Quotulatiousness

January 25, 2015

Prescribing modern drugs for Richard III

Filed under: Britain, Health, History, Science — Tags: , , , — Nicholas @ 02:00

In Richard Lehman’s BMJ journal review, there was an amusing bit of interest to Ricardians:

King Richard III of England was 32 when he died at Bosworth and then famously suffered the indignity of being buried in a Leicester car park. I think I probably drew your attention to this account of his post-mortem examination when it appeared online last September. Had Richard III been spared avoidable mortality in the form of a bashed-in skull and a spear through his spine, he would probably have needed a walking frame by the age of 70. He was never in the best shape:

I, that am curtail’d of this faire Proportion,
Cheated of Feature by dissembling Nature,
Deform’d, unfinish’d, sent before my time
Into this breathing World, scarse halfe made up,
And that so lamely and unfashionable,
That dogges bark at me, as I halt by them.

(from The Tragedy of Richard the Third: with the Landing of Earle Richmond , and the Battell of Boʃworth Field by Wm Shakespeare c.1592, First Folio text 1623)

With his nasty scoliosis and his habit of moving around castles with smoky rooms and no hand rails on the stairs, Richard III would have needed an OT assessment and a dosset box containing all the drugs which are now compulsory for elderly people in the UK:

simvastatin 40mg to add 2 days to life and cause muscle aches
tramadol 50mg to fail to ease pain & cause dependency, falls, confusion
naproxen 500mg to cause GI bleeds and fluid retention
furosemide 20mg to reduce fluid retention due to naproxen
omeprazole 20mg to prevent GI bleeds, encourage C diff
senna 7.5mg to counter tramadol constipation
citalopram 20mg to cause serotonin syndrome with tramadol
trazodone 50mg for agitation due to serotonin, to worsen it & cause falls
gababentin MR 800mg to see if it will help pain
paracetamol 500mg because it hasn’t helped the pain
tamsulosin 400mcg for nocturia due to age and furosemide
lisinopril 5mg for “grade 2 CKD” due to furosemide & naproxen
Seretide inhaler for low FEV1 due to scoliosis
etc.

My kingdom for a bit of horse-sense.

January 24, 2015

Problems besetting the British health system

Filed under: Britain, Bureaucracy, Health — Tags: , , — Nicholas @ 04:00

At Samizdata, Natalie Solent shares a post written by “ARC” discussing why the National Health Service seems to be under such pressure lately:

1) Flow-though is crucial to A&E: you must get people out the back-end of the process to maintain your rate of input to the front-end. However ever-increasing regulations mean a patient without family cannot be released until a boat-load of checks have been done. This is clogging up the back end. It may be preventing the release of a few who had better not be sent home yet (not much and not often, is the general suspicion) but it is definitely delaying hugely processing the release of all others who could be. All this admin takes time and effort — delaying release and also using up time of staff in non-health work — and costs money.

This effect needs to be understood in the context of the 15-years-older story of the destruction of many non-NHS nursing homes by galloping regulation. These homes were mostly owned and operated by senior ex-NHS nurses and provided low-grade post-operative care. The NHS relied on them as half-way houses to get patients out of NHS hospitals when they no longer needed intensive care but were not yet recovered enough to go home. These nurses did not want to spend time form-filling instead of caring for patients, and for each home there was always one of the 1000+ rules that was particularly hard for that given home to meet without vast expense or complication. So they died one by one. The ‘waiting times have increased’ story of Tony Blair’s early-2000 years — “If the NHS were a patient, she’d be on the critical list” — was caused by this and the resultant bed-blocking more than any other one cause.

The problem with waving the regulatory wand to “solve” a problem like this is that it tends to create perverse incentives so that the artificial target can be achieved — like this post from a couple of years back where the regulators dictated a maximum time a patient could be kept waiting for admission to A&E. The reaction of the people running the system was to change the definition of “admission” so that now patients’ timers don’t start running until they’re unloaded from the ambulance … so the end result is people are spending more time in the back of ambulances waiting outside the hospital until there’s an open slot. This meets the artificial target, but creates a worse situation because patients are still waiting as long (or longer), but now they’re also tying up ambulances from attending other emergency situations.

Back to ARC’s list of NHS problems:

2) The new 111 service is sending many more patients to A&E.

