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Litt om Helsevesenet her og der

InnleggSkrevet: 05 Mar 2009, 17:19
Mye av det som sies gjelder også for Norge ikke bare UK, Canada eller Sverige.

"OK, Williams," you say, "Sweden is the world's socialist wonder." Sven R. Larson tells about some of Sweden's problems in "Lesson from Sweden's Universal Health System: Tales from the Health-care Crypt," published in the Journal of American Physicians and Surgeons (Spring 2008). Mr. D., a Gothenburg multiple sclerosis patient, was prescribed a new drug. His doctor's request was denied because the drug was 33 percent more expensive than the older medicine. Mr. D. offered to pay for the medicine himself but was prevented from doing so. The bureaucrats said it would set a bad precedent and lead to unequal access to medicine.

Malmo, with its 280,000 residents, is Sweden's third-largest city. To see a physician, a patient must go to one of two local clinics before they can see a specialist. The clinics have security guards to keep patients from getting unruly as they wait hours to see a doctor. The guards also prevent new patients from entering the clinic when the waiting room is considered full. Uppsala, a city with 200,000 people, has only one specialist in mammography. Sweden's National Cancer Foundation reports that in a few years most Swedish women will not have access to mammography.

Re: Litt om Helsevesenet her og der

InnleggSkrevet: 05 Mar 2009, 17:41
Vet ikke nøyaktig hvordan det er her, men dette er uansett ganske ille.

It would be bad enough for the FDA to make it illegal for doctors to treat patients with an FDA-approved drug that was not specifically approved for the prescribed purpose (i.e., "off-label" use). But forbidding the dissemination of published information is worse. It basically asserts that free speech and freedom of the press are concepts that do not apply to medicine. That is ominous, as the forbidding of the publication of such journal articles is but a short step away. What happens to medical science if researchers cannot share the results of their research without prior government permission?

One of the reasons off-label prescriptions have become more important is the FDA's expensive and time-consuming approval process for new drugs. In many cases it is not worth the cost for a drug manufacturer to take a drug through that process a second or third time. That is especially the case if the relatively short term of their patent on the drug will soon expire. It will be even more unlikely under proposed measures that would require approved drugs to go through yet another lengthy review for "comparative effectiveness" with other drugs. (Soon a drug that is more effective for you may not be allowed if another drug is just as effective for other patients.)

Re: Litt om Helsevesenet her og der

InnleggSkrevet: 11 Mar 2009, 15:58

A welfare statist recently asked what we should do with all the poor people who will line up outside public hospitals that will close if we don’t extend socialized medicine. My reply: Give them all a piece of paper that reads, “Americans are not your slaves.”

Health Care Is Not A Right

InnleggSkrevet: 12 Mar 2009, 17:28

Now our only rights, the American viewpoint continues, are the rights to life, liberty, property, and the pursuit of happiness. That's all. According to the Founding Fathers, we are not born with a right to a trip to Disneyland, or a meal at McDonald's, or a kidney dialysis (nor with the 18th-century equivalent of these things). We have certain specific rights—and only these.

Why only these? Observe that all legitimate rights have one thing in common: they are rights to action, not to rewards from other people. The American rights impose no obligations on other people, merely the negative obligation to leave you alone. The system guarantees you the chance to work for what you want—not to be given it without effort by somebody else.

The right to life, e.g., does not mean that your neighbors have to feed and clothe you; it means you have the right to earn your food and clothes yourself, if necessary by a hard struggle, and that no one can forcibly stop your struggle for these things or steal them from you if and when you have achieved them. In other words: you have the right to act, and to keep the results of your actions, the products you make, to keep them or to trade them with others, if you wish. But you have no right to the actions or products of others, except on terms to which they voluntarily agree.

To take one more example: the right to the pursuit of happiness is precisely that: the right to the pursuit—to a certain type of action on your part and its result—not to any guarantee that other people will make you happy or even try to do so. Otherwise, there would be no liberty in the country: if your mere desire for something, anything, imposes a duty on other people to satisfy you, then they have no choice in their lives, no say in what they do, they have no liberty, they cannot pursue their happiness. Your "right" to happiness at their expense means that they become rightless serfs, i.e., your slaves. Your right to anything at others' expense means that they become rightless.

