Wednesday, November 30, 2005

Belling the cat

The New York Post reported yesterday:
POLS' PROMISE TO TRAGIC MANNY

November 28, 2005 -- Outraged over the death of Manuel Lanza — an uninsured man who was denied lifesaving surgery at St. Luke's-Roosevelt Hospital — lawmakers are ripping state health officials and promising to introduce a "Manny's Law" to prevent similar tragedies.

City Councilwoman Christine Quinn (D-Manhattan) said she would propose a measure to require hospitals to inform patients that they can't be turned away simply because they're uninsured.

That was the tragedy that befell Lanza, a 24-year-old Wendy's worker who died when malformed blood vessels in his head burst — after officials at the hospital put off an operation that would have corrected the problem.

Manny's Law would also require hospitals to keep precise records of the number of uninsured patients they do treat.

"One of the reasons we want to pass this bill is because we heard so many reports of people being turned away from hospitals when they were uninsured," said Quinn, who chairs the council's Health Committee.

"And when they go to the state for help, they just seemed to run into brick walls. The state doesn't take any action to hold hospitals accountable. No matter who goes to them, no matter how tragic and potentially life-threatening their story is, the state either ignores them or finds in favor of the hospitals. This bill will help create a true safety net."

The announcement came a day after The Post reported how St. Luke's -Roosevelt refused to schedule surgery for Lanza, telling his mother, "When you get insurance, we'll take care of your son."

The mild-mannered native of Shirley, L.I., died last Jan. 6 when the blood vessels burst — a well-known complication of his condition....

Meanwhile, Assemblyman Richard Gottfried (D-Manhattan), chairman of that body's Health Committee, said he has been trying for years to force hospitals to treat the uninsured.

A bill co-sponsored by Gottfried and Peter Granis (D-Manhattan) would require hospitals to provide such services either for free or on a sliding scale depending on the patient's income level....
And today in a follow-up:
GOV'S MANNY PLEDGE

November 29, 2005 -- ALBANY — A "very concerned" Gov. Pataki promised yesterday there would be swift Health Department action over the death of Manuel Lanza, who may have been denied lifesaving surgery at St. Luke's-Roosevelt Hospital because he lacked insurance.

"The governor is very concerned by the reports brought to light by The Post, since it is already illegal for hospitals to deny emergency treat ment to any patient based on lack of insurance," Pataki spokesman Andrew Rush said.

"The Department of Health has launched a full investigation . . . and we are confident they will move swiftly and take whatever action is necessary so that a tragic incident such as this does not occur in the future."

Federal and state rules require emergency care for all hospital patients. The state will check whether the needed surgery was put off over a lack of insurance, Health Department spokesman Robert Kenny said.

Of interest will be the level of services Lanza received while admitted to the hospital, whether he should have been discharged and whether his case should have been considered an emergency, Kenny said.

St. Luke's-Roosevelt spokesman Jim Mandler said the hospital "intends to cooperate fully" with the investigation....

The family has also petitioned Sens. Hillary Rodham Clinton and Charles Schumer in hopes of spurring a U.S. Senate investigation. In a joint statement, Clinton and Schumer called Lanza's death "a tragic example of how our health-care system is broken " and vowed to monitor the state investigation.

Meanwhile, St. Luke's-Roosevelt has been cited by the state Health Department for three incidents of questionable emergency care since August, records obtained by The Post show. Mandler declined to comment.
What happened to Manuel Lanza is terrible, but big government is compounding the tragedy with greater wrongdoing. We already have laws, varying from jurisdiction to jurisdiction, requiring hospitals to treat emergency room patients, regardless of the ability to pay. This led to Congress giving $1 billion to the state of Texas earlier this year, for all the money its hospitals have spent on health care for illegal immigrants. With the proposed laws that will provide enforcement, hospitals all across New York state will have to make sure they tell uninsured patients they can't be turned away, or else.

But it is not government's responsibility or prerogative to use tax dollars to assist people, no matter how charitable and desperate the reason, and no matter how willing the majority of people are. Rather than soliciting the nearly almighty power of the state to coerce others into "helping," the family should have sought private charity, whether through a few wealthy philanthropists or a fund drive. Particularly in this age of the Internet and blogs (the story of baby Jordan needing a heart transplant was widespread), such drives have a greater chance of success.

No doubt I will sound cold and callous to many, but hospitals need to be run like real businesses. They need to be profitable, or at least operated so they don't run in the red, and that means charging enough money to cover expenditures. Otherwise we run into situations like the Westchester Medical Center, which has some $750 million in currently outstanding bonds. The Journal News last June had a very informative article on its woes. Politicians, naturally, wanted government to bail out the hospital, but as expected, they never pointed fingers at their constituents and said, "It won't be government, it will really be you who pays!"

The figures last June were that the hospital needed $100 million in annual revenue to become fiscally sound, including $60 million in government "contributions." I don't know if it ever passed, but there was also a bill proposing to turn the center from an academic hospital to a public one. The difference is that as a public hospital, it could get Medicaid dollars. Again, it's just another way of using tax dollars, especially from people who do not use the hospital.

A hospital is a consumable resource like any other. If I choose to go there instead of spending my money on something else, it is because I placed a greater priority on receiving -- purchasing -- health care. Let's say I choose the reverse, spending little (if anything) on health care. Yet when I am taxed, and that money is spent on services for someone else, I am no longer able to spend it on what I wanted, and though my money is going toward health care, it is for another person. I believe strongly in charity, as I will detail later, but I want to do it on my own terms, instead of giving money to someone a government bureaucrat tells me is most worthy. Such force-induced "charity" also discourages me, and others, from working as hard, because we know the more we earn, the more we lose in taxes. At a certain point, the marginal disposable (after-tax) income is not worth the loss of non-work time.

