Letter: Jesus’ reference to leadership wasn’t about medical care
Published: October 12, 2009
Jesus’ reference to leadership wasn’t about medical care
Jim Evans writes, “Jesus’ insight about to whom much is given much is required, applies to every resource on this planet, from corn to penicillin.” By quoting Jesus out of context, Evans enlists him as a drum major for a government monopoly on health care.
In context (Luke 12), Jesus tells a parable about a manager who gets drunk and beats up the servants under his supervision. He says, “From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked.”
Jesus is talking to his “managers,” his handpicked, inner circle of disciples on whom he has lavished three years of instruction, and he is reminding them about their leadership responsibilities, explaining that a breach of responsibility is deeply sinful for them. Any serious Christian “manager,” including Evans, knows that Jesus was talking about leadership responsibilities in the church and not about corn and penicillin.
Evans writes, “It is a gross national sin for us to have the medical resources we have and then only provide them to people who can pay for them.” But “we” don’t own any medical resources. We don’t own the expertise of medical doctors who invest a quarter-million dollars in graduate education, or multi-million dollar hospitals, or life-saving medicines and technology.
America built the finest medical system on earth by rewarding doctors, inventors, hospital investors and chemists for their sacrifices with competitive returns in the free market. In contrast to countries with government medical monopolies, Americans can choose their physicians, schedule immediate appointments and receive state-of-the-art treatment.
If government “managers” foolishly destroy this national treasure, we do great harm to the “servants” in our care.
Bruce Murray
Auburn
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We beat this horse perhaps to death but to add to the theme of the Harvard/Cambridge study on the thousands of deaths from the lack of health insurance we now have a John Hopkins study that claims 17,000 children arguably died from a similar health insurance deficit between 1988 and 2005. Please see http://www.hopkinschildrens.org/Lack-of-Insurance-May-Have-Figured-In-Nearly-17000-Childhood-Deaths.aspx for details. I read the righteous and responsible Bruce Murray often weeping and gnashing teeth over abortion yet seemingly for him, and frankly a good number of culture warriors of his type, being pro-life fades once a child leaves a woman’s womb.
Good evening David,
I have integrated much of what we are discussing within my comment on the recent Mike Rogers press release. Your take, will be of most interest from my perspective.
David
David
i pray this note finds u well
i apologize for not responding sooner, please educate me on all aspects u mentioned
i must admit, your arguements are compeling, but have swayed me very little of at all
i have mixed feelings, if they go forward with a public option as it appears they are, there is likely to b a very strong public rebound in the next election toward more moderate-conservative congressmen (women- humans-persons…whatever), i like that
i will read your (and others) emails..and enjoy learning, but this time of yr i am hitting a big lick (running hard, flying low, working long hrs)and likely not b responding much 9which is ok as i have little to add to the conversation)
keep the faith (from somewhere in NC or Va or Oh ?)
Capitalism vs. capitalism
Good evening,
Of the many accomplishments within the relatively short existence of our republic, two of the strongest pillars are a functional 3 branch power structure and maintaining an environment such that capitalistic advantages have generally flourished.
Not unlike the consequences of E=mc2, which can be used to build nuclear power systems, or turn the planet into a roman candle; we benefit from keeping touch with the difference between revering the image of “Capitalism” as an ideal, as opposed to the daily hard work of maintaining a reasonably regulated capitalistic market place.
Laissez-Faire is great in a totally free market that key incentives of behavior between buyers and sellers aren’t (on balance) materially contraindicated, relative to the larger society. Of course, empirically, neither of these standards are totally met, thus we attempt to reasonably regulate a balance of incentivizing markets when possible and regulating desired behavior that can’t easily be rewarded within the business transaction model.
Healthcare is currently delivered in highly monopolistic markets where for, 159 million people covered under their employer, 86% have one choice, yes or no. (The Kaiser Family Foundation Employer Health Benefits 2009 Annual Survey). The 14.5 million + that buy insurance on the individual market face preexisting illness limitations and premium multiples of up to 25 times (senate finance committee chairman’s mark)and vary from state to state.
-Physicians are primarily paid to provide individual procedural services.
