No, it's not very likely, at least in my lifetime, but who knows? I happened to catch some CNN on an airport TV while waiting for a delayed flight yesterday, and saw some coverage of (congressional?) hearings on concussions in football. CNN is a bit behind, as usual, because it ran this as 'breaking news' when these studies have been ongoing for a while, and Mr. Tipping Point wrote a very interesting article about it in the New Yorker recently.
Is watching tackle football really akin to dogfighting though? Not so sure about that conclusion. But I do know that while most societies consider themselves to be civilized, eventually some future culture looks back at certain aspects of said society and thinks, "those barbarians! how could they live in a world where _____ passed as entertainment! I'm glad we're more enlightened than they were back then." Is tackle football going to fill in that blank one day?
Showing posts with label health. Show all posts
Showing posts with label health. Show all posts
Thursday, October 29, 2009
Friday, August 14, 2009
Another Perspective on Health Care
This article from The Atlantic is certainly thought-provoking. Now, I can't vouch for the veracity of the author's statistics or other claims, but at face value it's a compelling article. A few items that I zeroed in on while reading it:
The author's proposed solutions (on page 6 of the article) are attractive and certainly seem to make sense, but I suspect that we're already stuck too far down in the system; if people are up in arms about relatively modest changes, how would we ever succeed in so fundamentally changing the way that health care is paid for?
- This excerpt below reminded me of Bjorn Lomborg's take on global warming, that's it's really not so bad, when compared with all the other bad stuff that we could be spending money trying to mitigate:
As a nation, we now spend almost 18 percent of our GDP on health care. In 1966, Medicare and Medicaid made up 1 percent of total government spending; now that figure is 20 percent, and quickly rising. Already, the federal government spends eight times as much on health care as it does on education, 12 times what it spends on food aid to children and families, 30 times what it spends on law enforcement, 78 times what it spends on land management and conservation, 87 times the spending on water supply, and 830 times the spending on energy conservation. Education, public safety, environment, infrastructure—all other public priorities are being slowly devoured by the health-care beast.
By what mechanism does society determine that an extra, say, $100 billion for health care will make us healthier than even $10 billion for cleaner air or water, or $25 billion for better nutrition, or $5 billion for parks, or $10 billion for recreation, or $50 billion in additional vacation time—or all of those alternatives combined?
- Why does health insurance work so differently from every other form of insurance?:
Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance. Most pregnancies are planned, and deliveries are predictable many months in advance, yet they’re financed the same way we finance fixing a car after a wreck—through an insurance claim.
Insurance is probably the most complex, costly, and distortional method of financing any activity; that’s why it is otherwise used to fund only rare, unexpected, and large costs. Imagine sending your weekly grocery bill to an insurance clerk for review, and having the grocer reimbursed by the insurer to whom you’ve paid your share. An expensive and wasteful absurdity, no?
Is this really a big problem for our health-care system? Well, for every two doctors in the U.S., there is now one health-insurance employee—more than 470,000 in total. In 2006, it cost almost $500 per person just to administer health insurance. Much of this enormous cost would simply disappear if we paid routine and predictable health-care expenditures the way we pay for everything else—by ourselves.
- We hear a lot about how other nations' citizens have it better-off because of universal coverage. That might be true, but evidently they're struggling with rising costs too (of course, their care costs, on average, are still much cheaper than ours):
Whatever their histories, nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits.
The author's proposed solutions (on page 6 of the article) are attractive and certainly seem to make sense, but I suspect that we're already stuck too far down in the system; if people are up in arms about relatively modest changes, how would we ever succeed in so fundamentally changing the way that health care is paid for?
Tuesday, August 11, 2009
Health Care Town Hall Hysteria Goes Local
Ben Cardin held a "town hall" meeting on health care in Towson last night, with predictable results. Yes, the polarization of this country continues, with lobbyists and interest groups pulling strings (on both sides) and opponents of reform - any reform - hoping that volume alone will win the day.
O.K., so maybe you think the government plan is socialized medicine. Could even be true, depending on which form the final plan takes, but is that the best you've got, roll out the specter of scary socialism and hope that it sends everyone running for the hills? Now go one step further, and tell us why that's so terrible. Can't do it? Words escape you? Too hoarse from shouting down your senator/congressman recently? How about you make an actual argument or shut up. There's enough real data out there to argue for or against health reform, but if you're too lazy to do so, by all means continue shouting. Eventually though, you'll lose your voice, so it's win-win either way; a meaningful discussion, or blissful silence.