Moreover, it eventually becomes a moral hazard when people receive services they do not pay for. Some people will no longer bother to get insurance for catastrophic situations, knowing they can receive hospital treatment anyway. And no hospital will ever absorb the costs of treating uninsured patients: it passes it onto patients who are paying, or onto taxpayers who bail it out. When the costs are passed onto paying patients (whether out of their own pocket or through insurance), this can price some of them out of receiving health care. Just like with minimum wages, we are helping those at the very bottom, but we are injuring those who are just above them. So using tax money is preferable so that health care is not too expensive, right? There is no difference in net effect, though. While the health costs may stay the same, the increased tax burden means a reduction in a person's disposable income.

Either way, paying patients end up paying a higher percentage of their disposable income to cover the costs of the uninsured. Another problem with using tax money is that people pay, against their will, for services they don't use but that others do. Look again at the mess with Westchester Medical Center, and the proposed sales tax increase for seven counties that Westchester County executive Andy Spano (whose unfortunately successful re-election bid I strongly opposed) and others supported. Ulster County is one of them. Some of its residents do go to Westchester Medical Center, that is true. However, look at this map, and you'll see that Ulster is quite some ways from Westchester. For reference, it's about a full hour's drive from the southern tip of Westchester to the north border with Putnam County. Why should everyone making commercial purchases in Ulster have to pay extra to support a hospital in a county quite far from them, especially one they might not use, and very infrequently if they do use it?

Nor can we simply make "the rich" pay a heavier tax burden, because the rest of the economy is dependent on them to spend or save their money. Taxing millionaires more sounds "fair," but that means less money the millionaires have that they spend on goods and services that are almost universally provided by people of lower incomes. It also means less money the millionaires can save, which finances the mortgages and auto loans that lower-income people need, and that provides capital to small businesses (which provide jobs).

But politicians must appeal to voters if they wish to retain their offices, and it makes them appear "compassionate" and "caring" to pass a law requiring hospitals to inform uninsured patients in dire need that they cannot be turned away. I'm not surprised Hillary has seized on this issue, for that very reason. I've already predicted the 2008 Democratic candidate will campaign on universal health care and universal employment.

This debacle reminds me of the Aesop's fable of the young mouse who proposed putting a bell around the cat's neck, so that the mice would be alerted to its presence. After the other mice applauded him, a wise old mouse simply asked who was going to do it. Whether it's getting Westchester Medical Center solvent or helping uninsured patients get treatment, politicians are doing nothing more than making a new proposal to bell the cat. It's easy for them to pass a law, but who is going to pay for it?

Am I a cruel social Darwinist who doesn't want to help anyone? Far from it. Like Capital Freedom, I love our market system where force is not the principal means by which people acquire things. Subsequently, I recognize there are those who are less competitive, or simply down on their luck, and that we should have compassion on them. However, I don't believe in the power of the state to help people. I believe in the power of people helping each other. Did Charles Dicken write about ghosts that frightened Scrooge into paying his taxes? Did Christ mention in Matthew 25 that we should pay our taxes cheerfully so that government can take care of the needy? Thus I give money to private charities, usually the Salvation Army because I trust it, and Toys For Tots at this time of the year.

Individual, private charity also breeds a certain type of strength in the American character, which I discussed toward the end of this entry on those who feel "entitled" to government help. I first quoted part of something I posted on Conservative Philosopher:
I believe that government "charity" has greatly dampened the spiritual aspect of American life. "Spiritual" doesn't necessarily refer to believing in God (which I do), but to that American essence of community. Not this ridiculous notion that we're all a "family," but that we are a community. And for all our "cutthroat" competition and entrepreneurialism, we still manage to help our neighbors in need. Though man is capable of great evil, we are still capable of great compassion. I further believe that, after several decades of being told that only government can significantly alleviate poverty and other social problems, we've been deprived of an ineffable part of American character. I think it's an innate quality, the same thing that drives many of us to believe the U.S. is still the best country, despite our flaws.
Then I concluded:
The best thing we can do for "the poor" is to promote economic growth for everyone, even if "the rich" benefit. "A rising tide lifts all boats" isn't just about economic growth, but about the standard of living. As we continually advance our technology and abilities, today's latest technology will eventually become more affordable to the lower incomes. This is how today's "poor" are able to have lighting, indoor heat and telephone service, which once upon a time were things only "the rich" could enjoy. The "capitalist competition" that socialists claim is evil is the very thing that alleviates the condition of the poor.

And meanwhile, let us have charity on an individual level, for those who are truly worthy of help. We don't need government to tell us that, proven in Americans' private donations to charity, now up to a quarter-trillion dollars annually. Nor should we need government to direct us to help the less fortunate. I'll say again: when government does it for us, we lose something in our spirit. Today, how many of us think to help the widow, or the orphan? Very few, because government has conditioned us to believe that it will take care of things." We're a less caring society for it, in danger of degenerating into impersonal units. That's just what a socialist economy needs: workers, not individuals.
Let me add something I've said before: the politicians proposing this coerced charity should instead set an example by donating their own money. Surely someone with the financial means of Hillary Clinton could have written a check. She could have also assured the hospital, using the power of her name, that they could proceed immediately with the operation and that she would personally pay all costs. Now that would have been a worthy petition for the family to make, instead of crying out to the state for salvation.

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