Health Care myths around the world

Last year, Washington Post correspondent, TR Reid, created an amazing documentary entitled "Sick Around the World."  So good, I've made it required viewing for my Public Policy class ever since.  He's got a new book on the matter, too, that I am really looking forward to reading.  I don't expect many of you to watch the video or read the book, but fortunately for you, he's summed up some of the best points into a nice little essay in a recent essay for the Post in which he takes on 5 health care myths. My favorite parts:

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free
enterprise — private-sector, for-profit health insurance — is
naturally the most cost-effective way to pay for health care. But in
fact, all the other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative
costs in the world; they spend roughly 20 cents of every dollar for
nonmedical costs, such as paperwork, reviewing claims and marketing.
France's health insurance industry, in contrast, covers everybody and
spends about 4 percent on administration. Canada's universal insurance
system, run by government bureaucrats, spends 6 percent on
administration. In Taiwan, a leaner version of the Canadian model has
administrative costs of 1.5 percent; one year, this figure ballooned to
2 percent, and the opposition parties savaged the government for
wasting money.

The world champion at controlling medical costs is
Japan, even though its aging population is a profligate consumer of
medical care. On average, the Japanese go to the doctor 15 times a
year, three times the U.S. rate. They have twice as many MRI scans and
X-rays. Quality is high; life expectancy and recovery rates for major
diseases are better than in the United States. And yet Japan spends
about $3,400 per person annually on health care; the United States
spends more than $7,000.

And the conclusion:

All the other developed countries have settled on one model for
health-care delivery and finance; we've blended them all into a costly,
confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that
America has "the finest health care" in the world. We don't. In terms
of results, almost all advanced countries have better national health
statistics than the United States does. In terms of finance, we force
700,000 Americans into bankruptcy each year because of medical bills.
In France, the number of medical bankruptcies is zero. Britain: zero.
Japan: zero. Germany: zero.

Given our remarkable medical assets — the best-educated doctors and
nurses, the most advanced hospitals, world-class research — the United
States could be, and should be, the best in the world. To get there,
though, we have to be willing to learn some lessons about health-care
administration from the other industrialized democracies.

To understand the reality of health care around the world, rather than the myths, is to understand that we need dramatic reform that gives more of a role to the government (either through providing insurance or much more regulation of the insurance market).  Period.  To believe otherwise is to willingly ignore and deny the overwhelming evidence to the contrary.  Do yourself a favor and read all 5 myths, and if you have the time, I promise you will not regret watching the documentary. 

 

Forget the exercise, just eat less

No, that oversimplifies, but as someone who has been exercising regularly (and not eating particularly healthfully) for the past 18 years, I found this article in Time about exercise pretty depressing.  I have a lot more willpower to exercise than to eat right, but the evidence strongly suggests that eating right is the real key and that exercise makes surprisingly little difference.

 

"In general, for weight loss, exercise is pretty useless," says Eric
Ravussin, chair in diabetes and metabolism at Louisiana State
University and a prominent exercise researcher. Many recent studies
have found that exercise isn't as important in helping people lose
weight as you hear so regularly in gym advertisements or on shows like The Biggest Loser — or, for that matter, from magazines like this one.

The basic problem is that while it's true that exercise burns calories
and that you must burn calories to lose weight, exercise has another
effect: it can stimulate hunger. That causes us to eat more, which in
turn can negate the weight-loss benefits we just accrued. Exercise, in
other words, isn't necessarily helping us lose weight. It may even be
making it harder.

Of course there are important benefits to exercise, but weight loss is not apparently truly among them.  Sad conclusion for me: eat less pizza.  The whole article is definitely worth a read.

 

Torture investigations

Dahlia Lithwick, about the best person writing on legal/Constitutional issues for a lay audience, has a nice take on the Justice Department's proposed very limited investigations of only those who did the actually torturing, rather than those who crafted the policy.  After acknowledging Holder's politically difficult spot, we get to the key insights.  The highlights:

Holder starts from the dangerous notion that the baseline for Durham's
investigation should be the legal rules (spun from bad data and random
precedent) set out in the Office of Legal Counsel torture memos. To
suggest, as Holder did yesterday, that he would immunize from
prosecution "anyone who acted in good faith and within the scope of the
legal guidance given by the Office of Legal Counsel regarding the
interrogation of detainees" is to suggest that the low-level CIA
operatives and contractors who acted badly on the ground are legally
culpable while those who gave bad legal guidance are not. In other
words, we are now protecting the good-faith torturers.

That isn't just wrong, it's outrageous. It ratifies the most toxic
aspect of the whole legal war on terror: that anything becomes
permissible if it's served up with a side of memo. Paper your
misconduct with footnotes and justifications—even after the fact—and
you can do as you please. Prosecution of those who strayed beyond the
new rules, without considering the culpability of those who strayed in
creating the new rules, would mean that in America, a law degree
amounts to a defense. [emphasis mine] Rep Jerry Nadler, D-N.Y., put it this way earlier
this month when he warned that it makes no sense to prosecute the guy
who used 8 ounces of water to water-board but not the lawyer who said
it was OK to water-board someone with 3 ounces of water. We must either
look into both sides of the post-9/11 legal breakdown or neither. The
alternative is the same kind of scapegoating that occurred after Abu
Ghraib.