O.K., so maybe you think the government plan is socialized medicine. Could even be true, depending on which form the final plan takes, but is that the best you've got, roll out the specter of scary socialism and hope that it sends everyone running for the hills? Now go one step further, and tell us why that's so terrible. Can't do it? Words escape you? Too hoarse from shouting down your senator/congressman recently? How about you make an actual argument or shut up. There's enough real data out there to argue for or against health reform, but if you're too lazy to do so, by all means continue shouting. Eventually though, you'll lose your voice, so it's win-win either way; a meaningful discussion, or blissful silence.
Wednesday, January 02, 2008
SiCKO, Part Four
Did you know that there's a House bill sitting in Congress right now that creates a universal health care system? H.R. 676 was introduced by John Conyers last January, and was referred to subcommittee in February. What do you want to bet that it never finds its way out of committee for a vote?
I think it was Bill Maher who identified this brilliant Republican strategy of proclaiming that the federal government doesn't work and needs to be smaller, then they fuck it up and say "See?!?" Or something along those lines. Well, it's true, but they're not the only ones destroying government these days. Neither party has a stranglehold on corruption and incompetence. But despite their best efforts, there are some things that the feds do well, do OK, or used to do well. They built the federal highway system, created Social Security, and are good at fighting wars (whether the war is justified, and how the aftermath is managed, is another matter entirely). The administrative costs of existing federal health programs such as Medicare and Medicaid are a fraction of private providers' costs, about eight times less. The EPA and Department of the Interior, even while currently hamstrung by the White House, are still working for a cleaner environment and maintaining public parks and open spaces. U.S. attorneys, despite shaky/criminal leadership at the top, are still going after political corruption and organized crime.
Despite all this, there is still reticence about universal coverage. But what do we have to lose? There's widespread acknowledgment that the system is broken, so how are incremental steps to fixing the flawed privately-managed patchwork of health insurance going to help? Sure, people don't want to be taxed more, but if you can show people the numbers, and that any additional taxes would be less than their current premiums plus deductibles plus co-pays, what else is standing in the way? This idea that government will screw it up doesn't hold water, when comparing the two scenarios.
The existing scenario is privatized health care; a provider is interested primarily in providing a good return on shareholders' investments. There is financial incentive to deny costly procedures, while maintaining a minimum level of satisfaction. Why minimum? Well, since so much health care is employer-sponsored, not many people have a choice of who will insure them. Yes, there is often a choice of plans, but the provider is not negotiable. These companies have a captive audience, so to speak, so the level of service must simply reach a level where the company isn't getting the bad publicity that can be detrimental to earnings. Under the current arrangement, your health and personal finances are in jeopardy, should you be denied a claim or if a medical professional or administrator screws up.
Under a universal care scenario, let's assume you're paying about the same; more in taxes, but no premiums or deductibles, so it's a wash. The doctors stay the same, but they're paid by the government. The government administers the system, which they've already proven - with Medicare and Medicaid - that they can do more efficiently than private insurers. There is no incentive to deny care, there's only incentive to keep people healthy. Like docs in Britain, medical professionals would earn bonuses based on health improvements of their patients (accountability!). Yes, there would be screw-ups, but since the whole system doesn't have co-pays or deductibles, the only mistakes are going to be by the doctors, and those will happen no matter what system you're under. In other words, you can't be bankrupted by paying out-of-pocket for the coverage you need.
OK, time to move on, since a four part post on health care probably decimated my already minuscule readership [I'm guessing that it dropped from 5 people down to 2 or 3].
I think it was Bill Maher who identified this brilliant Republican strategy of proclaiming that the federal government doesn't work and needs to be smaller, then they fuck it up and say "See?!?" Or something along those lines. Well, it's true, but they're not the only ones destroying government these days. Neither party has a stranglehold on corruption and incompetence. But despite their best efforts, there are some things that the feds do well, do OK, or used to do well. They built the federal highway system, created Social Security, and are good at fighting wars (whether the war is justified, and how the aftermath is managed, is another matter entirely). The administrative costs of existing federal health programs such as Medicare and Medicaid are a fraction of private providers' costs, about eight times less. The EPA and Department of the Interior, even while currently hamstrung by the White House, are still working for a cleaner environment and maintaining public parks and open spaces. U.S. attorneys, despite shaky/criminal leadership at the top, are still going after political corruption and organized crime.
Despite all this, there is still reticence about universal coverage. But what do we have to lose? There's widespread acknowledgment that the system is broken, so how are incremental steps to fixing the flawed privately-managed patchwork of health insurance going to help? Sure, people don't want to be taxed more, but if you can show people the numbers, and that any additional taxes would be less than their current premiums plus deductibles plus co-pays, what else is standing in the way? This idea that government will screw it up doesn't hold water, when comparing the two scenarios.
