Scott Adams Blog: My Views on the Dilbert Survey of Economists

As a general rule, I find this argument to be a good approach on a lot of issues. However, I have to disagree with you on this issue because I think there are fundamental reasons why it's impossible for us to copy the health care systems that "work" elsewhere. I'm going to assume that you are talking about the socialized systems that exist in Europe in my argument below.

Having just lived for a year in England, I had a chance to learn a bit about how the NHS (the UK National Health Services) system works. Everyone receives cheap and reasonable health care through the NHS, but the system is always short on funds and looking for good ways to cut costs. Medical care is inherently expensive and even the more socialist governments can't throw unlimited amounts of money at it. Since the NHS is legally required to pay for any approved medical treatment that a doctor deems necessary, they stand to lose a lot of money whenever a brand new and expensive drug/treatment is invented. Thus, they've identified a convenient loophole to the problem: don't approve any medical treatment as "safe" until the patent runs out and a generic brand is available. The consequence for Europeans is that they may not have access to the latest/greatest new medical treatments and are always a few years behind, but they still get good cheap health care that's guaranteed.

The problem, though, is that their system depends entirely on the US. The pharmaceutical industry in Europe is basically dead because there is no longer a market to sell new products. There's plenty of good basic research still done at universities, but no new drugs ever come out of universities directly. University researchers are concerned with scientific research, not fulfilling legal requirements for getting drugs approved and making a profit. There are still big European drug companies out there that invent new drugs all the time, but their entire business models are based on the profits they expect to earn selling new drugs to Americans overseas. Overall, the medical industry worldwide continues to invent new drugs/medical devices and improve our overall lifespan and standard of living, but only because Americans are willing to pay for it.

By now you probably know where I'm going with this. The only way we can successfully copy the European system is if we could find some large external market that's willing to keep paying the huge costs for new, patented drugs. We are that large external market for Europe and no other large market exists. If we copy their system, all these drug companies (both American and European) are either going to go bankrupt or they're going to just manufacture drugs they've already invented. This means nor more medical advances, no new medical technologies, and the same health care available to us when we're 30 as when we're 80. It's not worth it.

Scott Adams Blog: My Views on the Dilbert Survey of Economists 09/17/2008

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Dean Ornish says your genes are not your fate | Video on TED.com

Dean Ornish shares new research that shows how adopting healthy lifestyle habits can affect a person at a genetic level. For instance, he says, when you live healthier, eat better, exercise, and love more, your brain cells actually increase.

Dean Ornish says your genes are not your fate | Video on TED.com

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Cancer's Cruel Economics

There are two cancer risk factors about which scientists have no doubt: tobacco and age. Smoking dramatically increases the risk of cancer--90% of all lung cancers cases can be linked to smoking. Eliminate cigarettes and cancer deaths would drop by a third. Not much can be done about age, however. Our cells constantly replicate themselves throughout our lives. As they do so, tiny genetic mistakes are made. Live long enough, and these mutations accumulate until they ignite uncontrolled tumor growth. The reason cancer is expected to become the nation's biggest killer in the next decade is becuase the population is aging, thanks to the baby boomers. Also, so much progress has been made against heart disease, currently the biggest killer, that we are living longer.Hopefully more progress will be made in deciphering cancer over the next decade, and new drugs will result that can change the outlook to the point where, we can live with cancer, not die from it. In the meantime, the best way to reduce risk is to quite smoking (or don't start), lose weight, and go for regular screening.

BusinessWeek

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Health insurer's letter seeks to get coverage canceled - San Jose Mercury News

Citing an effort to hold down costs, health insurance giant Blue Cross wants doctors in California to report conditions it could use to cancel new patients' medical coverage, it was reported Tuesday.

The state's largest for-profit health insurer is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," the Los Angeles Times reported on its Web site.

"Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately," according to the letter obtained by the newspaper.

One of the conditions noted in the letter that could force a new patient to be dropped by Blue Cross—pre-existing pregnancies.

WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, said it was sending out the letters in an effort to keep costs at a minimum.

