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Health care: Life and death and substance

August 28th, 2009 by Craig Westover

rumaisa_rahman_wideweb__430x286

It’s unfortunate that some opponents of federal government-directed health care jumped on the ‘Death Panel’ metaphor instead of the substance of the proposed legislation. Whether the federal legislation intends it or not, a government-directed plan necessarily requires bureaucrats to make life and death decisions that are more far-reaching and more complex than the hyperbolic ‘pulling the plug on grandma.’

No matter how wealthy we are as a nation, the government will never be able to provide health care for all AND provide all of the health care everyone would want. Trade-offs are inevitable; if universal access is a given, then the amount and quality of delivered medical treatment must necessarily be negotiable.

To understand the complexity and God-like power the feds are proposing to invest in some poor civil servants, let’s allow grandma to peacefully nap and consider the other end of the life spectrum, infant mortality. Imagine yourself charged with managing the cost of care for newborn infants under the government program. Here’s the situation you would face.

The U.S. has an infant mortality rate of approximately 7 deaths per 1,000 live births, compared with 5 deaths in other developed countries; in Norway, infant mortality is a mere 4.1. Race, geography, income and education all factor into those numbers, but irrespective of its genesis, low birth weight is a primary factor in infant mortality.

Low birth weight occurs in about 7 percent to 8 percent of all live births, but 40 percent to 70 percent of all infant deaths can be attributed to low birth weight (depending on how one defines “low”). When compared to normal weight infants (more than 5.5 lbs), infants with “moderate” (less than 5.5 lbs), “very low” (less than 3.3 lbs) and “extremely low” (less than 2.2 lbs) birth weights have 40, 200 and 600 times greater risk than normal weight infants, respectively.

According to the journal “Pediatrics,” 8 percent of 4.6 million infant hospital stays (2001 data) included a preterm/low-birth-weight diagnosis, accounting for 47 percent of the costs for all hospitalizations ($5.8 billion) and 27 percent of all pediatric stays. The average cost of the hospital stay (12.9 days) was $15,100 compared with $600 (1.9 days) for uncomplicated births. For infants less than 2.2 lbs, the average cost of hospitalization was $65,600.

Advances in medical technology have significantly improved the survival chances of infants with extremely low birth weights (without complications), but at a high cost. Complications, however, are common in infants with low birth weights, often requiring intensive, expensive care; still, the mortality rates remain relatively high.

What do you do? Here’s more data.

A study by the Rand Corporation found that 69 percent of infants who die during their initial hospital stay did so within one day of birth. Those infants were the least expensive to treat, an average of $6,310. For infants who died during the remainder of their initial hospitalization, average treatment was $58,800. Infants at “extremely low” birth weights, in aggregate, create the most costs; technology keeps them alive past the first day, but despite the extra effort and added cost, infants born weighing less than 2.2 lbs have the lowest initial hospitalization survival rate.

More data to consider: The aggregate annual incremental costs among low-birth-weight children ages birth to 15 have been estimated at $5.4 billion per year, not including long-term care, special services and special education often correlated with low-birth-weight children. All that said, remember, those are aggregate statistics; many low-birth-weight children grow into healthy, happy adults with no unusual health problems – you just don’t know who they will be.

So, were you tasked with managing the public newborn-care option, what would you do? Should the public health plan allow spending billions of tax dollars on technology and treatment attempting to save low-birth-weight infants when that practice has a high probability of complications yielding a relatively low survival rate with a high probability of ongoing medical and other expenses associated with survival?

Access, quality and cost — you cannot reduce costs if your promise is equal effort for every low-birth-weight child using whatever technology and treatment is available. In Switzerland, a country often cited for a lower infant mortality rate than the United States, infants weighing less than 2.2 lbs. at birth who die are designated stillborn, whether measures are taken to help them survive or not. Problem solved?

Infant mortality highlights the underlying question of the health care reform debate: How can individuals deal with unpredictable, unaffordable expenses? Neither the regulated, privately managed care approach we have today nor the government-run managed care proposals being debated in Congress provide an acceptable answer. A free market system where patients control the money, health care providers set prices for services, and private insurers are free to develop policies that convert unpredictable and unaffordable events into affordable and predictable premiums, could well be the best way to optimize (not perfect) health care resources.

Unfortunately, in the progressive rush to birth a government-run solution, the free-market solution is designated “stillborn.”

This commentary originally appeared in the St. Paul Pioneer Press, Friday August 28.

