Why Comparing US and European Health Care is Misleading

Simple reason ... Americans are way too fat! Check out the national obesity statistics here. Americans are 3 times as fat as most European countries.

Government has a role. Removing corn subsidies that ensure high-fructose corn syrup in all our foods would be a good start. (Oh, and it would also reduce starvation in third world countries which struggle to compete on an un-flat agricultural market) Town planners incentivizing more walkable communities will help. More awesome farmers' markets, like the one in my city, will help.

I personally don't even mind a tax on unhealthy foods, although I don't think its implementable.

The Intellectual Dishonesty of the Public Option

President Obama once again pitched for the public option last night and the mainstream media once again cheered. On the face of it, it is easy to be carried away. You can keep your insurance, or you can take the government plan. Sounds innocuous, right?

Wrong! The reality is that a public option is a lose-lose, unless you want a nationalized healthcare system.

For starters, even if the government plan is not subsidized by the taxpayer, it has several key advantages. One is that its cost of capital is much lower than any of its competitors, its debt being backed by the full faith of the US Government. The other is that since it does not have to make a profit, competition will kill returns in the private sector, driving us towards national healthcare.

Will we be able to keep the health plan we like? Absolutely not! Lets focus simply on the issue of those currently being covered by an employer-based health plan. If you are an employer, you can either buy health insurance from a private insurer, or you can pay a tax (if I remember the parts of HR3200 I read, it's in the vicinity of 8% of gross income)

If the government plan is cheaper, most employers will simply abandon providing health coverage and instead pay the tax. But we are not in the clear even if the government plan is more expensive. After all, this means that the clientèle for the government plan will dispropriately be the unemployed, individuals with pre-existing conditions, and other high-risk groups. That would make a government plan unsustainable (after all, the point of insurance is to spread risk, not aggregate the risky) Any bets that politicians would stay true to their word and allow a government plan to fail?

The mainstream media has bought this along traditional lines, and failed to do much analysis. It is easily to be carried away by the brilliance of Obama's oratorical skills, and by the extreme craziness from some on the right. But let's not get carried away - if the public option passes, we're coasting to a socialized medical system!

Are Medicare Administrative Costs Cheaper?

One of the persistent arguments for a government health care plan has been the lower administrative costs associated with Medicare compared with government plans. This has been a contentious issue, with others arguing this is simply not true. Well, is it?

The American Medical Association reports that Medicare administrative costs account to 5.2 percent of public programs versus 14.1 percent of private programs. Aha, we'd all save money if we went to a public program!!

Not so fast, sport! The AMA points out to the unfair comparisons in those estimates. An excerpt:

Perhaps the most obvious shortcoming of many estimates is that they ignore unreported spending on administration of government programs. Such uncounted administrative costs are especially evident in the Medicare program and include:
• Tax collection to fund Medicare—this is analogous to premium collection by private insurers, but whereas premium collection expenses of private insurers are rightly counted as administrative costs, tax collection expenses incurred by employers and the Internal Revenue Service do not appear in the official Medicare or NHE accounting systems, and so are usually overlooked
• Medicare program marketing, outreach and education
• Medicare program customer service
• Medicare program auditing by the Office of the Inspector General
• Medicare program contract negotiation
• Building costs of the Centers for Medicare & Medicaid Services (CMS) dedicated to the Medicare program
• Staff salaries for CMS personnel with Medicare program responsibilities
• Congressional resources exhausted each year on setting Medicare payment rates for services

There are other methodological issues - follow the link above for more.

Securitizing Health Care

As the health care debate rages, we are offered a series of poor choices due to our political system's inability for consensus. On one side is the growing chorus for a government plan. Seriously, have these proponents not been to a DMV? All the government plan will achieve is to exert Wal-Mart style cost pressures that will run private capital out of business. And what makes supporters think the government can manage such a program efficiently? The track record of Medicare is hardly inspiring - the program is likely to be insolvent in the near future!

