Category Archives: Health

Health care without profit

Health heaven is just around the corner…


House Democrats’ new Medicare for All bill asserts “a moral imperative . . . to eliminate profit from the provision of health care.” The legislation specifies that federal health funding— virtually all health funding if the bill were to become law—may not be used for “the profit or net revenue of the provider.” That makes it more radical and less realistic than even Bernie Sanders’ plan.

In one stroke, the House bill would sweep away the business model used by the vast majority of doctors in private practice, 28% of hospitals, 70% of nursing homes, and countless clinics, outpatient surgery facilities, dialysis centers, home-care agencies and more. The bill doesn’t detail an enforcement mechanism, but it seems to mean that thousands of providers would either have to reorganize as nonprofits or shut down.

The legislation, introduced by Rep. Pramila Jayapal of Seattle and boasting 106 Democratic cosponsors, would also prohibit the use of provider funds for marketing, campaign donations or labor consultants. It would even proscribe “value-based purchasing,” a strategy for encouraging preventive, holistic medicine that was encouraged by President Obama’s Affordable Care Act. This micromanagement is what a government takeover of the health-care system looks like.

Eliminating profit from an entire sector of the national economy would be unprecedented. But the example of New York, on a smaller scale, shows why it is a recipe for dysfunction.

The Empire State’s hospital industry has been 100% nonprofit or government-owned for more than a decade. It’s a byproduct of longstanding, unusually restrictive ownership laws that squeeze for-profit general hospitals. The last one in the state closed its doors in 2008.

A report last year from the Albany- based Empire Center shows the unhappy results. The state health-care industry’s financial condition is chronically weak, with the second-worst operating margins and highest debt loads in the country. And there’s no evidence that expunging profit has reduced costs. New York’s per capita hospital spending is 18% higher than the national average.

The Medicare for All proposal from House Democrats follows New York state’s bad example.

The overall quality of New York’s hospitals, even factoring in Manhattan’s flagship institutions, is poor. Their average score on the federal government’s Hospital Compare report card was 2.18 stars out of five—last out of 50 states. Their collective safety grades from the Leapfrog Group and Consumer Reports magazine have also been dismal.

The state’s nonprofit hospitals also fall short on accessibility for the uninsured. On average they devoted 1.9% of revenues to charity care in 2015, a third less than privately owned hospitals nationwide.

Finally, New York’s antiprofit policy doesn’t even prevent people from getting rich. Seven-figure salaries are common among the state’s hospital executives. If banning profit is an effective way to improve health-care, there’s no evidence to be found in New York.

Not content to destroy the profit system for health-care providers, sponsors of the House Medicare for All bill would also blow up the patent system for prescription drugs. If a manufacturer won’t agree to an “appropriate” price for its product, federal officials could abrogate the patent and assign another company to make the drug. The original patent holder would receive “reasonable” compensation for its losses, but only after the government discounts costs as it sees fit. Knowing that patents could be overridden at anytime, the private sector would have far less incentive to invest billions to find medical breakthroughs, slowing progress against disease and disability.

The House bill’s supporters seem totally ignorant of the power of the profit motive, when properly harnessed, to drive health improvements and cut costs. If they ever get their way, patients will pay a steep price.

Mr. Hammond is director of health policy at the Empire Center.


Very, Very Rare Commodities

How about you? Got silence?
Silence, by Erling Kagge
Reviewed by Sara Wheeler, WSJ 12/22/2017

Twenty-five years ago, the Norwegian adventurer Erling Kagge trekked solo across Antarctica without a radio (actually, the aviation company that flew him to the coast insisted that he take one, and he did—but he dumped the batteries in the plane’s trash bin). The experience of being alone for 50 days inspired this book: a meditation on the need for, and meaning of, silence.

As the subtitle (“In the Age of Noise”) indicates, the notion of cultivating silence is mightily unfashionable as well as hard to achieve. Mr. Kagge began by asking himself the questions: “What is silence? Where is it? Why is it more important now than ever?” He reckons that he came up with 33 “attempts at answering them.”

Mr. Kagge has skied to the North Pole as well as its southern counterpart, summited Everest, and sailed across the Atlantic and back. He once did some urban exploring in New York City, sneaking to the top of the Williamsburg Bridge in the dark. He is a lawyer, a serious art collector and a distinguished publisher (his own house brought the book out in Norway). His previous six books include tomes on exploration and art collecting.

