Mortality Amenable to Health Care

From Paul Krugman:

A health care system to die for, by Paul Krugman: Rudy Giuliani warned us about what would happen if a Democrat wins:

You have got to see the trap. Otherwise we are in for a disaster. We are in for Canadian health care, French health care, British health care.

And that would be a terrible thing:

In “Measuring the Health of Nations: Updating an Earlier Analysis” (Health Affairs, Jan./Feb. 2008), Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc., both of the London School of Hygiene and Tropical Medicine, compared international rates of “amenable mortality”—that is, deaths from certain causes before age 75 that are potentially preventable with timely and effective health care.

And you see what that tells us:

Click to enlarge

Comments

[Pitt]

For what it's worth, the same group looked at the effect of income level and having insurance on health&healthcare, and the difference is substantial.

Americans with above-average income and insurance have comparable health to people with above-average income in Australia/Canada/NZ/UK, but Americans with below-average income or no insurance do worse than their below-average income counterparts in other countries (all of whom do worse than their countrymen with above-average income; the difference is simply larger in the US).

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=364437

[anne]

There has to be emphasis on gaining universal health care insurance as a fundamental right, as a logical extension of our civil rights, which is precisely what having health care insurance is. We are a disgrace in terms of health care, and we cover the disgrace by continually finding slogans and anecdotes to lash out at and crerate fear of alternative systems.

I know what it was like to be treated for a fall while running along a riverway in France and to be treated immediately at a local practice on a weekend and waved away in trying to pay so buying the doctor wine and being happy as a clam to be socialized.

[TigerPaw]

The results are no surprise on this side of the border. It's been known here for ages that if you're wealthy get sick in the US if you want private rooms and personalized service and don't mind paying for it. On the other hand if you're of modest means get sick here. The service may not be gold-plated and might take a while but you'll be taken care of and you won't end up in the poor house.

Simple example - coworker at a job I worked at had a daughter arrive 4-5 months premature. Total cost to him after months and months of the baby being in the hospital was something like $50 for oxygen when he first brought her home. I believe he did give a donation to the children's hospital concerned as thanks, but it wasn't required.

[donna]

My neighbor was in a car accident this morning and taken to trauma care immediately. He didn't get any choice, since he was unconscious.

In these kind of cases, you ought to be covered, no matter what, and know you will be taken care of.

And we are. And we DO pay for it already -- in higher health care costs for those who can pay, and in higher insurance costs for those who have it.

We are already paying for it. So that argument that we don't want our taxes to pay for it is ridiculous.

Yes, it's socialized medicine -- so what??? Companies and individuals shouldn't have to take on societal burdens any more. We are a society - let's live like one.

[anne]

Juan Cole has brought just the issue I have, which is the fundamental link that will have to be stressed between the squandering of hundreds of billions of dollars in Iraq and moving to universal health care. Moving to universal health care, even absent a single payer system to save on administrative cost, becomes a simple matter by using savings gained in leaving Iraq. Affording proper health insurance easily is a matter of leaving Iraq, let alone what could be gained were we only sane enough to gradually move to a single payer system.

The cost savings by technology or preventive medicine or healthier living, will be fine though nowhere the savings to be gained by moving to single payer insurance. So absent a tax battle, saving on squandered military spending must be kept in focus.

[anne]

Adding to Donna and TigerPaw and Pitt:

http://www.nytimes.com/2008/01/08/us/08grady.html?hp

January 8, 2008

A Safety-Net Hospital Falls Into Financial Crisis
By SHAILA DEWAN and KEVIN SACK

ATLANTA — Pamela Vaughn is a Grady baby.

Like tens of thousands of Atlantans over the last 115 years — like Gladys Knight, the soul singer, and Vernon Jordan Jr., the presidential confidante; like more than one in three babies born here in the last decade — Ms. Vaughn entered the world at Grady Memorial Hospital, one of the nation's largest safety-net hospitals.

Ms. Vaughn was not only born at Grady, she also works there, as a senior nurse in the diabetes clinic, where many of her patients are Grady babies, too. And now, like thousands of other Atlantans, she is hoping to save the teeming charity hospital that has provided her with both life and livelihood.

