Tuesday, March 31, 2009

Better than Believed

President Obama exaggerated the effect of healthcare cost increases on the economy to argue that healthcare reform must be accomplished together with economic recovery. Obama also nominated Kansas Governor Kathleen Sebelius for health secretary, who promptly completed the circle by insisting "We can't fix the economy without fixing healthcare." Are they right?

No. There's no connection between the credit collapse and healthcare. I've shown that American healthcare is quite good, and better than single-payer (Canada) and socialized (Britain, France) systems. Further, I've shown that Obama's model reform measure, adopted two years ago in Massachusetts, suffers run-away costs that now threaten to wreck that state's economy.

Could it be that America already has a reasonable healthcare scheme? Maybe we should retain our current approach, and fine tune it to increase competition by, for example, ending the tie between health insurance and employment.

Scott Atlas M.D., senior fellow at the Hoover Institution and professor at the Stanford University Medical Center, agrees. He published 10 Surprising Facts about American Health Care", in NCPA's Policy Analysis No. 649 (Mar. 24, 2009); here are the first six:
Medical care in the United States is derided as miserable compared to health care systems in the rest of the developed world. Economists, government officials, insurers and academics alike are beating the drum for a far larger government rĂ´le in health care. Much of the public assumes their arguments are sound because the calls for change are so ubiquitous and the topic so complex. However, before turning to government as the solution, some unheralded facts about America's health care system should be considered.

Fact No. 1: Americans have better survival rates than Europeans for common cancers.[1] Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

Fact No. 2: Americans have lower cancer mortality rates than Canadians.[2] Breast cancer mortality is 9 percent higher, prostate cancer is 184 percent higher and colon cancer mortality among men is about 10 percent higher than in the United States.

Fact No. 3: Americans have better access to treatment for chronic diseases than patients in other developed countries.[3] Some 56 percent of Americans who could benefit are taking statins, which reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons and 17 percent of Italians receive them.

Fact No. 4: Americans have better access to preventive cancer screening than Canadians.[4] Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate and colon cancer:
  • Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent).
  • Nearly all American women (96 percent) have had a pap smear, compared to less than 90 percent of Canadians.
  • More than half of American men (54 percent) have had a PSA test, compared to less than 1 in 6 Canadians (16 percent).
  • Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with less than 1 in 20 Canadians (5 percent).
Fact No. 5: Lower income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report "excellent" health compared to Canadian seniors (11.7 percent versus 5.8 percent). Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as "fair or poor."[5]

Fact No. 6: Americans spend less time waiting for care than patients in Canada and the U.K. Canadian and British patients wait about twice as long - sometimes more than a year - to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer.[6] All told, 827,429 people are waiting for some type of procedure in Canada.[7] In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.[8] . . .

Conclusion. Despite serious challenges, such as escalating costs and the uninsured, the U.S. health care system compares favorably to those in other developed countries.

[1] Concord Working Group, "Cancer survival in five continents: a worldwide population-based study,.S. abe at responsible for theountries, in s chnologies, " Lancet Oncology, Vol. 9, No. 8, August 2008, pages 730 - 756; Arduino Verdecchia et al., "Recent Cancer Survival in Europe: A 2000-02 Period Analysis of EUROCARE-4 Data," Lancet Oncology, Vol. 8, No. 9, September 2007, pages 784 - 796.

[2] U.S. Cancer Statistics, National Program of Cancer Registries, U.S. Centers for Disease Control; Canadian Cancer Society/National Cancer Institute of Canada; also see June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S.," National Bureau of Economic Research, Working Paper No. 13429, September 2007. Available at http://www.nber.org/papers/w13429.

[3] Oliver Schoffski (University of Erlangen-Nuremberg), "Diffusion of Medicines in Europe," European Federation of Pharmaceutical Industries and Associations, 2002. Available at http://www.amchampc.org/showFile.asp?FID=126. See also Michael Tanner, "The Grass is Not Always Greener: A Look at National Health Care Systems around the World," Cato Institute, Policy Analysis No. 613, March 18, 2008. Available at http://www.cato.org/pub_display.php?pub_id=9272.

[4] June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."

[5] Ibid.

[6] Nadeem Esmail, Michael A. Walker with Margaret Bank, "Waiting Your Turn, (17th edition) Hospital Waiting Lists In Canada," Fraser Institute, Critical Issues Bulletin 2007, Studies in Health Care Policy, August 2008; Nadeem Esmail and Dominika Wrona "Medical Technology in Canada," Fraser Institute, August 21, 2008 ; Sharon Willcox et al., "Measuring and Reducing Waiting Times: A Cross-National Comparison Of Strategies," Health Affairs, Vol. 26, No. 4, July/August 2007, pages 1,078-87; June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."; M.V. Williams et al., "Radiotherapy Dose Fractionation, Access and Waiting Times in the Countries of the U.K.. in 2005," Royal College of Radiologists, Clinical Oncology, Vol. 19, No. 5, June 2007, pages 273-286.

