Thursday, 5 November 2009

REPOST House bill 676 (AKA evil Nazi comunist healthcare bill)

Disclaimer: I lean anarcho-capitalist and I'm British, everything I say is biased. Read the bill and make your own mind up.

Americans spend more on health care per capita than just about anywhere. This is largely due to the poor not wanting to pay for preventative medicine and so paying out massive lump sums for emergency operations etc (one of the highest causes of bankruptcy in the US is medical debt). So it makes sense for preventive medicine to be paid for by central funding, thus putting more people into the labour market and increasing general goodness and utility. However massive government health care programs (eg the british NHS) are often inefficient and expensive for their own reasons (not not as much per capita as America). The NHS is the 5th largest employer in the world after the Red army, Walmart, US defence department and Indian national railways.

Ok enough preamble, the bill. The only version I can find is the bill as presented to the house, this is the short (30 page) bare bones version before lobbies and others can expand that hell out of it with thousands of sub clauses. The entire thing is at or

* Chiropractic services. ( bluntly chiropractic 'treatment' is psudoscientific nonsense, no well conducted study has shown any benefit for the kinds of conditions it claimed to deal with, on top of that is is dangerous in a very real and well documented way.

* freedom of choice ( this is a good if not vital idea, but this one sentence is not nearly enough to deal with it, we'll have to see how things turn out after editing and expanding.

* No balance billing ( this is the sort of thing we have problems with in the UK, the sharp discontinuity between private and public, accepting any govt. money at all renders your services non-billable.

* Favouring community-based care ( is another one that needs to be watched post edit, in theory this leads to much better outcomes for the patient, but not universally, I can imagine many situations where this will either be interpreted too strictly or opposed by NIMBYs.

* Official prescription drug buyer ( if you have to legislate to say that people should be encouraged not to give their patients drugs that are dangerous you're doing it wrong.

* Promotion of generics ( fantastic, this is an absolutely necessary part of the legislation (watch it get watered down or pulled in committee. While we're at it lets use free software on all govt computers.

* right to petition ( two things: you don't need to tell us we have the right to petition, that's given in the the first, what you mean is that people have to listen, that's a different matter. secondly the word region here scares me, I get images of the UK's postcode lottery where different services are available depending on where you live.

* funding ( not being very familiar with the American system is putting what taxes will be raised a normal part of bills? If so it's a very clever idea so people can know what everything costs and where the money comes from. Though this is just nonsense, you can't cut paperwork by saying you're going to, bureaucracy breeds, secondly you're raising a large chunk of this by taxing only the top 5%... is it really fair/sensible etc to have such a dichotomy, with only the rich paying for only the poor.

* replacing medicare offices by new regional offices ( Is this really a good use of resources? If medicare is running things now why can't they carry on, keep all the same offices just expand them as required, I dont see the benefit of what looks like a massive re-branding exercise.

* Huge list of duties for regional director ( Is it sensible to centralise things in this way? I see no logical reason why the same person who decides when and where hospitals are built should also decide on an area's health budget, surely the first needs to be done at a really local level and the second at a huge area?

* electronic records ( I know I'm jaded by the NHS, but huge computer systems dont work. it wont cut down on paper either, everyone will still print things out. We need records of what drugs are give an what tests take for sure, but do we also need all the rubbish that are always in government databases? There is also the problem that people who fear computers wont tell doctors things because they worry about it being on the system.

Conclusion: This bill will pass, but it'll look nothing like this by the end, America could never accept such radical change. The bill has far too wide a mandate as it stands, you'd need to tear down half the health industry to implement it. There are some very good points but the focus is quite wrong. What this bill should be about is providing the basic services that the uninsured dont get, not trying to put vast swathes of heath care into the government's hands in one fell swoop.

Both sides are misrepresenting this, the impression I get from republican officials is of a far more limited bill than this one. The impression I get republicans ... well the impression i get from republicans is that republicans are stupid, but the bill is presented as actually evil. This is not destroying anyone's rights, nor will it cost half the national budget, nor will there be mass killings or the amount of government involvement described.

What it is is badly balanced and inefficient (half the bill is spent creating new middle management posts) but with enough wholesale re-writing this bill could very easily become serviceable.

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