Truck and Barter

The Ideal Healthcare System

Don Boudreaux writes that the Canadian healthcare system -- the rules and regulations imposed by the Canadian government on its apparently grateful peons -- is inevitably dysfunctional:

And yet, many Canadians continue to fancy themselves "lucky" to be saddled with such a system for providing their health care....

How on earth can a system that invites consumers to treat a scarce good as if it were free possibly work? Isn’t it inevitable – isn’t it utterly unavoidable – that any such system will suffer dysfunctions and troubles that make consumers worse off rather than better off?

I think this both identifies and ingores the critical point about health care/insurance in modern democracies: this dysfunctional system is exactly what people want.

I am guessing that in the common wisdom of Canadians and Americans, the very archetype of a "good" health "insurance" plan -- and hence an ideal "healthcare system" -- is one in which all the care one wants comes without delay or cost. The essential principles of this ideal are very simple; in terms of the American consumer:

1) the full premia are paid by one's employer or the government

2) there is no co-payment for any office visit

3) there is no co-payment for any prescription medication

4) all pre-existing conditions are covered in full

I'd also suggest the following criteria, but these are not as important as the first four:

5) any doctor -- especially top-notch specialists -- can be seen just by making an appointment, preferably on the same day

6) all surgical, restorative, remediable aspects of dental and vision care
are completely covered

7) whatever the patient asks for -- x-rays, antibiotics, anti-depressants,
repeated toxin screening, appendectomies -- is provided immediately without question

That these criteria are unworkable in reality is irrelevant; the healthcare system in utopia is not subject to the constraints of scarcity or opportunity cost.

Drug Reimportation May Not Be So Easy

The debates over drug reimportation from Canada often leave out much of the "Canada" bit. That is, they simply assume that nothing would change on the part of our Northern Neighbor (well, "our" if you're in the US anyway) should the US government decide to get out of the way of buying pharmaceuticals there. Turns out Canada may have a few things to say about it:

Many Canadian internet pharmacies supplying Americans with cheap prescription drugs would be forced to close under proposed licensing restrictions.

The restrictions were proposed by regulators in the prairie province of Manitoba, where close to half of the roughly 150 Canadian internet and mail-order pharmacies are based.

Of course, this is simply regulation masking itself as benevolence. Since the Canadians are buying drugs from the same companies that are supplying the US, "safety concerns" are limited to preventing that great wave of people faking prescriptions because they are able and anxious to take massive amounts of heart, diabetes, and cholesterol medications once they realize they can get them for a lot less than down in the states. Or maybe Paul Martin hears a Canadian version of the great "sucking sound" and knows its possibly the US vacuuming up all the available medicines should reimportation be allowed to go forward.

Just because I'm against reimportation doesn't mean I favor more government intervention to prevent it.

Neuroeconomics

Tyler Cowen points to this survery of the current findings in neuroeconomics. Considering how new this field is and the probability that one of the early practitioners will get a Nobel, I'm a little surprised that more aren't chomping at the bit. I can't say that the area is a particular interest to me, but this line of inquiry that Tyler mentions is:

What I would want most: A testable neuroeconomic theory of why risk premia vary over time in securities markets. But that is very far away.

I think I'm reading Tyler's mind( or he mine) since this is almost the exact question I find interesting. Here in Claremont we have Paul Zak who does work in this field and since he's my current Macro prof, I get a lot info about his findings. He was talking about using brain scans to map people's utility curves and the problem of investment decisions popped into my head.

The scenario he tests is this: what game would a person play? In one, there are four outcomes, with two of them the person gets $10 for a total expectation for the game of $5. In the second, there are four outcomes, but in only one is there a payoff of $20 with expected value $5. He has them play the game as he scans their brains. Initially people choose the first, but the payoff in the second is changed until they choose it. With this information, he maps their curves.

