Sunday, May 22, 2016

Limits of Societal and Health Care Intervention
There is a proper measure of all things, certain limits beyond which and short of which  is not to be found.

Horace (65-8BC), Satires
50% to 70% of all premature deaths could be prevented if only people stopped smoking, ate a proper diet, kept a healthy weight, exercised a half-hour each day, followed doctors’ orders,  took their prescriptions,   stayed away from opioids and other addictive drugs ,  didn’t text while driving,  otherwise behaved themselves,  individually, collectively, and nonviolently,  we would all be better off.  But that is not to be.
Humans Are Humans
But alas, humans are humans.  No tree grows to the sky, very few people live past 100, and government cannot control how people or societies behave.
There are limits of how much government can do to protect us against ourselves and improve our health.    It can pass ObamaCare with its 400,038 pages of regulations and its $2.5 trillion in costs over the next decade, and it can institute 114 laws with 3410 regulations,  as it has done during Obama’s reign, to protect people against profit-seeking corporations and doctors.
Cost and Hassle Factor for Doctors
To control costs,   it can cut doctors’ pay to below Medicare, which is roughly 80% of private pay.   It can create and add  to the  Hassle Factor for doctors -  defined as any time-consuming  paperwork-ridden maneuver required of physicians to satisfy  3rd party payer s– Medicare, Medicaid, or insurers ,- who provide payment for any treatment, service,  procedure, or drug.
Unfortunately,  The Hassle Factor results in:
1.        Reduced benefits for the patient 

2.       Decreased number of primary care doctors

3.      Erosion of physician-patient relationship 

4.      Higher costs

Higher Taxes
Government can raise taxes, such as these for ObamaCare.
60.1 Billion: Tax on Health Insurers (Takes effect Jan. 2014): Annual tax on  industry imposed relative to health insurance premiums collected that year.  Phases in gradually until 2018.  Fully-imposed on firms with $50 million in profits.
$32 Billion: Excise Tax on Comprehensive Health Insurance Plans (Takes effect Jan. 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). 
$23.6 Billion: “Black liquor” tax hike (Took effect in 2010) This is a tax increase on a type of bio-fuel
$22.2 Billion: Tax on Innovator Drug Companies (Took effect in 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year
$20 Billion: Tax on Medical Device Manufacturers (Takes effect Jan. 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. 
$15.2 Billion: High Medical Bills Tax (Takes effect Jan 1. 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). 
$13.2 Billion: Flexible Spending Account Cap  (Takes effect Jan. 2013): Imposes cap on FSAs of $2500 (now unlimited).  Indexed to inflation after 2013. 
 $5 Billion: Medicine Cabinet Tax (Took effect Jan. 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin).
$4.5 Billion: Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D (Takes effect Jan. 2013).
$4.5 Billion: Codification of the “economic substance doctrine” (Took effect in 2010): This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed.
$2.7 Billion: Tax on Indoor Tanning Services (Took effect July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons.
$1.4 Billion: HSA Withdrawal Tax Hike (Took effect Jan. 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent.
$0.6 Billion: $500,000 Annual Executive Compensation Limit for Health Insurance Executives (Takes effect Jan. 2013(,
$0.4 Billion: Blue Cross/Blue Shield Tax Hike (Took effect in 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services.
More Regulations and Higher Taxes Have Little Effect on Health Status
But more regulations and higher taxes rarely change a nation’s health status or how patients behave.  In 2006,  Satcher and Pamies pointed out  in their book  Multicultural Medicine and Health Differences  that a nation’s health system accounts for only 15% of a nation’s health status, life style makes for 30% and other factors – poverty, inferior education, income differences, and lack of social cohesion make up the other 55%. Therefore, any reform of our system is unlikely to increase the nation’s overall health status.
 In other words, a nation’s culture,   life style habits, and  economic  prosperity  determines its health, not government regulations and taxes.


No comments: