Dems Vote to Keep Us From Reading the Bill

I try to stay away from partisan politics in this blog, but this is just too rich to ignore. President Obama and the leaders of the Democrats lectured us endlessly about transparency during the transition and at the beginning of this session. To me, transparency means letting the citizens of the US see what is happening in the halls of government. The Democrats in the Senate Finance committee defeated a measure to require that the committee post the language of any bill and get CBO scoring 72 hours before a vote is taken. The Dems claim that it would add weeks to the deliberations. I guess they don't know that 72 hours is three days. And even if it does add weeks, our right to know, trumps their need for speed.

Here is the article in the American Spectator.

US Health Care; worth saving

In "The Business of Health" the authors address more indicative measures of quality instead of the life expectancy statistic explored here. First with cancer survivor rates, then with a menu of services. The full book is here. Below is their re-cap.


"When more specific performance metrics are used that are (at least
potentially) more sensitive to health-systems differences, in many cases the
United States does, indeed, appear to outperform other, less expensive
health systems. Table 1-6 reports age-adjusted five-year survival rates for
several types of cancers. In all cases, the survival rates for the United States
overall exceed those for European nations. Within the United States, survival
rates for whites are higher than those for African Americans. Presumably
this, at least in part, reflects race differences in average socioeconomic status
and access to health care. Even so, survival rates among African Americans
tend to be on a par with the overall survival rates in European nations." (snip)

"Similar themes are observed in a recent study by the Commonwealth
Fund International Working Group on Quality Indicators, which collected
data on twenty-one health care quality indicators from Australia, Canada,
New Zealand, England, and the United States. The measures included
survival rates for nine different diseases and conditions (such as breast cancer
and ischemic stroke), eight different avoidable events (such as suicide
and hepatitis B), and four process indicators (such as breast cancer screening
rate and influenza vaccination rate for individuals sixty-five years of age
and over). Efforts were made to ensure reasonable comparability across
countries. Among the five countries, the United States ranked either best or
second-best in just over half of the twenty-one categories. It was first or
second in three of the nine survival indicators (breast cancer, cervical cancer,
and leukemia in children ages zero to fifteen), all but one of the eight
avoidable-event indicators, and one of the four process indicators (cervical
cancer screening rate). The authors conclude that 'no country scores consistently
the best or worst overall, and each country has at least one area
where it could learn from international experience. Each country also has
an area where it could teach others.'”

Combine these outcomes with the fact that the vast majority of life-saving drugs, medical equipment (MRIs, CT scans, pacemakers, etc. ), and medical procedures are developed or manufactured in the US, and one concludes that there is much to save about medical services in the US. We have something unique. Something which adds value to us and to the rest of the world. Whatever reform we undertake should protect that, not destroy it.

Doctors don't provide health care

We call it health care; let's think about what the words mean. The implication is that some group is providing care that leads to health or a healthy life. That's not exactly true. We each are responsible for our own health. Some of it can be affected by the choices we make, some is beyond us (environment, genetics, accidents, etc.), some depends upon getting quality care when we are sick or injured. Regardless, the people and organizations that provide "health care" do not really purport to make us healthy. We show up at their offices when we need a service. They provide medical care for us.

Why does it matter? When judging how good a job medical services providers do, we need to concentrate on how well they do at tending to our sicknesses and injuries not how healthy we are in general. They can affect the former; not so much the latter.

Some analysts judge the medical services provided in the US to that of other countries by looking at a calculation called life expectancy. The fact that the life expectancy at birth in the US is among the lowest of developed countries and ranks with some developing countries is taken as proof that the high cost of health care in the US is wasted.

Life expectancy does measure health outcomes but is a poor indicator of the quality and effectiveness of the services of medical providers. Life expectancy is the result of all inputs. Adjusting for differences in just violent deaths, the US has among the highest life expectancies.

Broad statistics describing the health of the population are inappropriate to use in judging the effectiveness of the providers of medical services that we commonly call health care providers. In later posts, I'll look at some outcomes that directly go to the quality of care.

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The adjusted calculation of life expectancy comes from a book entitled "The Business of Health" by Robert Ohsfeldt and John Schneider. You can read it in a pdf here.

How big is health care?

The typical pundit uses the throw-away line that the health care industry is one-sixth of the economy. Somehow that stat, although true, loses its impact; after-all, there still is five-sixths of the economy.

Let's think about it using a different set of numbers. How about the number of people employed? The 2009 Statistical Abstract includes the number of people employed in the health care industry here.

One needs to include direct writers of health and medical care, agents who write medical insurance, health care retailers, and health care manufacturers to get all the people who work in health care. That adds up to something approaching 17.5 million people.

No other segment of employer equals that number except government employees (22 million). Two that are close are manufacturing (excluding medical manufacturing) and retailing (excluding pharmacies).

So, nationalizing health care is more ambitious than nationalizing manufacturing in this country or nationalizing retail. Nationalizing health care is the equivalent of the government running all of the following retailing industries: auto sales (new and used), furniture stores, electronics stores, building material stores, food stores, gasoline retailers, clothing stores, sporting goods, stores, general retailers, miscellaneous, and all of the internet retailing.

Or nationalizing the health care industry is the equivalent of nationalizing all of the manufacturing industry. That includes: food providers, beverage, tobacco, textile, apparel, leather, wood, paper, printing, petroleum, coal, chemicals, plastics, fabricated products, machinery, computers, electrical, transportation, miscellaneous, and furniture.

Actually, manufacturing and retail (adjusted for health care workers) each have significantly fewer employees than health care. They have about 14 million employees each.

Think about it. Nationalizing health care is the equivalent of nationalizing the entire manufacturing industry of the US or the entire retailing industry of the US.