Tag: Medicine

Brown: Die, But Don’t Try

A couple of weeks ago, California governor Jerry Brown signed a “right to die” bill that gave Californians the right to get lethal drugs if they wish to end their life. I am mildly supportive of this. I think people have the right to their lives but am uncomfortable with doctors being involved in the process.

This week, Brown vetoed a bill that would have let terminal patients petition drug companies to use experimental or unproven medications. In vetoing it, Brown said that the FDA already allows compassionate use. But 24 states have over-ridden that process because the FDA is slow and cumbersome in its compassionate use. It doesn’t do a patient much good to get permission to use a drug is he’s dead by the time the approval is granted.

Wesley Smith says it perfectly:

Good grief: A “right to die,” but no “right to try and live.”

I honestly don’t what Brown is thinking. I’ve liked some of this recent vetoes, including one where he noted that the legislature was criminalizing things that were already illegal. But this one is mystifying.

(In other news, Brown also approved a law banning conceal carry from college campuses. This also makes no sense. Conceal carry holders, especially in California, are the model of what the Left claims they want: carefully vetted registered gun-owners who have a very low rate of criminal activity. I think the veto — and ongoing protests in Texas against conceal-carry on college campuses — reveals that carefully vetted licensed use of weapons is not what the Left really wants. The more this debate drags out, the more I think it’s a part of the Culture War: one side wants an America with a culture of guns; the other wants that culture abolished.)

Update: Orac makes the case against right to try laws. I’m finding his reasoning weak, paternalistic and motivate heavily by his distaste for the Goldwater Institute. But it’s the best reasoning I’ve seen so far.

Vermont Falls

I am Hal’s total lack of surprise:

Vermonters will not be part of a single-payer healthcare system.

Gov. Peter Shumlin had hoped to create the first state-based single-payer system in 2017, but skepticism from both state lawmakers and constituents has halted the idea.

“This is not the right time” for enacting single payer, Shumlin said in a statement.

Shumlin cited the big increases in taxes Vermonters would see that would be required to pay for the plan.

“These are simply not tax rates that I can responsibly support or urge the Legislature to pass,” the governor said. “In my judgment, the potential economic disruption and risks would be too great to small businesses, working families and the state’s economy.”

Federal funds available were also $150 million less than expected, Shumlin added.

Note that Jonathan Gruber was involved in this, just in case you might be wondering what his overall intentions for Obamacare were.

I’m sure this will be blamed on the “greed” of Vermont voters, wanting to keep more of their money. But Megan McArdle called this months ago. The plan was slated to cost $2 billion, requiring Vermont to raise taxes by 75% at least.

Especially when you consider that estimates for this plan’s cost are likely to err on the optimistic side, because, well, people drawing up proposed budgets for their pet ideas tend to be a little optimistic. Yes, yes, there may be fabulous cost savings from using the government’s monopoly buying power to bargain prices down with providers. But Vermont is already the beneficiary of significant monopoly buying power: One insurer has 74 percent of the state’s small-group business. It’s a Blue Cross/Blue Shield, so don’t count on fabulous savings from squeezing out profits. The large group market is even more concentrated, though on a for-profit insurer.

Nor can you get much administrative saving at the provider level, because they still have to deal with out-of-state insurers quite a bit. And the once-vaunted fabulous savings from preventative care have mostly turned out not to exist.

So this is going to be expensive. So expensive that I doubt Vermont is actually going to go forward with it.

Supporters of single-payer healthcare tell us constantly that such a system would be massively more efficient than what we have now. They base this partially on bogus claims that Medicare and Medicaid have low overhead costs. They base this partially, as McArdle points out, on comparisons to a healthcare system that is already, in many states, a monopsony, one that Democrats have fiercely resisted challenging by allowing insurance to be sold across state lines.

But, in the end, it’s mainly wishful thinking. We’re supposed to believe that socialized medicine magically keeps costs down. But the cost curve in the evil capitalist US system has basically matched that of socialized systems for the last twenty years. Most of the explosion of medical costs occurred in the 1970’s and 80’s and is baked into the system we have.

Vermont has now shown that switching to a single-payer system would be expensive and intrusive. Can’t we try anything else before we go there?

To Quarantine Or Not to Quarantine

As you may know, there is a brewing controversy over what to do with healthcare workers returning from the Ebola hot zone in West Africa. After Craig Spencer came down with Ebola, several governors imposed quarantines on returning healthcare workers. Controversy erupted and, I believe, we are down to home quarantine for 21 days.

