‘Nuff said.

Today, the Cato Institute releases a study by attorney Kent Masterson Brown titled, “The Freedom to Spend Your Own Money on Medical Care: A Common Casualty of Universal Coverage.” Brown addresses a dark side of universal coverage that proponents tend to de-emphasize:

Most people would agree that a patient should always be able to spend his own money on the health care services he desires. Yet that freedom is often threatened or denied when government tries to provide universal health insurance coverage, as in the U.S. Medicare program, which provides health insurance to seniors and people with disabilities. Over the past 20 years, the Medicare bureaucracy—and to a lesser extent Congress itself—has limited the freedom of Medicare beneficiaries to purchase medical services with their own money. Those limitations violate beneficiaries’ right to privacy, undermine a tool that could reduce the burden Medicare imposes on taxpayers, and may deny care to Medicare beneficiaries outright, or deny them access to the highest quality care available.

Brown was the lead attorney in Stewart et al. v. Sullivan (1992) and United Seniors Association et al. v. Shalala (1999), two cases challenging Medicare’s efforts to eliminate beneficiaries’ freedom to spend their own money as they wish.

Note that New York Times columnist Paul Krugman, presidential candidate Dennis Kucinich, and others want “Medicare for All,” while Hillary Clinton wants to open Medicare or a similar program to all Americans.

This debate is going to be fun.

The U.S. health care sector is fundamentally broken. Yet most reform proposals, including Congress’ plan to expand the State Children’s Health Insurance Program, would just throw more money at the dysfunction without doing anything to fix it. (Mind you, that suits the health care and insurance industries just fine.) 

Another example of what such reforms won’t fix emerged in this week’s New England Journal of Medicine. Researchers examined the medical records of 1,500 children and found that the kids received (what the evidence suggests is) high-quality care only 47 percent of the time. 

Similar studies have found that adults receive recommended care only 55 percent of the time. One of those studies even found that having insurance doesn’t much improve the quality of care that adults receive:

Although having insurance increases the ease of access to the health care system, it is not sufficient to ensure appropriate use of services or content of care. Indeed, within systems where access to care is more equitable … substantial gaps between observed and optimal quality remain. In the United Kingdom, with universal coverage, a study using our methods found that the overall proportion of recommended health care that was received was similar to what we have reported.

This week’s study on the quality of pediatric care did not compare the quality of care received by insured children to that received by uninsured children. Nonetheless, the researchers closed with an illuminating comment on the current debate over SCHIP:

Expansion of access to care through insurance coverage, which is the focus of national health care policy related to children, will not, by itself, eliminate the deficits in the quality of care.

Yeah … but … oh, what the hell. Who’s up for throwing more money at the problem?

Presidential candidate Hillary Clinton has proposed new 401(k)-style savings accounts. But the proposal is not really a savings program, it is a new entitlement program. Savings is about people being frugal today in order to improve their prosperity tomorrow. Real savings helps families and benefits the broader economy. But Senator Clinton’s plan would impose $20 billion per year of damage on families paying the cost, while distorting the economy with higher taxes.

The plan would take money from people who earned it, and simply give it to other people to spend on retirement, buying a house, paying for college, and other items. Those eligible could receive $1,000 a year, but at the expense of others who would bear the burden. I see no justice in that, nor any economic benefit.

I’ve got a better idea: Let’s allow Americans to keep their own money, downsize the giveaway factory in Washington, and reduce government hurdles to individual savings.

Senator Clinton should consider supporting expanded and simplified Individual Retirement Accounts. These accounts would not rob Peter to pay Paul, while boosting real savings and spurring growth to the benefit of all families.

I got to share my thoughts on the State Children’s Health Insurance Program with Farai Chideya of National Public Radio’s News & Notes program yesterday.

Click here to listen.

My review of Shannon Brownlee’s new book says,

The point is that getting the advantages of McMedicine may not be a matter of sheer collective will, as Brownlee would have it. Instead, it might require radical deregulation of medical licensure and practice regulations.

I like the fact that her book often inverts the usual story of villains and victims in health care. For example, lawyers and doctors who fight insurance companies for approval of a desperate cancer therapy turn out to be wrong.

Amid the debate over the State Children’s Health Insurance Program, author and Washington Examiner columnist Tim Carney asks the question, “Does SCHIP insure kids or subsidize savvy HMOs?”:

[W]hile Democrats are dragging children to the White House for photo ops, as if the children are the primary constituency of this bill, federal lobbying records tell a different tale.

Lobbying records from the first half of 2007 show that the health care industry spent more than $227 million lobbying Washington. Congressional Quarterly Healthbeat News reported last month: “What’s behind health care lobbyists’ spending frenzy? Most signs point to … SCHIP.”

Sure enough, the biggest lobbyists in the industry all support the Democratic bill. America’s Health Insurance Plans (AHIP), the trade association for HMOs, supports the bill, as do its biggest members, such as Blue Cross Blue Shield.

The Pharmaceutical Research and Manufacturing Association (PhRMA), one of Washington’s most powerful lobbyists, is also behind the bill. So is the American Medical Association.

Because the details of any substantial bill or regulation will be complex, the mainstream media will always portray the debate as a battle between the interested parties. In this case, the official storyline is that it’s poor children against a president overly concerned about the boogie man “government-run health care.”

But poor children don’t have clout on Capitol Hill. They’re not the reason this bill got 68 votes in the Senate and 265 votes in the House.

It’s got to be nice [for] the Democrats now. You get to do a favor for the HMOs, and everyone’s convinced it’s “for the children.”

I include the nation’s governors — who are always in favor of more federal money — in the bootleggers category.

Kudos to Tim Carney for reporting what less-rigorous reporters will not. (Why, oh, why can’t we have a better press corps?)