tag:blogger.com,1999:blog-17232051.post1682509196382104548..comments2024-03-18T22:32:52.802-04:00Comments on Noahpinion: Market priesthoodNoah Smithhttp://www.blogger.com/profile/09093917601641588575noreply@blogger.comBlogger234125tag:blogger.com,1999:blog-17232051.post-52809380211580062562014-05-22T08:03:30.087-04:002014-05-22T08:03:30.087-04:00Levitt and Dubner aren't posing as healthcare ...Levitt and Dubner aren't posing as healthcare policy gurus.<br /><br />They're doing what they always do and boiling the issue down to it's fundamentals. In practical terms alternatives are complex. This is why it helps to keep in mind the fundaments problem which is a simple one of agency.<br /><br />Healthcare consumers rarely pay for healthcare directly. If they did they'd consume less and demand lower prices and higher quality standards.<br /><br />Insurance companies / Governments do pay for healthcare. But they're not the ones receiving care so they're much less quality sensitive, and they recover the costs through premiums / taxation so they're much less price sensitive.<br /><br />Governments bargain better than Insurance companies because of policital considerations, social responsibility, purchasing power and so on. This is why the UK system is more efficient than the US system.<br /><br />But in the age of the internet consumers bargain best, simply because they have more to gain and lose in terms of both cost and quality. It's a simple matter of incentives.<br /><br />The real question is how to turn healthcare over to the freemarket while keeping it affordable for those who really can't afford it.<br /><br /><br /> <br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-43925979417543041152014-05-21T13:47:07.034-04:002014-05-21T13:47:07.034-04:00Anon 7:30 - if that's true, it's just like...Anon 7:30 - if that's true, it's just like Medicare's supplemental insurance market. There is still room for competition and private insurance in the presence of a single payer system - not to replace the system but to supplement it. There is no need for an inane thought experiment. We've had the example here for years.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-56180361052667194012014-05-21T13:05:23.281-04:002014-05-21T13:05:23.281-04:00" I think I'm going to rush right down an..." I think I'm going to rush right down and get some open heart surgery today, because it's "free"."<br /><br />It's more like: "You can use this generic drug that costs us $20, or you can use this marginally-changed prescription drug that costs us $200. They're both free to you - which one do you want?"<br /><br />If both are free, most people will take the prescription drug, even though it's a lot more expensive to society. Windchasershttps://www.blogger.com/profile/11554275410734284781noreply@blogger.comtag:blogger.com,1999:blog-17232051.post-17653960527690861152014-05-21T13:04:37.407-04:002014-05-21T13:04:37.407-04:00Apparently you are creatively misreading the propa...Apparently you are creatively misreading the propaganda found in Forbes:<br /><br />"About six million Brits now buy private health insurance, including almost two-thirds of Brits earning more than $78,700."<br /><br />http://www.forbes.com/sites/scottatlas/2013/07/05/happy-birthday-to-great-britains-increasingly-scandalous-national-health-service/<br /><br />There are 63 million Britons, so the accurate percentage is less than 10% - not 2/3ds.<br /><br />I can see how a reader of Forbes might think that "people earning more than $78,700" is the same as "people."Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-66869935279773241882014-05-20T20:09:25.600-04:002014-05-20T20:09:25.600-04:00well, he does have the (flawed) rand study on his ...well, he does have the (flawed) rand study on his side: of course, there are myriad problems with that story- but it still, for some odd reason, serves as the gold standard for health care financing emperics in the us Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-78598060163668780052014-05-20T11:13:55.039-04:002014-05-20T11:13:55.039-04:00Can I say that the First Anonymous is not necessar...Can I say that the First Anonymous is not necessarily completely wrong? I agree with you fp3690 on general principle that it is a terrible idea to tie employment to insurance. But when we're working with actual, integrated health systems as they exist (and not just the insurance product), there can be some major benefits to involving employers. Employers are often interested in implementing health programs (think worksite vaccinations, exercise programs, tobacco cessation, etc.) that can be highly effective but near impossible to implement in the general population or through the political apparatus. Take away the premium support employers have to pay, and you take away part of the incentive for employers to support these programs (employee health alone is not always a large enough incentive). Again, I agree that in the aggregate it would probably be better to divorce employment from healthcare (especially when it comes to job lock and perverse subsidies in place of wages), but it's definitely a bit more nuanced. Anything you replace needs to consider health systems' effects as well.