A few thoughts:

First, it’s true that there has been a bit of an over-reaction. So far, we have only had two people infected while in this country and both of them were healthcare workers taking care of a dying man without adequate protection. Naturally, we need to be vigilant. The virus is unlikely to mutate to become airborne but it may mutate to become far more infectious. As Nobel Prize winner Bruce Beutler has noted, we don’t have as much information as we’d like about how infectious this strain is. But, even with those caveats, the policies being advocated in some quarters are unwarranted at this stage.1

Second, the most important thing about fighting Ebola is stomping it out in Africa. If we do not stop Ebola in Africa, it will spread. It will spread to bigger cities. It will spread to other countries. Right now, we only have to worry about people who have actually been in West Africa. If this goes on and blows up to hundreds of thousands of cases or millions, we will have to worry about everyone. A house in our neighborhood is on fire. We’ve had a few cinders land on our roof. But the most important thing is not that we spray water on our roof; it’s that we put out the fire before the whole neighborhood is ablaze.

Anything that discourages healthcare workers from going to West Africa to fight this thing is likely to make things worse. Quarantine sounds like an easy burden to impose. But, in The Hot Zone, Richard Preston describes the psychological trauma that quarantine imposes on workers at USAMRIID. This is not a light burden. And isolating them in hospitals is a good recipe for getting them sick with the opportunistic diseases that infest every hospital in the world.

That having been said, it’s not irrational to be afraid of this disease. It’s not irrational to think that healthcare workers — who are the most at risk and who have close contact with dozens of people very day — should back off until they are clear. We have been very lucky so far that this hasn’t erupted in a school or something. We’ve been very lucky that infected people have sought help immediately. We have been very lucky that this hasn’t mutated to be much more infectious. All it takes is one idiot to wait until he literally drops dead in the street for this to become a serious serious problem. All the reassurances about how we can contain this are going to be cold comfort to someone who gets infected by a returning healthcare worker.

The dilemma is that treating potential victims like pariahs increases the odds of that nightmare scenario. It encourages them to hide their symptoms and to lie. So what do we do?

To me, these problems are interlocked: getting more healthcare workers to West Africa and keeping them from spreading the disease when they return are the same problem. So here is what I would propose:

  • Healthcare workers who go to West Africa should be guaranteed early spots in the line for experimental drugs like ZMAPP. These drugs are difficult to produce and will come online in small quantities (you can read a great summary of this from the aforementioned Preston). The biggest worry healthcare workers have about Ebola is not that they will lose their jobs; it’s that they will die. Promise them that they will get the best possible care. They deserve it.
  • Congress should authorize a fund to give hazard pay to healthcare workers who volunteer to fight Ebola in West Africa. We have to be careful here to not undermine the volunteer organizations that are the frontline for these epidemics. But they are being overwhelmed. They desperately need reinforcements. This fund would also pay for healthcare, life insurance and maintaining their existing jobs. This in addition to the funds needed to provide medical equipment for them to work with.
  • This fund would will also pay volunteers to undergo a three-week home quarantine on their return, during which they will be monitored for symptoms and maintain a log of any contacts.
  • We have laws that protect military reservists from being financially or legally ruined when they are called up to active duty during a war. Extend those laws to healthcare workers who volunteer to fight Ebola or are in quarantine after their return.
  • If we are going to go to war with Ebola, we have to treat it like a war. Doctors and nurses are our soldiers in this war. Pay them, reward them, protect them. Treat them in a manner that is good for public safety but also recognizes the tremendous risks they are taking and the tremendous good they are doing. Whatever else one may think of Craig Spencer or Kaci Hickox, they have risked their lives to try to save people, most of whom are a different nationality and race from them. Let’s recognize that even as we move to secure our public health.

    1. Of course, the same media telling us we are over-reacting were also saying Ebola would never come here in the first place.

    We Don’t Need a Czar and We Don’t Need a Murthy Either

    Having seen their attempts to blame Ebola on Republican budget cuts go up in flames, the Democrats have stumbled upon a new meme: this outbreak is the fault of Republicans because they’ve blocked Obama’s nominee for Surgeon General.

    CNN host Candy Crowley on Sunday challenged Sen. Ted Cruz (R-TX) while asking him how Republican decisions may have negatively impacted the United States’ ability to address Ebola.

    Crowley asked how the sequester hurt funding for the Centers for Disease Control and how the National Rifle Association’s opposition to President Obama’s nominee for surgeon general, Dr. Vivek Murthy, also hurt the American response.

