Posts Tagged ‘Healthcare’

The Return of Linkorama

Saturday, February 22nd, 2014

Linkoramas are getting rarer these days mostly because I tweet most articles. But I will still be occasionally posting something more long-form.

To wit:

  • A fascinating article about how Vermeer used a camera obscura to enable his paintings. Yet another example about how people were pretty damn clever in the supposedly unenlightened past.
  • This is a couple of months late, but someone posted up Truman Capote’s christmas story. The recent death of Phillip Seymour Hoffman reminded me of this little gem.
  • This is the second and by far the largest study yet to show that routine mammography is basically a gigantic waste of money, being just as likely to precipitate unnecessary treatment as to discover a tumor that a breast exam wouldn’t. Do you think our “evidence-based” government will embrace this? No way. They already mandated mammogram coverage when the first study showed it to be a waste.
  • I don’t know even know if this counts as mathematical malpractice. There’s no math at all. It’s just “Marijuana! RUN!”. Simply appalling reporting by the MSM.
  • This on the other hand, does count as mathematical malpractice. The gun control advocates are hyping a Missouri study that shows a rise in murder rate after a change in the gun control laws. However, in doing so they are ignoring data from 17 other states, data on all other forms of violent crime and data from Missouri that showed a steep rise in the murder rate before the laws were changed. They are picking a tiny slice of data to make a huge claim. Disgraceful. And completely expected from the gun-grabbers.
  • I love color photos from history. Just love them.
  • This is old but worth reposting: one of the biggest feminists texts out there is loaded with garbage data, easily checked facts that are completely wrong. This was a big reason I distanced myself from third-wave feminism in college: it had been taken over by crackpots who would believe any statistic as long as it was bad. In college, we were told that one in three women are raped (they aren’t) that abuse is the leading cause of admission to ER’s (it isn’t), that violence erupts very Superbowl (it doesn’t). I even had one radical tell me — with no apparent self-awareness, that murder was the second leading cause of death among women (it’s not even close). As I seem to say about everything: reality is bad enough; we don’t need to invent stuff.
  • Mathematical Malpractice Watch: Cherry-Picking

    Sunday, September 15th, 2013

    Probably one of the most frustrating mathematical practices is the tendency of politicos to cherry-pick data: only take the data points that are favorable to their point of view and ignore all the others. I’ve talked about this before but two stories circling the drain of the blogosphere illustrated this practice perfectly.

    The first is on the subject of global warming. Global warming skeptics have recently been crowing about two pieces of data that supposedly contradict the theory of global warming: a slow-down in temperature rise over the last decade and a “60% recovery” in Arctic sea ice.

    The Guardian, with two really nice animated gifs, show clearly why these claims are lacking. Sea ice levels vary from year to year. The long-term trend, however, has been a dramatic fall with current sea ice levels being a third of what they were a few decades ago (and that’s just area: in terms of volume it’s much worse with sea ice levels being a fifth of what they were). The 60% uptick is mainly because ice levels were so absurdly low last year that the natural year-to-year variation is equal to almost half the total area of ice. In other words, the variation in yearly sea levels has not changed — the baseline has shrunk so dramatically that the variations look big in comparison. This could easily — and likely will — be matched by a 60% decline. Of course, that decline will be ignored by the very people hyping the “recovery”.

    Temperature does the same thing. If you look at the second gif, you’ll see the steady rise in temperature over the last 40 years. But, like sea ice levels, planetary temperatures vary from year to year. The rise is not perfect. But each time it levels or even falls a little, the skeptics ignore forty years worth of data.

    (That having been said, temperatures have been rising much slower for the last decade than they were for the previous three. A number of climate scientists now think we have overestimated climate sensitivity).

    But lest you think this sort of thing is only confined to the Right …

    Many people are tweeting and linking this article which claims that Louis Gohmert spouted 12 lies about Obamacare in two minutes. Some of the things Gohmert said were not true. But other were and still others can not really be assessed at this stage. To take on the lies one-by-one:

    Was Obamacare passed against the will of the people?

    Nope. It was passed by a president who won the largest landslide in two decades and a Democratic House and Senate with huge majorities. It was passed with more support than the Bush tax cuts and Medicare Part D, both of which were entirely unfunded. And the law had a mostly favorable perception in 2010 before Republicans spent hundreds of millions of dollars spreading misinformation about it.

