Friday, July 31, 2009

Taipan Daily: Throwing Rocks at the Healthcare Hornet's Nest

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Friday, July 31, 2009
Taipan Daily: Throwing Rocks at the Healthcare Hornet's Nest
by Justice Litle, Editorial Director, Taipan Publishing Group

Man... it looks like we really touched a nerve. Your responses to Tuesday’s piece, The Seven Myths of U.S. Healthcare Reform, were truly raw and unfiltered. The inbox was seared by a flood of red-hot responses, both pro and con.

Sentiment ran the gamut from deeply in favor – the basic equivalent of “Hell Yeah, Right On!” – to many responses that were flat-out unprintable.

It was tough to get a bead without doing a hand count, but my rough sense is that the reader response breakdown between “Strongly Agree” and “Strongly Disagree” ran about 60/40.

In addition to expletive-filled rants, there were numerous thoughtful responses from both camps... too many to count in fact. This makes it harder to represent the diversity of views via shorthand generalization. But with that said, there were some very clear themes to point out.

For instance, here is a printable excerpt that fairly represents the dissent camp (or at least the non-profanity faction): “It's hard to imagine a more heartless person than this Asness guy. I guess money must triumph always over human suffering, in his view.”

Indeed there was a deep, rich vein of “heartless bastard” type sentiments on the nay side. (There were also plenty of passionate defenses of Canada’s healthcare system, and numerous reiterations of how crooked Big Pharma is and how messed up the U.S. system is.)

Again, at risk of over generalization, those who thundered “NAY” seemed to overwhelmingly focus on fairness issues. The idea that wealth buys health was a major sore point.

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In contrast, those who agreed with Mr. Asness – which, I must point out, includes yours truly – were less focused on fairness and more naturally skeptical of the government’s ability to deliver on promises.

It isn’t a matter of being heartless, the affirmative responses seemed to argue. It’s a matter of what’s possible and what works in the real world. Who wouldn’t want top-notch medical care for everyone if such a world were possible? The question is whether it really is achievable, or rather the best means of moving toward such an ideal over time...

If anything, those who agreed with Cliff Asness would say the free market system, messed up as it is, is more humane in the long run, not less. Unfulfilled promises do no one any good at all, and the hidden failures (or not-so-hidden failures) of the world’s socialized healthcare systems are the skeptics’ main reason for concern.

It was either John Ray in the 17th century or Saint Bernard of Clairvaux in the 12th century who first observed, “The road to hell is paved with good intentions.” We have already seen what good intentions have wrought via the unholy nexus of Washington and Wall Street.

Note, too, that complexity as well as corruption is one of the real potential killers here. If you look to the graphics below – both which require clicking to enlarge – you can see the Rube Goldbergian aspects of the latest attempt as compared to “Hillarycare” circa 1993.

View Larger Image Here


View Larger Image Here

One might consider the complexity issue in light of a simple question. The U.S. government can barely deliver the mail in an efficient manner... so do we really want to grant them a monopoly a thousand times as large and complex?

In Your Own Words

And now, to the mailbag! As it turns out, Taipan Daily gets around. Perhaps the most surprising response came from the man himself:

A friend sent me your article on my piece. While I think "hero" is an exaggeration, I'm biased enough to enjoy exaggerations on my side more than the opposite!

Also, your summary was appropriately short, but amazingly well done covering most of my more important points. I could use you as my editor!

Thank you,

– Cliff

Hmm. I may have to keep that e-mail address on file. Just kidding... I’m not going anywhere any time soon. This editorial director gig is just too much fun.

From reading his rant it's fairly obvious that [Cliff Asness] has never had a health problem [or] if he did he is rich enough to not have a problem. His arrogant richer and better than thou attitude towards us common folk borders on rude. I would guess he has major holdings in the drug companies that he would stand to lose when all the rest of us could only stand to gain. Pompous republicans like him leave a bad taste in my mouth.

TD Reader Jerry C.

Really? Those conclusions don’t seem obvious to me at all. How can you know whether someone has had a health problem or not? Quite frankly, the prospect of rationing might even be scarier for people with serious health problems. If one has to wait in line for a time-sensitive treatment, it’s the public system that turns into a nightmare, not the private one.

As for being rich enough not to have a problem – a dysfunctional system is everyone’s problem. The less efficiently the system performs, the fewer life-changing or life-enhancing drugs and technologies are produced by that system. If the cure for what ails you hasn’t been invented yet – or if it’s languishing in a lab under a pile of bureaucracy and innovation restraining red tape – then it doesn’t matter if you’re a billionaire or even a trillionaire. A hidden cost of dysfunction is innovation foregone.

As for Republican politics and drug care holdings, again, what does this have to do with the argument? If anything, the view presented was more libertarian than Republican... especially given how George W. Bush, the last Republican president, pretty much blew out every big government spender that preceded him (including all-time champs like LBJ).

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I would suggest, again, this isn’t a debate on fairness – or shouldn’t be at any rate. It’s a debate on the merits of what is feasible and what isn’t. A solution that doesn’t work, while costing a lot to implement, is far more expensive than no solution at all.

