Comments on FiveThirtyEight: Politics Done Right: Is it "Schlocky" to Compare Life Expectancies Betw...

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2009-10-10T08:20:47.980-04:00

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I forgot about the Tarters. There was no slight in...

2009-06-24T16:55:20.145-04:00

I forgot about the Tarters. There was no slight intended. (What made me think about that was a film with Charles Bronson in it.) You see the Polish Republic was so diverse it was hard to keep track of all our minorities.

@Jacob, I hadn't noticed Santo Turdo's comment. Th...

2009-06-22T22:27:00.861-04:00

@Jacob,
I hadn't noticed Santo Turdo's comment. Thanks. As one who is half Scottish (and consequently part Norman and Norwegian) and half Polish (and consequently part Lithuanian) it is something of an irony. Yes Poland was once a very diverse Republic (Poles, Jews, Germans, Lithuanians, Latvians, Estonians, Belarus, Ukrainians, Ruthenians, Maldovans, Gypsies etc. etc. etc.), almost as diverse as the British Empire, before the Nazis arrived. She is now much more homogeneous and has lost some of her character. But it wasn't really her fault.

@SantoTurdo I would appreciate your not labeling ...

2009-06-22T14:04:53.892-04:00

@SantoTurdo

I would appreciate your not labeling Poland a backwater. Kindly move your ignorance further to the East.

You are correct about racial diversity. Today. But Poland had substantial racial diversity, and then came along this little thing called the Holocaust...

My wife's a primary care physician. Time she spend...

2009-06-22T13:02:14.762-04:00

My wife's a primary care physician. Time she spends working with patients on how to reduce obesity and other "life-style indicators" doesn't get reimbursed in our system. Procedures to treat the expensive consequences of obesity do, in a big way. So obesity is not a background condition, a given you need to take into account before assessing the efficacy of U.S. health care. Our system doesn't work effectively to fight obesity, or substance dependencies, lack of exercise, and so on, and so forth.

Nice argument Nosimpleway, Primatologists have ob...

2009-06-22T10:36:13.179-04:00

Nice argument Nosimpleway,

Primatologists have observed plenty of examples of primates showing sympathy and caring so I don't think this behavior is uniquely human. Nevertheless, taking care of the sick and injured is certainly a good sign of a well balanced person or society.

But we are talking about moving from the feeling of empathy for another's suffering into responsibility to provide help. The codification of this obligation is the granting of a civil right.

Natural rights are those principally of liberty. It is the very agreement to cede many of our liberties that distinguish a moral and civil society from a brutish chaos.

The USA frequently struggles to find the balance between liberty and respect for moral peaceful civil rights. This discussion is really about the rights of insurers, pharmaceutical companies and health providers to generate as much profit as they freely wish, with an agreed moral responsibility to care for the sick and injured, and to do so in an affordable and comprehensive manner.

I would also argue that we humans have a collective responsibility to afford natural rights to animals, particularly when we are in danger of causing an extinction. Humans are currently racing towards responsibility for the greatest mass extinction since the dinosaurs were wiped out. It will notably be the first mass extinction on this planet propagated by a life form. That this life form is sentient and considers itself moral is a grand tragic irony.

@Stan I would argue that healthcare is more of a ...

2009-06-22T08:52:10.161-04:00

@Stan

I would argue that healthcare is more of a universal, natural right than most of the statutory rights we have in this country.

Let's posit Bob, he's of any culture you can find: Maori, Belgian, Apache, New England Yankee, Puelche, Maasai, Tuareg, Druze, Kazhak, Bonan, Tofolar, whatever. Now faced with several situations which one is he most likely to feel a deep, intuitive knowledge that he must help an individual. In other words, in which situation is Bob most likely to recognize a Natural Right.

1. A political dissident is arguing against a leader Bob strongly supports. The leader's supporters want to stifle the agitator. Bob has the opportunity to protect the agitator, who is calling for peaceful disruption of services and a complete change of government. Should he support the dissident's right to speak and allow the overthrow of his own group?

2. A guy is walking down the street carrying a loaded assault rifle. A police officer says, "put that gun away. It's dangerous." Bob has the opportunity to tell the cop to butt out. Should he assist the gunman?

