| Thursday,
Malpractice Costs
The figure Cochran cited is probably pretty accurate,
actually. You are assuming that there is a rational connection between the
price of malpractice /insurance/ and the amounts paid out by the insurers.
Unfortunately, that's not generally the case. Where there IS a significant
correlation is in the performance of the insurance companies' investment
portfolio. That relationship is inverse.
There is a lot of talk about "defensive medicine" --
unnecessary tests performed out of the doctor's fear of a malpractice suit
-- but very little about the "defensive medicine" that is required by health
insurers before authorizing procedures. When the insurer requires that and
MRI or CAT scan be on file before they will authorize a surgery (even though
imaging is a poor indicator) that is another unnecessary cost to the system.
It is easy, and popular, to blame the woes of the
system on trial lawyers, but the actual numbers just don't bear that out. As
to your pediatrician, he was a victim of what has become a a policy among
malpractice insurers--to drive out the occasional surgeons. Hospitals have
joined in that effort. The reasoning is that a surgeon who does surgery
every day is less likely to have adverse outcomes than a doctor who only
does surgery occasionally. It's why you almost never see a General
Practitioner in a surgical suite these days, even though it used to be
fairly common.
Jim Keech
==
2% figure for malpractice costs
The 2% figure cited by Gregory Cochran is from a
footnote in the document he linked to (the document was prepared by the
Congressional Budget Office -- CBO). The text of footnote 3 reads:
(3) The 2 percent figure is a CBO calculation based on
data from Tillinghast-Towers Perrin (an actuarial and management consulting
firm) and the Office of the Actuary at the Centers for Medicare and Medicaid
Services.
So, in order to evaluate the 2 percent figure, one
would have to find the actual calculations and source data. I'm looking.
The document is dated January 8, 2004, and is based on
2003 data. I've seen claims that malpractice premiums have risen in the past
five years, and other claims that they have gone down. Need to find some
hard data.
The CBO document rather airily dismisses indirect cost
drivers related to "defensive medicine" (excessive procedures ordered by
doctors to avoid malpractice suits), saying without even a footnote that
"However, evidence for those other effects is weak or inconclusive." I would
like to see the data behind that statement as well.
Steve Setzer
I have no dog in this hunt. I'd be astonished if
the legal system added that low a cost to the system, but I'm glad to hear
it if it's true.
=================
Healthcare
Dr. Pournelle,
You ask (rhetorically, I know): "So which
industrialized country has the system we ought to emulate?"
The founders of the British NHS were fond of saying
that it would become "the envy of the world".
They continued saying this until perhaps fifteen years
ago.
Those of us who actually have to use the system
(tellingly, most politicians have private health insurance), are in no doubt
that it is not the envy of anyone, anywhere; it is in fact, by far the worst
healthcare system in use in the First World. But it has become a sacred cow,
and nobody dares make any real changes.
Don't go there, Americans!
Andrew Duffin
==
Subject: Health Care
Here's a conservative analysis of the European
experience: <http://www.heritage.org/research/healthcare/hl711.cfm
> . Based on personal experience, the NHS in Britain is not a good
model. It provides basic health care, but it's poorly managed, there's a
post-code lottery, and services are capped at a level lower than what most
middle-class Americans would expect.
Harry Erwin PhD
-- If we knew what it was we were doing, it would not
be called research, would it? (Albert Einstein)
==
Subject: free medical care
Dear Dr. Pournelle,
I do know of one country where free medical care works
quite well. The United States could never succeed in emulating or imitating
it for reasons shown below.
The country is Saudi Arabia. I received free treatment
for nasty allergies, free dental care, and a free necessary operation during
contract service there. All citizens of Saudi Arabia and legal visitors are
entitled to free health care, but read on.
Quality of health care and health facilities is
governed by status of the person. This is decided by a number of factors
Royal family gets the best. Saudi Arabian citizens and those visitors with
European status come next. Third country nationals rank last. Muslims get an
automatic priority. Women share the status of their husbands. Unaccompanied
women are generally treated as third country nationals, or worse. The King
can alter any person's status at will. So can the Saudi Arabian sponsor of
any contract labor. All legal visitors carry an Igama, a Saudi Arabian ID
document similar in appearance to a passport. No Igama means no medical
care, and instant arrest. Muslims carry white igamas, everyone else carries
green.