"Enrolling an applicant who did not disclose their true condition (and the condition is chronic or acute), will quickly drive increased utilization of services, which drives up costs for all members," WellPoint spokeswoman Shannon Troughton said in an e-mail to the newspaper.

Health insurer's letter seeks to get coverage canceled - San Jose Mercury News

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Health Care, Health Industry, etc

http://googleblog.blogspot.com/2008/02/google-health-first-look.html

U.S. Health Care Spending to Double by 2017, Report Predicts
http://www.washingtonpost.com/wp-dyn/content/article/2008/02/26/AR2008022601380.html

Shortage of surgeons pinches U.S. hospitals
http://www.usatoday.com/news/health/2008-02-26-doctor-shortage_N.htm

Health care information matters
http://googleblog.blogspot.com/2006/11/health-care-information-matters.html

Putting health into the patient's hands
http://googleblog.blogspot.com/2007/05/putting-health-into-patients-hands.html

http://adambosworth.net/2007/11/26/health-and-the-aspen-institute/

Adam Bosworth left google. I wonder why.

OpenMRS

Health insurer's letter seeks to get coverage canceled

Citing an effort to hold down costs, health insurance giant Blue Cross wants doctors in California to report conditions it could use to cancel new patients' medical coverage, it was reported Tuesday.The state's largest for-profit health insurer is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," the Los Angeles Times reported on its Web site."Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately," according to the letter obtained by the newspaper.One of the conditions noted in the letter that could force a new patient to be dropped by Blue Cross—pre-existing pregnancies.WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, said it was sending out the letters in an effort to keep costs at a minimum.

San Jose Mercury News - Health insurer's letter seeks to get coverage canceled

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To avoid the Big C, stay small

EVERY day there are new stories in the tabloids about the latest link, sometimes tenuous, sometimes contradictory, between cancer and some aspect of lifestyle. If this is a recipe for confusion, then the antidote is probably a weighty new tome from the World Cancer Research Fund (WCRF). It is the most rigorous study so far on the links between food, physical activity and cancer—and sets out the important sources of risk.

Given the rising costs of dealing with cancer alone—in America this is more than $100 billion a year—prevention and early detection look set to take off.

http://www.dietandcancerreport.org/

Alternative Medicine: Homeopathy, Acupuncture, etc

Something few people seem to recognize is there are two separable elements to most of homeopathy. The first is the treatment itself, and the second is the explanation for how it works. For whatever reason people aren't satisfied to know that something works, they also need to know why it works. And unfortunately if there isn't a self-evident explanation one will be invented. And it doesn't end there, the invented rationale is then usually extended to develop other treatments (which don't work of course because what they are based on isn't true).

Take acupuncture. Twirling small needles in the top layer of the skin has a variety of benefits. But why? Traditions tell the story that it balances the energy flows, etc etc. A recent study examined three groups, one with no acupuncture, one with acupuncture in the traditionally prescribed locations, and one with acupuncture in random locations. Both of the latter two groups were better than the first (no treatment), but interestingly they weren't different from each other.

So yes acupuncture has some effect, but the traditional explanation has nothing to do with why it works.

Arstechnica article

James Randi

QuackWatch.org

US Employer Health Premiums Up 6.1 Per Cent

Employer sponsored health insurance premiums in the US went up on average by 6.1 per cent in 2007 compared to 2006, outstripping workers' pay (rose by 3.7 per cent on average) and overall inflation (up by 2.6 per cent).

These are the key findings of the 2007 Employer Health Benefits Survey announced this week by the Kaiser Family Foundation and Health Research and Educational Trust. A version of the report is published in the September/October issue of the journal Health Affairs.

The average health insurance premium for a family now amounts to 12,106 dollars a year, with workers on average paying 3,281 dollars.

Dr Drew E Altman, President and CEO of Kaiser said while there was evidence of some "moderation" in the increases (this latest figure is an eight year low in the rate of increase) there was still no cause to celebrate:

"Every year health insurance becomes less affordable for families and businesses. Over the past six years, the amount families pay out of pocket for their share of premiums has increased by about 1,500 dollars."

