Obama's Healthcare Detailing

Supposedly, this was "detail" offered by Barack Obama, in his nomination acceptance speech, on his plans for reforming healthcare…

Now is the time to finally keep the promise of affordable, accessible health care for every single American. If you have health care, my plan will lower your premiums. If you don't, you'll be able to get the same kind of coverage that members of Congress give themselves. And as someone who watched my mother argue with insurance companies while she lay in bed dying of cancer, I will make certain those companies stop discriminating against those who are sick and need care the most.

So an Obama administration is going to lower premiums for people who currently have health insurance without altering the scope of their coverage and create a massive new entitlement program for people who currently don't have insurance -- all without raising taxes on anybody but "big" business and the top 5% of the working population.

Going beyond the speech, Senator Obama claims he can achieve his goals through increased regulation and through something called the "National Health Insurance Exchange"…

The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.

It's not economically possible for anyone, even Barack Obama, to lower prices and expand access to healthcare through increased regulation, without reducing the range of medicine covered by insurance. And while a "National Health Insurance Exchange" could, in theory, help expand access by allowing people who are self-employed or who work for companies that don't offer health insurance to get the same tax-benefits that people who work for companies with health insurance currently get, it's doubtful that such a program can help lower prices, unless policies sold through the exchange are given regulatory exemptions that non-exchange programs don't get, which is the kind of thing that a government does when it's trying to run non-government endeavors out of business. This is all pretty straightforward economics, unless there's some major detail about what a "National Health Insurance Exchange" would do that I'm missing.

Related: I thought this part of Senator Obama's speech was blatantly dishonest…

How else could [John McCain] offer a health care plan that would actually tax people's benefits, or an education plan that would do nothing to help families pay for college, or a plan that would privatize Social Security and gamble your retirement?

John McCain supports a universal tax credit for health insurance, regardless of who your employer is…

While still having the option of employer-based coverage, every family will receive a direct refundable tax credit - effectively cash - of $2,500 for individuals and $5,000 for families to offset the cost of insurance. Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts.

How exactly is that "taxing benefits"?

Evidence of the Problem Is Not Always Proof of One's Solution

I'm sure there are examples on the Right, as well, and taking my own biases into consideration, I wouldn't be confident declaring an imbalance. But it does seem as if the Left has a habit of assuming the soundness of its solutions and seeing any evidence of the initial problem as explicit proof for its assumption. Consider Ian Donnis:

Speaking of Carcieri, our governor has been an energetic supporter of what proponents call medical malpractice reform. Yet those who believe the medical system is plagued by unwarranted lawsuits might want to watch a segment aired last night on 60 Minutes, featuring actor Dennis Quaid.

The interview with Quaid is certainly chilling. In brief, his newborn twins were given adult dosages of a blood thinner, resulting in a thousandfold overdose that nearly killed them. The reason was that, at three steps between the receipt and administration of the drug, nobody read the label on the vials carefully enough, and the different shades of blue on the two versions' packaging were not sufficient to raise alarms.

A few details worth noting: According to 60 Minutes, there have been two similar incidents over a span of several years, one before and one after Quaid's experience. After the first, the pharmaceutical company that manufactures the drugs "issued a nationwide safety alert" and modified the packaging. Curiously, Quaid is suing the drug company (for failure to recall), but not the hospital, because:

"I'd like to see Cedar Sinai take the lead in doing something to change what's going on in what I consider to, in the end, a broken healthcare system in patient medical care."

All of which leads one back to Donnis's curious insertion of our governor into the story, which requires him to ignore the fact that the agent for dramatic change in the 60 Minutes report wasn't litigation, but the involvement of a wealthy and famous man. Moreover, of the five components of Carcieri's favored tort reform that Ian cites, only one — limits on non-economic damages and reimbursable attorneys' fees — would have any implications whatsoever for legitimate complaints in the service of rapid change. To insist on the necessity of eye-popping awards from lawsuits, one must imagine that some millions of dollars would add substantial motivation on top of the possibility of killing children to avoid the decisions and mistakes that ushered the wrong drug into Quaid's newborns. One must imagine, in other words, that the packaging designers, pharmacy technicians, nurses, and managers along the line understood, on some level, the possibility of being responsible for deaths and shattered lives and still took less care than they would have in the face of financial liability.

Keep in mind, too, that the financial liability is mostly borne by others: insurance companies, proximately, and policy holders and their clients, ultimately. Therein lies the cognitive dissonance of Donnis's juxtaposition. Malpractice insurance is driving up costs and driving out doctors, and as fewer medical providers are available — working in an environment of ever-tighter margins — mistakes will likely become more common, not less.

Then, true to form, the Left will up its rhetoric in the push for government healthcare... without questioning government workers' capacity for mistakes or government leaders' tolerance for high-profile, high-price-tag litigation, let alone taxpayers' ability to absorb new costs that come with the backing of police power.

Just Because It's the Rational Solution Doesn't Mean I'm Going to Stop Talking About It

AFSCME Council 94's President, as reported by Katherine Gregg in the Projo, has named his union's immediate goal in the wake of Judge Patricia's Hurst's decision allowing the Governor's imposition of contract terms to go forward, as least as far as executive branch employees are concerned…

Our number-one goal is to stop the administration from taking money out of the paychecks of the people we represent without negotiations,” Council 94 president J. Michael Downey said.

Just keep in mind, if healthcare were decoupled from employment, the administration wouldn't be able to take money out of anyone's paycheck without "negotiation" to pay for insurance or most anything else, just like they can't take money out to make house payments or rent payments or car payments on your behalf.

How RI's State Employee Unions And Everyone Else Would Be Helped By a More Rational Healthcare System

If there are any union folks still reading this site, let me use the Council 94 situation as the basis for explaining to you how conservatives would like to reform healthcare. Non-union folks might be interested in this too!

1. Instead of negotiating a plan and spending money with a health insurer, your employer would take the thousands of dollars currently spent per employee on health insurance, and give that money directly to the employees. In operational terms, every employee gets a multi-thousand dollar bump in their paycheck.

2. The employee can then use that money to buy an insurance plan directly from an insurance company. The laws would be changed so that people would be free to purchase insurance plans from any insurer in any state, and so that other government-created factors that artificially increase the price of non-employer health insurance would be removed.

2A. Most importantly, the tax-code would be changed so that individuals who purchase health insurance would get the same tax-break that companies who purchase health insurance for their employees currently get. Right now, businesses that buy health insurance for their employees are allowed to deduct that money from their corporate income tax calculations, but individuals who spend money directly from their paychecks on the exact same plans are not allowed to deduct from their personal income taxes.

