Bullet: First Do No Harm
Tuesday, April 24, 2007
LTC Comment: How
does the first rule of medical ethics apply to health and LTC policy?
After the ***news.***
THE BOOMER CENTURY. Remember
the two-hour Ken Dychtwald PBS special we've mentioned a couple times?
Now you can get a DVD copy of the program for $10 shipping and
handling. Simply contact Robyn
Hamilton at Ken's company Age Wave, 415-705-8015 or email@example.com.
She'll send you an order form and instructions.
Otherwise: check the
PBS website for future air dates: http://www.pbs.org/boomercentury/airdates.html.
One way or the other, don't miss this entertaining and
educational program. ***
*** TRUSTEES' REPORT.
Security, Medicare Get a Year's Reprieve http://www.fee.org/in_brief/default.asp?id=1258,
4/24/2007, "The trustees who oversee Social Security and Medicare
issued new warnings yesterday that the two programs are becoming
unaffordable but pushed back slightly their predictions of when the
crunch will hit." (Washington Post, Tuesday) http://www.washingtonpost.com/wp-dyn/content/article/2007/04/23/AR2007042301963.html.
If your kids were as irresponsible as politicians, you'd ground
them. FEE Timely Classic:
"A College Fund on the Social Security Model" by
William B. Conerly http://www.fee.org/publications/the-freeman/article.asp?aid=4619.
following article contains links to the full text of the Social Security
Trustees' 2007 report, to a summary and to Treasury Secretary Hank
Paulson's comments on the report.
U.S. Social Security trust funds are expected to be exhausted by 2041, a
year later than last year's estimate, while the Medicare trust fund is
projected to go broke by 2019, also one year later than 2006
projections, according to the latest annual report from the funds'
trustees." Source: Benton
Ives-Halperin, "Funding of Social Security Is Seen as Slightly Less
Dire," WSJ Online, April 23, 2007, http://online.wsj.com/article/SB117733366955278937.html.
BOOMER BOOMERANG. The idea
that younger workers will meekly bear the huge tax increases needed to
pay all boomers' promised benefits is delusional, says Robert Samuelson
in the Washington Post at http://www.washingtonpost.com/wp-dyn/content/article/2007/04/10/AR2007041001311.html.
Daily Policy Digest 04-11-2007. ***
LTC BULLET: FIRST
DO NO HARM
LTC Comment: My
health policy hero is John Goodman, Founder, President and CEO of the
National Center for Policy Analysis in Dallas.
His 1992 book (with Gerald Musgrave) Patient
Power was my introduction to acute care health policy and I've often
applied Goodman's ideas and principles to my own analysis of long-term
Today I want to share with you a short piece Dr.
Goodman published recently that I think holds the key to both health
policy and long-term care policy reform.
First do no harm.
In other words: don't
let public policy crowd out personal responsibility and private
with permission from "Health Alert - Reform, April 2, 2007,"
on the John Goodman Blog at http://www.john-goodman-blog.com/:
the Economic Way of Thinking to Health Policy
am probably the only person you know (or are likely to meet) who thinks
all the major problems in our healthcare system are caused by bad
you want to see the case for this position, look at the article I wrote
for the Journal of Legal Medicine [see below for a link to this
article]. In it, I ask
readers to perform a thought experiment: identify the major ways in
which government policies create perverse incentives to do socially bad
things. Then imagine
replacing those harmful policies - not with good polices, but with
policies that are completely neutral, I call this the "do no
harm" approach to public policy.
how it works:
Number 1: Our system of government funded (and mandated) free care
encourages people to forego insurance and rely on the charity of others.
Solution: Let government offer just as much financial incentive for
people to privately insure as the expected free-care spending under the
current system, making private insurance just as financially attractive
as reliance on charity care.
Number 2: The existence of government funded insurance (Medicaid and
SCHIP) encourages people to drop their private coverage and become
insured at taxpayer expense.
Solution: Let people apply their Medicaid subsidy to private insurance,
making the two types of insurance equally attractive from a financial
point of view.
Number 3: While the current system provides lavish tax subsidies for
employer-specific insurance, it provides very little tax relief for
people who purchase individually owned, personal and portable insurance.
Solution: Create a level playing field for all forms of insurance under
Number 4: Although there is in principle no limit to the amount of tax
subsidy available for spending on third-party insurance, the tax relief
for self-insurance (though a savings account) is very limited and
Solution: Put third-party insurance and individual self-insurance on a
level playing field under the tax law.
Number 5: Largely in response to the problems created by all of the
above, government has essentially outlawed a real market for risk -
encouraging individuals to be uninsured while healthy, secure in the
knowledge that insurance will be available at premiums totally unrelated
to the expected cost of their care if they get sick.
Solution: Like the market for life insurance, allow the market to price
and manage risk.
that in adopting these solutions we are not trying to do good.
We are mainly trying to avoid doing harm.
The result: a system so completely different from our own, it
would hardly be recognizable. (And there are many more harmful
distortions yet to be removed!)
the 'Do No Harm' Principle to Health Policy" by John Goodman:]
on this Health Alert: