Healthcare in America

UPDATED 03March2010

Here are the big issues IMHO that real healthcare discussion rests on

Measuring healthcare:  Depending on whom you ask, we either have the best healthcare in the world or one of the worst healthcares of an industrialized nation.  To the credit of the proponents of the latter, this group actually has some metrics to back up their claim.  The logic behind the former is that America spends the most or is the best country in the world therefore we must have the best healthcare.  This leads to my question.  What metrics should we judge healthcare by?  Without fully understanding the answer to this question, we have no hope to even start to improving healthcare.

Efficiency:  What factors actually do create significant changes?  Is this change of cost or quality or both?  The good news (or bad news) is that we live in a federation-type government.  States have implemented a wide spectrum of health-care policies that we can examine.  Of course we can also look at various countries.  

Morality:  This subject matter is of course the toughest to talk about.  There are no facts or data to support our statements.  Only philosophical arguments can guide us.  What we can do is try to dispel and eliminate some of the inconsistency, hypocrisy, and “double-speak” and try to get a clearer picture. 


Measuring Healthcare?

            I think one of the easiest metrics or measures to go by is simply life expectancy.  I think most would agree on this and it is also simple, straightforward measurement to make.   I could make a list, but someone on wikipedia made a nice figure

Certainly, the US has pretty good life expectancy but not the best.  Japan, Canada, France, and Italy are just a few I’ve noticed.  Where does US exactly rank (according to the CIA)?

49th behind Puerto Rico (I guess that’s not US), Jordan, Malta.  Looks like U.S. is in the top 20%. 

People would argue that life expectancy is a bad metric.  Factors influencing life expectancy are not directly related to health care or are confounded with other factors.  Fair enough but I hope this little demonstration at least dispels the most extreme opinions (i.e. we have the best healthcare in the world.)   

Much hoopla was made of the WHO rankings.  It might be insightful to look at how they came out with their rankings. 


            First a word of caution; I think it’s very easy to start to look at all the different types of health care systems in the world.  Unfortunately, not all government structures are the same and it may not be wise to compare the policy of a federation state (such as U.S., Canada, Mexico, Germany, Russia)  versus a unitary state (such as U.K., France, Greece, Israel, PRC*, Spain*).  Since we could go on and on, it might be simpler to compare apples to apples.  I think because of the separation of power is usually explicit in federated countries, it would be tough for these countries to enact policies popular in unitary countries.  There are also cultural, wealth, and technology difference amongst countries.  I think it would be logical to first examine policies among the states of the U.  S. before delving into international policies.

            Tort Reform

            Tort reform has been a policy championed by conservatives and GOP.  It is a waterfall effect. 

1)      Cap/reduce the amount doctors are liable for in civil case

2)      This cap reduces the amount of insurance for doctors

3)       Less money spent for insurance, less the cost for healthcare.

This is the simplest logic as I understand it. 

            Has this had a real effect?  Klick & Stratmann [Journal of Legal Studies, vol. 36, June 2007] came to the conclusion that this only affected “high-risk” medical practitioners and did not have any substantial effect on the quality of health care.  Even if it does not improve health care, decreasing cost is probably good enough for most people.  The problem is putting a monetary value on what we have lost by capping civil suits from medical malpractice.  What have we lost or what rights have we giving up to save money?  I don’t know how to put a value on this; that requires a professional economist.


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