The Sucess of Socialized Medicine

[Inquartata]

Originally Posted by jeff

You know that's not what I'm saying, Inq. It's consistent with, but much more than common sense,. These results are shown from decades of experience in public health by people who track the programs and look for statistically valid changes.

We hope and believe that this is what they have done, but unless we've looked at their studies---not just their conclusions, but their methods---can we just take their words that this is what they've done? That they have looked at all possible variables, that they haven't overlooked or misconstrued or measured one incorrectly?

And in all candour I'd be more comfortable if at least some of the studies were done by people OUTSIDE of the public health sector. Someone less inclined to assume that a medical explanation MUST be involved. Someone less immersede and invested in the field, who might be more inclined to ( I hate this phrase, but ) "think outside the box". ( Which is why many police departments have civilian review boards---police investigators sometimes have blind spots and prejudices that tend to lead them to certain conclusions, not maliciously but unconsciously. )

I thank you now for at last conceding the point you previously denied in the other thread we argued this subject - that actual domain knowledge is necessary, rather than vague understanding and "general principles". I'm glad you've finally come around.

Ah, not so fast! I have conceded no such thing. What I have said is that "domain knowledge" is crucial for making conclusions about the internal matters of that domain. It is not necessary, and indeed can be positively deleterious, to drawing conclusions about matters external to the field. That is, medical expertise is needed for investigating the medical effects of medicine. It is of little use in investigating the economic effects of medicine. Or the sociological effects, or the political effects, etc.

An economist does not need to know how a carburetor works in order to study the elasticity of demand for mid-sized American-made automobiles. And he does not need to know HMO accounting or medical billing procedures to study the economics of the way the health care industry works. Any more than your wife needs to know economics in order to treat an economist.

( That BTW was the source of my amusement when you presented your wife's opinion about the AMA as a cartel as though it were relevant to the economic argument of it---it was an argumentum ad verecundiam, a resort to expert opinion in a wholly different field. It's as though I asked you to accept the opinion of an oilfield roughneck as expert on the issue of the workings of OPEC as a cartel... )

Your inconsistency is funny and revealing - advocates of policies you don't like must demonstrate causality, yet you're happy to rely on Adam Smith's Invisible Hand (Sorry, gojujay), where the whole point of "invisible" is that causality can't be seen, yet somehow we must bow our heads and just believe.

The workings of self-interests in generating economic efficiency have been empirically tested for several centuries. Don't let Smith's term of art, "invisible", mislead you---he only meant that self-interest operates automatically and whether it's scientifically observed or not. He did not mean "take my word for it". Whether you believe it or not, economists are skeptical fellows, and they would not have built so much on an untested foundation...

The operation of self-interest CAN be seen. It has been seen. But it need not be watched constantly lest it suddenly stop working.

Magnetism too works invisibly. That doesn't mean it hasn't been or by its nature cannot be tested, but only assumed.

Take "universal healthcare -> better health" as a given.

Why?

Prenatal screening -> healthier mothers and babies.

Why?

Let me cite here a study I encountered a while back. It's called the Black Study ( Townsend and Davidson, 1982 ), and it looked at infant mortality within socioeconomic segments of a UK population and the effects of universal health care upon it. Before universal health care, the wealthier segment of the population had lower infant mortality rates than the pooer segments---about half the rate, in fact. This is very intuitive, right? The rich had better access to health care, naturally that would tend to make their babies healthier on average. The natural conclusion would be that if one raised the access to health care of babies of the poor, the disparity in mortality rates would ebb. The results of the two groups would become more similar as the health of the poor babies rose, assuming that it was ONLY access to health care that was causing the large difference in outcomes.

And the actual result? After universal health care was instituted and the poor had access to health care for their infants ( and yes, prenatal care for the mothers ), the difference in infant mortality rates between the two classes remained the same. There was no measurable drop in infant mortality rates among poor babies vis-a-vis those of the wealthier ones. After NHI, the infant mortality rate among the wealthiest class remained about half that of the lowest class.

What could account for this counterintuitive finding?

