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Posts Tagged ‘Healthcare’

Having already written several dozen columns on public policy and the coronavirus, it’s time to add my two cents to the debate over Sweden’s (comparatively) laissez-faire approach to the pandemic.

If nothing else, it’s remarkable that the nation Bernie Sanders praised for socialism (albeit incorrectly) is now the poster child for (some) libertarians.

What makes Sweden special, as depicted in this graphic from CNN, is a more lenient attitude about letting ordinary life continue.

Did Sweden make the right choice?

Let’s review several analyses, starting with Hilary Brueck’s article for Business Insider.

In Sweden, bars and restaurants are open to the public, you can go get a haircut, and primary school is in session. …life goes on. …If anyone can have success with such a low-enforcement disease-fighting strategy, it may be Sweden. …The Swedish prerogative asks citizens to act like adults, and then trusts that, left to their own devices, people will. …The Swedes are also seriously weighing concerns that have been taken as inevitable, if unfortunate, collateral damage in other countries, such as the mental health risks of being stuck inside, rising rates of abuse, and substance use disorders. …Other countries, including the UK and the Netherlands, originally toyed with the idea… Both were accused of heartlessness: sacrificing the old and vulnerable… But Sweden has persevered. …The economy has…taken a hit. …8% of the country is now unemployed, a figure that’s projected to continue to rise, possibly hitting 10% by this summer.

Writing for Reason, Johan Norberg explains his nation’s strategy.

The Swedish government has declared no state of emergency and no orders to shelter in place. …Those who want to show how great Sweden is doing have produced charts comparing us to countries like Britain, Belgium, France, Spain, and Italy. Those who want to prove the opposite replace those countries with Norway, Denmark, and Finland, all of which have fewer deaths. …Sweden has had more COVID-19 deaths per capita than our Nordic neighbors. But that is an obvious result of those countries’ decisions to postpone cases and deaths by locking down whole societies for a period of time. The thing to watch is what happens when they begin to open up again and will face a new wave of COVID-19. …A Harvard model projects that a 60 percent suppression of the disease will result in a higher peak later on and a higher number of total deaths than a mitigation strategy like the one Sweden used, where the spread is reduced by no more than 20 or 40 percent, so that the disease can pass through the population to create herd immunity during a period when the vulnerable are protected. Other models come to other conclusions, of course… We just don’t know yet, and only time will tell. Herd immunity might yet beat herd mentality. …our economy still hurts… But losing two-thirds of your revenue rather than 100 percent might mean the difference between life and death for many entrepreneurs. …Perhaps Sweden will do worse long term… Or perhaps Sweden is the one place that is succeeding in limiting long-term damage, caring for the sick, and protecting the vulnerable, all while working toward herd immunity. …What we do know is that Sweden has not cracked down on basic liberties like others have, and has not wrecked society and the economy to the same extent.

In a column for the New York Times, Ian Bremmer, Cliff Kupchan, and Scott Rosenstein cast doubt on Sweden’s approach.

In Sweden, business is not actually proceeding as usual. …But restrictions from government are considerably less severe than many other countries. …The results have been mixed. Sweden has the highest fatalities and case count per capita in Scandinavia, but is lower than some of its neighbors to the south. Economic disruption has been significant but not as debilitating as other countries. …the nation’s top infectious disease official recently estimated that approximately 25 percent of the population has developed antibodies. …But if immunity is short-lived and only present in some individuals, that already uncertain 25 percent becomes even less compelling. We also still don’t know what total population percentage would be necessary to reach the herd immunity goal. …there are huge risks with copying the strategy in a country like the United States. The American people are far less healthy than Swedes.

The Wall Street Journal opined this morning about Sweden’s strategy.

While its neighbors and the rest of Europe imposed strict lockdowns, Stockholm has taken a relatively permissive approach. It has focused on testing and building up health-care capacity while relying on voluntary social distancing, which Swedes have embraced. The country isn’t a free-for-all. Restaurants and bars remain open, though only for table service. Younger students are still attending school, but universities have moved to remote learning. …the country’s strategy…is to contain the virus enough to not overwhelm its health system. …Sweden has been clear it is aiming for a “sustainable” strategy that it can practice until there is a vaccine or cure while also being economically tolerable. The lockdown countries have held the virus in relative check for now, though probably with less broad immunity in the population. They appear to be delaying some deaths but at the risk of a larger outbreak once they open up if there is no cure. …No one knows which mitigation strategy will save the most lives while doing the least economic harm. But the rush to condemn Sweden isn’t helpful.

