Fogel on Universal Healthcare
82 year old Nobel Prize winning University of Chicago economist Robert Fogel spoke recently at the annual Lindau meeting for Nobel Laureates. Fogel won the Nobel prize along with Douglass North in 1993 for the application of statistical methods to economic history, often with controversial results. At the Lindau meeting he said that the rising spending on healthcare in developing nations reflects the rising income of consumers along with a strong appetite for heathcare. He argued that “As people get richer they want to spend a larger share of their income on health.”
This comment drew an almost unanimous expression of sarcastic derision from readers of the Wall Street Journal, most of whom, evidently failed to understand that independently of the current American healthcare system, rising wealth, whether individual or national, correlates with greater healthcare spending. Fogel also said that governments should not interfere to decrease demand for healthcare in an effort to lower costs but should move to some form of universal healthcare for essential services with extra user costs for additional services such as shorter wating times, private hospital rooms, and expensive elective surgeries. Now, am I daft or can these comments be constructively applied to the USA?
Faint Praise for Medicare, Drug Benefit
The Kaiser Family foundation released studies on Thursday showing that most Physicians and Pharmacists believe that the Medicare, prescription, drug benefit is helping people save money but feel that it is overly complex.
Among the findings in the survey of 834 Physicians and 802 Pharmacists:
For the complete article visit the Kaiser network.
Can anyone say “Nationalized Healthcare?”
Acceptable Medical Losses?
In a Canadian retro-review of 1240 heart attack cases only 3% (41 patients) survived after efforts to restart a heart through CPR, electric shock and transport to hospital, discouraging results to be sure.
Lead researcher Dr. Laurie J. Morrison of the University of Toronto then isolated three criteria to help rural paramedics determine when to cease resuccitation efforts in the field and avoid additional measures that can severely strain healthcare delivery systems and that pose unique hazards of their own. ”Taking such lost causes to the hospital ties up ambulances and emergency departments, and the race to get there is hazardous for rescue workers and other motorists,” the researchers said.
The team’s recommendations specified that paramedics terminate CPR if a pulse couldn’t be restored, if the defibrillator determined that an electric shock shouldn’t be given and if the cardiac arrest wasn’t witnessed by a rescue worker. The criteria were applied in the course of ongoing emergency responses. Researchers say that the test closely predicted throughout the study who was likely to die. Overall, 776 patients met all three criteria, and all except four died, a survival rate of 0.5 percent (1 in 200).
“If the test were applied,” said the article, “it would reduce by about two-thirds the number of patients taken to the hospital, the researchers said. When two more criteria were added — paramedic arrival time of more than eight minutes and an attack not witnessed by a bystander — the test worked even better.”
For Feedback:
1) What level of payoff is insignificant for emergency care? 1 in 200? 1 in 400?…
2) Are you comfortable allowing a rural paramedic with 2 years or less of training to decide whether you live or die?
John Kay: The Hedgehog and the Fox
British economist, John Kay has just recently published a new book, “The Hare and the Tortoise,” a collection of essays. Not yet available in America, it has been available in England since June 5th and may be ordered through Amazon.UK. A quick peruse of his website will soon whet anyone’s appetite for more.
In one recent essay published at Johnkay.com, he pnders the conclusions of Philip Tetlock’s new book Expert Political Judgment (Princeton University Press) and reframes the oft used concept of the hedgehog and the fox to explain why, as Tetlock’s study found over a period of 20 years and 30,000 predictions from 300 experts, that amateur prognosticators performed better than the experts. As a small consolation he found that experts did perform better than chimps who answer randomly.
In considering the seemingly paradoxical finding he asks the question, “Why are the predictions of well known experts worse than those of people who linger in obscurity? Isaiah Berlin’s distinction between the hedgehog, who knows one big thing, and the fox, who knows many little things, provides a clue to the answer.”
The quotation itself is based on a line found among the fragments of the Greek poet Archilochus which says: “The fox knows many things, but the hedgehog knows just one.” For those familiar with Jim Collins’ book, “Good to Great,” it is the “hedgehog concept” that offers superiority but for Kay it is the inherent qualities of the fox that, for differing reasons, lend advantage in a complex world.
Kay writes, “But these hedgehog characteristics are exactly those that politicians, journalists and business leaders demand of advisers and commentators. Harry Truman famously sought a one-armed economist, who would never say: “On the one hand, then on the other.” Broadcast media look for snappy soundbites. Corporate executives demand “the elevator pitch” for new ideas. Fund managers want specific forecasts. Business audiences do not want to hear that the world is a complex and uncertain place. But, unfortunately, it is.”
