Thursday, June 13, 2019

Thousands in Britain left to go blind due to eye surgery rationing

And the NHS isn't even apologetic.  Aint single payer healthcare grand?

Thousands of elderly people in Britain are left to go blind because of rationing of eye surgery in the National Health Service (NHS), a report revealed on Saturday April 6.

The Times newspaper said a survey by the Royal College of Ophthalmologists (RCO) found tens of thousands of elderly people are left struggling to see because of an NHS cost-cutting drive that relies on them dying before they can qualify for cataract surgery.

The survey has found that the NHS has ignored instructions to end cataract treatment rationing in defiance of official guidance two years ago.

The RCO said its survey has found 62 per cent of eye units retain policies that require people's vision to have deteriorated below a certain point before surgery is funded.

With more than 400,000 cataract operations carried out each year, the National Institute for Health and Care Excellence (NICE) concluded that there was no justification for policies that denied patients cataract removal surgery until they could barely see.

The RCO said that refusal to fund surgery was insulting and called into question the entire system through which the NHS approves treatments.

Ms Helen Lee of the Royal National Institute of Blind People (RNIB) said: "Cataracts can have a dramatic impact on someone's ability to lead a full and independent life, potentially stopping them from driving and increasing their chance of serious injury by falling. The NICE guidelines make it clear cataract surgery is highly cost effective and should not be rationed. It is nonsensical for clinical commissioning groups to deny patients this crucial treatment."

Ms Julie Wood, CEO of NHS Clinical Commissioners, which represents local funding bodies, defended the restrictions.

She told the Times: "NICE guidance is not mandatory and clinical commissioners must have the freedom to make clinically led decisions that are in the best interests of both individual patients and their wider local populations. The NHS does not have unlimited resources."



No, My Study Did Not Find Medicare for All Would Lower US Health Costs By $2 Trillion

Charles Blahous

Last year I published a study with the Mercatus Center projecting that enacting Medicare for All (M4A) would add at least $32.6 trillion to federal budget costs over the first 10 years. After the study was published, some advocates misattributed a finding to it, specifically that M4A would lower national healthcare costs by $2 trillion over that same time period. This misattribution has since been repeated in various press reports. Multiple fact-checking sites have pointed out that the study contains no such finding, as did a follow-up piece I published with e21 last year. However, because the mistake continues to appear occasionally, this article provides additional detail about how and why it is wrong.

First, some brief background on the study itself. The study estimated the federal budget costs of M4A, as this is an important number that would guide Congress’s procedural points of order if such legislation were considered. The study did not focus on aggregate changes to national health spending under M4A, in part because such estimates do not affect Congress’s legislative procedures. Whenever Congress considers legislation with budgetary significance, such as a new federal program or a tax cut, its procedures are affected by what the bill would do to federal spending, revenues, and deficits, but not private-sector spending. For example, no Congress would consider a large tax cut as having zero budgetary effect, based on the irrelevant rationale that the reduction in federal revenues would be offset by an equal gain in taxpayers’ after-tax income.

Accordingly, my study’s estimates, like any performed by the Congressional Budget Office, focused on M4A’s effects on the federal budget rather than on other areas of the U.S. economy. This is a primary reason why neither the $2 trillion figure nor any other such estimate appears in the study.

However, a critical additional reason why the attribution of $2 trillion in savings is wrong is that it is inconsistent with the study’s conclusions. Some have attempted to convert the study’s lower-bound federal cost estimate of $32.6 trillion into an estimate of savings in national health spending, arriving at the $2 trillion number. It is incorrect to do so, as the following analogy may help to explain.

Imagine that members of a family have separate cell-phone data plans that add up to $57 a month. Now imagine the following conversation:

Q: How much would it cost my mother to buy my cell-phone data for me instead of continuing to pay it for myself? I think she’s better than I am at negotiating a good deal.

A: Well, if she buys it and allows you to use it for free, your usage will typically go up. Even if she’s the brilliant negotiator that you say, it’s going to cost her at least another $33 a month on top of her current expenses. Most likely her extra costs would be between $33-$39, possibly more.

