To hear some folks tell it, budget cuts in Virginia over the past three to four years have been so savage it’s a miracle there’s any state government left. We long ago cut out all the fat and hacked through the muscle; now we’re sawing deep into bone. Localities are scared stiff that the state will stiff them come January. And it’s only going to get worse. Gov. Bob McDonnell has had state agencies prepare plans cutting 2 percent, 4 percent, and 6 percent from their budgets. The stories have grown numbingly familiar.

Still: The general fund has grown roughly $1 billion from last fiscal year to this one. That represents about a 6 percent hike. So why is the governor asking agencies to plan for cuts?

… For example: From fiscal 2008 to fiscal 2012, general-fund outlays for the Department of Medical Assistance Services (that’s the one responsible for administering Medicaid and the state’s Children’s Health Insurance Program) have grown 35 percent. General-fund revenue hasn’t grown anything like that, so the difference has to come from the pockets of other programs.

Huh. Maybe we really should talk about reforming Medicaid.

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Education used to make up a bigger share of state spending. When the association first began compiling the report in 1987, elementary and secondary education made up the biggest share of state spending, and higher education the second-biggest share. Medicaid surpassed higher education as the second-biggest state program in 1990, and in 2003 it became largest state program for the first time. Since then it has vied with schools for the biggest share of state spending, but for the past three years it has been in the lead, with an increasing margin.

Maybe it’s time to consider reforming Medicaid? Before it eats up state budgets completely? And maybe we could do it without demonizing the one party that’s willing to talk about it? (Hello, Congressman Paul Ryan.)

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The bill barred insurers or employers from forcing patients to use mail-order plans for prescription drugs, except for plans negotiated by unions. Instead, consumers would be guaranteed the choice of having their prescriptions filled either through mail-order or at the local drugstore, without any added copayments or fees.

So, at a time when health plans are under tremendous pressure to cut premiums (or at least to raise them as little as possible), the Governor is going to raise health plans’ costs? Not exactly.

But the governor signed both bills late Monday on the condition that the Legislature would retroactively amend them to require retail pharmacies to accept the same reimbursement rates for drugs as mail-order pharmacies.

Oh, okay. The Governor is going to force small mom-and-pop stores to lose money on every prescription that they fill. Yeah, that’s going to work out well. <sarcasm />

There’s absolutely no good way to fulfill this requirement without raising somebody’s costs. The patient’s preference for locally filled prescriptions is more expensive. By rights, patients should pay for that preference. Instead, the Governor is looking to make someone else pay instead. That’s always a bad idea and this is going to end up back-firing.

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• Complex Systems Cannot Be Managed from the Top, Down
• The Core Components of Complex Systems Cannot Be Copied
• Choosing Public Policies for Complex Systems
• Public Policy Lessons

Most people in health policy do not understand complex systems. They really don’t understand social science models either. As a result, when they advocate or enact public policies, they are almost always oblivious to the inevitability of unintended consequences. The idea that a policy based on good intentions could actually make things worse is beyond their comprehension.

Speaking as someone who works in healthcare: yup. Every time healthcare people get together in large numbers, I see the belief that they can figure out a master plan, using the power of good intentions to make everything better. (Usually, of course, without using any evil profits either.)

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• Complex systems can never be accurately modeled
• There is no reliable model of the health care sector
• Complex systems have unintended consequences
• Implications of unintended consequences.

The key take away is that it’s impossible to centrally plan a complex system and that trying to do so is generally counterproductive.

Why are unintended consequences so important? Because in trying to solve one problem we can create other problems. Also in trying to solve problems, we can end up making them worse. ObamaCare has three principal goals: control costs, raise quality and increase access to care. Yet there is no model which allows us to predict that any of the three objectives will be even partially achieved. In fact, readers of this blog know that we expect all three problems to get worse.

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Ms. Traweek focuses on Texas’s ridiculously restrictive regulations but it’s a question that other States should examine as well.

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The U.S. Centers for Disease Control and Prevention estimates that nearly 1% of children across the country have some form of autism — 20 times the prevailing figure in the 1980s. The increase has stirred fears of an epidemic and mobilized researchers to figure out what causes the brain disorder and why it appears to be affecting so many more children. Two decades into the boom, however, the balance of evidence suggests that it is more a surge in diagnosis than in disease.

via Instapundit

There’s a lot of quotable stuff in this article. Do, please, read the whole thing. I do think that a lot of the increase in “autism” is really an increase of paranoid parents not of disabled children.

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Over the next two months, Garfield was subjected to repeated probing of the wound with unsterile fingers and instruments, non-aseptic incisions to drain abscesses, and other invasive procedures in an effort to locate the bullet, which was, in fact, located harmlessly in fatty tissue behind the pancreas. Eventually, the original three-inch deep wound was converted to a twenty-inch long contaminated, purulent gash stretching from the president’s ribs to his groin.

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Her mother couldn’t remember the names of close relatives or what day it was. She thought she was going to work or needed to go downtown, which she never did. And she was often agitated.

A workup at a memory clinic resulted in a diagnosis of early Alzheimer’s disease, and Ms. Katz was prescribed Aricept, which Ms. Atkins said seemed to make matters worse. But the clinic also tested Ms. Katz’s blood level of vitamin B12. It was well below normal, and her doctor thought that could be contributing to her symptoms.

Weekly B12 injections were begun. “Soon afterward, she became less agitated, less confused and her memory was much better,” said Ms. Atkins. “I felt I had my mother back, and she feels a lot better, too.”

Now 87, Ms. Katz still lives alone in Manhattan and feels well enough to refuse outside assistance.

Still, her daughter wondered, “Why aren’t B12 levels checked routinely, particularly in older people?” . . . A severe B12 deficiency results in anemia, which can be picked up by an ordinary blood test. But the less dramatic symptoms of a B12 deficiency may include muscle weakness, fatigue, shakiness, unsteady gait, incontinence, low blood pressure, depression and other mood disorders, and cognitive problems like poor memory.

Have you had your vitamin levels checked recently? (Or the levels of your loved ones?)

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The concept of opportunity cost allows us to see that if we don’t trust spending totals in the international accounts, there is another way to assess the cost of health care. We can count up the real resources being used. Other things equal, a country that has more doctors per capita, more hospital beds, etc., is devoting more of its real income to health care than one that uses fewer resources — regardless of its reported spending.

On this score, the United States looks really good. As the table below (from the latest OECD report) shows, the U.S. has fewer doctors, fewer physician visits, fewer hospital beds, fewer hospital stays and less time in the hospital than the OECD average. We’re not just a little bit lower. We are among the lowest in the developed world. In fact, about the only area where we “spend” more is on technology (MRI and CT scans, for example), as is reflected in the second table.

We might be able to see these lower costs if we could only get some real price competition into the market.

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