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-16505973440739419152014-05-20T11:12:54.483-04:002014-05-20T11:12:54.483-04:00Can I say that the First Anonymous is not necessar...Can I say that the First Anonymous is not necessarily completely wrong? I agree with you fp3690 on general principle that it is a terrible idea to tie employment to insurance. But when we're working with actual, integrated health systems as they exist (and not just the insurance product), there can be some major benefits to involving employers. Employers are often interested in implementing health programs (think worksite vaccinations, exercise programs, tobacco cessation, etc.) that can be highly effective but near impossible to implement in the general population or through the political apparatus. Take away the premium support employers have to pay, and you take away part of the incentive for employers to support these programs (employee health alone is not always a large enough incentive). Again, I agree that in the aggregate it would probably be better to divorce employment from healthcare (especially when it comes to job lock and perverse subsidies in place of wages), but it's definitely a bit more nuanced. Anything you replace needs to consider health systems' effects as well.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-19014722413092503402014-05-20T11:07:02.604-04:002014-05-20T11:07:02.604-04:00Can I say that the First Anonymous isn't compl...Can I say that the First Anonymous isn't completely wrong? Yes, I agree with you fp3690 that it is on general principle and ceteris paribus a terrible idea to tie employment to insurance. However, when we're working with actual health systems as they exist (and not just the insurance product), there are can be some major shortterm benefits in involving the employer. Employers are often willing to push to for pool-wide interventions to improve health (think worksite vaccination programs, exercise-programs, tobacco cessation, etc.) that can otherwise be extremely difficult to otherwise implement in the wider population or through the political apparatus. Without employer-sponsored insurance (the premium support that employers pay for), there's also less of an incentive for employers to pursue those health programs on the basis of employee health alone. Again, I still think that in the aggregate it's more important to keep health insurance and employment separate, but it's a bit more nuanced than that.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-32617314993348190362014-05-19T14:53:45.560-04:002014-05-19T14:53:45.560-04:00Noah, I think your point about the Maserati is imp...Noah, I think your point about the Maserati is important. We can argue with Levitt about how rational people are, but someone who views people as Levitt does really should hate his proposal. This is because above £8000 the person writing the cheques isn't the person choosing the healthcare provider. This disconnect means rich people and people with expensive conditions will be able to spend through the roof. Unless Levitt's got a fix for this, his proposal is even more anathema to the market priesthood than what we have now.Michael Bench-Caponhttps://www.blogger.com/profile/13715068990919309271noreply@blogger.comtag:blogger.com,1999:blog-17232051.post-65251680012640263152014-05-19T14:27:19.552-04:002014-05-19T14:27:19.552-04:00Lots of men die with prostate cancer, hardly any d...Lots of men die with prostate cancer, hardly any die because of it. It's unclear which figure is being discussed here.<br /><br />Fact is that very often prostate cancer is better if left untreated. It is slow growing and doesn't spread, meaning that it generally does not affect lifespan (hence, removing it doesn't generally reduce mortality). This relatively benign common form of prostate cancer can still affect quality of life in some ways (such as causing more frequent urination), but the side effects of treatment are generally much worse (such as causing uncontrollable urination). Thus, a finding of lower prostate-cancer fatalities in the US is not necessarily a good thing--it is likely, at least in part, indicative of over-diagnosis.