Health care in the 50s was cheaper and far superior then what the drug led doctors and hospitals give us today! I will take that any day. I am a senior and have to contend with a government run system called Medicare which SUCKS BIG TIME. Whenever you have a FED middle-man, costs go up, quality goes down and service is limited and the system turns to CRAP. Just take a good look at Medicare, my case in point! Health care should be left to free market forces and the government left out of it. Give us a tax free or tax deductible health account instead.

If a Fed run program becomes law it will eventually destroy any private system we have today. Than we WILL wish we were back in the 50s!

– TD Reader Herb M.

That touches on one of the most curious points of this whole debate. Just look at the U.S. government’s track record! Between the U.S. Postal Service, the Pentagon writing checks for $50,000 toilet seats, and the absolute shambles that is the U.S. public school system, one wonders how in the wide wide world of sports a proposal for Washington to take over 20% of the U.S. economy makes any sense. (Healthcare spending is projected to account for 19.5% of U.S. GDP by the year 2017.)

Oh dear,

I was hoping for an article about investing. Instead I feel I have been unfairly subjected to the likes of a one sided Rush Limbaugh rant.

Do you actually believe this? And why do you think we should? In the interest of balance, I think you should provide facts and opinions from both sides of the issue.

Have you had any loved ones with major health care issues lately? Do you pay for your own health care and insurance? Have you been forced to have your family go without insurance and hope for the best?

I find this article very one-sided and offensive.


Sorry you feel that way... we’re certainly not big on channeling Rush Limbaugh around here. Not that we go out of our way to agree or disagree with “El Rushbo” – he’s just not really on the radar screen.

The piece was meant as provocative food for thought – more a presentation of ideas and debate points than a laundry list of facts. And it certainly seemed to deliver in the provocative department, no? The intensity of feeling on both sides of the aisle shows what a major issue this is. That’s why it is worth discussing and considering, in our opinion... especially given that any time you are talking about the possibility of government taking over a 15-20% chunk of the economy, that has major potential ramifications on the investing climate.

In terms of your other questions, I can answer “Yes” to all three. Someone very near and dear to me had a major health scare over the course of the past year. Others in my family (as with most extended families) have issues they are dealing with currently. And as a fresh-faced youth with no money in his pocket and a taste for being self-employed, I went quite a while without proper insurance.

Given my setup as an independent contractor with my own LLC, you better believe I pay up now... right through the old nose I pay. And I hate it. Why? Because if something serious happens to me, my health insurance is probably a waste of time and effort anyway.

There is almost no way to plan around those types of tragic events that result in a hospital bill that costs hundreds of thousands of dollars or more. The premiums required to cover serious tragedy aren’t worth paying, and the premiums for lesser coverage seem a blatant rip-off in comparison. I know this full well.

It’s not a great situation. But does that mean the answer is to push hard for a solution that probably won’t work? I sometimes wonder what people did a hundred years ago. They probably just made the best of it. And over time things improved, to the point where ER care today is better than what the richest 19th century robber baron could have received in the event of an emergency.

You fail to mention that pharmaceutical companies spend more on advertising, marketing and bribing doctors than research.

– TD Reader Tom S.

I haven’t seen the stats, but I wouldn’t necessarily dispute that claim. I think that’s part of the confusion here... there’s no doubt that the current system is rotten in a lot of important ways. Big Pharma engages in some very questionable practices – some would say evil practices – and they don’t spend huge sums of money on lobbyists for nothing.

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But again one has to ask, what is the pragmatic solution? How do we solve this problem? And how is getting government even more intimately involved – thus providing even more room for back-scratching, corruption, complexity and complacency – supposed to be a help?

To say “no” to a big-government solution isn’t necessarily a “yes” vote for the current system and all its problems. It’s more a nod to that physicians’ creed known as the Hippocratic Oath: “First, do no harm.”

Here is an interesting thought experiment. (If you took philosophy in college, you’ve probably heard it before.) Imagine that you are tasked with building the rules of a new society from the ground up. The only catch is, after you have built and designed this society, you have to take your place within it based on random chance. That is to say, you don’t know whether you will wind up rich or poor... healthy or sick... connected or disenfranchised.

The idea is that, not knowing what your station will be, you would want to design this society to be as fair and equitable a place as possible. (After all, you might just as well end up at the bottom versus the top!) Given that starting point, what type of healthcare system would you design? You wouldn’t give Big Pharma their present ugly role, that's a given... but would you really want to hand the keys to Big Government?

Most of those who make a moral argument for free market healthcare would argue that, in the long run, it is the best choice we have among a series of unpalatable ones – regardless of whether one is rich or poor. This is not the same as saying our current system is perfect or anywhere close to it! It’s more about heading off a disaster, and then finding small, incremental ways to improve the situation over time, than heaping praise on what we have here and now.

Thanks again for the incredible outpouring of responses. It will be interesting to see what happens next...

Warm Regards,


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