Nice rant about the federal government inflicting harm on medicine, but you’re dead wrong about RFK Jr and the new ACIP. Sorry that TDS has blinded you into parroting the parasitic credentialed class talking points. Science is belief in the ignorance of so-called consensus experts—do your homework which should start with Aaron Siri deposing Plotkin.
The US health system is generally known for its exorbitant overall cost in exchange for relatively mediocre overall health outcomes. So arguing for doing less of the same does appear to be the sane position to take. But the author seems to lump the disparate eggs of health policy (HHS, CDC), regulation (FDA), funding (CMS, Medicare), research (NIH), and insurance (ADA), all in with direct care provision into a single “centralized government control” basket.
Full disclosure: I work in the single-payer Canadian system, and that’s certainly not rainbows and butterflies all day every day either.
I think most can agree that, just as government doesn’t belong in our bedroom, it doesn’t belong in the exam room wedged btw doctor and patient in their relationship either.
But one of the prior US issues, as I understand it from afar, was the number of uninsured people. And to say that people “can get what they want at prices they can afford” seems to ignore that some people previously could not afford to get what they needed. And if the solution for that is “social security” and “child tax credit”….that is not only still very much a central government line item (and a fairly large one at that), but also ignores childless non-elderly people in need.
It is lamentable that various parts of the health system have become politicized, much like seemingly every other aspect of society. The author’s example of the ballooning of the OBBBA illustrates that. The current shutdown- straw that is breaking the bulging health system-camel’s back is very much a product of politics. It would be preferable if politicians did less politicking and more governing for the greater good. It would be preferable if health policy, regulation, and research decisions, were purely evidence based and overseen by Dr. JMM’s posse of neutral martians. But such a system doesn’t exist. Nor will it ever.
In the end, I tend to agree with the author that “more government” is not the answer. And since “better politicians” aren’t coming, “better government” likely isn’t on offer either.
I appreciated Mr. Silver’s arguments. The problem in this country is the duality of healthcare services: government (Medicare/Medicaid) versus the private health plans.
I spent decades along with six very sharp nurses challenging insurance companies, both in the government as well as private health plans regarding denial of payments for hospital services provided in good faith and medically indicated.
The private health plans take approximately 20% of the healthcare dollar premium for overhead/administrative cost. They list the $0.80 dollars they spend on medical care as the “medical loss ratio“🤔 😁-interesting.
My best quick story is a denial for a very functional elderly female who was admitted in septic shock (90% mortality) and died after four days in the ICU. The response from one of the largest private health insurers: denied, could have been treated in a skilled nursing facility!
The health plans teach their medical directors, one thing; how to say “no.” Needless to say I was so pissed after submitting my challenge,I demanded to speak to the National medical director who obviously agreed to pay for the hospitalization as billed-I asked him why would they deny payment for such an obvious case resulting in death? As he was retiring in a few weeks, he said because of the float and the unbelievable millions the health plan makes by delaying payment six months to a year.😢
Yes, Mr. Silver the government is grossly inefficient, but the private sector is run by acute, subacute, and chronic avarice. they must kiss the ring of the investor. Both the public and private sector has multiple warts.
Libertarians believe in small government and let the humanity of humans along with common sense, be the law of the land. The problem is individuals, as well as groups of citizens/private companies are not as benevolent or altruistic and as you might think.
Two incompetent entities, government and private, are responsible for the broken healthcare system we have.
I very much support removing the government from health care. I had the privilege of taking nursing students to London on 2 occasions. We visited NHS hospitals, a private hospital, and other nursing-related organizations. Not a single nurse came out in support of the NHS-they either avoided answering or openly discussed the failings.