(I'm not sure how the current employer tax-break works in the case where the state is the employer, but that only helps make my point: In the reformed system, the self-employed, the corporate-employed, and the state-employed will all be treated the same, which makes sense, as people's health needs don't fundamentally vary based on who their employer is.)

3. Finally, in this new system, a union like AFSCME could still use its negotiating prowess to go out and secure a preferred deal from a health insurance company for its members. AFSCME would bargain directly with the health insurers, choosing whatever health insurer in the country offered them the best deal, and not having to rely on the Governor to negotiate the details of its deal.

The night that Council 94 rejected the current contract offer, WJAR-TV (NBC 10) reporter Bill Rappleye interviewed state employee Sharon Moreno, who expressed a reasonable position about what she would like from the new contract...

Leave me where I am right now [in salary, but] don't touch my coverage.

The strength of the plan outlined above is not only that the state wouldn't have to touch health-coverage benefits during contract negotiations, but that the state would not be able to touch health-coverage benefits during negotiations. Unions and employees would talk salary with their employers, and talk health coverage with their health insurers.

I know it's too late for this kind of plan to help with the current situation, but this is the system that makes the most economic sense, the most political sense, and that gives workers the most direct control over their futures. This is the kind of system we need to be looking at moving towards for everyone.

How RI's State Employee Unions And Everyone Else Would Be Helped By a More Rational Healthcare System

If there are any union folks still reading this site, let me use the Council 94 situation as the basis for explaining to you how conservatives would like to reform healthcare. Non-union folks might be interested in this too!

1. Instead of negotiating a plan and spending money with a health insurer, your employer would take the thousands of dollars currently spent per employee on health insurance, and give that money directly to the employees. In operational terms, every employee gets a multi-thousand dollar bump in their paycheck.

2. The employee can then use that money to buy an insurance plan directly from an insurance company. The laws would be changed so that people would be free to purchase insurance plans from any insurer in any state, and so that other government-created factors that artificially increase the price of non-employer health insurance would be removed.

2A. Most importantly, the tax-code would be changed so that individuals who purchase health insurance would get the same tax-break that companies who purchase health insurance for their employees currently get. Right now, businesses that buy health insurance for their employees are allowed to deduct that money from their corporate income tax calculations, but individuals who spend money directly from their paychecks on the exact same plans are not allowed to deduct from their personal income taxes.

(I'm not sure how the current employer tax-break works in the case where the state is the employer, but that only helps make my point: In the reformed system, the self-employed, the corporate-employed, and the state-employed will all be treated the same, which makes sense, as people's health needs don't fundamentally vary based on who their employer is.)

3. Finally, in this new system, a union like AFSCME could still use its negotiating prowess to go out and secure a preferred deal from a health insurance company for its members. AFSCME would bargain directly with the health insurers, choosing whatever health insurer in the country offered them the best deal, and not having to rely on the Governor to negotiate the details of its deal.

The night that Council 94 rejected the current contract offer, WJAR-TV (NBC 10) reporter Bill Rappleye interviewed state employee Sharon Moreno, who expressed a reasonable position about what she would like from the new contract...

Leave me where I am right now [in salary, but] don't touch my coverage.

The strength of the plan outlined above is not only that the state wouldn't have to touch health-coverage benefits during contract negotiations, but that the state would not be able to touch health-coverage benefits during negotiations. Unions and employees would talk salary with their employers, and talk health coverage with their health insurers.

I know it's too late for this kind of plan to help with the current situation, but this is the system that makes the most economic sense, the most political sense, and that gives workers the most direct control over their futures. This is the kind of system we need to be looking at moving towards for everyone.

Using Government-Run Healthcare to End Age Inequality

William Saletan of Slate Magazine's Human Nature Blog says one of the purposes of government run health care system should be to reduce age inequality. And he's not just talking about making people with shorter lives live longer (h/t Mona Charen)…

Isn't health, like wealth, an unequally distributed asset? Isn't it, in fact, the ultimate asset? And if that's the case, should we means-test people on Medicare not just for wealth, but for age?

Actually, means testing is the wrong term. Age isn't really a means; it's more like an end. So let's call it an ends test. The theory is that just as some people have enough money, others have had enough time.

If you make it to 100 and can fund your own surgery, that's terrific. But Medicare should focus its resources on people who haven't been as lucky as you. Living to 99 is no tragedy. It's a blessing.

Remember, if you ever get stuck in a Medicare-for-all or other fully socialized type of healthcare system, the people who have ultimate control over your healthcare access could end up being people like William Saletan, who believe that it is a function of government to decide how much life is too much.

One of the reasons I chose healthcare as the topic for Anchor Rising's most recent appearance on the Matt Allen Show is that regular people need to start thinking about these kinds of arguments right now, as there is a very high probability that the next President of the United States is going to put some kind of major healthcare before Congress, and people need to be aware of how much "if there are fewer people living shorter lives, the people who are left will be better off"-type thinking is influencing American policy makers -- and whether that thinking needs to be vigorously challenged.

Finally, it is my sincere hope that Saletan's item makes a few people on the left ponder, even if just for a few moments, whether it is a good idea to always uncritically accept "ending inequality" as a legitimate goal for government policy.

Healthcare on the Radio

Andrew brought the healthcare conversation to the Matt Allen Show, last night; stream the discussion by clicking here or download it.

Confront Healthcare Inflation or Die: A Broad View of Healthcare Reform

This past Sunday, the Projo ran a contrarian Froma Harrop column, where she questioned the conventional healthcare reform wisdom that a focus on preventative care will lower costs in the long run…

The word “prevention” has a nice ring in any health-care discussion. Thus, many politicians argue that programs to stop smoking, improve diets and otherwise promote wholesome living save money in the long run. A healthier population at less cost. Sounds like a win-win situation.

Unfortunately, that formulation is a pleasant fantasy…

Let’s put it bluntly: Longer lives cost money. Those who make it to 90 thanks to exercise and six daily servings of vegetables are more likely to suffer the expensive ravages of old age. Everyone dies of something. So he who avoids a fatal heart attack at 70 is more at risk of cancer at 80. Those extra 10 years can mean extra CT scans, hip replacements and physical therapy, even for those in relative good health.

There is fodder for many important discussions here, but for now, I want to focus on just one aspect -- the costs of those extra CT scans.

Later in her op-ed, Harrop makes reference to the exorbitant rate of medical inflation…

Rapidly rising prices for health-care also add to the expense of moving big-ticket medical procedures into later years, explains [Arthur Garson Jr., provost at the University of Virginia Medical School]. “In today’s world, where the rate of medical-care inflation is twice the rate of regular inflation, anything done 10 years from now is, in real dollars, 25 percent more expensive.”

There are two ways to deal with that problem, according to Garson. Get medical costs down, and “keep people as healthy as possible as long as possible so that they don’t spend as much money being sick.”