    “We haven’t had a Surgeon General — who is the nation’s leading public health official, at least the voice of it — for a year. Some Democrats and some Republicans had opposed the particular surgeon general the president had nominated. Do you think it would have helped A. If NIH and CDC had had a little more money and B. Had there been a surgeon general to kind of calm what has been the fear of Ebola?” Crowley asked on CNN’s “State of the Union.”

    (Note that Crowley repeats the BS meme that Republicans have gutted NIH/CDC funding.)

    First of all, the claim that we do not have a Surgeon General is bullshit, no matter how often the left repeats it. Boris Lushniak has been acting Surgeon General for the last year. Lushniak spent 16 years at the CDC, including work with their anthrax team. He’s qualified to deal with the the current crisis. In fact, I think he’s more qualified to deal with the current crisis than Obama’s nominee, who was nominated mostly for founding the political advocacy group “Doctors for Obama” (now “Doctors for America”) and his support of advancing gun control as a healthcare issue.

    (Of course, Murthy’s lack of qualifications is probably seen as a qualification. Obama named an Ebola czar this weekend: a career Democratic political operative. Vox immediately defended the choice, saying we need a manager, not a doctor. Because, you know, if you have a rare and dangerous tropical disease, what you really want is a manager. Personally, I don’t think we need another czar for anything, certainly not for Ebola. Handling this is the job of CDC. Or maybe we should put these guys in charge.)

    Second, I’m not sure what the Surgeon General is supposed to do here. The main thing we need is for the public to be aware of the danger and what to do if they might have Ebola. And we need hospitals to have better isolation procedures. I guess the Surgeon General could help with a public information campaign. But I don’t see that this would desperately need the particular skills of Murthy.

    That having been said, the Republicans should let the Murthy nomination move forward. I’m tired of this filibustering, especially for a fairly unimportant position. Murthy may or may not be an anti-gun nut, but he’s Obama’s anti-gun nut so let Obama own up to whatever foolishness he says or does.

    Blaming Republicans Again

    I know you thought that the current Ebola outbreak was the result of dysfunctional countries with horrendous health care systems. Or maybe you thought it was the fault of organizations like the WHO to respond quickly enough. Or maybe you think it’s no one’s fault and that disease outbreaks are going to happen.

    But you’re wrong. The current Ebola outbreak is the fault of …. Republicans:

    “Republican Cuts Kill” is the message coming from The Agenda Project, a 501(c)4 organization that is placing ads in various battleground states. According to an email signed by the group’s founder Erica Payne and titled “If you die, blame them,” the group is starting a

    a multi-pronged blitzkrieg attack that lays blame for the Ebola crisis exactly where it belongs– at the feet of the Republican lawmakers. Like rabid dogs in a butcher shop, Republicans have indiscriminately shredded everything in their path, including critical programs that could have dealt with the Ebola crisis before it reached our country.

    The supposed proximate cause is “deep draconian cuts” in the budgets of the NIH and the CDC which hindered their disease response. Never mind that the US still spends a total of $8 billion on global health. Never mind that the CDC and NIH have nearly $40 billion in funding between them. Never mind that cuts to CDC/NIH and specifically cuts for disease control were included in the budget proposal of Barack Obama who, last time I checked, was not a Republican. Never mind that according to Daily Kos’s own graph, the steep budget cuts in PHEP started in 2006, when the Democrats controlled Congress. Never mind that the Republican increased CDC funding over the President’s budget.

    Conservatives, dammit!

    This was partially stimulated by the head of the NIH saying that we would have an Ebola vaccine if not for budget cuts. Numerous people have responded by finding silliness in the NIH budget — such as $666,000 grant to find out why people like watching Seinfeld reruns — that they did have money for. I’m a bit loathe to play that game because often projects that sound stupid aren’t or are, at least, massively misrepresented.

    But I will take issue with the NIH’s claim that we’d have an Ebola vaccine if it weren’t for budget cuts (a claim they are slowly backing away from). Vaccine research is hard. We’ve been spoiled because most of the vaccines we’re used to — like measles — are cheap, effective and have minimal side effects. Such vaccines have wiped out smallpox and brought polio to the brink of extinction. But not all vaccines are that easy. We’ve been working on an AIDS vaccine for thirty years. Enormous effort has gone into finding a vaccine for malaria — which kills hundreds of thousands of people a year — with no success. Even some of the vaccines we do have are hideously expensive, come with significant side effects or have limited effectiveness. NIH might have an Ebola vaccine if they had more money. They might also have nothing.