On the other hand, it is hard to argue with the fact that we have a seriously broken system. One in six Americans is uninsured, in a system where the costs of being uninsured are more dramatic because of inflated prices. Many more are excluded from the system because of pre-existing conditions. And the system does not encourage healthy lifestyle choices or preventative medicine, because of the lack of long-term commitments from the patients in question.

Democrats are living in la-la land, ignoring the cost side of the balance and seeking to run capital out of the industry. Republicans, even worse, seem to think that sticking their fingers in their ears and yelling 'socialism' means that we don't have a problem that needs fixing. What's missing is smart ideas that, like all the good ones, straddle the middle.

So here's an idea to consider - and it's not even that original. For all the criticism of our housing boom, Fannie Mae and Freddie Mac have dramatically changed home ownership in this country by providing coordination. The US government managed to achieve much greater home ownership rates without running the program by supporting these agencies whose role was to buy mortgages, repackage them and sell them to private industry. Before the distortions in recent years, this meant low risk to the government, aggressive competition in private markets and, well, a free-market system that largely worked.

In concept, I can't see why this isn't a valid idea for insurance. You have a pool of, let's say 100 people, 50 of whom might be relatively young workers, 10 of them are over 80, maybe 2 of them have cancer, 15 have diabetes, ... you get the idea. By pooling them, and doing so on a large scale and only government can, you offer the insurance companies the ability to greatly increase market share, but only if they are willing to pick up the unhealthy insurees as well as the healthy ones.

There would have to be some controls to ensure pools stay largely the same (i.e. if you're in Pool A, you are highly likely to stay in Pool A) - this gives insurance companies the incentive to improve your healthcare metrics as a risk mitigation tool.

Just thinking aloud ...

A Secondhand Perspective on a Health Care Crisis

I was at my mechanic today, chatting up with the owner's daughter, only to learn the owner had been hospitalized today for a diabetic condition. Turns out the owner did not have health insurance, as the soaring costs of premiums had resulted in a tab of $2,400 a month for the four employees in the business. Why? Insurance companies do not want to accept customers with pre-existing conditions, and hence such patients are forced to fork over exorbitant premiums to participate in plans will allow them in.

Here is a businessman whose family has run this shop for decades, long enough to qualify to be a historical feature of the city. And yet we have a health care system than endangers the well-being of such a model citizen! For politicians to pretend that there isn't a crisis is disingenous, and while I don't believe in a huge government solution like some, government's got to be part of the solution.

India's Traditional Knowledge Digital Library

I found this story very interesting: tired of American companies applying on patents for indigenous knowledge, the Government of India is building a Traditional Knowledge Digital Library, a giant database of indigenous knowledge from the medical traditions of Ayurveda (in Sanskrit), Siddha (in Tamil) and Unani (in Arabic, Urdu or Persian). This is a phenomenal effort in which some 30 million pages of ancient texts will be converted into digital data.

Socialized Medicine

Just heard a clip of Congressman Ron Paul, presidential candidate, pointing out that the quality of care at Veterans Administration hospitals is what you can expect from government medicine. At a time when people are happy to criticize the VA and yet want more government involvement in healthcare, this helps put things in perspective. Think VA, think DMV, think any of the myriad bureaucracies we deal with - do we really want more of that crap?

Quotes of the Day

I haven't had a lot of time to blog recently, so in a coming-back event, here are not one but multiple quotes of the day, spanning a variety of topics.

Richard Russell, editor of Dow Theory Letters, on January 31, 20007, in what now looks remarkably prescient given today's stock market carnage:

China is in a stock-buying super-frenzy with people mortgaging their homes, taking out loans, doing anything and everything to get in on that wild ride on the Shanghai Exchange. From below 1,000 in June of 2005, the Shanghai Composite has tripled to a current 3,000. The Composite has gone parabolic ... The price of the composite is an astounding 36% above its 40-week moving average. If you're looking for international trouble, you might start looking here. The Shanghai Exchange is on fire, and it's hard to know what to expect next. What would a stock crash in China mean? It would have worldwide implications, and it would be deflationary, particularly for commodities. By the way, the Chinese authorities are now actively warning the populace about over-speculating ("irrational exuberance"?)

