Quotulatiousness

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.

May 12, 2013

British emergency wards are overcrowded … so we’ll fine the ambulance service!

Filed under: Britain, Bureaucracy, Health — Tags: , , — Nicholas @ 08:59

Hard to come up with an explanation for this perverse policy:

Ministers came under fresh criticism for their handling of the NHS last night after it emerged the ambulance service will be hit with £90 million in fines — as punishment for the chaos blighting casualty departments.

Critics said the fines will simply deprive trusts of vital funds that could help tackle the deterioration in patient services.

A new penalty clause that was written into ambulance trust contracts from last month will levy fines of £200 for every patient who has to wait for longer than 30 minutes for admission to A&E, and £1,000 for each patient forced to wait more than an hour.

You can understand the desire to speed the delivery of injured people to the emergency services they need, but how does it make any kind of sense to punish the ambulance service because the emergency wards they need to get their patients into are overcrowded? Unless the ambulance service has some kind of magic ability to shift priorities in the hospitals, fining them for patients’ wait times makes less than zero sense.

But acute overcrowding in A&E departments has led to increasing ambulance ‘jams’ formed as they queue to unload, with waits of four hours recorded at some hospitals at the busiest times.

Damning new figures reveal that during the past year there were more than 265,000 occasions in England when ambulance staff took more than half an hour to deliver patients into the hands of hospital doctors.

And shockingly, more than 37,000 patients had to wait over an hour to move on to the wards.

Official guidelines say ambulances should deliver patients, clean the ambulance and be back out on the road within 15 minutes. A longer wait is seen as ‘unsafe’.

Yet the chaos in A&E departments is so bad that at one, the Norfolk and Norwich University Hospital, doctors were forced to put up a tent to act as a makeshift ward to treat patients alongside the ambulance queue.

May 2, 2013

Cherrypicking the result you prefer from a recent Medicaid study

Filed under: Health, Media, USA — Tags: , , , — Nicholas @ 10:43

Megan McArdle explains why a recent study’s results may be much more important than you might gather from the way it’s been reported so far:

Bombshell news out of Oregon today: a large-scale randomized controlled trial (RCT) of what happens to people when they gain Medicaid eligibility shows no impact on objective measures of health. Utilization went up, out-of-pocket expenditure went down, and the freqency of depression diagnoses was lower. But on the three important health measures they checked that we can measure objectively — glycated hemoglobin, a measure of blood sugar levels; blood pressure; and cholesterol levels — there was no significant improvement.

I know: sounds boring. Glycated hemoglobin! I might as well be one of the adults on Charlie Brown going wawawawawawa . . . and you fell asleep, didn’t you?

But this is huge news if you care about health care policy — and given the huge national experiment we’re about to embark on, you’d better. Bear with me.

Some of the news reports I’ve seen so far are somewhat underselling just how major these results are.

“Study: Medicaid reduces financial hardship, doesn’t quickly improve physical health” says the Washington Post.

The Associated Press headline reads “Study: Depression rates for uninsured dropped with Medicaid coverage”

At the New York Times, it’s “Study Finds Expanded Medicaid Increases Health Care Use”

I think Slate is closer to the mark, though a bit, well, Slate-ish: “Bad News for Obamacare: A new study suggests universal health care makes people happier but not healthier.”

This study is a big, big deal. Let me explain why.

March 10, 2013

Do they have to destroy the Republican Party to save it?

Filed under: Media, Politics, USA — Tags: , , , , , — Nicholas @ 10:00

The defeat of the Republicans in the last US federal election has a lot of them starting to consider radical changes to the party in order to attract new voters. Some of these proposed changes are so radical that it’s hard to believe they wouldn’t rupture the party and drive away nearly as many as they hope to bring in. The farcical notion of a “conservative welfare state“, for example, would likely jettison any last vestiges of reducing the size of government:

[Matthew] Continetti is not the first conservative to argue — falsely as I note in an upcoming piece for Reason magazine — that courting new constituencies such as Hispanics, Asian Americans and other minorities will require the party to give up even its pretense of limited government. Still, Continetti’s basic point that the GOP does not have a coherent ideology that will allow it to court new constituencies while hanging on to its old ones is well taken. After all, how does the party appeal to the “millennial generation” that includes gays, young foodies and indie-music listening hipsters without losing the meat-and-potato social conservatives in, say, Charleston, South Carolina?