To generations of Georgians, this city is unimaginable without Grady. Yet that has been the prospect facing the region for the last year, the result of a multimillion-dollar shortfall in the cost of providing charity and emergency care that no one — not the counties, the state nor the federal government — has been willing to cover, though Grady provides vital services to the entire region.

Once admired for its skill in treating a population afflicted by both social and physical ills, Grady, a teaching hospital, now faces the prospect of losing its accreditation. Only short-term financial transfusions have kept it from closing its doors, as Martin Luther King Jr.-Harbor Hospital in Los Angeles County did last year. That scenario would flood the region's other hospitals with uninsured patients and eliminate the training ground for one of every four Georgia doctors.

Ms. Vaughn feels the strain when she has to counsel 20 patients in a day, twice as many as she did only five years ago. Or when she has to tell diabetics at risk of blindness that it might take four months to get an eye appointment. "It makes me sad," she says, "that I'm a Grady baby and we have to go through all of this."

Although the hospital is unique in many ways, the code red at Grady is emblematic of the crippling effect America's health care crisis has had on public hospitals around the nation. Though Grady is among the most distressed of the country's 1,300 public hospitals, others have faced similar challenges in recent years, including those in Miami, Memphis and Chicago, said Larry S. Gage, president of the National Association of Public Hospitals and Health Systems. There are 300 fewer public hospitals today than 15 years ago, with hospitals having closed in Los Angeles, Washington, St. Louis and Milwaukee, Mr. Gage said.

Dr. Carlos Del Rio, Grady's chief of medicine, calls the hospital "the canary in the coal mine." ...

[anne]

When Martin Luther King hospital was closed I was puzzled, but no longer. As the portion of uninsured served by public hospitals increases, and the individual hospitals cannot recover expenses with privately insured or Medicare patients, who are attracted to hospitals catering to them, there is more and more pressure on hospital staff, more deterioration of services.

[Alex Tolley]

anne: "There has to be emphasis on gaining universal health care insurance as a fundamental right, as a logical extension of our civil rights"

That is exactly the mindset that we need, rather than the current "healthcare is no different than buying an automobile".

The fear mongering needs to be countered. I recall that Paul Wellstone did a week long health care teach in before his death and the end result was a huge swing in preference from a US style to a Canadian style system amongst the attendees.

[save_the_rustbelt]

I will be interested to see the research methodology here.

The measurement of "amenable mortality" would be difficult at best.

Krugman gives this immediate and complete credibility. Huh.

[calmo]

Well The Commonwealth Fund seems like a regular international body to me STR --do you feel that the article PK linked to was anti-American somehow?
Thanks for that additional link, Pitt, and your comment about income levels.

[JRossi]

Universal insurance would make my job easier. I saw a young woman today with right lower quadrant abdominal pain and no insurance. She refused a workup. I hope she's just got gas pains and not appendicitis. We shall see.

[Why So Expensive?]

What amazes me is the the taxpayers spend as much money to cover half the population as other countries spend to cover the entire population. Why is our system so expensive?

[Bruce Wilder]

A little investigation reveals that the Commonwealth Fund was doing the heavy spin. The authors of the study were dutifully skeptical of the value of the aggregate rankings, and were, in fact, focusing their attention on the value of looking more closely at finer-grain comparative component analysis.

Whether it shows up in this particular dataset, though, it remains true that U.S. healthcare is fantastically expensive, and achieves, at best, middling and decidedly mixed results.

Why is U.S. healthcare so ridiculously expensive? Corruption. Corruption (and related disorganization) in the administration of health insurance, in the administration of hospitals and allied health service enterprises, and in pharmaceutical and medical device industries.

[save_the_rustbelt]

Calmo:

What I am saying that one or two studies of questionable methodology should not cause us to draw strong conclusions.

The study may come to the right conclusion or be wrong, but a trained researcher should know better than to overreact.

Real mortality studies are very labor intensive and time consuming, and since the US has never developed a sound method of logging mortality causes, it would be tough for anyone to study the results.

