Pet Peeves

Sebastian Mallaby's recent effort on health care reform features two of my biggest pet peeves. First, the idea that cross-national differences in overall mortality is a good indicator of which kind of health care system is best. This one is ludicrous, but even smart guys like Mallaby and Krugman don't seem to understand how silly it is. One, of course, would be better served to look disease-by-disease, adjusted for age, for mortality differences. These more sensible measures routinely favor the US health care system.

The second is the idea that patients can't be consumers because they lose their rationality when death is staring them in the face:

Health is simply too complex for people to make smart, waste-reducing decisions; when you go to the hospital with screaming stomach pains, you have no idea how many tests you need -- and you're not in a fit state to embark on comparative shopping.

This is true enough, but very uninteresting and unhelpful. Contrary to common perception, only a small amount of overall medical decision making is made under such dire circumstances. Medical emergencies are the exception, not the rule, and to continue to use them as the example of the environment in which consumer decisions are made is ignorant at best and dishonest at worst.

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I assume you meant medical,

I assume you meant medical, not mecical?

Could you provide more

Could you provide more support for the thesis, that "good comparison’s routinely favor the US healthcare system". The two links to studies don’t sound convincing.

The first refers to an article from "The Sensible Knave", and it seems to conclude differently:
"The question, then, is whether health care spending is higher in the United States in part because we spend tremendous amounts of money treating children who, had they been conceived in certain other countries, would not have been born.”
This may be false, but it doesn’t support the argument. Certainly when confronted with the well known deficiency of the US in infant mortality comparison’s.
In search I find an article that links the high US abortion rate with reduced neo-natal mortality rates: "The effect of legalization and public funding of abortion on neonatal mortality: an intervention analysis. Population Research and Policy Review, Vol. 7, No. 1, 1988. 79-92 pp.”

The second link only goes to a McKinsey study. I don’t know who actually paid for it, but I’m confused by pay-wall lead-in/conclusions like this:
"In recent surveys, about 70 percent of respondents viewed that system positively. Another survey ranked Taiwan second best in medical practice among developed and newly industrialized countries and as the world’s second-healthiest country.[…a very short snip…] Taiwan’s health insurance system faces insolvency, and many providers, motivated by poorly conceived incentives, are delivering inappropriate health care. Taiwan must move quickly to address such problems.”

Comments about the German healthcare system from the Marginal Revolution are similarly unconvincing:
"Germany, on the other hand, has a system more like the United States had twenty years ago. In Germany, medical expenses are paid for on a task-by-task basis for services of doctors and hospitals. As a result, hospitals in Germany have no financial incentive to reduce length of stay.”
but McKinsey goes on to support it:
"We believe that Japan can dramatically improve the productivity of its health care sector by replacing the current fee-for-service system with a case rate payment system modeled after those of Germany and the United States and by banning provider ownership of pharmacies.”
especially noting that in the US most hospital’s own their pharmacies.

I’m perfectly willing to believe that we in the US get something for our healthcare dollars, I’m just not really sure it’s better care on average, and I’m completely unconvinced it’s longer life. If there’s a nice study on this not behind a pay-wall, I’ll read it. I’ve certainly heard from my MD friends that you don’t want to get sick in Japan. They’ll keep you healthy out patient, but you’ll die in the hospital. I had a really annoying Pharmacist in Germany that didn’t want to give me pseudophed (your nose is supposed to run), but boy did they do good plastic surgery on my student friend after a bike accident.

Also interesting is that the percentages of Americans on Medicare and Medicaid are both ~15%, as is the percentage without any insurance. About 3% is provided by the VA according to my meager web research. The remaining ~55% have employer or private health insurance. I’m not sure that this makes the US a great model of private insurance since so many of the high health cost users are publicly supported, or uninsured. Don’t the rest of us just pay for them anyway?

I know one ex-roomate of a friend who was a recovering speed addict and alcoholic with early on diabetes, who had 3 laser eye operations in the last year with no insurance at ~$10k/each. He’ll probably loose his legs, go blind, and die before he ever gets insurance… and even if he did it wouldn’t cover the "pre-existing condition". Perhaps they could just let him die, but they won’t. I’ve also been informed that if you get cancer, those 1M$ life time caps will bankrupt you and put you on Medicaid, if you don’t die nice and quick. Go for the 5M$ cap, if you have significant assets.

I spent days this year arguing with my top of the line insurance company PPO to reduce my bill from $22k to $7k due to what they now call billing errors. Well spent effort, but it cost me a few $k in my time, and my wife certainly wasn’t up for it. Is that cost added in? Should it be added in, just like waiting in line would be in Italy? I don’t know, but it seems like we’re left with a confusing and incomparable mess of statistics, payment methods, and treatment methodologies from different countries. Extracting comparisons of those without bias seems a difficult task.

If you travel to any country

If you travel to any country you will find the newspapers full of discussions about health care problems in that country. In countries having government financed programs you always get complaints about waits and delays for diagnosis and treatment, patients having to travel long distances for treatment and lack of up to date facilities.
The rejoinder you always hear is that outcome is as good or better in socialistic systems.

Due to the unique demographic and cultural differences between countries these statistics are suspect. You never see where these statistics are controlled for socioeconomic factors, population mix, nationality, age, nutrition, disease pattern and so on. They just amount to truisms that are repeated mindlessly by advocates for nationalized care.

I frankly don’t see how a country with a system which would make a patient with a painful condition such as a hernia or arthritic condition needing surgery wait months for treatment can be labeled as a country with adequate medical care. It is also true that a delay in diagnosis for many conditions has a deleterious effect on prognosis. It is amazing that the statistics touted by statist advocates never seem to reveal these obvious facts.

Hmm- I did see a nice BLS


I did see a nice BLS treatment of medical treatment inflation.
It brings up some of these same points about outcomes measurement as it relates to the value vs cost of medical treatment.

First spotted on AngryBear:

It is amazing that the

It is amazing that the statistics touted by statist advocates never seem to reveal these obvious facts.

Part of it is just how bad the statistics are, like you say, but in some sense it doesn't matter how bad the statistics are since statists judge their success by a double-standard. If the state succeeds, well that's great, and if the state fails, well that just shows the state has to try harder (with other people's money of course). And of course with newspeak you can always define seeming failures to be successes (a policeman murdering a citizen can be defined not to be murder if, say, the citizen was consuming the wrong food or drug, or carrying materials ill-favored by the ruling regime).

For a whopper epilogue to your statement, consider government murders in the 20th century, surely the most horrible measure of state malfeasance, and then ask yourself what meaning, if any, the "statistics" have...