The following is a guest post by Dan Franklin, the lead server programmer for the kids’ website Poptropica.com from Pearson Education. Outside of work Dan sings with the a cappella group Blue of a Kind and reads extensively. What he reads, and more importantly, how he speaks about it has impressed me for years, so I asked Dan to submit some posts. I hope this is the first of many. –Austin
Periodically, one sees the assertion that it’s a good thing that health care expenditures are rising, just as it would be good if more people bought Priuses. Last year, Geoff Colvin, Fortune senior editor at large, emitted this opinion.
We’ve all seen the graph that shows health-care costs increasing much faster than GDP; it’s usually presented as evidence of the crisis we’re in.
Take a graph with that same trajectory and label it “Sales of hybrid vehicles” or “Downloads from the iTunes Music Store,” and nobody proposes government intervention to stop it. Yet health-care costs, too, are in fact revenues, and fast-rising revenues are generally seen as exciting and laudable in every industry except one. How come?
To compare health care expenditures to car purchases is absurd. Purchasing a car is a discretionary purchase that improves the buyer’s life. The vast majority of health care expenses are to fix something that is no longer working properly. They are a necessity, and only serve to bring you back to the state of health you previously enjoyed. Health care is not like car purchases; it’s like car repair. You don’t do it unless you need to.
Every dollar spent on health care is a dollar not spent on increasing productivity or improving our lives. It is purely remediatory. By Geoff Colvin’s reasoning, the citizens of Florida should rejoice every time a hurricane passes through, because of the high construction expenditures that will surely follow.
Health care imposes a further unique burden. Every dollar spent represents time spent away from more productive or enjoyable pursuits. Those hours in the waiting room, on the operating table, recuperating, buying medicine, or just dealing with your health insurer are simply gone.
In short, this assertion is completely backwards. I devoutly hope it will stop circulating.
Taking on faith that John Chait’s interpretation of the reporting is accurate, it seems that Republicans have announced a plan to filibuster the first vote on the financial regulation bill and then fold. Something seems fishy about that plan.
Now that the Democrats know the Republicans are planning to defect after the first vote, why on Earth would they compromise? Moreover, what is the point of taking the hit by filibustering reform in the first place? It could work, in theory, if you could bluff the Democrats into thinking the GOP might hold the line indefinitely. But I’m pretty sure the Democratic party has access to articles published in Politico, which means the jig is up. So now the Republicans are trying to bluff in poker when they and their opponent know they have the weaker hand, and their opponent has heard them admit that their strategy is to bet for a couple rounds and fold before the end. Why not just cut their losses now? This makes zero sense.
Agreed. Though it isn’t necessary to appeal to game theory, this is an illustration of some game-theoretic ideas. After all, game theory is really just common sense with logic. But, in case the logic is lost on any Republicans (or Democrats), it isn’t hard to find a good review.
If you know with certainty that your opponent will fold [early] … then it is rational for you to fight because you will win. … However, if your opponent intends to fold in any round then it is only sensible for him to do so in round 1. Why pay [the costs of a] fight only to fold later? …
Hence, if either player is not willing to fight forever he should fold in round 1. If the other player knows this to be the case, the other player should fight. It turns out these are the two pure strategy Nash equilibria (game theory jargon) in this game: (1) you fight, your opponent folds in round 1 and (2) you fold, your opponent fights in round 1.
My latest Kaiser Health News column is online today. It begins,
The Patient Protection and Affordable Care Act continues the American tradition of privately provided, publicly subsidized health insurance. It’s how most Americans’ health insurance is financed today. But despite its advantages, there is a hidden cost to this arrangement: insurers have more information about health care coverage, spending and, utilization than the taxpayers that help fund them. The system’s opacity gives insurers the upper hand in debates over government payment rates.
Yesterday Jim Hufford put on a morphology clinic at Organon. His subject: the plural possessive of “attorney general.” He tries every which way. But the problem is over-constrained.
Law professor Mark Hall takes a stab at it (in the title of an otherwise commendable piece about the bogus legal claims of the states challenging the constitutionality of the Affordable Care Act) with the ill-considered phrase “Attorneys General’s.”
Now, I’m inclined to think there’s not a right answer here and that there are a few ways you could go. But I’m pretty sure that “Attorneys General’s” is not one of those ways. …
Part of the problem is that attorney general is not a phrase of English origin in the first place. Like many other legal phrases, it came into English from the French following the Norman invasion. The general part was originally an adjective modifying attorney. (In French, the adjective can come after the noun.) An attorney general might just as well have been called a “general attorney.” Think of it as meaning something like “top attorney.” We would have no problem talking about top attorneys or top attorneys’ arguments, but we would stumble all over attorneys top.