Photo Caption: Neonatalogist Jonathan Muraskas places his hand next to Rumaisa Rahman, known to be the smallest baby in the world to survive birth (8.6 ounces). Rumaisa was born at Loyola University Medical Centre in Chicago. Photo: Reuters

Videos from Climate Change Symposium

August 26th, 2009 by Adam Axvig

Remembering Rose Friedman

August 20th, 2009 by Margaret Martin

roseThis past week, Rose Director Friedman, economist, co-author and wife of Dr. Milton Friedman died at her home in California. She was believed to be 98 (no birth records exist for the village she was born in, in what is now the Ukraine). The Friedman Foundation has this to say about her passing. Minnesota Free Market Senior Policy Fellow King Banaian wrote the following remembrance:

Alongside

I was at a meeting this afternoon, a start of a new year for a volunteer board with new people, and as an ice-breaker we were to draw slips of paper with one of three questions. The one I drew was, who would you like to have dinner with most, but with the condition that that person is deceased. Given the events of the day, I could not think of anyone but Rose Friedman, who had died earlier in the day.

She was an accomplished economist of her own when she agreed to marry Milton, having worked on projects in Washington and New York relating to banking and bonds for new institutions like the FDIC and the National Bureau of Economic Research. She delayed their wedding until she had finished the Washington part of her FDIC work. And yet, in Two Lucky People, she wrote that following her husband was to be her lot, and one she gladly accepted.

Although we both started our life together as economists, there was a difference. From the beginning, I never questioned whose career came first. I left my job at the FDIC because I have never wanted a part-time marriage and Milton was not interested in a Washington career. When we left New York for Wisconsin [where he took an academic post before WW2 --kb], I gave up my job. In part this attitude on my part was probably a reflection of the times. Women’s lib was not yet on the horizon. Few married women with families had full-time careers that involved being away from their families most of the day. … Both Milton and I felt strongly that when we had a family, which we were anticipating, my primary career would be as a mother; the economist would come second.

In addition, in all of life’s activities, the personal element is crucial. From the beginning, I have never had the desire to compete with Milton professionally (perhaps because I was smart enough to recognize that I couldn’t). On the other hand, he has always made me feel that his achievement is my achievement. In an interview for the San Francisco Sunday Examiner on March 18, 1984, I was asked, as I often am, how I deal with the fact that we do not share equally in the popular limelight. My answer: “Fortunately, I was not born with a strong competitive gene, so his fame is our fame. I will never be a Nobel laureate, but I am very proud to be the wife of one. In addition, he is more gregarious and outgoing and less self-conscious than I, so he is better suited for the limelight.” (p. 87)

It is noteworthy that many of Milton’s greatest work, Free to Choose, Tyranny of the Status Quo, and Capitalism and Freedom, all bore her name as well as his. You read in Two Lucky People that it was Rose that encouraged Milton to follow through in making Free To Choose as a PBS series over his misgivings, encouraging him not to compromise on the idea that the American people, and eventually the world, was ready for a real intellectual argument for freedom. I left reading their memoirs thinking that the phrase “behind every great man stands a great woman” did not apply to them. She stood alongside.

The cover of Free to Choose has “Winner of the Nobel Prize” below his name and before hers. She never wanted it any differently. They will now share the limelight in eternity, their names forever together.

crossposted from SCSU Scholars

Climate Change Symposium Presentations and Photos

August 20th, 2009 by Adam Axvig

Many symposium goers requested we post the presentations from the speakers. As promised,

David Strom’s presentation on the EU Climate Trading Scheme can be found here.

Bruce Sayler’s, “The Customer’s Voice” can be found here.

Carolyn Sampson’s “The Cost of Climate Change” can be found here.

Bill Glahn’s post on nuclear power can be found here.

Paul Knappenberger’s “Observations vs. Models” can be found here.

*Note: You will need Microsoft Powerpoint to view the presentations, you can download a free viewer here.

This is just a start, more to come. Stay tuned.

Photos

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Aug 19th – Symposium on climate and energy “realism” with Dr. Fred Singer

August 13th, 2009 by Adam Axvig

Climate Change SymposiumJoin the Minnesota Free Market Institute as we host Dr. Fred Singer, renowned physicist, lecturer and author on the subject of climate “realism.” Plus other experts on climate, energy and the economy. August 19th at the Earle Brown Heritage Center in Brooklyn Center from 3-7pm including reception.