    The first bits of that are true but somewhat irrelevant: the Iraq War had massive support at first, but became very unpopular. The second is cherry-picked. Here is the Kaiser Foundation’s tracking poll on Obamacare (panel 6). Obamacare barely crested 50% support for a brief period, well within the noise. Since then, it has had higher unfavorables. If anything, those unfavorables have actually fallen slightly, not risen in response to “Republican lies”.

    Supporters of the law have devised a catch-22 on the PPACA: if support falls, it’s because of Republican money; if it rises it’s because people are learning to love the law. But the idea that there could be opposition to it? Perish the thought!

    Is Obamacare still against the will of American people?

    Actually, most Americans want it implemented. Only 6 percent said they wanted to defund or delay it in a recent poll.

    That is extremely deceptive. Here is the poll. Only 6% want to delay or defund the law because 30% want it completely repealed. Another 31% think it needs to be improved. Only 33% think the law should be allowed to take effect or be expanded.

    (That 6% should really jump out at you since it’s completely at variance with any political reality. The second I saw it, I knew it was garbage. Maybe they should have focus-group-tested it first to come up with some piece of bullshit that was at least believable.)

    Of the remaining questions, many are judgement calls on things that have yet to happen. National Memo asserts that Obamacare does not take away your decisions about health care, does not put the government between you and your doctor and will not keep seniors from getting the services they need. All of these are judgement calls about things that have yet to happen. There are numerous people — people who are not batshit crazy like Gohmert — who think that Obamacare and especially the IPAB will eventually create government interference in healthcare. Gohmert might be wrong about this. But to call it a lie when someone makes a prediction about what will happen is absurd. Let’s imagine this playing out in 2002:

    We rate Senator Liberal’s claim that we will be in Iraq for a decade and it will cost 5000 lives and $800 billion to be a lie. The Bush Administration has claimed that US troops will be on the ground for only a few years and expect less than a thousand casualties and about $2 billion per month. In fact, some experts predict it will pay for itself.

    See what I did there?

    Obamacare is a big law with a lot of moving parts. There are claims about how it is going to work but we won’t really know for a long time. Maybe the government won’t interfere with your health care. But that’s a big maybe to bet trillions of dollars on.

    The article correctly notes that the government will not have access to medical records. But then it is asserts that any information will be safe. This point was overtaken by events this week when an Obamacare site leaked 2400 Social Security numbers.

    See what I mean about “fact-checking” things that have yet to happen?

    Then there’s this:

    Under Obamacare, will young people be saddled with the cost of everybody else?

    No. Thanks to the coverage for students, tax credits, Medicaid expansion and the fact that most young people don’t earn that much, most young people won’t be paying anything or very much for health care. And nearly everyone in their twenties will see premiums far less than people in their 40s and 50s. If you’re young, out of school and earning more than 400 percent of the poverty level, you may be paying a bit more, but for better insurance.

    This is incorrect. Many young people are being coerced into buying insurance that they wouldn’t have before. As Avik Roy has pointed out, cheap high-deductible plans have been effectively outlawed. Many college and universities are seeing astronomical rises in health insurance premiums, including my own. The explosion of invasive wellness programs, like UVAs, has been explicitly tied to the PPACA. Gohmert is absolutely right on this one.

    The entire point of Obamacare was to get healthy people to buy insurance so that sick people could get more affordable insurance. That is how this whole thing works. It’s too late to back away from that reality now.

    Does Obamacare prevent the free exercise of your religious beliefs?

    No. But it does stop you from forcing your beliefs on others. Employers that provide insurance have to offer policies that provide birth control to women. Religious organizations have been exempted from paying for this coverage but no one will ever be required to take birth control if their religion restricts it — they just can’t keep people from having access to this crucial, cost-saving medication for free.

    This is a matter of philosophy. Many liberals think that if an employer will not provide birth control coverage to his employees, he is “forcing” his religious views upon them (these liberals being under the impression that free birth control pills are a right). I, like many libertarians and conservatives (and independents), see it differently: that forcing someone to pay for something with which they have a moral qualm is violating their religious freedom. The Courts have yet to decide on this.

