Thursday, March 16, 2006

3/16 FHPN Krugman's NYRB long essay, "The Health Care Crisis and What to do About It," brief excerpt

"FHPN," "Fair, Honest, Principled News," is a regular feature which gives links and excerpts from selected recent key stories, often focused on a single theme, with my bold italicized comments. 3/11 "Digests of my previous posts for busy people" link gives blog's core ideas.

This edition of FHPN focuses on the health care crises, presenting economist Paul Krugman's analysis and proposed solutions. 3/15 edition juxtaposed record profits at Goldman Sachs with record trade deficits for America, Inc. link

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3/23 NYRB "The Health Care Crisis and What to Do About It" link "the problem of medical costs is so pervasive that it underlies three quite different policy crises ... increasingly rapid unraveling of employer- based health insurance ... the plight of Medicaid ... the long-term problem of the federal government's solvency ... the evidence clearly shows that the key problem with the US health care system is its fragmentation ... the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from "integrated" systems, like the Veterans Administration, that directly provide some health care as well as medical insurance ... Insiders, who have good insurance, receive everything modern medicine can provide, no matter how expensive. Outsiders, who have poor insurance or none at all, receive very little ... the main source of high US costs is probably the unique degree to which the US system relies on private rather than public health insurance ... public insurance of the kind available in several European countries and others such as Taiwan achieves equal or better results at much lower cost ... the paperwork imposed on health care providers by the fragmentation of the US system costs several times as much as the direct costs borne by the insurers ... in a system of public health insurance is the ability to bargain with suppliers, especially drug companies, for lower prices ... if the United States were to replace its current complex mix of health insurance systems with standardized, universal coverage, the savings would be so large that we could cover all those currently uninsured, yet end up spending less overall ..."

2/22 USAT "Health spending rises at blistering pace" link "Within a decade $1 out of every $5 spent in the U.S. economy will go for health care, with annual spending consistently growing faster than the overall economy, the federal government said Tuesday. Increased spending on hospital care, home health services, drugs and public health programs will help push total health care spending from its current 16.2% of the economy to 20% in 2015, the Centers for Medicare and Medicaid Services projects. Economists differ on whether that is money well spent ... Rising health care spending can also push more people into the ranks of the uninsured, says economist Paul Ginsburg of the Center for Studying Health System Change. "The more expensive our system becomes the bigger the gap between the health care haves and have-nots," Ginsburg says. And there are few cost-control measures likely to change that trend."

3/10 NYT "Census Report Foresees No Crisis Over Aging Generation's Health" link " The next few decades will see an explosion in the percentage of Americans over the age of 65, but the economic and social impact of this baby boomer sunset may be gentler than had been feared because of a significant drop in the percentage of older people with disabilities, a new federal study has concluded. Released yesterday, the United States Census Bureau's 243-page report on the aging population, among the largest and most comprehensive on the subject that the bureau has ever compiled, showed that today's older Americans are markedly different from previous generations. They are more prosperous, better educated and healthier, and those differences will only accelerate as the first boomers hit retirement age in 2011 ... cautioned that the growing obesity rate in America may neutralize the positive trend."

3/16 WP "Medical Care Lacking but Equal: Blacks, Hispanics Fare Slightly Better Than Whites, Study Finds" link "Blacks and Hispanics tend to receive slightly better day-to-day medical care than whites when they see a doctor, a large and surprising study has found, sparking new debate about the impact of race on health in America. The study, the most comprehensive examination of the quality of primary care in the United States, found no significant differences among patients from different ethnic groups or incomes once they get to see a doctor ... The researchers stressed that other disparities in health care do exist. Poor people and minorities, for example, are less likely to see a doctor in the first place and they receive far less expensive care ... the minor variations among racial groups found in the study are swamped by the low level of care everyone gets, they said ... Other researchers said the findings may be skewed because the study may have missed the poorest people."
3/15 AP "Study: Most Get Mediocre Health Care" link "Overall, patients received only 55 percent of recommended steps for top-quality care — and no group did much better or worse than that ... all health experts interviewed fretted about the uniformly low standard ... Health experts blame the overall poor care on an overburdened, fragmented system that fails to keep close track of patients with an increasing number of multiple conditions."

3/15 Reuters "Happy 150th birthday: a new era looms for old age" link "Modern medicine is redefining old age and may soon allow people to live regularly beyond the current upper limit of 120 years, experts said on Wednesday. It used to be thought there was some inbuilt limit on lifespan, but a group of scientists meeting at Oxford University for a conference on life extension and enhancement dismissed that idea. Paul Hodge, director of the Harvard Generations Policy Program, said governments around the world - struggling with pension crises, graying workforces and rising healthcare costs - had to face up to the challenge now ... Jay Olshansky of the University of Illinois in Chicago is confident that longevity and health will go hand in hand and that delaying aging will translate into later onset for diseases like cancer, Alzheimer's and heart disease. But to get to the bottom of understanding the biology of aging will require a major step-up in investment."

FHPN: I would guess that Krugman's essay will be ridiculed with howls of "socialized medicine," since it strongly runs against the deeply entrenched economic/political "free market" zeitgeist of the elite, who of course have by far the best healthcare. I don't have anything to add or any comments on what Krugman has written at this time, other than to suggest that you read and consider with as little preconceived biases as possible his effort to grapple with a difficult policy area that to date has proven to be intractable.