<br /><br />Besides, even if the US is better specifically on prostate cancer, looking at all causes of fatalities the US still performs much worse. That we can reduce the fatality rate of one disease is not enough to warrant moving resources away from other life-saving endeavors.Matthew Martinhttps://www.blogger.com/profile/03395599411699593043noreply@blogger.comtag:blogger.com,1999:blog-17232051.post-50809464249338049662014-05-19T09:25:05.687-04:002014-05-19T09:25:05.687-04:00"So, how do all those misdiagnoses make the m..."So, how do all those misdiagnoses make the mortality/incidence ratios for pretty much all the cancers so much better in the US? They are forgetting to update the incidence stats? "<br /><br />The population of people who get cancer is different, essentially. Cancer is a disease of the elderly, and a significant number of the people who would have died from cancer in the US have already died of other causes before that. What's left at the later ages are the people who survived the earlier ones - meaning that the poor US healthcare system effectively culls away people with lower incomes or chronic conditions at earlier stages in the life table. You are left with a healthier, smaller set of survivors at the end of it.Fangzhttps://www.blogger.com/profile/17792907911535480701noreply@blogger.comtag:blogger.com,1999:blog-17232051.post-31916897523253655582014-05-19T09:20:54.663-04:002014-05-19T09:20:54.663-04:00Krzys, pharma is an easy business with huge margin...Krzys, pharma is an easy business with huge margins *because* the entry costs are large and so it is difficult for competition to emerge. There's giant economies of scales, advantages from long standing reputation, IP ownership, and so on and so forth. There are no mom and pop pharma companies.Fangzhttps://www.blogger.com/profile/17792907911535480701noreply@blogger.comtag:blogger.com,1999:blog-17232051.post-25524503471507539962014-05-18T23:37:33.205-04:002014-05-18T23:37:33.205-04:00@Epanechnikov
Sorry, something strange is happeni...@Epanechnikov<br /><br />Sorry, something strange is happening when I try to respond to you about the LNT standard being opposed by 90% of health physicists including the Health Physics Society and recently UNSCEAR. It started to be used after Muller one the Nobel Prize where he had ignored evidence that radiation is not harmful at low levels, certainly not close to 0.4mSv of radiation that a mammogram produces. That is just a 10% increase over U.S. average background radiation -- completely trivial. Noah is a physics guy and must have been following the Fukushima accident so probably knows this stuff, whereas most weren't aware before the 3/11 accident. heynoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-2181079450774937132014-05-18T23:10:40.912-04:002014-05-18T23:10:40.912-04:00So, how do all those misdiagnoses make the mortal...So, how do all those misdiagnoses make the mortality/incidence ratios for pretty much all the cancers so much better in the US? They are forgetting to update the incidence stats? Krzyshttps://www.blogger.com/profile/15794655390770135247noreply@blogger.comtag:blogger.com,1999:blog-17232051.post-49094728824940810262014-05-18T23:06:11.054-04:002014-05-18T23:06:11.054-04:00So, if the overdiagnosis risks are so high, we sho...So, if the overdiagnosis risks are so high, we should see higher incidence for all cancers and higher mortality rate to boot (compared to, say, Western Europe). Is that what are we seeing? Krzyshttps://www.blogger.com/profile/15794655390770135247noreply@blogger.comtag:blogger.com,1999:blog-17232051.post-47552353504737806262014-05-18T18:49:57.810-04:002014-05-18T18:49:57.810-04:00Anon,
United Kingdom public healthcare costs amou...Anon, <br />United Kingdom public healthcare costs amount to ~8% of GDP. <br />United States public healthcare costs amount to ~8.5% of GDP (even higher if you count subsidies in the form of tax breaks for employer provided insurance). <br /><br />Contrary to your assertion, single-payer leaves more money on the table for weapons. That Her Majesty's government chooses to spend the efficiency premium on other things than weapons is an unrelated matter. <br /><br />Source for public spending data: <br />http://data.worldbank.org/indicator/SH.XPD.PUBL.ZSAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-5010372388528656342014-05-18T17:27:03.249-04:002014-05-18T17:27:03.249-04:00Lee, market forces have not existed in health care...Lee, market forces have not existed in health care for decades. Indeed, back when they did, health care was around 5% of GDP. It's no coincidence that as soon as government started intervening in health care, costs started shooting up.Anonymoushttps://www.blogger.com/profile/05847533015061872562noreply@blogger.comtag:blogger.com,1999:blog-17232051.post-83717146014750631342014-05-18T17:18:59.498-04:002014-05-18T17:18:59.498-04:00Response to that point about Singapore as well:
h...Response to that point about Singapore as well:<br /><br />http://thecuriouscontrarian.blogspot.com/2013/10/why-conservatives-like-singaporean.html<br /><br />Anonymoushttps://www.blogger.com/profile/05847533015061872562noreply@blogger.comtag:blogger.com,1999:blog-17232051.post-22975149253334819832014-05-18T16:47:38.987-04:002014-05-18T16:47:38.987-04:00I thought my last response went up, but I guess no...I thought my last response went up, but I guess not. I'd have to find the article, but it compiled what health physicists thought about the old Linear No Threshold model that your stats are relaying on. The surveys ran 9 to 1 in favor of no longer using LNT. That is, the assumption that even the tiniest amount of radiation causes cancer, which the Health Physics Society and French equivalent argue should not be used to calculate cancers for below 50 mSv per year. US background radiation is 3.3 mVs on average, although Denver, CO has about 10 mSv. For most Americans, a mammogram dose would mean a 10% increase that year above background radiation, which is completely trivial. You can't get cancer from a mammogram.