21 thoughts on “The Hidden Cost Of Health-Care “Reform””
My family benefited from innovative treatments that probably wouldn’t be around if the United States had adopted socialized medicine when that was first proposed over half a century ago.
I think Reynolds underestimates the innovation that is possible in “socialized” industries (and ironically he does it using a medium, the Internet, that is a prominent counter-example). Much of the medical research behind the treatments he lauds was conducted with government money, not because there was a market but because there was a need.
The bigger point is that as persuasive as anecdotes can be — we are a species that loves to learn from stories — the innovation coming out of our private medical system has not made us healthier than peer countries that spend much less. That bottom line, and not a collection of stories, should draw our attention.
There is a big difference between basic research and the diffusion of the resulting practical applications into the broad world.
My opposition to state-controlled medicine is that some bureaucrat, or worse, some “policy”, impairs the diffusion of medical technology (materials or procedures) that *I* would pay for, if only I knew they existed.
And Jim, you are using a fallacious criterion:
Private medical system innovation and population health comparisons are not causally linked. Consider the following possibilities:
— We are subsidizing the globe’s medical innovation.
— We report health outcomes more honestly.
— We spend gobs of money on people who, 50 years ago, would have been left to die — and that other countries still do.
— We have a large population of undocumented, uncounted residents that receive emergency room care, but don’t count towards the “capita” in “per capita” numbers.
These are possibilities that actually have something to do with health care expenses and outcomes. Their solutions (if they exist) have NOTHING to do with impairing medical innovation.
Your “bottom line” is neither as rational, factual, nor as well-characterized as you seem to think it is.
Private medical system innovation and population health comparisons are not causally linked.
That was my point. What we (as a society) care about is the health of our population. If private medical system innovation is not a means to that end, it shouldn’t be a high priority for our society.
We are subsidizing the globe’s medical innovation.
And they are subsidizing ours; some of the biggest pharma companies are in Europe, and European markets are big consumers of American medical products.
We report health outcomes more honestly.
Says who?
We spend gobs of money on people who, 50 years ago, would have been left to die — and that other countries still do.
Why exactly is that a good thing? What are we gaining, and what are we giving up?
We have a large population of undocumented, uncounted residents that receive emergency room care, but don’t count towards the “capita” in “per capita” numbers.
Our per-capita costs are almost twice that of some peers. Unless you think there are 300 million illegals, it isn’t that.
What we (as a society) care about is the health of our population. If private medical system innovation is not a means to that end, it shouldn’t be a high priority for our society.
Nice giveaway, Jim. Thank you for so forthrightly declaring your collectivism.
The People will decide about my health care. And The People can’t be bothered with those kulaks who wish to purchase their own. Any more than Hillary could consider herself responsible for “every undercapitalized business” when she was trying to socialize medicine.
This is why I don’t want people like you and the other Democrats anywhere near my health care. And it’s why you will lose, thankfully.
What we (as a society) care about is the health of our population.
In other words, democracy trumps individual liberty.
We spend gobs of money on people who, 50 years ago, would have been left to die — and that other countries still do.
Why exactly is that a good thing? What are we gaining, and what are we giving up?
“Jim”, I rarely make internet arguments personal, but I find myself hoping you find out, through great personal loss, how seriously f*cked up that is.
Rand, if this crosses a line, feel free to remove it. I cannot let that statement go unanswered.
Rand, if this crosses a line, feel free to remove it. I cannot let that statement go unanswered.
I think it’s appropriate. As one who expects to be of the nomenklatura, Jim doesn’t worry about trivial things like that. He’d figure that if he was an Inuit, he’d decide who to put on the ice flow.
That’s what set me off: the apparent total disregard for the sanctity of (other people’s) life.
My mother, (who received a liver transplant two years ago at the age of 70) is still above ground. That’s what we (my family) have gained.
My mother, (who received a liver transplant two years ago at the age of 70) is still above ground.
What?!