He admits that he is as ready as the rest of us to busy himself “with this or that, avoiding the silence.” He also acknowledges the “fear of getting to know ourselves better.” But he argues that it is important to train the mind to hear silence. In the Antarctic, he writes, “the quieter I became, the more I heard.” He recognizes, too, that the next hardest challenge, after walking to the South Pole, is “to be at peace with yourself.” He is optimistic, despite the chaos that reigns. “I believe,” he writes, “it’s possible for everyone to discover this silence within themselves.” He quotes contemplative wisdom from a variety of sources, from the rock band Depeche Mode to the 19thcentury French novelist Stendhal (these two just a few lines apart). Mr. Kagge also cites scientific studies in which subjects were left alone with no external stimuli. In one such, a joint venture between the University of Virginia and Harvard, “nearly half of the subjects eventually pushed on the button to administer an electrical shock in order to reduce their silent time.”

“Silence” (fluently translated by Becky L. Crook) is a slim volume at 144 pages, with a biggish font and lots of white space, and it is as much object as book, something to be handled and savored. It is illustrated with photographs and paintings, many of the polar regions and all conjuring silence, if an image can (which it can); the production qualities are superb. Mr. Kagge is especially interested in visual representations of his subject. “The most powerful scream that I have ever experienced,” he writes, “is one that is void of sound: The Scream, by Edvard Munch.”  Other practitioners referenced include the Serbian performance artist Marina Abramović, who famously sat for 736 hours at New York’s Museum of Modern Art peering at visitors in silence.

Erling Kagge’s solo trek to the South Pole in 1993—without a working radio—taught him of the need to block out the noise sometimes.

The author has a sense of humor. “Having tried my hand at internet dating,” he says, “I am inclined to agree with Heidegger,” the philosopher having said that in order to achieve nearness, we must relate to the truth, not to technology. Mr. Kagge is also not afraid to dive into contemporary culture: There is a section on “the drop,” the pause near the beginning of a pop song when, after an introductory buildup, silence occurs before the main event.

There are truisms (“silence is an experience that can be had for free”), and many of the sentiments are not original. That doesn’t matter, but it might have been acknowledged. For example, Mr. Kagge ends his book with “You have to find your own South Pole.” A lot of people have said that. Shackleton, for example, the polar explorer, said, “We all have our own White South,” and Thomas Pynchon, who didn’t go anywhere near the South Pole, wrote in his novel “V.”: “You wait. Everyone has an Antarctic.” Sara Maitland’s 2008 “A Book of Silence” also champions the countercultural notion that silence is more than an absence of noise, though, unlike Mr. Kagge, she emphasizes the role of prayer. Curiously, both authors cite Rothko as a master of the pictorial representation of silence.

A little of the sanctimony in these pages rings hollow. After retailing an interview with Elon Musk, Mr. Kagge says: “I am not so stupid as to compare myself to Elon Musk. However, when I look back on my time as a publisher, the only unusual thing I have done, on a completely different scale to Musk, was to stand uninterrupted at the kitchen sink and raise a few questions about sanctioned truths.”

As a publisher, Mr. Kagge has learned that it is possible to sell hundreds of thousands of books “about knitting, brewing beer and stacking wood” and links this fact, plausibly enough, to “a desire to return to something basic, authentic, and to find peace, to experience a small, quiet alternative to the din.” He discusses the craze, among the wealthy, for relaxation retreats where silence is on the menu (he did a yoga version himself, in Sri Lanka). He also taught himself hypnosis, “in order to disconnect. . . . I lie there hovering a couple of centimetres above my bed each afternoon.”

I too remember crunching over ice at the South Pole— though I had not walked there like the author—and thinking about the ethereal quality of silence that the owned world cannot give (no country owns the Antarctic). Erling Kagge captures that wonder on the page.

Ms. Wheeler is the author, most recently, of “O My America! Six Women and Their Second Acts in a New World.”


Washington Price Choppers

Cool your jets, people….
WSJ 12/7/2016

The belief among Democrats that a Republican could never win another presidential election was apparently so firm that they’re still in a state of shock. They’re even more stunned that Donald Trump has dared to name an Obama-Care critic as his health-care point man—which makes for an instructive moment.

Tom Price, a six-term Georgia Congressman and mild-mannered orthopedic surgeon, is an unlikely villain. But liberals are already saying the Health and Human Services nominee will shred the social contract, leave poor people and cancer patients panhandling for care, and jail women for their reproductive decisions. Cecile Richards of Planned Parenthood claims that Mr. Price “poses a grave threat to women’s health in this country.” Earth to the abortion lobby: Declining to mandate and federally subsidize birth control coverage is not the same as “banning” it.