    I’m a big fan of science funding, obviously. I like NIH to be well-funded. Public health is one of the few things we can all agree government should invest in. And I think basic science funding falls under Adam Smith’s description of something “which it can never be for the interest of any individual, or small number of individuals, to erect and maintain” but that benefits the public generally. But Ebola is not the reason to fund the NIH. They should be funded because of the outstanding research they do on everything else, especially the chronic common diseases that affect all of us. I especially want them to be working on antibiotic-resistant diseases, which, to my mind, pose the greatest healthcare menace for the 21st century. They should research Ebola as well. With a $30 billion budget, there’s plenty to go around. But Ebola research is only a tiny fraction of what they do. And I’d prefer they not try to pretend otherwise.

    As for the CDC, a bit less money on public health issues and a bit more money on infectious disease would be a good idea. And that, my friends, is squarely on the President and the man he appointed to head that agency.

    As a general rule, however, I would prefer that we keep Ebola and politics apart. This isn’t an excuse to grind your favorite political axe, be it immigration, budget cuts or single-payer healthcare. This is a time to calmly but decisively react to a potential health crisis. The main effort should be stomp this out in West Africa before it really does rage out of control. Because if this blows up to hundreds of thousands of people, if this spreads to South Africa or India or China, we will have a global epidemic on our hands.

    The Right to Die

    Brittany Maynard has a few months to live. Or three weeks, if she ends her own life on November 1.

    For those of you who can’t or don’t want to watch the video, she has been diagnosed with terminal brain cancer. There is basically no chance she will live for more than a few months. She has moved to Oregon, which has a law allowing terminally ill people to self-administer drugs to end their own lives. Doctors may participate if they choose. She is using the last months and week of her life to advocate for other states to enact similar laws so that people may make similar decisions if they choose.

    I don’t know that I would personally make the same choice Brittany has but, then again, I’m not facing the same grueling brutal decline she is. I do think people should have the option to end their lives if they choose. It is, after all, her life. I’m a bit uncomfortable with laws that allow physicians to direct this (and I’m convinced that the infamous Jack Kervorkian was no hero). This is an issue I’m still pondering.

    I may have mentioned this before, but we have developed a medical system that has an astonishing ability to bring people back from the brink of death. But it can also drag out the suffering of the dying. Enormous amounts of money are spent keeping terminally ill patients alive. The left favors a solution that involves bureaucrats making decisions about withholding care. I prefer a simpler and more empowering solution: anyone who is on Medicare has to fill out a living will.

    There would be no regulation of what is in the living will. And Medicare patients could change it at any time. Many people will choose the most extreme life-saving measures and that’s fine. But I believe that a lot of patients would choose to forgo the extreme heroic measures that are the default in most hospitals. Doctors rarely choose extreme life-saving measures. My mother used to be a nurse and wealthy people who could keep themselves out of the hospital system almost always just wanted a quiet room and something for the pain. I’ve spoken to numerous seniors who don’t want extraordinary measures taken but have yet to fill out a living will. They rely on their families to remember this.

    What people don’t realize that if you are dying in a hospital and don’t have a living will, they will almost always go the last full measure to keep you alive. Hospitals do it because they don’t want to get sued for letting great-grammy die. And families allow it because they can’t let go or deal with the guilt of letting a loved one die who might be saved.

    If we are going to preserve a Medicare system, I don’t believe we can allow people the luxury of pretending they are never going to die. Make people express their wishes and then respect those wishes.

    Ebola Comes to the US

    This is why I agree with the President that we have to devote as many resources as we can to fighting Ebola.

    A patient being treated at a Dallas hospital is the first person diagnosed with Ebola in the United States, health officials announced Tuesday.

    The unidentified man left Liberia on September 19 and arrived in the United States on September 20, said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

    At that time, the individual did not have symptoms. “But four or five days later,” he began to exhibit them, Frieden said. The individual was hospitalized and isolated Sunday at Texas Health Presbyterian Hospital.

    The CDC is trying to identify his contacts and quarantine them for the week-long incubation period. I hope that this is an isolated case, but my natural pessimism tells me it isn’t.

    Right now, the barrier keeping Ebola patients off of airplanes is screening in Africa. We may need to consider something more rigid, especially if the projections of hundreds of thousands of cases is accurate. Screening people getting off of planes who have been to Western Africa within the last two weeks would be a start. I don’t think we need extreme measures like banning travel from Africa or quarantine … yet. But this is a warning. Let’s not ignore it.