Was the study flawed somehow? Was there some other factor boosting mortality among babies born into poorer families, one which overwhelmed any improvement caused by better health care? Did the poorer families just not avail themselves of the new care opportunities? Did the wealthy somehow go out and get care twice as good as the new NHI offered, to maintain the ratio? Was there something else about the populations studied that yielded the strage results?

Do those sound rather like the same questions I've asked aout the studies which purport to show "universal health care>better health"?

Mass vaccination -> less disease.

Or maybe just different disease. Less smallpox, and we get HIV taking its place. We immunize against existing influenzas, great---until H5N1 develops human communicability...

These attempts at pinpointing an easy, intuitive, identity relationship between one complex phenomenon and another are appealing, but IMO dangerous. Because human phenomena are just not that simple to pinpoint and understand.

Universal screening for heart disease, cancer, etc -> earlier detection and more effective (and less costly) treatment.

Or so the doctors tell us...the same doctors causing those hundreds of thousands of "iatrogenic deaths" Esskreemr was talking about. The same medical authorities who tell us one year to avoid alcohol, and the next that it's actually healthy in moderation.

Hmm.

But seriously, why is that easy, intuitive identity you've set up to be accepted uncritically?

It's well known to those who've taken the effort to learn.

Or to those who have a pre-existing belief to support?

I asked you to devise an experiment that would prove or refute "causality" to your satisfaction, while asking what basis in fact you had to doubt James' evidence. Do you have either?

No. I am not a scientist, much less a medical researcher. But I would suggest that any such experiments try to control for, or at least identify and examine the possible effects of, other conceivable variables on health and health indicators...

This is the rhetorical "old switcheroo". In the first snippet you complain that an argument must be supported by knowledge, and to cover yourself since facts and professionally accepted knowledge go against your argument, you then take the opposite stance that relevant professional knowledge shouldn't have primacy. Nice attempt to have your cake and eat it too.

It was and is delicious.

To be more precise with my own stance han you are inclined to be, my position is NOT that such evidence as has been collected is meaningless or even wrong, but that it may not be complete and may have missed other factors affecting the health indicators. I do not question the data, such as they are, only the validity of the conclusions drawn from them and the policy solutions founded on those conclusions. And that when it comes to the economics of health care, economists know more than doctors, nurses or medical statisticians. When it comes to health care as medicine, vice versa.

Again, your inconsistency is obvious: in the original Universal Healthcare thread you looked askance at any source you didn't feel was sufficiently credentialed in economics

Yes. Input on economics from a noneconomist is less valuable than that of an economist. So far so good.

while denying the legitemacy of credentialling authorities in medicine

Eh? You've lost me. Do you mean licensing and professional accreditations for doctors and nurses, or that I question the credentials of doctors with no economic background to speak about economics? If the latter, yes again...but I see no inconsistency. If the former, I don't recall saying that, but then I have lost track of much of this thread. If you could remind me of where I said it, I'll go back and refresh my memory.

(while demonstrating confusion on who those authorities are and claiming that credentialling was a cartel by an organization that doesn't license or credential.)

No, no---credentialing is an entry-restricting barrier erected BY a cartel. The organization ( the AMA ) is the cartel, not the credentialling process.

So, Inq - they're authoritative when they support your positions, but not so when they disagree. I see - all is clear.

Not for the first time, I have some doubts whether anything I say is really clear to you. ( Indeed, sometime it's not even clear to ME. )

I quite agree - which is why my arguments are copiously documented by supporting evidence, while yours are very rarely more than your loudly repeated opinion.

In the spirit of the season, and since this is a old post I'm answering, I let this pass.

Which of us takes the trouble, Inq, to go find referencable articles, or quote specific facts and figures, eh? You even went so far as to argue at length that knowing the specific facts wasn't necessary.

It isn't. It suffices to show that "the facts" may not lead to the conclusion you think it does.

Start doing more facts and less assertion, Inq, and address the facts presented to you even when they are inconvenient to your argument.

I have done. I just haven't chosen to do so in the way you would like me to do, ie dig up an equal and opposite fact. That is only one valid way to argue, or to refute or cast doubt upon an argument, not the only way.

There are slews of items you've not responded to, in this and the other thread (my Krugman post is an example), including the most recent points made by James and esskreemr.