In a column for National Review, John Fund and Joel Hay argue for the Swedish approach.

With a death rate significantly lower than that of France, Spain, the U.K., Belgium, Italy, and other European Union countries, Swedes can enjoy the spring without panic or fears of reigniting a new epidemic as they go about their day in a largely normal fashion. …Dr. Anders Tegnell, the chief epidemiologist of Sweden, …heroically bucked the conventional wisdom of every other nation and carefully examined the insubstantial evidence that social-isolation controls would help reduce COVID-19 deaths over the full course of the virus. …Tegnell has looked at other nations that are loosening their lockdowns. “To me it looks like a lot of the exit strategies that are being discussed look very much like what Sweden is already doing,” he told Canada’s Globe & Mail. …Jan Albert, a professor in the Department of Microbiology, Tumor, and Cell Biology at Sweden’s Karolinska Institute, told CNN that strict lockdowns “only serve to flatten the curve, and flattening the curve doesn’t mean that cases disappear — they are just moved in time.” …Initially, the main justification for the global lockdowns was that they were necessary to prevent a crush of patients from overwhelming hospital intensive-care units. …Despite no lockdowns and few social-isolation controls other than proper spacing in restaurants and a ban on gatherings of more than 50 people, the Swedish hospital system never experienced anything remotely like the crush of ICU patients in Italy, Spain, and New York City. …Of course, Sweden paid a price during the pandemic. …they will tell you it was worth it. And it is easy to figure out that price. They never cratered their economy… Now many countries and U.S. states are beginning to follow Sweden’s lead.

So who is right, the optimists or the pessimists?

The honest answer is that we don’t know, though it probably depends on how quickly (if ever) someone develops either a vaccine or a cure.

Here’s my back-of-the-envelope comparison of Sweden’s laissez-faire approach and the lock-down approach in the United States.

In the short run, Sweden has more cases and less economic damage.

But what really matters is how things evolve in the long run. If no vaccine or treatment materializes, then other nations will eventually be forced to copy Sweden’s approach. That presumably will mean a similar number of cases over time, so all the additional short-run economic damage will have been pointless.

But if a vaccine or treatment appears relatively soon, then people presumably will conclude that Sweden made the wrong choice (though even that will be a matter for debate depending on the degree to which people understand the long-run relationship between health outcomes and national prosperity).

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This bit of humor is somewhat similar to the Texas police exam joke from yesterday.

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So you’re a sick senior citizen and the government says there is no nursing home available for you, what do you do?

Our plan gives anyone 65 years or older a gun and 4 bullets. You are allowed to shoot four Congressmen.

Of course, this means you will be sent to prison where you will get three meals a day, a roof over your head, central heating, air conditioning and all the health care you need!

Need new teeth? No problem. Need glasses? That’s great. Need a new hip, knees, kidney, lungs or heart? They’re all covered.

And, as an added bonus, your kids can come and visit you as often as they do now.

And who will be paying for all of this? It’s the same government that just told you that you they cannot afford for you to go into a home.

Plus, because you are a prisoner, you don’t have to pay any income taxes anymore.

Is this a great country or what?

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This new video from the Center for Freedom and Prosperity discusses a proposal to solve Medicare’s bankrupt finances by replacing an unsustainable entitlement with a “premium-support” system for private insurance, also known as vouchers.

This topic is very hot right now, in part because Medicare reform is included in the bold budget approved by House Republicans, but also because Newt Gingrich inexplicably has decided to echo White House talking points by attacking Congressman Ryan’s voucher plan.

Narrated by yours truly, the video has two sections. The first part reviews Congressman Ryan’s proposal and notes that it is based on a plan put together with Alice Rivlin, who served as Director of the Office of Management and Budget under Bill Clinton. Among serious budget people (as opposed to the hacks on Capitol Hill), this is an important sign of bipartisan support.

The video also notes that the “voucher” proposal is actually very similar to the plan that is used by Members of Congress and their staff. This is a selling point that proponents should emphasize since most Americans realize that lawmakers would never subject themselves to something that didn’t work.

The second part discusses the economics of the health care sector, and explains the critical need to address the third-party payer crisis. More specifically, 88 percent of every health care dollar in America is paid for by someone other than the consumer. People do pay huge amounts for health care, to be sure, but not at the point of delivery. Instead, they pay high tax burdens and have huge shares of their compensation diverted to pay for insurance policies.