3. Bob's nation has been invaded by a foreign power and has fallen into a state of near anarchy, with bombing raids and gun battles in the streets. A local barracks has been destroyed in the fighting and ten soldiers need a place to stay, but Bob is worried about the men being in the same house as his beautiful teenage daughters. Should he say no?

4. Bob's neighbor is suspected of producing child porn (aged 3-5) in his basement, but there's no real evidence, just strong suspicion and gossip. The police decide to search the house. Should Bob intercede and prevent the cops from doing so?

5. Bob's car is stolen and Bob absolutely knows in his gut who did it. The man is brought to trial, but found not guilty of car theft due to lack of real evidence. The prosecutor, a friend of Bob's, offers to arrange for a new trial, so they have another chance to convict the man. Maybe this time, they'll get lucky. Should Bob agree?

6. Bob is hiking in the countryside one day and sees a little girl by the side of the road. She has fallen off her bicycle and seriously scraped her knee. It's bleeding freely, beginning to swell, and the girl is having difficulty walking. Bob has a basic first aid kit in his backpack, and some very basic first aid training. (He learned from his new son-in-law, an army medic.) Should he stop to help her, or just figure that if she and her family didn't make preparations for such an eventuality it's their problem and continue hiking?

While the first five illustrate rights we currently have in this country under the Constitution, the last one is the most natural, intuitive right.

Many cultures are willing to stifle dissent, or use frontier justice or give civil authorities strong-arm powers, but does any society, anywhere, believe that refusing help to the sick, aged or injured who can be helped is a good thing? One of the ways anthropologists gauge the degree of "human-ness" among our early ancestors is by finding remains that show someone survived for years after having an injury or disease that caused disability. In some ways, it is taking care of the sick and injured that defines us as human.

Is there a more natural right?

I've lived 13 years in the US and 18 years in Cana...

2009-06-22T05:07:41.354-04:00

I've lived 13 years in the US and 18 years in Canada. I currently have terrific private US health insurance through my work (no copays, lots of choices in health coverage, even drugs are free). There is no doubt in my mind that if I could choose between the status quo in the US versus the status quo in Canada for health care it is a no brainer - sign me up for the Canadian system.

Tying health care coverage to an employer in our age of turnover and layoffs is beyond stupid. Having private individuals who make more profits from denying you coverage is far far scarier than any "government bureaucrat".

One reason I was skeptical about Obama in the democratic primaries instead of Edwards or Hillary is because I don't think he'll really deliver on some of these popular "liberal" positions. End the waste the multiple insurance paperwork causes and go single payer!

+The health habits of the population are not an ex...

2009-06-22T03:08:05.261-04:00

+The health habits of the population are not an externality; they are a measure of the quality of healthcare delivery+
I agree, Skeptical1. Yet, will our healthcare system close down McDonalds, whether or not its universal coverage for insurance? Will anyone let "socialized medicine" take away our guns or the cars we drive two blocks to the store? How about restoring PE to our back-to-basics school curricula? Not even there can our healthcare system make any headway. So I don't blame it for that.

Complexity in all things. Socialized medicine enc...

2009-06-22T02:17:45.298-04:00

Complexity in all things. Socialized medicine encourages early intervention and preventative measures. People go to the doctor before they get deathly ill, which can help prevent some of the more serious illnesses for which survival rates are compared.

But also, governments which pay for socialized medicine engage in some social engineering practices to try to increase overall health. Canada provides tax credits for registering kids in sports programs. Employer-supplied bikes are a non-taxable benefit in the Netherlands.

End result...if survival rates are higher in the US, but life expectancy is lower, there must be a reason why disease incidence is so much higher. Some of these reasons do tie back to the lack of socialized medicine, so you need to factor that in when making the comparison.

D.W. The US does not need to reinvent the wheel. ...

2009-06-22T01:16:48.202-04:00

D.W.

The US does not need to reinvent the wheel. Just copy a pretty good template, pick the system in one of half a dozen countries.

