Category: Medicine

Here are the bald asseverations I made to Bryan Caplan yesterday, over Bolivian food:

1. Health care is very, very good for you.  Here is one good summary of the earlier blogosphere debate.

2. Don’t be fooled by studies that say the opposite.

3. At most those studies show that health care is not good for you at some additional margin.  Make sure you get to that margin.

4. It is true that many regressions show a zero positive effect for health care once you introduce a variable for income.  This mainly shows that income is a better proxy for real health care than many of our highly imperfect measures for health care.

5. Almost every family in my Mexican village has lost a kid or two before the kid reaches age five.  Few of these deaths would have occurred if a) a doctor rather than a shaman were around, b) they had a ready antidote for scorpion bites, c) they knew to take the right pills for diarrhea and fever and to stay hydrated.  These variables will be more closely correlated with measured income than with whatever screwy figure the Mexican government provides for expenditures on medical care.  Health care still matters, even though it won’t show up as significant in the regression.

6. The above example can be generalized to wealthier countries.  Might education be the best proxy of all for the consumption of real health care?  Yes stupid doctors can kill you but a smart patient will not do better staying at home.

7. It is obvious that health care leads to greater longevity, and this is the greatest good of all.  Just ask yourself, how much money would you have to receive to give up health care for the rest of your life?  For me no sum of money would suffice.

8. Yes the famous Rand Corporation study showed that more doctor visits don’t help people.  I can buy that, but advances in medical science still bring huge pay-offs.

Caveats: These are lunchtime comments, I am not accountable for them in the same way as if I posted them on my blog.  And I am still too afraid to go see the doctor and get a check-up.

I’ve three times tried to get insurance reimbursement from Allstate, and three times they have — in unambiguous cases — tried to screw me over or otherwise held up the claim for months. 

That is why so many intelligent people promote the nonetheless-still-quite-insane idea of a single-payer health care system for the United States.  Let’s keep in mind the words of Arnold Kling on Medicare:

There is no actual evidence that the elderly receive better care, or more cost-effective care, or more egalitarian care than people under 65. Particularly interesting is the data that the U.S. spends about 40 percent more per capita on health care for the elderly, just as we spend about 40 percent more per capita on health care for those under 65. Where in the data is the much-vaunted efficiency of Medicare?

Let’s also not forget that the best European systems reject the single-payer idea.  Furthermore, while I am frustrated at Allstate, government either does the same or costs and abuse go crazy.  Read Jane Galt as well.

Here is a good article from Investors Business Daily about how blogs increase the accountability of public health officials and organizations.  I am pleased to see the prominent mention of the Avianflu blog I founded and its major blogger, Silviu Dochia.

The masseuse was working on my chakra’s (or something like that) when she said:

"Has anyone told you that you are great today?  I can tell that you have a lot of loving energy.  You’re a very giving person."

"Wow," I replied, "no one has ever said that.  I’m an economist."

"Oh," she replied, pausing slightly, "I guess I was wrong."

A federal agency has begun notifying all 50 states that they don’t have to offer Medicaid-funded Viagra to sex offenders, a step taken after it was discovered that more than 400 convicted sex offenders in New York and Florida were reimbursed for the erectile dysfunction drug.

Here is the story.

if you want to live longer.

Health care costs now account for ten percent of the military budget; Randall Parker offers further discussion.

Tamiflu is effective against at least some strains of avian flu.  But if a pandemic comes, can you expect to get your tamiflu?  Why not buy some now and put it in the refrigerator?

Deborah Franklin (NYT, $) says you should not stockpile.  She claims you will have to pay too much, you might store the drug incorrectly, and you may exacerbate drug resistance. 

We can dismiss the first argument out of hand, as those costs ($65-$100 for a five day course) are internalized by the purchaser.

As for the second argument, will a centralized stockpile involve less wastage?  Just pick the correct temperature for storing the pills.  I’ll predict that bureaucracy and distribution and rent-seeking costs will be high if there is panic demand for Tamiflu.  If you’re smart enough to read MR, you’re smart enough to have lower storage and distribution costs than our government.  Which other assets — other than military hardware — do you prefer they hold for you? 

Resistance is a real issue, especially if you stop taking the drug too soon.  But I suspect fanatical early stockpilers are the people least likely to make this mistake.

A further question is whether you are most deserving to have some Tamiflu, in case a pandemic comes.  Maybe it should all go to the vulnerable elderly.  (What if the hoarders are the vulnerable elderly?)  On the other hand, early stockpilers tend to be relatively rich in human capital.  And your stockpiling behavior, in the meantime, bids up the price, runs down stocks, and encourages more production. 

Howard Markel, a medical historian at U. Michigan, offered a revealing comment for the NYT article:

"Historically, whenever there’s a crisis you’ll find stockpiling, hoarding, black marketeering and generally bad [sic] behavior"

No, I am not buying.  But as you can see, I am thinking about it. 