But why should hyper-inflation in healthcare prices, for decades at a time, be accepted as some unalterable force of nature? As technologies mature, why shouldn't the costs of producing and using medical hardware come down in exactly the same way that hardware costs in other economic sectors do; for example, think of cell phones or printers, which were once expensive luxury items, but are now affordable to nearly everyone. And then consider the CT-scans. A medical facility that has recently purchased CT equipment should be able to charge a lower price to each patient while paying off the costs of the equipment off just as quickly if they can treat 100 more of Froma Harrop's longer-living people per year than they would have if people were dying off more quickly. Why aren't these kinds of effects bringing the rate of healthcare inflation down to reasonable levels?

It is not possible to improve the combination of healthcare quality and access in the U.S. without grappling with the economic irrationality of continuing, runaway medical inflation. If policy makers involved in healthcare reform ignore the inflation question, declaring it to be some kind of iron law of modern society, the "best" they are going to be able to come up with is -- by definition -- a permanent regimen of forcing people to pay more for less, aka a program of rationing.

Of course, to do the right and effective thing, healthcare policy makers are going to have to confront the problems that have been created by poorly thought out government interference with individual medical choices. Health and Human Services Secretary Michael Leavitt wrote about a particularly egregious example earlier this month in the Wall Street Journal…

For years, the Government Accountability Office and the Department of Health and Human Services' inspector general have been saying Medicare is paying too much for Durable Medical Equipment (DME). Just compare what Medicare pays to the prices of equipment for sale on the Internet.

DME prices are based on a fee-schedule established by law in the 1980s and subsequently updated for inflation. But the fee-schedules weren't based on competitively determined market prices. It is a price-fixing program, and the equipment suppliers like it because they get overpaid and don't have to compete.

An oxygen concentrator, for example, is a device that delivers oxygen through a tube to patients, and it costs about $600 on the open market. Medicare beneficiaries typically rent the machines. The rental period, set by statute, is up to 36 months. The monthly rental payment, also set by statute, is $198.40. So renting an oxygen concentrator for 36 months costs $7,142.

As with most items and services in Medicare Part B, beneficiaries pay 20% of the costs, and Medicare pays the remaining 80%. The government, therefore, pays $5,714 – almost 10 times the free-market price of purchasing a concentrator outright. The patient pays $1,428 – more than twice the free-market price of purchase. Even allowing for the costs of setting up equipment, training and fitting the beneficiary, and other things, the rental fee is way out of line.

Do you think this is the only case where the cost of medical hardware has been grossly inflated by strange government priorities, or just the worst?

What Hospitals Want Isn't Necessarily Good For Everyone Else

I don't find anything persuasive in Charles Kinney and Fred Allardyce's Sunday Projo op-ed arguing in favor of legislation that would make insurance companies responsible for the uncollected debt related to the unmet deductibles and co-payments of their subscribers. Mr. Kinney and Mr. Allardyce begin by immediately linking uncollected debt to preventative care...

Our health-care system is undeniably broken. Insurance premiums are soaring, putting preventive health care out of reach for many. Employers and insurers are shifting costs to others by turning to plans with higher deductibles and co-payments. The result is a physically unhealthy society and a fiscally challenged health-care system overburdened by increasing numbers of people facing health-care crises with no means to pay.

One of the major issues hospitals are facing is the increase in bad debt — patients who do not pay their bills. For patients who do not have the means to pay, we provide free care.

But in any rational economic analysis, preventative care is an odd area to single out if you are concerned about "dangers" of consumer driven healthcare. As we've gone through in detail before here at Anchor Rising, it does not make fiscal sense to use an insurance-style system to pay for preventative medicine; it never has and never will. If you are really interested in seeing everyone be able to take advantage of preventative care opportunities, paying for them through the insurance system is an especially bad idea, as insurance programs can only increase costs to consumers when they include services that are widely used.

By linking uncollected debt and preventative care, Mr. Kinney and Mr. Allardyce are functioning as standard-issue, risk-averse big-business executives in search of ways to separate individuals from their money as quickly and as predictably as possible. The most efficient way for a hospital to do this is to force people to pre-pay for the services most likely to be used. That's good for organizational financial planning and good for the cash-flow and balance sheet of a hospital, but has nothing to do with controlling health care costs or making healthcare affordable.

What is especially egregious about Mr. Kinney and Mr. Allardyce's argument is that, at the same time they are pursuing a government-created fiscal advantage of dubious (and probably negative) value to the healthcare consumer, they are also advocating for their organizations to be insulated, by law, from the practical financial realities of their business…

If a patient has private insurance, such as United Healthcare or Blue Cross, and he or she doesn’t respond to reasonable collection efforts for co-payments and/or deductibles, we have to write off 100 percent of that loss at the present time. The role of the hospital turns from caregiver to debt collector. This burden should not be placed on the shoulders of non-profit hospitals; debt collection should be the responsibility of the commercial insurance companies.

The fundamental flaw in this argument is that hospitals aren't caregivers; nurses and doctors are. Contrary to Mr. Kinney and Mr. Allardyce, it is precisely the primary job of a hospital and its administrative staff to do the mundane, daily things that need to get done so that the primary caregivers have an environment where they can function with maximum effectiveness. The hospital worries about keeping the lights on and the water running and making sure that supplies are delivered to the right places, while the nurses and doctors worry about the caregiving. A hospital administrator who says he shouldn't have to worry about collecting the money to pay the bills makes about as much sense as one who says that he should be given land for free, because hospitals shouldn't have to worry about the details of financing and mortgage payments when deciding how best to expand their facilities to provide improved care.

Healthcare is a people business. If you don't want to deal with people, you should be in a different business.

ADDITIONAL INFORMATION

Roland Benjamin, who knows as much about the relationship between employers and insurance companies as anyone in Rhode Island, offers more detail on why making insurers responsible for uncollected hospital debts is a bad idea, in the form of a letter he sent on this issue to the House Corporations Committee...

Relieving hospitals from the most fundamental of business processes (collecting fees from users) is simply continuing the trend of requiring more from our insurance carriers and the employers that pay them. In effect, House Bill 7057 and Senate Bill 2414 referred to House Corporations on 3/18 will require insurance carriers that currently have no direct financial relationship with individuals to establish one from the ground up. The cost of doing so will present in premiums passed through to employers

Of particular note are three concerns:

1. Assuming the carriers can seamlessly transition to a broad financial arrangement with members, the costs of administering these relationships will be born more heavily by Consumer Directed Plans. While these plans are the subject of contention from the provider side, they represent the most viable means of applying consumer dynamics to the health care economy.
2. Should a patient fail to pay a bill from a hospital, the hospital will go after the carrier, who in turn will go after the employer, since they will have a statutory obligation to keep insuring the individual and thus no collection effort leverage. The result, should an employer refuse to make this payment on behalf of an employee (and due to privacy requirements will not know for whom or what they would be paying), the employer's account could be affected, thus leaving the entire employment base without insurance.
3. There is no indication that failure to collect payment from privately insured individuals represents a significant burden to hospitals as a percentage of total operating expenses. Thus, a solution attempting to solve this issue, at the expense of a massive administrative restructuring in the industry, will only serve to escalate overall costs.

