Thursday, November 4, 2010

Health Care: Some Background Reading

I was intending to do a post on health care today but no longer seem to have the time.  I came across a great link on Free Exchange though so I thought I'd recommend a couple of posts from the Incidental Economist blog as background reading before I get into my own take on the issues.  The first series is on cost, the second on quality.  Both show the US doing poorly on most measures.

On the cost piece, I think underspending on home health care services is likely at least a partial contributor to higher costs elsewhere.  Overall, I found the administration, red herrings, and underspending sections most interesting but I'd certainly recommend reading them all.

Starting this weekend I'll begin with a few posts trying to untangle what the problems with how we look at health care are and at how to fix this.  I've been wanting to do some graph with longer run numbers but I'm not sure I've got the time to commit, these may or may not appear.  I'd like something stretching back to before US health care costs diverge, which was before the 90s.  If someone knows of an existing blog, or other data source that already does this I'd love to hear about it.


  1. I can fully believe that the US does not deliver the highest level of care BECAUSE of the high cost. Drugs, treatments and invasive tests are over-prescribed, which leads to worse outcomes.
    For example and this is only one because it is most recent, I went to the emergency room for broken nose. I was disoriented and had some amnesia. I told the nurse taking care of me not to give me promethezine because of a sensitivity, but I forgot to tell the person who admitted me. I also told them I wasn't having a lot of pain and didn't need anything. She gave me pain meds and Fenergan (promethezine) anyway. This gave me tardive akathisia, a very serious neurological disorder, and now I'm having to take 3 different meds to control it and see a specialist regularly until it goes away. In an elderly or pediatric patient such a medical error could have caused permanent damage. The nurse gave me those drugs just because that's what they always do even though I said I didn't need them.
    But I've found that the attitude to treat first and ask questions later is very rampant in our medical system and lowers the over all level of care.

  2. The US system is insane in that way. Our doctors don't seem to be trained to make cost/benefit analyses. They're solely focused on doing the most treatment possible, even when the marginal benefit is low. I like to contrast this with Canada, where whenever health care did require some out of pocket expense doctors were always very careful to go over options. Of course, this is largely a cultural issue and difficult to change. The fact that more payment is given with more treatment of course doesn't help.

    What I do think is notable though, is that most of those arguing for the benefits of the free market over government regulations are ultimately making a cultural argument. To paraphrase a number of different arguments I hear rather frequently that the free market will make people more aware of costs and more likely to think of trade offs. In actual practice, my experience has been the opposite. While this remains anecdotal evidence, I think there are a lot of reasons to doubt that a number of the cultural benefits attributable to free markets actually exist. Looking at health care, I think there are other factors leading to these outcomes.