Was your mother such an unpatriotic ingrate that she was unwilling to sacrifice herself for the common good? The Supreme Jim will be displeased. Expect to show up at the reeducation camp shortly. Have a big kool-aid glass ready.
First of all, without more information, it would seem that the cost of Instapudit’s family treatments was largly borne by a) the state of Tennessee or b) MediCare – i.e. the dreaded governement. In no way shape or form could Instapudit have payed the full price for any of that treatment (or it’s amoratized R&D cost) himself, and it is not clear that Tennessee or the feds can in the long run.
Second, it should be recognised that the cost of prolonging (not “saving”) the life of your favorite person under the current system is implicitly putting two or three other peoples favorite persons into the ground, destroying the credit rating and living standards of ten or twenty strangers, and eventually backrupting everybody.
There has been a lot of whining about the socalist horrors of Obamacare, but without a convenient ice floe or >120 mg of morphine for every critically sick poor person, there is not a sustainable free-market alternative. All paths go through collectivism of one form or another. Suck it up.
There has been a lot of whining about the socalist horrors of Obamacare, but without a convenient ice floe or >120 mg of morphine for every critically sick poor person, there is not a sustainable free-market alternative. All paths go through collectivism of one form or another. Suck it up.
Then how did they manage to survive without Obamacare? Because it hasd’t been implemented yet…
Suck it up yourself.
Because you dont have a free market system right now – you have a very poorly implemented public/private collectivist system, with a lot of private operators making out like bandits.
Of course, one could say that a free market system has not been tried out; but one could also say that we have not had one based on crystals, incantations and the aggressive pointing of magic sticks at tumours. Both have about the same likihood of success.
I find myself hoping you find out, through great personal loss, how seriously f*cked up that is.
I’m sorry you feel that way; I suspect you misunderstand what I’m saying. I have had personal experience with these issues, and did not consider it a great personal loss to have friends turn down end-of-life care in favor of a better quality of life in their last days.
That’s what set me off: the apparent total disregard for the sanctity of (other people’s) life.
Respect for the sanctity of life, and a willingness to spend arbitrarily large amounts of money on medical procedures in the last days of life, are two different things. The fact that we spend more on end-of-life care than other countries does not mean that we hold life more sacred; it does not even necessarily mean that the recipients of that care live any longer, or with any better quality of life. It just means that they get more care, and we (as a society) pay for it, whether it is doing them or anyone else any good or not.
One area of medical innovation lately is something called “Shared Decision Making.” Hospitals make available educational materials (often videos) about medical procedures, covering what the experience is like, common complications, typical outcomes, risks, etc. Patients are then able to have a stronger voice in their care. Research has found that when patients go through that process they typically choose less agressive treatment than what the doctors would do by default. The obvious implication is that most patients, who don’t go through such a process, are probably getting more care than they want. This is particularly true of end-of-life care, where doctors are very reluctant to suggest not pursuing every possible treatment.
The fact that we spend more on end-of-life care than other countries does not mean that we hold life more sacred
“We,” “we,” we.”
A collectivist. Who thinks that he should judge how the rest of us should live, and when we should die.
What is better? To have reasonably good coverage that takes care of 90% of issues for all, or to have slightly more complete coverage for a selected few?
The statistics show western countries with public medical care spend less per capita *and* have better outcomes (mortality rate, child deaths, etc). This probably has a good reason. For medical care you get more efficient results when you can apply prevention rather than mitigation. People usually have a limited view and cannot bother thinking about problems which do not affect them, or so they think, at the moment. This leads to issues such as the tragedy of the commons.
In addition the fact there is public coverage for all under some program does not necessarily mean private services will be killed. Consider this: just because there is an extensive public water supply that provides clean tap water, does not mean private corporations cannot have a vibrant market selling bottled water. Why cannot the same happen with medical care? You get your public coverage, and if you want extra, you pay extra under the private system.
What is the problem?
How many countries provide taxpayer jets to their head of legislation just to go home?
Jim, you’re distorting MG’s point, which wasn’t about end-of-life care (If I’m wrong MG, let me know), but about treating people who went untreated, or undertreated, in the past.
