November 25, 2008

Amercians want to be able to make thier own choices in choosing their doctor

Why I Choose Low-Quality Healthcare

Daily Article by Jim Fedako | Posted on 11/20/2008

Before the renewed discussions and debates over socialized healthcare begin in earnest, I want to make my preference known to all: I desire low-quality healthcare.

All right, to be straightforward, I do not actually desire low-quality healthcare; I simply do not desire high-quality healthcare — at least not "high-quality healthcare" as defined by generally accepted standards.

Time for some background. Once a year, around this time, my employer allows open enrollment in the various health plans the company offers. As I went through the process, I took the opportunity to review the physicians I had chosen for my family. In order to select the best pediatrician for my children, I used a feature provided by my company's website: a link to a database of physician ratings. I looked up my children's current doctor to see how he fared. What I found was interesting: he was not rated as well as I imagined. Luckily, the reason was just a few mouse clicks away.

The database rates physicians in three categories: quality of care, cost of care, and number of patients treated. My interest is mainly around quality of care for the following reasons: quality of care and children go hand in glove. His cost of care is not my issue (it is a third-party-payer system), and the number of patients is a statistic that can be considered both positive and negative.

So why was my chosen physician not rated near the top in the quality-of-care category? My wife and I like him. We have never had any problem with the care he provided to our children. Moreover, he gets excellent reviews from other parents who use his services. I clicked again.[1]

Interestingly, it turns out that the evaluation rubric for quality of care is based on "a physician's compliance to medical guidelines established by the medical community." That's pretty heady stuff. Or is it?

"We do not want quality healthcare as defined by the medical community."

Another mouse click led to the breakdown of the quality metrics. The quality-of-care guidelines include standards for specific conditions, such as asthma, etc., as well as adherence to (inter alia) vaccination schedules. And here's the rub: my wife and I do not agree with the current guidelines for treating asthma or scheduling vaccinations. And we have found a physician who accepts our opinion — to his statistical detriment. In these important instances, we do not want quality healthcare as defined by the medical community.

Now I have no issue with guidelines or ratings. They provide a means to understand the services that a given physician might provide. They are not perfect, but what is? And, more importantly, they are not mandates from government. So my wife and I can receive the healthcare we desire for our children in spite of the guidelines. We are free, so to speak, to find our concept of high-quality healthcare unimpeded by government.

Of course, healthcare is highly regulated and therefore not to be considered a truly free market. Nevertheless, it displays some aspects of freedom by allowing the consumer to exercise a level of choice.

Let us contrast the above with public education, setting aside for the moment the fact that public schools are an arm of government. First, the federal government mandates statewide standards for educational outcomes. Then the feds layer additional levels of compliance on top of those standards. The promise is that no child will be left behind. Behind what? Behind the standards set by government, of course. But who seeks the same standards as government, under all circumstances? I venture to say no one other than the members of the committee that approved the standards. And they probably don't agree with their own consensus opinion in all instances either.

Complete the move of healthcare from the free market to the authority of government and the guidelines become mandates. Healthcare providers will no longer be judged against various guidelines, with the consumer deciding whether to accept or reject a guideline based on personal preferences. No, government will mandate that all healthcare providers adhere to its guidelines — under penalty of law.

Many believe that government always provides the efficient solution. They believe this to be so since government-mandated guidelines remove the possibility of ineffective treatment. In other words, the treatment will always reflect the current consensus opinion of medical professionals acting as altruistic government agents. However, following the accepted medical guidelines does not guarantee health. In fact, many claims in healthcare are widely, and reasonably, debated within the medical field.

"Allow government to decide levels of medical risk — to socialize personal risk — and healthcare follows the same path of any socialized sector of the economy."

Guidelines are simply a consensus opinion. They are not correct for all circumstances, nor are they meant to be. While it is true that humans act — they employ scarce means in order to obtain specific ends, it is not true that all humans select the same means or the same ends — or even the same means for similar ends. And we are all better off for that.

In addition, humans do not respond identically to medical procedures. Similar to entrepreneurial profit and loss in a free market, each medical procedure has the potential to provide benefits as well as lead to complications. In decisions involving health and business, true freedom only occurs when the owner of the decision is the respective property owner — the patient or parent in the doctor's office or the entrepreneur in his business office.