My thoughts had to do with international investing and why risk-premiums are different across countries and time. Studies have been done to show that emerging markets offer higher returns, but as history of the late 90's shows, this can be a bumpy ride. So why did investors pump money into these places in the mid-nineties only to flee a few years later? Or, why exactly were Russian bonds near 5% in the last couple of years?

On a side note, like biotech investing mentioned below, neuroeconomics also has barriers to entry not easily overcome. The first one is the need for a mountain of additional knowledge needed to study in this area. The second is that this is an expensive field with high costs to perform experiments. The cost per brain scan is, I think, $200(it maybe more). Unless your individually wealthy or working with somebody who has current funding, it would seem difficult to conduct research in this field. I should mention a third problem, this stuff makes me queasy.

Biotech

For econometrics, we have to do an event study on biotechs to see if there is anything significant when press releases are issued. The first thing that probably popped into your mind is that the prof is fishing for something to write a paper on and you would be right since he said he was. I am somewhat interested myself since I occasionally trade these stocks as well. However, there is a huge problem in doing so, mainly, these companies require a tremendous amount of specialized knowledge outside of a typical cash flow analysis skill set. Thinking about my classmates crunching numbers on data that very few of them actually understand gives me the chuckles. At this point, I'm just talking about the FDA approval process and not about whether a drug or contraption may be usefull. Of course, it's just a class project; economists always understand what they are analyzing and add value above and beyond crunching numbers, right?

The purpose of this post wasn't to mock my class or profession, but to look at how one gets around asymmetrical information barrier to investing in these companies. Rather than looking at the effect of an announcement of a new phase of trials(or whatever people are doing), I decided to look at the effects of financing. Just as people rush into a stock that Warren Buffet has recently purchased, one would expect a strategic partnership with Johnson&Johnson to have similar effects(I'm actually interested in any financing and what happens to a stock once it's announced, closed and different types). Of course, these events are mere signallings that company's prospects are perhaps better than the market was pricing in. Conversely, a simple stock offering from a company that's stock price has floundered in low single digits may signal more of the same. So, the quality of the financier may signal the quality of the company. One would expect it to look some like this; pharmaceutical company > private equity > the monkey from Etrade.

I assume that a mediocre company will always be so. If a new drug from an unfollowed single digit stock company was going to cure cancer, everybody would know it. By this, I don't mean that the Yahoo message boards would be filled with bragging about how this unnoticed company has a miracle drug and the only pople who know it are the posters, but that phase trials are administered by the same people, companies, hospitals and they talk. My brother bounces around from biotech to biotech and he always knows when a competitor lobotomizes one of their patients(this actually did happen). Rarely does one get a complete surprise like Genentech's from a couple of years ago, however there is always hope.

How does one get access to this information which is known to only a few? You have to rely on analysts, even dare I say, brokerage analysts. Last spring, the biotech analyst from Pipar Jaffray actually made me money by conveying information which was known within that circle mentioned above. He added value in two important ways to my decision making process. One was that the drugs prospects were poor(btw, the company was Genta). The second was that the company had done a poor job in analyzing/gathering its data which would lead to a rejection. With such specialized knowledge needed to make investment decisions in this industry, it appears that investing here is a hard go. It is always worth it to figure out what the smart money is doing and, here, the magnitude in difference between smart and dumb could be huge.

I will add another rule on investing. I listen to a lot of conference calls and the Q&A is mostly typically populated with analysts, but if an "investor" ever manages to get in a question, run! One more thing, I don't really invest, but trade options and these positions are often riskless(flys) in these type of stocks. The Genta mentioned above wasn't which add a few bucks to the P&L.

Proposition 72 Barely Defeated

FYI, Proposition 72 on the California ballot--the requirement that non-small businesses provide their employees wide ranging health care plans, and pay for a large share of the costs--has been defeated 50.9% to 49.1%.

Do you want to eat more? Here's how!