Cancer patients, for example. As little as sixty years ago they did not receive half the care they do now. Should we suspend research into treating or curing them and instead give them morphine or pot to “improve the quality” of whatever life they have left?
This is particularly true of end-of-life care, where doctors are very reluctant to suggest not pursuing every possible treatment.
Huh, a doctor trying to save their patient’s life, how very odd.
Jim,
Whenever somebody says “we as a society”, that person tips their hand. They don’t see me as an individual, but as part of a lumpen mass, awaiting molding into something different.
You are no potter, I am no clay. Nor shall I be a slave.
But by all means, put into practice your collectivist yearnings — but only on your fellow travelers.
Jim, you’re distorting MG’s point, which wasn’t about end-of-life care (If I’m wrong MG, let me know), but about treating people who went untreated, or undertreated, in the past.
MG was talking about things that don’t show up in overall health statistics.
If we are extending people’s lives with such treatment, and our peer nations aren’t, it would show up in life expectancy statistics, or in a lower rate of amenable mortality (deaths that can be medically avoided). In fact, in a recent survey of 19 industrialized countries, the U.S. had the highest rate of amenable mortality (France had the lowest — click my name for the article).
A collectivist. Who thinks that he should judge how the rest of us should live, and when we should die.
I definitely don’t want to judge how everyone else should live or when they should die. But I do recognize that there are people besides myself, and that there are things we have to do collectively, such as set national health care policy. I think that I should care whether the entire population is well served by those collective actions. In U.S. health care today, they aren’t.
Should we not care about the people who will die in the U.S. today, when they would have lived if they were in France, despite the fact that we are a richer country than France, and France spends much less on health care than we do? How exactly do those deaths demonstrate our respect for the sanctity of life?
We report health outcomes more honestly.
Says who?
I don’t know who if anyone reports health outcomes in a way anyone would consider adequate. But when it comes to death, US does pretty well. Look at the most notorious of health care statistics, infant mortality. Stillbirths aren’t counted in infant mortality statistics. Last I checked, both Canada and the UK had a much more generous definition of stillbirth than the US had. That conveniently makes the US health care system look worse.
My family benefited from innovative treatments that probably wouldn’t be around if the United States had adopted socialized medicine when that was first proposed over half a century ago.
I think Reynolds underestimates the innovation that is possible in “socialized” industries (and ironically he does it using a medium, the Internet, that is a prominent counter-example). Much of the medical research behind the treatments he lauds was conducted with government money, not because there was a market but because there was a need.
The bigger point is that as persuasive as anecdotes can be — we are a species that loves to learn from stories — the innovation coming out of our private medical system has not made us healthier than peer countries that spend much less. That bottom line, and not a collection of stories, should draw our attention.
There is a big difference between basic research and the diffusion of the resulting practical applications into the broad world.
My opposition to state-controlled medicine is that some bureaucrat, or worse, some “policy”, impairs the diffusion of medical technology (materials or procedures) that *I* would pay for, if only I knew they existed.
And Jim, you are using a fallacious criterion:
Private medical system innovation and population health comparisons are not causally linked. Consider the following possibilities:
— We are subsidizing the globe’s medical innovation.
— We report health outcomes more honestly.
— We spend gobs of money on people who, 50 years ago, would have been left to die — and that other countries still do.
— We have a large population of undocumented, uncounted residents that receive emergency room care, but don’t count towards the “capita” in “per capita” numbers.
These are possibilities that actually have something to do with health care expenses and outcomes. Their solutions (if they exist) have NOTHING to do with impairing medical innovation.
Your “bottom line” is neither as rational, factual, nor as well-characterized as you seem to think it is.
Private medical system innovation and population health comparisons are not causally linked.
That was my point. What we (as a society) care about is the health of our population. If private medical system innovation is not a means to that end, it shouldn’t be a high priority for our society.
We are subsidizing the globe’s medical innovation.