Yes, indeed. I am about 4 whole pages behind. And by this time tomorow I'm betting there will have been another page or two added to that.

The day may come when you find yourself the sole major proponent of a point of view, arrayed against three or four writers as prolific as yourself. When that day comes I will not attack you on the grounds that you cannot keep up with the barrage of new material and fresh arguments, simply because of the sheer volume of it, or impute base motives to your failure to keep up. I promise.


And speaking of falling behind---my scheduled relief called in sick, and so my supervisor is going to replace him. I had best get off the internet for the nonce...

[jeff]

In brief, as I'm short on time this Christmas evening:

- I'm at least one of the suppliers of the "30% overhead" claim. I've seen that in different articles in New York Times and Wall Street Journal. No, I didn't keep clippings.

- The bureaucratic overhead in the current system is not especially about government regulatory requirement, it's about the overhead in coding, billing, and filing and challenging claims. With the interest of the insurer counter to that of the insured, it's in the interest of the former to impede paying claims made by the latter, despite contractual arrangements.

- Inq, you misread the statistics you cite for causes of death "Fun with statistics. Here's another list of actual mortality causes: http://www.benbest.com/lifeext/causes.html It's sources seem to list accident, homicide, suicide, heart disease and cancer as the top 5" Inq, Read the article again: that applies to a table titled "FIVE LEADING CAUSES OF DEATH, USA, AGES 15-24, 1998". Young people very rarely have heart attacks. Overall causes of death in the US were listed above that: heart attack, cancer, stroke, respiratory disease, and then accidents in 5th place. Heart attacks and cancer together were about 50% of deaths.

Ooh. You've just replied to one of my posts (the above is from your conversation with ess). I'll go look at that now before signing off

[jeff]

Originally Posted by Inquartata

We hope and believe that this is what they have done, but unless we've looked at their studies---not just their conclusions, but their methods---can we just take their words that this is what they've done? That they have looked at all possible variables, that they haven't overlooked or misconstrued or measured one incorrectly?

And in all candour I'd be more comfortable if at least some of the studies were done by people OUTSIDE of the public health sector. Someone less inclined to assume that a medical explanation MUST be involved. Someone less immersede and invested in the field, who might be more inclined to ( I hate this phrase, but ) "think outside the box". ( Which is why many police departments have civilian review boards---police investigators sometimes have blind spots and prejudices that tend to lead them to certain conclusions, not maliciously but unconsciously. )

I had to go back a whole month to see what lines of mine you were referring to. I'll try to work quickly: in brief, the studies have been done in a wide variety of peer refereed reviews and by people in overlapping specialties. The wheels may turn slowly in science, but they do grind out and eventually root out bad research. Also, this material has been reviewed by people not directly in these lines; by policy makers, governments, and private sector organizations that implement policies based on these findings. So, this has already been done: the guys with lab coats AND the guys with suits have already been all over this.

Again, I have to say this illustrates inconsistency on your part. With economics you tend to insist that all bow in the direction of experts (even in areas where I know there is substantial disagreement among them), yet in other fields you are loathe to submit to their strongly held consensus and best understandings.

Originally Posted by Inquartata

Ah, not so fast! I have conceded no such thing. What I have said is that "domain knowledge" is crucial for making conclusions about the internal matters of that domain. It is not necessary, and indeed can be positively deleterious, to drawing conclusions about matters external to the field. That is, medical expertise is needed for investigating the medical effects of medicine. It is of little use in investigating the economic effects of medicine. Or the sociological effects, or the political effects, etc.

I think I can refer back to this in a few sentences. Hang on a bit...

Originally Posted by Inquartata

An economist does not need to know how a carburetor works in order to study the elasticity of demand for mid-sized American-made automobiles. And he does not need to know HMO accounting or medical billing procedures to study the economics of the way the health care industry works. Any more than your wife needs to know economics in order to treat an economist.

If those examples matched the situation it be fine, but we're not talking about procedural or accounting issues, we're talking (I remember the context this originally came from) about fundamental artifacts of the economics of medicine in the US. If an economist is unaware of them, doesn't know what assets are expensive, which are scarce, who controls supplies, and the forces acting on all playes, then he cannot understand how the health care industry works.