A long time ago, when I was a young adult, healthcare insurance was pretty much limited to the unforeseen catastrophe. I paid out of pocket for doctor's office visits, immunizations for my daughter and all medications BUT THEY WERE AFFORDABLE. I had to be judicious with my decisions, and had to adjust my priorities to accommodate, but you have to make good choices because you can only spend your money once, so if it was time for an MMR, I skipped going out to lunch, or put off the new pair of shoes. People don't seem to understand this principle anymore. As soon as insurance started paying for things, the prices went way up. People went to the doctor's office for splinters or a fever blisters, or for sniffles. Doctors needed to hire office help to process the complicated forms for insurance reimbursement and to review all of the government regulations. Suppliers realized they could charge whatever they wanted for medicine and supplies, because people wouldn't have to open up their wallets and so they thought everything was free. A good comparison, is how college tuition sky-rocketed when government loans became easy to get. I want to go back to 1975.
The covid fiasco is another example of the harms of centralized control of health decisions that most people can now see. The US healthcare system needs a healthy dose of deregulation. Counteracting these forces, though, is the desires of the public to be "kept safe" from all of life's misfortunes and to be given free stuff by politicians buying their elections and reelections, funded by the moneyprinter.
Healthcare is in the hands of investors, is it not? It should not be there. Maybe I'm wrong about that.
It surely is not being done well now.
I'd be happy to remove politics from medicine, but it's not just the government inserting them. Since you mention gender medicine, the HHS report on pediatric gender dysphoria is top notch. But the medical societies (AAP, ama, apa, endocrine society) are all pushing medical gender interventions absent reliable evidence that the drastic physically harmful interventions are likely to provide benefit for the distress they aim to treat, as well as neglecting to accurately report the alternatives such as psychotherapy also have low certainty of benefit but nowhere near the same risks. I surely don't trust them either. What they said about the HHS report was incorrect and what they say about the evidence is also, they are not following evidence based medicine on this topic. They are answerable to no one. They won't even listen to their own members (AAP for instance) or even their own committee members (Texas Medical Association, see recent Manhattan institute report).
My friends who are left wing like me won't read the HHS report unless they already have been following how our party has been running in the opposite direction from the evidence for a while.
There are us health agencies which I think are non political (isn't AHRQ)?
The proliferation of for-profit characters in health care has raised costs in the U.S. immensely.
This is the principle problem inflating US health costs, but it is ennabled by the poor scientific rigor applied to care. The absence of rigorous RCTs testing the effectiveness and safety of most of screening, and interventions in the US has allowed a bloated profit seeking system to grow. Government organized systems have greater longevity (Britain, Canada, Australia, Europe) at much lower costs.
Papanicolas I et al. Health care spending in the United States and other high income countries JAMA 2018 319(10):1024-1-039.
Fuchs VR. Critiquing US health care. JAMA 2014 312(20):2095-206.
Ketterer MW Cochrane's Brake: Randomized Conntrolled Trials and the Doctor's Pen. 2019.
Prasad V & Cifu A. Ending Medical Reversal 2015.
Hadler NM. Stabbed in the Back: Confronting Back Pain in an Overtreated Society. 2009.
Rettiog Ra et al. False Hope: Bone Marrow Transplantation for Breast Cancer. 2007.
Lenzer J. The Danger Within Us. 2017.
Wennberg JE. Tracking Medicine: A Researcher's Quest to Understand Healthcare. 2010.
Welch HG et al. Overdiagnosed: Making People Sick in the Pursuit of Health. 2011.
Entitlements = unlimited demand = rationing in short order in every socialized (government run) system. You cannot dream up a less efficient or more costly way to deliver healthcare. All of these schemes are built on the economic fantasy that healthcare should be a “right”, and therefore “free”. TANSTAAFL: There ain’t no such thing as a free lunch.
Which is why taxes in countries where government-funded health care works well are so much higher than in the US. Other countries benefit from the innovation and exceptionalism that the promise of huge profits allow in this country. They then take the discoveries commercialized here and manage to distribute them equitably and sensibly to all (or most).
Convincing argument, but I was convinced already. And I’m mostly a Trump guy. Not an RFKJ guy. Trouble is, without a somewhat promising alternative we’re stuck with what we’ve got. Newt Gingrich wrote a book on health care a while back and I think the Heritage Foundation had a policy paper on health care. Haven’t seen anything new in a decade or two. Come on, smart libertarians! Give us something we can get behind!