Please register by visiting http://mnfmi.org/climate/

See our flyer here.

On Milton Friedman

August 6th, 2009 by David Strom

IMG_0006[1]On July 31st, 2009 the Minnesota Free Market Institute held it’s annual Milton Friedman birthday party. The event was a great success.  Over 100 people attended the Friday afternoon event, hosted by Free Market Institute Chairman Tom Kelly. A drawing was held for 10 copies of Friedman’s Free to Choose and several Milton Friedman posters.

Senior Policy Fellow David Strom gave some brief remarks and offered a toast. Here is the text of his remarks:

It is a genuine pleasure to have the honor of toasting Milton Friedman on what would have been his 97th Birthday.

In many of Friedman’s biographies he is described as being an economist best known for having won the Nobel Prize in 1976.

That is, of course, completely wrong. If we only knew of Friedman as an economist, we hardly would know of him at all. After all, other such honored economists include:

  • Ragnar Frisch and Jan Tinbergen, the very first winners of the Nobel Prize in economics in 1969
  • Or Simon Kuznets, winner of the 1971 Nobel Prize
  • Or how about Leonid Hurwicz, Eric S. Maskin, Roger B. Myerson who won in 2007?
  • Of course we all know the 2008 winner, Paul Krugman, but primarily because he is a political crank, not because he is a prize-winning economist.

My point is simple: we have come here to celebrate Milton Friedman’s life not because of his excellent work as an economist, but because of his success as a tireless advocate for freedom.

It was not Friedman’s economic contributions that led to the abolition of the draft and the institution of an all-volunteer Army; it was his tireless working on Congress convincing them that a free labor market would produce a better army and freer citizens. And as a result fewer Americans have died in the entire Iraq war than did in a typical year of training accidents when we had the draft.

Friedman’s most memorable and popular work Free to Choose was published in 1980, along with a 10-part PBS series that took the country by storm. It was that same year, of course, that Ronald Reagan beat Jimmy Carter by a landslide and began pushing the country back from what seemed to be an inevitable slide toward socialism.

Friedman’s advocacy and Reagan’s success were not merely coincidental. In fact, I am convinced that without Milton Friedman’s sunny and optimistic promotion of Capitalism Ronald Reagan’s sunny and optimistic vision for renewing America would have had much more trouble catching on.

Friedman’s life work was promoting the idea that free markets are not just about making money to the exclusion of other values. Instead he showed how free markets are the best way for each of us to individually pursue our own vision of the good life and the good society and do so through the voluntary cooperation of others.

In these difficult times it is important to remember the contributions apostles of freedom such as Milton Friedman and Ronald Reagan have made. Without them our society would be much poorer and less free. And it is only by following their path that we can be assured of the better future we and our children all deserve.

Health Care Critics: An “Angry Mob” or “Expressing Their Concerns”?

August 4th, 2009 by Margaret Martin

health careThe health care debate is generating some press as members of congress hit their home towns with Town Halls. As some of the discussions have become heated, commentators are complaining that critics are promoting irrational fears and not engaging in serious debate.

Hyperbole aside, there are serious issues being raised by many ordinary citizens about the wide scope and massive changes that Congress and the President are considering making to how Americans receive their health care and how it is paid for.
Here are some stories to consider:

AP: “Plummeting tax revenues starve government just as Obama embarks on big plans”

August 4th, 2009 by Adam Axvig

debtAccording to an AP analysis, tax revenue is expected to fall 18% this year, the largest single year drop since the great depression. According to the article, individual income taxes are down 22%, corporate income taxes are down 57%. The news comes as the current Congress seeks to pass several new initiatives, including a health care overhaul with an estimated price tag of  over $1 trillion.  An ambitious agenda, especially when one considers the current state of the economy.

Unfortunately, lawmakers have a way of skirting around the lack of funds in the treasury, borrowing. So far, Congress has borrowed 50 cents of every dollar they’ve spent this year.  The White House continues to signal they are serious about the deficit, but so far their actions have not followed their rhetoric.  Treasury Secretary Timothy Geithner, appearing on Sunday morning talk shows, fueled speculation of a middle class tax hike to balance the budget, which the White House vehemently denies is part of the solution to the deficit. There seems to be a disconnect between the priorities of the administration and the priorities of the treasury. One thing is clear however, at least to the Congressional Budget Office and the Chinese, our current fiscal policy is unsustainable and needs to be addressed.

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