Genetic profiling while you wait

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Well, not quite, but according to a piece in The Times scientists at Oxford Nanopore have developed a new technique which could bring the cost of individual profiling down to $1,000 or less. Knowledge of our individual genetic defects and health risks would, of course, be a mixed blessing. On one hand, medical interventions - and even, before too long, replacement of faulty genes - could not only increase average lifespans but also improve the quality of life for many. On the other hand, there may be little benefit in the knowledge that you have a serious health risk for which there is as yet no cure, and the inner hypondriac in many of us needs little encouragement to flourish.

The point is that the first human genome sequence was published in 2001, at an estimated cost of $4 billion. The rate of technological advance since then has been staggering. It even puts the continual rapid advances in IT in the shade. Technologies such as this come seemingly from nowhere but can soon have a pervasive influence on our lives. The instant availability of information and communications on the move which we now take for granted was the stuff of science fiction only a generation ago. The next generation may also take for granted the availability of personalised preventive healthcare and marvel at the primitive nature of medicine in the noughties.

All this makes a nonsense of the fashionable concept of sustainability, which assumes that what we do today we simply do more of tomorrow. Progess isn't smooth; society is subject to a series of disruptive developments which are unpredictable and change our assumptions about resource use overnight. Rather than routinely predicting catastrophe, we should have more faith in the human race's innovative capacity and adaptability.

Guest author Martin Livermore is the Director of The Scientific Alliance

The top ten myths of American health care

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A new report has been published by the Pacific Research Institute, titled “The Top Ten Myths of American Health Care: A Citizen's Guide" by Sally C Pipes. The publication examines ten commonly held myths about health care in US, including:

  -  Government Health Care is More Efficient

  -  Forty Six Million Americans Can’t Get Health Care

  -  Government-Run Health Care Systems in Other Countries are Better and Cheaper then America’s

  -  Universal Coverage Can Be Achieved By Forcing Everyone to Buy Health Insurance

  -  We Need More Government to Insure Poor Americans

There are going to be many problems created over the coming years in relation to healthcare in the US, one can only hope that this book is read by those who need to. Indeed, this publication would be invaluable for many in free market policy in Europe to expose the lies of those who castigate the US system as one that is wholly private and extraordinarily exclusionary.

For a more in depth review of the publication please click here to read Doug Bandow of the Cato Institute, whose article appeared in the Washington Times.

DIY dentistry

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We all know that healthcare provision in the UK is a tangled mess. The massive influence and control that the government has over the NHS and its resources has created a huge gulf between the service and its patients. Politicians no longer see patients as humans, but as numbers within quotas and costs on balance sheets.
 
When politicians make decisions, they can often forget the real impacts that this will have on lives. This latest survey by Which? found that 8% of people had tried DIY dentistry. Of those 8%, one in four had tried to remove a tooth using pliers, 12% had tried by tying a piece of string to a door and 19% had tried to pop an ulcer with a pin (These results are painful to read!). Surely the provision of state healthcare cannot have become so bad in the UK that we are resorting back to Victorian standards?
 
As I have blogged in the past the system for allocating dental healthcare under the NHS is too confusing, bureaucratic and inefficient for both the dentists and the patients. I thought universal healthcare meant that anybody would be treated anywhere if they were in need of medical attention. This type of botched healthcare system simply cannot work and will continue to fail as long as there is continuing top-down political interference.

Under a privatized system the market would distribute medical services much more efficiently. Providers would be able to respond to the demands of patients in terms of quality and availability of care, rather than being forced to give a one-size-fits-all botched service. The state of British healthcare is embarrassing. We should be world leaders with a system to be proud of.

An unhealthy policy

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It's not difficult to complain about the misdirection and failings of the NHS. The list of problems is seemingly endless: Superbugs, waiting lists, failed computer systems..... One common theme throughout is that these problems have been caused by the poor management and misallocation of resources and Taxpayers' money.

However, news that children as young as 10 will be paid to stop smoking have raised the bar, even by the NHS' shocking standards. This scheme has been set up by the NHS in Brighton and Hove who will reward children with a £15 gift voucher if they do not smoke for 28 days and pass a carbon monoxide test. Pregnant teenagers will also be given £5 if they can prove they are no longer smoking.