In my case, I was a European status, college degree,
Christian, working for a US firm on a contract to support the Royal Saudi
Air Force. We were sponsored by a Saudi Arabian firm that monitored all
interaction with Saudi Arabians. For medical or dental problems, I would
contact the camp doctor, a contract MD, who would treat me or route me to a
local clinic or national hospital as appropriate. I was asked to show my
igama every time, and always received prompt, courteous, and able
assistance, My one operation rated a private room and bath, with as many as
three nurses on constant call. As promised, a sponsor representative checked
with me to make sure I was being treated properly.
This status business is at the discretion of the King
or his designated representative, such as my sponsor. I know of three men
elevated from third country to European status for good education and
exceptional skills. Also, Benazir Bhutto visited without needing her husband
as an escort because she was a guest of Prince Abdullah.
It is easy to see why the USA will never adopt this
system. Class distinctions, differences ue to religion and national origin,
arbitrary assignment at the whim of the government, sexual discrimination,
and other items that stir discontent in the USA. But it does work, and work
well in Saudi Arabia.
As you say, it's not likely that the US can afford
this...
==
Health care...
Hi Jerry, If you want to look at the best healthcare
systems in the world, look to Sweden or France. There your chances for
survival are the best even with complicated diseases, and waiting for
service is almost non existing.
From family experience I know how the treatment
similar to yours work in Denmark:
Time from diagnostic to first radiation treatment: 20
days. Treatment given 30 days, weekends off. The machines where similar to
what you experienced: Very modern (although radiation treatment in itself
has some positively medieval aspects). The healthcare system do have an
X-Knife system, which is an alternative way to radiate, but still not proven
better. But the doctors were still training with it. No particle beam
treatment yet in Denmark (the machines cost 150+ million USD). They are only
found in Germany and Japan.
Price for treatment: None. Everybody living (legally)
in Denmark is covered. No insurance necessary. Paid by taxes.
What we did see, was that the follow up appointments
with the doctors, meant waiting half a day in the hospital waiting room. A
lot of patients, but the doctors were very professional, and took the
necessary time to talk.
I can understand the point of view that healthcare
ought not to be a federal issue. It's not the most cost-effective decision,
but it does leave room for systems of a workable size, and for different
local preferences. But how do you prevent, sick people to move to states
which give better care? And what about older people moving to states with
free healthcare late in their lives? They pay low taxes in no-healthcare
states while young and healthy, and move to high service states late in
life, to enjoy what has been paid by the taxes of others?
Regards
Bo Andersen
Of course one wants some migration among the
states. The traditional control on such matters was restricting benefits to
residents, and having a one year physical residency requirement to be a
legal resident. The courts threw those out as somehow unconstitutional,
although they had been in place for 80 years or so at the time. Fresh new
rights.
I am glad that Denmark and France can afford such
plans. Why do they work better than Britain's? But in the US at the moment
we can't afford the government we already have. Is a depression the right
time to greatly expand government? At least we have -- assuming that
all works as well as you say -- a goal.
I do not believe that the present system of
earmarks -- more in number now than in previous years, and hugely more in
dollars -- is likely to create a national health care system that works; but
perhaps I am wrong. In any event the experiment is likely to be tried.
=============
ROTC and the Future of Liberal
Education - ChronicleReview.com
http://chronicle.com/free/v55/i36/
36b00801.htm?utm_source=cr&utm_medium=en
Dear Jerry:
The anti-military attitudes on college campuses and
the resulting cultural gap between the US military and the society it serves
has long been one of my concerns. This article indicates that, at long last,
the tide may be turning.
Sincerely,
Francis Hamit
Of course most of the land grant universities were
founded specifically to provide education for future officers of the state
militia and possibly the national army. Many of those have now denounced
ROTC on their campuses. O tempore o mores...
============
Conservatism
The split in the conservative movement used to be
called Wall Street vs. Main Street, or Freedom vs. Virtue, or Rockefeller
Republicans vs. Goldwater Republicans. To some conservatives it came down
whether Lincoln was a hero and the greatest Republican President, or not a
real conservative because of his expansion of federal power. Perhaps winning
elections will come down to proving that national prosperity and security
depends upon scientific and technological innovation and advancement, and
that limited government, free market capitalism, and good government (reform
and law and order) are the best ways to achieve those goals. The GOP will
win in 2012 if there is 10% inflation, or 10% unemployment or 0% GDP growth,
or some mix of bad numbers on the economy, or if Al Qaeda in America sets
off car bombs or IEDs in our country.