    I am reluctant to call something a “lie” when it’s a difference of opinion. Our government has made numerous allowance for religious beliefs in the past, including exemptions from vaccinations, the draft, taxes and anti-discrimination laws. We are still having a debate over how this applies to healthcare. Sorry, National Memo, that debate isn’t over yet.

    So let’s review. Of Gohmert’s 12 “lies”, the breakdown is like so:

    Lies: 4
    Debatable or TBD: 5
    Correct: 3
    Redundant: 1

    (You’ll note that’s 13 “lies”; apparently National Memo can’t count).

    So 4 only out of 13 are lies. Hey, even Ty Cobb only hit .366

    As I Predicted: EMR

    Friday, February 22nd, 2013

    I thought I’d put these three links into a separate post. Long ago, when electronic medical records were being cited as the way we could save money in our healthcare system, I was skeptical. I pointed out that these innovations might save lives and might make things easier on patients. But they were unlikely to save money. I based that on my dad’s experience with EMR, in which he found them to be very expensive, amazingly disorganized and somewhat bewildered by HIPPA requirements.

    Well, I was right. Here you can read about how EMR’s have encourage the use of boilerplate descriptions which leave critical information out of patient’s record. Here you can read about how it makes doctoring difficult. I’ve experience this personally, finding that doctors spend all their time screwing around with the EMR system rather than interacting with me (although this has improved in the last couple of years as doctors learn from their mistakes and save EMR maintenance until after the appointment). And here you can read about how the system are not saving money and don’t interact with each other.

    Some of these problems will eventually be solved. I expect that a uniform standard will eventually be created (probably by law). Improvements in computer transcription will probably restore dictation over boilerplate for making notes. And, as I noted, doctors are quickly improving their ability to use EMR without sabotaging their interaction with the patient. In the long run, I think this will improve healthcare.

    But easy-to-use systems that have a uniform standard, protect patient privacy and can correctly spell esophagogastroduodenoscopy (as I just did on the first try) are not cheap and are never going to be. This is not the solution to our healthcare woes. There is no silver bullet that is.

    Post-Xmas Linkorama

    Sunday, December 30th, 2012
  • Godspeed.
  • Heh heh. It turns out that some of those tests that say newborns have pot in their systems may be bullshit. Don’t you just love the War on Drugs?
  • You know, I actually think this guy gets it right. The whole “we’re miserable during the holidays” things always did cross me as a load of dingo’s kidneys. We see the stress of family and travel; ignore the absent stress of work.
  • As much as I respect the idea of building an ideal language, the idea is going precisely nowhere as Zamenhoff found out. Language is not about utilitarian efficiency. It’s about culture, history, nuance and tradition.
  • One thing I wondered while taking Sporcle’s blurred faces quiz is if the results would show a racial component: i.e., would white people be more likely to recognize the blurred features of other white people. This wouldn’t be about racism but about the way our brains process facial features.
  • Tuesday Linkorama

    Wednesday, November 28th, 2012
  • An interesting article on how child abuse panic is keeping men out of the childcare industry. My daughter had a male teacher at her school for a while. She really liked him and it was good to see her having a male role model in her life beyond me. But I also admired the man’s courage; I would not put myself in such a vulnerable position.
  • One of my favorite things to do as a grad student was to look up heavily referenced papers to see if they said what people said they said. At least a quarter of the time, they didn’t. Maggie McNeill just dug up a 30-year-old bit of Mathematical Malpractice that’s been cited incorrectly in support of innumerable bad laws.
  • A frustrating story about why we can’t watch WKRP in its original format. We really have to do something about fair use. The Republicans indicated that they might; then ran away from that position.
  • This video, of a hilarious bug in the FIFA 2012 video game, had me giggling.
  • I have to disagree with almost everything in this article claiming the alcohol industry is trying to make us drunks. It assumes alcoholism is entirely a function of government policy. And it mainly reads like a press release from the powerful forces trying to overturn the SCOTUS decision on out-of-state liquor importation, an issue of particular relevance to Pennsylvania.
  • Is airport security taking more lives than it is saving? Seems like.
  • I’ve been sitting on this story, about how doctor witheld information about a child’s medical future from the parents, for a while, trying to think of a way to approach it. Might still write a long form post. But I default to thinking people have a right to know. To presume to make that decision for them is arrogance. As our diagnostic tools get better, we need to give people the legal option: do you want know if we find anything bad? What happens if a cure is invented and this kid doesn’t know that he needs one?
  • Tuesday Linkorama

