• Race and population level health statistics – ctd.

    From yesterday’s NYT, a letter from Paula Braveman (emphasis mine):

    As a member of the panel that produced the report, I hope that wide awareness of these disturbing findings will lead to reflection and public debate about what we as a nation need to do to turn this dismal situation around.

    I also wish to add a point not noted in the article: that the United States’ “health disadvantage” is seen even when examining whites and high-income people alone. Minorities and the poor do have worse health and shorter lives, but our panel concluded that the problems producing the American health disadvantage affect all Americans adversely.

    Perhaps awareness of that will amplify the political will to address the issues.

    This pretty much just echoes what I said yesterday. Maybe those emails and comments will stop now…


    • It seems obvious to me that insurance is a poor way to pay for health care. America’s system is particularly bad since in the insurance is short-term. The average person stays in a job 5 years, and many companies change their insurance as often. Insurance companies have no incentive to care about a person’s long-term health.

      Smoking cessation, chronic disease management, weight control — all of these have significant long-term benefits and short-term costs. Is it any surprise that few insurance policies cover them?

    • Perhaps “American” style insurance is a poor way to pay for health care. But that’s a problem with the American system and implementation, not insurance.

    • Insurance companies will always have two ways of keeping costs down : either preventing clients from getting sick or discouraging sick people from becoming clients. Sure, you can try to fiddle with incentives to reduce the second behavior.

      Consider an insurance company that develops a great program to manage diabetes. Their patients have better managed diabetes have better outcomes and lower costs than at other companies. Does it bring lower costs for them? Maybe, or maybe diabetics enroll in this insurance at greater rates, raising costs. If this happens, no other insurance company will have an incentive to copy the program. Better their diabetics switch.

    • Obviously, everything in this report is WRONG! Here’s “Facts about America’s health care quality that the world doesn’t know” from yesterday (there are too many good quotes – you’ll have to read it to believe it! Here’s one.):

      “Objectively, the world’s leading medical journals are filled with studies demonstrating the excellence of American medical care in comparison to other systems more heavily controlled by government bodies, the very systems held as models by those asserting the need for radical change to US health care.”


      I was actually looking for this report issued yesterday from the Fraser Institute (a right-wing research organization in Canada with many of the same objectives as their U.S. counterparts).

      “Provincial Healthcare Index 2013 compares the per-capita cost of provincial health care systems to the availability and quality of medical goods and services in each province. The report measures 46 performance indicators comprising availability of resources, timeliness, volume of services provided, and clinical performance using publically available data from 2010 (or the most recent year available).”

    • awareness of these disturbing findings

      In 1930, average life expectancy in the United States was 59.85. By 2000, it rose to 77.1 years. (begin sarcasm)Disturbing! Very disturbing!(end sarcasm)

      I think that these international comparisons are not useful and that goes for heath and education. The USA scored at the bottom of the first PISA test comparisons. I bet it also scored lower that the others in the heath measures back in the 1950s and 60s. The PISA educational comparisons have been a factor in driving up up our education spending to a level much higher than the other counties and we still score near the bottom. It is a big waste of money.

      Also in a socialized medicine country there is motivation to try and make the statistics look better than they are so why do we put so much faith in them.

      • Sorry, but I agree that it’s disturbing that in the richest, arguably most advanced nation in the world we lag so far behind in so many metrics. Maybe you feel that doesn’t matter. Me? Seems like we’re not getting much bang for the buck.

        You may also not like cross-country comparisons, but I think they’re a far sight more meaningful than a comparison of now with 1930 as a way to feel good about ourselves.

    • Putting aside the international comparisons, our nation’s maternal mortality rate (MMR) offers a means to assess the unacceptable character of our nation’s healthcare. Looking at the MMR, state by state, the variability cannot be explained by demographics alone. The National Women’s Health Center maintains a 5 year analysis of this data. The best States are Alaska, Indiana, Maine and Vermont. The national average was 13. The MMR for these 4 states was 75% lower. Indirectly, the MMR of these four states would rank among the 10 best countries of the world. Think about it!

      AMNESTY INTERNATIONAL USA has published an extensive analysis of this data. It is their opinion that the unacceptable variability of our nation’s maternal mortality among the 50 states will not change until justly accessible primary health care occurs for all citizens. And, I would add, any improvement in its level of acceptability, efficiency and effectiveness will also not improve. As an aside, the United Nations report on MMR in 2010 ranks our nation at 41st worst among the 43 developed nations of the world. This international analysis is real.