Continetti’s answer, dusted off from a 1975 essay by Irving Kristol, is that what the GOP needs is an authentically conservative version of the liberal welfare state. To fashion such a state, Continetti argues, would require:

    Republicans to revisit some of the assumptions they have held since the end of the Cold War. Maybe the foremost concern of most Americans is not the top marginal income tax rate. Maybe you can’t seriously lower health care costs without radically overhauling the way we pay for health care. Maybe a political party can’t address adequately such middle-class concerns as school quality and transportation without using the power of government. Maybe the globalization of capital and products and labor hasn’t been an unimpeachable good.

I am all for rethinking post-Cold War assumptions, but do we have to throw globalization and trade liberalization under the bus in the process? After all, hostility to trade has become passé even among Third World anti-trade activists such as Vandana Shiva — the last ones holding their finger in the dyke to stop globalization. This is in no small part due to the debunking done by economists such as Jagdish Bhagwati who have shown that even the immediate losers of trade liberalization win in the long run. So what is the point of reviving this animus especially since Continetti offers no new (or even old) evidence of trade’s downside?

[. . .]

In short, the ideal conservative welfare state would be a libertarian dystopia of even bigger proportions than the liberal welfare state. There is less welfare and more state in it.

But what is deeply ironic is that a magazine that accuses libertarians of isolationism because they oppose American military interventionism has no qualms about recommending a restrictionist immigration policy to keep foreigners out and a protectionist trade policy to keep foreign goods out. If I had to pick a term for this foreign policy, I’d call it neo-isolationism. And maybe I lack imagination, but it is hard to see how a party that wants to engage the world through its “fearsome military” — rather than through voluntary exchange and mutual cooperation — could gain enough moral high ground to craft a winning political message, especially in a war-weary country.

February 17, 2013

Whinnygate is just a useful distraction from the real scandal in the NHS

Filed under: Britain, Bureaucracy, Health, Politics — Tags: , , , , , — Nicholas @ 11:09

The British media is doing a great job of distracting the public with the horsemeat story, and the politicians and National Health Service bureaucrats are delighted that nobody is paying attention to the real scandal:

At any given moment, there exists at least one delicate subject that all mainstream political parties would much rather not discuss. For many years the abuse of MPs’ expenses fell into this category. After this was exposed by a Telegraph investigation, everyone joined a tacit agreement to keep quiet about the criminality inside the Murdoch newspaper empire.

Now the subject which nobody wants to talk about is the National Health Service. It is just over a week since the publication of the Francis report into Stafford hospital, where some 1,200 patients died in appalling circumstances. Had any other institution been involved in a scandal on this scale, the consequences would have been momentous: sackings, arrests and prosecutions. Had it involved a private hospital, that hospital would have been closed down already, and those in charge publicly shamed and facing jail.

Astonishing to relate, nothing has happened. Politicians have made perfunctory expressions of concern, while agreeing that there must be “no scapegoats”, and that Sir David Nicholson (the senior figure responsible) must remain in his job.

Then, almost at once, the political class turned its attention to a far more lively subject: horse meat. Few “scandals” in living memory have carried less significance. And yet few stories have dominated the press quite as comprehensively since rival teams of crack reporters from The Sun and The Star pursued Blackie the Donkey across Southern Spain in 1987, in the wake of some dubious allegations of mistreatment by his Spanish owners.

Misdirection is a vital tool in the arsenal of the magician — and it can be even more valuable in the political arena. If they can fool you into watching the hand that isn’t hiding the coin, they can get away with a great trick (magicians) … or a great evil (politicians).

January 28, 2013

Japanese finance minister: “elderly are an unnecessary drain on the country’s finances”

Filed under: Government, Health, Japan — Tags: , , , — Nicholas @ 11:32

The Guardian reports on recent comments by the new finance minister in Japan:

Japan’s new government is barely a month old, and already one of its most senior members has insulted tens of millions of voters by suggesting that the elderly are an unnecessary drain on the country’s finances.

Taro Aso, the finance minister, said on Monday that the elderly should be allowed to “hurry up and die” to relieve pressure on the state to pay for their medical care.

“Heaven forbid if you are forced to live on when you want to die. I would wake up feeling increasingly bad knowing that [treatment] was all being paid for by the government,” he said during a meeting of the national council on social security reforms. “The problem won’t be solved unless you let them hurry up and die.”

Aso’s comments are likely to cause offence in Japan, where almost a quarter of the 128 million population is aged over 60. The proportion is forecast to rise to 40% over the next 50 years.

[. . .]

To compound the insult, he referred to elderly patients who are no longer able to feed themselves as “tube people”. The health and welfare ministry, he added, was “well aware that it costs several tens of millions of yen” a month to treat a single patient in the final stages of life.