The November 2004 Issue of Harvard Health Letter ($) asks "Why do we eat so much?" The answers: we eat too slowly, with too many people, with people who are too important to us, our food is too visible and accessible, we have too many choices, and stock up on prepackaged goodies. There was also this gem :

Plate, bowl, and cup size are important... In one experiment, researchers had people eat soup from bowls that were secretly connected to a hose that added more soup while they ate. They ate over 75% more from these "bottom-less bowls" than from normal bowls.

So now you know how you can cram even more food into you.

Also note that women eat 13% more when they're with men than when with women.

No Drug Reimportation? I know...Blame Canada!!

(Of course, now I have the song going through my head.)

Realizing the potential hollowing out of the Canadian drug market if the US is allowed to start ordering prescription drugs en masse, some Canadian pharmacies are going to start rejecting bulk orders.

Why politicians think a country of 31 million people that has price controls on pharmaceuticals has enough excess drugs just sitting around that the US can start shopping like Paris Hilton on a bender is beyond me. I'd consider this a smart move on the part of these pharmacies. On the other hand, of course, this just means that those pharmacies that will sell to the US are going to be able to demand higher prices. If enough places adopt the no sales policy (to swing once again the other direction), the prices for those drugs that are available may rise to near-US levels, eroding the benefit. (Does anyone know if the price controls in Canada apply to international sales? I couldn't find anything in a quick search.)

For more on the reactions to the greater outcry for reimportation, see this excellent NYT piece.

More than one side to every story...

I'm not the only one posting on the vaccine shortage. Russ Roberts has some great stuff in posts here and here. (While the good Professor obviously does a far better job than I, I would like to note that he too suggests the mess may have something to do with the way government buys vaccines).

This is all from the US perspective, however. What I also find interesting is looking at the issue from another side. What about Canada? They have a far more socialized health care system than we do, but it appears they have a small surplus they'd be willing to sell.

How can that be? To be honest, I'm not entirely sure. If I had the time, I'd look into their department of health and see how they go about purchasing to provide some comparison to the US method.

One thing I will note, however, is that the company that is poised to provide the extra vaccines is a domestic Canadian company. While I admit to drawing inference from a very thin source, might it be possible that the domestic company is financed largely by the Canadian government (cough --PEOPLE-- cough)? The US has no company that is producing flu vaccine, and looks to international producers for its supply. If this is, in fact, the case for Canada, then the cost of the vaccine is largely irrelevant for the production level, since the company may never have to worry about covering costs. Should that be true, it doesn't invalidate the claim that government purchasing is at the heart of the US vaccine shortage. Since the US is using its position as a near monopsonist to change prices, the private company is induced to produce less because of falling margins. A state-owned company doesn't have as much to worry about if funding from the government is available. (All else equal, of course, since there are plenty of cases where a state enterprise can fail even with the possibility of loan guarantee, bailout, whathaveyou.)

UPDATE: I stand corrected. Thanks to Tom North for pointing out that ID Biomedical is a public company in Canada. I tried looking for their ticker, but came up empty. Chalk it up to being too ignorant of Canada to make the search effective. I will admit, however, to being skeptical that this means that the company isn't otherwise guaranteed by the government, or that the cost structure for the company is radically different because of the more socialized system. I say that because in an environment where the end product is tightly controlled, and the product is (as almost everyone has mentioned elsewhere) tough to make and realizes thin returns, it's interesting that a publicly traded company can afford to exist where companies across the world failed. I'll have to look into it more. Hey, I'll be the first to admit it when I get it wrong...

Quick Pointer

For more on the health insurance issue, Arnold Kling has an interesting column up at Tech Central Station.

Rather than initiating the poor into the wonderful world of insurance company rules and claims-filing procedures, Fogel suggests that we would do more good by directly providing them with prenatal and postnatal care, health care education and mentoring, child health screening in public schools, and neighborhood public health clinics.

As I mentioned in the comments below, my reading of current health care issues would make me think that Fogel's right by saying that the poor under-utilize certain kinds of health care: preventative care, most notably. The later -- drastically higher -- cost of catastrophic health care is shifted towards other consumers then.