2.1) The service’s advice is very risk averse. The people who set up the process were afraid of the consequences of the statistical 1-in-a-million time when anything other than mega-risk-averse advice would see some consequence that would become a major news story blaming them.

2.2) Thanks to the post-1997 reforms, GPs work less hours on-call but the doctors are not just slacking off and doing nothing. The huge growth in regulation means they are in effect putting in as many hours as before, but on form-filling and admin to provide all the info the NHS and other government demand, to ensure they tick every box, etc. The out-of-hours on-call time they used to have is now swallowed by this work. So they are not in fact working less; it is the balance of what they are working on that has changed: less on healthcare, more on admin. Thus 111 must send people to A&E, not an on-call GP (and, of course, fewer on-call GPs mean more people phone 111).

From context, I assume the 111 service is a telephone health advisory service like Telehealth Ontario.

November 22, 2014

The rise of the Quebec libertarian movement

Filed under: Cancon, Liberty — Tags: , , — Nicholas @ 10:02

Back when I was active in the Libertarian Party of Canada, Quebec was an almost unknown area … there were so few libertarians or pro-free market people that we rarely tried to run a candidate in elections there. That apparently is now changing:

Published on 18 Nov 2014

“For a couple of years now, Canada has had a freer economy than the United States.”

That’s Martin Masse, one of the leading figures in the Canadian libertarian movement. Back in the late 90s, when libertarianism was a thoroughly marginal ideology in the country, Masse started Le Quebecois Libre, an online gathering place for allies to the cause.

Things have since changed. Free market ideas now inform Canadian public policy to a degree that’s probably surprising to the average American. Reason TV recently sat down with Masse to find out about this transformation and to discuss the future of liberty in our neighbor to the North.

June 25, 2014

“The only serious black mark against the NHS was its poor record on keeping people alive”

Filed under: Britain, Cancon, Europe, Government, Health, USA — Tags: , , — Nicholas @ 07:25

Britain’s NHS came in for rave reviews in a recent study that compared healthcare systems in several European countries and the Anglosphere. There was, as John Kay points out, only one minor flaw in the way the measurements were weighted:

“NHS is the world’s best healthcare system” was a headline last week in The Guardian newspaper. However, six paragraphs in, the authors observed: “The only serious black mark against the NHS was its poor record on keeping people alive.” Further investigation was clearly required.

The newspaper was reporting a survey of health provision by the US-based Commonwealth Fund in 11 advanced countries: seven European states, the US and Canada, Australia and New Zealand.

The findings use measures of service quality, mainly derived from judgments by patients. The effectiveness of care is judged by the intensity of preventive activity – whether necessary tests are carried out, whether doctors advise on a healthy lifestyle – and the reliability of management of chronic conditions.

The safety of care is judged by the frequency of medical mistakes, and the incidence of hospital-induced infection. Good care is patient-centred and timely, with necessary treatment easily accessible. The survey also reports measures of efficiency, or more often inefficiency – how great is the burden of medical administration, how much unnecessary use is made of emergency services, how reliably test results reach medical professionals.

The UK’s National Health Service is at or close to the top on almost all these indicators, and its health spending per head is the second lowest in the survey. The US system scores badly on everything except preventive care, and US medical costs are off the scale when compared with other countries.

The problem, however, is that when it comes to keeping you alive, the World Health Organisation puts Britain tenth out of 11; only the US is worse. If your objective is to live a healthy life, go to France. Medical outcomes are judged by reference to three measures: avoidable mortality, infant mortality, and healthy life expectancy at age 60. And the NHS does not do well on these metrics.

May 23, 2014

He was for the Veterans Health Administration before he was against it

The Wall Street Journal‘s James Taranto rounds up some amusing-in-hindsight bloviations by Paul Krugman about the efficiencies of the Veterans Health Administration:

There was no ObamaCare in January 2006, when former Enron adviser Paul Krugman wrote this:

    I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system’s success provides a helpful corrective to anti-government ideology. For the government doesn’t just pay the bills in this system — it runs the hospitals and clinics.

    No, I’m not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.

The “secret” of the VA’s “success,” Krugman argued, “is the fact that it’s a universal, integrated system.” That saves on administrative costs and allows for efficient record-keeping. Krugman acknowledged that the VA had a history of mismanagement and mediocre care, until “reforms beginning in the mid-1990’s transformed the system.” But wait. Hasn’t it been a universal, integrated system all along? Maybe the secret is something else. At any rate, the Phoenix revelations suggest it’s the system’s failures that are being kept secret.