Originally Posted by Inquartata

( That BTW was the source of my amusement when you presented your wife's opinion about the AMA as a cartel as though it were relevant to the economic argument of it---it was an argumentum ad verecundiam, a resort to expert opinion in a wholly different field. It's as though I asked you to accept the opinion of an oilfield roughneck as expert on the issue of the workings of OPEC as a cartel... )

With all due respect to your metaphor, if a professional working in the field knows that an organization is a toothless rag doll without any power to influence the big picture, then that constitutes expert knowledge in the precise domain that is necessary. So, I consulted an expert who has expert testimony to render (certainly compared to us yakkers) on the subject. In discussing the AMA I gave plenty of examples to demonstrate its powerlessness, so I even went to the trouble of illustrating it in a concrete fashion.

Originally Posted by Inquartata

The workings of self-interests in generating economic efficiency have been empirically tested for several centuries. Don't let Smith's term of art, "invisible", mislead you---he only meant that self-interest operates automatically and whether it's scientifically observed or not. He did not mean "take my word for it". Whether you believe it or not, economists are skeptical fellows, and they would not have built so much on an untested foundation...

Economist are also careful to qualify their findings by stating where and how they apply. Alluding to a sweeping rule like the invisible hand doesn't work in situations where the marketplace is distorted, say, by monopoly (what was that cool word for not-quite-a-monopoly) or any of a number of other factors. So, in the most general case there is the 'invisible hand', but that hand is not always the most powerful one on the lever. This does not excuse you from making specific arguments for specific circumstances.

Originally Posted by Inquartata

The operation of self-interest CAN be seen. It has been seen. But it need not be watched constantly lest it suddenly stop working.

Magnetism too works invisibly. That doesn't mean it hasn't been or by its nature cannot be tested, but only assumed.

To use your analogy: magnetism is not in doubt, but whether the materials being observed are magnetic must be first established. Gravity isn't in doubt either, but an object may be subject to other forces (wind, being held up by a support structure, flames coming out of a rocket engine) and therefore we know that objects don't always accelerate towards ground at 32 feet/second squared.. So, we can acknowledge overarching theory, but we have to know where and when it applies to individual cases.

Originally Posted by Inquartata

Why?

Why?

I suggest you bow in the direction of the experts - this is medical knowledge as it is best understood. Better care does provide better results unless there is some additional factor that wasn't observed,. Sorry (and I know you're about to go on about iatrogenic deaths), but this is much more deterministic and better understood than arguments based on citing two-century-old aphorisms from Adam Smith that cannot apply equally in every set of circumstances

Originally Posted by Inquartata

Let me cite here a study I encountered a while back. It's called the Black Study ( Townsend and Davidson, 1982 ), and it looked at infant mortality within socioeconomic segments of a UK population and the effects of universal health care upon it. Before universal health care, the wealthier segment of the population had lower infant mortality rates than the pooer segments---about half the rate, in fact. This is very intuitive, right? The rich had better access to health care, naturally that would tend to make their babies healthier on average. The natural conclusion would be that if one raised the access to health care of babies of the poor, the disparity in mortality rates would ebb. The results of the two groups would become more similar as the health of the poor babies rose, assuming that it was ONLY access to health care that was causing the large difference in outcomes.

And the actual result? After universal health care was instituted and the poor had access to health care for their infants ( and yes, prenatal care for the mothers ), the difference in infant mortality rates between the two classes remained the same. There was no measurable drop in infant mortality rates among poor babies vis-a-vis those of the wealthier ones. After NHI, the infant mortality rate among the wealthiest class remained about half that of the lowest class.

What could account for this counterintuitive finding?

Was the study flawed somehow? Was there some other factor boosting mortality among babies born into poorer families, one which overwhelmed any improvement caused by better health care? Did the poorer families just not avail themselves of the new care opportunities? Did the wealthy somehow go out and get care twice as good as the new NHI offered, to maintain the ratio? Was there something else about the populations studied that yielded the strage results?

Do those sound rather like the same questions I've asked aout the studies which purport to show "universal health care>better health"?