Just more reasons that I'm not sure the real issue facing the country is health care insurance per se, but rather the cost of health care provision.

Do the uninsured subsidize the insured?

Did you ever play with one of those liquid-filled balloon-like toys that, when you squeeze one end the other end extends, usually displaying a picture of a snake of some sort? The impression was supposed to be that the snake was inching along at the effort you expend on one end, since the whole contraption was wrapped in on itself. I remember being fascinated with the mechanics of it when I was young. There seemed to be change and progress, despite the clear lack of introducing new liquid or removing the old. I'm no expert, but something about the issue of health insurance in this country strikes me as similar to this old toy.

Case in point, this (to me) odd editorial from the USA Today: Uninsured billed unfairly.

According to the article, the uninsured are facing higher prices for their health care than the insured, since hospitals charge insurers less, and face a cap on the price they can charge to medicare patients. The article sounds almost incredulous that hospitals are attempting to recoup their cost of operation in places like care for the uninsured. Rather than be shocked at the behavior, I'm personally shocked at the surprise this seems to have aroused in the op/ed writers. Though, I suppose I shouldn't be since they've brazenly declared their poor reasoning from the outset:

Scott Ferguson, a retired artist without health insurance, was billed $66,900 for treatment of a heart condition at St. Anthony Central Hospital in Denver last December. If he had had insurance, his attorneys claim, the tab would have been about $10,000. Last month, he joined a lawsuit that accuses St. Anthony and other non-profit hospitals of reneging on promises to provide charity care in exchange for their tax-exempt status.

Well, yes, the bill for the insured would be lower, as that's the very point of having insurance. Pooling risk makes it possible for the insured to recoup some of what they've previously spent on the insurance. Sure, Mr. Ferguson has a higher bill, but he also hasn't had to face a couple hundred dollars a month in insurance costs. The act of having the insurance should, by definition, make the payments lower. How this shows anything aside from poor logic, I have no idea. Rather, it's this that makes me the most alarmed:

Ferguson's experience highlights the double whammy against uninsured patients who aren't poor enough to qualify for Medicaid. Not only do they have to pay their own medical expenses, but they often are victims of price-gouging by hospitals that offset the lower fees they charge insurers, which have the clout to demand deep discounts.

Worse, many hospitals employ strong-arm collection tactics that include garnishing wages, seizing homes and seeking arrest warrants. The financial impact can be severe. Medical bills are the second-leading cause of personal bankruptcy, a 2003 Harvard University study found. The unfair disparity in hospital fees is just one price society pays for a health care system that leaves 44 million without insurance and few with protections from exorbitant charges that have little relation to actual costs.

I suppose it's my fault for being surprised, since I had always assumed that people simply understood the relationship between prices and costs. It's not obtuse economic theory. Every day, in almost every part of the globe, people are assembling goods and seeking to sell them. It's a truly rare individual who isn't attempting to at least recoup the cost of production in the price of the good. After all, if they keep taking less than the thing cost to produce, they will soon have no money with which to produce more.

Why should health care be any different? If a hospital costs a certain amount to run, then, through the prices charged to all those who use its services, it will need to cover that cost in order to keep running. Telling a hospital that it can only charge certain amounts to certain people, it's only natural that the gap between the price charged and the cost incurred must be covered somewhere else. You can squeeze the balloon in one place, but that just means the liquid will rush to someplace else; it doesn't just leave.

And notice the odd reasoning in the second paragraph above. Insurers, according to this piece, are able to demand massive discounts in the prices they face; but the problem is that too few people are uninsured. Extending insurance coverage would, by extension, mean that everyone takes advantage of the discounts offered to insurers, right? What happens, then, to the gap that isn't being covered? The hospital hasn't gotten cheaper to run. The cost of provision of care hasn't become more efficient. Instead, every consumer (the insurer) is simply paying less. Either hospitals will close, or someone else will have to pick up the tab: if it's not the person needing health care, and its not the insurer, then who? The only likely candidate I can think of is the government. Which means, ultimately, the people. So not only would we all pay for insurance, but we'd also end up paying for the subsidization of hospitals. After all, in this article and my example, there has been no change in the cost of health care provision.