As a studied buyer of insurance products for more than 100 participants in my plan, I simply do not want to pay for this coverage. I urge that the House Corporations Committee not recommend passage of this bill.

What?

This component of the RI House budget plan is nuts:

he plan also includes funding for 100 of 400 slots slated to be eliminated from the early childhood education program, Head Start. In addition, the budget restores health care coverage for all but 1,000 of more than 7,000 adults slated to lose coverage under a plan released by Governor Carcieri earlier in the year. ...

... it generates $5.6 million in new revenue by increasing the health insurer tax on medical premiums from 1.1 percent to 1.4 percent. Costantino said he hoped the increase wouldn't be passed on to health care consumers, although that's what happened when the tax was expanded last year. The tax, previously only applied to health insurers, would now apply to Delta Dental as well.

So the budget will continue to pay for the healthcare of a few thousand adults who can't afford it, but it most definitely increase the price paid by everybody else. It would seem that the state's budget is not constructed with much by way of strategy — instead by picking and choosing various numbers to call the result "balanced."

Stacking the Healthcare Deck

The state of Rhode Island likes monopolists, it would seem:

The other condition that Tufts needs to change is a state law that says only health plans that did business in Rhode Island in 2001 can take the health status of members into account in setting rates for small groups. As a result, only Blue Cross and United can increase premiums for groups whose members are less healthy.

Changing that rule ought to be an obvious step.

Readers should note that such regulations — questions of bias in their application aside — are one of the reasons that healthcare costs so much.

Toward Universal Healthcare

In a comment to my recent post about being a doctor in Rhode Island, Old Time Lefty asked (among some insults, statements seeped in common spin, and other junk that I'll ignore):

Health insurance should not be joined to employment. It should be a right. If it’s not a right, do you think it’s a worthwhile endeavor to establish program or programs to cover them all? What program to do this are you espousing?

I'm always hesitant to assent to calling something "a right" in the presence of left-wingers, because the definition of what a given right might entail is generally more expansive and fluid than I believe to be appropriate. However, I'll express general agreement with the proposition that access to healthcare is a right, mainly in order to draw attention to my disagreement with the proposition that health insurance is a right.

Plainly put, "healthcare" and "health insurance" shouldn't be considered synonymous in this discussion. There's a reason you don't use your auto insurance card every time you get an oil change, buy new seat covers, and have your car detailed. Insurance ought to be bought against that which is rare and harmful, not that which is habitual and foreseeable.

So, with this distinction made, how would I provide everybody with access to healthcare?

The first step would be to end price-raising regulations and mandates. That would include all laws that push health insurance into the employee agreement. (Ask Andrew about ERISA.) It would also include requirements that insurance cover viagra, sex-change operation, and a whole medicine cabinet of more common procedures and drugs. Make it possible, in short, for the average citizen to purchase his or her own catastrophic coverage, for use in such illnesses and injuries as ought to bring one to the emergency room or the life-saving surgeon.

The second step would be to make that insurance mandatory. Once we've agreed upon a bare minimum of coverage (taking into consideration severity as well as cost to the public of uncovered treatment). The price really shouldn't be that much, considering the rarity of the use, and perhaps those who still cannot afford it could be covered under a government-negotiated plan with a private provider.

The third step would be to create health savings accounts for every American, created upon birth or naturalization. Each citizen (or his or her parents) would select a firm to administer the account, with the government's role being mainly in establishing the account number and other minor start-up requirements. (The administration would be more akin to bank practices, as opposed to investment practices.) Over a person's lifetime, the individual, employers, charities, and so on could put money into the individual's account (tax free), and he or she could use it solely for medical expenses, including doctor visits, medicine, perhaps even plastic surgery and other electives.

At a certain age, the money could be withdrawn to enhance retirement income, and the full remaining dollar amount could be bequeathed to others, placed in their accounts.

This is just a summary, with some debatable points and specifics to be added for a full-throated policy discussion, and there are a variety of costs and benefits (notably an increase in pay when employers are no longer "responsible" for insurance costs) to such a program that would require more time than a lunch half-hour provides.

Lack of Freedom a Threat to Health

Periodically, somebody on the Left will throw in some anti-corporate rhetoric and sneer about the "free market." Mark Patinkin's column on the state's difficulty attracting doctors provides yet another example illustrating that one can hardly point to our problems in condemnation of economic freedom:

I began by asking where he’d rank us nationally in fees paid for medical procedures.

"In many if not most areas," he said, "it's 49th or 50th in the country."

The reasons are complicated, he said — one factor being restrictive laws.

What kind of laws?

He mentioned several typical procedures for which Medicare will pay a doctor around $300, almost below cost, he said. In some states, top doctors can charge an extra few hundred for patients happy to pay for their expertise. Here, as in Massachusetts, the law forbids that.

"In other businesses," he said, "when you get seniority and experience, you raise your prices. I make the exact same fees as the doctor fresh out of residency. The only way I make more money than that doctor is by seeing more patients. I'm not allowed to charge more for procedures."

Here's a stunning bottom line for doctors:

He gave the real example of a 30-something cancer doctor who recently finished his training. His offer in Rhode Island was $125,000 with three weeks vacation and being on call every third night — being available for patient calls or going to the hospital. On the West Coast, The Doctor said, this same candidate was offered $250,000, eight weeks vacation and "call" every 10th night.

Rhode Island's much touted (but selectively described) "quality of life" is surely threatened if our battle against the free market drives away high-end professionals.

The McCain Healthcare Plan

Presumptive Republican Presidential Nominee John McCain has sketched out his healthcare reform plan in the (electronic) pages of National Review Online…

I believe the key to real reform is to restore control over our health-care system to the patients themselves. To that end, my reforms are built on the pursuit of three goals: paying only for quality medical care, having insurance choices that are diverse and responsive to individual needs, and restoring our sense of personal responsibility.

American families know quality when they see it, so their dollars should be in their hands. When families are informed about medical choices, they are more capable of making their own decisions, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices. Health Savings Accounts are tax-preferred accounts used to pay insurance premiums and other health costs. They put the family in charge of what they pay for, and should be expanded and encouraged.

Americans also need new choices beyond those offered in employment-based coverage. They want a reformed system so that wherever you go and wherever you work, your health plan goes with you. And there is a very straightforward way to achieve this.