A very thought provoking and well written article by one who has been thinking about this for very long time evidently. It seems slanted toward new administration is bad for medicine, I tend to think that the whole system was terrible prior to current administration and the struggle to dismantle is very painful!
1. I am impressed with all? the governmental screw-ups, listed in one piece!
2. I don't agree with everything, but I have to agree with the overall premise.
3. Everyone should be "Libertarian!" The principle that our country was founded upon?
4. Do people make more difference in their own health and longevity, than "medicine"??
5. The current (libertarian?) Aesthetic medicine, beauty/wellness/fitness, industry, is almost unregulated by comparison and the dollars spent are phenominal.
Can you give an example of a country that does this libertarian approach to healthcare well? If not, why not? What are the limitations and potential downsides? This was missing from your otherwise provocative piece.
It's a great question. As the old saying goes, lack of evidence of efficacy is not evidence of lack of efficacy. And one could point to U.S. healthcare pre-1965. But that was a different era and it will be claimed (incorrectly, I believe) that it's apples and oranges. Your question does beg for an answer. My personal opinion is that the urge of human beings to control other human beings runs so deep that libertarian initiatives in any arena are quickly overwhelmed by politicians promising something better, that no one will have to pay for. As this planet's foremost contributor to a working model of freedom, we should aim to answer your question.
Government run healthcare is not as controversial in other places because it is a political third rail, so even parties who might be against it can hardly fundamentally touch it. They have to be much more clever in what they do to it.
The government's involvement in the administration and delivery of healthcare in a lot of European countries doesn't seem to mirror the problems that exist in the U.S. and that are enumerated in this essay. Maybe the solution is to reform and change our government rather than remove it from the equation.
Nice rant about the federal government inflicting harm on medicine, but you’re dead wrong about RFK Jr and the new ACIP. Sorry that TDS has blinded you into parroting the parasitic credentialed class talking points. Science is belief in the ignorance of so-called consensus experts—do your homework which should start with Aaron Siri deposing Plotkin.
The US health system is generally known for its exorbitant overall cost in exchange for relatively mediocre overall health outcomes. So arguing for doing less of the same does appear to be the sane position to take. But the author seems to lump the disparate eggs of health policy (HHS, CDC), regulation (FDA), funding (CMS, Medicare), research (NIH), and insurance (ADA), all in with direct care provision into a single “centralized government control” basket.
Full disclosure: I work in the single-payer Canadian system, and that’s certainly not rainbows and butterflies all day every day either.
I think most can agree that, just as government doesn’t belong in our bedroom, it doesn’t belong in the exam room wedged btw doctor and patient in their relationship either.
But one of the prior US issues, as I understand it from afar, was the number of uninsured people. And to say that people “can get what they want at prices they can afford” seems to ignore that some people previously could not afford to get what they needed. And if the solution for that is “social security” and “child tax credit”….that is not only still very much a central government line item (and a fairly large one at that), but also ignores childless non-elderly people in need.
It is lamentable that various parts of the health system have become politicized, much like seemingly every other aspect of society. The author’s example of the ballooning of the OBBBA illustrates that. The current shutdown- straw that is breaking the bulging health system-camel’s back is very much a product of politics. It would be preferable if politicians did less politicking and more governing for the greater good. It would be preferable if health policy, regulation, and research decisions, were purely evidence based and overseen by Dr. JMM’s posse of neutral martians. But such a system doesn’t exist. Nor will it ever.
In the end, I tend to agree with the author that “more government” is not the answer. And since “better politicians” aren’t coming, “better government” likely isn’t on offer either.
Healthcare should not be a for profit venture. Is the DOD for profit?
I appreciated Mr. Silver’s arguments. The problem in this country is the duality of healthcare services: government (Medicare/Medicaid) versus the private health plans.