Unless something can poke a hole in the balloon -- that is, reduce the growing costs of health care provision -- the extension of insurance strikes me as just squeezing one end and calling it progress.

Youth Smokers Should Quit by 30

This New York Times article describes academic evidence that lifetime tobacco smokers live an average 10 years fewer than nonsmokers; it also contains the following, to me shocking, paragraphs:

The study also found, however, that kicking the cigarette habit has equally dramatic effects. He found, for instance, that someone who stops smoking by age 30 has the same average life expectancy as a nonsmoker, and that someone who stops at 50 will lose four, rather than 10, years of life....

Doll and Peto said that while the harm of smoking is dramatic, so is the benefit from quitting. According to their findings, a person who stops smoking at 60 will have a life expectancy three years longer than someone who continues; a 40-year-old will have a life expectancy nine years longer; and a 30-year-old will have a life expectancy no different from that of a nonsmoker.

We've known that not every cigarette is harmful--each butt certainly does NOT take 11 minutes off your life.

To me, what this means is that the only longevity justification for preventing a youth from smoking is that the youth may not stop smoking in his 30s. Otherwise intervention must be justified on financial grounds, or (perhaps specious) quality of health grounds.

Hence, there are two plausible government policies, if you think government should get involved in private--not "public"--health matters: 1) stop kids from smoking, and 2) stop adults in their late 20's and early 30's from smoking. It seems to me that we don't know whether 1, 2, or a mix is the more effective or cost-effective method of aggregate life extension.

In fact, cost-benefit guidelines suggest that we try to keep as much benefit and eliminate as much cost as possible. We should focus government funds on reducing smoking where the marginal costs start to outweigh the marginal benefits. This means, if it were administratively possible, don't tax tabacco for teens, but ramp up the taxes prohibitively for those over 30, and target anti-smoking campaigns to that demographic. And who cares of tobacco companies target teens through Joe Camel adverts if kids can smoke without permanent harm, should they quit by 30?

Note: I don't smoke. Frankly, I don't see why I should. However, this article doesn't tell me why I shouldn't, at least for a few years, until I hit 30.

California HealthCare

Daniel Weintraub, of the Sacramento Bee, talks about health care in his column today and notes that trend of doctors opting out of the insurance networks is continuing:

Dr. Marcy Zwelling-Aamot is sick of being told how to care for her patients. So the Los Alamitos physician - and president of the Los Angeles County Medical Society - says that as of July 1, she will no longer be working with health insurance companies.

"I am divesting myself of every insurance contract," said Zwelling-Aamot, an internist. "I can offer better care less expensively to my patients. I have a list, a waiting list, and I haven't even started advertising yet."

Zwelling-Aamot hopes she is on the leading edge of a wave of the future, which would really be a return to the past. She envisions an era when doctors and patients once again deal directly with one another, without the reams of paperwork, authorizations, second-guessing and billing nightmares that come with the current system.

All well and good, over on the previous site, we have talked about this trend before. Weintraub then brings up an unfortunate little bill standing in the way of market forces in California, SB 2.

But Zwelling-Aamot's dream of bureaucracy-free medical care is clouded by one thing: SB 2, the proposal heading for the November ballot that would require California companies with more than 50 employees to provide health insurance to their workers.

The idea sounds good at first. So good that it was enthusiastically supported by the California Medical Association, the state's largest professional physician group and the parent of Zwelling-Aamot's county medical society.

But Zwelling-Aamot and a number of prominent CMA members fear that the measure, if approved by voters this fall, will bring the downfall of quality health care in California by putting still more distance between doctors and their patients.