The morality of health care finance

As a class, are the old and sick needier than the young and healthy? No they are not. They have more assets and less poverty than any other group.

As a class, are the old and sick unluckier than the young and healthy? Considering people as beings with duration in both time and space, no they are not. The overwhelming majority of old and sick people were once young and healthy. They got to be young and healthy, and old and sick.

As a class, are the young and healthy more responsible for the bad health of the old and sick? Quite the reverse. Many people in the old and sick category did nothing at all to deserve their fate; they just aged or were victims of fate. But some members of the "old and sick" class contributed to their fate. Contra many of my interlocutors, there are a lot of very expensive diseases that have a substantial lifestyle component: high blood pressure, coronary artery disease, diabetes, lung cancer, emphysema/COPD, congestive heart failure . . . many of our nation's biggest killers, and consumers of health care dollars. So as a class, the old and sick are somewhat responsible for their poor healthcare outcomes, although I will leave it up to the doctors to argue exactly how much responsibility they bear.

The Drug Advertising Debate

Since 1997, when the FDA relaxed the rules on Big Pharma's television marketing, drug advertising surged to $5.3 billion in 2006, up 14% from 2005, according to TNS Media Intelligence. Ad spending in the pharma sector grew faster than that of any other industry among the top 10 spenders, including autos and telecom. And the three most heavily advertised drugs—Lunesta and Ambien CR for sleep, Cymbalta for depression—were approved just in the past three years.

Global Health : An introductory textbook, 2006

Is it possible to write a book on the health of all 6.5 billion persons living on the globe? Well we did it and now it is on sale from Monday 27/11 2006. We are six authors, but it was Ann Lindstrand who got it together and Birgitta Rubensson that brought it to print. Hundreds of students read and commented various versions.

We wrote it for those that in a short text want to learn:
-how the health of the world's population has changed over time;
-how the main determinants of health varied with time and place;
-how health can be measured;
about the causes of the main diseases in the world;
-what health care that exist around the world.

Our book is a summary of the works by greater scholars on global health. The pros with our book are the overviews; the cons are the simplifications and errors that are a consequence of our broad ambitions.

Morals and Medicine

"In designing the framework for health system performance, WHO broke new methodological ground, employing a technique not previously used for health systems. It compares each country’s system to what the experts estimate to be the upper limit of what can be done with the level of resources available in that country. It also measures what each country’s system has accomplished in comparison with those of other countries."

Oh brilliant! They are not looking at what the US does but what this bunch of pin heads thinks it could be doing. So they set up individual targets for every country - what *they* think is a good health care system and then they judge success and failure. In other words it is a comparison NOT with other countries but with a fantasy of their own creation.

GM Potato Controversy - A case with disturbing implications for present day science

Unfortunately, ethics have low priority in science nowadays. Powerful scientific committees, such as the Nuffield Council on Bioethics take the side of the establishment most of the time, regardless the merit of the case. Additionally, most of the important decisions are taken by the wrong people who have long retired from active scientific work and these people on the committees have little time to properly read anything. Many of them also either directly or indirectly receive funding from the industry and/or the allied scientific establishment. It is thus not surprising that the whole industrial and political complex came down so heavily on me and on our findings. However, it may have become obvious by now even to those who condemned our work at the time because it was against their interest that suppression of ’unpleasant’ but true facts uncovered by independent scientists is not only against the interest of society but in the long run also of their own. Hopefully, it is now generally realized that when Academic freedom is denied to professional scientists progress in science becomes impossible .

Stem Cell: The Body As Clinic

Dr. Balasubramanian outlines some of the emerging focus areas for SCT and research in India: "One is retinal reconstruction, Dr Taraprasad and Dr Geetha at lvpei are working on it; Dr Madhuri Bihari of AIIMS is pushing the case of neuro-muscular difficulties; Dr Shiv Sarin at the G.B.Pant Hospital in Delhi is routing for liver, and a clutch of hospitals with CMC Vellore are looking at heart. We are most likely to make good progress over the years in these areas." But diabetes is not yet a thrust area though there is a high incidence of it in India. Dr Balasubramanian says it is still a big question whether stem cell biology is required at all to tackle it. "But there are two or three centres looking into this area too," he noted.