-Hospitals are generally paid by the day (per diem) private insurance, and Medicare by the MSDRG (Medicare Severity Adjusted Diagnoses related), which means a hip replacement without complications or co-morbidity pays a flat rate. There are significant exceptions including the use of hospital charge masters and cost reporting in certain rate calculations significantly diverge the payments from broader market realities.
-Insurance underwriting success is maximized by minimizing CLR’s (claims loss ratios) and in the case of MA (Medicare Advantage) plans, maximizing the bid and benchmark system which does not allow for decreases. The current MA premium to FFS (fee for service) is running about 114% for 2009. (we pay about $1.30 to the private sector for services that cost $1.00 in traditional Medicare, (Medpac 2009 Report to Congress))
-CMS (center for Medicare and Medicaid) employees are generally retained based on demonstrated ability to implement and maintain defined processes.
Key capitalistic elements required any health reform plan?
1. Integrated health care delivery system”, payments to physicians must be, acuity adjusted, longitudinally based and outcome measured.
2. Hospitals payments must significantly further the current shift towards payment for reasonably controllable metrics.
3. With or without a government option, underwriting must be community based, with universal participation, otherwise adverse selection and preexisting condition, rationing will continue. If there is a government option, it must include fair cost of capital constraints and judicial oversight for fair private sector access to the courts concerning anti-competitive claims.
4. CMS employees must be rewarded for process results, as measured at the program level for financial, customer service, and outcome metrics.
David, what about doctors leaving the industry, the true cost medical malpractice, cost shifting, hospitals going out of business, loss of innovation, rationing, cost cutting within Medicare, and total cost of reform?
I will be pleased to listen to your and others perspectives as well as share a few considerations. If we take one topic at a time our discussion may be a bit more meaningful.
Care to pick one? Let’s run with it!
David
mpb3-sister i pray this note finds u well… i believe that only David understands this conversation..he is over my head.
i must admit , i went out to the truck and got an oxygen tank just to try to keep up
David - wow… u r the man, i agree with the ‘getting beyond the sound bite, agree we must get a handle on the cost and profits, but am still a capitalist perhaps with more gov oversite (if that works at all),
the evoking of the canadian system has been The Prez (on several occasions…as he says ‘like canada’) and both emmanuel and axelrod…all have evoked the canadian system (which has some awesome primary care/ preventative medicine portions of thier program, but appears to bite the it in many aspects of advanced medical procedures- specialty care )
and u may b very right that ( being old- rural background- and uh…. southern) i do not like being told, i like being asked
my personal healthcare sytem, that of my wife and grown kids is pretty good (the hip showed us that)and some other recent thangs,( but,.... we all work hard and plan) still i pray we can extend to others what we have, but…am unwilling to b forced to pay for other folks any more than i already do
reform ( tort ?, border control, profit control…but still allowing profits, ??) all might b needed
as far as the book…when the new edition comes out (a yr or so) holler…i might could scare up a copy…but it ain’t easy reading… it is a text book… and written by some fat bald red neck
keep the faith
Good Evening healthcare reform team,
David, hopefully Central PA’s large mammals are resting comfortably today.
Concerning the Human population, if we concur that society has decided not to openly provide for, or consider the current provisional cost of healthcare for undocumented immigrants; to the extent that their inclusion skews the data either direction, it would be logical to exclude them from the data.
To your point, most folks are angered by any situation that is perceived to be forced upon us without regard for the consequences. Although this population will continue to impact the larger society in many ways, including healthcare, it is consistent with human behavior to not advertize a “guaranteed service” e.g. healthcare, if our goal is to reduce the number of undocumented immigrants. Considering that we will have no data to prove the hypothetical “healthcare coverage impact” one is left to speculate as to the various societal impacts that would occur otherwise.
To your earlier point on the Canadian system, we are not legislatively contemplating that, although there is a sizable minority that would like to, David Himmelstein for example. Whether or not we move into a similar system over time will depend much more on our economic growth than the legislation that gets passed this year. We are only in a position to have this national debate because our economy has provided enough growth post World War II to accommodate shifting what has become 17.5% of GDP to healthcare. For any other county, this would have been not within the possibility of considerations.
