Submitted to a Candid World
Archive for March 11, 2009
Health Care in the U.S.: High Costs and Regressive Taxation
Oh, if only health-care reform was this simple ...
Americans consume much larger quantitites of high-tech and expensive procedures than do other OECD countries. The report used counts of MRI and CT machines as an indicator of prevalence of advanced medical services. The U.S. has 344% more MRI units and 230% more CT scanners than the median counts of these machines in other OECD countries. Of course, advancements in medical treatment are good, but when advanced technology is overused, it is inefficient. In the U.S., we are overusing expensive procedures.
Part of the reason we overuse expensive medical services is due to the high costs of malpractice. U.S. doctors practice defensive medicine in an effort to leave no stone unturned, lest they miss diagnoses and open themselves up to litigation. There is evidence that malpractice reform leads to less defensive medicine “without substantial effects on mortality or medical complications.” Personally, I have always been suspicious of damage-award caps. In today’s medical climate, with the incredibly high volume doctors must turn around to stay afloat, I figured caps removed an important incentive for doctors to be conscientious. But malpractice-insurance premiums are part of the pressure on doctors. I am amenable to malpractice reform provided it accompanies larger systemic changes.
Driving high costs, too, is administrative, intermediary costs, like the costs built into premiums to cover underwriting expenses as well as the taxes on insurance-company profits. OECD cites one study indicating 36% of the nearly $500 billion the U.S. spends over that spent by comparable countries is not directly related to health care. Also, overpayment for equipment and supplies by Medicare is a large drain on public health-care expenditures. Competitive bidding must be the norm, but its exansion to 70 locations was killed when Congress passed legislation (and overrode a Bush veto) in July that would have significantly reduced Medicare payments to physicians. Competitive bidding can save $1 billion annually. Additionally, the Sustainable Growth Rate [SGR], the spending targets that determine annual Medicare physician payments, needs major attention. Decreased reimbursements should be part of a larger goal to improve efficiency as part of overall reform, not — as was often the case with the Bush Administration — to cut government outlays simply to shrink a program and leave citizens holding the bag. Physician payments should fairly cover necessary treatment, but there should also be a disincentive to over-utilize unnecessary procedures. Last summer’s legislation postponed the inevitable changes to physician reimbursements that must be made if reform is going to be effective.
On to regressive taxation (after the jump) …
Coulter’s Creationism: a Virulent Mix of Ignorance & Sexism
Yesterday, “Politico” gave a brief run-down of Ann Coulter’s Monday-night showdown at Radio City Music Hall with Bill Maher. Those who were there, though, will notice that they left out a good number of highlights. After trotting out a twenty-year-old editorial to suggest that liberals should somehow be estopped (no apologies for lawyer-speak) from protesting the right’s invocation of Obama’s middle name to inflame and terrify, she went on to argue that because adult stems cells are so promising, embryonic cells are now useless, a partisan twist on the fact that embryonic stem cells, while still very useful, aren’t as research-critical today as they would’ve been eight years ago. Both are good examples of Ann’s primary debate strategy: blow the left’s little foibles out of proportion, distort the evidence until it fits your conclusion, repeat.
About halfway through the debate – in a section “Politico” failed to report – Coulter turned this technique to tearing down evolution. It was truly a sight to behold. After admitting to being an old earth creationist, Coulter claimed that science has never found any transitional forms, invoked publicly-disgraced “biologist” Michael Behe, cried censorship, and asked Maher to admit that evolution is a “religion.”
Maher’s best response would’ve been to note the many popularly-known transitional forms, both hominid and animal; gently remind her that even creationists acknowledge the existence of transitional forms; and close by noting that the non-perjured elements of Behe’s testimony in Kitzmiller actually proved that ID creationism has NO scientific basis.
Sadly, Maher’s no scientist, and he took the alternate path of reminding Coulter that 99.9% of scientists disagree with her – so who are you gonna trust? Despite skimping on directly contradictory evidence, this turned out to be tactically sound: Coulter’s only response was to really break out the crazy, with this reply:
Half of those are these women scientists who faint at the sight of blood, or biologists. Biologists aren’t real scientists.
And there you have it: the only way Coulter can get out of evolution’s firmly scientific basis is to discount both the entire field of biology and the contributions of all women scientists. If it were possible for me to take Coulter seriously after that little rant, I’d be offended on behalf of the many brilliant women scientists I know. But at this point, she’s more like the ugly puppy that accidentally wets the carpet: sure, it’s wrong, but you knew it was coming.