Without your providing additional information about this one particular study it's hard to know what the answer is. I've personally never heard of the study, so am not prepared to answer these questions on the spur of the moment. Since you've read on it, why not finish the job and tell us what the conclusions eventually were? I'll try to look at this later, but will be away from computers for several days and will have no opportunity to do that now. There must have been other factors at play - is that totally surprising?

Originally Posted by Inquartata

Or maybe just different disease. Less smallpox, and we get HIV taking its place. We immunize against existing influenzas, great---until H5N1 develops human communicability...

These attempts at pinpointing an easy, intuitive, identity relationship between one complex phenomenon and another are appealing, but IMO dangerous. Because human phenomena are just not that simple to pinpoint and understand.

I'm sorry Inq, that's rhetorical fun, but it totally misses the empirical (and studied) evidence of medicine since Pasteur and Jenner. We do know that immunization saves lives. Or, if you want to be fatalistic about it: everyone dies eventually so total mortality is 100%. Is that your point? That's not how people think about medicine: people are cured of one problem or innoculated against it means that they live until they die of something else. That's the way it works.

Originally Posted by Inquartata

Or so the doctors tell us...the same doctors causing those hundreds of thousands of "iatrogenic deaths" Esskreemr was talking about. The same medical authorities who tell us one year to avoid alcohol, and the next that it's actually healthy in moderation.

Hmm.

But seriously, why is that easy, intuitive identity you've set up to be accepted uncritically?

Actually, advice on moderate consumption of alcohol really hasn't changed that much over the years. There's been discussion about how much, which type, whether its the flavonoids, but it's really not a big controversy.

Frankly, if you're going to bring up iatrogenic deaths as a reason to cast doubt on all medical findings, then I'll just retort that the examples of depressions, recessions, bread lines, and hyperinflation give great examples of how economists surely must be a bunch of fools and we shouldn't believe what they say. I also have to point out the irony of your using a set of claims about medicine as an argument to deny the validity of claims about medicine in general. That's a self-contradicting argument. That's even without my wondering who the "The Nutrition Institute of America" is and whether or not I should believe them.

Originally Posted by Inquartata

Or to those who have a pre-existing belief to support?

Did you not just chastise esskreemr for arguing that a position is wrong because some individuals hold that position? That's what you're doing right here.

Originally Posted by Inquartata

No. I am not a scientist, much less a medical researcher. But I would suggest that any such experiments try to control for, or at least identify and examine the possible effects of, other conceivable variables on health and health indicators...

Well, here's the thing, Inq. We're debating various points, and the question is whether or not there is any argument that could be posed that would convince you - ironic considering that your sentence immediately above is about "those who have a pre-existing belief to support". If nothing ever could convince you, and no experiment could be devised that could change your mind, then it's fruitless to discuss this. This is not much more than "I've already made my mind up"

As it turns out, there's an entire profession that has done exactly what you suggest would be a good idea to do, and they've done it for decades, and are the same people who (a) came to the conclusions you dispute and wrote "Why?" above, and (b) are the experts you've already said you don't want to have to trust. So, this work has already been done, and you've already said you don't want to put any faith in their results. So why ask for the studies if you're going to dispute their validity again?

Originally Posted by Inquartata

It was and is delicious.

To be more precise with my own stance han you are inclined to be, my position is NOT that such evidence as has been collected is meaningless or even wrong, but that it may not be complete and may have missed other factors affecting the health indicators. I do not question the data, such as they are, only the validity of the conclusions drawn from them and the policy solutions founded on those conclusions. And that when it comes to the economics of health care, economists know more than doctors, nurses or medical statisticians. When it comes to health care as medicine, vice versa.

Thanks for the articulation. However, that's why I've taken care to refer to people who are medical economists on as many opportunities as possible. Including citing the publication Medical Economics, which pretty much hits the nail right on the head.

Originally Posted by Inquartata

Yes. Input on economics from a noneconomist is less valuable than that of an economist. So far so good.

See above.

Originally Posted by Inquartata

Eh? You've lost me. Do you mean licensing and professional accreditations for doctors and nurses, or that I question the credentials of doctors with no economic background to speak about economics? If the latter, yes again...but I see no inconsistency. If the former, I don't recall saying that, but then I have lost track of much of this thread. If you could remind me of where I said it, I'll go back and refresh my memory..