Sadly, I think that in a situation like this, a law degree does amount to a defense.  Ultimately, though, it is just another shining example of two standards of justice in this country.  One for the wealthy and educated, another for everybody else.  Unfortunately, there's little doubt on whether the law-degreed political appointee or the agent working on the ground is going to get more consideration from prosecutors and politicians.

Who’s to blame for the deficit?

Lot of talk about the deficit this week.  American Progress was kind enough to put these numbers in some context of where they came from:

The policies of President George W. Bush make up the largest share,
followed by the current economic downturn, and then President Barack
Obama’s policies.

Shares of contribution to fiscal deterioration 2009 and 2010

Cause	Percent of total
President Bush’s policies	40%
Current economic downturn	20%
President Obama’s policies	16%
Financial rescues begun by President Bush	12%
All other	12%

 

Had President Bush not cut taxes while simultaneously prosecuting two
foreign wars and adopting other programs without paying for them, the
current deficit would be only 4.7 percent of gross domestic product
this year, instead of the eye-catching 11.2 percent—despite the weak
economy and the costly efforts taken to restore it. In 2010, the
deficit would be 3.2 percent instead of 9.6 percent…

President Obama’s policies have also contributed to the federal
deficit—but only 16 percent of the projected budget deterioration for
2009 and 2010 are attributable to those policies. The American Recovery
and Reinvestment Act, designed to help bring the economy out of the
recession is, by far, the largest single additional public spending
under this administration.

One wonders where all the conservatives complaining so loudly about government spending where when Bush was president.  

The ESPN approach to political coverage

I loved this post from Anthony Wright about the media (excepting Fox news, of course) would do well to cover the truly nutty town hall protesters in the way in which ESPN covers streakers, etc.  Which is to say, not at all.  Wright:

Everybody deserves a chance to speak his or her mind; nobody
disputes that. But how much attention should the media give these
people? It seems to me this is one case when the political media–or,
at least, Fox–could take its cues from the sports media.

When fans at a professional sporting event try to make a spectacle
of themselves–by being unruly or abusive, or running onto the
field–the networks go out of their way to avoid showing it. Why?
Because providing airtime to the disrupters would give too much
incentive for others to do the same at stadiums across the country.
Similarly, the media should focus on the issues of health reform,
rather than the rude and belligerent behavior of a relative few.

It seems clear to me that the protests are less about the substance of
the health reforms–which is often attacked with claims that have no
basis in reality–and more about a vehicle to oppose President Obama,
for whatever reason. They are merely the second episode to the “tea
party” programming that Fox News sponsored earlier in the year, where
the channel even provided the headline speakers across the country,
including here in Sacramento. (Those were similarly disconnected from
actual policy, as it was an anti-tax protest directed at the stimulus
which actually included a major tax cut.).

No one disputes the right to peacable protest, but actual disruption is another matter.  Televised baseball games would end up taking another hour dealing with all the crazies if those running on the field, etc., were rewarded by TV coverage.  Covering the nuts encourages the nuts. 

Leer Esta

After a break, my conquering of foriegn-language media hits, EFE, the world's largest Spanish-language news service (or so I'm told by the reporter.

 Su gradual evanescencia del Senado durante los largos meses de
enfermedad ya se ha dejado sentir en las negociaciones sobre la reforma
del sistema de salud, la cual pretende cubrir a los casi 50 millones de
estadounidenses sin seguro.

"El hecho de que haya estado muy enfermo ha tenido un impacto muy
serio", dijo Steven Greene, profesor de ciencias políticas de la
Universidad Estatal de Carolina del Norte.

 

Using the Minotaur for torture

This is brilliant (I especially enjoyed it having recently read a book that featured a minotaur):

Is Using A Minotaur To Gore Detainees A Form Of Torture?

Me on health care (again)

I was on our local PBS station discussing health care and the nuts at town hall meetings recently.  Here's the video.

UPDATE: I also just got the link for this week's appearance (there's less of me, I have to share with smarter people).  It's the health care reform video on this page.

Alternative Energy (just save it in the first place)

Foreign Policy had a really nice article recently on "The Seven Myths About Alternative Energy."   Not all that surprising upshot: alternative energy is far from a panacea.  Sure, it can do some, but we need to be smart about it and do realistic costs/benefit assessments.  Point five, "there is no silver bullet," is really important, and should really be labeled, "it's efficiency, stupid."  Far and away the best, most cost-effective way to address our long-term energy issues is to use the energy we have now much more efficiently.  The truth is, it isn't even that hard.  This is low-hanging fruit that we are largely just leaving sitting there.  Of course, that's one reasons something like cap and trade, which changes the incentive structure in energy use would really help.  From the article:

And one renewable energy resource is the cleanest, cheapest, and most
abundant of them all. It doesn't induce deforestation or require
elaborate security. It doesn't depend on the weather. And it won't take
years to build or bring to market; it's already universally available.