You are entitled to something, the politicians say, simply because it exists and you want or need it—period. You are entitled to be given it by the government. Where does the government get it from? What does the government have to do to private citizens—to their individual rights—to their real rights—in order to carry out the promise of showering free services on the people?

The answers are obvious. The newfangled rights wipe out real rights—and turn the people who actually create the goods and services involved into servants of the state. The Russians tried this exact system for many decades. Unfortunately, we have not learned from their experience. Yet the meaning of socialism is clearly evident in any field at all—you don't need to think of health care as a special case; it is just as apparent if the government were to proclaim a universal right to food, or to a vacation, or to a haircut. I mean: a right in the new sense: not that you are free to earn these things by your own effort and trade, but that you have a moral claim to be given these things free of charge, with no action on your part, simply as handouts from a benevolent government.

How would these alleged new rights be fulfilled? Take the simplest case: you are born with a moral right to hair care, let us say, provided by a loving government free of charge to all who want or need it. What would happen under such a moral theory?

Haircuts are free, like the air we breathe, so some people show up every day for an expensive new styling, the government pays out more and more, barbers revel in their huge new incomes, and the profession starts to grow ravenously, bald men start to come in droves for free hair implantations, a school of fancy, specialized eyebrow pluckers develops—it's all free, the government pays. The dishonest barbers are having a field day, of course—but so are the honest ones; they are working and spending like mad, trying to give every customer his heart's desire, which is a millionaire's worth of special hair care and services—the government starts to scream, the budget is out of control. Suddenly directives erupt: we must limit the number of barbers, we must limit the time spent on haircuts, we must limit the permissible type of hair styles; bureaucrats begin to split hairs about how many hairs a barber should be allowed to split. A new computerized office of records filled with inspectors and red tape shoots up; some barbers, it seems, are still getting too rich, they must be getting more than their fair share of the national hair, so barbers have to start applying for Certificates of Need in order to buy razors, while peer review boards are established to assess every stylist's work, both the dishonest and the overly honest alike, to make sure that no one is too bad or too good or too busy or too unbusy. Etc. In the end, there are lines of wretched customers waiting for their chance to be routinely scalped by bored, hog-tied haircutters, some of whom remember dreamily the old days when somehow everything was so much better.

You have a right to work, not to rob others of the fruits of their work, not to turn others into sacrificial, rightless animals laboring to fulfill your needs.

Some of you may ask here: But can people afford health care on their own? Even leaving aside the present government-inflated medical prices, the answer is: Certainly people can afford it. Where do you think the money is coming from right now to pay for it all—where does the government get its fabled unlimited money? Government is not a productive organization; it has no source of wealth other than confiscation of the citizens' wealth, through taxation, deficit financing or the like.

But, you may say, isn't it the "rich" who are really paying the costs of medical care now—the rich, not the broad bulk of the people? As has been proved time and again, there are not enough rich anywhere to make a dent in the government's costs; it is the vast middle class in the U.S. that is the only source of the kind of money that national programs like government health care require. A simple example of this is the fact that all of these new programs rest squarely on the backs not of Big Business, but of small businessmen who are struggling in today's economy merely to stay alive and in existence. Under any socialized regime, it is the "little people" who do most of the paying for it—under the senseless pretext that "the people" can't afford such and such, so the government must take over. If the people of a country truly couldn't afford a certain service—as e.g. in Somalia—neither, for that very reason, could any government in that country afford it, either.

Some people can't afford medical care in the U.S. But they are necessarily a small minority in a free or even semi-free country. If they were the majority, the country would be an utter bankrupt and could not even think of a national medical program. As to this small minority, in a free country they have to rely solely on private, voluntary charity. Yes, charity, the kindness of the doctors or of the better off—charity, not right, i.e. not their right to the lives or work of others. And such charity, I may say, was always forthcoming in the past in America. The advocates of Medicaid and Medicare under LBJ did not claim that the poor or old in the '60's got bad care; they claimed that it was an affront for anyone to have to depend on charity.

But the fact is: You don't abolish charity by calling it something else. If a person is getting health care for nothing, simply because he is breathing, he is still getting charity, whether or not any politician, lobbyist or activist calls it a "right." To call it a Right when the recipient did not earn it is merely to compound the evil. It is charity still—though now extorted by criminal tactics of force, while hiding under a dishonest name.

I would like to clarify the point about socialized medicine enslaving the doctors. Let me quote here from an article I wrote a few years ago: "Medicine: The Death of a Profession."

