health care reform
ddobbs | July 2, 2009An article from the Standard ponders why, despite widespread recognition that the country needs health care reform, we may not get it.
The relatively new field of behavioral economics--a blending of psychology and economics--helps makes sense of these clashing views. One major tenets of this sub-discipline is that people value a "loss" about twice as much as they value a "gain." And as a result, people are more risk averse than might be suggested by traditional, rational economic theory. In other words, instead of "rationally" weighing risks and rewards equally and then forming a judgment,…
ddobbs | July 2, 2009What's been distracting me lately from the big story I really really need to finish writing ...
A splendid, rich fracas over Chris Anderson's Free, set off particularly by a pan from Malcolm Gladwell in the New Yorker. The net fairly exploded -- search, and ye shall find -- with many noting that a pot was calling a kettle black. E.g., Itâs like War of the Speakerâs Bureaus and a more gently titled but equally damning (to Gladwell) post by Anil Dash. ,And one young writer accused Anderson of being a feudal lord. Anderson himself has been remarkably unfiltered in his tweet-pointers to reviews,…
ddobbs | June 24, 2009Nate Silver makes George Will clear:
Will's argument is apparently this: The government does not need to make a profit and will have greater leverage with providers; therefore it will deliver the same service for less money. That's unfair!
Is this really the best argument that one of the most prominent intellectual conservatives can mount against the public option?
Post is a bit longish for tweetish attention spans -- but a great exposure of the real objection to public plans (Congressional conflicts of interest notwithstanding), and of why no real competition exists in the insurance…
ddobbs | June 23, 2009Ezra Klein makes his call TKTK:
I think health reform is going to go the way of stimulus.
The stimulus was a huge and important accomplishment. If you had told liberals in 2007 that they were going to pass an $800 billion dollar spending bill that made good on decades of promises about infrastructure rebuilding and comparative effectiveness research and train construction and broadband internet and green energy, they would have laughed at you.
But by the time the bill actually wound its way through Congress, most liberals were frustrated by the outcome: A few Senate moderates had lopped $100…
ddobbs | June 23, 2009
I can't claim to be 'objective' or neutral on health-care reform -- but who can? Everybody needs health care, some more than others. I need it less than most, as my family and I are, knock on wood, generally blessed with good health. Even so, we laid out $18K last year for health care, still owe money -- and no one in the family ever entered an ER, got a scan, received a prescription costing more than $100, or got admitted to a hospital. And we're among the lucky ones who can (supposedly) afford insurance. (We pay $10K for a plan with a $5K deductible.) This is one of several reasons I'm…
ddobbs | June 18, 2009
A key component of health-care reform -- and saving our ass from going bankrupt and sick from spending too much on lousy treatments -- is establishing comparative effectiveness measures, otherwise known as "actually knowing WTF works and what doesn't."
This idea terrifies companies who don't want such objective measures. It also generates a lot of fear, partly via confusing or intentionally frightening arguments. Yet making sure we don't pay for stuff that doesn't work is key to reform -- a point made in this Times op-ed from libertarian economist Tyler Cohen, keeper of the blog Marginal…
ddobbs | June 16, 2009SciAm ponders evidence that fish hatcheries are watering down the trout and salmon gene pool.
Matt Yglesias looks at one of many lies being told by those opposing health-care reform â confirming Salon's prediction that the opponents of reform are not going to play nice. See also The American Prospect on How Big Pharma Intends to Kill the Public Option. I should add this campaign is having an effect: On the radio this morning I heard NPR Steve Insky Inskeep vigorously press the "public plan as trojan horse" attack on Kathleen Sibelius; I can only hope he'll as vigorously ask people such as…
ddobbs | May 18, 2009via Ezra Klein comes this bottom-line chart from the Center for Economic and Policy Research:
That orange line headed heaven-ward? That's our deficit. All those other lines dipping down? That's our deficit if we had the same health care spending per person as France, Germany, Canada, and the UK (all countries, incidentally, with higher life expectancies than our own). You might say, of course, that even radical reform would not bring us down to their health care spending. We could copy France's system wholesale and still pay more for care. You would be right. But such reforms would bring…
ddobbs | May 12, 2009Ezra Klein thinks the stars -- and the forces -- are so far lining up much more promisingly than in 1994:
The opponents of health reform are, at this juncture, entirely isolated. Industry is adopting an attitude of relentless positivity. Republicans are grudgingly attempting to appear cooperative. The only straight opposition is coming, as Maddow and Howard Dean say, from Rick Scott, a disgraced former hospital executive whose company was convicted of defrauding the federal government in the largest ever case of its kind.
You can say, of course, that the traditional opponents of reform will…
ddobbs | April 29, 2009As I've noted before, the U.S.'s health-care and education systems share some fundamental flaws: In both medical care and schooling we spend far more than other countries and get substandard results; in both cases, the overspending and poor results occur partly because our decentralized "systems" mean everyone does and measures everything differently, so you can't compare apples to oranges to even find out what works.