From Darryl Miyahira, Honolulu, Hawaii.
At the end of Carter's 4 years the misery index --
inflation plus unemployment -- was about 20%. Given the massive deficits and
decreasing employment, it's hard to see how it will be lower in 2012.
Estimates of inflation vary, but given the continuing deficits it is sure to
rise -- the worry is not to keep it from rising at all, but to keep it from
going catastrophic. Inflation is a tax on savings and those living on fixed
incomes. It is a very effective task on those who scrimped and saved,
sometimes amounting to confiscation.
============
The Coming Ice Age By David Deming
http://www.americanthinker.com/
2009/05/the_coming_ice_age.html
...For thousands of years, people have learned from
experience that cold temperatures are detrimental for human welfare and
warm temperatures are beneficial. From about 1300 to 1800 AD, the climate
cooled slightly during a period known as the Little Ice Age. In Greenland,
the temperature fell by about 4 °F. Although trivial, compared to an ice
age cooling of 50 °F, this was nevertheless sufficient to wipe out the
Viking colony there....
...Earth's climate is controlled by the Sun. In
comparison, every other factor is trivial. The coldest part of the Little
Ice Age during the latter half of the seventeenth century was marked by
the nearly complete absence of sunspots. And the Sun now appears to be
entering a new period of quiescence. August of 2008 was the first month
since the year 1913 that no sunspots were observed. As I write, the sun
remains quiet. We are in a cooling trend. The areal extent of global sea
ice is above the twenty-year mean.
We have heard much of the dangers of global warming
due to carbon dioxide. But the potential danger of any potential
anthropogenic warming is trivial compared to the risk of entering a new
ice age. Public policy decisions should be based on a realistic appraisal
that takes both climate scenarios into consideration...
Did I hear Angels Falling?
Larry Bayern
Full Text of Article:
The Coming Ice Age By David Deming
Those who ignore the geologic perspective do so at
great risk. In fall of 1985, geologists warned that a Columbian volcano,
Nevado del Ruiz, was getting ready to erupt. But the volcano had been
dormant for 150 years. So government officials and inhabitants of nearby
towns did not take the warnings seriously. On the evening of November 13,
Nevado del Ruiz erupted, triggering catastrophic mudslides. In the town of
Armero, 23,000 people were buried alive in a matter of seconds.
For ninety percent of the last million years, the
normal state of the Earth's climate has been an ice age. Ice ages last
about 100,000 years, and are punctuated by short periods of warm climate,
or interglacials. The last ice age started about 114,000 years ago. It
began instantaneously. For a hundred-thousand years, temperatures fell and
sheets of ice a mile thick grew to envelop much of North America, Europe
and Asia. The ice age ended nearly as abruptly as it began. Between about
12,000 and 10,000 years ago, the temperature in Greenland rose more than
50 °F.
We don't know what causes ice ages to begin or end.
<snip>
We can very much hope that the ice is not coming
back. It's harder to live under ice than with hotter weather.
===========
Cap-and-trade' 'deadly' to elected officials? - Arctic
no warming since 1958! - 'Psychosocial' effect on health!
Get the latest climate news and entertainment at
www.ClimateDepot.com
Breaking News:
'Is Cap-and-Trade Deadly to Elected Officials?...Dems
are getting scared of being too close to the Waxman-Markey bill'
Danish Meteorological Institute records show: No
Arctic Warming Since 1958! - 'Arctic was warmer in the 1940s than now'
'Charge your iPod, kill a polar bear?...Environmental
alarms raised over consumer electronics'
Did the Obama administration put a knife in
cap-and-trade intentionally?
Claim: Global warming biggest public health threat of
21st century -- 'eclipsing infectious diseases, water shortages and
poverty!'
Doctors fear climate change will have a 'psychosocial'
effect on health!
Arctic Comedy: Global warming trek 'makes it less than
half way' to North Pole due to temps dropping below -40C!
Green Groups to Bail on Climate Bill?! 'We are
extremely troubled...by compromises' - declare Greenpeace, Friends of the
Earth, and Public Citizen
Is Obama's climate-change plan getting sabotaged from
within?
