Michele Bachmann, Right About Health Care
Ricochet friend Jim Pinkerton has been saying for years, especially on his excellent (though slightly wonky) blog Serious Medicine Strategy, that we need to be thinking a lot bigger about health care than we are.
Right now, the sad, small-timers in the Obama administration are concentrating on allocating -- read: rationing -- resources.
Pinkerton has been arguing that we need to be focusing on curing diseases, not treating them. And he's apparently convinced Michele Bachmann, the hugely misunderestimated congresswoman and potential presidential candidate. From the Daily Caller:
There are essentially three ways to lower the cost of health care — two of which get all the attention. The first option, supported by many liberals, is bureaucratic rationing of care. The second option, supported by many conservatives, involves cuts in overall spending, plus the use of market forces, to control costs. The first two options are perpetually in conflict, and so far, at least, the two options seem to be fighting to a stalemate. But there is a third option for conservatives, which builds on the free-market/limited government model — and which offers the hope for a political breakthrough.
And that third option — currently being championed by Rep. Michele Bachmann — is to actually cure diseases.
Bachmann’s argument, which she first sounded on “Fox News Sunday” on May 1, is that [Paul] Ryan-type fiscal rigor needs to be linked to pro-medical science vigor. As she told Fox’s Chris Wallace, “We should focus on…cures — cures for things like Alzheimer’s, cures for things like diabetes. It’s very expensive to just cover the care for sickness. I’d prefer to see money that we have at the federal level go for cures.”
It is an interesting, albeit seemingly obvious, point — a cure is cheaper than care. But actually, it’s not so obvious. The idea of curing diseases as a health care strategy — as opposed to financing the care for those diseases — seems to have faded from the political discourse in recent years. Whether it’s Ryancare or Obamacare, both parties have chosen to focus on the mechanisms of health care finance, as opposed to health itself. The immediate question comes back: Are cures even possible?
And Bachmann has an answer to that, too, pointing back to past successes for a can-do America; as she told Wallace: “Probably one of the best examples is polio. If you look in the 1950s, polio was a huge issue. And government was forecasting at that point that we might be looking at $100 billion in costs. Today, polio costs us really virtually nothing. Why? A private charity, March of Dimes, put money in to finding a cure. We all have the little vaccines that Jonas Salk came up with. Thank God. I would like to see that with Alzheimer’s and diabetes and others.”
I love it when a conservative politician speaks eloquently and passionately and especially optimistically about health care. We shouldn't fall into the Obama Gloom trap. We're Americans. We solve problems. There's nothing intrinsic about health care to suggest that it's any different from any other technical or industrial problem. I like the way Bachmann is reframing the debate, and I hope she does more of it.
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Comments:
May '10
Re: Michele Bachmann, Right About Health Care
Rob Long:
[Bachmann:] "Probably one of the best examples is polio....A private charity, March of Dimes, put money in to finding a cure. "
Government should not be investing in finding cures. Taxpayers should be free to donate if, when and how they want to.
Feb '11
Re: Michele Bachmann, Right About Health Care
(For what it's worth, I'm a doctor.)
The problem with looking for cures (and with science in general) is that you don't know where the solution is before you find it. It's an exceedingly slow and low-return process, except in retrospect when you say "Look at Jonas Salk! That's what we should be doing!" You don't see the tens of thousands of scientists who worked their whole careers to be the next Jonas Salk but didn't find very much.
There is no reason to believe that looking for cures will have better or worse returns than looking for treatments, and even if it does, whether gov't or private industry should be looking is a legitimate question.
Market forces are the only possible fix here, which eventually will have to mean getting rid of the employer health insurance deduction and phasing out Medicare.
(Again, for what it's worth, my analysis of how health care broke and how to fix it, from a Milton Friedmanish perspective, is here.)
Edited on June 6, 2011 at 3:44pmJul '10
Re: Michele Bachmann, Right About Health Care
In all seriousness, what do you think GSK, Pfizer, Merck, et al. have been doing all these years? Do you think NIH money for chemistry is aimed at what, exactly, besides advancing the careers of well-connected scientists?