Q: But then it wouldn’t cost me anything, right? Don’t you have to think of it in terms of how much money everyone in the family, together, would pay? If she bought it, how much would my family as a whole be paying?

A: Well, she was already paying $22 each month, so altogether the family would pay at least $55, probably between $55-$61, again possibly more.

Q: But otherwise we’d pay $57. So, you’re saying we’ll save $2 a month because of her superior negotiating skills?

A: No, I didn’t say anything about her negotiating skills; you did. Her actual history shows a tendency to overspend. I’m just saying that even under your assumption, it’s going to cost the family at least $55, probably somewhere between $55-$61. It’s actually highly unlikely it would be as low as $55.

Q: Great, so you’re saying we’ll save $2!

Basically, what some advocates have done is the equivalent of the above. They’ve done this by taking my study’s lower-bound federal cost estimate and converting it into a claim of savings relative to currently projected national health spending. The study does indeed emphasize the lower-bound estimate, but it does so only by way of explaining that the federal costs of M4A would be at least $32.6 trillion over 10 years, and more likely substantially higher. The study does not present the $32.6 trillion number in a manner consistent with a finding of $2 trillion in national health cost savings.

The study is clear and explicit that the $32.6 trillion estimate is a lower-bound (best case) estimate, and repeats this caveat throughout the report. This point is made in the study’s abstract, on its first page of text, and in many other passages. To cite but some of the quotes from the study explaining the nature of the lower-bound estimate:

It is likely that the actual cost of M4A would be substantially greater than these estimates” (Abstract)

 “Conservative estimates” (Abstract); “conservative estimates” (p.3)

“It is likely that the actual cost of M4A would be substantially greater” (p. 3)

“These cost estimates essentially represent a lower bound” (p. 4)
“Actual savings (from lower drug prices) are likely to be less than assumed under these projections (p. 14)

“This is an aggressive estimate of administrative savings that is more likely to lead to M4A costs being underestimated than overestimated” (p. 14)

 “The resulting implicit estimates of national and federal spending on LTSS should be regarded as conservative” (p. 17)
“This study’s assumption of no net increase in LTSS benefit utilization. . . is an additional factor contributing to these projections’ being more likely to underestimate costs than to overestimate them” (p. 17)

The study does contain a couple of isolated references to scenarios in which national health spending would decrease relative to current projections. One such reference is preceded by a reminder that the actual cost of M4A would likely be “substantially greater” than this “lower bound” estimate, while the other one notes that this decrease would only occur “under the assumption that provider payments for treating patients now covered by private insurance are reduced by over 40 percent,” along with other aggressive assumptions, and that “whether providers could sustain such losses and remain in operation” was a “critically important” unanswered question.

In other words, the study emphasizes that the $32.6 trillion federal cost minimum cannot be accurately converted into a claim of $2 trillion in national health cost savings. Actual costs would likely be substantially greater (specifically, factors such as drug costs, health provider payment rates and long-term care utilization would probably all be greater than assumed in that lower-bound estimate). It is the same principle by which, if someone tells you that something now costing $57 would cost somewhere between $55-$61 after a policy change, it would be incorrect to claim thereafter that the person had concluded you would save $2.

It is not possible to correct every advocate’s mistaken claim that my study found that M4A would lower national health costs by $2 trillion over 10 years. But anyone interested in accurately understanding the study should be aware that it contains no such finding.



Leftism Makes People Meaner: Reflections on the Torture of Paul Manafort


The sadistic treatment of Paul Manafort illustrates something I have believed since I attended graduate school in the 1970s and saw the behavior of left-wing students: Leftism makes people meaner.

There are kind and mean conservatives and kind and mean liberals. Neither liberalism nor conservatism makes people kinder or meaner. But this is not the case with leftism. With the handful of exceptions that accompany every generalization, leftism makes people meaner, even crueler.