US forecaster may cut Atlantic hurricane outlook
'because sea temperatures are cooling'
Climatologist: 'Solutions being offered don't provide
any detectable relief from this so-called catastrophe'
Not so sustainable: Eco-friendly election posters
'split and disintegrate'
WSJ: Even With a Climate-Change Deal, Some Democrats
Uncommitted
Rep. Barton: 'We are not prepared to accept unilateral
economic disarmament of the U.S. economy'
GOP Mocks: 'Quick, Pass Cap-and-Trade! --Before a
suspicious public takes notice'
Democrats waver on greenhouse gas emissions bill: 'I'm
still not prepared to vote for a bill'
Marc Morano ClimateDepot.com
I believe Morano used to be a Congressional
(Republican) staffer. This is the first I have seen from this organization.
I find the site too busy and a bit hard to get information from, but there
are headlines and leads.
===========
Gee, climate scientists must be upset (Ocean
Circulation Doesn't Work As Expected)
Jerry,
Color me surprised, it turns out the model doesn't
match the actual data! In this study, the ocean currents defy the computer
model: <http://www.physorg.com/news161439846.html>
. So, how long before the climate-change barnstormers decide that humans
have already changed the ocean circulation and action must be taken right
away with no questions asked?
Cynical in Cleveland, Jim L.
The important news is that actual research has
falsified a long accepted model. We don't yet have a replacement for the
theories that went into constructing the model. As Helmholtz noted,
the more practical thing in the world is a good theory. We could use some in
climate modeling.
The problem is that politics trumps science now;
there are just too many people whose entire life's work as well as income
are at stake here.
===========
malpractice costs
CBO is supposedly nonpartisan; and in 2004, if anyone
controlled them, it was the Republicans. It was headed by Holtz-Eakins, one
of Bush's economic advisers and later McCain's chief economic adviser.
Admittedly, he's a liar.
\ The idea that tort lawyers have played a significant
role in medical inflation is not correct. You might as well look for all the
supply-side reasons that caused eggs to go for a dollar each in San
Francisco in 1849. It's a demand thing, other people's money.
Here are current (2007) average malpractice premiums
for US, by specialty. Family practice, 12,500. GPs, 7,500 Internists,
12,500. Ob/gyns, 55,000 Pediatricians, 12,500 All primary care: 17,500 .
There are about 750,000 MDs in the country : a ballpark number for total
malpractice premium costs is going to be (0.75 x 10 e 6) x (~2 e 4) = 15
billion. But that might be low - maybe specialists pay a lot more. Since
total premiums were about 10 billion in 2000, let's say that they're paying
20 billion total now - that's reasonable, since nothing I've seen suggests
that rates have doubled over that period. We're on the same page. . Total
health care costs for the US passed 2 trillion (2 e 12) in 2006. Malpractice
premiums account for about 1% of total healthcare costs. . Here's the
breakdown:
As for defensive medicine, the only part I object to
is the part that has low payoff. I don't think anyone has been able to come
with a decent estimate of those costs. As for the idea that any argument can
be won by citing some unmeasurable factor - well, I'm not from Missouri, but
I grew up near there.
Gregory Cochran
Well, of course it's a demand thing. The demand for
a free good is infinite. As to CBO and nonpartisan government agencies, my
experience has been mixed, and most of the permanent CBO staff has been
there a long time. But if malpractice costs are not a major contributor to
the high costs of health care, and tort reform is not so high on the
priorities as I had thought, that's a good thing and one less thing to worry
about. I mentioned it largely because the lecture I heard from Lester Thurow
on health care systems devoted considerable time to the subject; his father
in law is a physician. This was several years ago, but he emphasized that
malpractice insurance premiums had skyrocketed.
I am not as interested in winning arguments as I
used to be. I have found that one way to find out something is to
assert it here: someone who knows more may come up with data I don't have.
============
Dr Pournelle
Hubble has photographed the Mote in God's Eye.
"[I]n tribute to Hubble's longest-running optical
camera, a planetary nebula has been imaged as the camera's final 'pretty
picture.'
"Known as Kohoutek 4-55 . . . [t]he entire system is .
. . surrounded by a faint red halo that looks like an eye in the sky."
http://www.dailymail.co.uk/sciencetech/
article-1180435/Eye-sky-Hubble-cameras
-photo-astronauts-replace-final-overhaul-mission.html
Live long and prosper h lynn keith
=================
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