Why Obama's health reforms are quite wrong

If you simply read and listen to many in the mainstream media talk about this story, you might ask whether any of them bothered to critically review the legislation passed by the Congress and signed by Obama on healthcare.

In the simple, binary world of so many the impression is given that health care in the US is a "privately owned fully commercial free market system where people are left to die on the streets unable to pay for ambulances or lying in hospitals not being treated because they can't pay".

This is a bold faced lie on multiple levels. How many say that half of all US healthcare is funded by government through Medicare and Medicaid, which provide healthcare for the elderly and poor families respectively? How many say that the budget for Medicare is 20% of the federal budget, with Medicaid being half that again?

How many say that the health market in the US is heavily regulated, with hospitals required to treat accident and emergency patients regardless of ability of pay? How many say that some states restrict the market to protect some health providers, so there isn't free and open competition across the country? How many talk about the burden that precedents to allow ridiculous tort law claims imposes upon the health sector? (In the last case the Republicans do, because high profile Democrats include tort lawyers).

The failure in the US is not about universality. As Libertarianz Leader Dr. Richard McGrath (himself a health professional) states:

"When the figure touted was 47 million uninsured, the breakdown was like this:

18 million earned over $50k (half of this group earn over $75k) and chose not to insure themselves;
13 million were illegal aliens;
8 million were under age 18 and had public cover available if poor;
leaving 8 million uninsured (3% of the population), many of whom were 18-20 year olds at low risk of medical problems."

So the REAL figure of those without insurance is far less than is bandied about by the press. The big issue in the US is cost, and the biggest source of cost inflation has been the public sector. Who says that? The Congressional Budget Office notes:

"total federal Medicare and Medicaid outlays will rise from 4 percent of GDP in 2007 to 12 percent in 2050 and 19 percent in 2082—which, as a share of the economy, is roughly equivalent to the total amount that the federal government spends today. The bulk of that projected increase in health care spending reflects higher costs per beneficiary"

In other words, the GOVERNMENT side of US healthcare (which is largely ignored) is growing exponentially. The legislation signed by Obama doesn't touch this at all.

The Cato Institute solution is wiser. Its proposals are:
- Eliminate tax incentives for employer bought health insurance and apply them to individually bought health insurance. This means people have a vested interest in buying health insurance that meets their needs, and puts pressure on such insurance to not provide excessive cover;
- Eliminate restrictions that prohibit people buying health insurance from providers in other states, this is an unnecessary restriction on competition;
- Eliminate state specified minimum requirements for health insurance that in some cases include cover for procedures many would not wish (e.g. in vitro fertilisation) (indeed allowing interstate competition would produce strong incentives on states to do this);
- Licensing and regulation of what medical practitioners can do, and standards for licensing should be shifted towards industry driven accredited standards.

For example, it makes sense to be able to insure against accident or disease that is not predictable. Not to insure against self injury, or the consequences of heavy drug or alcohol consumption. No bigger incentive towards healthier lifestyles would exist than for people to notice that if they smoked, they might not get any health cover for respiratory diseases.

The Obama health reforms tinker with health insurance to make it compulsory for everyone to have health insurance, and to subsidise those who can't afford it. It does not address the cost escalation in the heavily regulated market, but especially does not address cost escalation in the US's own socialised health care - Medicaid and Medicare.

Expect future years to have healthcare remain a major issue in the US, because Obama is, for now, printing money and borrowing it, to pay for his grand plans. Living for now, letting future generations bear the cost - a curious metaphor for how so many of those living at the bottom treat their own lives.

Oh and while you consider that, it is worth noting that both the UK and New Zealand are rare among developed countries in not having an insurance based model for healthcare. The result of that is a continued growth in concern about significant groups of people who live unhealthy lifestyles, and a desire to tell them what to do in order that governments ration spending on diseases of lifestyle.

A better approach is for people to pay themselves, buy insurance and face higher premiums or the inability to get insurance because no one will sell it to them if they are eating, drinking, smoking and idling themselves into chronic conditions.

However, socialists prefer to treat such people as children, and for you to pay when they don't listen.

The bureaucrats for whom freedom is unknown

I have said before that I despise smoking, I don’t like the smell and I hate walking behind smokers and don’t like walking through them outside buildings. So you might think I’d welcome what the Auckland Regional Public Health Service is calling for as reported in the NZ Herald.

ARPHS (why not say ARS) calls for what is effectively a ban on smoking anywhere but in one’s own home, which looks to me quite simply as the sort of nanny state authoritarian bullying that I thought was voted out in the last election. However, it would be a fair bet that those who “work” for that organisation are unlikely to have much philosophical truck with personal freedom.

The thought process appears alarmingly simple:

People smoke - it is bad for them - it's already illegal to allow smoking at places of employment, retail outlets and on public transport, so let's make it illegal everywhere else, except the home (that would be seen as too far).

Banning something that is bad for people is good. The very idea that perhaps it is morally wrong to do this appears to have not crossed their minds, after all it's for the "greater good" (as is the justification for all limitations on personal freedom). Fascists? Well, they wouldn't think so, they just think they are acting for the interests of others. However, they are treating the public as children. It's only one step removed from treating tobacco like an illegal drug.

So what should the response be to this?