<br /><br />Unfortunately, LNT started after Nobel Prize winner Hermann Muller declared it vital in his acceptance speech despite having seen evidence a week earlier that LNT was wrong. His motive was to stop all nuclear weapons testing. After the Fukushima accident, UNSCEAR moved away from using LNT as the French Academy of Science did years earlier. <br /><br />heynoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-90814731029855002992014-05-18T16:34:55.279-04:002014-05-18T16:34:55.279-04:00British person here
The reason Cameron didn't...British person here<br /><br />The reason Cameron didn't give them the time of day is because the NHS is hugely popular in the UK. Any politician suggesting he or she may be in favour of getting rid of it has no chance of getting elected.<br /><br />People don't seem to understand how much people in the UK like the idea of not having to worry about money or insurance exemption if they or any other family member or friend suddenly has a health disaster.Rob Hnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-665908453057441342014-05-18T14:27:55.631-04:002014-05-18T14:27:55.631-04:00Yes, I am being facetious. You fail to recognize, ...Yes, I am being facetious. You fail to recognize, however, the need for incentives to drive progress forward. The biggest contributor to the the much higher costs in the US is precisely the cost of technology and pharma. Different estimates put it at roughly 2/3 of the expense gap. Consequently, you singing praises of the "cheap" NHS system misses the small issue of who really pays for your cheap stuff.Krzyshttps://www.blogger.com/profile/15794655390770135247noreply@blogger.comtag:blogger.com,1999:blog-17232051.post-9186680111611113302014-05-18T14:20:12.004-04:002014-05-18T14:20:12.004-04:00There is a discipline called Biology. It's lea...There is a discipline called Biology. It's learned a few things, like evolution. There is a discipline called history. It's recorded a few things, like world war two. There is a discipline called climatology. It's learned a few things, like global warming. Even religious studies has eliminated demonology, which had quite the corpus of learned papers. But you long for the dark ages. "derp derp" magical incantations to cloud minds!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-41574320703444937492014-05-18T14:05:21.023-04:002014-05-18T14:05:21.023-04:00More leeches, more leeches! The patient is dying!...More leeches, more leeches! The patient is dying! The people have spoken!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-70538959444961231712014-05-18T13:43:21.896-04:002014-05-18T13:43:21.896-04:00I'd have to look it up again. The article comp...I'd have to look it up again. The article compiled surveys of health physicists who study radiation, who have rejected the LNT standard by about 9 to 1. <br />A mammogram radiation does is 0.4 mSv while the average U.S. background radiation is about 3.3 mSv. A 10% increase in one's very low annual radiation level will not cause cancer in anyone. A person living in Denver gets around 10 mSv per year, That is roughly equivalent to an average American receiving 17 mammograms per year. An increase in cancer risk has not been found in Denver, either. Most doctors don't understand radiation risk and the highly politicized background of initially using LNT in the 1950s. A Nobel Laureate, Hermann Muller, who wanted to ban nuclear weapons testing, simply made up a story, going against recent evidence that he saw a week earlier, that even the tiniest amount of radiation could cause cancer.<br /><br />When you go against the evidence, you automatically get cancer deaths out of a huge sample size of 100,000 or a million. Once LNT was established on emotional grounds, it has been extremely difficult to overturn despite the American Health Physics Society, the French equivalent among other groups to stop its use. After the accident at Fukushima, UNSCEAR moved away from LNT. heynoreply@blogger.comtag:blogger.com,1999:blog-17232051.post-70981635514696552242014-05-18T13:13:53.108-04:002014-05-18T13:13:53.108-04:00Nat, LOL. Seriously, "Derp derp derp!" ...Nat, LOL. Seriously, "Derp derp derp!" makes you sound insane. (Which I hope is true: it would be an improvement on your understanding.)<br /><br />You're like a medieval bloodletter: the patient is dying. Yeah, right Nat, you just have not bled him enough.<br /><br />At least you may come to understand that your vaunted "extreme forms of regulation" produced today's broken system. You broke it, you own it. Time for new ideas.<br /><br />No, no!! More bleeding!!! The regulatory humors are imbalanced!Anonymousnoreply@blogger.com