Nonsense, errant nonsense, and nonsense that is actually killing people

[womzilla]

I have recently encountered the statistic that about 12,000 people die every month in the United States because they have inadequate health care. I don't know the source, but it's actually at the lower end of such estimates.

Keep that in mind as I make a point and give you a few links.

I saw my ENT today. I like him--he's been very good to me, and for me. Somehow we keep ending up talking about politics, though, and there we disagree on a great deal. Unsurprisingly, he thinks the biggest problems in American health care could all be treated by reforming medical malpractice suits. (He did make the amusing point that if he tried to run a charity which ate 30% of its donations in administrative fees, he'd be laughed at, but malpractice lawyers claim that routinely.) I know that, in general, medical malpractice is one of the weaker forces driving costs up, but I agree that there are problems with the American legal system and we let it go at that. In the middle of our discussion he also mentioned that the UK National Health Services don't offer dialysis. I was pretty darn sure that was flaming bullshit, but I didn't have the internet in my pants to prove it. Well, I was right. What bothers me more is not that he believed this, but that he was so casually certain of it! It wasn't Typical Doctor Certainty; it was just a fact he actually knew that, you know, actually happened to be 100% false.

Via a flocked post, I came across this related essay: "An Open Letter To My American Friends About The NHS", by Andrew Hickey. Sample:

Many of your politicians and journalists have been saying things like "Ted Kennedy wouldn't get treatment for his brain tumour in the UK because of his age" (a Republican senator called Chuck Grassley said that). Sarah Palin said that in the UK babies with Down's Syndrome would have to go before a "death panel". And so on. I'm sure you've all heard many claims like this yourself.

These claims are lies, pure and simple. They're not "opinions" that people can disagree about, they're not things that can be debated, they're not honest mistakes, they're out-and-out lies.

And, finally, I have occasionally wanted to make more people aware of the fact that Kenneth Arrow's classic 1963 paper, "Uncertainty and the Welfare Economics of Medical Care", is available in its entirety online as a PDF (553 Kb; alas, not text-searchable) , courtesy of the American Economic Association and the World Health Organization. Here's the Wikipedia entry on Arrow's contribution to the economics of information:

In other pioneering research, Arrow investigated the problems caused by asymmetric information in markets. In many transactions, one party (usually the seller) has more information about the product being sold than the other party. Asymmetric information creates incentives for the party with more information to cheat the party with less information; as a result, a number of market structures have developed, including warranties and third party authentication, which enable markets with asymmetric information to function. Arrow analyzed this issue for medical care; later researchers investigated many other markets, particularly second-hand assets, online auctions and insurance.

The basic takeaway of Arrow's paper (which is very readable) is that there are structural reasons in the nature of health care that leave it poorly suited to the type of price discovery and rational analysis that a free market supposedly brings to goods. Markets are a tool to producing a better world; they are not the only tool, nor do they always bring the best world.

Comments

[washa-way.livejournal.com]

Did you happen to run across this beautiful bit of self-pwnage in Investor's Business Daily, by chance?

"People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

The IBW has now changed the editorial to reflect the fact that, oops, Stephen Hawking was born in England and has somehow managed to continue to survive and work despite the National Health Service's nefarious scheming to end his worthless life, but it doesn't seem to have altered the column's position.

[washa-way.livejournal.com]

Link: http://voices.washingtonpost.com/ezra-klein/2009/08/how_stehpen_hawking_proves_tha.html

[despotliz.livejournal.com]

The bit I can't wrap my head around is: what did he think we do with patients who have kidney problems in the UK? Did he think they had to pay privately, or do we just let thousands of patients with kidney problems sit around until they die?

[womzilla.livejournal.com]

Pay privately, I'm pretty sure.

[del-c.livejournal.com]

Which implies it's possible to pay privately in the UK. Actually, that's true; it is.

But doesn't that make all the angst about how the NHS denies people the health care they need completely pointless? If that were true, it would just mean that people who don't get what they want for free would pay for it instead, which is only the American system, after all.

The Arrow paper sounds interesting. Right-wingers are fond of saying Arrow's famous Theorem about voting "proves" that democracy never works, so I'm sure they'll be just as quick to claim that his other papers "prove" that markets never work.

[bigscary.livejournal.com]

"He did make the amusing point that if he tried to run a charity which ate 30% of its donations in administrative fees, he'd be laughed at, but malpractice lawyers claim that routinely"

Charities don't also go down to the street, hand a new suit and a wad of money to a homeless person, and cross their fingers and hope to make it back when the homeless person is a millionaire and feeling generous. Contingency fees are only so high because if there's no recovery, the attorney gets nothing and is out of pocket not only their time, but their court costs, expert fees, paralegal salaries etc. etc. etc.

[shelleybear.livejournal.com]

Did he bring up the "Downs Death Squads"?

[womzilla.livejournal.com]

Right-wingers are fond of saying Arrow's famous Theorem about voting "proves" that democracy never works...

Heh. I almost made that point myself.