The existing scenario is privatized health care; a provider is interested primarily in providing a good return on shareholders' investments. There is financial incentive to deny costly procedures, while maintaining a minimum level of satisfaction. Why minimum? Well, since so much health care is employer-sponsored, not many people have a choice of who will insure them. Yes, there is often a choice of plans, but the provider is not negotiable. These companies have a captive audience, so to speak, so the level of service must simply reach a level where the company isn't getting the bad publicity that can be detrimental to earnings. Under the current arrangement, your health and personal finances are in jeopardy, should you be denied a claim or if a medical professional or administrator screws up.
Under a universal care scenario, let's assume you're paying about the same; more in taxes, but no premiums or deductibles, so it's a wash. The doctors stay the same, but they're paid by the government. The government administers the system, which they've already proven - with Medicare and Medicaid - that they can do more efficiently than private insurers. There is no incentive to deny care, there's only incentive to keep people healthy. Like docs in Britain, medical professionals would earn bonuses based on health improvements of their patients (accountability!). Yes, there would be screw-ups, but since the whole system doesn't have co-pays or deductibles, the only mistakes are going to be by the doctors, and those will happen no matter what system you're under. In other words, you can't be bankrupted by paying out-of-pocket for the coverage you need.
OK, time to move on, since a four part post on health care probably decimated my already minuscule readership [I'm guessing that it dropped from 5 people down to 2 or 3].
Monday, December 31, 2007
SiCKO, Part Three
So how is it that we have a health care "system" here in the U.S. that provides such mediocre care, on average, but costs so much more money per capita than other nations' systems? First, there are the problems that are specific to the health care industry; you may have heard some of these before, and some of them are actually true:
Meanwhile, back home we're stuck with an inept, corrupt government that few people trust. We have an entrenched two-party political system, strengthened by ridiculous congressional redistricting that protects incumbents. We have spectacularly expensive legislative and presidential campaigns that are almost entirely privately funded by corporations and trade groups. We have a Supreme Court that equates political donations with free speech, which serves to legalize this corruption. We have lobbyists that write legislation. We have ludicrous taxpayer-funded projects. We not only have private health care, but an increasingly privatized military. We have out-of-control educational expenses, expenses that are unheard of in other industrialized countries that provide free higher education to citizens. When that's the government that most Americans see, how could they ever be convinced to let it be in charge of their health? Looks like I am gonna need a Part Four....
- The health insurance bureaucracy eats over 30 percent of all health care costs.
- Blame the lawyers! Medical malpractice insurance stemming from huge lawsuit awards drive up costs. Not really: malpractice premiums are less than 1% of total health care costs, according to the AMA. "Defensive medicine" administered to help guard against malpractice claims is estimated to be 2% of total costs.
- Too many doctors! You've probably heard that the opposite will be the problem as the Baby Boom generation ages, but it may just be that there are too many specialists and not enough primary care physicians.
Meanwhile, back home we're stuck with an inept, corrupt government that few people trust. We have an entrenched two-party political system, strengthened by ridiculous congressional redistricting that protects incumbents. We have spectacularly expensive legislative and presidential campaigns that are almost entirely privately funded by corporations and trade groups. We have a Supreme Court that equates political donations with free speech, which serves to legalize this corruption. We have lobbyists that write legislation. We have ludicrous taxpayer-funded projects. We not only have private health care, but an increasingly privatized military. We have out-of-control educational expenses, expenses that are unheard of in other industrialized countries that provide free higher education to citizens. When that's the government that most Americans see, how could they ever be convinced to let it be in charge of their health? Looks like I am gonna need a Part Four....
Saturday, December 29, 2007
SiCKO, Part Two
Michael Moore's website has a nice page that provides references to many of the assertions in SiCKO, it's definitely worth a look. I did take notice of a few of the film's facts that didn't sound quite right, however, that I wanted to check out myself. This also led me to seek out other bits of data:
- France has more productive workers than the U.S.? I could have sworn that the U.S. was at or near the top of the latest OECD statistics in this category, but I could be wrong. Alas, the link on Moore's website that leads to the specific OECD page is broken, so I had to look around a bit. I also kept in mind that whatever OECD numbers Moore was using were 2005 numbers; current stats may tell a different story, but one would think that these types of metrics wouldn't change all that much in a two-year period. I found my way to the OECD database portal, which as productivity data as of October 2006. For some reason the sort function didn't work, so I pulled the numbers offline, but this is what I found:
- surprisingly, the U.S. ranks 18th in hours worked per person - I assumed that this would be higher! We're waaaay behind the #1 country, South Korea, which has us beat by over 600 hours per year (2357 vs. 1708). Good for us! France, by the way, weighs in with 1555 hrs/yr/person, good if you can get it!
