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POLICY: Dogs and sores at the Gray Lady, yet again

I thought that the NY Times was getting better, honestly. After all Gina Kolata, a major offender in the dogs licking sores series of last year, did feature Jack Wennberg this summer. But then recently the Times published an op-ed written by a big Pharma PR flack. At least that was an op-ed, even if it should have been on the op-ed pages of the WSJ. Now, we have “economic view” on health care written by Greg Manikw, the former chief Bush economic adviser who appears to be reinventing himself as a Romney flack. Manikw has some interesting ideas about carbon taxes (which of course never saw the light of day while he had any influence in the Administration), but why does the Times “economic view” on health care means regurgitating a bunch of Manhattan Institute talking points?

For that matter, if he’s an economist, why isn’t Manikw making any attempt at balance? And why is the Times letting him get away with this. As I said, it’s not the WSJ.

OK, so what are the points he makes. Standard Manhattan talking point stuff, so let me add the standard talking point answers.

1) While life expectancy and infant mortality rates are worse here
than in other countries but they are not good measures of a health care
system. Yes and somewhat true, but a) conceded by sensible health
economists, and b) these differences are not due to our different
ethnic makeup. (Yes that stuff about us having more teenage mums is
conservative code for us having too many minorities).

Except, that a big study of white English people and white Americans last year showed that richer white Americans had the health status of poorer English people.
That might somehow have some connection to the fact that we also have
worse coordination of care here than in most countries with universal
coverage. And of course part of the reason we have more low birthweight
babies may be that unlike the Brits, the Japanese and the French, we don’t have a comprehensive system of pre-natal care.

And even if it isn’t reflected in the numbers, shouldn’t it be mentioned as a possible cause. There’s plenty of data about it.

2) The uninsured numbers. What’s the unthinking argument?

  • Some people are either offered it at work or are rich and don’t buy insurance—so don’t count them. Except
    if they don’t buy it after being offered it at work they are far more
    likely to have low incomes. And the rich may not be that rich (high
    income families with several people in them) and may not be able to buy
    affordable insurance. Or at least so it says in this months Health Affairs.
  • Some people ought to be on Medicaid, so don’t count them as they’re “uninsured in name only”. Except of course if they did all try to sign up for Medicaid, the states
    would change the limits and dump a bunch of kids out as they did with
    S-CHIP in Florida and a bunch of other states in 2003
    . Perhaps those kids didn’t have names.
  • And some of these people are not even citizens, so they don’t even exist. Except
    a) a whole bunch of them are legal immigrants (I’ll admit to being
    grumpy about this as a former legal immigrant and now citizen) and b)
    most immigrants living here are paying taxes and even the illegals are
    not much of a burden to the system according to Rand. So why shouldn’t they be paying into the pool?

And even if all Manikw’s points have some validity, why is the
counter argument not mentioned? Let alone someone making the minor
point that if you don’t have insurance for whatever reason and you get
seriously ill, your life is financially devasted. A point made eloquently elsewhere in the NY Times yesterday by Bob Herbert.

3) “Health care costs don’t matter because we’re getting richer and
because we want it that way.” I cannot believe that after the reaming
this argument has taken from sensible people it’s allowed to be
repeated in the NY Times again!  No comment other than….aaarrgghhh!!
OK, OK. For the millionth time, this time I’ll quote Tom Leith who made
this argument on THCB in response to the last time the sore licking dog thing happened:

That portion of American health spending that is in excess of
other nations is predominately the result of supply-side market forces
that essentially "up-sell" the consumer. 3-D body scan instead of
X-ray; brand name drug instead of equivalent generic; surgical
procedure over non-surgical treatment with similar long-term outcomes;
disease management instead of health promotion, etc. It is true that
Americans expect heroic measures without an understanding of the costs,
but so much of our expectations are set by providers, particularly
physicians. The "consumer" is spectacularly ill-informed about
best-practices and the industry is far too often unmotivated to find
them because efficiency reduces payments.

So where are the counter-arguments? Apparently the New York Times
either thinks its readers are such geniuses they can validate these
arguments already, or it’s decided to become a mouthpiece for Manhattan
et al. Don’t they already have the WSJ?

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9 replies »

  1. > this time I’ll quote Tom Leith
    Thanks for thinking it was me, but it wasn’t: it was jd. Not that I mightn’t have said it…
    t

  2. tcoyote:
    It may be cash flow, but I tend to think that those folks are behaving pretty rationally in not paying for something they believe to be over-priced when compared to their perceived risk.

