THE HUGE COSTS OF THE MEDICAL BUREAUCRACY

Even if partisans disagree about what government should do to expand health coverage, we should at least be able to agree that government should stop doing things that make health care unnecessarily expensive. One prime example is the many outmoded and questionable federal regulations that riddle our health care system. On Oct. 4, the Cato Institute released a study by Duke University professor Chris Conover that demonstrates that the costs of health care regulation outweigh the benefits by 2-1.

After studying 47 different types of health care regulations, Conover estimates those regulations cost Americans $169.1 billion on net in 2002 alone. The total costs are actually $339.1 billion, but the regulations provide about $170.1 billion in benefits. For the typical American, this translates into a hidden tax of more than $1,500 per household per year. And because that cost is built into medical prices, it makes health coverage unaffordable for about 7.5 million people.

So how do the candidates address this issue? Bush has made a gesture toward deregulation, but neither has a serious plan for reducing this enormous barrier to medical care. Conover estimates the single greatest regulatory cost is the medical liability system, which imposes a net cost of $80.6 billion annually. (That's after subtracting the benefits of compensating injured patients and preventing medical errors.) A reasonable way to curb those unnecessary costs would be to let patients and doctors negotiate a mutually acceptable level of negligence protection prior to treatment.

Instead of adopting that sensible reform, Bush would have Congress impose damage caps and other substantive rules of tort law on the states, despite its having no constitutional authority to do so. It is doubtful that Kerry or his running mate -- former personal injury lawyer Sen. John Edwards -- would support anything that allows patients to reveal how much they value the services of the trial bar.

The next greatest regulatory cost, according to Conover, is imposed by the Food and Drug Administration, which regulates medicines and medical devices. The FDA has long been criticized for delays in approving new medicines and for preventing patients from trying new therapies. Conover estimates those delays impose a net annual cost of $41.8 billion. A sensible way to cut down on unnecessary delays would be to let independent private agencies certify the effectiveness of new medicines, just as they now certify effectiveness for new uses of existing medicines. Yet neither Bush nor Kerry has issued a proposal that would reduce the lives lost to the FDA's delays or reduce the costs the FDA builds into the prices of prescription drugs.

Nor has either candidate proposed serious efforts to deregulate hospitals and other health facilities (net cost: $25.1 billion) or doctors and other health professionals (net cost: $7.1 billion).

To his credit, Bush has proposed allowing consumers to avoid expensive health insurance regulations by purchasing coverage from out-of-state insurers. In essence, this means your average Minnesotan would not have to purchase coverage for hairpieces (yes, hairpieces) or the 59 other types of coverage required by Minnesota law. Instead, he could purchase coverage from whatever state imposes regulatory costs that are more to his liking. If applied to all types of health insurance regulation, Bush's proposal could go a long way toward eliminating the net cost of such health insurance regulation ($14.4 billion).

There's more than just affordable coverage on the line here. Conover notes the more money people have, the better able they are to purchase greater health and safety. He estimates that by depriving Americans of $169 billion annually, health care regulations lead to 22,205 unnecessary deaths each year. The Institutes of Medicine estimate 18,000 Americans die each year from a lack of health insurance, making over-regulation a bigger problem than the uninsured. It would be nice if our politicians saw it that way.

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SURGICAL TRAINING RATIONALIZED IN BRITAIN

I suppose some people will criticize this but it sounds like a breaking down of bureaucratic barriers to me. I cannot conceive of ANYTHING that would take more than seven years of training

The amount of time that it takes for a medical student to qualify as a surgeon is to be cut by almost half in an effort to boost numbers and encourage more women to take up the specialty. Under the current medical curriculum, junior doctors must complete at least 12 years of postgraduate training to become a consultant surgeon. Major reforms of the tuition process, outlined yesterday by the Royal College of Surgeons, will allow trainees to be fast-tracked to consultants in as little as seven years.

The new system, which could see fully qualified surgeons as young as 30, is designed to speed the rise of junior doctors set on surgical specialties, most of whom currently spend years in general medical training. It is also hoped that the timetable - which will let doctors opt out and then rejoin the training programme - will also encourage more women into surgery who had feared sacrificing the chance to have children.

Hugh Phillips, president of the Royal College of Surgeons, said that it was vital that an outdated curriculum was overhauled to guarantee the highest quality of surgeons for future generations. Instead of leaving doctors drifting for years in junior roles, the new system would target those with an aptitude for surgery and fast-track them into their desired specialty, he said. "The arrangement for training is not efficient," he said. "How can we possibly accept a situation where young people spend up to five years at the level of a senior house officer without any sign of progress?" At present there are more than 3,500 senior house officers waiting to become specialist registrars - when a junior doctor develops surgical specialties - but less than half will eventually progress to this stage. Under the new system, they will be able to progress in just two years. "There are too many talented surgeons-in-training stuck at this grade," Mr Phillips said. "Not only is this wasteful of human resources, it makes for an insecure and difficult time at a crucial stage in the surgeon's career."

The new curriculum will be introduced in 2007, with pilot schemes due to start in England and Wales from next year. Mr Phillips, an orthopaedic surgeon, said there was also an urgent need to address the work pressures created by government targets that were preventing consultants from spending time passing on their expertise to junior doctors. "There is now an incentive which gives surgeons œ100 for treating an additional patient (to help to meet government targets)," he said. "I would rather surgeons were incentivised to train instead of taking the extra case. It may not appeal to ministers, but it has got be the way forward."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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