Take the transfer of Manafort, the one-time Trump campaign manager, from a federal prison to New York's Rikers Island prison. Rikers Island is universally regarded as a wretched place. As Harvard law professor Alan Dershowitz wrote:

The decision to move Paul Manafort ... from the decent federal prison to which he was sentenced to solitary confinement to the dangerous hell hole that is New York City's Rikers Island seems abusive and possibly illegal.
I know Rikers well having spent time there visiting numerous defendants accused of murder and other violent crimes. It is a terrible place that no one should ever be sent to.

Mass murderers and torturers are among those incarcerated at Rikers Island.

Moreover, Manafort, found guilty solely for white-collar crimes, will be placed in solitary confinement -- "for his own safety."

Virtually everyone who has written about solitary confinement, both on the right and the left, deems it torture. Manafort will therefore be tortured after being sentenced to seven years' imprisonment for fraud and, in the words of the Daily Wire, "a little-known law that requires lobbyists to report that they are working on behalf of a foreign government (in Manafort's case, Ukraine)."

Angry over the possibility that Manafort may be pardoned by President Trump, the Manhattan District Attorney, Cyrus Vance, charged Manafort with additional crimes based on state law. That way, if found guilty of state offenses, he cannot be pardoned by Trump, as the president's power to pardon applies only to federal -- not state -- crimes.

Everyone knows this prosecution is politically motivated. Vance hates the president and wants to use solitary confinement in a hellhole with violent criminals to squeeze Manafort into testifying against the president.

As Dershowitz said to me on my radio show, what Vance is doing reminds him of Stalin and Beria -- the infamous state prosecutor, a man Stalin referred to as "my Himmler." Dershowitz, a lifelong liberal Democrat and supporter of Hillary Clinton, does not use Stalin analogies loosely.

To her credit, Alexandria Ocasio-Cortez tweeted: "A prison sentence is not a license for gov torture and human rights violations. That's what solitary confinement is. Manafort should be released, along with all people being held in solitary."

I might add that my opposition to Manafort's treatment is not partisan or new. On a number of occasions over the years, I have cited favorably New York Review of Books articles describing the horror of solitary confinement.

Despite its history of opposition to solitary confinement, The New York Times article reporting the plan to relocate Manafort said nothing against the unnecessary transfer but did comment on the expensive suits Manafort used to wear.

Solitary confinement is "basically a deathtrap," former New York City Police Commissioner Bernard Kerik wrote when Manafort was placed in solitary at his federal prison. Manafort should never have been sentenced to solitary confinement. But Robert Mueller (and Judge Amy Berman Jackson) sought it for the same political reason Vance has: to break the man.

As former federal prosecutor Sidney Powell wrote:

When a witness or defendant from whom prosecutors want 'cooperation' does not do as they demand, they put him in solitary confinement. And it works. It literally breaks people.
Solitary does have a place in our prison system, but only for those people who are simply too dangerous to be placed around others at all. However, the torture of solitary confinement should never be used as it is now to break people to prosecutors' will -- to torture them until they will say or do anything to get out.

"Solitary is also called the 'hole.' It's a small space, barely large enough to stand, with a slit for light, to which prisoners are confined/caged for 23 hours a day...

Paul Manafort, seventy years old, has endured this torture for eight months. He's now in a wheelchair, while Judge Amy Berman Jackson mocks his rapidly deteriorating health. Where is the outcry from the ACLU?

So, then, what enables Vance, Mueller and Jackson to engage in such evil?

The only answer is their politics -- the politics of the Trump-hating left. Cyrus Vance, Robert Mueller and Amy Berman Jackson may well be good parents, loving spouses, loyal friends and charitable individuals. But leftism has given them permission to act vilely and mercilessly while thinking of themselves as fine people -- just as evil doctrines have done throughout history.

As noted at the beginning of this column, when I was at Columbia, I witnessed this leftist mean-spiritedness firsthand in the personal cruelty of left-wing agitators against professors and others with whom they differed.

Here's a question perhaps millions of parents will be able to answer: If your child returned home from college a leftist, was he or she a kinder or meaner person than before he or she left for college?

The question is rhetorical.



For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCHPOLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here (Pictorial) or  here  (Personal)


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