Under current law, the federal government gives a tax benefit when employers provide health-insurance coverage to American workers and their families. This benefit doesn’t cover the total cost of the health plan, and in reality each worker and family absorbs the rest of the cost in lower wages and diminished benefits. But it provides essential support for insurance coverage. Many workers are perfectly content with this arrangement, and under my reform plan they would be able to keep that coverage. Their employer-provided health plans would be largely untouched and unchanged.

But for every American who wanted it, another option would be available: Every year, they would receive a tax credit directly, with the same cash value of the credits for employees in big companies, in a small business, or self-employed. You simply choose the insurance provider that suits you best. By mail or online, you would then inform the government of your selection. And the money to help pay for your health care would be sent straight to that insurance provider. The health plan you chose would be as good as any that an employer could choose for you. And if a church or professional organization wishes to sponsor insurance for its members, they should be able to do so. The bottom line: Health insurance would be yours and your family’s health-care plan to keep without worrying that it will go away along with your job.

The Other Problem with the Roberts Healthcare Plan

There is very little chance that the core of Lieutenant Governor Elizabeth Roberts' healthcare plan, if passed into law, would survive a court challenge. The doomed element, described by Cynthia Needham of the Projo, is the requirement that…

Businesses with more than 10 employees would be expected to purchase insurance for their workers, or face fines.

Here's the technical description of the employer mandate from the legislation itself…

28-43-8.7. Health security assessment. – (a) Each employer, except those employers employ ten (10) or fewer employees, subject to the provisions of this chapter shall be required to pay, in the same manner and at the same times as the director prescribes for the other required by this chapter, in addition to any other contributions required under this chapter, a health security assessment of each employee of eight percent (8%) of the taxable wage as defined in section 28-43-7, in addition to any other payment which that employer is to make under any other provisions of this chapter…

(b) An employer may deduct from the amount owed for each employee under subsection (a) its average expenses per employee for providing health insurance coverage or other health care benefits for its employees, allowable for the current quarter by the Internal Revenue Service as a deductible business expense;

The problem is that the Federal courts have consistently struck down state attempts to mandate health insurance by private employers for conflicting with the Employee Retirement Income Security Act of 1974 (ERISA), which makes it illegal for states to regulate employee benefits any more stringently than the Federal government does. Last year, the Fourth Circuit Court of Appeals nullified a Maryland law that would have required employers bigger than a certain size to pay a certain percentage of their payroll towards health benefits. The Fourth Circuit's ruling did not depend on the details of the mandate, who was affected or how much they had to pay. Just the fact that Maryland was trying to require a particular employee benefit was enough to run afoul of Federal law…

Because Maryland’s Fair Share Health Care Fund Act effectively requires employers in Maryland covered by the Act to restructure their employee health insurance plans, it conflicts with ERISA’s goal of permitting uniform nationwide administration of these plans. We conclude therefore that the Maryland Act is preempted by ERISA and accordingly affirm [the lower-court decision to strike it down].

Bottom line: because of ERISA, whether you like it or not, states are not allowed under current Federal to mandate any employee health benefits.

The Roberts Paradox

Cynthia Needham reports in today's Projo on the beginning of Lieutenant Governor Elizabeth Roberts' statewide tour to promote her proposed new healthcare mandates…

Lt. Gov. Elizabeth Roberts last night kicked off a statewide tour in South Providence to promote her health-care plan, making the first of 15 stops…

Similar to the Massachusetts system, the Roberts plan would require nearly all Rhode Islanders to have health coverage. Businesses with more than 10 employees would be expected to purchase insurance for their workers, or face fines. Individuals making at least $40,840 and families making $82,600 would be asked to purchase their own health care. The plan would also create a HealthHub, a quasi-public agency to help coordinate purchasing and regulate plans…

Roberts made only brief mention of the immigration issue. “This week I’ve been discouraged with how we do things in this state. But I still have confidence we can work together,” she said, segueing back to the evening’s conversation.

With respect to the illegal immigration issue mentioned by Ms. Needham, Lieutenant Governor Roberts has adopted the position that it is out-of-bounds for the state of Rhode Island to verify the citizenship/legal residency status of its new hires, believing it either to be too big a job for the government to handle, or maybe just unreasonable to ask. Yet at the same time, according to her healthcare legislation, Lt. Governor Roberts also believes that state government is ready and able to take on the burden of verifying the health insurance coverage status of every Rhode Islander...

44-30-101. Qualified coverage required -- (c) Every person required to file an individual income tax return as a resident of the state of Rhode Island, either separately or jointly with a spouse, shall indicate on the return, in a manner prescribed by the tax administrator, whether such person, as of the last day for the taxable year for which the return is filed:
(i) has qualified coverage in force as required under subsection 44-30-101(a) whether covered as an individual or as a named beneficiary of a policy covering multiple individuals; or
(ii) claims an exemption under section 44-30-102.

(d) If a person required to obtain and maintain qualified coverage under subsection 44-30-101(a) above who files a tax return in Rhode Island does not indicate on the return that he or she had such coverage in force, or if the person indicates that he or she had such coverage in force but the tax administrator determines, based on the information available to him or her, that such requirement of subsection 44-30-101(a) was not met, then the tax administrator shall compute the tax for the taxable year based on one less personal exemption, as set forth in section 44-30-2.6, than would otherwise be allowed….

44-30-103. Review -- An individual subject to section 44-30-101 who disputes the determination of applicability, as enforced by the department of revenue, may seek a review of this determination through an appeal established by the division of taxation under section 44-30-89; provided, however, that no additional penalties shall be enforced against an individual seeking review until the review is complete and any subsequent appeals have been exhausted.

Tell me, which sounds like an easier job to do, verifying the health insurance status of every Rhode Islander every year, or verifying the citizenship status of new state employees, one time, at the time of hire? The contrast emphasizes an obvious reality, that enforcing immigration law is something that certain politicians don't want to do, not something they believe can't be done.

I suppose that you might reach the conclusion that government doesn't have the time or resources to take the steps to prevent foreign nationals from breaking the law, as Lt. Governor Roberts apparently has, if you subscribe to the idea that the most important function of government is managing as tightly as possible the lives of law-abiding, gainfully employed citizens and residents. Still, it is legitimate to ask the Lt. Governor why she believes that government is competent enough to track the health insurance coverage of 1,000,000 Rhode Island residents on a year-to-year basis, but unable to reasonably determine the citizenship status of new state hires one-time.

Or does she just believe that illegal aliens are entitled to state jobs?