I'm Canadian, I have a government issued health card - like a credit card with an unlimited balance, for which I do not get the bill. It is good for any doctor, clinic or hospital of my choice. There are no co-pays or deductibles. Very simple and stress free. It sounds insanely expensive, yet this socialized system on a per capita basis costs the Canadian taxpayer half of what Americans pay for their health care.

No Canadian families go bankrupt through health costs. No Canadian worries about loosing coverage if they loose their job or contemplate quitting to start up a business. Small businesses do not have to shoulder escalating premiums. Canadians don't go through the stress of bickering with an insurer for coverage or permission to seek treatment. Thats a whole mess of stress collectively lifted off our society.

The challenge for the USA is not to recognize what a good smooth running health care wheel looks like, the challenge is to stand up to the vested interests and put patient care above profits.

D. W. said... . . . mandate (i.e., require) high-d...

2009-06-21T23:57:13.470-04:00

D. W. said...
. . . mandate (i.e., require) high-deductible health care insurance for all residents of the United States,

Ah yes. That is a formula that will work for

oh

maybe

about 25% to 50% of the population.

And that solution says to hell with the rest of the people. To hell with the young worker who has no savings. To hell to the wife now divorced because the husband wanted to chase the new young thing in the office. To hell to the young parents, who through no fault of their own, their baby was born premature, and needs hundreds of thousands in medical care to have any opportunity to live.

Is that actually your best idea, D.W.?

Do you know how much medical care costs for something as simple as an appendectomy? A broken bone? Both happen at a very disproportionate rate to pre-teen and teenagers.

Not to mention something as costly as cancer, or heart disease, or an auto accident?

I think you need to go back to the drawing board and rethink your entire philosophy.

Mike in Maryland

My Blogger ID is http://www.blogger.com/profile/02848893412251095965

I think there are some things that we can do to im...

2009-06-21T23:27:44.928-04:00

I think there are some things that we can do to improve health care in this country without turning to a completely centralized national health care system-- namely, mandate (i.e., require) high-deductible health care insurance for all residents of the United States, and provide preventive care and certain routine procedures for free. It's a strong step in the direction of nationalized health care, maybe in a more American sense. I just blogged about this on my own site: www.approximatingpoliticaltruth.com. Check it out if you want to read a bit more about it--I don't want to take up a bunch of comment space here!

Rudy said... blah, blah, blah Rudy? Got any sta...

2009-06-21T22:48:03.806-04:00

Rudy said...
blah, blah, blah

Rudy?

Got any statistics or authoritative sites to back up those Lush Rimbaugh talking points?

Mike in Maryland

My Blogger ID is http://www.blogger.com/profile/02848893412251095965

The main problem with thinking the US can emulate ...

2009-06-21T22:21:29.113-04:00

The main problem with thinking the US can emulate one of these other health care systems is that they have all been effectively subsidized by the US for many years, both in technology and drugs.

Few new drugs or innovative technologies could have been developed over the last forty years if US reimbursement was similar to the price controls in any of these other countries.

US health policy tacitly has acknowledged that subsidization of medical progress for our citizens and the world. There is no one to subsidize the US.

People are conflating the overall health of people...

2009-06-21T22:15:17.196-04:00

People are conflating the overall health of people in a country with the effectiveness of the health CARE SYSTEM. an overweight populace that eats unhealthy diets, does not exercise, smokes, etc would need an extraordinary advantage in its health care system to compensate and end up with overall health metrics similar to a country going against less headwind. The debate is changes in the health care system, not in healthy lifestyles.

I would find greater focus on healthy behavior to be an exciting option if there were evidence that spending on education and health promotion worked. Does anyone know whether it does? I find it hard to believe there are people in the US who do not know that MacDonalds is not a place for healthy food, that they need daily exercise, that they should not smoke. Would spending massive amounts on educating the last 5 people who don't know this accomplish anything?

We should have health care for everyone. Whether the government should run the system is a separate question.