Allow government to decide levels of medical risk — to socialize personal risk — and healthcare follows the same path of any socialized sector of the economy. This is apodictically true.

We are acting individuals with our own preferences. We are not automatons seeking to conform to an imposed definition of quality. Though the government may appear to be the safe solution, it is the siren enticing us onto the rocks.

I do not want to be forced to conform to someone else's guidelines. I want the healthcare I desire. Call it high quality or low quality; I could not care less. Simply allow me to make my decisions — informed or ill informed — based on my evaluation of the options. Only then am I free.

Jim Fedako, a homeschooling father of six who lives in Lewis Center, OH, maintains a blog: Anti-Positivist. Comment on the blog.


[1] Interestingly, our pediatrician rates high in the number-of-patients category. So we know for certain that he is providing healthcare that is sought by many parents. And that alone is enough reason to question his low metric for quality of care. Who better to decide quality of any product or service than the consumer?


November 18, 2008

Is it time to perform surgery on NAFTA?

Will NAFTA be re-opened?


By Melvin J. Howard


One of the results of the G-20 meetings in Washington was member countries would refrain from raising new trade barriers — but only for the next 12 months. Now according a Bloomberg report  Barack Obama may delay re-opening NAFTA.

Nov. 18 (Bloomberg) -- Barack Obama, who threatened during the presidential campaign to withdraw from the North American Free Trade Agreement unless he could renegotiate it, may delay reworking the accord as he focuses on the U.S. economic crisis.

After he becomes president in January, Obama will order a study on the world’s largest trade agreement, then seek longer- term negotiations with Mexico and Canada on how to change it, according to three advisers, who spoke on condition that they not be identified. A delay would be a victory for companies such as Caterpillar Inc., General Electric Co. andCitigroup Inc., which have tried to head off protectionism in the U.S.

Canadian Trade Minister Stockwell Day also voiced reluctance. “We don’t want to be putting any kind of a drag on a relationship with Nafta that has led to significant prosperity and job creation for both parties,” he said in an interview. So if no one wants protectionism across the board then health care should be on the table. Even Mexico has some form of private health care including private hospitals. Given that there are conflicting legal opinions concerning the extent to which Canada’s public health care system is exempted or protected from the obligations imposed by international trade liberalization agreements. Why in this day and age in 2008 Canada should be exempted from the very same agreements that all other member countries signed. By increasing the private component of Canada’s health care system the shield has eroded from full NAFTA national treatment requirements provided by the Annex I reservation. I am also calling attention to GATS commitments in health care sectors in the Doha. Canada has opened areas for-profit firms that were currently the sole preserve of nonprofit organizations. This was not the doing of any of the member countries of NAFTA this is home grown by Canada for Canada. Now the Government of Canada is saying we are still exempt how can that be. Does anybody else see the double standard here? Yes Canadian firms can open shops for private for profit health services. But all other countries need not apply. We may not be United Health Care yet but our complaint should non the less be taken seriously. Canada we demand compensation if your borders are closed for business.

Another thing that bothers me is so called trade experts such as T.J. Grierson-Weiler an adjunct professor of law at the University of Western Ontario. Who quotes “ It’s a shame he’s going to get a year of free press”. That is the most asinine thing I have heard if Mr. Weiler thinks Four Million Dollars is free in addition to One Hundred and Fifty Million Dollars on stand-by. Mr. Weiler could write me check right now case closed we would take our marbles and go home. “I guess some teach and some do”. Whether NAFTA is re-negotiated or kept the same is of no matter. As far as I am concerned either way its put this issue on the table. Speaking of expropriation in addition I will be sending Canada a bill for $3.7 Million dollars for one EBT machine. This machine stayed in a warehouse while the Province and the Federal Government of Canada argued over private health care. You can see the full Canadian Medical Association article here.      

November 01, 2008

Centurion to resume NAFTA proceedings after U.S. Presidential Election

Centurion will resume NAFTA claim proceedings shortly after the U.S. Presidential election on November 4, 2008. You may click on the Government of Canada web site you  may also check back here periodically for more in-depth information. I also would like to thank everyone’s input from Spain, the UK, Switzerland, Rome, Ireland, France, and Germany. I am sure I left out a great deal more please be patience I will respond to all of your inquiries shortly.