Meanwhile, the American Medical Association is facing an internal and social-media revolt over an anodyne statement that called Mr. Price “a leader in the development of health policies to advance patient choice and marketbased solutions as well as reduce excessive regulatory burdens.” Supposedly this was a betrayal of doctors and patients, or something, but the big health-care societies always cater to power. They do so because so much of medicine is decided by government.

Mr. Price’s nomination is a refreshing signal that such state control isn’t an inevitability or necessity, starting with replacing ObamaCare. Most liberals are getting the bends coming up from their false triumphalism. They’ve spent years claiming the center-right vision for health care isn’t worth serious study while mocking Republicans for supposedly futile repeal votes. Maybe Republicans meant what they said.

You’d think that the people who designed and enforced a failed program might show more humility, or at least stop lecturing others. Even Hillary Clinton’s staff recognized the law is imploding. In a private Nov. 23, 2015 memo published by WikiLeaks, Chris Jennings, a former Obama aide who joined the campaign, wrote that the law’s performance is “at best, disconcerting” and identified other “troubling” signs.

One of them is that only about eight million people have paid the tax penalty for violating the individual mandate to buy insurance, and another 12 million have received regulatory exemptions. In other words, more people who were supposed to benefit from ObamaCare have opted out than have enrolled. Now Democrats are assailing Mr. Price for proposing alternatives to the mess they created. The Republican, who took over the House Budget Committee from Paul Ryan, is a thoughtful and well-informed problem solver. Unlike many of his colleagues, Mr. Price hasn’t dodged details and specifics. He proposed an alternative to ObamaCare during the 2009-10 debate and in the years since he’s put flesh on the bones, including with legislative language.

Mr. Price’s Empowering Patients First Act relies on fixed-value tax credits to stabilize the insurance markets outside of employer-sponsored coverage. The switch to a defined contribution from a defined-benefit model is based on the transition to 401(k)s from pensions.

The American Medical Association is also right about Mr. Price’s opposition to central health-care planning. ObamaCare says the HHS Secretary “shall” write more than 1,800 regulations, and HHS has put out tens of thousands of pages of rule-makings. The Bureau of Labor Statistics notes that employment among “medical and health services managers” has increased by 31.5% since 2011. These are administrative workers who don’t treat patients but merely ensure compliance with federal and state mandates, and they help explain why U.S. health care is so expensive.

On that score, Mr. Trump also excelled by making Seema Verma his director of the Centers for Medicare and Medicaid Services, with its trillion-dollar budget. She’s an architect of the Health Indiana Plan under former Governor Mitch Daniels and then Mike Pence that makes Medicaid more like private insurance and encourages beneficiaries to contribute to their own care. Ms. Verma even got a waiver from the Obama HHS, which in general has tried to suppress state innovation.

Republicans will have challenges as they attempt to transcend their own divisions and take responsibility for health-care policy for the first time in a decade. But sending Mr. Price over to HHS is one of Mr. Trump’s better personnel decisions.


Fans of CrossFit Training Brag About Extra Bulk

My son is into Cross Fit – and good at it too.  I would say that this article is intended to take a look at Cross Fit from a bit of a humorous perspective.

By Rob Copeland
Feb. 16, 2015 8:52 p.m.

Claire Koch is proud of her hard-earned physique. So she wasn’t bothered when her jeans went up a size or when a seam split on her pencil skirt.

But when the 27-year-old student weighed herself after a recent shower, she lost it.

“I wrapped myself in a towel, walked outside and threw the scale away,” Ms. Koch said.

 Kaitlyn Viola, 28, has seen her size swell after committing to Crossfit workouts. Photo: Kaitlyn Viola

Ms. Koch is a disciple of CrossFit, a fast-growing fitness trend that emphasizes quick spurts of heavy weightlifting. And her exasperation is becoming increasingly common as the movement goes mainstream.

There are no ifs, ands or “butts” about it: CrossFit athletes, as all participants are called, are finding that their bodies morph in unusual—and sometimes inconvenient—ways.

“I’ve gotten re-proportioned,” said Rachael Ashton, 24, a former college cheerleader turned CrossFit enthusiast in Houston. In a twist on the conventional pre-wedding diet, Ms. Ashton, a construction project engineer, cut back on her workouts last spring to slim down for her walk down the aisle.

Crossfitters of both genders alternatively complain, and brag, about broad shoulders that won’t fit into jackets or long-sleeved shirts. Some who live in cold climates wear shorts year-round because they can’t find long pants that will contain their buttocks.