Here is a question. Let's say that under a new system you have better preventative care, and let's assume that it really works, people are healthier, get their cancer and heart disease later, fewer car crashes from drunk drivers, etc. Recall that most health care costs are consumed in the last 6 months of life. Recall that everyone dies eventually, and that there is no reason to think that preventative care will significantly reduce the number of people who get cancer, and if it reduced the number who got severe heart disease, then these people would continue to get fatal illnesses of some kind. So... you invest trillions in preventative care. Everyone still dies, and, with universal coverage, a larger proportion of them get expensive end of life care. After all that you have satisfied a moral imperative by providing care to everyone. But have you actually reduced costs?

Well Stan, we are not discussing an intrinsic natu...

2009-06-21T21:02:44.155-04:00

Well Stan, we are not discussing an intrinsic natural human right to health care, we are discussing a civil right. This is a right bestowed on citizens by the choice of the nation. Most modern democracies have made the decision to bestow the right to comprehensive affordable healthcare. The USA stands alone among the wealthy democracies for a refusal to take this step.

Ironically, despite the consequent suffering that many less fortunate American citizens will suffer, the cost to the country overall is much greater than the cost bourn by the countries who have concluded that a caring civilized society grants the right to health care to all of its' citizens.

It is also ironic that the first proponent of the civil right to health care was Thomas Jefferson.

Stan, Actually I think this is pretty simple. If w...

2009-06-21T20:32:20.533-04:00

Stan,
Actually I think this is pretty simple. If we choose a single metric, say performance per cost then we have two dueling criteria. Life expectancy per cost or cancer survival rate per cost (because presumably cancer survival rates affect life expectancy more than most other health treatments). By the life expectancy criteria, Japan takes the crown. By survival rate per cost criteria, Cuba takes the crown. Both of these healthcare systems are universal.

I apologize that I haven't read all 79 - or whatev...

2009-06-21T20:20:47.900-04:00

I apologize that I haven't read all 79 - or whatever - comments, so I may be plowing old ground here. But first, the infant mortality statistics, the favorite statistic of the America-does-everything-worse-than-everyone-else crowd, is 100% fraudulent. The only reason our infant mortality numbers are bad is that many babies born with potentially mortal defects are classified as live births in the U.S., and they try to save them; whereas in Europe and Canada many of those babies would be classified as stillborn. The correct statistic to use is stillbirths PLUS infant deaths. The last time I knew of the numbers (which was admittedly a bunch of years ago), the U.S. was the best in the world in that statistic.

Secondly, on the original topic, many commenters have done a much better job than either Nate or Mankiw (against whom Nate seems to have some kind of inexplicable personal grudge) of expressing the need for adjusting and normalizing the statistics for things like age and ethnicity (among other things)if we're going to use either life expectancy OR survival from various diseases as benchmarks to compare health systems.

Third - the person or people who keep braying that health care is a "right" really need to bow out of the discussion. No one who has the slightest clue what the word "right" means will ever utter such nonsense - and I exempt no one from that assertion.

Fourth and last, we are talking in circles when we jump from the issue of the quality of health care to the COST of health care and then back again - UNLESS we acknowledge the unpleasant necessity of placing dollar values on years of life saved, years of pain alleviated, etc. No one seems to be willing to do that because it seems so calloused. Despite the histrionic proclamations of some, however, NO ONE believes that a human life is more important than any number of dollars. If we truly believed that, then ALL of our economic resources would go toward health care, health research, and producing the basic necessities of life, like food and shelter. We wouldn't be spending any money on museums, parks, music, jewelry, or sports - not to mention sex and drugs.

Isn't Mankiw's point analagous to the ceo of a com...

2009-06-21T18:06:01.922-04:00

Isn't Mankiw's point analagous to the ceo of a company stating that his company's profit margins are below it industry competitors and its return on capital is far below its industry competitors but they are tops in managing their travel and entertainment expenses?

Mankiw was part of a team who policies gave us our present economic situation. They crashed the hedge fund. Even a broken clock is right twice a day, but I would not pay too much heed to this person's view. The policies they espouse didn't work. If you own an NFL team, do you hire Matt Millen as GM?

Slow newsday . . . Iran in revolt . . . same film ...

2009-06-21T17:21:42.639-04:00

Slow newsday . . . Iran in revolt . . . same film at 11 . . . .