Efficiency isn't sexy, and the idea that we could use less energy
without much trouble hangs uneasily with today's more-is-better
culture. But the best way to ensure new power plants don't bankrupt us,
empower petrodictators, or imperil the planet is not to build them in
the first place. "Negawatts" saved by efficiency initiatives generally
cost 1 to 5 cents per kilowatt-hour versus projections ranging from 12
to 30 cents per kilowatt-hour from new nukes. That's because Americans
in particular and human beings in general waste amazing amounts of
energy. U.S. electricity plants fritter away enough to power Japan, and
American water heaters, industrial motors, and buildings are as
ridiculously inefficient as American cars. Only 4 percent of the energy
used to power a typical incandescent bulb produces light; the rest is
wasted. [emphasis mine] …

The
biggest obstacles to efficiency are the perverse incentives that face
most utilities; they make more money when they sell more power and have
to build new generating plants. But in California and the Pacific
Northwest, utility profits have been decoupled from electricity sales,
so utilities can help customers save energy without harming
shareholders. As a result, in that part of the country, per capita
power use has been flat for three decades — while skyrocketing 50
percent in the rest of the United States. If utilities around the world
could make money by helping their customers use less power, the U.S.
Department of Energy wouldn't be releasing such scary numbers.

So, sure, put in that CFL lightbulb, but if we really want to change, we need to change policies so that you have a truly strong incentive (other than my suggestion, of course), to put in some CFL light bulbs (and other actions, too, of course).  And while I'm at it, let me know if you are aware of any CFL light bulbs that will work in ceiling fans.

Ends, not means

Nice little post by Matt Yglesias on some notable examples of Ted Kennedy taking up the cause of deregulation.  When did he endorse deregulation?  When it served to meet progressive policy goals.  As I've argued before, I think Republicans get too hung up on the means and don't think enough about ends, e.g., "markets are always good," "more government is always bad."  In truth, markets are often great, but they are often really bad, too (hello, Credit Default Swaps).  Likewise, too much government can be a problem, but it can also serve to keep your car safe, your air clean, and keep you from eating rancid meat.  Context matters.  More than many Conservatives will admit, I believe.  You really don't see many liberals arguing that government is always better or that markets are always bad.  Anyway, Yglesias' nice summary point on Kennedy:

The moral of the story isn’t that “regulation is bad” but that
progressive politics at its best isn’t about bigger government but
about attacking privilege and power. At times that requires more
government and more regulation (right now we badly need more regulation
of polluters whose carbon dioxide emissions are threatening the
viability of the planet) but at times the forces of privilege and power
are using existing regulatory structures to re-enforce their own
position. Kennedy, rightly, saw no contradiction between his record as
a deregulator and his record as a champion of the little guy.

Moral values

Fascinating new research from some Dutch psychologists
further demonstrates just how flawed human reasoning is.  We don't
reason.  We know what we think and then look for reasons to back it up.
 

According to a paper recently published in the journal Psychological Science,
the brain takes a mere quarter of a second to react to statements that
contradict or challenge our ethical belief system. That nearly
instantaneous neural response colors the way the rest of the sentence —
and thus, the rest of the thought — is interpreted.

The research suggests that if you feel abortion is repugnant,
reading the statement "I think abortion is appropriate in some cases
because it means fewer unwanted, unloved children" is a two-stage
process. The phrase "I think abortion is appropriate" sets off neural
alarm bells in the brain, which may cause you to read the rest of the
sentence — which contains the reasons behind the belief — with an
attitude of skepticism or hostility…

The research has its limitations, including the fact that all
the study participants were men. But it provides evidence that our
unconscious reaction to statements challenging our beliefs occurs
literally in milliseconds. So if you're trying to influence someone's
opinion on a moral-values issue, it might be more effective to start
with neutral language and build up to the morally controversial
conclusion.

People will always disagree, but a sentence structured in such a way
to avoid an instantaneous negative response, such as, "Since we don't
want to add to the already too-large number of unwanted children, I
think abortion is appropriate," might be a better starting point for a
discussion.

Better yet, forget about trying to influence someone's opinion on a moral values issue. 

Torture time

I haven't written much on torture lately, but is is still 1) evil and 2) stupid policy.  Kevin Drum's recent post in response to the latest revelations sums up my views quite well.  It's short, read the whole thing.  If not, I love the bottom line:

We managed to get through WWI, WWII, the Korean War, the Vietnam War,
the Gulf War, and a dozen smaller engagements without making the
torture of prisoners into official government policy.  We can get
through this one without selling our souls too.