    Monday Roundup

    For reasons that I hope I’ll explain one day, this week is going to be a bit crazy. So here are a few stories I’ve been sitting on, awaiting longer commentary:

    A few weeks ago, Marvel comics unveiled an alternative Spiderwoman cover which was immediately decried as sexist because of her pose. I suspected that this criticism was largely coming from people who weren’t terribly familiar with the medium. And indeed, Maddox easily found a spiderman cover that was almost identical. As a general rule, if you ask a rhetorical question like, “Would they draw Spiderman like that?” you should probably do a little bit of research to make sure the answer isn’t “yep”. I don’t agree with everything Maddox says, but his point is well taken.

    Another video you want to take in is Matt Ridley talking about global greening — the apparent rise in plants that has resulted from global warming. I disagree with parts of what he says, but toward the end he hits a very important point: Europeans are now planning to burn zillions of tons of trees under the belief that this is “green energy”. There’s a reason we stopped burning trees for fuel.

    A few months ago, the town of Peoria launched a SWAT raid into the home of Jon Daniel. This incredibly dangerous man had … uh … created a parody Twitter account of Mayor Jim Ardis. During the raid, the cops found some pot on one of Daniel’s roommates. A judge has decided that the raid was lawful and they can proceed with the felony possession charges. I have no idea how the raid could be lawful when the prosecutor is not bringing charges because mocking someone on Twitter is not illegal. We have now gotten to the point where cops can raid your house based on something that isn’t a crime.

    Obama has unveiled a plan to deal with drug-resistant bacteria, mainly by curtailing the massive overuse of antibiotics in farming and creating incentives for companies to develop new antibiotics. All things considered, this could be the biggest accomplishment of his administration. I mean, he’s not actively making things worse, so it’s got to be one of the top five things he’s done, at least on par with the Great Deckchair Rearranging of 2011.

    Just a reminder if you need one: slavery did not make America rich.

    The Exercise of Vital Powers

    Marlise Munoz was taken off life support and allowed to die yesterday.

    A public battle over the fate of a brain-dead, pregnant Texas woman and her fetus ended quietly and privately as she was taken off life support and her family began preparing for her burial.

    John Peter Smith Hospital in Fort Worth complied Sunday with a judge’s order to pull any life-sustaining treatment from Marlise Munoz, who was declared brain-dead in November, but kept on machines for the sake of her fetus.

    Munoz was removed from the machines shortly afterward and allowed to die. The fetus, which was at 23 weeks’ gestation, was not delivered.

    The hospital’s decision brought an apparent end to a case that inspired debates about abortion and end-of-life decisions, as well as whether a pregnant woman who is considered legally and medically dead should be kept on life support for the sake of a fetus, per Texas law. Anti-abortion activists attended Friday’s court hearing and spoke out in favor of trying to deliver the fetus.

    While I think the court made the correct decision — indeed, it’s not clear if the hospital applied the law correctly or used it as a shield against liability — I do want to unpack this debate a bit.

    There were two questions tied together in the Munoz case: a moral one and a legal one. The legal question, which I’ll get to in a moment, was whether the Munoz family should be forced to keep Marlise on life support until her baby could be delivered. The moral question was whether she should be kept functioning until her baby could be delivered, regardless of the law. To my mind, the latter question was dismissed far too easily.

    In this specific case, the question was largely moot; the medical records indicate that the fetus was suffering from severe deformities and would not have survived (fetuses do not gestate well inside of dead people). But the larger issue remains and will come back again in the future. We’ve long accepted that the right of the mother to live is more important than the right of the fetus to live in rare cases of life-saving abortion. But is there a point where the right of the fetus to live would be more important than the right of the mother to die? Can a person who is legally dead even be said to have rights? Had Munoz been, say, 34 weeks pregnant, the issue would have been a straight forward premature delivery of the fetus. But what happens when you have a case where the brain death of the mother occurs before viability? Do we turn the woman into nothing but a zombie incubator for a fetus? Or do we compound one tragedy with a second? Supposing the fetus is brought to term or prematurely delivered and has a lifetime of health issues. Who is responsible for taking care of him?

    Much of the debate simply assumed that pulling the plug was the morally right thing to do. But what if Munoz’s had expressed that she would have wanted to be kept alive? This case came up with a friend who is pregnant and said that she would want to stay on life support until her fetus could be delivered. As medical technology improves and the window of viability continues to move backward, this issue will come up again and in other contexts. No matter what happened in this particular case, we can’t wish the moral issue away. Nor can we pretend that everyone is going to see the moral case the same way.