The former, not the latter. This was in the "AMA is a cartel" distraction/red herring we indulged for a while. You made explicit comments to that effect, referring to the bodies and organizations that accredit physicians to practice medicine. So, opining on economics requires getting a PHd. in economics - a tightly controlled commodity, yet practicing medicine should not be restricted to those getting an MD and getting licensed. That's how you portrayed it.

Originally Posted by Inquartata

No, no---credentialing is an entry-restricting barrier erected BY a cartel. The organization ( the AMA ) is the cartel, not the credentialling process.

Well, if they had any ability to control the supply of physicians to the market they might be, but they don't, so they aren't. We've been down this road all too many times.

Originally Posted by Inquartata

Not for the first time, I have some doubts whether anything I say is really clear to you. ( Indeed, sometime it's not even clear to ME. )

I think my point was that you'll happily appeal to authority when it backs you. That's an "if and only if" predicate.

Originally Posted by Inquartata

In the spirit of the season, and since this is a old post I'm answering, I let this pass.

Agreed, but understand my frustration. I go to a lot of trouble sometimes, and it isn't rewarded by an intellectual discussion backed by complementary documentation from the other side.

Originally Posted by Inquartata

It isn't. It suffices to show that "the facts" may not lead to the conclusion you think it does.

I have done. I just haven't chosen to do so in the way you would like me to do, ie dig up an equal and opposite fact. That is only one valid way to argue, or to refute or cast doubt upon an argument, not the only way.

We will simply have to continue to disagree on this. Not being aware of the facts of a situation, (add history, context, and meaning as relevant) disqualifies one from ruling on a situation. I can't call a touch if I was in a different room when the action was made.

Originally Posted by Inquartata

Yes, indeed. I am about 4 whole pages behind. And by this time tomorow I'm betting there will have been another page or two added to that.

The day may come when you find yourself the sole major proponent of a point of view, arrayed against three or four writers as prolific as yourself. When that day comes I will not attack you on the grounds that you cannot keep up with the barrage of new material and fresh arguments, simply because of the sheer volume of it, or impute base motives to your failure to keep up. I promise.

And speaking of falling behind---my scheduled relief called in sick, and so my supervisor is going to replace him. I had best get off the internet for the nonce...

Good night then, and we'll continue later.

[Inquartata]

Originally Posted by jeff

- I'm at least one of the suppliers of the "30% overhead" claim. I've seen that in different articles in New York Times and Wall Street Journal. No, I didn't keep clippings.

I have boxes stuffed full of clippings, carefully annotated with the date and periodical from which they were clipped.

I never use any of them.

If I ever have occasion to use any of them, I will be unable to locate the specific one for which I'm looking. Sheer volume and lack of any organized filing system will ensure this.

I conclude that clippings are useless, and that I am an idiot for keeping any. Also that nevertheless I am not going to throw them away any time soon.

- The bureaucratic overhead in the current system is not especially about government regulatory requirement, it's about the overhead in coding, billing, and filing and challenging claims.

Some anecdotal evidence ( not being in the field it's the only sort I have ):

My mom took care of her invalid mother at home for a good 15 years, including almost constant strivings with Medicare and various private insurers. She would have disagreed with your assessment. ( And now she handles the medical paperwork for herself and my father, who has numerous health problems. She would still disagree with your assessment. She can hold forth for hours on the subject, in fact. )

My aunt's husband had severe Alzheimer's, and spent several years in a VA hospital. She too would object to the idea that government regulatory requirements and bureaucratic red tape is insignificant in the health care business, I think.

@#!*&ing "images" limit!

[Inquartata]

Sigh. Part II.

Originally Posted by jeff

With the interest of the insurer counter to that of the insured, it's in the interest of the former to impede paying claims made by the latter, despite contractual arrangements.

You'd think that eventually they'd tumble to the fact that sooner or later they are probably going to have to pay those bills anyway, and that fighting a lost battle is piling cost onto cost. Especially if lawyers have to be brought in at any point. But no doubt it's a time-value-of-money thing.