Wendy Wright, President of Concerned Women for America, a conservative group that focuses on women's rights, on the Newshour on PBS about the new trend for states to mandate HPV vaccines on kids as young as 11 to eliminate their risk of cervical cancer:

About a little less than 4,000 women a year die from cervical cancer. About 36,000 people a year die from the flu, but we don't mandate that each person get a flu vaccine.

P.J.O'Rourke, author of "On the Weath of Nations" speaking in a must-watch interview with Paul Solman of the Newshour on PBS:

I've never been able to get it straight about what these people who are worried about the trade deficit are worried about. When they say that we're buying too much from overseas, that we're sending too many dollars overseas to get all these goods and services they got, they're saying that the American dollar is too strong and that is hurting our economy. And the result of this will be that the American dollar will get too weak, and that will hurt our economy. Well, make up your mind! What are you worried about? Are you worried that the dollar is too strong? Or are you worried that the dollar is too weak?

Unhappy Meals

You've got to love an essay that starts like this:

Eat food. Not too much. Mostly plants. That, more or less, is the short answer to the supposedly incredibly complicated and confusing question of what we humans should eat in order to be maximally healthy. I hate to give away the game right here at the beginning of a long essay, and I confess that I'm tempted to complicate matters in the interest of keeping things going for a few thousand more words.

What follows is Michael Pollan's brilliant (and humorous) essay in the International Herald Tribune, titled Unhappy Meals. But before you shut your browser and head out to snack on your favorite brand of potato chips, consider this:

And you're much better off eating whole fresh foods than processed food products. That's what I mean by the recommendation to eat "food." Once, food was all you could eat, but today there are lots of other edible foodlike substances in the supermarket. These novel products of food science often come in packages festooned with health claims, which brings me to a related rule of thumb: if you're concerned about your health, you should probably avoid food products that make health claims. Why? Because a health claim on a food product is a good indication that it's not really food, and food is what you want to eat.

In a piece that spans 14 pages, he turns to expose why our nutrition system is quite so confusing, exposing the politics and the economics of making things that way.

It's hard to imagine the low-fat craze taking off as it did if McGovern's original food-based recommendations had stood: eat fewer meat and dairy products. For how do you get from that stark counsel to the idea that another case of Snackwell's is just what the doctor ordered?

And fundamentally points to getting back to food, rather than nutrients in processed foods:

Of course it's also a lot easier to slap a health claim on a box of sugary cereal than on a potato or carrot, with the perverse result that the most healthful foods in the supermarket sit there quietly in the produce section, silent as stroke victims, while a few aisles over, the Cocoa Puffs and Lucky Charms are screaming about their newfound whole-grain goodness.

Here's another classic paragraph on why you should ignore the scientists and focus on what has worked for centuries:

Also, people don't eat nutrients, they eat foods, and foods can behave very differently than the nutrients they contain. Researchers have long believed, based on epidemiological comparisons of different populations, that a diet high in fruits and vegetables confers some protection against cancer. So naturally they ask, What nutrients in those plant foods are responsible for that effect? One hypothesis is that the antioxidants in fresh produce — compounds like beta carotene, lycopene, vitamin E, etc. — are the X factor. It makes good sense: these molecules (which plants produce to protect themselves from the highly reactive oxygen atoms produced in photosynthesis) vanquish the free radicals in our bodies, which can damage DNA and initiate cancers. At least that's how it seems to work in the test tube. Yet as soon as you remove these useful molecules from the context of the whole foods they're found in, as we've done in creating antioxidant supplements, they don't work at all. Indeed, in the case of beta carotene ingested as a supplement, scientists have discovered that it actually increases the risk of certain cancers. Big oops.