I’ve explained before that this inefficient system causes spiraling costs and bureaucratic inefficiency because it erodes any incentive to be a smart shopper when buying health care services (much as it’s difficult to maintain a good diet by pre-paying for a year of dining at all-you-can-eat restaurants).  In other words, government intervention has largely eroded market forces in health care. And this was true even before Obamacare was enacted.

Medicare reform, by itself, won’t solve the third-party payer problem, but it could be part of the solution – especially if seniors used their vouchers to purchase real insurance (i.e., for large, unexpected expenses) rather than the inefficient pre-paid health plans that are so prevalent today.

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Eline van den Broek probably is not happy today since she was in South Africa watching her team lose a high-scoring battle with Spain, but she should be very proud of the new video she narrated that urges the repeal of Obamacare – and also points out some of the other reforms that are needed to restore markets to the US healthcare system.

Her comments on how the American healthcare system was a mess even before Obamacare are particularly important.

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I don’t get to talk for the first three minutes, but I then kick the you-know-what out of Obama’s statist healthcare scheme.

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I had to laugh when I saw this article linked on the Drudge Report. Does Obama really think that Democrats in the House will be intimidated by a threat not to campaign for them? Look what wonders Obama did campaigning for Corzine in New Jersey and Coakley in Massachusetts. If he can’t boost Democrats in very blue states, I doubt he would be helpful for Blue Dog Democrats from red states. Here’s the laugh line from the article:

Barack Obama has said he will not campaign for any Democratic congressmen who fails to support health care reform.

Jay Leno was much more accurate when he joked the other night that, “President Obama turned the heat up on Congress to pass healthcare reform. He’s telling Democrats if they don’t vote for this bill, he will campaign for them in November.”

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As usual, Tom Sowell uses basic economics to explain a confusing topic. His core insight is that government has undermined market forces, which is leading to rising costs. Obama and the other statists somehow think more government will make things better:

…policies based on political hype over the years are what have gotten us into what is most wrong with medical care today– namely, the way it is paid for. Insurance companies or the government pay directly for most of the costs of most medical treatment in the United States. That is virtually a guarantee that more people will demand more medical treatment than they would if they were paying directly out of their own pockets, instead of paying indirectly in premiums and taxes. Since people who staff either insurance company bureaucracies or government bureaucracies have to be paid, this is not bringing down the cost of medical care, but adding to it. What also adds to the costs are politicians at both state and federal levels who mandate additional benefits to be paid for by insurance companies, thereby driving up the cost of insurance. If medical insurance simply covered risks– which is what insurance is all about– that would be far less expensive than covering completely predictable things like annual checkups. Far more people could afford medical insurance, thereby reducing the ranks of the uninsured.

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Click on the box and the image will appear.

And if any wordpress experts want to give me advice on getting pictuers to show up without this extra step, let me know. I am completely baffled (my collectivist friends will say that’s a common occurence) why pictures embed properly only 50 percent of the time.

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I’m finishing up a swing through Canada, giving speeches for the Fraser Institute to audiences in Vancouver, Calgary, and Toronto. I’ve been talking about the size of government and the future of capitalism. As you might imagine, several people have asked about the battle in America over government-run healthcare and how the sysetm in the United States today compares to the Canadian system. I make two points. First, I tell tham that America’s health care system already is largely run by government. Obama’s proposal simply increases the level of control from perhaps 70 percent to 80 percent. Second, I tell them that the surviving remnants of a free market in the United States are worth preserving. Politicians have made the American system very cumbersome and expensive, but it is nonetheless the place where people want to be when their lives are on the line. So it’s quite appropriate that this bit of news was just unveiled:

Newfoundland and Labrador Premier Danny Williams is set to undergo heart surgery this week in the United States. CBC News confirmed Monday that Williams, 59, left the province earlier in the day and will have surgery later in the week. The premier’s office provided few details, beyond confirming that he would have heart surgery and saying that it was not necessarily a routine procedure.

Why is it that Canadian politicians come to the United States, but the medical traffic never heads in the other direction? Somebody should ask Obama to provide an answer.

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This is a great speech by Judge Napolitano. The first and last parts focus on whether Congress has the authority (or competence) to run a health care system. The answer, for those who care about the Constitution, is no. The middle part of the speech, though, is about government oppression and the PATRIOT Act. I hope that he somehow has it wrong and this is not really part of the law.

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In a Cato podcast, I explain why government-run healthcare system will be vastly more expensive than we are being told. This covers some of the same material that is in my recent video, but there’s no need to see my face (and if you don’t like my voice or want to see my face, you can read a two-page report on the topic from Cato).

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Here’s a very clever video from the Ladies4Liberty. It’s funny, but the lesson about what will happen to our healthcare system is deadly serious.

