Posts Tagged ‘Healthcare Reform’

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.

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?
  • 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”.