Cost aside, caring for the elderly is a major challenge for Japan’s stretched social services. According to a report this week, the number of households receiving welfare, which include family members aged 65 or over, stood at more than 678,000, or about 40% of the total. The country is also tackling a rise in the number of people who die alone, most of whom are elderly. In 2010, 4.6 million elderly people lived alone, and the number who died at home soared 61% between 2003 and 2010, from 1,364 to 2,194, according to the bureau of social welfare and public health in Tokyo.

The government is planning to reduce welfare expenditure in its next budget, due to go into force this April, with details of the cuts expected within days.

Sadly, expect more of this kind of comment from hard-pressed governments as the baby boomers move out of work and into retirement.

November 28, 2012

70 years later, “don’t wish Beveridge a happy birthday”

Filed under: Britain, Government, History, WW2 — Tags: , , , — Nicholas @ 10:06

In sp!ked, Rob Lyons looks back at the 1942 Beveridge Report and what it led to:

On 2 December 1942, the UK government published the Report of the Inter-Departmental Committee on Social Insurance and Allied Services, usually referred to as the Beveridge Report after its chair, the social reformer (and eugenicist) William Beveridge. The report is commonly regarded as a watershed in the development of the welfare state in Britain, a sign that we were becoming a more civilised and humane society. But the seventieth anniversary of the report on Saturday will no doubt prompt much handwringing about the system that the report helped to create.

[. . .]

The fact that the report’s recommendations were largely implemented by a Labour government, elected after the Second World War ended in 1945, has led to the creation of a myth that these were somehow ‘radical’ or ‘socialist’ policies. In fact, the general assumption that the state had to step in to reorganise and manage large swathes of society had been broadly accepted both before and particularly during the war. Compulsory national insurance had been introduced in a limited way in 1911 and state pensions had been enacted, for the very few people who lived past the age of 70, in 1908. The first call for a national health service came from the distinctly un-radical think tank, Political and Economic Planning, in 1937 — a call which was backed by the British Medical Association a year later.

[. . .]

Beveridge also built his belief in social insurance on another idea: that it was the function of the state to ensure full employment. Beveridge was inspired by the establishment’s new ideologue-in-chief, John Maynard Keynes; ideas about planning and state management of the economy started to become all the rage. The welfare bill would never become too large, Beveridge assumed, because the government would never let unemployment get out of hand. Individuals suffering temporary unemployment would be covered by their insurance contributions. In any event, it was widely assumed that people would, by and large, be too proud and independent to abuse the system and would choose work over welfare.

Yet as the decades passed, the welfare state expanded. The notion of a connection between national-insurance contributions and entitlements has pretty much disappeared. Now there is an amorphous sense of entitlement to welfare, regardless of one’s contributions. The state has positively encouraged this sentiment even as politicians have attacked ‘scroungers’ rhetorically.

For example, incapacity benefit has been expanded, so that millions of people who could work but are not currently employed are effectively told not to bother looking for jobs. This suited politicians when it became abundantly clear that full employment was gone, never to return. Taking those who might struggle to find work off the dole figures, and putting them on benefits that are not reliant upon them looking for work, might seem like a humane or generous thing to do. But in truth, the incapacity system effectively disabled them, by officially branding them ‘incapable’ — a label which many of these people have now internalised.

November 16, 2012

Reason.tv: Ladies, We’re Screwed: Why Obama’s Re-election is Bad for Choice

Filed under: Economics, Government, Health, USA — Tags: , , , — Nicholas @ 10:03

Obama’s re-election is great for moms, right? Aren’t we just a bunch of mindless free spenders, so in love with humanity we want to support every cause and child as though they were each our own? Oh, hells no.

From jobs to health care to education, let’s face it ladies, we’re screwed…and not in the much needed 50 Shades of Grey way.

This election all boils down to choice. Because ours are now sadly limited. To make a simplistic sexist argument, how would you like it if you waltzed into the shoe department at Nordstrom’s or Bloomingdale’s and instead of ankle booties and wedges you found one or two styles of sensible, comfortable clogs? To borrow a term from Joe Biden, malarkey!

With the employer mandate, small businesses are now compelled by law to provide health care for their full-time employees. What will this do? Will it bolster families and working moms by offering free medical care to those in need? Hardly!

October 22, 2012

The “unbridgeable gap” of Gerald Caplan

Filed under: Cancon, Media — Tags: , , , , , — Nicholas @ 09:45

In the National Post, Jonathan Kay pokes fun at Globe and Mail columnist Gerald Caplan:

… the plucky Caplan is still at it. And his theories remain ambitious and apocalyptic. Over the weekend, for instance, he grandly declared that Canada “is no longer a united county.”