    Tuesday, October 2nd, 2012
  • Paul Ryan and the Republicans appear to be backing down on DADT. About time.
  • Apparently, there is a new blood test that could detect some types of cancer.
  • Yeah, I never thought much of the writing fever approach to teaching writing skills. You learn to play music by learning scales. You learn writing by learning vocabulary, grammar and sentence construction.
  • A fascinating profile of one of the CIA’s operatives. What’s telling is precisely why we provide aide to loathsome regimes.
  • Hmmm. Kids getting their grandparents’ Holocaust tattoos.
  • UK Linkorama

    Tuesday, May 22nd, 2012
  • The rise of resistant diseases is one of the biggest reasons I fear socialized medicine. Innovation is critical to the next century and I am afraid that price controls will kill it.
  • Amazing pictures of the Kowloon City.
  • This is why I read Joe Posnanski religiously. A post about nothing. And it’s beautiful.
  • I was going to write an article taking apart Buzz Blowhard Bissinger on the subject of college football. Now I don’t have to.
  • A study says women value sleep more than sex. This is unsurprising although the reasons are a bit different than what they think. It’s pure economics. For women, sex is available (mostly) when they want it so sleep takes priority. For men, you have to get it when you can, so everything else is secondary. I think Seinfeld did an episode on this, no?
  • My Belly and Me

    Thursday, April 5th, 2012

    You’ll excuse me if this isn’t up to my usual standard. I’m still feeling a bit delicate and out of it.

    I knew I was in trouble when they came into my ER room with morphine.

    Tuesday was going to be a heck of a day. I had a bunch of stuff at work to do and was on call for a spacecraft. Sue was coming home from her mother’s funeral in Australia and I was going to pick her up from the Harrisburg airport. So it was going to be a busy day, but I knew that if I got through it, the rest of the week would be a breeze.

    And then about 2:00, my belly started hurting.

    This had happened three weeks before. It had hurt so badly, in fact, I had gone into the ER. They had diagnosed a bad case of reflux and used a GI cocktail — maalox, lidocaine and belladonna — to set me right. So I chomped down some Maalox and tried to relax.

    It got worse. By 6:00, I knew I was going to have to go the ER again. But I held on until 7:00, when Sue was changing planes in Chicago, so I could let her know. All our plans went out the window. I went over to our neighbors and imposed on them to look after Abby and drive me to the ER.

    I thought they would give me a GI cocktail and have done with it. But then they came in and gave me some morphine for the pain. I have to say that while I respect morphine’s role in history, I don’t care for it myself. It makes the chest heavy and the mind wander. But I knew something was wrong. And then the doctor told me: he thought it was not reflux, but my gallbladder. A quick ultrasound confirmed it. And with two attacks in three weeks, I was going to have to have it out.

    I had surgery the next afternoon through a laparoscope. They put four small ports on my right side and inflated my belly with CO2. They found my very diseased gallbladder, cut it out, closed off the arteries and ducts, cleaned me up and had me out in about half an hour. I have a vague recollection of being somewhat combative in recovery because I had to urinate badly and could not. I was confused and, to be frank, a little delusional. In fact, it would be a few hours before my systems recovered enough from anesthesia for me to empty my bladder of almost a liter of fluid. And it took me many hours before my mood recovered. I can’t imagine what it’s like for people who get really sick and have very serious surgery. The comparatively less amount of pain and suffering in this was enough for me. Now I can understand those people who say, “Hell with this. Give me some pain meds and let me die with dignity.”

    It’s now been 24 hours and I’m home. And the more I think about it, the more I am amazed with modern medicine. A couple of centuries ago, my gallbladder would probably have led me to an agonizing death. A couple of decade ago, I would have had open surgery and spent weeks recovering. Now, four cuts and a day later, I’m home and should be recovered within a week or two.