My intent is not to present too much of the article, for really it is best read as the author intended, in one piece, but I leave you with one last tidbit:

For reasons of economics, the food industry prefers to tease its myriad processed offerings from a tiny group of plant species, corn and soybeans chief among them. Today, a mere four crops account for two-thirds of the calories humans eat. When you consider that humankind has historically consumed some 80,000 edible species, and that 3,000 of these have been in widespread use, this represents a radical simplification of the food web. Why should this matter? Because humans are omnivores, requiring somewhere between 50 and 100 different chemical compounds and elements to be healthy. It's hard to believe that we can get everything we need from a diet consisting largely of processed corn, soybeans, wheat and rice.

Also, if you don't have the time to read the whole article (shame on you!), at least skip to page 12 to look for Pollan's tips on how to restructure your diet. You will lose a lot, but I guess it's better than losing it all!

Quote of the Day

Stephen Colbert, comedian and host of the Colbert report, on Bush's healthcare proposal to allow tax deductions to encourage greater access to health insurance among the uninsured:

It's simple. Most people who can't afford health insurance also are too poor to owe taxes. But if you give them a deduction from the taxes they don't owe, they can use the money they're not getting back from what they haven't given to buy the healthcare they can't afford.

My Many Cents on the SOTU

So the State of the Union is out, and many have thrown in their opinions on President Bush's performance. Some called it tired, Bob Schieffer thought he'd done a better job than his press conference. So how could someone as opinionated as me not chime in?

I thought Bush didn't do very well, but not just because he appeared deflated. I thought he spent too much time with general cliches and not enough on specifics. Let's start with what he didn't, ...

Iraq

The let-freedom-ring rhetoric is wearing thin. What I thought he should have pointed out, something I heard from an embedded reporter on the Newshour with Jim Lehrer was that the additional troops serve an important function - to date, American troops only patrol hotspots, and the insurgents just wait out the patrols before wrecking havoc. The additional troops would actually help establish bases in the hotspots, a significant function.

To be fair, he did, for the first time, seem to get tough on the Iraqi government, at least verbally, putting them on notice asking them to deliver. I suspect this will not yield much though, since Maliki's butt belongs to the Shiite militias craving Sunni blood, but it's a start. Maliki doesn't want US troops to leave, and we need to start indicating that if he wants to kiss up to Sadr, maybe he'll have to step aside for Sadr when American troops leave.

GRADE: B-

Energy and Climate Change

Bush wants to cut oil consumption by 20% in the next 10 years - fuggadeboutit! Not happening! At present, none of the other technologies will dramatically reduce oil consumption by more than a few percent in the next ten years, as I understand it, and fuel efficiency standards improvements will probably be counterbalanced by greater consumption. Listen, it all comes down to this - now everyone's talking about this issue (don't get me wrong - as a tree-hugger, I love that people are) because of concerns about global warming, but especially because people still remember the high gas prices in the recent past. All the OPEC would need to do is allow low oil prices for a couple of years and people will return to their gas-guzzling ways!

I do think oil will eventually be on the downslide, but not quite yet. The optimists often point to how competitive alternate fuels are (I was in a talk Friday where someone from GE Energy has a similar chart) but these assume record oil prices which are largely driven by speculation. I do think every price spike encourages more money into R&D for alternate fuels, but I think Bush would have done well to detail more specific initiatives to help in the development of alt fuels. For wind power, for example, the greatest deterrant is that most farmers who can build the wind farms are not close enough to the grid to sell their generated power back. Tax and other initiatives in this area would go a lot longer than a wannabe green president.

GRADE: C

Healthcare

I'm with Bush on needing to reform the healthcare system. The tax initiatives are an interesting step, as is his push for Health Savings Accounts. But again, I think his plan to help uninsured is flawed - most of the uninsured pay little by way of income taxes, so tax initiatives are unlikely to spur them to buy insurance. I do think there is a need for a creative solution, and this isn't necessarily it.