Should it be to ask whether a study has been made as to the health benefits to non-smokers of the measures proposed? If not, why not? Why not come clean about what “public good” there allegedly is, or is there really none at all? I suspect the health benefits to non-smokers are virtually undetectable, after all the emissions from motor vehicles are in greater volumes and significantly more toxic (smokers don't die from a lung full of tobacco smoke, but you wont last long intentionally inhaling petrol exhaust).

Should it be to ask to what extent these measures are likely to reduce smoking? If not, why not? How about noting how effective these measures are at reducing illegal drug use?

Why are you not simply being honest about wanting to criminalise smoking other than in the private home? Or does that just show you up for what you are, as petty fascists wanting to change behaviour by force rather than persuasion?

Or, how about simply asking why the hell they think it is their business what adults do with their bodies on their own property or in public spaces?

Clearly the public health bureaucrats have no clue what private property means, and what private property rights mean, for long ago they surrendered the idea that you can decide whether or not to allow otherwise legal acts on your property.

However, they also seek to control public space. To have people prosecuted for smoking as a way of reducing the propensity to smoke. The idea that there are adults who voluntarily choose to smoke because they like it would bewilder them all.

How can people LIKE harming themselves? Well the joyless do-gooders who think they know best for everyone else can't grasp that not everything everyone does is “good” for them. Some people drink to excess, some people eat to excess and don’t exercise. Some people have unsafe sex. Some people take illegal drugs. Some people participate in dangerous sports.

The proportion of smokers who do not know it is bad for their health will be very low, so it isn't about that. Tobacco smoking has addictive qualities, but plenty give up smoking and the state has used other people's money for some years subsidising methods to do this. So the conclusion is that people smoke because they enjoy it.

People have freedom to choose to smoke or not smoke. Those who do should have that right on their own property or with the permission of property owners. Those who do not like it should prohibit it on their own property and not enter places where it occurs. Public (as in local and central government owned) locations should be places where people can peacefully go about their activities without initiating force against others, that includes smoking.

The only appropriate response to this proposal is incredulity.

It demonstrates the profound need for all policy proposals to government to be subject to a test of whether it enhances or detracts from individual liberty, and whether it represents the initiation of force or defending citizens from initiations of force or fraud. Such a simple test would see such proposals dumped in the inbox of the Labour, Green and Maori Parties who think that individuals are a means to an end, not an end in themselves.

While we're at it, abolishing the Auckland Regional Public Health Service would make a modest contribution to reducing the budget deficit.

Labour thinks you're too stupid to lose weight

Labour Health spokesperson Ruth Dyson says this "The Government apparently thinks people will simply be able to change their diet and exercise without any assistance or form of nutrition education"

I'm astonished. Changing your diet is impossible without the government. The carefully hidden knowledge that eating mostly vegetables, fruit, lean meat, fish and cereals, and avoiding high fat and high sugar foods helps you lose weight is something that almost nobody knows surely. In addition, without the government how COULD people go to the gym, or go for a walk or swim?

Does anything more clearly show the patronising and condescending attitude the Labour Party, and indeed many statists have for the general public than that? The idea that without the government, people can't look after themselves, don't know any better and wont change.

Ms. Dyson might wonder if one of the reasons Labour became far less popular is that people are sick of being treated as imbeciles, and sick of being forced to pay for bureaucrats to hand hold people.

If people get obese and do nothing about it, then it isn't anyone else's business. If you want to address rationing the health system, then maybe linking its provision to what people pay for it, might make a difference. Imagine, for example, if most people had health insurance and paid more every year if they were deemed to be obese. How much of a better incentive would it be if you paid more for healthcare because of your risk factors, than for some patronising do-gooder to give you nutrition education and tell you to exercise more?

Why is it that so many politicians prefer telling people what they should do than have them face the costs of their actions?

Turmeric kills cancer cells

Want an excuse to have curry? Here it is.

The BBC reports the Cork Cancer Research Centre has found that the spice turmeric kills gullet cancer cells within 24 hours of contact. The chemical curcumin is responsible.

When will adults be given full time parents?

This sort of scheme is absurd. "A smart card that subsidises healthy foods has been recommended by obesity researchers. The system was proposed in research commissioned by the Ministry of Health, the New Zealand Herald reported."

We have the nonsense that people who are overweight, are actually poor. The opposite of the developing world. The latest excuse is that "it's cheaper to eat badly". This, of course, is nonsense.

Here are some ideas:
- Pasta (without cheese);
- Soup, with bread;
- Canned vegetables;
- Water, the universal drink - or even tea and coffee.

The attitude that people are overweight because of money is the attitude that there are adults incapable of looking after themselves, that they should be wards of the state, that nanny looks after them, feeds them, spends their money and ensures they are healthy. It is at best patronising, at worst a damnation of decades of welfarism that has produced people who are no better than children, because the state houses them, gives them money to spend and expects little in return. Of course once obese, people have the delight of the state picking up the tab for health care, because it sends no price signals over the years about how much extra it will cost.

I love this at the end though "Pensioners should be excluded because they had not been found to experience food insecurity, he said."

Oh hold on, so pensioners don't have this problem because presumably they aren't so stupid as to buy unhealthy food, or they aren't so lazy to not think a little bit about their shopping?

It's time to give up on this nanny approach, start thinking about health care as a personal responsibility and move towards people paying towards their health costs. I don't support removing GST on food, as GST should simply be abolished altogether. Removing GST on food makes food relatively cheaper than other "entertainment". However, it wont make any difference to obesity.