This line of argumentation offered by Pinkerton is worse than arguing beside the point. It's fiddling while Rome burns.
Those imaginary drugs will cost money. As Richard Muller says about global climate change, nothing substantial will happen unless someone can make a profit.
Jan '11
Re: Michele Bachmann, Right About Health Care
In addition to those excellent points, I'd point out a couple of others that make cures an unobvious solution to lowering costs. We've cured all sorts of diseases in the last 50+ years. Our health costs haven't gone down, they've exploded. A big reason is that when you live longer, you end up using a lot more healthcare. The guy who used to die at 50 from a heart attack now ends up living long enough to contract prostate cancer. No problem, we've also gotten a lot better at curing prostate cancer. But now he may live long enough to not only be treated for heart disease and prostate cancer, but he'll make it to an age where he'll get Alzheimers. But what if we cure Alzheimers and Parkinsons and a lot of other diseases that many elderly suffer from too? Well, one thing I doubt we'll ever cure is old age. At a certain point you just can't take care of yourself anymore and and you have to pay people to take care of the elderly, who will continue to rise in number and live even longer and longer.
Jan '11
Re: Michele Bachmann, Right About Health Care
Continued from above.
Now I'm not against the elderly living as long as they can, or for us having as many elderly as we can. I love old people, I hope to be one someday. I just don't think people living longer makes our health care demand really go down.
And lastly, what if we find a cure for a disease and the cost of the cure, not counting the billions that went into finding it, is as expensive or more expensive as the current treatments we are using short of a cure?
Apr '11
Re: Michele Bachmann, Right About Health Care
Albert Fuchs: (For what it's worth, I'm a doctor.)
(Again, for what it's worth, my analysis of how health care broke and how to fix it, from a Milton Friedmanish perspective, is here.) · Jun 6 at 6:42am
Edited on Jun 06 at 06:44 am
In reading your articles, I found that this section was an extremely attractive option.
My suggestion is that the age for Medicare eligibility should be increased by one year every two years. That way, no current beneficiary ever loses benefits, but as time goes on the age for enrolment would creep ever higher. So a current 60 year-old will not be able to enroll until the age of 70, and a current 40 year old will not be able to enroll until he reaches 90 (and will have plenty of time to budget for his health expenses).
I also agree in carrying only catastrophic or high deductible policies and that eliminating the tax break for companies would eliminate much of the problem.
Thanks for a perspective from the other side.
Jan '11
Re: Michele Bachmann, Right About Health Care
No eligibility until I'm 90? Screw that. I've already been paying in for twenty years and will continue to pay in for another 20-30. I'm not waiting until I'm 90 to see any of that come back my way. You want me to start budgeting for something to supplement medicare when I'm 70, fine. You want the more needy to get more than I do, even though I've paid in a lot more than them, I'm even okay with that on altruistic grounds. You want me to forego altogether something I've been paying into for twenty years already? No. We can make medicare solvent without making people wait until they are 90 to use it.
Apr '11
Re: Michele Bachmann, Right About Health Care
BT the main problem is that Medicare won't be around when you or I reach 70. So we get to make other plans anyway. The real question is whether we should bankrupt the complete U.S. with a program that will either eliminate itself (and the country) or be slowly eliminated by us over the next 30 years. Personally, I think I'd rather save the country.
Apr '11
Re: Michele Bachmann, Right About Health Care
Rob,
On a past podcast you mentioned being severely under the weather and purchased at little cost to yourself a strong, and I'm sure expensive, antibiotic. I too purchased one myself at the cost of a small co-pay.
I believe you stated then Rob, and I believe I agree now, is that we are spoiled by the fact we don't see the true cost of our care. Until we do then the incentive is for the healthcare industry to keep giving us care and for the government, insurers and ourselves to go on acting like it is fine.