Health Insurance and the Web Worker

While we watch this insurance-reform-through-the-tax-code wind its way through the political process, there are some resources online to help us make insurance decisions today. Apologies to our international readership, this post only applies to web workers living in the United States. If you live outside the US, and have tips to share, please leave a comment.

Health Care Rationing: What it Means

ABSTRACT

The United States spends more on health care than any other nation. In 2003, medical spending made up more than 15 percent of U.S. GDP, and if historical trends persist, this share will climb to more than one-third of GDP by 2040. With medical technology advancing at an ever-increasing rate, the potential for spending on procedures not worth their costs is growing. But there are few good ideas for reining in medical costs without hurting patients.

One approach, used in Britain for many years, is rationing. This brief examines many of the issues involved with rationing health care by applying its principles to radiology, using examples from the budgetlimited British health system. There, policymakers and medical providers routinely grapple with two difficult and value-laden questions: How much should be spent on the expensive but life saving technology? And how much should be spent on very costly research to evaluate that investment?

The United States has not had to confront such issues. But as outlays rise, the need for the government, private insurers or employers to set health care spending priorities will intensify. It is time for the United States to begin investing in the knowledge it will need to control growth of health care spending.

POLICY BRIEF #147

Markets operate in a simple way to encourage efficient consumption. Consumers buy things if they are worth more than they cost. The key to efficient market outcomes is that prices reflect costs of production. The market for health care does not operate that way. Once health bills exceed insurance deductibles, patients pay little or nothing for their care, however high the cost and however small the benefit.

Managed care sought to curtail highcost/ low-benefit care—that is, to ration—by various forms of private regulation. It failed principally because consumers' incentives to seek all beneficial care overwhelmed administered limits managers sought to impose. Other nations have rationed health care for years by setting health care budgets or regulated fees, effectively controlling the numbers of hospitals or the amount of medical equipment, or other devices. None spends nearly as much as the United States does, and many achieve dramatically superior health outcomes, at least as measured by such gross indicators as life expectancy and infant mortality.

If per capita health care spending continues to outpace income growth by the same margins as have prevailed for the past forty years, current projections indicate that total health care spending will claim more than one-third of national output by 2040. The increase in health care spending would absorb half of all economic growth by 2022 and all of it by 2051. Medicare and Medicaid spending as a share of GDP in 2040 would be as large as all income and payroll taxes are today.

Long term competitive disadvantage: Automobile Industry

Two sources close to UAW leadership say that the union is willing to negotiate a deal at least on health care that would greatly reduce the $1,500 to $1,800 per car disadvantage in health-care costs that General Motors (GM), Ford Motor F, and Chrysler Group (DCX) each suffer.

Why the West is outsourcing healthcare

With more than 45 million U.S. citizens lacking health insurance and no end in sight to the rise of health care costs, Americans are increasingly turning to places like MedRetreat to help them outsource their health care to hospitals in India, Thailand, Turkey and Singapore. It's estimated that 150,000 foreigners sought treatment in India alone in 2004, and that number is growing by 15% a year, according to the international independent consulting firm Oxford Analytica.

Mega Multivitamins and Prostate Cancer

Men who take too many multivitamins may be increasing their risk of dying from prostate cancer, according to new research from the National Cancer Institute.

Taking a multivitamin more than seven times a week was associated with a 30% increased risk of advanced prostate cancer and a doubling of the risk of death from the disease in the study.

Regular multivitamin use (one to six times a week) did not appear to increase cancer risk, and excessive vitamin use was not associated with an increased risk of early, or localized, prostate cancer.

But there was also no evidence to suggest that taking multivitamins at any dosage helped prevent prostate cancer.

NCI researcher Michael F. Leitzmann, MD, PhD, tells WebMD that more research is needed to confirm the association and understand how vitamin and other dietary supplements affect cancer risk.

“Based on our findings, we would recommend that men adhere to recommendations for dietary supplements and consult with their physician before taking supplements in excessive doses,” he says.