What the Numbers Show

Unfortunately, neither Community Catalyst nor RIte Care Works, the author and promoter respectively, seem interested in providing the full details behind a press release from The Clarendon Group that appears to support the conclusion that every dollar of RI government money taken from RIte Care comes with a 12¢ cost in economic activity but save Rhode Island — overall, not just its government — 14¢:

The report from the national non-profit advocacy organization Community Catalyst, broke down where the dollars cut from the RIte Care program would go:

• 52-cents of each dollar stays with the federal government rather than making it to Rhode Island in the form of federal matching funds.
• 35-cents of each dollar is shifted to the private sector in the form of high-cost uncompensated care that’s ultimately left to hospitals, insurers, and premium payers to pay.
• 6-cents of each dollar is lost in reduced state tax revenue that is no longer being collected on the economic activity associated with the lost federal matching funds.
• ONLY 7-CENTS REMAINS AT THE DISPOSAL OF THE STATE AS "SAVINGS."

Clearly, the authors are measuring "the state" more broadly than just its government, because they include the cost "shifted to the private sector," and surely a failure to merit matching funds doesn't shift to the expense column (for the government) in addition to being erased from the revenue column. What's notable about the findings is that money is saved even with this broad analysis.

On the other hand, they don't give the cost of lost economic activity, just the taxes on it, so the proper interpretation is probably that our analysts stirred a bunch of quick calculations in an activist pot until they arrived at a mixture that they thought to be salable.

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The Behavior Gap

Let me say right up front that access to healthcare must be improved and expanded, although it goes beyond the scope of this post to delve into the different understandings of the whats and hows of that mandate. Even were that goal to be achieved quickly, however, I suspect that the life expectancy gap between rich and poor would continue to increase, because I think the behavioral explanations play a large role and would bleed into matters of access:

While researchers do not agree on an explanation for the widening gap, they have suggested many reasons, including these:

¶Doctors can detect and treat many forms of cancer and heart disease because of advances in medical science and technology. People who are affluent and better educated are more likely to take advantage of these discoveries.

¶Smoking has declined more rapidly among people with greater education and income.

¶Lower-income people are more likely to live in unsafe neighborhoods, to engage in risky or unhealthy behavior and to eat unhealthy food.

¶Lower-income people are less likely to have health insurance, so they are less likely to receive checkups, screenings, diagnostic tests, prescription drugs and other types of care.

As you can see, New York Times reporter Robert Pear offers four examples, evenly split between behavior and "the system," but the former can be as numerous as the attributes of life. Here's another, which touches on an area about which I've written copiously (from an article to which I linked yesterday):

Hymowitz points out that all classes of Americans once followed the same life script of marriage before children. When divorce rates started soaring in the 1970s, everyone was fleeing their marriages. But then the classes started diverging. The Economist cites statistics that show among college-educated women married between 1990 and 1994, only 16.5 percent were divorced 10 years later. Among those with a high-school education or less who married in those same years, about 40 percent were divorced after a decade.

Advocates for government-propelled fixes tend to believe that forcing an expansion of access to a service will yield equal gains across groups, but that's certainly not true. Ask yourself: Would a class with a higher percentage of smokers, poor diets, and divorce be more or less likely, on average, to make full use of even completely prepaid medical services?

As I said, our healthcare system is most definitely in trouble, but change must begin with the culture.

Speaking of Illegal Immigration...

... and other budget draining policies in Rhode Island, I'd suggest that most of the solutions for this problem are of an indirect nature:

The heads of four Rhode Island hospitals testified yesterday that their medical institutions are teetering on the brink of financial disaster.

And they pleaded with key lawmakers to help — or at least not hurt — their hospitals in the 2008-09 state budget being debated before the House Finance Committee.

Governor Carcieri's proposed budget would force hospitals to pay $32.7 million more for their licenses in the coming year, a move his office said is necessary to help close a deficit of at least $348 million. The proposal, along with the rest of the governor's cost-cutting plans, now rest with the General Assembly.

"We need your help. The budget that we're looking for is a life preserver. The one that's out there now is made out of concrete," Charles S. Kinney, president and chief executive officer of Westerly Hospital, told the committee. "The entire budget ... is just going to have a further denigration on the finances of the hospitals, which are precarious."

We will never achieve the right formula for providing affordable healthcare unless we retune our overall policies to decrease the number of people who are a drag on the system and increase the number of people who are not.

Healthcare Consumer Question of the Day

Here is a question for the sage and practical-minded readers of Anchor Rising:

Recently, a friend of mine had an appointment with a doctor who has a policy requiring a $40 payment for appointments cancelled on the same day. Said friend arrived on time. Said doctor did not, not seeing the patient until 45 minutes after the scheduled appointment time.

The question is: in a completely fair universe, shouldn't the patient get $40 knocked off of the bill in circumstances like these?

Just Stop It!

Why do our legislators have such difficulty seeing the problem with bills like this:

Already successful in securing enactment of legislation to increase the level of hearing aid coverage in health insurance policies, Rep. Robert B. Jacquard (D-Dist. 17, Cranston) has introduced a bill aimed at assisting more hearing-impaired citizens.

Under Representative Jacquard’s bill, health insurance providers in Rhode Island would be required to provide coverage for cochlear implant surgery. A cochlear implant is a small electronic device that is used by individuals who are severely hard-of-hearing. Rather than amplifying sounds as a hearing aid does, cochlear implants bypass damaged portions of the ear and stimulate the auditory nerve, which sends a signal to the brain, enabling deaf people to hear speech more clearly. More than 35,000 children and adults in the United States have received a cochlear implant, and the number of surgeries performed grows each year by about 30 percent. ...

Costs for the implantation procedure have a price tag of between $45,000 and $55,000. If there are complications with the surgery or the patient requires extensive rehabilitation, the total costs can amount to over $80,000. Although many health insurance companies cover the surgery in their policies, some are reluctant to pay for the procedure due to the high up-front cost.

From where does Jacquard think the reluctant insurance companies will get the money to pay for these expensive procedures? They'll tack it on to everybody's premiums, and if they can't get away with that, they'll stop providing health insurance in Rhode Island.

Perhaps the point isn't simple enough for members of the General Assembly to comprehend: what we need in healthcare more than anything is competition. We need more providers, and to manage that, we may need to allow for a non-cochlear-inclusive program or two.

First, the Stick

Amazingly, even as they stumble into understanding of that which is making it hard to breathe in Rhode Island, they continue to tighten the noose:

In an effort to slow down the steep rise of health insurance costs in Rhode Island, Sen. Joshua Miller has introduced legislation that would prohibit health insurers in the state from increasing subscribers' premiums by more than 10 percent a year.