"In medicine, above all, the mind must be left free. Medical treatment involves countless variables and options that must be taken into account, weighed, and summed up by the doctor's mind and subconscious. Your life depends on the private, inner essence of the doctor's function: it depends on the input that enters his brain, and on the processing such input receives from him. What is being thrust now into the equation? It is not only objective medical facts any longer. Today, in one form or another, the following also has to enter that brain: 'The DRG administrator [in effect, the hospital or HMO man trying to control costs] will raise hell if I operate, but the malpractice attorney will have a field day if I don't—and my rival down the street, who heads the local PRO [Peer Review Organization], favors a CAT scan in these cases, I can't afford to antagonize him, but the CON boys disagree and they won't authorize a CAT scanner for our hospital—and besides the FDA prohibits the drug I should be prescribing, even though it is widely used in Europe, and the IRS might not allow the patient a tax deduction for it, anyhow, and I can't get a specialist's advice because the latest Medicare rules prohibit a consultation with this diagnosis, and maybe I shouldn't even take this patient, he's so sick—after all, some doctors are manipulating their slate of patients, they accept only the healthiest ones, so their average costs are coming in lower than mine, and it looks bad for my staff privileges.' Would you like your case to be treated this way—by a doctor who takes into account your objective medical needs and the contradictory, unintelligible demands of some ninety different state and Federal government agencies? If you were a doctor could you comply with all of it? Could you plan or work around or deal with the unknowable? But how could you not? Those agencies are real and they are rapidly gaining total power over you and your mind and your patients.

In this kind of nightmare world, if and when it takes hold fully, thought is helpless; no one can decide by rational means what to do. A doctor either obeys the loudest authority—or he tries to sneak by unnoticed, bootlegging some good health care occasionally or, as so many are doing now, he simply gives up and quits the field." (The Voice of Reason: Essays in Objectivist Thought, NAL Books, 1988, pp. 306-307)

Any mandatory and comprehensive plan will finish off quality medicine in this country—because it will finish off the medical profession. It will deliver doctors bound hands and feet to the mercies of the bureaucracy.

Dr. Peikoff was associate editor, with Ayn Rand, of The Objectivist and The Ayn Rand Letter (1971-76). He is author of Objectivism: The Philosophy of Ayn Rand. He is founder of the Ayn Rand Institute.

Words Versus Realities

InnleggSkrevet: 22 Apr 2009, 14:27

Much as I hate to be the bearer of bad news, I must report the shocking facts: Medical care is medical care. Nothing more and nothing less.

This may not seem like a breakthrough on the frontiers of knowledge. But it completely contradicts what is being said by many of those who are urging "universal health care" because so many Americans lack health insurance.

Insurance is not medical care. Indeed, health care is not the same as medical care. Countries with universal health care do not have more or better medical care.

The bottom line is medical care. But the rhetoric and the talking points are about insurance. Many people who could afford health insurance do not choose to have it because they know that medical care will be available at the nearest emergency room, whether they have insurance or not.

This is especially true for young people, who do not anticipate long-term medical problems and who can always get a broken leg or an allergy attack taken care of at an emergency room -- and spend their money on a more upscale lifestyle.

This may not be a wise decision but it is their decision, and there is no reason why other people should lose the right to make decisions for themselves because some people make questionable decisions.

If you don't think government bureaucrats can make questionable decisions, then you haven't dealt with many government bureaucrats.

It is one thing to deal with bureaucrats when you are at the Department of Motor Vehicles and in good health. It is something else when you have to deal with bureaucrats when you are lying on a gurney and bleeding or are doubled over in pain on a hospital bed.

People who believe in "universal health care" show remarkably little interest -- usually none -- in finding out what that phrase turns out to mean in practice, in those countries where it already exists, such as Britain, Sweden or Canada.

For one thing, "universal health care" in these countries means months of waiting for surgery that American get in a matter of weeks or even days.

In these and other countries, it means having only a fraction as many MRIs and other high-tech medical devices available per person as in the United States.

In Sweden, it means not only having bureaucrats deciding what medicines the government will and will not pay for, but even preventing you from buying the more expensive medicine for yourself with your own money. That would violate the "equality" that is the magic mantra.