The Whizzinator is a fake penis, urine bag and syringe designed to beat drug tests.  It is said to be "foolproof" although according to the May Atlantic "actor Tom Sizemore" [insert joke here] "was caught using one during a drug test in February."  It also does not inspire confidence to read that "YES, WE SELL DEHYDRATED URNIE SEPARATLEY."

As Tyler has noted, Markets in Everything is often sad but in this case it’s the demand, or rather the reasons for the demand, not the supply that I find most sad.

Since 1999 America has accounted for 71% of the sales of new chemical entities, up from 62%. Japan and Germany, the next two largest pharmaceutical markets, account for just 4% each.

That is from Doug Bandow at Cato, here is the link.  Of course this figure stems from both high volume and high price in the U.S.; it is a massive form of implicit foreign aid.  By the way, for those of you interested in Cato University seminars on economics — "for citizens" — read more here.

Steve Landsburg weighs in on Terri Schiavo:

I have less understanding of why Schiavo’s parents want to keep feeding her. And insofar as they want others to keep feeding her–through Medicare, etc.–I think we can safely ignore their preferences. But provided they and their supporters are willing to bear those costs, I infer that this is something they want very much and there’s not much reason to stop them.

I doubt that a "willingness to pay" standard accurately values human life in such instances (in fairness to Landsburg there is more to his position, read his entire post).  Often it picks up a mere ability to spend money, rather than any relevant notion of human welfare.  Whether the husband can outbid the parents may simply depend on whether he has gone bankrupt from his previous involvement in her care.   

Nor do I think that family decisions — whatever your view in the Schiavo case — should be decided by a real or hypothetical societal auction.  If there is any "protected sphere" for human decision-making, surely it is here.  The problem is that we don’t agree on how to define the guardian of the sphere — is it "Terry" or "husband as guardian of a no-longer-living Terry"?

This case will only grow in symbolic importance.  Keep in mind, the care of Terriy Schiavo has been financed by the state of Florida and Medicaid for the last several years.  According to one AP story, it costs $80,000 a year to keep her alive.  Note that "a judge approves all expenditures, from attorneys’ fees to the woman’s haircuts."

Therein we see the problem for the future.  Say you take a "pro-life" stance on this case.  What will happen when we can maintain, say, 30 percent of the "dying" population in this kind of state for decades?  Such technologies are probably only a matter of time.

Say you take a "pro-husband" stance.  Presumably you cite evidence for Terri’s severely impaired mental facilities.  What will happen when we can keep, say, 30 percent of the "dying" population in a somewhat less impaired state for decades?  Such technologies are probably only a matter of time.  Was her vegetative state really the issue, or was it just cost?  Our views will be tested, sooner or later.

I don’t see much guidance here from economics, political philosophy, or virtue ethics.  My instincts are to "look toward the future," but I don’t have a good argument that avoids all possible repugnant conclusions.  (I will never forget Julie Margolis, asking me in my job interview at UC Irvine, why we do not value human life at replacement cost.  That would be no more than a few thousand dollars, given that some women stand right on the verge of wanting another baby.  I didn’t have a good answer, although they hired me anyway.)

As Medicare grows as a percentage of the federal budget, this issue will become increasingly important.  And as technology advances, no one will be left with a comfortable intellectual position.

Arnold Kling writes:

I am prepared to make the following bet: ten years from now, it will be objectively clear that the United States provided significantly better health care to its citizens between 1990 and 2005 than did other developed countries. From the vantage point of 2015, the policy blunder of the past fifteen years will not be that the United States spent too much on health care, but that other countries spent too little. The socialized systems, forced to ration health care because tax revenues are not sufficient to pay for state-of-the-art care, are constraining their citizens from being diagnosed and treated as well as Americans.

And why do we spend so much on health care?

While the usual suspects receive attention that is disproportionate to their true impact on U.S. health care spending, two important factors receive relatively little attention: physician compensation; and the utilization of high-tech procedures. Both of these are much higher in the United States than elsewhere.

Physicians are paid more than twice as much in the United States as in other developed countries. Because physician services are about one fourth of all health care spending, we could eliminate one eighth of our health care spending by reducing doctor salaries to the levels of other countries.

The other big factor is utilization of high-tech procedures, such as MRI’s, CT scans, and open-heart surgery. If Americans would cut back on the utilization of these procedures, that would reduce health care spending by hundreds of billions of dollars.

The question is whether our medical care would deteriorate if we were to pay our doctors much less while at the same time reducing our utilization of expensive capital resources. It seems reasonable to conjecture that the quality of diagnosis and treatment ultimately would suffer.

Read the whole thing; this could be my favorite Arnold Kling essay.  And if there could be five issues I wish I understood better, this would be one of them.