The problem:

One-third to one-half of all patients do not take medications as prescribed, and up to one-quarter never fill prescriptions at all, experts say. Such lapses fuel more than $100 billion dollars in health costs annually because those patients often get sicker…about one-tenth of hospital admissions and one-quarter of nursing home admissions result from incorrect adherence to medication.

Aetna’s solution:

[Patients] can win $10 or $100 each day they take the drug — a kind of lottery using a computerized pillbox to record if they took the medicine and whether they won that day.

Pay-for-performance for doctors:

Aetna has begun paying doctors bonuses for prescribing medication likely to prevent problems: beta blockers to prevent heart attacks, statins for diabetes sufferers. Currently, 93,000 doctors are in Aetna’s “pay for performance” program; bonuses average three percent to five percent of a practice’s base income.

Full article on paying people money to take their medicine.

I am one of very few capitalists you know (probably the only one, actually) who is intensely interested in understanding who gets what under socialism. At the other end of the spectrum, almost every socialist I know is focused only on the idea of socialism and has very little interest in discovering how socialist systems actually function.

So, what you are about to read, I am afraid, is something you are unlikely to find in any other place.

Suppose the government nationalizes the school system and makes schooling available for free. Without knowing any institutional details, could you predict in advance which students will end up in the classroom of the best teacher? How about the worst teacher? And how will the other students be sorted in between?

I certainly could not predict with any accuracy. But I can almost guarantee you the students will not be distributed randomly. I can also almost guarantee you that the distribution will not be independent of the parents’ income, wealth and social status.

Similarly, suppose the government nationalizes the health care system and makes medical services available for free. Without knowing any institutional details, could you predict in advance which patients will be seeing the best doctors and entering the best facilities? How about the worst doctors and the worst facilities?

Again, I can virtually guarantee you that the patients will not be distributed randomly and that the distribution will not be independent of income and social status.

Brother Can You Spare a Dime

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If you have depression, you are probably being undertreated or overtreated.

Man wins $1,000 in lottery; government cuts his Social Security income by $980.

Americans spend about $3.6 billion on [mostly worthless] over-the-counter cold, cough and throat remedies — and millions more on antibiotics that have no effect on viral infections.

Neal Wanless, a 23-year-old, down-on-his-luck rancher, won a $232.1 million Power lottery jackpot last week. Yet you are unlikely to see editorial outrage at the New York Times, Vanity Fair, Slate or in any of the columns of writers who routinely bash capitalism for its excesses. But why not? Of all the complaints ever made against capitalism – from Karl Marx to the present day – there is one area of life where the complaints ring true: the lottery. Consider:

• One person becomes extremely rich.
• The winner's riches come at the expense of everyone else – the vast majority of whom have below-average incomes and many (maybe most) are actually poor.
• The winner did nothing to deserve, merit or earn his reward – everything he has is the result of sheer luck.
• In one single drawing this lottery produced more inequality (among the participants) than any act of Congress or private sector venture ever could.

So why is the left so blithely acceptant not just of lotteries, but of state-created-monopoly-lotteries? Why do columnists who become apoplectic about the salaries of CEOs ignore those whose riches are the result of random chance? Why are lotteries such a popular source of revenue among Democrat politicians? I report. You decide.

• Homelessness Update: Michael Moore was wrong. LA hospitals aren't dumping homeless patients; they are recruiting them-with offers of food, cigarettes and even cash to buy crack cocaine. The reason: more excuses to bill Medicaid [link].
• Cancer update: Almost everything that's fun to eat or drink is bad. "Even being a little bit overweight is a risk" [link].
• Health tip for bird watchers. Geese usually don't defecate while flying [link].
• How do Canadians doctors get rid of patients? By lottery [link].

On Christmas Day 2002, Jack Whittaker won the lottery. He won big. At $315 million, he held the largest single winning ticket in the history of American lotteries.

Where did all that money come from? It came disproportionately from people on the bottom end of the income ladder – people who might otherwise have paid the rent, clothed their children or put food on the table for their families. (Whittaker, by the way, is an exception to the general rule; he was already worth $1 million before he bought his lucky ticket.)

As a result, that fateful Christmas Day will be remembered for achieving yet another milestone: An act of government that created more inequality per dollar spent in the shortest amount of time in all of human history. Continue reading »