I spent decades along with six very sharp nurses challenging insurance companies, both in the government as well as private health plans regarding denial of payments for hospital services provided in good faith and medically indicated.
The private health plans take approximately 20% of the healthcare dollar premium for overhead/administrative cost. They list the $0.80 dollars they spend on medical care as the “medical loss ratio“🤔 😁-interesting.
My best quick story is a denial for a very functional elderly female who was admitted in septic shock (90% mortality) and died after four days in the ICU. The response from one of the largest private health insurers: denied, could have been treated in a skilled nursing facility!
The health plans teach their medical directors, one thing; how to say “no.” Needless to say I was so pissed after submitting my challenge,I demanded to speak to the National medical director who obviously agreed to pay for the hospitalization as billed-I asked him why would they deny payment for such an obvious case resulting in death? As he was retiring in a few weeks, he said because of the float and the unbelievable millions the health plan makes by delaying payment six months to a year.😢
Yes, Mr. Silver the government is grossly inefficient, but the private sector is run by acute, subacute, and chronic avarice. they must kiss the ring of the investor. Both the public and private sector has multiple warts.
Libertarians believe in small government and let the humanity of humans along with common sense, be the law of the land. The problem is individuals, as well as groups of citizens/private companies are not as benevolent or altruistic and as you might think.
Two incompetent entities, government and private, are responsible for the broken healthcare system we have.
Ben Hourani MD, MBA.
I very much support removing the government from health care. I had the privilege of taking nursing students to London on 2 occasions. We visited NHS hospitals, a private hospital, and other nursing-related organizations. Not a single nurse came out in support of the NHS-they either avoided answering or openly discussed the failings.
A long time ago, when I was a young adult, healthcare insurance was pretty much limited to the unforeseen catastrophe. I paid out of pocket for doctor's office visits, immunizations for my daughter and all medications BUT THEY WERE AFFORDABLE. I had to be judicious with my decisions, and had to adjust my priorities to accommodate, but you have to make good choices because you can only spend your money once, so if it was time for an MMR, I skipped going out to lunch, or put off the new pair of shoes. People don't seem to understand this principle anymore. As soon as insurance started paying for things, the prices went way up. People went to the doctor's office for splinters or a fever blisters, or for sniffles. Doctors needed to hire office help to process the complicated forms for insurance reimbursement and to review all of the government regulations. Suppliers realized they could charge whatever they wanted for medicine and supplies, because people wouldn't have to open up their wallets and so they thought everything was free. A good comparison, is how college tuition sky-rocketed when government loans became easy to get. I want to go back to 1975.
The covid fiasco is another example of the harms of centralized control of health decisions that most people can now see. The US healthcare system needs a healthy dose of deregulation. Counteracting these forces, though, is the desires of the public to be "kept safe" from all of life's misfortunes and to be given free stuff by politicians buying their elections and reelections, funded by the moneyprinter.
Healthcare is in the hands of investors, is it not? It should not be there. Maybe I'm wrong about that.
It surely is not being done well now.
I'd be happy to remove politics from medicine, but it's not just the government inserting them. Since you mention gender medicine, the HHS report on pediatric gender dysphoria is top notch. But the medical societies (AAP, ama, apa, endocrine society) are all pushing medical gender interventions absent reliable evidence that the drastic physically harmful interventions are likely to provide benefit for the distress they aim to treat, as well as neglecting to accurately report the alternatives such as psychotherapy also have low certainty of benefit but nowhere near the same risks. I surely don't trust them either. What they said about the HHS report was incorrect and what they say about the evidence is also, they are not following evidence based medicine on this topic. They are answerable to no one. They won't even listen to their own members (AAP for instance) or even their own committee members (Texas Medical Association, see recent Manhattan institute report).
My friends who are left wing like me won't read the HHS report unless they already have been following how our party has been running in the opposite direction from the evidence for a while.
There are us health agencies which I think are non political (isn't AHRQ)?
The proliferation of for-profit characters in health care has raised costs in the U.S. immensely.