Krugman lamented that his argument “runs completely counter to the pro-privatization, anti-government conventional wisdom that dominates today’s Washington.” That was 2006, remember, when Republicans had the White House and both houses of Congress. If Krugman is to be believed — a big “if,” to be sure — the Bush administration did a far better job running the VA than the Obama administration is doing now. Which reminds us of something Waldman wrote: “There’s an old saying that when they’re out of office, Republicans argue that government is inefficient and incompetent, and when they get in office, they set about to prove it.”

Krugman concluded that 2006 column as follows:

    Ideology can’t hold out against reality forever. Cries of “socialized medicine” didn’t, in the end, succeed in blocking the creation of Medicare. And farsighted thinkers are already suggesting that the Veterans Health Administration, not President Bush’s unrealistic vision of a system in which people go “comparative shopping” for medical care the way they do when buying tile (his example, not mine), represents the true future of American health care.

Good Glitches,” anyone?

Krugman managed to get two more columns out of the glorious VA. One, in September 2006, also damned Medicare Advantage and complained that the administration opposed the idea of letting elderly vets use Medicare benefits at VA hospitals:

    “Conservatives,” writes Time, “fear such an arrangement would be a Trojan horse, setting up an even larger national health-care program and taking more business from the private sector.”

    Think about that: they won’t let vets on Medicare buy into the V.A. system, not because they believe this policy initiative would fail, but because they’re afraid it would succeed.

OK, but think about this: According to The-Military-Guide.com, “if you’re eligible for any level of VA care, whether it’s high-priority or low-priority, you’re no longer eligible for ACA exchange subsidies.” (ACA is an abbreviation for PPACA, in turn an abbreviation for the Patient Protection and Affordable Care Act, ObamaCare’s official title.) There are worse things than being excluded from ObamaCare, of course — but the VA may be one of them.

May 21, 2014

“The VA really is a good example of a single-payer, socialized health system”

Filed under: Bureaucracy, Government, Health, USA — Tags: , , , — Nicholas @ 07:22

J.D. Tuccille on the Veterans Health Administration:

Just a couple of years ago, Paul Krugman pointed to the Veterans Health Administration (VHA) as a “huge policy success story, which offers important lessons for future health reform.” He gloated, “yes, this is ‘socialized medicine.'”

Similarly, a letter touted by Physicians for a National Health Program trumpeted “the success of 22 wealthy countries and our own Department of Veterans Affairs, which use single-payer systems to provide better care for more people at far less cost.”

How could a bloated government bureaucracy achieve such low-cost success? As we found out recently, it’s by quietly sticking veterans on a waiting list and putting off their treatment for months — sometimes until the patients are far too dead to need much in the way of expensive care. Which is to say, calling it a “success” is stretching the meaning of the word beyond recognition.

And, while the White House insists it learned from press reports about the secret waiting lists, Press Secretary Jay Carney acknowledges that the administration long knew about “the backlog and disability claims” that have accumulated in the VHA.

This should surprise nobody. Canada’s government-run single-payer health system has long suffered waiting times for care. The country’s Fraser Institute estimates [PDF] “the national median waiting time from specialist appointment to treatment increased from 9.3 weeks in 2010 to 9.5 weeks in 2011.”

Likewise, once famously social democratic Sweden has seen a rise in private health coverage in parallel to the state system because of long delays to receive care. “It’s quicker to get a colleague back to work if you have an operation in two weeks’ time rather than having to wait for a year,” privately insured Anna Norlander told Sveriges Radio.

[…]

So the VA really is a good example of a single-payer, socialized health system. Just not in the way that fans of that approach mean.

February 21, 2014

QotD: The unexpected benefit of government incompetence

Filed under: Bureaucracy, Government, Quotations, USA — Tags: , — Nicholas @ 14:56

As Eugene McCarthy, of all people, observed: “The only thing that saves us from the bureaucracy is inefficiency. An efficient bureaucracy is the greatest threat to liberty.”

Luckily the United States is blessed with one of the most incompetent governments in the developed world. It isn’t simply that the Americans have a bloated government, it’s that they have a bloated government that accomplishes far less dollar for dollar than the bloated governments of other leading nations.