One thing might though. Getting rid of subsidies for bus services would encourage more people to walk and cycle.

Give up the aspirin if you're healthy

It does more harm than good, according to a study by the Wolfson Unit for Prevention of Peripheral Vascular Disease in Edinburgh, according to the Sunday Telegraph.

"More than 3,000 men were randomly assigned to receive a daily dose of aspirin or a dummy pill and were followed up for an average of eight years.

There was no difference in the rate of heart attacks or stroke between the two groups and deaths from any cause were similar.

However there were 34 major bleeds in people taking aspirin, or two per cent, compared with 20 or 1.2 per cent of those on the placebo."

So aspirin is for headaches or prescription.... that's it...

UPDATE: Yes bollocks to my grammatical error, that I would give other people hell for... thank you Opinionated Mummy.

Explaining the US healthcare system

and not defending it, is Lawrence Lindsay in the Sunday Times.

He was a former advisor to George W. Bush, so many on the left will shut their eyes anyway. However, he makes many valuable points about the US system. Does it ration by price? No...

"Medicare is an entitlement. This means it isn’t subject to an appropriation by Congress — the spending is automatic and unconstrained. Whatever bills Medicare’s beneficiaries run up, the government will pay without so much as a by-your-leave by Congress."

"So the real issue in America is not that we ration by price — by and large we do not. Our bigger long-term problem is that we effectively do not ration at all"

what do you get?

"First, there is much less queueing. Any insured American can get an appointment with his or her physician at a mutually agreed time with almost no waiting.
Americans have much better cancer survival rates. A study of cancer survival rates in 31 countries published last year in The Lancet bears this out. America was consistently in the top three for both men and women in the four different kinds of cancer studied. Britain tended to rank about 20th. First, Americans are more likely to get tested, thanks to the lack of rationing, and therefore the cancers are likely to be diagnosed sooner. This naturally makes them more curable. Second, unrationed American healthcare throws a ton of money at cancer, relative to Britain.
The third main service obtained from the higher cost of the American system is “extra spending at the end of life”.

He doesn't say this is all necessarily good, but it is what Americans might lose from an NHS based system, which rations more by regulation.

Have a read, it is one of the most balanced articles I have seen yet about the two systems. It should destroy the myth that the US system is about the free market, but also explains some of the reasons why it is more expensive as a proportion of GDP compared to the NHS.

Sadly, the debate on health care in both countries has been driven by largescale support of systems that are both fundamentally flawed.

McCarten's usual non-analysis on healthcare

It is pretty damned obvious that more often than not I'm going to disagree with Matt McCarten, this week using smears and distortions to spread the typical leftwing lie of American healthcare bad, socialised healthcare good. Simple concept. I'm sure it's one that the vast majority of New Zealanders agree with. Most have heard the propaganda about Americans dying in the streets without healthcare, turned away from hospitals and being ruined because of the high cost. Most of it is nonsense of course, but it suits the vested interests who profit from a state controlled and taxpayer funded system. What? Profit? Yes. You see that's one of the many points Matt gets very wrong. So what did he say?

"You only have to look at the United States to see what a nightmare it is when you mix profiteering with healthcare" Really Matt? So when healthcare worker unions go on strike demanding more pay from people who are unable to choose whether or not to take their money and go elsewhere, that isn't profiteering? Or is it ok for employees to engage in rent seeking from taxpayers? Perhaps you could look at Singapore, Australia, the Netherlands or others that have significant private sector involvement? Oh no, doesn't fit with your binary view of private sector untrustworthy, bad, rips people off vs public sector, benevolent, efficient, kindly, does it?

"Given that tens of millions of American citizens have no healthcare" Really? Nearly 85% of Americans have health insurance. Of the 15%, over a third live in relatively wealthy households (US$50,000 per annum plus), so prefer to pay for healthcare directly rather than through insurance. Let's bear in mind that all of the elderly and the very poor are covered.

So 10% of Americans have no healthcare. Bear in mind that in New Zealand (and the UK), healthcare is not always available when you need it too. Matt somehow thinks a majority will throw away what they have, but he forgets, a majority of Americans don't trust the government like he does.

"Seemingly ordinary people are mobilising noisily to oppose reform and keep their overpriced, inaccessible, ruthless health system. None of this universal, open-access health coverage for them. Apparently that's socialism" Yes Matt, maybe they know something you don't? Maybe the fact that this high price happens to deliver some of the best health professionals, leading edge procedures and technology in the world? Maybe because there isn't queuing?

Yes Matt, forcing everyone to pay for a monopoly state provider than you cannot demand service from IS socialism. You embrace socialism, are you scared of the word?

He says it is because "they've never known anything else so they can't imagine what it might be like not to live under a fear-based system". Of course Matt hasn't either, ignorant he just assumes the people campaigning are stupid. He also forgets that there is a fear based system in New Zealand as well, such as fearing when you'll get the operation you are queuing up for, when you are in pain or it is life threatening. No, forget that.

Then he completely misrepresents capitalism, describing democracy instead "a good chunk of Congress has been bought and paid for by the interests that stand to lose the most if Americans were to change their system. So it's not madness at all, it's just capitalism doing what it does best - fighting hard, and dirty, to protect its interests" Capitalism doesn't involve using the state to give privilege, no that's rent seekers, moochers, seeking state force to get what they can't get from persuasion.