Those who think in terms of talking points, instead of trying to understand realities, make much of the fact that some countries with government-controlled medical care have longer life expectancies than that in the United States.

That is where the difference between health care and medical care comes in. Medical care is what doctors can do for you. Health care includes what you do for yourself -- such as diet, exercise and lifestyle.

If a doctor arrives on the scene to find you wiped out by a drug overdose or shot through the heart by some of your rougher companions, there may not be much that he can do except sign the death certificate.

Even for things that take longer to do you in -- obesity, alcohol, cholesterol, tobacco -- doctors can tell you what to do or not do, but whether you follow their advice or not is what determines the outcome.

Americans tend to be more obese, consume more drugs and have more homicides. None of that is going to change with "universal health care" because it isn't health care. It is medical care.

When it comes to things where medical care itself makes the biggest difference -- cancer survival rates, for example -- Americans do much better than people in most other countries.

No one who compares medical care in this country with medical care in other countries is likely to want to switch. But those who cannot be bothered with the facts may help destroy the best medical care in the world by falling for political rhetoric.

Doctors: Stand Up to the Political Bullies

InnleggSkrevet: 02 Jul 2009, 16:13

by Michael J. Hurd (June 28, 2009)

Government does not own my skills. Government has no property rights over either myself or my patients. My competence depends on government being out of the way, not in the middle of my treatment and my procedures. If government wants to help, as our current President claims, then he should do everything in his power to lift any and all restrictions on health professionals. He can best do this by freeing up the patient to shop for medical care in an open market. This will provide the competition he claims he seeks. Stay out, and get out. Government does not tell farmers how to produce food, and government does not tell technological companies how to improve cell phones, iPods, and web browsers. Government did not until very recently own an auto company, and government had nothing whatsoever to do with the invention of the automobile, and even less to do with the development and expansion of life-saving medical pharmaceuticals.

So why must government now become totally involved in my practice? Get out. You have no right to be here. You're bothering me enough already! I don't want you here. You're a big enough headache as it is, with Medicare and with the regulations on private insurers which are tantamount to Medicare in disguise. Leave me alone, leave my patients alone, and step out of the way!"

I don't know about you, but this is the kind of assertiveness I want my medical doctors to have. The American Medical Association won't do this.

Instead, they give the President a bully pulpit from which to lie and rationalize about his planned government takeover of all things medical.

The Market Does Not Ration Health Care

InnleggSkrevet: 16 Sep 2009, 18:19

The Market Does Not Ration Health Care: Voluntary Exchange Is Not Rationing (Part 1)
by Ari Armstrong (September 12, 2009)

In response to the criticism about rationing, advocates of politicized medicine routinely reply that the market also "rations" health care, so the debate is merely about which form of rationing is best. Many critics of Obamacare agree to the terms of that debate and proceed to argue that political rationing is worse than market "rationing."

But obtaining goods and services on an open market via the price system of supply and demand is not rationing at all. Claims that it is distort the language and obscure crucial distinctions between political rationing and market distribution.

Peter Singer is among those explicitly calling for health rationing. As Don Watkins reviews, Singer writes for the July 15 New York Times:

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.

The Market Does Not Ration Health Care

InnleggSkrevet: 16 Sep 2009, 18:27

The Market Does Not Ration Health Care: Politically-Controlled Insurance and Rationing (Part 2)
by Ari Armstrong (September 13, 2009)

The Harm of Conflating Price Distribution with Rationing
Whether price distribution counts as a type of rationing is not merely some semantic dispute. Conflating price distribution with political rationing obliterates the crucial distinctions between the two. A system of property rights and voluntary association is nothing like a system of political control of goods and services.

Price distribution on a free market rests on the right of producers to their property. If you produce something, using your own resources and in voluntary interaction with others, you have the right to exchange your product with others as you see fit. Generally on a free market people exchange goods and services using money as the intermediary, according to the principles of supply and demand.

Political rationing means that some governmental agency assumes command of some set of goods or services, in violation of the producer's rights to the product and of the consumer's rights to offer a voluntarily exchange. Rationing entails collectivism in ownership.

In her 1946 letter (see pages 320 to 327 of Letters of Ayn Rand), Rand writes, "Rationing IS coercion, that is, orders, and nothing else whatever. The essential distinction of a free market, as against any other kind of system, lies in the absence of coercion and in the method of exchange by voluntary choice" (page 322).