This is why Americans should have no fear of Canadian style socialized health care being imposed on them, their government isn’t smart enough to run it. That said Obamacare is turning out to be something that makes Canadian Medicare look like the Swiss Army. I grimly await the flood of American health care refugees trickling north of the 49th. That’s bad news for them and worse news for us. What kept the Canadian system semi-functional was the American escape hatch. If upper middle class Canadians can no longer sneak across to Buffalo, Burlington or Seattle for treatment, that puts more pressure on our system.

From time to time I’m asked why government is so incompetent. It’s such a truism among conservatives, libertarians and classical liberals that it’s rarely reflected upon. February is cold in Winnipeg, governments are generally incompetent. We accept these things perhaps too readily. The truism is true, but in assuming it so blithely we fail to communicate its importance to reasonable people who are uncommitted.

Richard Anderson, “The Incompetence of Evil Government”, The Gods of the Copybook Headings, 2014-02-20

November 28, 2013

Colby Cosh on Obamacare’s international ripples

Filed under: Cancon, Government, Health, USA — Tags: , , — Nicholas @ 11:12

You’ll have guessed from the tone of my Obamacare links and comments that I didn’t think it was a good idea from the start and it’s been a great example of how not to implement a major government initiative. That said, it’s a sure bet that Obamacare will have influence on other countries as they consider their own health programs. Colby Cosh is surprised that the scandal-addled Canadian media hasn’t been paying more attention to the Obamacare train wreck as the wheels fall off in all directions:

Obamacare isn’t going to make major systemic change in either direction look more appetizing to Canadians. That’s an important Canadian angle right there. Not long ago it looked as though national pharmacare was likely to become an election issue here, quarterbacked by the NDP and perhaps the Liberals, too. The concept has plenty of support among economists and other health policy experts—the same class of kindly boffins that, in the U.S., lined up almost unanimously behind the Affordable Care Act.

For better or worse, nationalizing prescription-drug insurance seems likely to be a much tougher sell here in the immediate future. Any large, complex health care experiment will be. The more wise heads support it, the easier it will be for supporters of the status quo to shout, “Unintended consequences! Ivory-tower tomfoolery!” Indeed, political strategists may already be saying it to themselves.

American commentators are already starting to wonder if Obamacare’s difficult start and increasingly troubled prospects may end up as a victory for small-government conservatism. The problems for the program do not end with the calamitous state of the federal insurance-exchange website, or even with the nasty surprises handed to the self-employed and freelancers in the “individual market” who were falsely promised: “If you like your plan you can keep your plan.” Some Obamacare buyers are finding themselves shut out from their preferred doctors and hospitals; employers are junking non-compliant health plans; and many in the middle class who liked the Obamacare concept are facing sticker shock.

[…]

The redistributive aspects of Obamacare were undersold, and possible pitfalls obviously not foreseen. The neoliberal Democrat Walter Russell Mead put it neatly the other day: “President Obama may be the Democrat who ends up convincing millions of American millennials that Ronald Reagan was right, and that the progressive administrative state is neither honest nor competent enough to solve the problems of the American people.” If that is the case, the effects cannot be confined to the U.S.

October 18, 2013

QotD: The hidden problem with regulating prescription drug prices

[W]hen negotiating with other governments, pharmaceutical companies operate at a severe disadvantage, not because the governments’ buying power is so vast (the national health-care systems of Canada and many European countries cover fewer people than Aetna), but because the people you’re negotiating with can change the rules under which your product gets sold. At any point they can say, like Lord Vader, “I am altering the deal. Pray that I do not alter it any further.”

But if Canada started paying more, that wouldn’t mean we’d pay less. Drug companies are charging what they think we will pay. The result of Canadians and Europeans paying less is not that we pay more for drugs; it’s that fewer drugs get developed. To the extent that they are harming us, it is in hindering the development of cures or better treatments that we are missing, and don’t even know about.

Unfortunately, this is a classic case of Bastiat’s dilemma. It is easy for each country’s government to see the high prices that people are paying and intervene to lower them. It is hard for each country’s government, much less its citizens, to envision the new medical treatments that they might get if they paid more for drugs. So their incentives are heavily skewed toward controlling the price here and now, even if that means losing future cures.