However, Matt isn't into persuasion, he is into using state force to promote interests. Yes, the greatest corruption of government ARE those who use state force to get their interests - hardly surprising that health providers would do it. They do it in New Zealand, through monopoly associations and unions, but Matt thinks that's just fine.

Now he is right that some claim Obama's socialist ideas are about compulsory abortion or euthanasia, yes there are some wingnuts, but he uses that to smear the lot.

"US is becoming more a negative than a positive role model. And we can learn a lot from it, about things like keeping corporate money out of politics, about defending what we have and opposing the encroachment of the private profit-makers into matters that involve the public good." Well of course it's ok to have union money in politics, and confiscating private money for so called "public good". He loves the public good, but when it fails individuals they should just shut up and stop being selfish - I mean it's only health right?

"There's an argument that another even less savoury element underlies the screaming and yelling in America - racism. The mad-dog "birthers" who deny Obama is a natural-born citizen are its most obvious face, with those who labelled the new Supreme Court Justice Sotomayor a racist." Yes the birthers are mad, but Sotomayer DID make a racist comment, but in the world of leftwing doublespeak a Hispanic woman saying someone of her race can make better decisions than a white man - but if it was the other way round, McCarten would shout racism.

However, in the end Matt offers nothing of substance. Nothing to suggest what is wrong with the US other than it isn't government provided for all - he can't even conceive that it isn't a free market because he thinks businesses rip people off, but unions and governments are benevolent and always give good service to those who pay.

You see there is reason to have concern about costs in the US system, there are enormous distortions that privilege employer provided insurance over individually purchased insurance, costs through litigation that has become increasingly non objectively based, and the government provided medicaid and medicare systems are facing significant inflation. However, Matt has an ideological opposition to private provided healthcare, or insurance based models, even though many universal systems are dominated by private providers and insurance. Have a quick look at wiki, Singapore for example is virtually entirely private, with the government only topping up care for the poor.

Though you wouldn't expect a former Alliance Party President to spread that sort of information would you?

Daniel Hannan talks truth of NHS

Yes, Daniel Hannan is most well known as a Conservative MEP who attacked Gordon Brown in the European Parliament.

However, David Cameron isn't very happy with him now, because he has been telling the truth about the most centralised (and possibly most socialist) state run health system in the developed world - the NHS.

Daniel said that the US should not copy the NHS. He said so on TV and on his Daily Telegraph blog. Quite rightly he pointed out that those claiming it is the greatest British invention are forgetting the abolition of slavery, common law, penicillin and discovering DNA among other things. In short, they are idiots.

He notes that cancer survival rates in the UK are lower than in many developed countries including the US. Think tank "progressive vision" notes that Singapore spends only 4% of GDP on healthcare, but has better life expectancy and infant mortality stats than the UK - partly no doubt due to diet, but it has a private insurance based system.

He concluded by saying:

Imagine that, in 1945, we had created a National Food Service. Suppose that, in the name of “fairness” and “need and not ability to pay”, sustenance had been rationed by the state. Conjecture that every citizen had been allocated one butcher, one baker, one café and so on. We all know where that would have led: to bureaucracy, to duplication, to surpluses in one field and scarcity in another, to racketeering, to hunger.

Exactly. However, David Cameron hasn't the intellectual fortitude or the courage to handle this debate - for he knows Labour will use the old lying incandations that the NHS is sacred, and that any alternative means people dying in the streets without healthcare (apparently better to die of infections in substandard hospitals).

He said "The fact that in this country you can go to a hospital, you can go to a family doctor, and they do not ask you how much money is in your bank account ... is one of our great national institutions".

Such complete nonsense. Why not go to the supermarket and the same? Why not a landlord? Food and shelter are more important than healthcare after all. Besides, the money does come from somewhere - your taxes, by force, with no accountability.

The NHS IS a disaster, it is extraordinarily wasteful, it treats patients as production line items, and doesn't deliver the sort of results it promises, and is too big, too impersonal and full of rent-seekers who know that if they don't get what they want, they can frighten the public (and politicians) to give them more. It is time that UK public discourse started being honest about the NHS, that the socialist lying about how "great" it is be confronted, that the lies about the US system be confronted (it doesn't kick accident victims on the street if people arrive in ambulances without the means to pay) and some honest debate about healthcare occurs.

You see, without it, UK taxpayers will continue to be lumbered by ever growing costs, ever stagnating performance, and ever growing lack of responsibility for one's own healthcare.

In the meantime, the Conservatives are too gutless to take this on - so the debate needs to happen outside the three main (socialist) parties.

Daily Telegraph odds and ends

Greek woman sets fire to British sexual assaulter: After resisting his advances, after pouring Sambuca on him to cool him down, the guy wouldn’t stop. So the woman set fire to the man, to the cheer of onlookers – gave herself to the Police claiming self defence. The young man’s dad said “He's not the kind of lad that gets himself in trouble – he's a kind-hearted, generous boy”. He now has second degree burns for being a drunken fool.

HIV genome decoded: Scientists at the University of North Carolina claim to have decoded the entire HIV genome, raising hopes of new treatments to neutralise the virus. Given that drug therapy in recent years has significantly extended the life expectancy of HIV carriers, this may well be the next chance for a breakthrough.

Beetroot juice increases stamina: The University of Exeter's School of Sport and Health Sciences has found that a glass a day of beetroot juice can help men work out for 16% longer.