And they are subsidizing ours; some of the biggest pharma companies are in Europe, and European markets are big consumers of American medical products.
We report health outcomes more honestly.
Says who?
We spend gobs of money on people who, 50 years ago, would have been left to die — and that other countries still do.
Why exactly is that a good thing? What are we gaining, and what are we giving up?
We have a large population of undocumented, uncounted residents that receive emergency room care, but don’t count towards the “capita” in “per capita” numbers.
Our per-capita costs are almost twice that of some peers. Unless you think there are 300 million illegals, it isn’t that.
What we (as a society) care about is the health of our population. If private medical system innovation is not a means to that end, it shouldn’t be a high priority for our society.
Nice giveaway, Jim. Thank you for so forthrightly declaring your collectivism.
The People will decide about my health care. And The People can’t be bothered with those kulaks who wish to purchase their own. Any more than Hillary could consider herself responsible for “every undercapitalized business” when she was trying to socialize medicine.
This is why I don’t want people like you and the other Democrats anywhere near my health care. And it’s why you will lose, thankfully.
What we (as a society) care about is the health of our population.
In other words, democracy trumps individual liberty.
“Jim”, I rarely make internet arguments personal, but I find myself hoping you find out, through great personal loss, how seriously f*cked up that is.
Rand, if this crosses a line, feel free to remove it. I cannot let that statement go unanswered.
Rand, if this crosses a line, feel free to remove it. I cannot let that statement go unanswered.
I think it’s appropriate. As one who expects to be of the nomenklatura, Jim doesn’t worry about trivial things like that. He’d figure that if he was an Inuit, he’d decide who to put on the ice flow.
That’s what set me off: the apparent total disregard for the sanctity of (other people’s) life.
My mother, (who received a liver transplant two years ago at the age of 70) is still above ground. That’s what we (my family) have gained.
My mother, (who received a liver transplant two years ago at the age of 70) is still above ground.
What?!
Was your mother such an unpatriotic ingrate that she was unwilling to sacrifice herself for the common good? The Supreme Jim will be displeased. Expect to show up at the reeducation camp shortly. Have a big kool-aid glass ready.
First of all, without more information, it would seem that the cost of Instapudit’s family treatments was largly borne by a) the state of Tennessee or b) MediCare – i.e. the dreaded governement. In no way shape or form could Instapudit have payed the full price for any of that treatment (or it’s amoratized R&D cost) himself, and it is not clear that Tennessee or the feds can in the long run.
Second, it should be recognised that the cost of prolonging (not “saving”) the life of your favorite person under the current system is implicitly putting two or three other peoples favorite persons into the ground, destroying the credit rating and living standards of ten or twenty strangers, and eventually backrupting everybody.
There has been a lot of whining about the socalist horrors of Obamacare, but without a convenient ice floe or >120 mg of morphine for every critically sick poor person, there is not a sustainable free-market alternative. All paths go through collectivism of one form or another. Suck it up.
There has been a lot of whining about the socalist horrors of Obamacare, but without a convenient ice floe or >120 mg of morphine for every critically sick poor person, there is not a sustainable free-market alternative. All paths go through collectivism of one form or another. Suck it up.
Then how did they manage to survive without Obamacare? Because it hasd’t been implemented yet…
Suck it up yourself.
Because you dont have a free market system right now – you have a very poorly implemented public/private collectivist system, with a lot of private operators making out like bandits.
Of course, one could say that a free market system has not been tried out; but one could also say that we have not had one based on crystals, incantations and the aggressive pointing of magic sticks at tumours. Both have about the same likihood of success.
I find myself hoping you find out, through great personal loss, how seriously f*cked up that is.
I’m sorry you feel that way; I suspect you misunderstand what I’m saying. I have had personal experience with these issues, and did not consider it a great personal loss to have friends turn down end-of-life care in favor of a better quality of life in their last days.
That’s what set me off: the apparent total disregard for the sanctity of (other people’s) life.