Another part of the problem is that possessive forms of title phrases are often clumsy. When the President of the United States has a plan, it’s the President’s plan—not the President’s of the United States plan, or the President of the United States’s plan. But the latter might not sound so silly in some contexts. Say, at a global summit, where there are lots of presidents. Or think governors. It doesn’t really sound weird at all to talk about the Governor of Georgia’s plan.
There’s so much more. It’s worth a read, if you care about such things. (And I know you do, deeply. As you should!)
The Senate is planning a vote on a revamp of the Child Nutrition Act that was first passed back in 1966.
It’s a case of competing interests: nutritionists, the farm lobby, and even First Lady Michelle Obama.
We’re joined by Sound Medicine‘s health policy expert, Dr. Aaron Carroll to walk us through this debate.
Dr. Aaron Carroll is a regular analyst here on Sound Medicine. He directs the Center for Health Policy and Professionalism Research and is Associate Director for Children’s Health Services Research at the IU School of Medicine.
A surprising number of you wrote to chastise me for telling my wife not to get the salad a few days ago. Evidently, you believe that salad is getting a bad rap.
First of all, I’m not claiming that salads are inherently bad. I was just saying it’s a mistake to always assume the salad is the safe choice in a restaurant. Case in point – Claim Jumper.
Holy crap. Let’s try to get past the fact that the salad has almost a full day’s calories in it. Get a load of that sodium. It’s 1.5 to 2 times the recommended daily amount of sodium. I hope you weren’t planning on eating anything else today. Or tomorrow.
And, yes, Claim Jumper isn’t known for its healthy eating, but here’s the Widow Maker:
Name: The Widow Maker Calories: 1594 Sodium (mg): 2920 Price: $10.95 Menu Description: “Applewood smoked bacon, hand-battered onion rings, avocado, double-thick Tillamook cheddar, mayo and red relish.”
Look at that thing. It’s named appropriately. And it’s less sodium and less calories than the salad.
I’m confused. Some of you are emailing me as if this is some sort of vindication that you were right and I was wrong. As if you’ve uncovered some hidden truth that the law will make things cost more.
Huh?
No one claimed that covering 30 million more people would cost less. Some have claimed that it will slow cost growth. The jury is still out on that. But come on. This is still a decent deal. Ezra Klein shows it well through two charts:
The first looks at national health expenditures with and without the Affordable Care Act:
Now look at the change in the uninsured:
And that actually understates the case. Third Way, the centrist policy outfit, sent over its own analysis of the data. “The fact is that by 2019, national health spending per insured person will be $15,132 compared to $16,812 without the new law,” they write. “That’s 10 percent less spending per insured person than it would have been, according to the actuary’s report.”
You don’t have to love the law. And it has flaws. But this report hasn’t found a new one.
I just went to my doctor’s office for a sinus/ear infection. I had never seen this particular physician before and certainly didn’t bring up politics with him, but as I was about to pay my bill, he volunteered, “We take cash, check, credit or debit card. No chickens.” I’m in Indiana, mind you. I think Sue Lowden is in real trouble if even random doctors in Indiana are mocking her to near-total strangers.
In general, assume I’ve not read anything on a “Reading List” post. Beginning today, I’ll be clearly indicating which are books. Anything not indicated as such is an article. Also, all summaries and abstracts are taken from the site to which I link. They’re not written by me unless indicated otherwise.
What now? Despite the rancorous, divisive, year-long debate in Washington, many Americans still don’t understand what the historic overhaul of the health care system will—or won’t—mean. In Landmark, the national reporting staff of The Washington Post pierces through the confusion, examining the new law’s likely impact on us all: our families, doctors, hospitals, health care providers, insurers, and other parts of a health care system that has grown to occupy one-sixth of the U.S. economy.
Landmark’s behind-the-scenes narrative reveals how just how close the law came to defeat, as well as the compromises and deals that President Obama and his Democratic majority in Congress made in achieving what has eluded their predecessors for the past seventy-five years: A legislative package that expands and transforms American health care coverage.
For many years, scientists thought that the human brain simply decayed over time and its dying cells led to memory slips, fuzzy logic, negative thinking, and even depression. But new research from neuroscientists and psychologists suggests that, in fact, the brain reorganizes, improves in important functions, and even helps us adopt a more optimistic outlook in middle age. Growth of white matter and brain connectors allow us to recognize patterns faster, make better judgments, and find unique solutions to problems. Scientists call these traits cognitive expertise and they reach their highest levels in middle age.
In her impeccably researched book, science writer Barbara Strauch explores the latest findings that demonstrate, through the use of technology such as brain scans, that the middle-aged brain is more flexible and more capable than previously thought. For the first time, long-term studies show that our view of middle age has been misleading and incomplete. By detailing exactly the normal, healthy brain functions over time, Strauch also explains how its optimal processes can be maintained. Part scientific survey, part how-to guide, The Secret Life of the Grown-Up Brain is a fascinating glimpse at our surprisingly talented middle-aged minds.
