Posts Tagged ‘health’

‘This American Life’ on Healthcare

Thursday, November 5th, 2009

The two recent This American Life episodes about the American healthcare system were both incredibly informative and really great radio. These segments fundamentally changes my thoughts about the nature of the healthcare problem. I learned a lot from them and I think it’s likely you would, too. Free downloads on these pages:
More is Less
Someone Else’s Money

I’ll comment on a few thoughts distilled from these episodes soon.

Health and Opportunity

Thursday, November 5th, 2009

I’ve had serious writer’s block about this topic for a while, so I’m using the old “lower your writing standards and go for it” method that allows most of these posts to be written.

Why would society owe people health care? We don’t have mandates for a lot of other important things, and it seems that the default answer to this question should be ‘no’. People are not owed success, but they are owed an opportunity to succeed. The more I think about it, the more it seems like the health care system as it is robs many, many people of this opportunity.

According to NCHC:

A recent study found that 62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Of those who filed for bankruptcy, nearly 80 percent had health insurance.

(and I’ve seen similar numbers elsewhere)

If a family member is uninsured and is suddenly stricken with a serious, expensive illness, that family loses a tremendous amount of financial freedom. Will they be able to send their kids to college? Will they be able to try a new work venture? Tied down by extraordinary expenditures, it seems to me like they’re not nearly getting a fair opportunity to succeed.

Health and class

Tuesday, October 13th, 2009

My Mom sent me this NYT article a little while ago… I highly recommend it:
Life at the Top in America Isn’t Just Better, It’s Longer
The article describes three people having a heart attack and how their socioeconomic position affected their treatment and recover. Definitely worth reading.

Antibiotics in animals

Monday, October 5th, 2009

I meant to pass this along a while ago…

Food animal production accounts for 70 percent — 70 percent! — of the antibiotics used in the United States. That doesn’t even include the antibiotics used for animals that actually get sick.

source

The cost of healthcare

Sunday, September 27th, 2009

I found this map from CNN showing health care costs, percentage of government-run care, etc. The most striking thing to me was the health care spending per capita.

A few selected countries (ordered by increasing life expectancy):
– USA: $6714
– UK: $2939
– France: $4056
– Canada: $2754
– Sweden: $3143

Just examining a couple of variables leaves quite a bit out, of course, but for me these numbers make arguments about abuse in public options seem a lot less convincing. Even if we have “the best health care in the world”, as some claim, I haven’t seen much convincing evidence that it’s /that/ much better.

I wondered if this might have something to do with exorbitant medical malpractice claims, but it turns out that’s not the case. According to the Congressional Budget Office:

Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2 percent of overall health care spending.

(from CBO.gov)

Quite a divide

Wednesday, September 9th, 2009

Taking a quick break from work to write a bit..

I haven’t seen any of Obama’s speech, but this sentence on the FiveThirtyEight liveblog struck me:

Note, though, that many Republicans didn’t stand up and clap when Obama said “no one should go broke because they get sick.”

That’s a real fundamental value difference between the sides of the debate. I think how you answer that question really defines where you want to go from here.

The tie between bankruptcy and medical problems is quite clear and seems to be getting stronger, according to the Washington Post earlier this year:

Sixty-two percent of all bankruptcies filed in 2007 were linked to medical expenses, according to a nationwide study released today by the American Journal of Medicine. That’s nearly 20 percentage points higher than that pool of respondents reported were connected to medical costs in 2001.

Of those who filed for bankruptcy in 2007, nearly 80 percent had health insurance.

That last sentence never ceases to amaze me.

T.R. Reid interview

Friday, September 4th, 2009

Mandatory listening for anyone interested in the healthcare debate:
Fresh Air’s interview with T.R. Reid. The description from NPR:
“Journalist and author T.R. Reid set out on a global tour of hospitals and doctors’ offices, all in the hopes of understanding how other industrialized nations provide affordable, effective universal health care.”

You should really listen to it, but a few notes of things that struck me…

No rich country other than the US lacks universal coverage of some sort. I don’t know how this is defined: what’s the 2nd-richest country to lack universal coverage. Reid divides health care into four camps: UK-style socialist structures, Canadian-style public insurance with private doctors, German-style employer-based healthcare, and 3rd-world-country style “good luck!”. America includes all of these systems. If you have insurance through employment, you’re probably in the German system. If you’re on medicare you’re in a Canadian system. If you’re a veteran or American Indian, then you’re in a UK-style system. If you’re unemployed and uninsured, you’re in the 3rd-world-style system (though you of course have better emergency room access than most 3rd-world people). The author claims, sensibly, that a large part of the out-of-control costs that we have in the US are because we have to implement all of these separate systems. (More on cost soon)

Seriously, though, listen to the interview.. Reid is very non-ideological and does a good job of pointing out the real pros and cons of the things he experienced in each system.

Franken on health care

Friday, September 4th, 2009

Al Franken’s discussion with some constituents (including real skeptics) about health care is worth your time:

This is the first time I’ve heard a politician talk about health care and sound rather convincing (that includes the small amount I’ve heard from Obama).

(via boing boing, who incorrectly referred to the group as an “angry mob”, IMO)

Rationing

Thursday, September 3rd, 2009

The term “rationing” has been thrown around a lot in health care discussions. If we have government control, we’re going to have to ration, they say. They’re right, given a finite budget and resources, it’s necessary to ration what procedures can be done. But, importantly, it’s a fallacy to believe that there’s no rationing in the current system. The market is a device for allocating limited resources: it’s the rationing agent. It allocates the resources to those who can afford them, basically. There’s nothing inherently wrong with this, but to present the choice as “do we want rationing?” is disingenuous. The question is: what kind of rationing do we want?

The best health care system

Tuesday, August 25th, 2009

I was talking to my Mom, who teaches nursing, about health care last weekend. She made the point that a sign of the quality of the American health care system over that of other countries is that people from Canada come here for surgeries sometimes (and pay for it!). This does happen, but I’m not truly convinced by the implication of it.

One meaningful thing that I think a whole lot of people involved in the healthcare debate can agree on is this:
The American health care system is the best health care system in the world for wealthy people.

While I’m not quite sure that this is 100% correct, it’s certainly a lot more correct than it would be without the last few words.

Despite our expenditures (more on that later), we’re 50th in life expectancy, at least 33rd (lowest) in infant mortality, and the WHO ranks our overall health system as 37th in the world in overall quality.

Some more information about the WHO’s methodology is here, and in fact the US did well in one of the components of the performance index:

Responsiveness: The nations with the most responsive health systems are the United States, Switzerland, Luxembourg, Denmark, Germany, Japan, Canada, Norway, Netherlands and Sweden. The reason these are all advanced industrial nations is that a number of the elements of responsiveness depend strongly on the availability of resources. In addition, many of these countries were the first to begin addressing the responsiveness of their health systems to people’s needs.

I’m not entirely sure what this means in practice, but I can’t think of any other (good) health stats in which the US leads the list.

No one measure is a good summary of the quality of a health measure, as the systems are hopelessly complex. The WHO stopped doing the index in 2000 for this reason (and maybe some political ones..). Life expectancy seems like a good measure in general, since that’s a main point of these systems, but the inputs are completely different. Americans live differently, eat differently, drive more, and shoot each other more than most countries on the list.

The ‘best’ system must take cost into account, something the WHO did. A healthcare system that lest you live a year longer, but at twice the annual cost for your whole life probably isn’t an improvement.