- When it comes to GDP per hour worked, we're #6 at $50.4 per, which is well behind leaders Luxembourg and Norway, which are at $72.2 and $71 respectively. Why is Norway's number so high, oil money? Ikea? Wait, that's Sweden. Anyway, France is right behind the U.S. at $49.9. Close enough that it could very well be that it was slightly different in 2005, and France was ahead that year.
- Searching for this data led me to what looks to be a pretty neat blog, The Big Picture, that I'm going to check out in greater detail a bit later. The particular entry that popped up as I was searching for productivity stats was this one, which is worth a quick read. It makes some fantastic - and succinct! - points about the future of America's economic might, and how current policies could cause problems for our economic engine going forward. One of my favorite questions also pops up in that post; who would/could sacrifice money-based wealth for time-based wealth? I know where I stand, which is why at some point in this SiCKO informational odyssey, I'll be looking up immigration policies of other countries...just for fun ;)
- Looking up OECD statistics in one's spare time ranks in the top five of most pathetic uses of free time for non-retired persons.
- The most recent United Nations Human Development Report (link to pdf) ranks the U.S. at #12, ahead of #14 U.K. but behind #10 France and well behind #4 Canada (the countries Moore visits in SiCKO). Our high per capita GDP boosts us up the list, while we take a hit for slightly lower life expectancy and eduction stats. Cuba ranks #51, with its low GDP number dragging it down but with life expectancy 0.2 years higher than the U.S. and its education score higher as well. All sorts of neat stats are available in this U.N. report! A few favorites that I picked out:
- Our use of coal has remained steady from 1990 to 2005, while it has dropped, sometimes precipitously, in Europe. The U.K. dropped from 29.7% to 16.1%; that's impressive. While in Japan, Israel, and Australia, coal use has actually increased. Yuck.
- Electricity consumption per capita - the U.S. isn't quite as bad as I thought, although when one considers the latitudes of the nations that consume more than us, then the U.S. numbers seem awful. Too bad we're so averse to paying more for efficient, long-lasting appliances.
- Hmmm, I don't think we're nearly as generous, as a nation, as we think we are.
- Finally, a metric that the U.S. leads the world in, health expenditures per capita!
- We also kick ass in homicide rate, although plenty of South and Central American and Eastern European countries have us beat. We'll have to work on that....
- How do these countries that provide universal health care do it? It's hard to find reliable tax data - the rates tend to be all over the place, depending on which site one visits - plus there are ranges due to tax brackets, and then VAT taxes and local/state taxes also throw wrenches into any objective comparison. But here goes:
- The World Taxpayers Associations indicate that the U.S. has it pretty good when it comes to tax rates.
- Wikipedia's numbers seem to indicate that, when one factors in state taxes and sales taxes, maybe the average U.S. citizen is being taxed like Europe and Canada.
- None of these sites provide a comparison of effective tax rate - how do I know if France gets all the deductions and credits that an America provides? Do they get more deductions? Fewer? This is almost impossible to figure out.
- Back to the OECD - Table 0.2, near the bottom of the page, indicates that the U.S. worker pays less than most other OECD nations in terms of income tax and social security contributions. That's actually quite reassuring - we're not paying too much for all those government services that we don't receive!
Friday, December 28, 2007
SiCKO, Part One
We watched SiCKO last night; maybe not the best film to watch during the holiday season, as it doesn't exactly leave one feeling warm and cuddly afterwards, but it was next on the Netflix queue.
How was it? Well, I would definitely give it 4 out of 5 stars, but there are caveats. I happen to be a Michael Moore fan - he's a great entertainer, he's provocative, and for better or worse, he gets people talking about the issues that his films present. No, he's not a journalist, he's not fair and balanced, but that's not his job, he obviously has an agenda and he's not trying to hide it. If you watch one of his movies thinking that you're going to get both sides of the story, you're going to be just as disappointed as if you were to approach Fox News or Salon.com with the same expectations. Not gonna happen. If you're looking for a documentary that presents facts without emotion, again, good luck. One of his most effective tools is giving a human face to the given issue, something that the evening news does all the time, albeit much more subtly and less effectively. One perfectly valid criticism of his past movies is that he's on screen too much, pulling dumb stunts that likely hurt his cause as much as help it. OK, I'll buy that, even if the stunts are usually entertaining. SiCKO, fortunately, moves away from the Fahrenheit 9/11 in-your-face style; Moore doesn't even make an on-screen appearance until the film's half over, and the publicity stunts are limited to a silly trip to Cuba at the end of the film that unfortunately isn't entertaining or effective (you want a good Cuba documentary, try Buena Vista Social Club, awesome movie).