I believe the incentive in finding a polio cure was because the cost would have been direct to the one who is sick or their family. Not so anymore we will drive the incentive for a cure when the cost for our care becomes overwhelming.
Aug '10
Re: Michele Bachmann, Right About Health Care
Exactly. The reason cancer has gone up is that we no longer die of infectious disease. The basic fact is that we are all going to die of something and we can either die of something cheap (heart attacks or smallpox) or die of something expensive (alzheimers, most types of cancer).
Maybe there's a case for trying to skew research dollars towards things that are expensive to treat, but I'm skeptical that any complex degenerative disorder can be "cured" or "prevented" for a few bucks, as is the case for vaccination against infectious disease. Rather it's more likely that we'll end up with much more expensive things like statins or gastric bypass to prevent heart disease.
The converse though is letting ourselves die of things that are cheap. Modest proposal: repeal all taxes on cigarettes so that we all drop dead of heart attacks at 60, before we bill our $200,000 oncology treatment to Medicare.
Jan '11
Re: Michele Bachmann, Right About Health Care
If you leave it as is. Paul Ryan's plan offers something which can still be usable, albeit with perhaps less benefits you'd need to supplement, without making people wait until they are 90 to get it. I'll take a cut in what I get, but I expect something at an age when it actually matters to me.
If you want to eventually eliminate it, gradually decrease benefits but keep the age it kicks in reasonable. Don't make someone pay in for 50 years and say, hey I know you can't work anymore but you you've had 30 years to figure something out, so we get to keep all 50 years of your pay in and you can go pound sand.
Jan '11
Re: Michele Bachmann, Right About Health Care
To quote Donald Rumsfeld, we don't know what we don't know.
In computer programming, we "debug" programs. It's easy. You write a bunch of code. When you attempt to run your code, most programming environments (like Microsoft's Visual Studio) will stop the process if any of your code is wrong. They usually tell you which line of code broke down, and why. But I've also had to work with programming environments which don't (or can't) identify breakdowns. They simply say, "the execution failed," and give you nothing to start working on.
Unfortunately, the human body is the latter. When the cellular programming misbehaves, and the body's code goes haywire, there's nothing that pops up and says, here's where the problem is.
When you don't know where to start, you have to start everywhere, and work from the broad to the precise. By definition, most of your money will be spent on areas which won't pay off, but you don't know ahead of time which areas will or won't. That's what makes research expensive, but there's no faster way.
Mar '11
Re: Michele Bachmann, Right About Health Care
These observations are exactly on point. Michelle Bachmann saying we should cure diseases is a lot like John Edwards promising to make Christopher Reeve walk again. We all wished for it, but expressing that sentiment got us no closer to our goal.
We seem to agree that government taking the lead won’t work because politics, not the promise of results, will direct the funds. We are also in favor of private charities and profit-motivated companies directing most research because they are the most incentivized to reach realistic goals, whether they lead to treatment or cure.
So the question becomes: What is the government’s role? It can remove the bureaucratic obstacles that impede the creation of new therapies or cures, make them more costly, and/or provide insufficient incentive to invest what it takes to create them.
Specifically, what do Ricochet members suggest?
Edited on June 6, 2011 at 4:52pmApr '11
Re: Michele Bachmann, Right About Health Care
Agreeing with Boots on the Table I feel that the "third party" that Milton Freidman spoke about is also mucking things up immensely. We have let the government become our caretakers. We need to repeal, not streamline, make efficient or smartly govern anymore all the areas the government cares for us. We have forgotten that we all left our homes to be self sufficient and make it on our own but since the 1950's we have allowed those we elected to take more of our personal property ( our wages) and give it others or back to us in ways not of our choosing.
I agree Boots, scrap it all and give us back our hard earned money and let us do with it as we do with it everyday, spend it wisely or foolishly but let it be our choice.
Let the free market supply the way it does best by giving the consumer, not the Federal Government, what it wants, needs and desires.
