Ischemic Attack!

The word is out on the digital street that I was in the E.R. last night, standing in for George Clooney. That's not entirely accurate.

Last Tuesday I felt a tingling sensation in my right leg, as though my leg were asleep. After a couple of hours the feeling passed. Thursday the sensation returned and covered the entire right side of my body. Friday night I checked my blood pressure and it was high. So Mrs. Islander drove me down to the Island Emergency Room.

Checking into the ER when you don't have a broken limb or gaping wound seems a bit false, as though you are malingering. At those prices, though, it's no joke. I could feel the money flying out of my wallet.

Because the issues involved are your own health and life, yet you spend so much time alone in a strange room, time spent in the ER swings from boring to fascinating. Lying in a bed, connected to different monitors, I couldn't get up and walk around, so I had to devise my own entertainment.

The monitors to which the nurses hooked me up are set to sound an alarm if the patient's bpm drop below 50. I have a normally low resting heart rate (49 beats per minute). After responding to the third alarm, the nurse reset the monitor alarm to 45 bpm.

I laid back, relaxed, and slowed my breathing, timing it to my heartbeats. I dropped my heart rate to 44 bpm and triggered the alarm again.

Good times, good times.

I was given a diagnosis of TIA Transient Ischemic Attack (mini-stroke). A CT scan could see no lesions (brain damage), so I'm doing well so far. (No snide remarks from my siblings--I have doctor's proof of no brain damage. Do you?)

Monday morning I report into my own doctor's office and get an ultrasound of my neck and schedule an MRI.

I'll post more as events warrant. You are free to go about your daily lives.

Articulate

Now that the Republican Party is looking for it's next standard bearer, we all have been compiling lists of what qualities the ideal candidate will have, and what priority we should impose on those qualities.

Let me state that whoever leads the party and whoever becomes the candidate in 2012 must be, in the words of Joe Biden, "...articulate and bright and clean and a nice-looking."

She aces "bright," "clean," and "nice-looking;" but much as I love Governor Palin, she did not demonstrate "articulate" during the recent campaign.

Why is this so important? I think that while we have seen that George W. Bush has been an effective administrator in protecting the country for the last 8 years, his inability to communicate his plans and directions ceded to his opponents the marketplace of ideas and opinions. So his accomplishments (no attacks on the order of 9/11, forstalling a depression in 2002, etc.) became not victories, but clubs used by the left to beat him.

James Pethokoukis points out that if the Democratic plans for US health care policy proceed unopposed, Conservatives may never recover the ground. He makes this observation:

3) Republicans better learn to competently talk healthcare.
John McCain's healthcare plan was perhaps the most provocative policy proposal of the entire 2008 campaign. Too bad he could neither fully explain how it worked nor persuasively argue why it was better than Barack Obama's plan. Also too bad since his plan would have smartly reduced healthcare costs by getting companies out of the healthcare benefits business and empowering individuals to buy insurance on their own. This would have helped fix what economist Arnold Kling calls the insurance vs. insulation problem: "Insulation relieves the patient of the stress of making decisions about treatment. The patient also does not have to worry about shopping around for the best price. The problem with insulation is that it is not a sustainable form of healthcare finance."

Mr. Pethokoukis ends with this:

Another interesting healthcare reform option is highlighted by Ross Douthat and Reihan Salam in the book Grand New Party. Uncle Sam would require individuals and families to put 15 percent of their income into health savings accounts. If you run out of money before year-end, the government steps in. If you don't, you get the money back or it rolls over into a retirement account. Of course, any conservative alternative would be easier to implement if it doesn't first have to kill an existing nationalized health plan. But thanks to Tom Daschle, that is just what might have to happen.

The Constant Reader will remember that I endorsed this idea when it was proposed by Megan McCardle.

Jane Galt on Healthcare

I'm been a big fan of Megan McArdle since her Live from the World Trade Center days. She has become my model for not jumping into a discussion without questioning the assumptions. Here are four of her recent blog entries on healthcare, culminating with her suggestion for addressing the problem. I have included excerpts, but this is something that I think deserves a lunchtime read-through of the original entries.

I am going to advocate her approach to my congresscritters.

What's happening on health care?