This is the principle problem inflating US health costs, but it is ennabled by the poor scientific rigor applied to care. The absence of rigorous RCTs testing the effectiveness and safety of most of screening, and interventions in the US has allowed a bloated profit seeking system to grow. Government organized systems have greater longevity (Britain, Canada, Australia, Europe) at much lower costs.
Papanicolas I et al. Health care spending in the United States and other high income countries JAMA 2018 319(10):1024-1-039.
Fuchs VR. Critiquing US health care. JAMA 2014 312(20):2095-206.
Ketterer MW Cochrane's Brake: Randomized Conntrolled Trials and the Doctor's Pen. 2019.
Prasad V & Cifu A. Ending Medical Reversal 2015.
Hadler NM. Stabbed in the Back: Confronting Back Pain in an Overtreated Society. 2009.
Rettiog Ra et al. False Hope: Bone Marrow Transplantation for Breast Cancer. 2007.
Lenzer J. The Danger Within Us. 2017.
Wennberg JE. Tracking Medicine: A Researcher's Quest to Understand Healthcare. 2010.
Welch HG et al. Overdiagnosed: Making People Sick in the Pursuit of Health. 2011.
Entitlements = unlimited demand = rationing in short order in every socialized (government run) system. You cannot dream up a less efficient or more costly way to deliver healthcare. All of these schemes are built on the economic fantasy that healthcare should be a “right”, and therefore “free”. TANSTAAFL: There ain’t no such thing as a free lunch.
Which is why taxes in countries where government-funded health care works well are so much higher than in the US. Other countries benefit from the innovation and exceptionalism that the promise of huge profits allow in this country. They then take the discoveries commercialized here and manage to distribute them equitably and sensibly to all (or most).
Convincing argument, but I was convinced already. And I’m mostly a Trump guy. Not an RFKJ guy. Trouble is, without a somewhat promising alternative we’re stuck with what we’ve got. Newt Gingrich wrote a book on health care a while back and I think the Heritage Foundation had a policy paper on health care. Haven’t seen anything new in a decade or two. Come on, smart libertarians! Give us something we can get behind!
A very thought provoking and well written article by one who has been thinking about this for very long time evidently. It seems slanted toward new administration is bad for medicine, I tend to think that the whole system was terrible prior to current administration and the struggle to dismantle is very painful!
1. I am impressed with all? the governmental screw-ups, listed in one piece!
2. I don't agree with everything, but I have to agree with the overall premise.
3. Everyone should be "Libertarian!" The principle that our country was founded upon?
4. Do people make more difference in their own health and longevity, than "medicine"??
5. The current (libertarian?) Aesthetic medicine, beauty/wellness/fitness, industry, is almost unregulated by comparison and the dollars spent are phenominal.
Can you give an example of a country that does this libertarian approach to healthcare well? If not, why not? What are the limitations and potential downsides? This was missing from your otherwise provocative piece.
It's a great question. As the old saying goes, lack of evidence of efficacy is not evidence of lack of efficacy. And one could point to U.S. healthcare pre-1965. But that was a different era and it will be claimed (incorrectly, I believe) that it's apples and oranges. Your question does beg for an answer. My personal opinion is that the urge of human beings to control other human beings runs so deep that libertarian initiatives in any arena are quickly overwhelmed by politicians promising something better, that no one will have to pay for. As this planet's foremost contributor to a working model of freedom, we should aim to answer your question.
Government run healthcare is not as controversial in other places because it is a political third rail, so even parties who might be against it can hardly fundamentally touch it. They have to be much more clever in what they do to it.
Excellent piece.👍
The government's involvement in the administration and delivery of healthcare in a lot of European countries doesn't seem to mirror the problems that exist in the U.S. and that are enumerated in this essay. Maybe the solution is to reform and change our government rather than remove it from the equation.
Try getting a hip replacement in Canada. Or a variety of treatments in the UK.
Why don’t patients complain in the EU?
Because they’re dead.