News for May 29

The High Costs of Health Care

Atul Gawande has a riveting piece in this month’s New Yorker examining why health care is so expensive in, of all places, McAllen, Texas. Gawande, a physician himself, looks at hospital practices, doctor referals, the general health of the population and insurance availability, and his conclusion lays the responsibility at the feet of capitalism and the reckless entrepreneurism to which medicine is turning. Gawande writes:

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.

It’s a grand narrative that’s generating links and discussion across the blogosphere over what the government and the public can do about the rising costs.

xpostfactoid links to the article and writes:

Creating the right incentives — or unwinding the wrong ones — is complicated. Some institutions have done so by creating systems in which doctors essentially oversee each other and the institution holds itself collectively responsible for outcomes. Some, like the Mayo clinic, produce excellent outcomes at low cost. But how to replicate their successful cultures is not yet clear.

Matthew Yglesias @ThinkProgress offers two comments about the issue of entrepreneurship and health care. In the first, where he joins Ezra Klein @The Washington Post in cheerleading readers to go read Gawande’s article for themselves (and I third their encouragement), Yglesias looks to further the conversation:

I suspect the kind of reforms currently being contemplated by congress are really only going to be the first steps in a substantially longer journey that we’ll have to take as a country. In addition to things being totally screwed up in terms of who gets health insurance and how and from whom, the actual delivery of health care happens in a very screwed-up way. But the common view is that it actually isn’t screwed up, and so short-term politics dictates spending a lot of time reassuring people that no terrible change for the worse is on the way in terms of delivery. Which is fine as far as it goes, since the insurance mess really does need to be cleaned up. But then there’s this other problem, where the actual practice of medicine in America, though perceived to be good, is actually extremely hit-or-miss and in some respects getting worse.

Later, Yglesias muses that in fact, universal health care would boost entrepreneurship:

I’m the sort of person who’s prone to saying that we could have a more entrepreneurial economy in the United States if we had a universal health care system. The thinking is that our current system unduly punishes risk-taking. There are a lot of different aspects of this, but basically the American health care system both produces labor market rigidities (”job lock”) and makes jobs at small firms relatively unattractive.

Finally, Andrew Sullivan @The Atlantic offers a one-line comment on the piece:

I understand the problems of McAllen. I also shudder at the phrase “totality of care.”

Global Crisis Hits Human Rights  |  BBC News

BBC News and Truthout both highlight Amnesty International’s annual report, which says that the global economic downturn has distracted the world’s attention from human rights abuses and is causing newer ones. According to the BBC:

The world’s poorest people were bearing the brunt of the economic downturn, Amnesty said, and millions of people were facing insecurity and indignity.
Migrant workers in China, indigenous groups in Latin America and those who struggled to meet basic needs in Africa had all been hit hard, it said.

Where people had tried to protest, their actions had in many cases been met with repression and violence.

The group warned that rising poverty could lead to instability and mass violence.

“The underlying global economic crisis is an explosive human rights crisis: a combination of social, economic and political problems has created a time-bomb of human rights abuses,” said Amnesty’s Secretary General, Irene Khan.

The Irony of Social Networking Technology  |  Atlantic Correspondents

Lane Wallace blogs about how social networking technology both helps and hurts our societies.  On the one hand, social networking technology like Facebook and cell phones have expanded our range of community networks. On the bad side, the abbreviated means of expression that social networking systems like Twitter have stunted how we express ourselves. Wallace calls for balance:

It’s not a new problem. Technology often creates new problems, even as it solves old ones. The advent of computerized flight management systems in airline cockpits, for example, was supposed to relieve the workload and improve safety. While the new technology achieved that goal overall, having to program the systems created a new problem of pilots being “heads down and locked” — or, concentrating on programming the computer to the detriment of overall safety awareness. (see: American Airlines’ 1995 crash in Cali, Columbia). As a result, new training and procedures had to be developed to counter the safety problems the new technology had unintentionally spawned.

Unfortunately, it’s harder to train humans how to use cell phones and internet-based social networks for all the advantages they offer without letting the technology get in the way of the very thing it was supposed to assist. Balanced use is a challenge with any new technology, and we don’t always do such a terrific job of achieving it.

Historically, America Both Legalized and Deported Immigrants — Since 1996 it Only Deports Them  |  AlterNet

Why should undocumented migrants in the U.S. be offered amnesty? Perhaps a better question might be, why shouldn’t they, since the U.S. has done it before, repeatedly. AlterNet offers a history of U.S. immigration policy, which shows that the U.S. has switched between legalizing the statuses of migrants and deporting them, depending on its needs. Policies also vary depending on which country the migrant is from.

A Starry Night. A Warm Gun  |  alias Bruce

How a bill allowing citizens to bring guns into U.S. national parks became a law:

Oklahoma Senator Tom Coburn (R) buried the gun bill in the credit-card legislation as an amendment, a trick often used by both parties for pet causes that need propping up. Dems knew the credit card package was a must-pass. But rather than use their majority to revolt against this perversion of process, some Dems ducked their heads and went along. Others, including Majority Leader Harry Reid, (D-Nevada) and many Dems from Southern and Midwestern states, actively bought into this Dodge City bill on the basis, as Reid claims, that it reflects the Second Amendment (that sloppily-written, impossible-to-decode provision that needs to be coherently refashioned to reflect civilization in the 21st century). As for Repubs, the vote was a mixture of guns-are-good gospel and let’s-get-the-liberal-bastards politicking. The law is due to go into effect on February 22, 2010.