"Huge increases in premiums are pushing health insurance out of reach for more Rhode Islanders every year. Even people who have good jobs and decent salaries are struggling to pay their share of it, let alone those who aren't insured through their employers and have to pay the whole cost on their own," said Senator Miller, a Democrat who represents District 28 in Cranston and Warwick. "Of course insurers have to be able to raise their prices to cover costs, but average Rhode Islanders simply can't afford the size of some of the increases that have been proposed. There has to be a limit on them." ...

He says those experiences have made him aware of the pressures on the insurance industry, and also of the possible solutions that are available to make rates more reasonable.

"We've been examining both sides of this issue, and there are many underlying components that contribute to increased costs for health insurers. There are a wide range of solutions available, but until consensus has been reached within the industry about implementing them, the state should step in with some limits. In fact, these limits may accelerate the implementation of those reforms," said Senator Miller.

So, the legislator understands that there are "solutions" that we ought to pursue, but in the meantime, he's just gonna go ahead and continue with the approach that has had such wonderful results in Rhode Island thus far. Do these people think that if they mix a bit of "I know we shouldn't be so demanding" into their rhetoric, then folks will cease to be concerned about the increasing demands?

(Let whining about "right-wingers on the side of corporations" begin.)

Cross-Purpose Reform

Lt. Governor Elizabeth Roberts's healthcare proposal (PDF) strikes me as a hodgepodge with components at odds with each other. There doesn't appear to be a guiding principle, creating the risk that the good points of the program would put a reform-like light on the bad parts, potentially without even passing themselves.

New representative Frank Ferri (D, Warwick) today put forward a bill advancing one of the better suggestions:

The legislation (2008-H 7493) — which Representative Ferri is submitting in conjunction with Lt. Gov. Elizabeth H. Roberts as part of her "Healthy Rhode Island" health reform act — would allow health insurers licensed in Massachusetts and Connecticut to offer insurance products in Rhode Island without having to get any additional licenses.

This reciprocal licensing would make Rhode Island a more inviting market to insurers, and could increase the number of insurers in the state. Currently, Blue Cross & Blue Shield of Rhode Island and United HealthCare of New England are the only insurers licensed in Rhode Island.

But other parts of Healthy RI increase state government involvement, fine employers that don't provide health insurance coverage $1,000 per employee per year. and layer on mandates, such as the requirement that all dependent "children" up to age 25 may be covered under their parents' policies whether they're in school or not. Representative (D, Providence) Edith Ajello's mandate appears to be additional:

A state mandate already requires insurers to cover fertility treatment for women between the ages of 25 and 42 who are otherwise healthy but are unable to achieve or sustain pregnancy for a period of a year or more. But under current law, the mandate applies only to married women.

Arguing that that the stipulation is discriminatory and would not be permissible in other areas of state law, Representative Ajello has submitted legislation (2008-H 7239) to eliminate the word "married" from the mandate and extend coverage to all 25- to 42-year-old women, regardless of their marital status.

So the state is seeking to attract insurers to Rhode Island, and it may force employees to finance the policies, and it's going to require everybody over four times poverty to have a plan, while layering on regulations that will drive the price up — all under the increasingly pervasive watch of the nation's most corrupt and (arguably) incompetent government. Shouldn't health-conscious politicians be attempting to lower citizens' stress levels?

Well, Maybe if the Doctor's Office Was in the Mall....

I gotta say, even I was surprised to learn that somehow RIPTA depended on Medicaid money to keep running.

A federal clampdown on the state’s Medicaid program will cost as many as 18,000 needy Rhode Islanders their free bus passes and will force the state to make up for millions of dollars in lost transit money to avert wreaking havoc on the state’s bus system, state officials say.

The state is also expecting an attempt by the federal government to demand repayment of millions of dollars in past Medicaid money that was spent on transit. Those payments, reaching back to 1995, total more than $60 million, according to figures from the Rhode Island Public Transit Authority, although state officials say they expect the amount sought by the federal government in “recoupment” to be much smaller, between $4 million and $5 million.

The development means that the state, which paid an increasing amount of the cost of running the state bus system with Medicaid money, will now have to pick up that expense or face a major disruption, probably including bus service cuts and perhaps layoffs, at RIPTA.

Only a bureaucrat and/or the most committed government=mommy proponent could possibly think that a blanket ride-the-bus-for-free pass (versus a certain allotment per year, for instance) was a legit use of Medicaid funds.

DHS Director Gary Alexander said the change will affect about 18,000 of the 27,000 RIte Care members who now get bus passes, worth $45 a month. He said the other 9,000 will continue to get passes through the Family Independence Program, formerly the welfare program.

The reason for the change is that Medicaid doesn’t pay for general transportation, only for transportation related to medical treatment, according to the Centers for Medicare & Medicaid Services, which runs the Medicare, Medicaid and related programs.

Hey, I can understand the need to pay for transportation to the doctor or hospital and how there is some justification for Medicaid dollars to be used to subsidize such transport. But how did they ever think that Medicaid could be legitimately used to pay for unlimited trips to the mall, too? I guess so long as they could get away with it, it was OK, right? And now 18,000 people will be ticked off because their "right" to free transportation will be yanked. Thus does the enablement of the entitlement mindset end up hurting those who are supposed to benefit from the "helping hand." At least until the money (about $10 million) disappears.

Redefining Corporate Welfare

Ian Donnis points to a "strong post" (alluded to earlier) which illustrates how approximately $11.2 million of taxpayer dollars are going to government supplied health care for workers who don't get health care through their jobs.

Where is that money going, you might ask….

It is going to Bank of America, and their 382 employees on RIte Care / Rite Share/ or Medicaid. It is going to the 610 employees of Citizens Bank that are getting our taxes. It is only 310 folks at CVS (plastic bag, anyone) but 500 Wal Mart employees are paid for by the State. In total more than 4,000 workers for these corporations get us to pay for the health insurance. That, my dear reader, is corporate welfare.

First, a correction. The numbers above are taken from the Public Health Access Beneficiary Report and are equal to the combined total of employees + dependents covered by RIte Care / Rite Share / Medicaid, not just the employees as was claimed. In reality, the numbers of employees of Bank of America, Citizens Bank, CVS and Wal Mart that qualify for the aforementioned programs are, respectively, 112, 179, 86 and 140 (not 382, 610, 310 and 500).

Regardless of all that, underlying the charge is the false premise that companies should be obligated to provide all employees (including part time and temporary workers) health care. Last time I checked, there is no such law or rule. So companies aren't shirking their responsibilities--and taking "corporate welfare" from the government--if they never made the promise in the first place.

Additionally, as the Health Insurance Commissioner Christopher F. Koller explained in his overview of the 2005 Rhode Island Employer Survey Report (both referenced in the Public Health Access Beneficiary Report):

Faced with annual double digit premium increases, small employers are being forced to decide between increasing cost sharing with employees, dropping health benefits altogether, or taking a hit to core business performance. Employees are forced to decide between the risks of going uninsured or sharing in the rising costs.