It might be his best movie since Roger and Me in terms of content, but it's also the most frustrating film he's made. I think you would need three or four sequels to do this problem - health care in the U.S. - any justice, but even so there aren't enough Whys being asked in SiCKO. It doesn't take a genius to figure out that health care in the U.S. is fucked up, but why? It's helpful to point out countries such as Canada, Britain, and France where universal government-run care seems to be working, since I'm sure there are plenty of Americans that are ignorant that there are these kinds of systems in place that people are happy with, but how do they make it work? At one point, Moore asks a French doctor whether the national model that's in place in France would work in the U.S. He says "No", then walks away...what, no follow up? Just 'No'?!? I'm not expecting that this doctor would have all the answers, but I was waiting for someone on screen to at least attempt to explain this mess. It's easy to tag Richard Nixon with the blame, as Moore does at one point, but there is no possible way that it's that simple. I have my own theories and suspicions about who and what is to blame, but in the interest of brevity I'll save those for another post. There are also zero suggestions on how to fix the obviously broken American system.
I'll be spending at least one more entry on this topic, picking out scenes and themes from the film, delving into fact vs. fiction, checking some numbers, and searching for any practical ideas for fixing the system. Universal health care is also a great jumping-off point for discussions about the role of government in our lives, so who knows what tangential topics might end up being put in play - taxes, education, infrastructure, libertarians?
How was it? Well, I would definitely give it 4 out of 5 stars, but there are caveats. I happen to be a Michael Moore fan - he's a great entertainer, he's provocative, and for better or worse, he gets people talking about the issues that his films present. No, he's not a journalist, he's not fair and balanced, but that's not his job, he obviously has an agenda and he's not trying to hide it. If you watch one of his movies thinking that you're going to get both sides of the story, you're going to be just as disappointed as if you were to approach Fox News or Salon.com with the same expectations. Not gonna happen. If you're looking for a documentary that presents facts without emotion, again, good luck. One of his most effective tools is giving a human face to the given issue, something that the evening news does all the time, albeit much more subtly and less effectively. One perfectly valid criticism of his past movies is that he's on screen too much, pulling dumb stunts that likely hurt his cause as much as help it. OK, I'll buy that, even if the stunts are usually entertaining. SiCKO, fortunately, moves away from the Fahrenheit 9/11 in-your-face style; Moore doesn't even make an on-screen appearance until the film's half over, and the publicity stunts are limited to a silly trip to Cuba at the end of the film that unfortunately isn't entertaining or effective (you want a good Cuba documentary, try Buena Vista Social Club, awesome movie).
It might be his best movie since Roger and Me in terms of content, but it's also the most frustrating film he's made. I think you would need three or four sequels to do this problem - health care in the U.S. - any justice, but even so there aren't enough Whys being asked in SiCKO. It doesn't take a genius to figure out that health care in the U.S. is fucked up, but why? It's helpful to point out countries such as Canada, Britain, and France where universal government-run care seems to be working, since I'm sure there are plenty of Americans that are ignorant that there are these kinds of systems in place that people are happy with, but how do they make it work? At one point, Moore asks a French doctor whether the national model that's in place in France would work in the U.S. He says "No", then walks away...what, no follow up? Just 'No'?!? I'm not expecting that this doctor would have all the answers, but I was waiting for someone on screen to at least attempt to explain this mess. It's easy to tag Richard Nixon with the blame, as Moore does at one point, but there is no possible way that it's that simple. I have my own theories and suspicions about who and what is to blame, but in the interest of brevity I'll save those for another post. There are also zero suggestions on how to fix the obviously broken American system.
I'll be spending at least one more entry on this topic, picking out scenes and themes from the film, delving into fact vs. fiction, checking some numbers, and searching for any practical ideas for fixing the system. Universal health care is also a great jumping-off point for discussions about the role of government in our lives, so who knows what tangential topics might end up being put in play - taxes, education, infrastructure, libertarians?
Wednesday, May 30, 2007
Mad Cow 'Conservatives'
This Republican administration standing up for the free market? One might think so, but apparently not. Al really got it right with the title of the new book; Assault on Reason indeed.
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