Many firms in many industries employ the 'SPAR' strategy: Slow Payables, Accelerate Receivables. Not exactly ethical accountancy, but that doesn't seem to deter businesses any more...

- Inq, you misread the statistics you cite for causes of death...that applies to a table titled "FIVE LEADING CAUSES OF DEATH, USA, AGES 15-24, 1998". Young people very rarely have heart attacks. Overall causes of death in the US were listed above that: heart attack, cancer, stroke, respiratory disease, and then accidents in 5th place. Heart attacks and cancer together were about 50% of deaths.

That was a way of emphasizing my point: even in that age cohort, 'death by doctor' isn't listed before heart disease and cancer. ( Young people presumably are as subject to bad drug reactions, post-op infections and so on as the general population---but it isn't even ahead of CVD and cancer for THEM... )

The 'iatrogenic' category only seems to be touted by groups advancing an agenda. I was unable to find any website mentioning it which wasn't a tendentious one, whatever the respectability of the authors of the studies involved.

But perhaps the issue is being suppressed by the medical cartel.

Ooh. You've just replied to one of my posts (the above is from your conversation with ess). I'll go look at that now before signing off

You sound WAY too excited by that.

[Inquartata]

I've just lost another reply. I had gotten through about 2/3 of your last post, and in view of answering your request for more information on the Black Report I typed a few phrases into the Google search window on my toolbar. After getting the information I was looking for, I came back to my reply, only to find that only your pristine post remained, with none of my interpolated answers to it. I don't understand why it wiped the slate clean this time; I've done this same thing many times before and upon backing up found my reply page still whole.

Discouraging, to say the least. ( How well am I concealing the fact that I have been cursing colorfully for several minutes? )

Well, at a minimum I can give you a better citation for the Black Report. Here is a page about it, with "summary and comment".

http://www.sochealth.co.uk/history/black.htm

If you would like to do your own search, the full title to use is "Inequalities in Health: The Black Report". There are several pages giving abstracts and synopses of various length as well.

[jBirch]

A couple of opinions on this day in lieu of boxing day...

1) Medical opinion suffices for medical phenomenae. If I want to know whether certain policy decisions effect public health, it's not an economist I'm going to turn to for help. If I want to know the economic ramifications (in monetary utility benefits) of certain policy decisions, then it's not a doctor I'm going to turn to. I would submit that in the case of improving health care systems that there is both an economic and a medical element (and many other elements) that need to be analysed to understand the ramifications of policy. So, the opinions of BOTH groups need to be given equal play, not economics above medicine or vice versa.

2) The Black Report has actually gotten some play up here in recent years. The most prevelant finding, if I remember correctly, was that the disparity was the wrong thing to look at. The entire populace experienced a universal decrease in infant mortality while the proportional difference between rich and poor stayed the same.

Interestingly, one of the theories put forth in section 6 of the Black Report for why there is a health inequality in the first place is Darwinian in nature. That people are rich because they are healthy, in fact. Interesting, no?

3) The analysis of universal health care systems implies that universal health is better for the population, selective health care better for the individual. So you will get higher QUALITY care in a private health system, yet not everyone will get that quality. The race by socialised countries seems to be to figure out how to get private quality in a public system. Not sure if that can be done or not.

4) If you are analysing a populace's health care system qualitatively, why would universal coverage not be something of interest in scoring/ranking? The statistical variance in health care based on socio-economic position is irrelevent to whether the populace is healthier or not as the outcomes are not drastic enough to significantly effect the health indicators. In short, you can reduce the sample to analyse whatever subgroup of the populace you want in order to produce more favourable rankings, but it still does not represent the results of health care policy on a state's populace.

5) The belief that all people need health care is axiomatic. As such, I don't think it makes any sense debating it at all. Jeff is unlikely to be convinced that less then universal health care is a good thing. Inq, is equally as unlikely to be convinced that it is.

Inq, it would be really nice if you could apply your brain to the problem of providing universal health care. As I've said before, I don't think that health care for all can be provided by any private entity but if you've got an idea, I'd love to hear it. Specifically, I hope you've got a theory about how to:

a) ensure every citizen receives adequate health care.
b) improve the quality of health care over time (as indicated by improved health indicators)
c) make it economically sustainable (ie// it at least nets out as equal with the resource input requirements and the beneficial outputs measured economically)

Saying, "It can't be done" isn't an answer. Saying "some have to be excluded" equally isn't an answer.