Drug development is essentially a giant international collective-action problem. The U.S. has kept it from being a total disaster because we don’t have good centralized control of our insurance market, and our political system is pretty disorganized and easy to lobby. If that changes — and maybe we just changed it! — we’ll knock down the prices of drugs to near the marginal cost using government fiat, and I expect that innovation in this sector will grind to a halt. Stuff will still be coming out of academic labs, but no one is going to take those promising targets and turn them into actual drugs.

Megan McArdle, “U.S. Consumers Foot the Bill for Cheap Drugs in Europe and Canada”, Bloomberg, 2013-10-14

October 4, 2013

Why this government shutdown is different from the last 17 shutdowns

Filed under: Bureaucracy, Government, USA — Tags: , , , , , — Nicholas @ 07:24

Jonah Goldberg on what sets the current US government “shutdown” apart from all the others in recent memory:

Obama has always had a bit of a vindictive streak when it comes to politics. I think it stems from his Manichaean view of America. There are the reasonable people — who agree with him. And there are the bitter clingers who disagree for irrational or extremist ideological reasons.

In his various statements over the last week, he’s insisted that opponents of Obamacare are “ideologues” on an “ideological crusade.” Meanwhile, he cast himself as just a reasonable guy interested in solving America’s problems. I have no issue with him calling Republican opponents “ideologues” — they are — but since when is Obama not an ideologue?

The argument about Obamacare is objectively and irrefutably ideological on both sides — state-provided health care has been an ideological brass ring for the Left for well over a century. But much of the press takes its cues from Democrats and sees this fight — and most other political fights — as a contest pitting the forces of moderation, decency, and rationality against the ranks of the ideologically brainwashed.

What’s unusual is the way Obama sees the government as a tool for his ideological agenda. During the fight over the sequester, Obama ordered the government to make the 2 percent budget cut as painful and scary as possible.

[…]

When Republicans vote to fund essential or popular parts of the government, the response from Democrats is, in effect, “How dare they?” Nancy Pelosi calls the tactic “releasing one hostage at a time” — as if negotiators normally refuse to have hostages released unless it’s all at once.

In the 17 previous government shutdowns since 1977, presidents have worked to avoid them or lessen their impact. Obama has made no such effort out of an ideological yearning to punish his enemies, regardless of the collateral damage.

September 30, 2013

The breathtaking scale of Obamacare

Filed under: Bureaucracy, Health, USA — Tags: , , — Nicholas @ 09:28

Mark Steyn explains just how big the effective nationalization of the US healthcare system really is:

No one has ever before attempted to devise a uniform health system for 300 million people — for the very good reason that it probably can’t be done. Britain’s National Health Service serves a population less than a fifth the size of America’s and is the third-largest employer on the planet after the Indian National Railways and the Chinese People’s Liberation Army, the last of which is now largely funded by American taxpayers through interest payment on federal debt. A single-payer U.S. system would be bigger than Britain’s NHS, India’s railways, and China’s army combined, at least in its bureaucracy. So, as in banking and housing and college tuition and so many other areas of endeavor, Washington is engaging in a kind of under-the-counter nationalization, in which the husk of a nominally private industry is conscripted to enforce government rules — and ruthlessly so, as Michelle Malkin and many others have discovered.

Obama’s pointless, traceless super-spending is now (as they used to say after 9/11) “the new normal.” Nancy Pelosi assured the nation last weekend that everything that can be cut has been cut and there are no more cuts to be made. And the disturbing thing is that, as a matter of practical politics, she may well be right. Many people still take my correspondent’s view: If you have old money well managed, you can afford to be stupid — or afford the government’s stupidity on your behalf. If you’re a social-activist celebrity getting $20 million per movie, you can afford the government’s stupidity. If you’re a tenured professor or a unionized bureaucrat whose benefits were chiseled in stone two generations ago, you can afford it. If you’ve got a wind farm and you’re living large on government “green energy” investments, you can afford it. If you’ve got the contract for signing up Obamaphone recipients, you can afford it.

But out there beyond the islands of privilege most Americans don’t have the same comfortably padded margin for error, and they’re hunkering down. Obamacare is something new in American life: the creation of a massive bureaucracy charged with downsizing you — to a world of fewer doctors, higher premiums, lousier care, more debt, fewer jobs, smaller houses, smaller cars, smaller, fewer, less; a world where worse is the new normal. Would Americans, hitherto the most buoyant and expansive of people, really consent to live such shrunken lives? If so, mid-20th-century America and its assumptions of generational progress will be as lost to us as the Great Ziggurat of Ur was to 19th-century Mesopotamian date farmers.