[7] Nadeem Esmail and Michael A. Walker with Margaret Bank, "Waiting Your Turn 17th Edition: Hospital Waiting Lists In Canada 2007."

[8] "Hospital Waiting Times and List Statistics," Department of Health, England. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics
(via Carpe Diem)


Thai said...

You can lead a horse to water but you can't make him drink...

Carl, why you don't see most of your points as easily explained by the fact America simply spends more than any other country I continue to fail to understand?

And if points number 1 and 2 are not as good an example of a "ethics bubble" by blog authors as any I have read, I don't remember.

You seem trapped in the same cognitive dissonance most conservatives (who don't work in health care) maintain.

The logic of your post might make perfect sense to someone who purchases health care services (i.e. a prospective patient) but it entirely ignores the perspective of someone who thinks of themselves as an "owner" (e.g. voter) of America. It also ignores probabilities and how someone who might or might not get realistically get sick in their life, but also has to weigh such a possibility vs. every other possibility life might throw them- how would this person look at things?????

I give up.

AND, again, you fail to reconcile your main recurrent theme:

America = free market health care = good care


1. Almost 1/2 of all our health care spending comes from government.
2. America is running a much larger public debt as % GDP than our northern neighbor
3. America's private sector has amassed a debt that now amounts to almost 350% GDP.

It's like listening to a USC cheerleader describe why USC is better than UCLA- bizarre in every way imaginable.

And after you finish your "feel good America" point you then fail to explain this.

Certainly other conservatives get it.

Why is this point so hard to understand?

Are you a conservative or are you not?

How do you define a conservative?


OBloodyHell said...

Sorry, Thai, your argument fails to hold water because it ignores the fact that the largest part of the real health care spending increase derives from procedures on an increasingly elderly population.

I have a very good friend who had both his failing knee joints replaced with titanium/artificial ones last year.

He's freakin' 84 this year.

a) He was a former employee at the Smithsonian. I gather that is still a major part of his health care coverage, even though he retired waaay back in 1991.

b) I have no problem of any kind with regards to DOING this, but it's an obvious reason for your claim to be accurate in fact but not as to cause or relevance. Granted, we aren't necessarily increasing life expectancy -- which is ONE LONE MEASURE of why we spend money on healthcare -- but we are making far more late-in-life Quality of Life expenditures. People now routinely get fairly expensive procedures which benefit them for a term of 5, 10, 15 years instead of 35,40, or 50.

c) Mentioning it as a % of GDP is also specious, when comparing it to other nations. We're a bunch of rich fucks when it comes to comparing to other nations -- our one-twenty-second of the world's population produces more than a quarter of its wealth. And we keep a moderately large part of that, sure. We EARN it. So is it surprising that we apply a larger chunk of that retained wealth to enhanced late-in-life QoL issues that the people of other nations can't afford to do ?

At its heart, this isn't about just efficient use of money.

It's about freedom of choice and quality of life issues.

I recently came across a highly relevant quote/observation from economist Friedrich Hayek:

"In a competitive society, most things can be had for a price -- though it is often a cruelly high price we have to pay... The alternative is...the favor of the mighty."

I'd much rather be able to depend on charity and essential decency, as well as my own wits and capability to find/create wealth for my needs, than to depend on the largess of The Mighty.

If you don't like that, hey, great. There are PLENTY of socialist health-care states in the world. Go live in one, and stop trying to screw up this one too.

Because once you screw this one up, the R&D money train that all the others are utterly dependent on is going to dry up -- since a HUGE chunk of them do virtually no medical R&D compared to the USA, another source of that difference in expenditures (and not one I'm complaining about, though that might appear the case -- it goes with being rich as hell -- we CAN afford to spend more than the others, so we do... and others reap benefits since we don't charge an arm and a leg to share the benefits of that work).

Thai said...

"If you don't like that, hey, great. There are PLENTY of socialist health-care states in the world. Go live in one, and stop trying to screw up this one too"

Junior, let the adults talk until you have something intelligent to say.

... Though I am impressed to see you are picking up a little on the idea of rationing (unless I misunderstand your point). That you chose your first pubic support for rationing on 84 year olds with knee replacements in fact puts you squarely in the line with socialist Britain.

Funny how strange intellectual bedfellows can be... Now understand that aging itself is only responsible for 3% of the increase in the growth of health care spending???

On top of your obvious lack of understanding of how things work in health care in America, your comment clearly shows you don't even understand my point- calling me Socialist, please. Calling me anti R&D? Now you truly couldn't be further from my position (nor those of the blog authors I directed you towards).

And when you say: "It's about freedom of choice and quality of life issues", where does the money come from to pay for this freedom of choice and quality of life issue you so admire?

Yet another example of conservative "magic thinking" (part of the same way you equate stiffing hospitals with good old free market capitalism?? Bizarro world (are you too a USC Cheerleader? Your blond is really showing through. Did you come up with this idea on your own? Or did your conservative "power crystals" help you reach this enlightened idea?

Is this why religion and conservatives have become so intertwined in recent decades- both now share magical thinking??? God help us all.

