Category Archives: Healthcare

Tuesday Night Linkorama

  • Paycheck Fairness is basically a sop to lawyers.
  • While the plagiarism charge won’t wash with the public, here’s a reminder of why it’s important.
  • The DNC drinking game. Gotta love it.
  • Boy do these alternative medicine idiots infuriate me. My opinion of Christian Applegate went up substantially with the way she dealt with her cancer. If my mother had had breast cancer, if I had the BRCA1 gene and if I had cancer at the tender age of 36, I’d have done the exact same thing.
  • It’s getting better all the time:

    The number and percentage of Americans without health insurance actually declined slightly in 2007 compared to 2006. The share without insurance in 2007, 15.3 percent, is actually lower than it was a decade ago.

    Median household income is not falling: “Between 2006 and 2007, real median household income rose 1.3 percent, from $49,568 to $50,233—a level not statistically different from the 1999 prerecession income peak.”

    The share of households earning a middle-class income of between $35,000 and $100,000 in real 2007 dollars has indeed shrunk slightly compared to a decade ago, but so too has the share earning less than $35,000 a year, while the share earning more than $100,000 continues to rise. The middle class is not shrinking; it is moving up.

    The 12.5 percent of Americans living below the poverty line in 2007 was statistically unchanged from 2006, and remains below the 13.3 poverty rate in 1997. The poverty rate has been trending downward since the early 1990s during a time of growing trade and immigration flows.

    The Gini coefficient, a statistical measure of income inequality, was .463 in 2007, down slightly from earlier in the decade and virtually the same as it was a decade ago.

  • Error 404

    I have to disagree with Cato. The shift of insurance companies to refuse to pay for “medical errors” is a good idea in principle but likely to be horrid idea in practice.

    First, many of the things called medical errors and not medical errors at all. Post-operative infections are a perfect example. When you cut people open, a certain number of them are going to get post-op infections. This isn’t “error”. This is reality. Bedsores are the same way. They happen, no matter how diligent you are.

    Often times, medical errors are just misjudgements. Early symptoms of illness are sometimes unclear and doctors have to go on intuition. If that intuition is wrong, is that a medical error? Let’s say, for example, that a patient comes in with flu-like symptoms but they really have inhalation anthrax. If you’d caught this rare disease early, a simple antibiotic course would have handled it. But now the patient is in the ICU.

    Who is going to judge whether something is an error or not? Ten to one it won’t be a practicing physician. And the record of insurers — especially Medicare — in judging medical cases is abysmal. My first experience with Medicare was when they refused to pay for removing a patient’s bowel obstruction because it was “medically unnecessary”. I hate the idea of giving those idiots the power to decide what was an error and what wasn’t.

    Second, I suspect this will mainly provide excuses for many insurers to simply refuse to pay. If a patient has complications, they will simply refuse to pay for it, claiming it’s the result of a medical error, even when it clearly isn’t.

    Third, I love this quote:

    Imagine remodeling your kitchen and paying the contractor extra to fix your garage door because he backed his truck into it. When Medicare and private insurers reward medical errors this way, Americans pay higher taxes and insurance premiums to cover the costs of other people’s mistakes.

    If it’s a matter of someone cutting off the wrong leg or something, I would agree. But there are better examples. If my mechanic replaces my alternator and it turns out that it was the battery that was broken, I still have to pay for both fixes. I have frequently had to pay mechanics to repair things they broke — mostly because it’s hard to prove that they broke it.

    Fourth, what I most fear is the creation of perverse incentives. When I worked in the field, we would treat a breast lump by doing a biopsy, having it analyzed while the patient was on the table and then, if necessary, doing a mastectomy. Medicare refused to pay for the biopsy. Their logic was “you removed the whole breast; why should we pay you for removing part?” This encouraged doctors to do the biopsy, send the patient home and then bring them back later for modified radical.

    I suspect the medical error thing will have the same happy result. Unscrupulous hospitals will sends patients home so that they can claim that a post-op infection or bedsore was the patient’s own fault.

    This “no error pay” policy sounds good. And I would support it if it stuck to obvious things like giving the wrong medicine or cutting off the wrong foot. But I suspect this is a backdoor way for the insurance companies to cut payments to doctors. And in the end, the improvement in both cost and health will be small. (I also suspect that this would not actually save any money — it would just increase the amount of healthcare people consume.)