In 2008, 70% of our GDP was consumption, up from about 62% in the early 1980’s. About 9% of consumption is consumer debt, therefore 6.3% ((9*70)/100) of our economy is consumer debt. For 1983–2008, the mean growth rate of real GDP was 3.21 percent (www.BEA..gov). Better said, consumer debt growth over time has lead to total household debt to exceed total GDP, which is about 13.7 Trillion. While household assets are currently about 66.8 trillion (Federal Reserve 2009 Q2) the question becomes what ratio is sustainable?
Touching of a few additional elements, the recent financial crisis was largely discussed in terms of “subprime mortgage” defaults. Subprime mortgagees as of 2007 had a total value of about 1.3 trillion, however much goes into default, is but a grain of sand relative to the beach of wealth already extracted from the once 45 trillion (notational value) in synthetic derivatives.
Yes, the current administration kicked up the deficit which is also not sustainable, however, by any serious account, the abject meltdown of our socioeconomic fabric would have otherwise been unsustainable for either political party.
The elephant without color in the room is that on a national level, we discuss healthcare as though the US has the option to continue living a vision of perpetual resources that will never cross paths with economic facts. This challenge afflicts both sides of the aisle. We attack corporate profits which ranged from 3.8, 4.1, and 4.5 percent for United WellPoint and Aetna respectively in 2008, actually rather low relative to most industries, yes, in the individual and small group markets the profits reflect a particularly monopolistic market and are priced well beyond obtainable levels for those that become ill.
The problem is not the profit, it’s the inefficiency of the corporate processing machine that extracts from ~7 (large self funded plans) to ~40 (individual coverage) cents of each premium dollar to managed the process. On average Medicare is less, however, not as much as some assume, fraud is certainly an issue but less discussed is the fact that the average Medicare claim is much larger than the average private insurance claim due to the high acuity of Medicare beneficiaries, therefore, the claims cost appear less than they actually are on a total cost basis.
If we can at least get to a point where sound bytes of “for and against” government vs. private sector; and focus on how we consider blending the two, we may have chance maintain some innovation and reasonable access while retargeting cost to a sustainable level.
David, I think I should get a courtesy copy of “Sheep and Goat Medicine” after all we are almost friends! If you do, I promise to ask thoughtful questions! (or at least as best I can figure)
David
Hi Doc! So is the D in DG David? Cool!
I’m going to say right now, I have no idea what you two Davids are talking aobut! Ha. Ha. Not really. I have an idea, I just am lost in the statistics talk!
But, apropo to numero cinco—you are correct. I just read in Harpers that the population most likely to suffer death or injury on the job were Hispanic (Latino) immmigrants.
As for textbooks not being pricey? In what world? 
Have a good Wednesday, doc. You too David.
David, good evening
uno - thanks for reading my post, i was unsure anyone but The Capt and mpb3 actually read others posts on here
2-oh - my positon is consistent that all life is precious…. well… all mammalian life , but nothing is free, and at my age i am willing to donate some money and time (and do) but am less willing to pay for others when forced
trace - u see why auburn assigned a statitician(sp)/epidemiologist to work with me (of the ~400 thangs with my name on them…u will always find someone who could at least spell statistics)
quatro - i said linear..and meant it…as in line not regression, but i reversed the numbers ...but still believe using the study guestament that 1/3 to 1/4 of the 43,000 folks dieing from lack of insurance would b illegals (~12-15,000). thier lives are no less valuable than mine…but should they b included…and should they b used in an argument that WILL raise my taxes and/or cut some of the medicare funding ?