News that's not news anymore:

Two American military die in Afghan rocket raid

http://tinyurl.com/lees94

Keith Olbermann was said to have no comment.

petekent01 (on twitter)

The real issue, it seems to me with Mankiw's argum...

2009-06-21T16:31:07.372-04:00

The real issue, it seems to me with Mankiw's argument is to do with his logic. The real firebell that this rings with me is the right are about to come at healthcare with flawed logic. They will essentially go at the wheeny bits of argument from the left that maybe don't ascan, like Mankiw does here, and assume that knocks down the argument over healthcare. (Ie You are wrong that life expectancy is an important comparitive measure, therefore you are wrong about the need for healthcare.) IMHO the left as a whole needs to stay out of these arguments. Stick on the main issue- that its stupifyingly immoral that the richest nation in the world has no universal system of healthcare. To me thats the issue. That in the USA the current healthcare system works for the wealthy, but not the poor. I guess thats why life expectancy might be important in the issue, but to me its being forced down into the minutiae of details rather than the big picture, which is what is important in the healthcare debate.

I've been doing a little research. The US spent ab...

2009-06-21T16:30:47.833-04:00

I've been doing a little research. The US spent about $7500 on healthcare per person in 2008. Cuba spent about $570 per person in PPP terms. And yet by Becker's metric (higher cancer survival rates) they have a better healthcare system. Perhaps the solution to our current economic crisis is dramatic health care reform using Cuba as a model.

From the perspective of a patient, no rational per...

2009-06-21T16:06:16.563-04:00

From the perspective of a patient, no rational person would select the current US health care system over a single payer public system.

Comprehensive health care for all citizens should be considered a basic right in a modern democracy.

No objective analysis of the myriad metrics, of health outcomes, of longevity, of infant mortality, of financial ruin, or of pain and suffering - not one metric supports the current US system.

From the perspective of a strong financial model - profit for health insurers, medical clinics and many doctors - the current fee for service system has no equal!

The simple question, does America wish to reverse this financial model and place the patient at the center of heath care focus? To do so will both reduce cost and increase health outcomes.

Nate is absolutely right that you can control for ...

2009-06-21T15:38:20.073-04:00

Nate is absolutely right that you can control for a lot in statistics and ultimately should be able to design a model that will predict if socialized care is a positive or negative contributor to domestic health care and societal well-being, longevity being one indicia.

I think to ask the question is to answer it and that we should proceed with a great deal of caution especially at this time when we are nearly broke and our credit rating as a nation is under assault and the number of unemployed is climbing and looking to remain steadily so as we collectively march into the Obama era of slow but “correct” growth economics. Who can say where his “command and control” will lead us? What are lists scientific underpinnings?

Some debate is in order here.

Obama’s promise of slow, measured safe growth will grow stale and sound discordant to a working class populace that is insecure about its work.

The Promise of Slow Growth” There's an election slogan, but I digress.

Mr. Big Ideas Obama is not content with trying to fix the existing broken entitlement programs, be wants to create a few more. Adding trillions to the budget like it were no big deal.

Medicaid and Medicare are seriously underfunded and while cited (esp MCare) as successful socialized medicine, they depend on private sector subsidization and not just from extensive tax revenues but from market dislocations that shift costs on the non-government patient, which is most of us.

There's populism for you!

The real scandal of course is that Medicare reimbursement is so low that the private system is called upon to subsidized it and the even worse funded Medicaid. The problem with the cost of healthcare today is not the uninsured, but the cost of the Federally insured. Eventually the private systems will collapse as unable to compete against the poor paying government plans (who will also losing many willing providers, those who practices cannot afford them to take the loss on the federal patients).

Fewer and fewer patients will be able to find providers will to accept their business.

The private insurance companies will be forced into the business of offering supplementary coverage (for that which the government will not pay). It will be a booming business!

The outcome it seems is that we wind up on some sort of Medicaid style universal coverage where there is theoretical coverage for all conditions/disease states, but the range of choice and the availability of providers is limited.

For the 2/3rds of Americans who are satisfied with their coverage today (including many of the uninsured) along with the tens of millions who work or invest in the medical industry, we have a lot at stake and hope the government gets it right.

Please report, so we can decide.

petekent01 (on twitter)