“Why? Because an “unbridgeable gap” has opened up between “extremists” and people who are “level-headed.” Caplan suggests the former category is composed of Canada’s equivalent of “The Tea Party, the Koch brothers [and] the National Rifle Association.” The latter category, meanwhile, is composed of people who think like Gerald Caplan.

A few paragraph later, Caplan tells us that “Many Canadians believe the Harper government has shattered the historic mould. Harperland is a place many Canadians do not recognize as theirs. Mr. Harper seems not to share many traditional Canadian cultural values.”

Values like what, precisely? I wondered. Universal health care? The welfare state? Equalization? Bilingualism? Gay marriage? The land of unregulated abortion?

None of those have changed.

Or maybe Caplanites feel alienated in a country without a Wheat Board and a long-gun registry. But that’s like saying you don’t “recognize” your house since your wife rearranged the tupperware drawer.

July 1, 2012

Reason.tv: 3 Big Takeaways From Obamacare Decision

Filed under: Government, Health, Law, USA — Tags: , , , , — Nicholas @ 10:59

Here are the three most important things you need to know in the wake of the Supeme Court’s decision on The Affordable Care Act, a.k.a. Obamacare:

1. Government is still unlimited.
2. Mitt Romney is still lame.
3. Health care costs will still soar.

For more details, go to http://reason.com/blog/2012/06/29/3-essential-takeaways-from-the-obamacare

“… except in Canada”

Filed under: Cancon, Economics, Government — Tags: , , , , , — Nicholas @ 10:25

The National Post editorial board celebrates Canada Day by making a case for Canadian exceptionalism:

The acronym “EIC” can refer to a newspaper’s editor-in-chief, the various forms of the storied East India Company, the Engineering Institute of Canada, and, in scientific circles, Electromagnetically-induced chirality. But in these odd times, they might also be deployed, for verbal economy, to denote “except in Canada.”

As in: Banks all over the Western world have suffered a series of shocks since the 2008 financial crisis – EIC. Economies have slowed — EIC. Real estate bubbles have popped — EIC. Deficits have ballooned to crisis proportions — EIC.

OK: Perhaps national pride leads us to exaggeration. A more truthful acronym might be EICAG — to include Canada “and Germany.” Various smaller European nations, as well as countries in Asia and Latin America, also have fared well. Yet it is hard to remember a time (if ever there was one) when Canada’s fortunes, taken as a whole, were so rosy compared to those of all other Western nations. This good fortune is something worth celebrating as we prepare to celebrate Canada’s 145th birthday this weekend.

They even have some praise to lavish on two former prime ministers who don’t normally get a kind word from the right:

Canada’s relative lack of red ink also is no accident. Two decades ago, Canada was what Greece was today: a bloated welfare state running up massive bills that it couldn’t pay. The unpopular job of fixing the balance sheet feel primarily to Jean Chrétien and Paul Martin — and they accomplished the task without any of the political chaos that has been gripping Athens and other southern European capitals in the last year. The prosperity and stability we enjoy today is in large part due to what those two men did with the fiscal mess bequeathed to them by Brian Mulroney and Pierre Trudeau.

Of course, not everything is going wonderfully well in the Dominion: we still have not emulated one of the notable successes of our European friends:

One of the few institutional factors holding Canada back is its healthcare system. As Shaun Francis writes elsewhere on these pages, our refusal to explicitly permit full-blown private alternatives to the current government-payer health monopoly is bad policy that is out of keeping with that of leading European jurisdictions.

Fortunately, this is a shortfall that can be cured easily. As the furor over Obamacare in the United States shows, building a universal public health system is difficult. But Canada has already done this heavy lifting over the last 50 years: All we lack now is a parallel private track — and that is something that will spring into being without any governmental action at all, save the legislative stroke of a pen needed to modify the Canada Health Act accordingly.

March 30, 2012

Reason.tv: Remy explains health care mandates

Filed under: Economics, Government, Health, USA — Tags: , — Nicholas @ 00:06

March 28, 2012

The “Greatest Generation”, then the “Luckiest Generation”, and now the bill comes due

Filed under: Economics, Government, Politics — Tags: , , , , , — Nicholas @ 10:01

John Kay on the luck of the Baby Boomers:

I belong to a lucky generation: too young to have experienced the Depression, or the second world war, or postwar austerity. The first political figure I recognised was Harold Macmillan, who told voters they had never had it so good.