5 - i view the illegal group much differently, i thank u said they were here to work thus healthier, whereas my thought is they are here to work in agriculture, building, and such..thus even more likely to b injured and or die (sad….but ag/farm/heavy labor related deaths r very high)
six - the book is a text book, i am proud that it is now in 5 languages (and i can barely speak the alabama dialect of english)but, a text book, and thus is not that pricy, the second ed will b out within a yr (can u say shameful self promotion…. hay i am no longer drawing milk from the breast of AU)
i really will read all the refs u sent, and am enjoying the education u r giving me (honestly)
keep the faith (from some where in central Pa)
papadoc
Good Morning David, you raise some interesting points within a colorful colloquial writing style,
Although the topic considerations we are focusing on today seems a counter intuitive choice of emphasis, relative to your previous thought “i truely believe that one human loss (citizen or not) is one tooooo many”; I take your point to mean that this is an important example of Challenges surrounding the SUDAAN SURVIVAL software module running underneath SAS to address sampling errors in the stratification and selection process of the PSU’s (primary sampling units) , specifically, over sampling within the NHANES III survey. Perhaps you can identify a more widely excepting approach addressing complex sampling errors?
In addition, the study survey took place between 1988 and 1994 during which time the undocumented population was eight million (2000 Census bureau), considering this, and other illegal population data are suspect, perhaps we can agree that relative to the (88-94) period, this number errors significantly on the high side.
The national median age overall is about 36.7 years (United States – Age and Sex, 2007 American Community Survey)
The national median age for non documented people is around 30 (Median age 28 (Michael C. LeMay 2007; 25.5, Social Contract Journal Fall 1992)
56% of undocumented people are uninsured (Center for Immigration Studies March 2005)
It seems unlikely to suggest that half of the survey population is composed of 44% of 8 million people with a median age around 30.
Today we have larger numbers, however, it stands to reason that currently, and during the last two decades, most folks coming to this country illegally are doing so to work, probably are not generally on deaths doorstep. Over time this differential will become less.
I need a little help following your arithmetic modeling the 19,000 to 20,000 estimate based on a linier relationship. What CI’s in which calculations require dispensing with the other 15000 data points? As you know, linearity refers to the predictably of a relationship (“goodness of fit”) not a particular frequency, hence, whether or not a simple linear relationship exist, (which we have establish does not) it would not predict the number in and of itself, one way or the other. If your point is the R(2) would be so low that the data is worthless, it would not predict 19,0000 any better than 45,000. Maybe you are referring to the IOM reports that generated similar numbers?
I appreciate your affinity to sheep a goats, I am interested in your book but it’s too pricy!
David
David
good morning to u, we can agree some and disagree some ...i pray
i appreciate the refs..i will digest some time this week
i agree with “each of us brings a lens of personal security to the discussion, based on our respective experiences”... amen
per my question…if 43,000 folks die yrly in the USA due to lack of health insurance, and ~47 million have no health insurance, of which 12-15 million (w/o health insurance) are illegal aliens ... then it would stand to reason that a higher % of that guestamte would not be US citzens(as reasonable in any biologic system , or a causality of tobacco smoke being associated/causing an increase risk of lung associated dieases in certain populations/genetic based groups, etc)
perhaps part of a reform of our health care system might include controlling our borders, as that might drive down that number substantially ???
i would believe there is a limited to no linear relationship between 1he 47 million and the 12-15 million and the guestamated 43,000 most regreatable deaths due to (potentially ) lack of health insurance
linear model would yield somewhere about 19-23,000 potential deaths of US citizens inside the USA (again potentially) due to lack of health care…but of course this is not linear at all
my knowlede of human health care is very limited, obviously, and so i draw on (unfortuantly) anticdotal/personal prejudice… i needed a knew hip, i worked hard to get where i am inlife, i went to the dr, got dx, got a new titanium hip in 19 d post dx…. i have 2 colleagues in canada with similar conditions, similar age, both university professors, who have been waiting over a yr for thier new hips… (one is going to pay out of pocket in and have his done in chicago)
if u apply a model of herd health programs into a herd of sheep (some say flock) or goats-deer, and campare where health care is provided vs where it is offered, you would see very few of the assertions the pro human health universal health care lobby are saying,
u will also see populations that are riskier shouldering a greater burden of disease…in animals…we cull them…in people i pray we would never do that… but that is where this appears to be heading, not death panels (that is just dumb to suggest)...but redistribution of resources… i can say with as much certainty as i see a causl relationship with smoking and lung disease that i would still b waiting in canada for my knew hip
so ... if u use the number 43,000 ...be honest that we all know a greater % of that population are not even US citzens
i pray u r well
keep the faith
DG Pugh
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