September 15, 2013

Why “Breaking Bad: Canada” is a ludicrous meme

Filed under: Government, Health, Media, USA — Tags: , , , , , — Nicholas @ 09:57

Megan McArdle is a fan of the TV show Breaking Bad, but she also is fairly well informed about the US healthcare system. This means that the idea that the TV show’s Canadian counterpart would look like this…

Breaking Bad Canada

…depends on the audience for the real TV show not actually knowing much about the US system.

The series starts with Walter White, a high school chemistry teacher in Albuquerque, New Mexico, who is diagnosed with lung cancer. His lousy health maintenance organization won’t cover a decent doctor, or treatment. So Walter is forced to turn to crime just to pay his medical bills and … whoa, wait a minute. You know who has excellent benefits, compared with basically everyone else in the country? Teachers, firefighters and cops. Maybe they’re overworked and underpaid, but the one thing that you cannot say about them is that they’re forced to endure shoestring health-care plans. According to the Internet, Albuquerque school district employees are eligible for

    Medical, Dental, Vision, Basic and Additional Life Insurance, Long Term Disability, Pre-tax Insurance Premium Plan (PIPP), Flexible Spending Accounts, Long Term Care Insurance, 403(b) and the 457(b) Deferred Compensation Plans.

That’s a generous package. Moreover, the Albuquerque school district self-insures, so any complaints about benefit levels should be directed at the city government, not your “lousy HMO.”

Later, after Walt’s actions accidentally result in the shooting of his brother-in-law, a Drug Enforcement Agency agent, Walt’s wife takes a bunch of the meth money to pay for Hank’s treatment. On his government salary, Hank can’t possibly afford the treatment he needs, because, of course, his lousy insurance policy won’t cover more than a few visits to the physical therapist … and whoa, we just went from “unrealistic” to “ludicrous.” You know who has even better benefits than employees enjoying a compensation package collectively bargained with a local government? Federal employees in a low-cost state such as New Mexico. Moreover, extra benefits are available to people injured in the line of duty.

In short, a number of key plot points hinge on the improbable assertion that people who actually enjoy some of the best health insurance in the country actually suffer some of the worst — so bad that we are expected to believe that Walt had no choice but to cook meth to cover the gaps. For an otherwise great show, this is incredibly silly.

September 14, 2013

Reason.tv: George Will’s Libertarian Evolution

“I’ve lived in Washington now for 44 years, and that’s a lot of folly to witness up close,” says Washington Post columnist George Will. “Whatever confidence and optimism I felt towards the central government when I got here on January 1, 1970 has pretty much dissipated at the hands of the government.”

“In part, I owe my current happiness to Barack Obama,” continues the 72-year-old Will, who “so thoroughly concentrates all of the American progressive tradition and the academic culture that goes with it, that he’s really put the spring in my step.”

Branded “perhaps the most powerful journalist in America” by the Wall Street Journal, Will received the Pulitzer Prize for commentary in 1977 and is the author of numerous books, including Statecraft as Soulcraft: What Government Does, Men at Work: The Craft of Baseball, and One Man’s America: The Pleasures and Provocations of our Singular Nation. A regular panelist on ABC’s This Week, Will has the distinction of having been attacked in the pages of Doonesbury and praised in an episode of Seinfeld (for his “clean, scrubbed look”).

More recently Will has become a champion of libertarianism, both in print and on the air. “America is moving in the libertarians’ direction,” Will wrote in a 2011 review of The Declaration of Independents, “not because they have won an argument but because government and the sectors it dominates have made themselves ludicrous.”

Will sat down with Reason‘s Nick Gillespie and Matt Welch to discuss his libertarian evolution (2:16), how Sen. John McCain spurred his political transformation (4:07), Ronald Reagan (4:29), the tax code (8:45), why the Republicans are becoming more interesting (19:30), what the government should be spending money on (23:14), war hawks and foreign policy (25:19), the benefits of judicial activism (34:49), gay marriage (37:55), marijuana legalization (39:04), the importance of Barry Goldwater (40:28), Mitt Romney (45:45), the 2016 election (46:37), Medicare (48:52), how Everett Dirksen’s untimely death changed his life (50:42), why President Obama makes him happy (52:06), affirmative action (53:07), and his optimism in America’s future (57:31).