Strauch, medical science and health editor at the New York Times, sets out to offer reassurance to parents baffled by their kids’ seemingly irrational and erratic behavior. She discusses the latest research, including brain scans that show changes in the brain’s structure and function that could explain the crazy behavior exhibited by teens. In addition to reviewing various research projects around the country, Strauch also includes discussions with both parents and teenagers. Parents lament their inability to understand why a straight-A student suddenly loses interest in school or starts behaving miserably. The teens are surprisingly open about their often ill-advised behavior, but seem unable to offer reasons for such actions. One possible explanation, still debated by scientists, is whether adolescence is a critical brain period, that is, an important period of development. Particularly interesting is the chapter Crazy by Design, in which Strauch offers evidence of the cognitive and emotional development of teens. Just as there are growth spurts for babies and young children, there are developmental milestones for teens roughly ages 11, 15 and 19. For example, While a younger teen might see a parent as a hypocrite if he holds two opposing views, an older teenager would begin to understand how two things can be true at the same time, and weigh the evidence for each. While the book does not offer how-to guidance, readers will be struck by the wonderfully candid comments by those interviewed as well as Strauch’s insightful narrative.
After a scientist found that runners’ widespread habit of using ibuprofen before long races didn’t help them, and may even cause more inflammation than doing nothing, a group of runners presented with the evidence still said they would continue using the drug, reports Miller-McCune, a Santa Barbara-based public policy magazine. The researcher who conducted the study said, “They really, really think it’s helping. … Even in the face of data showing that it doesn’t help, they still use it.”
That reaction is not usual. “A surprising number of medical practices have never been rigorously tested to find out if they really work. Even where evidence points to the most effective treatment for a particular condition, the information is not always put into practice.” But, the reticence to accept new ideas in medicine may be an obstacle for government officials who hope to spend billions of dollars on so-called comparative effectiveness research that would determine which treatments are most effective. “These efforts are bound to face resistance when they challenge existing beliefs”
In the 1970s and 1980s, a number of states adopted all-payer rate-setting systems as strategies to control the rate of increase in health care costs. These systems brought stakeholders to the table to negotiate the allocation of costs associated with caring for the uninsured and created, briefly, an opportunity for states to address access problems more broadly with the participation of major stakeholders. This article uses a case study of Maine and comparisons with other states to argue that the payment disparities between public and private payers that have grown over time since the demise of all-payer systems constitute a significant barrier to successful health reform.
Health policy debates are replete with discussions of federalism, most often when advocates of reform put their hopes in states. But health policy literature is remarkably silent on the question of allocation of authority, rarely asking which levels of government ought to lead. We draw on the larger literatures about federalism, found mostly in political science and law, to develop a set of criteria for allocating health policy authority between states and the federal government. They are social justice, procedural democracy, compatibility with value pluralism, institutional capability, and economic sustainability. Of them, only procedural democracy and compatibility with value pluralism point to state leadership. In examining these criteria, we conclude that American policy debates often get federalism backward, putting the burden of health care coverage policy on states that cannot enact or sustain it, while increasing the federal role in issues where the arguments for state leadership are compelling. We suggest that the federal government should lead present and future financing of health care coverage, since it would require major changes in American intergovernmental relations to make innovative state health care financing sustainable outside a strong federal framework.
This paper employs a nationally representative, household-based dataset in order to test how the compensation method of both the specialists and the primary care providers affects surgery rates. After controlling for adverse selection, I find that when specialists are paid through a fee-for-system scheme rather than on a capitation basis, surgery rates increase 78%. The impact of primary care physician compensation on surgery rates depends on whether or not referral restrictions are present.
Health Care Reform and Federalism
Scott L. Greer and Peter D. Jacobson University of Michigan
Health policy debates are replete with discussions of federalism,most often when advocates of reform put their hopes in states.But health policy literature is remarkably silent on the questionof allocation of authority, rarely asking which levels of governmentought to lead. We draw on the larger literatures about federalism,found mostly in political science and law, to develop a setof criteria for allocating health policy authority between statesand the federal government. They are social justice, proceduraldemocracy, compatibility with value pluralism, institutionalcapability, and economic sustainability. Of them, only proceduraldemocracy and compatibility with value pluralism point to stateleadership. In examining these criteria, we conclude that Americanpolicy debates often get federalism backward, putting the burdenof health care coverage policy on states that cannot enact orsustain it, while increasing the federal role in issues wherethe arguments for state leadership are compelling. We suggestthat the federal government should lead present and future financingof health care coverage, since it would require major changesin American intergovernmental relations to make innovative statehealth care financing sustainable outside a strong federal framework.
Austin and Aaron are participants in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.
04/27/2010
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