Woman who drink two glasses of red wine a day have better sex lives: You might expect the University of Florence to undertake THIS study. Overall, women who drank two glasses a day scored an average of 27.3 points (sexual arousal points), compared to 25.9 for those who drank one glass and 24.4 for the non-drinkers. Whether this continues to rise with each glass is a moot point, but it no doubt makes the drink feel like it is better! No doubt it also improves the sex lives of the men (and even women) they meet too.

BBC move to cost over £800 million: Whilst businesses sometimes shift from London to the regions to save money, the BBC’s move of the sports department and Radio 5 to Manchester is going to cost money. Proving once again, how unaccountable government organizations can be when the money they have to spent was taken by force by people who may not want its services anyway.

Iran executes 24 drug traffickers in mass execution: The second biggest (known) executor of prisoners continues form (I say known, because there are more than one or two governments that do this rather informally and privately). 219 people are known to have been executed in Iran since the start of the year. The total last year was 246. Of course many don't sympathise with drug traffickers, assuming of course the said individuals had a fair trial, that they were violent and forcing drugs on people or supplying children, hmmm. Oh and Iran has a horrendous drug addiction problem, demonstrating how effective a deterrent this is!

Sonia Sotomayer confirmed as latest US Supreme Court judge: True to those who value what is skindeep over character, most of the publicity about this is that she is a Hispanic woman. That is a first for the US Supreme Court. However, this is also a woman who once said "a wise Latina woman with the richness of her experiences would, more often than not, reach a better conclusion than a white male who hasn't lived that life”. Objective is she? The Cato Institute thinks she wouldn’t be in the running if she were not Hispanic.

Turia - Associate Minister of teen pregnancy?

An unlikely Hat Tip to Tony Milne at Just Left for pointing out this one.

Tariana Turia is now Associate Minister of Health with the following delegated responsibilities:

Functions and responsibilities relating to:

• Maori health (including Maori provider development);
• Disability Support Services funded and managed by the Ministry of Health for people under 65 years of age;
• breast and cervical screening programmes;
• communicable diseases (infectious and notifiable diseases, but excluding immunisation);
• sexual health;
• diabetes;
• tobacco.

Reassuring stuff, except Turia is on the record believing that the Maori teenage pregnancy is not a problem. Her own view appears to be that Maori should go forth and multiply, for political demographic reasons.

Nice given that one of the biggest problems facing Maori, demographically, is the high numbers of unplanned pregnancies, children growing up in homes that barely wanted them, and the disproportionate amount of child abuse in Maori homes. Turia presumably is happy every time a Maori child is born, regardless of how interested the parents are in looking after him or her, or how much taxpayers are forced to carry the cost, because of her own barely hidden agenda of eugenics.

Newspeak at the Standard

Let's say I have a shop, and I have a product on display. You want me to hide it, I choose not to do so. Have I changed the situation? No. YOU wanted the change and didn't convince me. Right?

No - not according to The Standard's Ministry of Truth. Apparently the government's refusal to ban tobacco displays in shops is going to make it EASIER for kids to get tobacco than at present, which funnily enough is that shops can have tobacco displays.

Like has been allowed the entire term of the government The Standard has glowingly loved.

Not only that, but the government WANTS kids to smoke. The reason given by Health Minister Tony Ryall was the lack of evidence that such a ban would be effective, but The Standard prefers a Parliamentary select committee (which face it is just MPs expressing opinions, NOT experts) to a Minister taking advice from officials.

You can see how the folks at The Standard could get a job overseas, such as at the Korean Central News Agency, which is a daily factory of twisted Orwellian fiction.

Of course I'd simply say that it is nobody else's business how a shop displays products that it is selling legally. If you don't want your kids to go to the shop, don't take them or tell them not to. Unless, of course, you have the kids sick of being told what to do by you, or are really dumb and will start smoking because of a product display, despite you warning of the health risks.

Making the fun police squeal

I'm unsure what it is, whether it is some sort of inate desire to evade the parenting finger pointing and "do what I say" judgmental nannying of do-gooders, but few things are quite as satisfying as pissing off Sue Kedgley.

The government decision to scrap the "only healthy foods" policy for schools is one I don't get too heated up about myself. You see I think schools should make their own decisions on this sort of thing (in fact all decisions if they could get funded from parents directly), so this is a minor step forward. However, for the chief conducator of nanny state, Sue Kedgley to describe it as "an astonishingly stupid move which will cost the nation dearly" is her usual hysterical cry of nonsense.

Kids can eat some unhealthy food, it's fine. You see, they ENJOY it. Enjoying some unhealthy food is part of life Sue - enjoying non-organic, sugar salt or fat laden deliciousness - like a decadent chocolate cake, like deep fried fish and chips. It's part of living, and the do gooding harpies like yourself make people want to do it more.

Because frankly the more you tell people to not do something, the more they want you to just fuck off and mind your own business. Especially since you want a state run health monopoly that doesn't charge people more or less if they live less or more healthy lifestyles, and rations due to politically agreed criteria instead of price.

It's like telling teenagers not to drink, not to smoke, not to have sex - the obvious response is to want to do it, just because you say no, and because the common theme among do-gooders is to want to regulate having fun.

That's the same response I give to Dr Alan Maryon Davis in the UK, who the Daily Telegraph reports as saying "I see an increasing acceptance that we, all of us, need not only more information and guidance from government, but also more legislation to save us from ourselves". He WANTS more Nanny State, he thinks people are stupid and should be treated like children and saved from themselves.

