I think this debate shows a fundamental lack of vision, a lack of confidence, a lack of understanding of what's possible.
Also from PM, last March: 20 New Biotech Breakthroughs that Will Change Medicine.
Via The Agenda.
Also from PM, last March: 20 New Biotech Breakthroughs that Will Change Medicine.
Via The Agenda.
As noted earlier, Princeton economist Uwe Reinhardt bemoans the confusion and opacity surrounding health pricing.
Someone is doing something about that. The Surgery Center of Oklahoma has a public schedule of prices for common procedures. Furthermore, it has heard the term "competition."
Gee, Congress better act quickly, because if this approach catches on it might not be necessary to enact a health care takeover bill that channels vast sums to favored interest groups, and then where would our politicians be?
Classical Values points out that a dog can get better and cheaper care than a person. He muses:
A presentation by Dr. Arthur Robinson explains at least some of the difference:
An audio of his whole presentation is here.
A number of posts here have emphasized the importance of policies that promote (or at least avoid deterring) health care innovation.
CLI's interests extend far beyond health care -- to areas of broadband and telecom, intellectual property, software, innovation (collaborative and proprietary). And one of our fundamental points is that all of these interests are connected.
See, for example, this note by Anoop Gupta, Microsoft VP for Technology Policy & Strategy, on Moving a National Broadband Plan Forward:
For example, at Microsoft we envision a connected health ecosystem that enables predictive, preventive, and personalized care. Telehealth technologies can be used to remotely monitor patients, facilitate collaboration between medical professionals, exchange medical data and images, and instantaneously provide efficient emergency service to remote areas. We see medical research increasingly benefiting from the HUGE amounts of patient and genomics data for drug discovery and personalized medicine.
He links to a letter recording a tele-meeting with FCC Chairman Genechowski and CEOs John Chambers (Cisco); Steve Ballmer (Microsoft); Jeffrey lmmelt (GE); and Steve Hemsley (UnitedHeath) at which the sectoral breadth of the broadband plan was emphasized.
To talk of "broadband policy" is misleading. You can't think effectively about broadband policy as a pure abstraction. You also need to think health care policy, education, and energy.
It works in reverse, too, in that thinking about these substantive areas requires consideration of the capabilities of broadband.
The FCC, in developing a broadband policy, is also developing health care policy, and energy policy,a nd so on. Example: Net neutrality, in its strong form of uniform treatment of all bits, whether related to the latest P2P piracy or on-line surgery, would do a lot to prevent innovation in medical services.
A WSJ column today by Brit Rupert Darwell makes a crucial point about "what might be termed the 'lump of health care' fallacy," in which "health-care resources are assumed to be fixed, [so] those resources should be prioritized for those who can benefit most from medical treatment." In contrast:
Exactly. Government health care makes us all into political pleaders rather than customers. The health care budget is set irrespective of demand by the public as consumers, and various disease-related interest groups then lobby to get bigger shares of this politically-determined pie.
One likely outcome -- suppression of innovation. New treatments are usually expensive because they lack a broad base over which to spread the costs, and research is certainly expensive, so innovation looks bad from the stand-point of short-term, static cost-benefit analysis.
There is a bit of karmic justice here. Seniors (a group of which I am a reluctant member) have asserted that they have a "right" to have their health care subsidized by the rest of society, so they voluntarily gave up their autonomy as customers in favor of their electoral clout. It's a good scam, but eventually the burden becomes too great and there is indeed a backlash against us greedy geezers.
The moral: it is better to be a customer rather than a supplicant.
Jeffrey Flier of the Harvard Medical School has written a fine piece on health care reform, making the basic point that cures must start with the proper diagnosis, and that this is sadly missing from the health care debate. For example:
First, there is our inefficient and inequitable system of tax-advantaged, employer-based health insurance. While the federal tax code promotes overspending by making the majority unaware of the true cost of their insurance and care, the code is grossly unfair to the self-employed, small businesses, workers who stick with a bad job because they need the coverage, and workers who lose their jobs after getting sick.
This employer-based system arose not by thoughtful design but as an unforeseen result of price controls during World War II and subsequent tax policy. How this developed and persisted despite its unfairness and maladaptive consequences is a powerful illustration of the law of unintended consequences and the fact that government can take six decades or more to fix its obvious mistakes.
He fears the pig-in-a-poke nature of the current bills:
Some have proposed that comprehensive reform must be achieved quickly, capitalizing on a sense of crisis. I see unacceptable risks to this approach. Instead of achieving a far-reaching and necessary solution for our economy and the nation’s health, the necessity of pleasing enough special interests to get a bill passed will exacerbate our long-term crisis of cost and access. Who can tell what deals within a thousand-page bill that few, apart from lobbyists, have read will influence the state of health care for decades to come?