GRADE: C

Immigration

Finally a topic where I thought Bush whacked it out of the park. Short but sweet! Securing the borders is nice, but impossible unless we reduce the stress. Allow legal workers and border agents can focus on drug dealers, criminals and terrorists. And by documenting this workers, we can keep track of them. Excellent! I couldn't say much more.

GRADE: A

The Smoking Isotope

Question: what do recently murdered ex-KGB spy Alexander Litvinenko and your favorite serving of Marlboro Lights have in common?

Answer: Poloniom 210.

Turns out that cigarettes contain the deadly radioactive isotope in sufficient quantities that pack and a half smokers get as much radiation as 300 chest X-rays a year! With an estimated 100 million dead from smoking already, now may be the time to put that cigarette away!

Equity in Obesity

While incomes and living standards between rich and poor countries are constantly diverging, the Third World is catching up with the West in one area - obesity. I was shocked to read that obesity is a HUGE issue in Africa. Consider this:

More than one-third of African women and a quarter of African men are estimated to be overweight, and the World Health Organization predicts that will rise to 41 percent and 30 percent respectively in the next 10 years... Some 56 percent of South African women are now either obese or overweight, compared to fewer than 10 percent who are underweight. More than 17 percent of adolescents here are overweight _ for teenage girls, it's 25 percent, according to the Medical Research Council.

Already, diabetes is the fourth largest disease in most developed countries, with an estimated 194 million sufferers. This number is expected to skyrocket as the incidence of diabetes in the developing world increases, as is expected. Just how much is evident when you check out the Diabetes Atlas put out by the Internation Diabetes Foundation. Switch the year from 2003 to 2025, and bam!

Young at Heart

I had a very distressing conversation with one of our janitors today, a wonderful woman whose 26-year old neice just passed because of a heart attack. While all deaths are tragic, the loss of a young single mother in the prime of her life of a disease considered an older-person's disease is truly shocking. So I looked on WebMD to see how common heart attacks among younger people are. The study they cite was quite shocking:

The investigators examined young people aged 15 to 34 who had died in a car accident, homicide, or suicide and found that even in men as young as 15, over 2% of them had advanced cholesterol plaques in the arteries of their heart. More than 20% of men aged 30 to 34 had these advanced plaques. Such plaques can turn into atherosclerosis, or hardening of the arteries. That can lead to complete blockages, heart attacks, and strokes.

They recommend that everyone over 20 check their cholestrol levels every five years. But in the end, for most people, there are the same familiar words: diet, exercise, lifestyle choices. So think about your mom weeping over your hospital bed or casket the next time you decide that fries are a vegetable or switching channels on a remote is exercise!

Fast Food Nation: The Movie

I'm looking forward to the release of the movie version of Eric Schlosser's 'Fast Food Nation '. I loved the book, about the various facets of our fast food chains, from their meat handling practices to their pursuit of a temporary workforce, to what the implications of this culture are on our landscape. I am especially curious about the movie because it's fiction rather than a documentary. The International Herald Tribune gave it a pretty positive review, and I think so did NPR. This movie is currently playing in a theater near you.

Is This Guy for Real?

Every now and then, I like to light up. Not often, but about once in a while or so, sometimes when I am super-stressed and haven't been able to make it to the gym, a cigarette really calms me down. A cigarette a month aint that bad, right? But the new Surgeon General begs to differ. I was shocked by just how toxic he suggested cigarette smoke, even second hand smoke, was, pointing to research that suggested cellular and arterial changes within seconds of exposure! You can watch his interview with Jim Lehrer here. I confess I find it a little hard to believe that exposure to such minor amounts of smoke can affect you if it's not on a consistent basis (I know I'm not a doctor, just a biased consumer!)