His statement was true, if foolish, and my contemporaries and I benefited. The government paid us to go to university. We took for granted we would choose between attractive job offers. I was quickly appointed to a post from which it was practically impossible to be fired and which offered a pension scheme with generous, index-linked benefits. I bought a flat with a mortgage whose value was wiped out by inflation. By the time I was paying a higher rate of income tax, the level had been cut from 83 per cent to 40 per cent. My life expectancy is several years longer than my father’s, and I have already considerably exceeded the age at which his father died.

If young people today want to attend university, they will have to pay for tuition and borrow to meet living expenses. When they graduate, they face a much more competitive job market. Few careers will offer the job security once characteristic of middle-class employment. Defined benefit schemes have almost disappeared from the private sector, and public sector pensions are to be substantially less generous. Tax rates must rise, partly to pay for the care and medical treatment I will demand as senility advances. The only financial consolation for the next generation is the windfall when we leave them our houses.

The first half of the baby boom generation certainly were the luckiest cohort in human history. The second half of that generation didn’t do quite as well, the Gen X kids and the Millennials are going to be stuck with most of the bill for all the government-provided goodies that the early boomers have arranged for themselves. Pensions and healthcare, in particular, will have to be reined in for younger workers … just as the bulk of the early boomers have squeezed all the juice out of the system.

Aside from retroactively cutting back the benefits to baby boomers, the only other way to mitigate the financial burden is growth, but most governments in the west are pursuing goals that will not help and in many cases will retard economic growth.

March 27, 2012

Reason.tv: Obamacare goes to the Supreme Court

Filed under: Government, Law, Liberty, USA — Tags: , , , , — Nicholas @ 14:33

Does the fate of a federal government with limited powers rest in the hands of Supreme Court Justice Antonin Scalia? And if so, will he rule against broad federal powers (as he did in the Gonzales case) or in favor of the feds’ right to regulate just about anything (as he did in the Raich case)?

The Supreme Court case over The Affordable Care Act, a.k.a. Obamacare, “is certainly the most important case on the reach of federal power in 50 years” says attorney and legal scholar Timothy Sandefur of the Pacific Legal Foundation. “The constitutional principle of where is the line drawn on federal power — that’s a matter that our children and grandchildren will have to live with.”

The ruling will come sometime in early June, predicts Sandefur, who tells Reason.tv that the Affordable Care Act raises multiple constitutional issues: Can part of the law be struck down and other upheld? Is the “individual mandate,” which forces all Americans to purchase insurance as a condition of simply being alive, legal? Does the law’s massive expansion of Medicaid shred the right of states to govern their own finances?

November 3, 2011

A “fat tax” would not improve anyone’s health or the healthcare sector

Filed under: Government, Health, Liberty, Media — Tags: , , , — Nicholas @ 09:10

Politicians and “food celebrities” in many western countries are calling for a tax on obesity, either on the foods that “make people fat” or on obese people themselves. Other than being incredibly regressive (poor people in the west tend to be fatter than well-off people), such a tax would do nothing to address the problem it is supposed to solve:

The regular calls for a fat tax — whether on the ‘wrong’ foods or on fat people themselves — are symptomatic of two regressive trends in society. The first is the view that experts know best, that these latter-day sages can come to an impartial view based on The Science, then guide government about the appropriate policy action. The new, evidence-based policy usually involves some kind of manipulation of our individual behaviour from gentle ‘nudges’ and increasing taxes through to criminalisation, as in the case of the smoking ban.

But this is not evidence-based policy, but policy-based evidence, with preconceived ideas being pushed through in the name of science at a time when those at the top of society have lost the ability to convince the electorate on the basis of a moral or political argument. This style of policymaking rarely solves social problems, but it does distort both politics and science.

The second worrying trend is the sheer intolerance towards obese people. Being very overweight has always attracted a certain amount of moral opprobrium. But Hatton’s outlook reflects a sea-change. Once, the NHS reflected a progressive outlook that disease was a misfortune that could strike any of us at any time and that the best thing to do was to share that burden across society. Now it’s every man and woman for themselves. In the worldview of Hatton and Coren, some morally weak individuals are costing them money and must be punished.

Ironically, this flows from a left-wing view of disease as having social causes. In the late Seventies, left-wingers correctly saw that some ill-health was the result of poverty, poor housing, polluted air, and so on rather than infection or bad luck. Unfortunately, this has morphed into the idea that disease is caused by individual behaviour — and so health professionals have taken to camping out in our private lives, demanding we stop smoking, drinking and eating the wrong things. Every naughty little pleasure must now be sacrificed to the god of longevity. If we don’t play ball, this intolerance suggests we should lose our right to treatment.

The disease of intolerance is likely to have a far more detrimental effect on society than obesity ever could.

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