The folks at Economix look at this dynamic in education from a return-on-investment perspective:
Education is a form of investment in a country%u2019s labor force and its…
ddobbs | April 13, 2009
This report on Olympia Snowe's position suggests he might (if he doesn't get too many Democratic defectors). Snowe's importance to Obama's agenda was made clear in her support of the stimulus package -- she was one of 3 GOP senators whose support allowed the bill to go through. It appears she supports substantive action on health-care reform as well.
Via Ezra Klein:
Last Friday, an alert reader linked Steve Benen to this The Bangor Daily News writeup of Olympia Snowe's health care listening session. This quote, in particular, caught his eye:
"We have a totally dysfunctional system now,"…
ddobbs | March 9, 2009"Primates on Facebook" -- "Even online, the neocortex is the limit" to how many people we can really have as friends.
People who use more textual shortcuts (lk whn they txt in skl) when texting have higher reading skills. The coverage seems to assume this is causal, but it's almost surely just an association -- people with good reading skills more quickly come up with or absorb textual shortcuts.
Does "pay for performance" work in learning? For a bit, then not. "A number of the kids who received tokens didn't even return to reading at all," Dr. Marinak said. From the Times.
Babies can…
ddobbs | March 6, 2009Ezra Klein reviews Obama's handling of yesterday's health summit -- a piece well worth reading for a taste of how sharply focused and serious Obama is about truly comprehensive health-care reform.
Karen Tumlty, a health-care expert, describes in Time her own family's grueling wrestling match with the health-insurance industry. A timely story -- no pun intended -- as it makes painfully clear that it's not just the 46 million people uninsured (did I just say "just" 46 million people) who fare poorly in the current system.
Genetic Future looks at how a Victorian-era height-prediction system…
ddobbs | March 2, 2009Over at Healthcare ZDNet, a site new to me, Dana Blankenhorn says
The Obama strategy for achieving health reform is now clear.
Get the money first. This changes the terms of the debate, from what will it cost to how do we do things more efficiently?
He's got a point, but it seems to me he's only half right -- or a bit less -- for the push to establish comparative effectiveness data based on (the establishment of) electronic health records also does much to answer how to do things efficiently. That data will help identify where expensive procedures and drugs bring benefit and where they don't…
palmd | March 1, 2009Remember when President Obama said something about returning science to it's rightful place? Well, our new president has a real tough climb ahead of him. The previous administration shoved science aside for political expediency and religious ideology. Now, forces in the president's own party are trying to insert their own quasi-religious beliefs into health care reform, leaving science in a whole different place altogether.
Here's the deal. Some years back, Senator Tom Harkin (D-IA) helped set up the National Center on Complementary and Alternative Medicine (NCCAM). The whole idea of…
ddobbs | March 1, 2009Ezra Klein gives the short whodat on Kathleen Sebelius, the Kansas governor who will be Obama's health and human services secretary.
Sebelius's tenure as insurance commissioner in Kansas seems to have been both successful and fairly quiet: She is not defined by the battles and struggles of that period. She was not at the center of any tremendously controversial initiatives. Rather, she seems to have been a politically skillful and administratively competent commissioner. In 2001, Governing magazine named her one of the top public officials in the country and gave a nice summary of her…
ddobbs | February 10, 2009Reader Jay, in a comment on my post about health-care costs tanking the economy, raises an interesting question about the sorts of standardized medical records that would be needed to evaluate efficacy (and therefore economic efficiency) of various treatments:
The idea is clearly to have standardized health-care records systems so that data can easily be aggregated and analyzed
[he writes, quoting my post.]
That's a shift in priorities, away from records centered around benefit to the patient, a subtle but not insignicant difference. Broad based statistical research involves, though…
ddobbs | February 9, 2009Check this very scary projection of what current trends in health-care spending will mean for our economy: a growing weight that will account for half of GDP by 2082:
Peter Orszag, Obama's budget director, shows that slide in his standard talk on what's wrong with our budget. It shows why, as Ezra Klein puts it,
an odd bedfellows coalition of centrist economists ranging from Dean Baker to Henry Aaron to Paul Krugman to, well, Peter Orszag and Jason Furman have been forcefully arguing that there is no such thing as an "entitlement crisis." Social Security is safe. The crisis is in Medicare.…
ddobbs | February 8, 2009The health-care system's maddening inefficiencies -- high per-capita spending with poorer overall health outcomes; tens of millions uninsured and tens of millions more underinsured; insane-making battles with insurers to get reimbursements you're entitled too -- are reason enough to spur reform.
But "The Big Fix," David Leonhardt's marvelous-but-long piece on the fiscal crisis in last week's Times Magazine, argues that these inefficiencies are a) a prime example of a vested elite's ability to manipulate the economy for its own good and b) one of the most serious obstacles to the nation's…
oracknows | January 12, 2009The seemingly never-ending quest of advocates of unscientific medicine, the so-called "complementary and alternative medicine" (CAM) movement is to convince policy makers, patients, and physicians that, really and truly, it no longer deserves the qualifier of "alternative," that it is in fact mainstream and even "scientific." That very search for respectability without accountability is the very reason why "alternative" medicine originally morphed into CAM in order to soften the "alternative" label a decade or two ago. Increasingly, however, advocates of such highly implausible medical…