He is right -- especially because Washington has thousands of lawyers trying to plant exactly such long-term time bombs, and brandishing the cash to do it. To requote Collis P. Huntington: "I think this coming session of Congress will be composed of the hungriest set of men that ever got together, and that the d____ only knows what they will do."
Mother Jones has a graph illustrating comparative health care costs, from which it concludes the conventional "the U.S. spends too much."
Coyote blog raises the eternal question about such data: "Is this a bug or a feature?"
My guess is that you could draw the same chart in the same shape with the US on the far left for consumption of items as diverse as “big screen TVs” and “pro sports tickets.” We would chalk up spending in any other area as simply a result of wealth. Why not on health care? Why is it so bad that we spend more money on something like health care which is arguably less frivolous and more critical than TV’s or baseball games?
(There's more -- RTWT).
Coyote is right. In fact, Robert Fogel, in his NBER paper, which has more detail than his American article (and will cost you $5), looks at changes in U.S. consumption patterns from 1875 to the present. A striking number is the reduction in the costs of the basics -- food, shelter, clothing took 74% of income in 1875; 13% in 1995. This has freed up a lot of income, and one of the great gainers has been health. In 1875, it took only 1% of consumption, largely because there was little to be bought, except for patent medicines loaded with alcohol and opiates, or a saw to lop off an injured limb. By 1995, it was 9%.
Leisure was another big gainer -- 17% in 1875; 68% in 1995.
So if improvements in medical technology lead people to reallocate money toward health, fine.
But it goes beyond technology. I am an acolyte of the benefits of massage therapy for many ills, including post-operative recovery. Indeed, my neurosurgeon brother tells me that massage was once a crucial part of orthopedic practice, but was dropped out because it is labor intensive. So if rising incomes enable people to afford such a useful but low tech service, also fine. (Do not be deceived by the term "low-tech" -- the tech component is small but the skill level is high and the training required is extensive.)
Acupuncture is good, too; also low-tech, high skill, high pay-off.
Nobel prizer Robert Fogel has a piece at The American on Forecasting the Cost of U.S. Healthcare which puts some analytic muscle behind the view that increases in income lead to increases in health expenditures, and that maybe we should be spending even more.
I added my two cents:
Fogel's article also has some fascinating stuff on the life cycle of health care expenditures -- for example, expenses in the last two years of life rise to 6X the norm for 50-54 year-olds, and take up 40% of all Medicare expenditures. Prolonging life does not change this; it simply pushes the high-cost period back a few years.
Looking at this cost data reinforces the view that many of our health care dilemmas come from two terrible policy decisions:
(1) The accidental decision to tie health care to employment, which started as an outgrowth of WWII price controls and has been perpetuated by the tax laws:
(2) The decision that all seniors deserve to have their health care subsidized by their juniors, even though seniors are the wealthiest part of the population and are free of family-raising expenses, which means they have more unallocated resources anyway. Someone who earns $10 per hour on a poultry processing assembly line pays 3.4% of her salary to subsidize my health care -- maybe this is someone's idea of justice, but it sure isn't mine.
I am just back from a visit to my home town, a smallish one in the mountains of British Columbia. The last time I was home, many residents were upset because the local hospital, including the emergency room, was being closed down. It did not make sense cost-wise, according to the health care accountants. The hospital in the next town over would have to do; 72 miles away--a concern in the winter months, when the curvy, narrow mountain roads are icy and snowbound. Some suspected that the closure was politically motivated. My home town consistently votes for parties that tend to be in the minority politically, such as the NDP (well left of center), and so is perpetually out of favor with the provincial government. There may well be nothing to this suspicion... perhaps the area's tax base is dwindling.
On this visit, however, I was interested to see that the hospital is not to be closed after all. A sign proclaimed that the emergency room was being revitalized and refurbished, as a part of an economic stimulus package. It rather baffles me, that the same expense items can be a drag on the economic system in good times, and a stimulus in bad times, but I am not a formally trained economist; I have only been studying public policy for twelve years, and no doubt some subtlety escapes me
There was more to come. In my favorite local toy store, I noted the
For some time now, my economist friends have had to put up with my dabbling in economics. See, e.g. They will be relieved to hear that I am presently more interested in psychology.
The role of emotion in policy (as opposed to politics) does not get much direct or systematic attention as such in the policy community. Perhaps we are all pretending that it is not there, because in one sense it ought not be there. One might say that people ought to decide among policy options objectively, and choose the best policy based on rational considerations and evidence. Of course this is not entirely possible. There is no point in asking people not to feel things. Since there is nothing to be done, perhaps there is nothing to be said, either?
My take is that this is in danger of becoming a self-fulfilling prophecy. To start, we certainly do not know for certain there is nothing to be done until after some sort of discussion or analysis is complete. let me set out a few personal observations to serve as a starting point.