they could not depend. And even if these firms chose this action, someone else would be sure to come along to do the research and inventing. Universities already do much of the original medical research and there is no reason why they wouldn’t continue to do so. And many original inventions have been made in home workshops and garages. The prospect of wealth is not and never has been the only motive for creativity.
The real upshot is that if wealth were removed from the equation, the result could very well be more truly dedicated people entering medicine and better drugs and medical equipment, for just as the greatest art has often been produced by the dedicated but impoverished artist, the best medical care system could also be the result.
© John Kozy, Jr. 2005