I sometimes wonder who comes up with these ideas, and who approves them. This scheme is fundamentally flawed and shows a total lack of regard for taxpayers' money. If a 10 year old has the cash available to spend £5 on a pack of cigarettes will £15 worth of BodyShop vouchers really provide an incentive to kick the habit? Secondly, for any young person considering taking up smoking, this scheme could actually act as an incentive for them to start. They can try smoking and if they don't like it, they can stop and be paid in the mean time.

Children are taught from a young age that smoking is unhealthy and a bad habit to start. If I were a 10 year old, I would be pretty miffed if my classmates who were smoking and subsequently being given £15 whilst I was given no such reward for making a healthy choice.

This type of scheme is indicative of poorly considered government plans that reward and create incentives to act in a sub-optimum way. It is absurd. But no doubt a government department somewhere is cooking up an even crazier one right now.

A trojan horse

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Most US Republicans were against the $900 billion stimulus package, designed by Nancy Pelosi, which President Obama encouraged Congress to support. Obama’s package lost even more credibility after the detrimental elimination of Tom Daschle from his cabinet, a hard liner in American health care collectivization. In fact, the package has become increasingly unpopular among US voters for many reasons, but especially because the federal government will receive a large percentage of it. Consequently, there will be stealth implications for the health system, as a leading physician has opinied.

The stimulus bill will increase state subsidies to health care, and therefore enhance federal government intervention. It is basically a bail out of troubled state Medicare budgets, transferring huge state debts to the federal government. These billions will most likely become invisibly absorbed by the health care system, just as has happened in the UK during the Labour government's NHS spending spree.

This is the exact opposite of health care reform, and in some regard it results in middle class tax churning at a time when the US tax burden is ever increasing. Furthermore, thirty billion dollars of the stimulus package will be devoted to the healthcare sector under a program called COBRA, which will provide federal assistance to citizens who earn up to one million dollars per year.

Don't do it, President Obama

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Dr Helen Evans, an ASI Fellow and Director of Nurses for Reform, has written an excellent new briefing paper for the Washington-based Heritage Foundation, titled Comparative Effectiveness in Health Care Reform: Lessons from Abroad. It assesses President Obama's proposals for the creation of an 'Institute for Comparative Effectiveness' (sounds sinister, doesn't it?) in the light of the British, Danish and German experience.

The key point that Helen makes is that the idea that government is intrinsically superior to a spontaneous and free market in healthcare is groundless – and that you only have to look at the UK's socialized system to see why. In particular, the government's reliance on coercion and 'cost effectiveness' has led to a system of rationing that most Americans would be appalled by.

It's an interesting paper, and well worth a read. It is clear to me that the US healthcare system is definitely in need of reform, but it's also clear that Obama's ideas are not the right ones. The real key to bringing down costs – and thereby widen coverage – is to stengthen market forces (allowing interstate competition, for instance, and introducing individual, rather than corporate, tax credits), not putting big government in charge.

The big government tipping point

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In this article for the Wall Street Journal, Peter Wehner (a senior fellow at the Ethics and Public Policy Center) and Paul Ryan (a US Republican congressman) argue that socialized healthcare is a big government 'tipping point'.

They are right. In the article they point to Britain, saying that:

Once a large number of citizens get their health care from the state, it dramatically alters their attachment to government. Every time a tax cut is proposed, the guardians of the new medical-welfare state will argue that tax cuts would come at the expense of health care -- an argument that would resonate with middle-class families entirely dependent on the government for access to doctors and hospitals.

Sound familiar, anyone?

Of course, there is also another way in which socialized healthcare alters the relationship between the individual and the state, one which Wehner and Ryan don't mention. That is that once the government is in charge of your healthcare, they think they have a right to tell you how to live your life. Don’t smoke, don't drink, don't eat salt or sugar or fat, exercise, etc, etc! Pretty soon they get tired of telling you what to do and start trying to bully you into it with taxes, regulations, and 'social-stigmatization'.

Perhaps this is what Ayn Rand was getting at when she said, "The difference between a welfare state and a totalitarian state is a matter of time."

Personal budgets in the NHS

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On Friday the Department of Health announced the extension of 'personal budgets' to healthcare (following their successful introduction in social care) for people with long-term conditions such as Multiple Sclerosis. What this means is that patients will receive direct payments that they are then able to spend on the health services of their choice. 

This is good news. Individuals know their own needs and preferences far better than the state or its agents ever can. Putting them in charge of directing their own care improves outcomes and increases cost-effectiveness.