    I think people are far too eager to throw the Munoz case into the abortion rubric. The debate gets a lot easier when you can just bash Republicans (even though the Republicans have been mostly silent on this and the law that was used to keep Munoz alive was not really intended for that purpose). Much of the rhetoric I’m reading is borrowed from past abortion debates. But I suspect the debate would have changed had the Munoz family made a different decision. If they had decided on their own to prolong her death long enough for the fetus to be delivered, would some of those supporting them now have turned on them for turning Marlise into a little more than a womb?

    In the end, the moral and legal issues have to come down to the wishes of the family whatever those wishes are. Moral, medical and bioethical issues like this one are far too complex, emotional and personal for the state or anyone else to come stomping in. I feel the same way about the Jahi McMath case — where a family has made the opposite decision to keep alive a brain-dead 13-year-old girl. In both cases, I have moral qualms about the decision that has been made. But in both cases, I believe the deciding factor should be either the pre-expressed wishes of the patient or the wishes of the family. That’s the only way to handle this without drowning in moral and legal quicksand. It’s the only way to handle this without politicians and pundits speculating about medical and moral issues they aren’t remotely qualified to decide.

    That should have been the course followed in this case two months ago. And I hope it will be going forward so that the next family is spared this kind of drawn-out pain. Or vilification for whatever decision they make.

    The $2000 Eye

    One of the biggest problems with our healthcare system, as David Goldhill has relentlessly argued, is that the incentive system is completely messed up. Almost all the economic forces in healthcare push us toward more expense for less return. Insurance insulates people from cost, the government shells out money with little concern for its use and so the pressure to push costs back down — a pressure that exists in every other industry — is mostly absent. Most people don’t even know how much their healthcare costs, let alone what cheap alternatives might be available.


    The two drugs have been declared equivalently miraculous. Tested side by side in six major trials, both prevent blindness in a common old-age affliction. Biologically, they are cousins. They’re even made by the same company.

    But one holds a clear price advantage.

    Avastin costs about $50 per injection.

    Lucentis costs about $2,000 per injection.

    Doctors choose the more expensive drug more than half a million times every year, a choice that costs the Medicare program, the largest single customer, an extra $1 billion or more annually.

    The WaPo, being the WaPo, blames this on greedy drug companies and kickbacks paid to doctors. Certainly, that plays a role. But it’s part of a bigger problem with Medicare which is that they simply don’t give a damn about costs. No, that’s not quite correct. The have set up elaborate schemes to try to control costs by setting prices and either freezing or lowering those prices over the last thirty years. What they have no control over, however, is people who obey the rules but use them to game or defraud the system.

    Here’s me, back in 2009, pointing out that Medicare’s much-vaunted “efficiency” is, in fact, a giant load of crap:

    Second, Medicare saves money because they have, arguably, too little administration. Decisions about what to pay for are handed down from the bureaucrats. I know — I’ve worked for years to get a hearing with an Administrative Law Judge on whether or not Medicare was going to pay for something. But if the Medicare rulers have decreed that something will or will not be paid for, there is usually no argument. And Medicare often cuts checks with little regard to whether those checks are going to actual services that have actually been rendered. If you’re an honest doctor, you get screwed by low Medicare fees. If you’re a crooked doctor, you can do fine.

    But don’t believe me. I wouldn’t. Believe the CBO (PDF), which noted that Medicare has very few cost controls. Believe Obama, who has claimed Medicare is subject to $60 billion a year in fraud (a number I find unbelievable, frankly). Believe recent testimony that Medicare needs to increase the money spent on claims review by a factor of 10-20 to cut fraud.

    This isn’t fraud, but it’s in an adjacent boat. The Medicare administrators — who are actually private insurance companies — just cut checks. Whether the check is for $2000 or $50 doesn’t matter. They get the claim, they process the claim. I won’t say this sort of thing doesn’t happen with private insurance companies. But they are known to try to avoid it by encouraging the use of generics and cheaper drugs. The private insurance companies, when their own money is at stake, tend to be a bit more circumspect. When it’s Medicare’s money? Meh.

    Keep this story in mind. This is unlikely to be an isolated incident. As more and more of us are swept into the glories of Medicare and Medicaid, the press may actually start doing their job and look into these bogus claims that our government-run insurance agencies are so very efficient. And once they open up that can of worms, it’s going to get very ugly very fast.