    I’m also very happy about my iPhone, which became my lifeline. Thanks to the iPhone, I was able to call all my favors in, keep Sue updated on my status, e-mail my colleagues so that they would take care of Swift and even play a few games of Scrabble and let everyone know, via Facebook and Twitter, what was happening. It could have been a very lonely night in the hospital with Sue out of town and Abby with friends and the rest of my family scattered over the country. Thanks to modern communications, it wasn’t.

    And I’m also grateful to the good people I’ve surrounded myself with who made sure work was covered and that Abby was taken care of. Thanks to them, nothing was dropped on the floor.

    Life is good.

    The Healthy 1%

    Sunday, December 4th, 2011

    Some attention has been focused on a recent analysis that health care costs are highly skewed. Apparently, 1% of patients accounts for a fifth of all healthcare costs. For half of us, our healthcare costs are only a few hundred bucks a year. For the top 1%, they exceed $100,000.

    I’m not sure what the point of this is. The very idea of health insurance is to insure against catastrophic illness. $100,000 is the cost of a moderate to bad health problem. That 1% is not a static group; people move in and out as they get sick or healthy. We don’t need government to tax us all to help people pay bills; that’s what insurance does. The only impact his has on the healthcare debate is to either link mandated coverage with mandated purchase — i.e., prevent people from waiting until they’re sick to buy insurance. It could also argue for high-deductible plans that only cover disasters.

    Naturally, this is being used to argue for all kinds of other things. Preventative care is a big one. But as I’ve noted, preventative care does not save money even if it saves lives. It’s also being used to argue for end-of-life planning, which I support but is unrelated to this.

    Really, I don’t know this stat has suddenly become so big. Healthcare doesn’t cost much until you need it. We knew that, didn’t we?

    Wednesday Linkorama

    Wednesday, June 8th, 2011

    Non-political links:

  • Speak of healthcare, could information save $300 billion. That number sounds big but within an order of magnitude.
  • There were a number of cracked’s old-timey ads that gave me the facepalm.
  • This is one of the best article written about steroids and the drop in offense in MLB. I think he’s right that what has changed is not so much PEDs but the thinking about them in management circles.
  • Political links:

  • Texas passes tort reform. The usual suspects are screaming but I can tell you that the malpractice environment in Texas has produced a healthcare system that may not be cheaper but is massively more responsive than tort-happy Pennsylvania.
  • More Healthcare Lies

    Wednesday, May 11th, 2011

    Sullivan has posted Medical Billing and Coding’s infographic on why our healthcare cost so much. I have rarely seen such a huge a stack of healthcare lies collected in one place.

  • They claim that America’s obesity rate is not driving our healthcare costs, only accounting for $25 billion in spending. If that’s the case, someone needs to tell the CDC, which has estimated obesity to be responsible or at least 10% of our healthcare spending and projects it to eventually cause 20% of our spending. Obesity is a primary risk factor for heart disease, something we spend a lot of money on. Lipitor alone is a $7 billion expense.
  • They claim malpractice isn’t driving healthcare costs, only being responsible for 2% of spending. This ignores defensive medicine. Now I’m aware that Haav-vud has estimated defensive medicine to be a tiny expense. But their lawyer-friendly study is far far too conservative. The Kessler study estimates 10% and I would even say that’s conservative. A huge amount of our healthcare spending is for end of life care and a huge driver of that is the fear of lawsuits. Many procedures and tests that are considered “routine” would not be without lawsuit threats. Additionally, the effect of malpractice is not linear. For hospitals, it’s a small part of the budget. For practicing physicians — especially OB/Gyn’s — it can cost more than the rent on their office.
  • They then say that providers charge more because they can — true enough — because the US government is not involved in price regulation. So Americans have “less power” over healthcare costs. I’m not going to re-open the price control debate again. It’s too complicated for a group this stupid. But I will note that there are other ways for consumers — not “the people” to have power over healthcare costs.
  • They complain that admin costs are 21% of our healthcare bill — twice what other countries spend and that 85% of this is due to private insurance. This tells me that they are buying the lie — and it is a lie — that Medicare’s costs are only a tiny fraction of the private sector. Keep in mind, this is the Medicare that is currently spending 20 cents on the dollar on fraud — a problem that they perversely try to blame on the private sector.
  • They complain that 41% of healthcare costs are for outpatient procedures. But outpatient procedure usually save money. They specifically site the example that 60% of UK hernias are treated inpatient, but only 11% of US hernias are treated inpatient. What?! Treating a hernia — usually not really an optional procedure — is MUCH cheaper done as an outpatient. Outpatient procedures save money. And lots of it.
  • Finally, they say are doctors are overpaid. I’ll leave that talking point for the class.
  • Sullivan should embarrassed to have posted this on his site. It’s quite clear that the people who put this together have an agenda and have resorted to distortions of fact that would make Michael Moore blush. This isn’t adding to the debate. It’s setting it back twenty years.