But why can't the government make the very small leap of logic from saying that people with long-term care conditions should have personal budgets, to saying that we should all be given the freedom to manage our own healthcare. If it's good for people in social care, and good for people with long-term conditions, then why not for the rest of us? The same logic applies regardless of who you are talking about.

It's easy to see how it might work. Assuming we stick with an egalitarian, tax-financed system, we could all be given health savings accounts, which the government would credit annually with our basic personal budgets. Then we would simply pay directly for the care we needed, as we needed it.

The best thing about this is that we would quickly get a healthcare sector shaped by the individual choices of hundreds of thousands of people and driven by consumer control, rather than one designed by central planners and commanded from the top-down. In other words, we'd have a market instead of a Soviet-style 'service'.

The Daily Outrage

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The Daily Mail has a large story about how much the NHS is paying to hire agency staff to cover holes in the payroll.

Millions of pounds of health service funds are being wasted employing agency nurses on up to £128 an hour. This is almost ten times the amount paid to an experienced staff nurse  -  and equates to a salary of £250,000. Overall, the health service spent almost £800million on agency doctors, nurses and consultants in 2006-07, according to the figures uncovered in a Freedom of Information request. That could fund around ten hospitals or employ 30,000 full- time experienced nurses.

But the important line is I think this:

He said many nurses were emigrating, partly because the NHS could not help with high housing costs in many areas.

Or if you want to put that more properly, the NHS cannot vary wages across areas with different living costs, for it is bound into a rigid straitjacket of national pay scales. We looked at this near the beginning of last year.

Wages and living costs vary widely across the country but NHS pay (bar a too small London weighting) does not. Thus a nurse of a specific grade trying to live in the SE is in poverty compared to one on the same wage elsewhere. Not surprisingly those parts of the NHS in the more expensive areas of the country find it difficult to recruit and retain staff. They thus have to hire agency staff at great expense....and note that being agency staff is the only way that staff in such expensive areas can earn more than the nationally set NHS wages. This leads to less than desirable outcomes: 

A 10 percent increase in the outside wage is associated with a 4 percent to 8 percent increase in AMI death rates.

That is, in richer areas of the country, where wages are higher, death rates from heart attacks are higher than in areas with lower general wages, because the NHS national wage rate makes hiring and retaining staff more difficult. It isn't just the cost of those agency staff which is the daily outrage, it's that people are dying because we have a national pay scale.

The obvious answer is to abolish the national pay scale and tell hospitals to pay whatever they need to to attract the necessary staff. Sadly it won't happen, for there are those who would insist that death for some is better than any violation of their sense of what is just or righteous. Like, for example, wages set upon supply and demand rather than central planning.

A lesson from Indiana?

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I went to a fascinating lunchtime discussion at the International Policy Network yesterday. The guest of honour was Grace-Marie Turner (left), the president of the Galen Institute in DC and an expert in free-market healthcare reform. She gave a fascinating talk about the problems facing US healthcare, and the approach President-elect Obama is likely to take to reform.

One of the interesting things about the healthcare debate in the US is that they actually have so many different systems operating at once: there are health savings accounts, private insurance, managed care, government 'insurance' (Medicare), and even single-payer systems (healthcare for veterans and native Americans). And then there is Medicaid (publicly-funded healthcare for the poor), which operates differently in every state. Such multiplicity may make the system difficult for outsiders to understand, but it also means that there is enormous scope for both experimentation and the analysis of different policies.

One state in particular seems to be taking an innovative – and potentially very significant  – approach. Indiana Governor Mitch Daniels has essentially turned Medicaid into a high-deductible insurance plan for those earning less than 200 percent of the Federal Poverty Level. Participants get fully subsidized and comprehensive healthcare, but must pay for the first $1100 of annual treatment themselves. The plan requires individuals to make mandatory monthly contributions (topped up by the state if necessary) to a health savings account, which can then be used to pay directly for these expenses.

The great thing about this system is that ensures everyone has access to healthcare while also confining 'insurance' to its proper place – protecting people against big-ticket expenses. Extending third-party payment to minor treatments (as most health systems, public or private do) is actually a major driver of cost inflation in healthcare, since it imposes significant administrative costs, gives both the doctor and the patient an incentive to maximise costs, and blunts incentives to stay healthy. Getting patients to pay directly solves these problems.

It is fairly easy to see how such a system could be translated into the UK as a major NHS reform, which could have significant benefits for patients, doctors and taxpayers.