September 13, 2013

Medicare costs as seen by the public

Filed under: Government, Health, USA — Tags: , , — Nicholas @ 07:58

The Harvard School of Public Health released a summary of public opinion on various issues surrounding the Medicare system:

As debate over the national debt and the federal budget deficit begins to heat up again, an analysis of national polls conducted in 2013 shows that, compared with recent government reports prepared by experts, the public has different views about the need to reduce future Medicare spending to deal with the federal budget deficit. Many experts believe that future Medicare spending will have to be reduced in order to lower the federal budget deficit [1] but polls show little support (10% to 36%) for major reductions in Medicare spending for this purpose. In fact, many Americans feel so strongly that they say they would vote against candidates who favor such reductions. Many experts see Medicare as a major contributor to the federal budget deficit today, but only about one-third (31%) of the public agrees.

This analysis appears as a Special Report in the September 12, 2013, issue of New England Journal of Medicine.

One reason that many Americans believe Medicare does not contribute to the deficit is that the majority thinks Medicare recipients pay or have prepaid the cost of their health care. Medicare beneficiaries on average pay about $1 for every $3 in benefits they receive. [2] However, about two-thirds of the public believe that most Medicare recipients get benefits worth about the same (27%) or less (41%) than what they have paid in payroll taxes during their working lives and in premiums for their current coverage.

Differences between experts on the financial condition of Medicare and the public can also be seen when examining the reasons for rising Medicare costs and ways to reduce future Medicare spending. Unlike many experts, the public does not see overuse of medical care and the cost of new medical technologies as among the most important reasons for rising Medicare costs. Only one in six Americans (17%) believes that “people receiving drugs and medical treatments they don’t need” is one of the most important reasons why Medicare care costs are rising, and only 6% see “new drugs, tests and treatments being offered to the elderly” as one of the most important reasons. The three reasons cited most often by the public are poor management of Medicare by government (30%), fraud and abuse in the health sector (24%), and excessive charges by hospitals (23%).

Many experts believe that one of the most important reasons for rising Medicare costs is unnecessary care provided to patients. The public, however, sees the bigger problem for people on Medicare as not getting the health care they need (61%), rather than receiving unnecessary care (21%). Many experts see capitated payments (doctors getting paid a fixed amount of money so they can manage all of a patient’s health care for the year) as a preferred way of reducing future Medicare spending. However, a majority of the public favors continuing fee-for-service payments (65%) rather than changing to capitated health care arrangements (30%). This resistance to change may be related to the fact that a majority of the public sees Medicare in some cases already withholding treatments and prescription drugs to save money, including 63% who believe this happens very or somewhat often.

June 4, 2013

Finland’s cardboard box babies

Filed under: Europe, Health, History — Tags: , , , — Nicholas @ 08:56

An interesting bit of history on the BBC News website:

It’s a tradition that dates back to the 1930s and it’s designed to give all children in Finland, no matter what background they’re from, an equal start in life.

The maternity package — a gift from the government — is available to all expectant mothers.

It contains bodysuits, a sleeping bag, outdoor gear, bathing products for the baby, as well as nappies, bedding and a small mattress.

With the mattress in the bottom, the box becomes a baby’s first bed. Many children, from all social backgrounds, have their first naps within the safety of the box’s four cardboard walls.

Mothers have a choice between taking the box, or a cash grant, currently set at 140 euros, but 95% opt for the box as it’s worth much more.

The tradition dates back to 1938. To begin with, the scheme was only available to families on low incomes, but that changed in 1949.

“Not only was it offered to all mothers-to-be but new legislation meant in order to get the grant, or maternity box, they had to visit a doctor or municipal pre-natal clinic before their fourth month of pregnancy,” says Heidi Liesivesi, who works at Kela — the Social Insurance Institution of Finland.

So the box provided mothers with what they needed to look after their baby, but it also helped steer pregnant women into the arms of the doctors and nurses of Finland’s nascent welfare state.

In the 1930s Finland was a poor country and infant mortality was high — 65 out of 1,000 babies died. But the figures improved rapidly in the decades that followed.

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