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The punitive class-warfare mentality of the left can be found buried in the healthcare bill. The Wall Street Journal dug deep and found a big capital gains tax increase. Ideally, there should be no double taxation of income that is saved and invested, which means the right tax rate is zero. Boosting the rate from 15 percent to 25.4 percent is a big step in the wrong direction, of course, and almost surely will lose revenue (and definitely will undermine growth):

Our job is to read bad legislation so you don’t have to, and on that score we may demand combat pay for plowing our way through the House health-care bill that passed on Saturday. …House Democrats are funding their new entitlement with a 5.4% surtax on incomes above $500,000 for individuals and above $1 million for joint filers. The surcharge is intended to snag the greatest number of taxpayers to raise some $460.5 billion, and so the House has written it to apply to modified adjusted gross income. That means it includes both capital gains and dividends. That surtax takes effect on January 1, 2011, or the day the Bush tax rates of 2001 and 2003 expire. Today’s capital gains tax rate of 15% would bounce back to 20% because of the Bush repeal and then to 25.4% with the surtax. That’s a 69% increase, overnight.

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This video provides 12 reasons in less than 7 minutes.

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Republicans usually are not very creative, so I’m uncharacteristically impressed that they have come up with a devastating chart showing the bureaucratic nightmare that will be created (on top of the current mess) for health care.

Congressman Brady of Texas gets an award for the best one-liner, saying about the Pelosi plan that “If the IRS and Medicare had a baby, it would look like this.”

Pelosi Plan

For a closer look, click this PDF link.

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Yesterday’s elections were almost a complete disaster for the White House. In the races for governor, the GOP won a huge landslide in Virginia and knocked off the Democratic incumbent in New Jersey. The only silver lining to Obama’s dark cloud came in upstate New York, where the collectivist Republican nominee apparently was successful in helping the Democratic candidate beat the Conservative Party candidate in the race to fill a seat in the House of Representatives.

But this was a 99 percent defeat for the Obama Administration. Especially New Jersey.

From a policy perspective, it will make Democrats on Capitol Hill much more nervous about supporting government-run health care. This does not guarantee the defeat of Obamacare, but it is much less likely now than it was 24 hours ago.

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In this new video from the Center for Freedom and Prosperity, Eline van den Broek of the Netherlands needs only about four minutes to explain why government-run healthcare in Europe is a mistake and why the problems in the U.S. healthcare system are the result of too much government, not too little.

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The Politicians and Bureaucrats Are Lying about the Cost of Government-Run Healthcare. The Wall Street Journal issues a devastating indictment against the absurd claim that the Senate plan for socialized health care will reduce the deficit:

Washington has just run a $1.4 trillion budget deficit for fiscal 2009, even as we are told a new health-care entitlement will reduce red ink by $81 billion over 10 years. To believe that fantastic claim, you have to ignore everything we know about Washington and the history of government health-care programs. …Let’s start with the claim that a more pervasive federal role will restrain costs and thus make health care more affordable. We know that over the past four decades precisely the opposite has occurred. Prior to the creation of Medicare and Medicaid in 1965, health-care inflation ran slightly faster than overall inflation. In the years since, medical inflation has climbed 2.3 times faster than cost increases elsewhere in the economy. …Next let’s examine the record of Congressional forecasters in predicting costs. Start with Medicaid, the joint state-federal program for the poor. The House Ways and Means Committee estimated that its first-year costs would be $238 million. Instead it hit more than $1 billion, and costs have kept climbing. Thanks in part to expansions promoted by California’s Henry Waxman, a principal author of the current House bill, Medicaid now costs 37 times more than it did when it was launched—after adjusting for inflation. Its current cost is $251 billion, up 24.7% or $50 billion in fiscal 2009 alone, and that’s before the health-care bill covers millions of new beneficiaries. Medicare has a similar record. In 1965, Congressional budgeters said that it would cost $12 billion in 1990. Its actual cost that year was $90 billion. Whoops. The hospitalization program alone was supposed to cost $9 billion but wound up costing $67 billion. These aren’t small forecasting errors. The rate of increase in Medicare spending has outpaced overall inflation in nearly every year (up 9.8% in 2009), so a program that began at $4 billion now costs $428 billion. The Medicare program for renal disease was originally estimated in 1973 to cover 11,000 participants. Today it covers 395,000, at a cost of $22 billion. The 1988 Medicare home-care benefit was supposed to cost $4 billion by 1993, but the actual cost was $10 billion, because many more people participated than expected.

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