Thus, even if employers had offered generous health care benefits in the past, the economics have changed and adjustments had to be made so that companies could remain competitive. (Something the public sector seems to have a hard time grasping, incidentally). This includes reducing their ability to subsidize employee health care plans (or offer defined benefit pension plans for that matter). So long as we continue to rely on an employer-centered health care system, that is the way it will continue to be. Such reductions don't mean employers are shirking their responsibilities. Often times it's just the opposite: they're trying to remain competitive and continue to employ people.

Willful Naivete on Healthcare

Although I'm fully sympathetic with the inclination to ignore complications, I find it hard to believe that syndicated columnist Froma Harrop hasn't heard the basic argument against the following assumption, spoken this time with reference to health insurance (emphasis added):

You see, health care has become just another racket by which clever operators can scoop up fortunes. There's a ton of money to be made nickel-and-diming doctors and hospitals while making sure you don't sell insurance to sick people — and that's the legal part. Once government offers coverage, it's Game Over for the manipulators — and more of our health-care dollars go for health care.

She can't really believe such a bromide as "once government offers coverage, it's Game Over for the manipulators," can she? The manipulators just shift gears, becoming part of the government, pulling its levers, and pushing for laws favorable to them. It's a peculiarity of the liberal mind that identical problems transported to government somehow obtain a sheen of good intentions. Companies are evil because they cut corners and pressure providers in order to make a profit to sustain themselves; government is simply doing the best it can when it shaves corners through legislation and rations services to fit budgets.

From my experience, those greed-inspired businessmen are at least more likely to cut corners internally than the government, with its unionized and well-entrenched interests. The reason Harrop doesn't "hear Medicare beneficiaries clamoring for a return to private coverage" is that government services — financed systematically by somebody else's money — are more generous and less risky. They can only be so, however, at the expense of the rest of the industry and must, therefore, remain a relatively small percentage of the market.

Alzheimer's Research Breakthrough and the RI Economy

Take this with a grain of salt--it's early research after all--but there may have been a substantial breakthrough in Alzheimer's research:

A drug used for arthritis can reverse the symptoms of Alzheimer's "in minutes".

It appears to tackle one of the main features of the disease - inflammation in the brain.

The drug, called Enbrel, is injected into the spine where it blocks a chemical responsible for damaging the brain and other organs.

A pilot study carried out by U.S. researchers found one patient had his symptoms reversed "in minutes".

Other patients have shown some improvements in symptoms such as forgetfulness and confusion after weekly injections over six months.

The study of 15 patients with moderate to severe Alzheimer's has just been published in the Journal of Neuroinflammation by online publishers Biomed Central.

The experiment showed that Enbrel can deactivate TNF (tumour necrosis factor) - a chemical in the fluid surrounding the brain that is found in Alzheimer's sufferers.

When used by arthritis sufferers, the drug is self-administered by injection and researchers had to develop a way of injecting it into the spine to affect the brain cells.

Sue Griffin, a researcher at the University of Arkansas for Medical Sciences, said: 'It is unprecedented to see cognitive and behavioural improvement in a patient with established dementia within minutes of therapeutic intervention.

'This gives all of us in Alzheimer research a tremendous new clue

about new avenues of research.' Enbrel is not approved for treating Alzheimer's in the U.S. or the UK and is regarded as highly experimental, said Dr Griffin.

'Even though this report predominantly discusses a single patient it is of significant scientific interest because of the potential insight it may give into the processes involved in the brain dysfunction of Alzheimer's,' she added.

Lead author of the study Edward Tobinick, of the University of California and Director of the Institute for Neurological Research, said the drug had 'a very rapid effect that's never been reported in a human being before'.

He added: 'It makes practical changes that are significant and perceptible, making a difference to his daily living.

'Some patients have been able to start driving again. They don't come back to normal but the change is good enough for patients to want to continue treatment.'

For any who have been effected by Alzheimer's, this could be great news. What does this have to do with Rhode Island? The manufacturer of Enbrel--the drug used in the study--is Amgen and the drug is made right in her in its West Greenwich plant. The same facility has experienced a rough patch lately as Amgen attempted to make up for losses other areas by implementing cost-cutting measures (read: job cuts) here in Rhode Island (it appears to have worked). This new use for an established drug could mean an economic boon to the company and perhaps--eventually--more jobs here in Rhode Island.

RE: Rhode Island's Literal Depressed Status

There may be a reason the state as a whole is so depressed: not enough Republicans!

Republicans are significantly more likely than Democrats or independents to rate their mental health as excellent, according to data from the last four November Gallup Health and Healthcare polls. Fifty-eight percent of Republicans report having excellent mental health, compared to 43% of independents and 38% of Democrats. This relationship between party identification and reports of excellent mental health persists even within categories of income, age, gender, church attendance, and education.

***

What are the implications of these findings?

Correlation is no proof of causation, of course. The reason the relationship exists between being a Republican and more positive mental health is unknown, and one cannot say whether something about being a Republican causes a person to be more mentally healthy, or whether something about being mentally healthy causes a person to choose to become a Republican (or whether some third variable is responsible for causing both to be parallel).

Previous analysis...shows that a number of variables are related to self-reported mental health -- including, in particular, income. Because Republicans have on average higher incomes than independents or Democrats, part of the explanation for the relationship between being a Republican and having better mental health is a result of this underlying factor. The same is true for several other variables.

But the key finding of the analyses presented here is that being a Republican appears to have an independent relationship on positive mental health above and beyond what can be explained by these types of demographic and lifestyle variables. The exact explanation for this persistent relationship -- as noted -- is unclear.

OK, I can hear the wisecracks coming. But I'll see your "blissfully ignorant" and raise you an "optimistic about the future." Regardless, I think the path to a happier state is clear, don't you?

Rhode Island's Literal Depressed Status

The number and kinds of lists that Rhode Island is placing near the bottom of is starting to get just plain ridiculous. Here is yet another one from an organization called Mental Health America…

Using data from nationally representative surveys conducted by the United States government, Mental Health America created two different rankings of the states: one showing the state rankings of depression and one showing the state rank in terms of suicide rates.

Four different measures of depression and mental health status were used to develop one composite measure of the level of depression in a given state. The four measures were: (1) the percentage of the adult population experiencing at least one major depressive episode in the past year, (2) the percentage of the adolescent population (ages 12 to 17) experiencing at least one major depressive episode in the past year, (3) the percentage of the adult population experiencing serious psychological distress, and (4) the average number of days in the past 30 days in which the population reported that their mental health was not good….

• (12) Vermont
• (16) Massachusetts
• (20) New Hampshire
• (38) Connecticut
• (41) Maine
• (48) Rhode Island