    Krugman Consumes His Own Tail

    Saturday, April 23rd, 2011

    Cross-posted from the other site.

    Paul Krugman has written a bizarre op-ed in opposition to the GOP Medicare plan. Let’s have some fun with it.

    Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.

    It’s acceptable to call them consumers and providers because that’s what they are. The only reason this language strikes Krugman as odd is because he, like many liberals, has becomes used to thinking of healthcare as a “right” — something akin to Freedom of Speech. But any time there is a voluntary exchange of services, the relationship is one of consumer to provider. There’s nothing repulsive or sinister about this. Teachers, fireman, cops, doctors, clergy — none of these people work for free. All of them provide services that we consume.

    Note also that Krugman is engaging in the “I’m On Your Side” tactic. He praises the doctor-patient relationship as something sacred. But, as we will see, he does this on the way to severing and controlling that bond.

    We have to do something about health care costs, which means that we have to find a way to start saying no. In particular, given continuing medical innovation, we can’t maintain a system in which Medicare essentially pays for anything a doctor recommends. And that’s especially true when that blank-check approach is combined with a system that gives doctors and hospitals — who aren’t saints — a strong financial incentive to engage in excessive care.

    I agree. One way we can do this is to put more responsibility on the consumers who have shown the ability to make complex and difficult decisions about homes, cars, schooling, computers and other supposedly opaque disciplines. We could, or example, adopt David Goldhill’s proposal of moving back to a major medical system where the first few thousand dollars of healthcare — the most discretionary part — is controlled by the consumer and employers or government provide a voucher for a $5000 deductible. It’s difficult to imagine such a system now because we’ve gotten so used to first dollar coverage. But that’s what we used to have when our healthcare spending wasn’t so out of line. That’s what we have in non-insured regions like lasik surgery or fertility treatments, where price guarantees are normal.

    Alternatively, we could move toward something like the Australian system. In Australia, there is a socialized insurance system that provides basic care and pays a basic fee. If you’re poor, you can go to lower-tier hospitals that accept those fees. If you have more money, you can buy additional insurance or pay out of your own pocket to get better care. But the key is that you pay the bills and are then reimbursed. So the consumer is decidedly in the loop. (My understanding of the Aussie system is based on talking to my wife and her family; blame any errors on them.)

    So certainly Krugman, an economist, is going to suggest something along … oh.

    Hence the advisory board, whose creation was mandated by last year’s health reform. The board, composed of health-care experts, would be given a target rate of growth in Medicare spending. To keep spending at or below this target, the board would submit “fast-track” recommendations for cost control that would go into effect automatically unless overruled by Congress.

    Dr. Krugman, please send a nice package of whatever it is your smoking to my house. Have you been watching the budget debate? We endured weeks of rending of garments and gnashing of teeth over the cutting of unspent budget authority. Do you think Congress is going to stand up to seniors and tell them they can’t get care? Even assuming this board makes some tough choices — do you really think Congress will let unpopular ones stand?

    We don’t even need to ask these questions — we’ve already seen what will happen. When PPACA was being debated, a study came out claiming routine mammography should start at 50, not 40. Congress immediately moved to prevent this from being acted on, whether the result was valid or not. Their previous mandate on unproven CAD technology led to a huge surge in this expensive procedure. One of the reasons Republicans want insurance sold across state lines is that state governments have become incredibly pliable in mandating coverage, including “alternative medicine”. During the PPACA debate, several senators tried to get alternative medicine like therapeutic touch and prayer therapy into the bill (these being fringe guys like um, … the 2004 Democratic nominee for President). Any government board is going to be controlled by special interests (who are solidly behind the idea) and overridden by a spineless Congress.