Respect for the sanctity of life, and a willingness to spend arbitrarily large amounts of money on medical procedures in the last days of life, are two different things. The fact that we spend more on end-of-life care than other countries does not mean that we hold life more sacred; it does not even necessarily mean that the recipients of that care live any longer, or with any better quality of life. It just means that they get more care, and we (as a society) pay for it, whether it is doing them or anyone else any good or not.
One area of medical innovation lately is something called “Shared Decision Making.” Hospitals make available educational materials (often videos) about medical procedures, covering what the experience is like, common complications, typical outcomes, risks, etc. Patients are then able to have a stronger voice in their care. Research has found that when patients go through that process they typically choose less agressive treatment than what the doctors would do by default. The obvious implication is that most patients, who don’t go through such a process, are probably getting more care than they want. This is particularly true of end-of-life care, where doctors are very reluctant to suggest not pursuing every possible treatment.
The fact that we spend more on end-of-life care than other countries does not mean that we hold life more sacred
“We,” “we,” we.”
A collectivist. Who thinks that he should judge how the rest of us should live, and when we should die.
What is better? To have reasonably good coverage that takes care of 90% of issues for all, or to have slightly more complete coverage for a selected few?
The statistics show western countries with public medical care spend less per capita *and* have better outcomes (mortality rate, child deaths, etc). This probably has a good reason. For medical care you get more efficient results when you can apply prevention rather than mitigation. People usually have a limited view and cannot bother thinking about problems which do not affect them, or so they think, at the moment. This leads to issues such as the tragedy of the commons.
In addition the fact there is public coverage for all under some program does not necessarily mean private services will be killed. Consider this: just because there is an extensive public water supply that provides clean tap water, does not mean private corporations cannot have a vibrant market selling bottled water. Why cannot the same happen with medical care? You get your public coverage, and if you want extra, you pay extra under the private system.
What is the problem?
How many countries provide taxpayer jets to their head of legislation just to go home?
Jim, you’re distorting MG’s point, which wasn’t about end-of-life care (If I’m wrong MG, let me know), but about treating people who went untreated, or undertreated, in the past.
Cancer patients, for example. As little as sixty years ago they did not receive half the care they do now. Should we suspend research into treating or curing them and instead give them morphine or pot to “improve the quality” of whatever life they have left?
Huh, a doctor trying to save their patient’s life, how very odd.
Jim,
Whenever somebody says “we as a society”, that person tips their hand. They don’t see me as an individual, but as part of a lumpen mass, awaiting molding into something different.
You are no potter, I am no clay. Nor shall I be a slave.
But by all means, put into practice your collectivist yearnings — but only on your fellow travelers.
Jim, you’re distorting MG’s point, which wasn’t about end-of-life care (If I’m wrong MG, let me know), but about treating people who went untreated, or undertreated, in the past.
MG was talking about things that don’t show up in overall health statistics.
If we are extending people’s lives with such treatment, and our peer nations aren’t, it would show up in life expectancy statistics, or in a lower rate of amenable mortality (deaths that can be medically avoided). In fact, in a recent survey of 19 industrialized countries, the U.S. had the highest rate of amenable mortality (France had the lowest — click my name for the article).
A collectivist. Who thinks that he should judge how the rest of us should live, and when we should die.
I definitely don’t want to judge how everyone else should live or when they should die. But I do recognize that there are people besides myself, and that there are things we have to do collectively, such as set national health care policy. I think that I should care whether the entire population is well served by those collective actions. In U.S. health care today, they aren’t.
Should we not care about the people who will die in the U.S. today, when they would have lived if they were in France, despite the fact that we are a richer country than France, and France spends much less on health care than we do? How exactly do those deaths demonstrate our respect for the sanctity of life?
Says who?
I don’t know who if anyone reports health outcomes in a way anyone would consider adequate. But when it comes to death, US does pretty well. Look at the most notorious of health care statistics, infant mortality. Stillbirths aren’t counted in infant mortality statistics. Last I checked, both Canada and the UK had a much more generous definition of stillbirth than the US had. That conveniently makes the US health care system look worse.