Tag: International

POLICY/INTERNATIONAL: More boring pointless mush from the AEI

So the WSJ gives another know-nothing big oil-sponsored hack from AEI another forum to use the same tired defense of the US system in the Elizabeth Edwards case. Oh look! Cancer outcomes are worse here than in Europe therefore their health care systems must be worse. With the unspoken implication that if her husband’s plans get enacted she’d be dead.

Just for a minute ignore all the other issues about costs, the 18,000 people whom the IOM says die each year here earlier than they would in those European countries because they’re uninsured, medical bankruptcies up the wazoo, etc, etc, and feast your eyes instead on this little nugget from a much longer article at the Annals of Internal Medicine.

Contrary to popular belief, the health care here isn’t always the best. Many other industrialized countries provide health care that is just as good and sometimes better. For instance, 30-day acute myocardial infarction case-fatality rates are below 7% in Denmark, Iceland, and Switzerland, compared with almost 15% in the United States. Incidence of major amputations among diabetic patients in Finland, Australia, and Canada is less than 10 per 10,000 compared with 56 per 10,000in the United States. And Australia, Canada, England, and New Zealand all have a better 5-year kidney transplantation survival rate than the United States.

There are so many better things to be arguing about.

But if the AEI and the fake free-marketeers want to play that game, why is the American health care system killing people with heart attacks, or chopping the legs off diabetics at more than double the rate of foreigners? Does the AEI really want to go down that path–particularly as there are way more Americans  with heart disease and diabetes than with cancer.

INTERNATIONAL: Having run ahead on primary care PCP, Brits copying Medicare on hospital P4P

The Brits have decided that in at least some regions their hospitals are going to try American style P4P

Health bosses have announced a plan to reward hospitals for low death and infection rates and few readmissions. NHS North West said it was piloting a scheme where cash bonuses are paid to hospitals following the success of a similar programme in the US. Trusts will compete for a total pot of £1.5 million, with any ranking in the top 10 per cent or 20 per cent getting a share. Initially, payments will be made for treatments for heart failure, pneumonia, heart bypass grafts, and hip and knee replacements. But critics said people would expect hospitals to be prioritising safe care anyway.

Don’t forget that on the primary care side they’ve been well ahead of anyone else. Although that’s had it’s issues too. The first year the GPs beat their targets so easily, they’ve made lots more money then the government thought they would.

POLICY/INTERNATIONAL: A split in the libertarian right? (albeit a Canadian one)

Buried at the end of a rant about the evils of the Canadian system from our northern brethren’s version of Cato/PRI—the Fraser Institute—is their solution for what to do about it all.

Canada should adopt a system like Switzerland’s that offers universal compulsory private health insurance that includes drug coverage. That way we could have both the benefits of cost-efficiency and the broadest possible access to advanced medicines and medical care," Skinner concludes.

Err.. so some libertarians do think that we should have compulsory health insurance including drug coverage? That’s not very free market of them. No wonder David Gratzer and John Graham had to run away! After all, I need here to quote what Cato’s Michael Cannon wants, or at least doesn’t want, from comments he’s written just last month on THCB.

You’ve been kind enough to put me in the "sensible libertarian" category in the past, so on behalf of all of us: yes, abolish mandates, abolish community rating, and let people group and pool voluntarily. Per Pauly and Herring, you might be surprised how much pooling you get. But if you’re still unsatisfied, this Guide to Subsidies can help:

Voluntary subsidies via insurance: good.Involuntary subsidies via insurance: bad.Involuntary subsidies via cash: less bad.

Michael and I will agree to disagree on the merits of mandated/involuntary subsidies (or community rating)/taxes et al—and for that matter on the validity of Mark Pauly’s body of work. But I’m surprised to see that the Fraser guys are coming down on my side of the line.


My dad told me never to become a doctor. As I failed physics "O" Level and wandered off into social sciences that was probably sound counsel for me, but in general his advice may not have been correct. With the bonus payments and a bunch of other incentives, it looks like British GPs are really making out these days. Apparently average income is now north of 100K GBP, which is far in excess of income for primary care docs over here (if you take it at the $2 to 1GBP exchange rate).

And they are pretty happy about it, or as we Chelsea fans say "top of the league and having a laugh"

INTERNATIONAL: Japan’s Health Minister engages mouth, brain not yet in gear

    You’ve got to hope that this one was "lost in translation"!

Japan’s health minister described women as "birth-giving machines" in a speech on the falling birthrate, drawing criticism despite an immediate apology. "The number of women between the ages of 15 and 50 is fixed. The number of birth-giving machines (and) devices is fixed, so all we can ask is that they do their best per head," Health, Labor and Welfare Minister Hakuo Yanagisawa said in a speech Saturday, the Asahi and Mainichi newspapers reported.

Birth rates (and dependency ratios) are indeed a serious issue. But perhaps Yanagisawa’s been spending too much time reading Malcolm Galdwell and not enough at charm school!


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