    Where is this sudden surge of political courage going to come from? This seems like an inverse of the “starve the beast” theory. I’ll call it “gorge the beast”. The idea is to let government healthcare spending get so out of control that Congress will have to act.

    Now, what House Republicans propose is that the government simply push the problem of rising health care costs on to seniors; that is, that we replace Medicare with vouchers that can be applied to private insurance, and that we count on seniors and insurance companies to work it out somehow. This, they claim, would be superior to expert review because it would open health care to the wonders of “consumer choice.”

    Notice the two-step here. Krugman has spent his time running down consumer-controlled healthcare. But now he’s running down a very different proposal on privatizing Medicare. These are not the same things, unfortunately.

    “Consumer-based” medicine has been a bust everywhere it has been tried. To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most “consumer-driven” health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.

    You know, it must be nice to be a Nobel Prize Winner. It apparently means you never have to bother with facts anymore and can just pull things out of your ass.

    Because this is pulled out of Krugman’s ass. RAND has studied consumer-controlled healthcare and shown considerable savings, a result that has held up under some scrutiny. And we are most decisively not the most “consumer-driven” healthcare system in the world. According to the OECD’s 2008 data, out of pocket spending accounts for 12.1% of healthcare spending in the US. That’s less than Switzerland (30.8), Sweden (15.6), Japan (14.6 in 2007), Australia (18% in 2007), Canada (14.7% in 2007) and just about every country except France (7.1%). Decisions might be consumer controlled; spending is not. And any economist — any economist not talking out of his ass that is — can tell you what happens when consumers have no restrictions on spending other people’s money. The Kaiser Foundation has specifically identified the decline in patient responsibility (from 40 to 10%) as one of the reason for rising healthcare costs.

    Medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.

    This is a straw man made of red herrings. Under consumer-controlled plans, no one would be comparison shopping when they are incapacitated, under sever stress or need action immediately. Such situations would be well into the insurance-controlled regime. Additionally, the idea that healthcare spending is “involuntary” or that patients are incapable of making difficult choices is ridiculous and arrogant. Two thirds of healthcare spending occurs in non-emergency situations. Patients make decisions about healthcare every God-damned day, including about the most expensive and wasteful of care — end of life management. Medical procedures, by law, have to be explained to the patient who then has to be told of his prospects and alternatives. They almost always do everything he provider says. But is that, at least in part, because they’re not paying the bills?

    The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.

    No. This is reality. It’s not repulsive to describe patients and doctors and consumers and providers. That’s precisely what they are. We’ve just forgotten because of our diseased system. All economic transactions — all goods and services — take place between consumers and providers. Describing that relationship as “sickening” is like the describing the Law of Gravity as “sickening”.

    Weekend Linkorama

    Sunday, April 3rd, 2011

    Non-political links:

  • Honestly? This racy ad on HPV doesn’t bother me. As my blogging on porn has shown, my offense threshold is very high.
  • Orac destroys Mann Coulter’s sloppy research on radiation.
  • Now this is interesting. Maybe we don’t have to drug up our livestock and risk epidemics.
  • Political Links:

  • This just in: Nancy Pelosi is also a lying fool. Maybe she just felt bad that the Republicans were making such idiots of themselves and joined the fool parade in solidarity.
  • Signs that Newt Gingrich’s Presidential campaign is doomed: over at the very Right Wing site Hot Air, only half of the users are buying his bullshit in re: flip-flopping on LIbya. When the half the Right Wing already thinks your full of shit and the election is still 19 months away, you’re doomed.
  • Justice in America: banks get off, home-owners go to jail. What’s most disturbing is how they found this guy – the IRS is targeting people for acting too rich.
  • I’m beginning to think that the GOP really has lost their fucking minds on the abortion issue. The law being proposed (outlawing abortion after 20 weeks) sounds restrictive, but is of a piece with the view of large majorities of Americans (assuming you think these things should be decided by majority rule). But the rhetoric accompanying it is insane.
  • You know, at this point, the fact that AARP was bribed to the tune of a billion dollars to support PPACA doesn’t surprise me.
  • Was Bill Clinton more conservative than George Bush? Hells yes.
  • Oh, that liberal media. Right.
  • The latest idiocy from PPACA. Healthcare is going to get a lot worse before it gets better.