    It will, of course, have the usual results of having accountants dictate medical practice. Procedures will get more expensive. Because if the hospital is going to have to foot the bill for every post-op infection, bedsore or fall, they’ll just charge you for it from the very beginning.

    I’ll close with my usual theme: the human body is not like car; it doesn’t always give clear signals of what’s wrong; it doesn’t always respond in expected ways; and it frequently goes wrong for no clear reason at all. People who rant and fulminate about “medical errors” often forget this.

    In the end, I fear this is a titanic deck chair thing. The disconnect between patient and physician is at the heart of our health insurance woes. What this is doing is getting the insurance company — and Medicare — more involved. That’s not necessarily a good thing.

    Update: I e-mailed the above to Michael Cannon. His response was that he mostly agreed. Having third parties trying to influence medical decisions is not necessarily a good thing.

    Tuesday Afternoon Linkorama

  • I missed the report that food and obesity are giving us cancer. Turns out, I didn’t miss anything. It’s garbage.
  • Why an “energy Manhattan plan” is a bad idea. Read the whole thing.
  • Want do donate toys to kids? Or kids to toys for that matter? Be sure to bring your lawyer.
  • 35 million hungry Americans, say the Fetus Whisperer. Garbage says the Department of Agriculture.
  • Shame on Princess Cruise Lines. They all do this. My wife and I got quite nervous about our honeymoon. That’s why we booked our own airfare rather than go through their travel agency slime engine. I just wish they ID’d the woman so people could give her money for an actual trip — on someone other than Princess
  • Illegal immigrants are gobbling up our health care! Nope. Let’s see if Boortz or Hannity link to this study.
  • Vaccines

    Megan McCardles on vaccinations:

    I’m opposed to many sorts of state interventions, but public health measures strike me as a no-brainer. I mean real public health measures: not nannying people about their trans-fat consumption, but preventing the transmission of infectious disease. The negative externalities of infection seem to me to give the state a perfect right–indeed, an obligation–to curtail your freedom to fanny about spreading cholera.

    Vaccines work primarily not by protecting you, but by creating “herd immunity”: denying the virus a reservoir in which to incubate. Public schools* used to be the perfect incubators, because there you have large numbers of people with no prior immunity herded together, making disease transmission a near-certainty. Vaccines have destroyed those disease reservoirs.

    Now that the disease reservoirs are destroyed, of course, parents are tempted to free ride on society. They trust in other parents to vaccinate their children, thus maintaining a disease-free environment in which their own precious princes and princesses can run around safely without taking precautions. They do this for reasons logical and illogical–vaccines do pose some very small risk to kids, but more of their fears seem to be based on junk science like the thimerosol-autism connection. But even their real fears about the safety of the vaccine would be vastly outweighed by their fears of disease if other parents didn’t vaccinate, so it’s accurate to describe their behavior as free riding.

    I agree with every word, although I still oppose mandating the HPV vaccine.

    Doctoring Like It’s 1984

    This is downright disturbing:

    Thanks to guidelines issued by the American Academy of Pediatrics and supported by the commonwealth, doctors across Massachusetts are interrogating our kids about mom and dad’s “bad” behavior.

    We used to be proud parents. Now, thanks to the AAP, we’re “persons of interest.”

    The paranoia over parents is so strong that the AAP encourages doctors to ignore “legal barriers and deference to parental involvement” and shake the children down for all the inside information they can get.

    One of the reasons doctors have left the AMA? They endorsed this Soviet Union 1984 horse manure. Only a fascist state tries to get kids to inform on parents.

    Friday Morning Linkorama

  • I haven’t commented much on immigration on this site, since it seems to me everyone involved is using the issue to grind unrelated axes. But you have to grin at this story. A town in New Jersey outlawed illegal immigrants and..

    With the departure of so many people, the local economy suffered. Hair salons, restaurants and corner shops that catered to the immigrants saw business plummet; several closed. Once-boarded-up storefronts downtown were boarded up again.

    Doh!

  • One of the big breakthroughs in my political thinking was realizing when people were cherry-picking the facts. Cato has a classic example. Supporters of NCLB are crowing about the improving test scores of 4th and 8th graders. Ignored? The ongoing plunge of high school seniors.
  • Some people are actually interested in having a good debate on healthcare. In this corner, we have Michael Cannon and in this one Jesse Larner, who was kind enough to e-mail me after I disagreed with him over at Moorewatch.
  • An interesting article at The Economist explains why France’s healthcare system works to the extent that it does. Big reason? Medical school is paid for and lawsuits are rare.