  3. 1) Have you ever read a newspaper before? It doesn’t sound like you have. As best I can tell, you are upset that Mankiw does not try to discredit his own valid arguments and that the NYT let him “get away” with that.
    2) On the immigrant thing. It’s a big deal and every hospital administrator in the south will tell you it is, even if Rand won’t. Not counting the legal children of illegal aliens as a cost of illegal immigration is a political maneuver. Up to 70% of the kids being born in many Texas children’s hospitals are the children of illegal aliens and I have to believe it’s similar in CA.
    3) You reference the big study of white Americans and white tea-sippers above. You have also stated before that disease treatment variances between countries also have much to do with the culture and history of that country (I think you referenced Fuchs and were essentially arguing that higher cancer survival rates in the US were a stupid thing to point to, but could be mistaken). So how much of the good/bad outcomes of any disease depend upon system vs. the culture of that country?

  4. “Terminal Condition” by Stephanie and Ralph Speken tells us that we spend more money than anyone else in the world – and have less to show for it. We have a second-rate system that doesn’t adequately cover half or more of the population. We encourage hospitals and doctors to perform unnecessary medical procedures on people who don’t need them, while denying the procedures to those who do. We clog our emergency rooms with patients who have insurance because they can’t get in to see their doctors. We stand a good chance of dying from a prescription drug taken at home. We charge the poor far more for their medical services than we do the rich. We force senior citizens with modest incomes to board a bus and travel to Canada or Mexico to buy drugs they can’t afford here. We require ambulances to drive around a city until they can find a hospital
    willing to accept a patient for emergency treatment. We have a system in such constant turmoil that almost everyone involved is unhappy – patients, doctors, nurses aides, technicians. Almost everyone. But for a lucky few, the turmoil is worth a lot of money. “Terminal Condition” documents the depth and extent of fraud in American healthcare, the resulting injury and death of patients, and the extraordinary efforts the healthcare industry has gone to divert the public’s attention from the issue. http://www.med-malpractice.com/terminalconditionface.htm

  5. With all due respect to all sides. This is a blog. It’s not supposed to be balanced. It represents a point of view. If you don’t like it, argue with your own facts. Otherwise, to be blunt, some of us are tired of hearing about how all arguments, however wrong, cruel, selfish or just plain people-hating are equal.
    Just because YOU hate people, Mr. Browning, doesn’t mean the rest of us have to. Just because YOU believe that people don’t naturally have a right to exist doesn’t mean the rest of us do. Just because YOU believe that we should all hail the “free market” and the goosestepping minority doesn’t mean the rest of us do.
    Just because you can put an arbitrary price on someone’s life doesn’t make it right. How about you let the rest of us have a go at it, since I think it’s obvious that your guys haven’t done so well.

  6. “if he’s an economist, why isn’t Manikw making any attempt at balance?”
    ‘Cmon Matthew. Economists are objective?

  7. There are two germs of truth in Mankiw’s spin oriented argument.
    Germ #1: homogeneous societies with compressed income distributions have fewer health disparities than societies like our own and higher average health status. Mankiw’s points here are valid and deserve to be made. The devil is in the lumpiness of the variations around the mean.
    Germ #2: wealthy societies can afford to spend more on health than poorer societies and do so. Whether it means that it is no problem that they do so is more complex. When one examines the opportunity costs of that spending in our “system”, one can see immediately the tradeoffs w/ corporate cash flow, wages of workers, R+D spending, public sector support of education, etc. Having recently visited Britain, Holt’s argument about how much better “co-ordinated” the care is over there is truly laughable.
    Minkiw’s intimation that most of those with incomes over $50 thousand are free riding on the health system and could easily afford to purchase health coverage is scary evidence of how out of touch the Republicans are in this political season. Though I can’t prove it, I believe the growing number of people in this income bracket who are uninsured is evidence of a serious emering household cash flow problem- fallout from high energy prices, rising food and housing costs, etc. To explain it away by suggesting that they are slackers is inviting calamitous political retribution. Bribing families with diminishing cash flow to take even more economic risk with high deductible health policies is political tone deafness taken to a new height.

  8. I find it interesting that you call for balance on the very, very rare occasion that a writer appears in the Times debunking the lies about life expectancy, infant mortality and the true number of uninsured. However, on a near daily basis – when these lies are presented as “facts” by the Times – they merit not a peep from Mr. Holt. Why have you never made a call for counterarguments in response to one of Paul Krugman’s recycled propaganda pieces? So much for balance and objectivity here.
    And yes – ethnic makeup and culture do have a big impact on life expectancy and infant mortality – regardless of what Mr. Holt says. Mr. Holt’s prenatal care argument is pure rubbish. Asian-American women seek prenatal care at an even lower rate than black women – yet they have the lowest rates of low-birth-weight babies and infant mortality. Could there be other cultural factors at play here – such as intact, functioning families with fathers?
    Come on Mr. Holt – prove that you can do better than ad hominen attacks and the inevitable charge of racism (your ever-reliable fallback position).

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