What he wants and needs are two different things. What he needs is, as Bob Jones would say, a smack in the chops. People take risks about their health because they face no consequences in the Soviet style National Health Service. The ultra healthy gain nothing, the ultra sick get all the health care the system can ration their way. If you change that, then it shouldn't be any else's business if you want to risk a short life being decadently unhealthy, or a long life being frigidly good - or indeed the opposite, as both happen.

The fun police are to be scorned and loathed and exposed for what they are, with their only argument of merit - that it is useful to inform people of risks and behaviour that can harm them - being something that the fun police should direct attention to. I like knowing blueberries are very good antioxidants, and butter really is rather bad for the circulation (with little else going for it). However, damn the health fascist who tells me off from lathering butter on toast once in a while, or tells me I am not eating enough blueberries.

In the meantime, upsetting Sue Kedgley is a pleasure - so let's all have a chocolate bar, hamburger or the like this weekend, to make her writhe.

GM tomatoes with higher antioxidants

The Sunday Times reports scientists at the John Innes Centre, Norwich, UK have developed genetically modified tomatoes, including snapdragon genes, to produce anthocyanins, which are antioxidants that offer some protection against cancer, heart disease and diabetes. This complements the lycopene in tomatoes.

A great step forward which potentially could enhance the health and wellbeing of millions.

So of course Pete Riley of the anti-science group "GM Freeze" says that even the idea of "GM superfoods is fundamentally flawed". There being "no need" for foods to ward off cancer. Furthermore it is unlikely to "benefit the world's poor". How utterly evil. Almost every single major advance in medical science has not benefited many of the world's poor, because they are hardly in a position to access it or afford it. Pete Riley would presumably prefer that research on disease stop till the "world's poor" (him not being one) have access to all other treatments, something he no doubt is doing little to achieve himself.

My own family, and a friend of mine both have propensities to cancer, without smoking, without any of the other lifestyle factors, it is genetic. Anything which can help ward off cancer is welcome, but the ecologist zealots, worshipping their "nature is better than science" dogma would stop that.

This is one area where it is clear what the Green Party (in any country no doubt) would think. It would say no. Ask yourself on what basis. Is it evidence of ill effects of genetically modified food? No. It is purely a belief that there are no positive effects and people "don't want it". People not wanting something is a good reason to ban it, apparently. That's what the Green Party is about.

One NHS fraud may end

According to the Daily Telegraph, NHS patients will be permitted to pay for drugs that are not funded by the NHS AND not lose their NHS treatment. I blogged on the current scandalous state of affairs some months ago. In short, the status quo is this:

Say you have cancer, and you receive treatment. You are made aware that there is this new, expensive drug, that is probably your only chance of recovery and saving your life. However, the National Health Socialists wont pay for it. You say you'll pay for it, you are desperate after all. The National Health Socialists say, "oh you're rich are you? Well pay for all your treatment now, bye".

The philosophy being simple - the NHS is either something you pay into and take what it gives you and be grateful it exists, or you buy something yourself and having taken you money, it gives you nothing. Nobody on the NHS should get a higher standard of care than anyone else, even if that higher standard is paid with using your money.

Apparently, the Brown government may relent. Apparently it can see how unpopular it is for people to pay to the socialist health system, and then have it turn its back on them when they want care that might actually save their lives. The left's magnanimity to those who pay for its totems knows no bounds!

Public health care + ACC = no accountability

This appalling set of cases reported in the NZ Herald are not the sort of thing Michael Moore describes when he waxes lyrically about how socialised health care is so wonderful. Take this:

"Patient 1 - Aug 2006: A suspected retinal detachment in Whangarei is referred to specialists at Auckland DHB.

Ten days later: No word from Auckland; patient asks Whangarei doctor to follow up. Auckland confirm they have the referral.

Feb 2007: Still no action from Auckland. Patient again asks doctor what is happening. By then the condition has worsened too much for the treatment.

Nov 2007: Patient's left eye is removed."

It can be explained, at one level, by the following.

- Capture by providers, who get funded according to what bureaucracies recommend, and certainly not based on what consumers want;
- ACC protecting providers from being sued.

ACC, you see, is an absolute travesty. It provides a one-size fits all socialised insurance scheme, where you get what the scheme dictates - because you couldn't have chosen another provider. The insurer doesn't claim it from the incompetent or the incompetent's insurer (which is ACC too), doesn't hike up the premiums from the incompetent. The incompetent says sorry, and the victim loses an eye.

Yes, fantastic system, so low cost - except for the victim of medical malpractice.

Yes, in the USA it would take months for a lawsuit to proceed, maybe years with appeals. However, the incompetent ones would seek to settle, to avoid those costs, and the mere fact of having to face up to these costs directly changes behaviour.

ACC is the socialist way of spreading the cost of accidents among everyone, including those who don't cause them, don't have them, and the costs for victims are flattened, ironed out, so you don't get more than "your share".

It needs to be opened up to competition, at all levels, so that people can choose the cover they want, so insurers can charge premiums according to risk, so that the incompetent face their costs, and others do not.

In the meantime, it will be simply another "oh we're very sorry" to those who lose an eye, have cancer spread potentially fatally, and have another stroke.