Let's repeal the amendment that has our taxes automatically deducted from our paychecks as Wisconsin has done for union dues.
Now that would be a " cure" we could all get behind.
Mar '11
Re: Michele Bachmann, Right About Health Care
There was an article on NRO some time ago relating to this. Aside from being one of the worst ways to go, dying of Alzheimer's is really, really expensive. I doubt that the cure (should it ever be found) will be comparable in cost.
Apr '11
Re: Michele Bachmann, Right About Health Care
BThompson
If you leave it as is. Paul Ryan's plan offers something which can still be usable, albeit with perhaps less benefits you'd need to supplement, without making people wait until they are 90 to get it. I'll take a cut in what I get, but I expect something at an age when it actually matters to me.
First: Why do you EXPECT the government to take care of you? (A standard Liberal/Socialist thought) Take responsibility for your own life and take care of you and yours by yourself.
BThompson
If you want to eventually eliminate it, gradually decrease benefits but keep the age it kicks in reasonable. Don't make someone pay in for 50 years and say, hey I know you can't work anymore but you you've had 30 years to figure something out, so we get to keep all 50 years of your pay in and you can go pound sand. · Jun 6 at 7:43am
Second: Either we gradually eliminate it or it will suddenly eliminate itself. Either you take the hit for time and money paid in or your children will take the hit.
Apr '11
Re: Michele Bachmann, Right About Health Care
Jack Richman:So the question becomes: What is the government’s role? It can remove the bureaucratic obstacles that impede the creation of new therapies or cures, make them more costly, and/or provide insufficient incentive to invest what it takes to create them.
Specifically, what do Ricochet members suggest? · Jun 6 at 7:48am
Edited on Jun 06 at 07:52 am
Governments role should be in the licensing of medical professionals and in their punishment if they act fraudulently or maliciously. Their role should have nothing to do with money. The government shouldn't be paying for healthcare nor should they be funding r & d. Private parties will fund r & d along with corporations who will see a profitability in the products developed.
Jun '11
Re: Michele Bachmann, Right About Health Care
We all are afraid of some things. We fear poverty, we fear loss of loved ones, we fear the inability to provide for those who count on us. Given our justifiable fears about life and potential experiences, we are hesitant to let something that should collapse, collapse.
If the current healthcare delivery system is truly untenable and bound for collapse as so many experts proclaim, what are we waiting for?
We have the most developed bankruptcy and reorganization system in the world. Some very bright people work in this system. One of the great strengths of our system is that in the bust after the boom new paradigms have the chance to emerge.
If the system is truly broke, why are all the solutions based on modifications of the rules set which created the failure in the first place?
Jan '11
Re: Michele Bachmann, Right About Health Care
Because before I was born people promised a significant chunk of my life earnings to the government without my say, and all that makes me not want to go march in the streets is that I still expect the government will honor it's obligations. If we were able to go back in history and give me a chance to vote on medicare, I'd say, no medicare. But don't take my money for 50 years and then tell me that I didn't take enough responsibility for myself and it's okay for the government to take 50 years worth of earnings I was obliged under the penalty of prison to cough up before I were even born.
I take plenty of responsibility for my life, I'm expecting for the parts I was never allowed to take responsibility for to be given back to me in some measure as I was promised for the last 20 years they would be.
Jan '11
Re: Michele Bachmann, Right About Health Care
Read my responses. I'm willing to take a hit. I'm not willing to throw everything away, nor should I be. The government made a contract with me. They should have to honor it in some way. I'm willing to renegotiate the contract, even though I wasn't allowed to be part of the negotiations the first time. And I'll do my damnedest to make sure my progeny aren't left holding the bag I was handed. Do you not grasp that there is a way to shore up medicare in the short term (30-40 years) and wind it down for the long term, in a more gradual, equitable way than telling people in their 40s that they're the ones who have to bear the lion's share of the burden for fixing the mess?
Edited on June 6, 2011 at 5:35pm