Nutritional Biohazards

One of the websites I visit every day is Men's Health. Yes, it's filled with advice I would never follow, often of a morally questionable nature or that requires you to spend such an incredible amount of time grooming yourself that you might as well be gay! But it's fitness and nutritional information is top-notch, and a daily visit gives me several new ideas to live my life.

Here's one y'all (men and otherwise) could use - four nutritional biohazards. They are:

High Fructose Corn Syrup

Trans Fats

Saturated Fats

Refined Carbs

Do be aware of some caveats, of course. For example, peanut butter is rich in saturated fats, but the good kind (rich in omega-3). But even in peanut butter, there is considerable nutritional variety between brands, and the generic brands are sometimes better. My preferred brand is Kroger, which does not have the crappy partially hydrogenated oils that Jif and some other brands have.

So live healthy and enjoy your life!

Forget the Sugar-Free

I've been too busy recently to blog, but thought I'd squeeze the time this morning to share with health article. I've sort of known how bad flour was before, but figured not many other people don't. But when I read this article from Dr Gabe Mirkin, even I was shocked to learn that white flour makes your blood sugar rise almost as much as table sugar. So he argues that there is no point buying sugar-free desserts loaded in white flour. I'm not white flour free - I still devour the cheap pasta from Sam's Club, but I use a lot of broccoli and cauliflower and blackeyed peas or chickpeas in my pasta sauce to add fiber and slow the rise of blood sugar. There are still probably some nutrients lost in the flour making process, but until Whole Foods can come out with a cheaper version of their whole grain pastas, this will have to do. I do eat whole wheat bread and brown rice already. You can buy the latter by the pound at Whole Foods - I recommend a 50-50 mix of long and short grain brown rices and using a 1:3 mix of rice and water if you use a rice cooker.

The Case for Breakfast

Men's Health magazine had eating breakfast as part of their 12-week physical transformation program, and had this to say about the importance of the meal:

University of Massachusetts researchers recently discovered that men who don't eat in the a.m. are 4.5 times more likely to be obese than those who make it an everyday habit...And timing matters: Make sure you eat your first meal within an hour and a half of waking. The scientists found that guys who waited longer than that increased the likelihood they'd become heavyweights by 50 percent.

And may I recommend the Boca burger and a bowl of Raisin Bran cereal - they are low in fat, loaded in fiber and the former has a fair amount of protein - potent combo!

Perspectives on Health Care Costs

Now, I'm a huge fan of the Newshour with Jim Lehrer on PBS, as you may have realized from the fact that I have it listed on my favorite sites tab on the right part of this page. Unlike the usual soundbite junk you find on the other network news, here you get true analysis from the experts. (I did like Peter Jennings, but have stopped watching all the major commercial networks' nightly news broadcasts after he left)

With that plug, on to this discussion Margaret Warner had with Susan Dentzer on health care costs in America. I found myself learning several things I didn't know from watching this segment. Some tidbits ...

Overall health spending in the US doubled from 1993 to 2004.

In 2004, total health spending accounted for 16% of GDP!

New drugs are one of the big cost drivers. A cancer drug like Urbatux extends life for colon cancer patients by at least a few months but it costs $100,000 a year.

Considering that the average child growing up today has a 50% chance of diabetes, not to mention other obesity and lifestyle-related ailments, the future health costs are scary! (For more on this statistic, check out my post on Frontline's diet wars)

The $1.9 trillion spent on health care represents $6,000 per person (children included). That's 50% more than the next biggest spender, Switzerland. And yet, a National Health Quality report analyzes 44 measures of health quality and says that the quality of healthcare is actually deterioting!

We now have 46 million uninsured in the US.

These are really startling revelations, and are only the tip of the iceberg. Some will see the last bullet and proclaim support for a national health insurance plan. And yet even the current Medicare plan is infeasible, and unless dramatic cuts are made, could seriously endanger US economic prosperity. (All that talk of Social Security privatization, and sane minds were pointing that a Medicare crisis was much more immediate!)