Jeff, is it possible to improve the public/private system of health care in order to ensure that more people take advantage of it? Are there segments of the populace that you should just "write off" as not worth the effort to save? Criminals and the chronically poor/unmotivated? If the Natural Selection theory of health care actually holds true, then is the health care system going to be spending inordinate amounts of energy keeping those alive who should probably be left to die? Triage as national policy, as it were.

If the goal is to improve national health as represented by the health indicators, then surely resources have to be spent in the areas where they are most likely to effect those numbers? At what point does the state no longer have an interest in doing whatever it takes to keep you alive? Instead of investing in breathing machines, risky drug therapy and expensive, risky, surgery, perhaps those conditions should be allowed to run their course to their conclusion?

This is not to say that people should be pre-judged based on their projected benefits to society and then accorded the prescribed level of health service but rather that the system should be structured to improve health care indicators on a national basis, without regard to individual conditions.

James.

[esskreemr]

Originally Posted by Inquartata

BTW, I still await confirmation of that 30% figure, before I accept any conclusions which depend upon it as a premise.

http://www.fencing.net/forums/349649-117-post.html

Results In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

Really, Inq... try to keep up.

[Epee_Pox]

Originally Posted by jBirch

Specifically, I hope you've got a theory about how to:

a) ensure every citizen receives adequate health care.
b) improve the quality of health care over time (as indicated by improved health indicators)
c) make it economically sustainable (ie// it at least nets out as equal with the resource input requirements and the beneficial outputs measured economically)

Let me try. The following setup is extremely likely to ensure that every citizen who seeks health care receives it; that such care is of the best quality; that there are all the incentives for improvement over time, and no disincentives leading to stagnation; that the system is economically sustainable; and that both Inq and Jeff's notions of fairness are met.

1) All medical care is paid for by the patient (either directly, or by medical insurance purchased by the patient).

..1a) We don't force anyone to get health insurance. If they want it, fine. If they don't want it, fine.

..1b) If anyone does want health insurance, the government pays X dollars worth of it. For taxpayers, this comes as a tax deduction/exclusion. For non-taxpayers, this comes as a credit (like the EITC).

..1c) The government doesn't tell you who you can or cannot buy insurance from. That stays up to the consumer.

..1d) If a company wants to provide it to its workers as a fringe benefit, they're more than welcome to (and they can get a deduction/exclusion for the expense). But nobody's going to hold a gun to their head and force them to do so.


2) If someone winds up needing emergency care, but can't afford it, the hospitals still provide it as a matter of ethics. The cost is spread out among everyone else who does pay. (Sort of like absorbing the cost of shoplifting in the cost to paying customers.)


3) Government may not take part in triage or go/no-go decisions.

..3a) Patients can seek out any health care they desire, and doctors can decide for themselves what services to provide.

..3b) Non-emergency-room doctors can accept or decline patients as they see fit.

..3c) Doctors can charge whatever they feel their market can bear.

..3d) Patients can choose whichever doctor they prefer, limtied only by the doctor's availability and price.


Let me see... the US already does all this. Except for 1b. Instead of 1b, we have unwieldy social insurance systems. Replace Medicare, Medicaid, etc. with 1b, and ta-da! Perfection.

[Epeecurean]

Nice post Epee Pox. The socialization of health care through Medicare/Medicaid should be rolled back and replaced with market-oriented policies. If health care, education, etc. are viewed as public goods then fine, have the government support it through vouchers or credits but let the consumer of such goods/services exercise free choice in picking their providers. That is the essence of the market and the most efficient (and moral) solution.

I haven't read through the whole thread (nor intend to at this stage), but one of the wrong-headed arguments I kept coming across is that other countries provide better health care at lower cost than the US. This is in great part because people in the US have a CHOICE to spend more money on what is a superior good. In many state-controlled health systems, health care is rationed and you have to queue for months to receive care and may not receive it at all because they deem it too costly. That's way thousands flee from the UK for operations/treatment overseas.