I might remind you that citizens of Nigeria and Haiti have plenty of choice as well. They just don't have much money from which to choose anything off the first shelf in the store.

And statements like: "Mentioning it as a % of GDP is also specious, when comparing it to other nations. We're a bunch of rich fucks when it comes to comparing to other nations"

Again, you are making my point.

But I might also remind you (yet again) WE ARE IN DEBT AS PRIVATE CITIZENS, AS A GOVERNMENT, AS A NATION.

WE ARE NOW ATTEMPTING TO INCREASE THE GOVERNMENT'S DEBT TO OFFSET THE PRIVATE SECTOR'S DEBT COLLAPSE. (I'll assume for a moment you are not in the camp that personally wants the government to do this since you reference Hayek, though it does not effect my point).

Oh and, in case you forgot to read the paper recently

Foreigner's have decided to stop loaning us money.

Again, those laid off workers with no health coverage are showing up at hospitals and still asking for care ( what we in the health industry refer to as "self pay" is most definitely rising nationally). And just as you stiffed your hospital when you needed care, so too do they hope that they too can "stiff the system" and get away with it.

And when hospitals don't get paid, they have ONLY 4 choices:

1. Look for someone else to pay (e.g. get more money from government or increase the fees on the people who are paying)
2. Stop providing care (makes it hard for people like you to stiff them when they don't even provide the care).
3. Reducing services provided (i.e. rationing)- this is currently against the law in the US.
4. Improve productivity- no one seems to want this since it is so likely to lead to 3.

Right now private health care pending as % of TOTAL health care spending is shrinking fast (and I mean fast).

Where will the money come from to finance point 1 to work?... Didn't Carl just put that wonderful bumper sticker up the other day "If you think health care is expensive now, just wait till it's free"? Do you read your own blog???

Right now it is you and I (well probably more me than you) that will pay for 1. Even you don't like 2 (or you wouldn't have had the chance to stiff the hospital), so that leaves 3 (and 4, which is kind of back to 3 again)- Ahh??!!!

Go ahead, promote choice all you want (all the while choosing with other people's money).

Now conservatives like you have magically been able to eliminate "personal responsibility". What a racket.

@nooil4pacifists said...


It mystifies me how you could think I equate America's healthcare with free healthcare. You also seem to miss the fact that I've made suggestions for improving healthcare here.

I know you agree that the relevant issue is selecting a policy that best balances price and quality. I don't know the right choice---rather, my contention is that freer markets will enable individuals and society to move toward that goal. That, by the way, is one way I define conservative.

Obviously, if "reformed" healthcare winds up costing more than the current system, it will aggravate the debt issue on which you focus. And, regarding life expectancy, you haven't considered these well-known points.

Thai said...

-"I know you agree that the relevant issue is selecting a policy that best balances price and quality."

A: Absolutely "yes", I agree.

-"I don't know the right choice"

A: No one does because there isn't one. It is always a values choice in the end... And by the way, one of the links I gave you, "The Covert rationing blog" is tying to do just that. e.g. a conservative is attempting to give us a method by which we most of us can reach agreement on the health care issue.

-"rather, my contention is that freer markets will enable individuals and society to move toward that goal"

A: Are you sure there is not a kind of cognitive dissonance on this issue? especially when you think of it with the same filter you think of the military? There is certain similarity in the common good features of health care we similarly see in the military.

Should Americans be able to chose whatever military protection they want individually? If the people of Berkeley California (my Alma mater) don't want anything to do with the US military, is that their right?

Freedom of choice is ALWAYS how you define a conservative?????

I might suggest Johnathan Haidt does a much better job on this issue than you.

Anonymous said...

There are other factors that impact
national health care and quality.
For example, Canada has only slightly more population than California and the UK has slightly more population than California and Texas combined and look at the outcomes of those two countries for
survival rates. If those two countries have financial problems
in their health care, how on earth
can U.S. government manage health care for 310,000,000 people without
severely rationing health care????

As for death rates..............
the US takes in more immigrants than all other western nations put together and most of these are third world citizens who arrive having had virtually no healthcare
and who have major health care problems--diabetes, multi drug resistant(MDR) TB, etc. This has a large impact on annual number of
deaths so I think our death rate is
skewed by this.

As for the amount the US spends on
healthcare: there is not one other
first world country with a population that is even near to
100 milllion and we have 310 million. Nothwithstanding the fact the the US is broke and living on
borrowed dollars, how can the US possibly provide national healthcare without a total socializing of the country. I really would like to see this explained along with how rationing
would apply.

@nooil4pacifists said...



Thai said...

Anony and Carl, then I suggest you read The Covert Rationing Blog.

Dr Rich's GUTH (Grand Unification Theory of Health Care) proposal is very very workable.

I can't see how conservatives or liberals with even half a brain can really disagree with it (unless they have no brain whatsoever).

Rich is a conservative

Anonymous said...

You know, I recommend looking up the actual references for those points. Because, you know, they sure don't say what the author claims they say !

And 4/10 points are cancer survival? He couldn't find 10 areas where the US does well?

Heck, go read the whole thing, and check all the references.