[Jay]

Anyone have a link to an ungated version. I find it odd that they report the statistic on...
"deaths from certain causes before age 75 that are potentially preventable with timely and effective health care"
without reporting...
"deaths from certain causes before age 75 that are PREVENTED with timely and effective health care"

Are we just to assume ceteris paribus for the second statistic? Is the French health care system burdened with the same number of sick people per 100,000 as the U.S. health care system?

[Alex Tolley]

Is the French health care system burdened with the same number of sick people per 100,000 as the U.S. health care system?

You mean that the French economic & socials systems might actually be healthier than the US? Are we possibly creating a sicker workforce by stressing our population too much with low pay and worries about health? Is this possibly the result of simply not providing preventative care for 40 odd million US citizens? ;-)

[hari]

The methodology is not reassuring because the definition of what's amenable may differ from country, cultural characteristics and/or traits.

If you're going to study the mortality rate of diabetes patients, for example, then use the basic national records to demonstrate the outcomes - based (also) on their economic class, if possible.

The real question is how and under what circumstances will it be possible to establish a Single Payer System in U.S.?

[macquechoux]

I suggest those using Kevin Drum’s analysis, that is where the graph comes from, should also read “Uncovering Some Really Bad Science” over at the Coyote blog where it comes under serious analysis. I suggest those favoring “universal health care” in the USA should find a better argument that this flawed study. In my opinion, Anne has a much more persuasive argument with, “..universal health care insurance as a fundamental right, as a logical extension of our civil rights.”

Anne, I have several problems with that; however, the largest problem is that most countries end up controlling cost by limiting health care coverage.They all do, honestly, Anne. See Canada and UK as obvious examples. Universal health care does not mean unlimited health care.

[JRossi]

macquechoux makes a point that bears frequent repeating. " Universal health care does not mean unlimited health care. " Everyone interested in this issue should repeat these words at frequent intervals. I would add that universal HI does not mean that everyone's hopes for HC will realized. Basic economics, but worth remembering. Any system designed to deal with human suffering will never be fun, never be a trip to Disneyland. Resources are always limited. People will want more than they can have. They will want their doctors to be nicer, their waits to be shorter, their diagnoses to be more certain, their treatments to be more effective. I think we will get to universal insurance, probably after all other plausible options have failed. Things will be better then, but no dancing in the streets.

[anne]

Macquechoux, I have no argument at all with your intelligently cautious intimation.

[James Killus]

For anyone not wanting to wade through the drivel at Coyote Blog (and it's some serious drivel), let me provide the information that their primary argument is that the effects could be due to "lifestyle differences."

Yes, friends, we again learn that low income people have higher mortality rates because they do foolishly unhealthy things, while rich people are more virtuous. That would also imply that all the health care that the better off consume is wasted, so we should stop rich people from having access to health care as well, shouldn't we?

Well, let me take this opportunity to suggest that all members of Congress should have their health care converted over to the Veteran's Administration. I believe that this would insure that veteran's get a decent health care system. Let me toss in the White House and all its staff, as well (though we will leave it unstated as to what I'd like to toss them into).

I am also willing to place a small wager that Krugman spent more time considering his opinion about the study in question than STR did in formulating his statement:

"Krugman gives this immediate and complete credibility. Huh."

[James Killus]

For anyone not wanting to wade through the drivel at Coyote Blog (and it's some serious drivel), let me provide the information that their primary argument is that the effects could be due to "lifestyle differences."

Yes, friends, we again learn that low income people have higher mortality rates because they do foolishly unhealthy things, while rich people are more virtuous. That would also imply that all the health care that the better off consume is wasted, so we should stop rich people from having access to health care as well, shouldn't we?

Well, let me take this opportunity to suggest that all members of Congress should have their health care converted over to the Veteran's Administration. I believe that this would insure that veteran's get a decent health care system. Let me toss in the White House and all its staff, as well (though we will leave it unstated as to what I'd like to toss them into).

I am also willing to place a small wager that Krugman spent more time considering his opinion about the study in question than STR did in formulating his statement:

"Krugman gives this immediate and complete credibility. Huh."

[Kary]

For those interested in watching Coyote get schooled on his "killer analysis", head over to Kevin Drum's site, and watch Lurker make mincemeat out of this genius.
http://tinyurl.com/2f28sc

[Kary]

Here's the permalink...
http://tinyurl.com/23rwbo