At this election, ACC has barely a mention. National will consider re-opening the employers' account to competition, which wont touch this. ACT would open all of ACC up to competition, which would make a difference. Libertarianz would open all of ACC up to competition, privatise it and restore the right to sue.

So what do you think? Would competition in ACC be enough, or should health professionals face being sued for their incompetence? I don't mean the crazy subjectivist US tort cases where people sue for their OWN incompetence, but clearly establishing on the balance of probabilities that the other party has been unreasonably negligent.

Pay for your mistakes?

While I bemoan those who give or take credit without being able to bear the risk either way, Crusader Rabbit has an interesting post on those who bemoan the "costs" of alcohol or drug use imposed upon the public health system.

Send them the bill. In other words, if the hospital determines that you are to blame for your accident - you pay.

That's inherently appealing - responsibility for the harm you impose on yourself or others. However ACC gets in the way - at the moment we all pay ACC for the costs of all those who have accidents causing personal injury. The better first step is to individualise ACC, and allow people to choose who to get accident insurance from - meaning premiums will vary. If you don't pay for accident insurance then you pay the bill. Of course such insurance would have to be compulsory unless the right to sue is returned - a big additional step.

So if you are turning up at A&E regularly drunk, then funnily enough your premiums go up. If you don't, your premiums go down. Then the only costs left that remain a concern are those who don't get insured - in which case you might ask, why drink alcohol heavily instead of buying accident insurance? That becomes another issue - but why should the costs of recidivist foolishness be socialised? Why should the state owned monopoly ACC be retained?

UK government locked up typhoid sufferers in asylum

The BBC reports that women who were chronic carriers of typhoid were locked up in a mental asylum from 1907 to as late as the 1990s. They were locked up as a risk to public health (note it was women, not men). The hospital - LongGrove - closed in 1992. In 1956 there were 26 and it was reported they were "deteriorated mentally". Unsurprising as they were physically sick, locked up as if they were mentally ill and dangerous. Almost all were incarcerated and died there. By 1972, most surviving had been cured and were relocated in non-isolation wards in the same institution.

The women effectively had life imprisonment, and isolated in a mental institution, even though they were simply infectious, not with any psychiatric condition. In the TV report on Newsnight, one nurse said it was prison like, the patients were seen as "objects" and life was not good. She talked of the women she looked after, saying most were not mentally ill. The tragedy of this case is that the women are dead. Moreso, the UK Department of Health denies that there was any such policy, although there remain powers to incarcerate carriers of disease. The state, meaning good for the masses, destroyed the lives of a minority - not by isolating them in a medical facility but imprisoning them out of sight and out of mind. Nobody will ever be accountable.

60 years of NHS- time for a rethink

The past week has seen the BBC and the UK, celebrating the 60th anniversary of the founding of the nationalised health service - the NHS. The system based on the openly socialist philosophy that the state should provide health care free at the point of use to all.

The reality of the risks of that system was largely ignored by the Labour Party at the time it was introduced. Britain was bankrupt from World War 2 and the Atlee Labour government used ample funds from the Marshall Plan supplied by the USA (and the UK got more than any other country in post war Europe) to fund its socialist plans of the NHS, iron/steel, coal, railway, bus, truck, airline etc nationalisations. The point that the NHS would result in over demand (with some going to doctors when they had little wrong with them), few incentives for healthy living (you pay the same regardless if you smoke, exercise and eat fatty foods or not), and a lack of accountability for any failure to perform as promised

Now the NHS is probably the UK's biggest sacred cow - it shouldn't be. For years the argument was that it needed more money - Labour did that, increasing NHS spending by 80% in 11 years. Improvements are difficult to see, as most of the extra spending has been sucked up by increased demands and increased pay. Another argument was that there needed to be administrative tinkering, which also has sucked in more money.

The Sunday Telegraph's editorial rather boldly proposes something else - an insurance based model which includes the private sector.

It states that the original vision of the NHS was that it would require less money over time as people became healthier, but ignored that people would expect more over time:

"It was assumed that, as the nation's health improved, so demand for medical treatment would diminish.

But the opposite has proved true. Increasing life expectancy means more people live to an age where they contract diseases that are expensive to treat. People are also less inclined to queue than they were in the austere days of the 1950s.

In a consumerist age, people compare their healthcare with the provision of other services and expect to have the same choice and speed of delivery.

Yet, while the NHS has evolved over the years, its structure and the way it is financed still owe more to a 1940s belief in the efficacy of state monopoly than to the realities of the modern world."

The paper continues, pointing out that both Germany and France have insurance based models with larger private sectors:

"Insurance schemes that let people decide how much of their own money to spend on healthcare and top up what they contribute in taxes are the way to bring greater investment into the system. Politicians must prepare the country for the realities that need to be faced; yet the totemic power of the NHS to stifle debate seems undiminished."

Indeed, the incentives of insurance could assist in encouraging people to look after themselves, and manage the costs of healthcare, in particular exposing people to the costs of what they expect. However, it is difficult to see the Tories (much like National in NZ) making any worthwhile change.

"Proposed Conservative reforms risk replacing Labour top-down targets with their own. The party must be willing to take on producer interests in the NHS and give greater choice to patients by embracing new ideas such as easier access to specialist doctors.