A typical CrossFit hourlong session mixes pull-ups, squats, overhead lifts and a brutal pushup/jumping-jack combination known as a “burpee.” Many of the more intense sequences are aimed to be completed in 10 minutes or less.

Traditional stand-alone cardiovascular activities, like running and biking, are largely verboten. The reason: CrossFit is among several fitness upstarts, like Barry’s Bootcamp, which pitch themselves as more effective because their constantly-changing workouts provide both cardio and strength training, while preventing the body from becoming static.

CrossFit is owned by privately-held CrossFit Inc., which licenses its name to CrossFit “boxes”—the term “gym” would be too gauche. The spaces clang with the sound of falling weights, and are usually set up in an open warehouse with no mirrors.

After a few months, recruits often have to learn to embrace a new body type, too.

“You start building this passion for squatting and cleaning and suddenly you can’t fit into your clothes anymore,” said Troy Monroe, 33, of West Hartford, Conn. Cleaning, for the uninitiated, doesn’t refer to scrubbing the tub. Rather, it is a move that involves lifting a weight off the floor and onto one’s shoulders in one quick motion.

Company spokesman Russell Berger said the program was designed to improve overall fitness among its participants, rather than lead to any specific body shape.

“We’re not in the business of telling people what to think about their bodies,” Mr. Berger said.

Indeed, to some, the resulting bulk can be a badge of honor. Mr. Monroe recalled a recent physical examination, during which his doctor solemnly delivered the news that he’d gained 10 pounds in one year.

“I said, ‘awesome!’ ”

The former graphic designer decided to help start a fashion business to solve some of the sport’s resulting sartorial problems. His company, Relentless Jeans, sells pants for CrossFit members whose existing pairs are “so tight on your legs you can’t get them up.” The jeans are a blend of denim and spandex, the stretchy material helped made infamous by Richard Simmons’ fluorescent duds in his 1980s workout videos.

The first order, of roughly 2,000 jeans, sold out online in six weeks, said Mr. Monroe.

Relentless is marketing to CrossFitters like Kaitlyn Viola, a 28-year-old physician’s assistant who said pulling up her medical scrubs had become a difficult task.

Last year, she was custom fit for pants. “The woman measuring me put the tape around my thigh and said ‘whoa,’ and then put it around my calf and said ‘wow.’ I was like ‘OK, I get it—that’s why we’re here.’ ”

Ms. Koch, the Denver resident who threw away her scale, co-hosts a CrossFit-themed podcast. She recently became certified as an introductory-level CrossFit trainer. Her new muscle tone, she said, gave her the confidence to wear more tank tops.

And then there is her bottom half.

“You say ‘oh wow, is that where my butt is supposed to go?’ ” said Ms. Koch. “It is its own category.”

The CrossFit movement has attracted plenty of detractors, who say many of the high-repetition exercises lead to injury in untrained athletes and frown upon the de-emphasis on cardiovascular activity. CrossFit Inc., based in Washington, D.C., went so far as to sue the National Strength and Conditioning Association last May for publishing an otherwise positive study that included information on injury rates. The suit, filed in U.S. District Court in Southern California, asked for the study to be recalled, among other demands. NSCA has denied the allegations as “frivolous” and asked for a jury trial. The litigation is ongoing.

Meanwhile, Crossfit’s popularity continues to boom. It now counts more than 11,000 affiliate gyms, up from around 1,000 in 2009. This month, hundreds of thousands of people world-wide are expected to take part in Crossfit’s annual “Open,” a month-long competition of rapid-fire, punishing workouts. Participants submit their best times and are judged against the larger pool.

Trace Tackett, a 42-year-old amateur drag racer, said a year ago she was an “empty bag of skin”—the aftermath of a 113-pound weight loss from a new diet and a membership at a more traditional gym.

After a few months of consistent CrossFit, she started putting on new weight in unexpected places, like a ball inside of her knee. She calls it her “soccer muscle” because of the shape.

“I went from wearing men’s jeans—and they were tight—to finally wearing women’s jeans and now I can’t wear them anymore,” said Ms. Tackett, a private security officer in West Portsmouth, Ohio.

The upshot is that Ms. Tackett can now dead lift 300 pounds and is less fixated on her weight.

“I used to think skinny was what I wanted to be,” said Ms. Tackett. “If someone calls me skinny now, I want to punch ’em in the throat.”

Write to Rob Copeland at