"The politicians say that people are uninsured and we need to cover them," Zwelling-Aamot says. "But coverage doesn't mean care."

The proposal would require any employer of more than 50 people to provide coverage or else pay a fee into a state fund that would buy insurance for their workers. Companies with more than 200 employees would also have to provide care for dependents of their workers. A government board would establish the minimum benefits required, and set the level of the fee charged to companies that cannot or will not provide coverage.

This is supposed to increase access to care for those who don't have it now. But as Zwelling-Aamot and others point out, it might not do a very good job of that and in the meantime could wreck health care for everyone who has coverage today.

"This just perpetuates a failing system," said Dr. James Knight, a San Diego urologist and president of that county's medical society. "It doesn't do anything to address the problem that we're seeing, and actually will perpetuate it. There are many physicians who believe this is very dangerous legislation."

With costs climbing fast, due in large part to an aging population and expensive new technology, many businesses will find it difficult to keep up with rising premiums, Knight believes. Instead, companies will, in increasing numbers, opt out of the system and pay the fee, shifting their workers to the government-run system.

"Employers are going to pay the fee and the government is going to buy the lowest common denominator," Knight says. "We are going to build a bureaucracy that is going to run health care for probably 80 percent of the population."

And the health care the government provides will probably look a lot like Medi-Cal, the bare-bones program that now provides care for the poor. Benefits will be limited, and patients will have a hard time finding doctors who want to be part of that system. If costs continue to climb, pressure will build on the government to cap doctors' fees. But that would only lead to still more shortages of doctors willing to participate.

"It's going to be the worst kind of insurance out there," says Dr. Thomas LaGrelius, a Torrance family care specialist and a consultant to independent doctors who are part of preferred-provider organizations. "We are going to move in the wrong direction."

Perhaps the greatest insult of all is that the proposal requires workers to pay up to 20 percent of the cost of this care, which could lead many employers who pay for all or most of the insurance now to instead bill their workers at the level established by the government as the standard.

"Many people will get less insurance and they will be forced to pay more," says Zwelling-Aamot, "and they will have less control than they do now."

Weintraub kind of muddies it by making it appear that this needs to be defeated in November when it is already law. The decision in November is whether to repeal it. That makes me nervous, because it is a lot easier to just make people vote no.

Overall, I think the analysis is dead on. Eventually, companies will abandone marlet rate insurance and go to the government because it will most likely price itself cheaper. Of course, it will provide less coverage, but in the long run for medium and large size companies who alreay provide health insurance, this just another cost of doing business and takes some headaches off of their hands.

Benefits in Risk Pooling Occurs to Fortune 500 Companies

Lots of good stuff in the news today.

A group of Fortune 500 corporations are getting together to offer health insurance to their non-full time workers.

What I find most interesting about the move is that it appears to be a direct reaction to the long-term externalities of an uninsured populace: the shifting of costs from the uninsured to the insured. Long term concerns play as much of a role in evaluating costs as do short run concerns, so this seems only natural. The Christian Science Montior agrees, but responds to the possibility that others may be scratching their heads.

But so what if self-interest is at work? That's how many social problems are solved in a market economy. The big-business alliance would help solve this one by pooling workers, thus offering them lower insurance rates which they couldn't find as individuals. The alliance estimates it could cover as many as 4 million people - 10 percent of the uninsured.

The presence of uninsured does have direct consequences for the insured. But it would seem wrong to believe that the presence of uninsured indicates a complete and continuing market failure that can only be addressed by government intervention.

The Perils of Choice

The topic is not a new subject around T&B: the impact of high levels of choice on the consumer.

This time it's manifested itself in the world of Medicare. Tthe range of discount card options has hit 73, and seniors are saying that it's tough discerning which one is the right one for them.

I have to admit, I'm not entirely sympathetic to the issue. Complexity of choices is inherent in a great deal of daily life, and building policy based on the perceived cognitive power of those to be affected strikes me as a quick way to devlove the whole issue into a "you don't know enough so let the government decide" sort of argument. (To put it rudely, I don't think we should regulate based on intelligence versus stupidity.)