People no longer see the NHS as the property of its practitioners, but of those who pay for it. The NHS must respond to that mood - or voters will want to put their money into something that delivers the care they expect"

People will complain and moan about public health care and fail to recognise the simple truths, that the price of socialised healthcare is queuing, not always getting what you want, and paying the same regardless of your good or bad behaviour. It is time to put healthcare in the hands of those paying for it, by moving towards insurance, private provision and competition. The status quo has failed, and will fail more as the population ages and biotechnology pushes the cost of the best treatment beyond a socialised system. People will simply not tolerate ever increasing taxes for a system that produces ever increasing queues.

So what IS the cost of drugs?

The NZ Herald is reporting a study conducted called the Drug Harm Index. It reports it was "designed by economists to help police decide where drugs do the most harm and enable them to use resources more efficiently."

On the face of it the report claims a $1.3 billion "social" cost for drugs. That, of course raises some big issues:

- How many of those costs are costs of prohibition? If prohibition ended, how many would go up, how many would go down or disappear?
- How many of these costs could be born by those using if the incentives were in place to do so? These wouldn't be "social" costs, they would be internalised. Indeed how many of these costs ARE internal?
- What are the benefits? People spend money on drugs not for nothing, but because they gain value in it. The value is not dissimilar to the value from drinking, eating a dessert, sex or the like. You see people take drugs because they feel good isn't it missing part of the equation to ignore that?

Now I don't think that long term drug use is a particular clever thing to do. It can be highly destructive and damaging, much as consistently high levels of alcohol consumption can be too. However, it is important to consider drugs dispassionately. It's not me to judge what another adult ingests, as long as it doesn't harm anyone else. So let's look at least at some points reported:

- "373,310 people used cannabis, but only 17 per cent of these were frequent users". It may suggest that the bulk of users are getting about their life reasonably well. At least no worse than the regular drinker. However if we enforced the law strictly, that would be equal to the population of Christchurch being in prison. That's what winning the war on drugs would mean.

- "Nearly 23,000 people used crystal methamphetamine (36 per cent of them often)" compared with 81,890 using MDMA and 38,890 using cocaine. Suggests the "P epidemic" isn't quite that, although it is undoubtedly the most destructive of the drugs listed.

- Drug use is related to absences at work, which is hardly surprising. However, this IS a matter between the user and the employer, and if the employer has the legal right to dismiss someone for excessive absences then the issue can be addressed. However, you wouldn't arrest a drug user purely for not turning up at work enough would you?

- 16% of the prison population is occupied by "drug related crimes", although it is unclear whether this is drug crimes per se. $108.7 million per annum to keep them there. However, this isn't a cost of drug use - it is a cost of drug prohibition. Add the $374 million court, community sentence and home detention costs also to drug prohibition, not drug use.

- 2292 patients admitted to hospital for drug related reasons, costing $6.76 million p.a. Hardly noticeable in a health budget of $11 billion p.a. The Ministry of Health says that the annual cost of alcohol related hospitalisations is $74 million p.a. Of course, if drug users had to pay for hospital costs it wouldn't be a social cost anymore.

- 1920 drug related deaths (including associated with homicide and road accidents). That statistic itself sounds like a wide catchment. Does it include people murdered in the criminalised drug sector? Curiously ALAC's website claims in 2000 that 1040 deaths were attributable to alcohol, but 980 were PREVENTED by alcohol, although the deaths were more likely to be premature and the deaths avoided older (presumably the preventive effect of red wine on heart disease and the like). Back to drugs, how many drug related deaths could have been avoided had it been easy to present information on safer use of MDMA and other drugs, for example? How many drug related deaths could have been avoided had drugs not been "fortified" by a range of substances to make them "go a bit further" for dealers - a consequence of prohibition.

- "While stimulants contributed 41 per cent of the total costs, figures showed that in 2006, police and Customs seized 33,480kg of cannabis compared with only 155kg of stimulants." It demonstrates the law enforcement agencies concentrate on the high volume easy catches, not the low volumes harder drugs. What does that say about incentives to target "catching people" rather than harm?

So the story is mixed. Yes drugs undoubtedly cost in productivity, and cost more in less tangible ways socially as their misuse can be highly destructive to motivation, character and attitude to life. However, is that a reason to lock up 1578 people? Are their wider education, cultural and philosophical reasons why this happens?

Yes drugs send people to hospital, but at a fraction of the rate of alcohol. We also don't know whether drugs have any positive health effect - some cancer patients report cannabis soothing their pain. We also don't know what other positive effects they have on people, relieving stress for example. Yes there are sceptics, but I'd like to see someone dispassionately investigating this. The cost of drugs is only half of the equation, what value are there on the benefits? I don't have any idea whether this would be smaller or larger than the costs, but surely we should ask both before coming to a conclusion.

Finally, the cost of the criminal justice system is not a cost of drug use, it is the cost of drug prohibition. That is also worthy of a study. The cost of prohibition includes all of those imprisonment and court costs, and Police costs. It also includes the higher price users pay, and an element of the health costs by reducing quality. Finally, if a cost of drug use is reduced productivity, a cost of prohibition is the cost to individuals of being incarcerated and forever having a drug conviction in their records. The cost in time can be calculated, the cost in lost earnings over life, and reduced opportunities to travel. The benefits would be worth calculating too - what do we save from prohibition?

Now none of this is about developing an economists answer to a question of individual freedom, but it is useful in identifying the consequences of policies and getting some order of magnitude. It is telling in itself that the health costs of drug use are quite low.