A few weeks back, I noted that national health care seemed to be the only major policy programme that the left could basically agree upon. Now, I hear the stirrings of a push for national health care rippling through the liberal blogosphere like a rising storm wind.

If this movement actually takes off, I expect that we'll see a great deal of vehement argument between conservatives screaming that the liberals are going to screw up our health care system, and liberals arguing that conservative people are hardhearted bastards who want the poor to die. So before that happens, I thought I'd set down some quasi-reasonable thoughts about what we want from our health care system, what a single-payer US system would probably look like, and what the pro's and con's of such a system would be.

The first point to make is that our health care system is already screwed up. The practice of having your employer pay for your health insurance is lunatic. We should not be surprised at what we get when the person who pays for your health insurance is not the person who consumes it....

Health Care, Part II

Let's think about where the money actually goes:

• 30% of all healthcare expenditures occur in the last six months of life
• 31% of expenditures are on hospital care
• 9% of spending is on nursing homes
• 22% of spending is on physician and clinical services
• 10% of spending is on prescription drugs
• 10% of spending is on dental/other professional care
• 10% of spending is on medical equipment, supplies, and construction
• 7% of spending is on administrative expenses

So how likely are either Health Savings Accounts, which encourage consumers to shop around because they're spending their own money, or single payer, to reduce any of these categories significantly?

In theory, either HSAs or single payer could cut down on many of these expenses. In practice, colour me unconvinced...

Health Care, Part III

It is possible, even likely, that a government-run health care system would be able to batter cost savings out of suppliers of medical equipment, supplies, and pharmaceuticals. But that doesn't strike me as a good thing. The high returns on medical equipment and drugs are what encourage people to invent more such. Get rid of the return, and you get rid of the innovation. Generating cost savings on new technology in order to cover today's uninsured simply privileges one small group of unfortunates over the very much larger group of people, living now or in the future, who have diseases which we can't currently cure. The lucrative American market is currently the only incentive left for medical innovation; I am very much against destroying it.

Single payer advocates retort that pharmaceutical companies spend a lot of money on marketing, which is true, but irrelevant--forcing pharmaceutical companies to price at cost-plus will kill the research along with the marketing. Actually, if I were running a pharma company, and something torched my profits, I'd kill the highly speculative research before the lucrative marketing campaigns. If we want to stop pharmaceutical companies from advertising, or selling directly to doctors, surely outlawing those things is a much more effective way to manage it than slashing their profit margins and hoping that they cut only the things you want them to.

Others argue that the government can take over the research. Perhaps the government is necessary to fund basic research; I haven't studied the question. But looking at the defense industry, where the government is the sole purchaser and major funder of new technology, it's very, very hard to believe that applying a similar model to health care would result in greater value for money. Rather, it seems very likely to me that politically popular diseases would get an even more disproportionate share of funds than they do now. Pharmaceutical companies have to pay attention to things like the size of the market, and the strength of demand. Politicians pay attention to how loud the lobby is, which is why breast cancer and AIDS get research funding all out of proportion to the number of people they kill...

Health Care, Part IV

All that's very nice . . . but how do we bell the cat?

Here is my suggestion. It is simple and elegant enough to be explained in a single sentence, yet powerful enough to meet all the criteria above:

Have the government pay for all health care expenditures above 15% of adjusted gross income, and cover 100% of health care expenditures by people living under 200% of the poverty line.

This preserves the market in most health care services--happy [Health Savings Account] advocates! It is progressive, and provides universal coverage--happy single-payer advocates! It directs coverage to those who really need it--the very sick--without a middle class subsidy--happy Jane! And it preserves market prices for almost everything from hospital beds to surgical procedures, since a significant fraction of the market will be paying their own way. That keeps the government from having to set prices, which as Soviet Russia showed us, is generally a bad idea. Most importantly (from my perspective) it preserves the market for innovations in drugs and medical equipment.

It is certainly not perfect. For one thing, I make no promises that it will control costs; I only allege that it will improve quality.

But you know what? We're rich. We're really, really rich. We're the richest country in the entire history of the world.

We're so rich that we have stores full of nothing but beautifully sculpted plumbing. What do we want to spend our money on that's better than health care?