On top of that, there seems to be a bit of a discrepancy in the story:

When Mildred Fruhling and her husband lost their prescription drug coverage in 2001, they suddenly faced drug bills of $7,000 a year. Mrs. Fruhling, now 76, began scrambling to find discounts on the Internet, by mail order, from Canada and through free samples from her doctors. "It's the only way I can continue to have some ease in my retirement," she said.

Last week, when the federal government rolled out a new discount drug program, Mrs. Fruhling studied her options with the same thoroughness. What she found, she said, was confusion: 73 competing drug discount cards, each providing different savings on different medications, and all subject to change.

Well, if one is able to keep track of deals from multiple websites, the mail, personal contact with physicians, and international comparisons, I'm not entirely sure why turning to a website as a single source of information should be that difficult. Certainly I can understand that government intervention has created a bit of a hydra here, when there are certainly more efficient ways to shift the price of drugs off of seniors to somewhere else, but compared to the adhoc method Mrs. Fruhling and others were resorting to before, isn't this at least a marginal improvement by way of reduced transaction costs?

Thomas Sowell on Price vs. Cost

Sometimes all you can do is link and quote:

The difference between prices and costs is not just a fine distinction made by economists. Prices are what pay for costs -- and if they do not pay enough to cover the costs, then centuries of history in countries around the world show that the supply is going to decline in quantity or quality, or both. In the case of medical care, the supply is a matter of life and death...

When politicians talk about "bringing down the cost of medical care," they are not talking about reducing any of these costs by one cent. They are talking about forcing prices down through one scheme or another.

All the existing efforts to control the rising expenses of medical care -- whether by government, insurance companies, or health maintenance organizations -- are about holding down the amount of money they have to pay out, not about reducing any of the real costs...

For political purposes, what "bringing down the cost of medical care" means is some quick fix that will win votes at the next election, regardless of what the repercussions are thereafter.

Reform=Nationalization

Saw this article over here. In a plan being put together by Australian states premiers that would appearantly put all schools under the control of government bureaucracy and create a new one for national healthcare, they are calling it reform when it really is nationalization. It is unclear from the article if it would include private healthcare in the proposal, it's implied, but I don't want to make that assertion. When they say,

" they want families to be "enrolled" with a selected GP or health clinic for life."

you can't be too encouraged on that front. The main points:

• Replacing COAG with a stronger and more influential Council of the Australian Federation.

• Creating a new public education system which would include not only government schools but also Catholic and independent schools.

• Encouraging greater integration of the health sector with less duplication and more services tailored specifically to meet patients' needs.

• Forming new national bureaucracies to reform and run the health and education sectors.

It is only a working paper of the Australian states premiers, but is worth watching in the run-up to the general election. I somehow doubt this women would be for such a plan:

A WOMAN who was told she'd had a partial miscarriage saved her unborn baby's life by getting a second opinion.

Toowoomba Hospital doctors told Sherri Ann Buchanan on April 28 she had had an incomplete miscarriage and booked her in for a curette the next day to remove the remains of the fetus.

After waiting for about five hours for the surgery, Miss Buchanan, 20, said "it didn't feel right" so she left and sought advice from her GP.

The mother-of-one, who is almost four months pregnant, said her doctor referred her to a private clinic and an ultrasound showed her baby was alive and healthy.

"I couldn't believe it. I just broke down," Miss Buchanan said.

It could be worse, my friend's sister had her baby die in the womb and they didn't notice for six weeks. The amazing thing is they did tests during that time. The fine hospital who did such a thing was Northwestern Memorial in Chicago(the lawsuit was settled some time ago, it damn near killed her). There could be incompetence by both private and public healthcare providers, but it seams that the latter was lacking in resources for the public(which seems implied in the article) hospital the Austrlian women went for her needs.