Medical Care Costs

This is actually from a thread on Political War Horse, a new forum mostly populated by refugees from Whistle Stopper – some in good standing, some banned, and some I would guess are likely to go from one status to the other some day. It’s not a bad forum, but of course it will never manage to match the original. ;)

Malpractice suits are not a particularly significant factor in health-care costs, and eliminating them serves little purpose but to deny recourse or compensation to people who have legitimate grievances. In many cases award caps (what most people mean when they talk about tort reform) did not have the desired effect, because award sizes were never the problem to begin with. Even the occasional honest medical magazine recognizes this fact, even going so far as to quote the GAO study showing the same thing. Punitive damages are necessary to get big companies to take notice of wrongdoing (they’ll shrug off small awards). While I happen to believe they should be paid to the state (lowering taxes) instead of to the plaintiff, I recognize that no change in this area will have an appreciable effect on overall health-care quality or cost.

The #1 reason health-care costs are so high is not even on the list above. As detailed in more detail than anyone could want in Laurie Garrett’s Betrayal of Trust, it’s the focus on medicine over public health. They’re not the same thing. For example, hospitals are all about medicine – treatment rather than prevention, and individual rather than collective outcomes. From a public-health perspective they’re often disaster areas, incubating and spreading the worst kinds of antibiotic-resistant disease. But you can make money on a hospital, so many hospitals have been built. There is actually a massive surplus of hospital capacity in the US, much of it built with public subsidies but returning profits to the private sector. The problem is that, even though it’s much more cost-effective overall than treatment, prevention is much harder to bill for and often requires the rather heavy hand of government to enforce quarantines or mandatory treatment. Thus the private sector has no interest, and even in the public sector public-health departments always seem to be a prime target for cost cutting. As a result emergency rooms end up providing thousands of dollars of care for ailments that a ten-dollar pill under a rational public-health program could have prevented. Then insurance costs go up, leading inevitably to more of those ER patients being indigent, and we all end up paying the bill.

You never reduce costs by focusing on who’s paying for what; you reduce it by focusing on the need for any money to be spent at all. If even one tenth of the money spent on treatment were instead given back to prevention (where it once was spent) the overall need to spend money on health would go down and so would the individual costs.

Amy’s First Meal

I know it has been a while, but here’s a video of Amy trying so-called solid food for the first time (1.8MB WMV).

End to End, or Not

Former CP commenter Richard Bennett, who has turned out to be one of the Internet’s most-banned jerks for his extreme dishonesty in political/social conversations1, turns out to be just as dishonest on technical issues. One of his “greatest hits” (in his own mind; check the category name) is Misunderstanding the Internet in which he takes aim at the end-to-end nature of the Internet. First, it should hardly be surprising that a guy whose professional reputation is based on work at the datalink layer thinks more network functionality should be moved downward and into the network instead of staying up in the hosts/endpoints, but the sheer hypocrisy of someone with such views accusing others of engaging in “turf wars” is astounding even for him. End-to-end architecture was adopted precisely because the lower layers designed by people like Bennett proved that they weren’t up to the task of providing reliable service, and the endpoints taking that responsibility turned out – empirically, again exactly opposite to Bennett’s claims about experiments making it into production – to work out better. In fact, it’s trivially demonstrable that no network layer (or below) that has knowledge and responsibility only for itself can provide better reliability than an endpoint using multiple networks.

Intellectual Gerrymandering

Something on my new favorite blog, It Affects You, got me thinking in a fairly Machiavellian direction.

If we had a magic bill which would instantly solve every issue women face but at the same time provide greater access to abortion, no social conservative would be able to vote for it. Abortion is a deal breaker, a non negotiable position.

In a more general sense, it seems like this is about combining or separating related beliefs or arguments in a way that produces a desired outcome. This is part of “framing” an issue, which is more usually thought of in terms of definitions and interpretations, but it’s a particularly Machiavellian part. It reminds me very much of congressional-district gerrymandering, in which two tactics are common:

  • Concentrating votes from what used to be several weak districts into one, to ensure a victory in that one instead of in none.
  • Splitting votes from what used to be one strong district into several (or from N into N+1) to produce narrower victories in more districts.

What IAY seems to be suggesting is the same sort of thing applied to boundaries between ideas rather than districts. The right has been very successful so far drawing the lines where it suits them, and maybe it’s time to start drawing them where they more intuitively belong.

Interesting Words

Can anybody guess what’s special about the phrase “polyphony reverberates”?


Usually I find Christmas/birthday shopping rather difficult. I don’t buy too many gifts, but (perhaps because of that) I generally want those I do buy to be unique reflections of my own aesthetics or knowledge – something only I would have bought. Sometimes this leads me on an extended quest to find the perfect embodiment of such an idea. Other times I have trouble coming up with one. Either way, it’s difficult.

Then there are the rare times when I see something that would just be so perfect for someone that I just have to buy it, even if it’s July and I’ll probably forget where I hid it by the time the next gift-giving occasion rolls around (so I usually just make it an early/late gift to be safe). For once, though, I seem to have found such a thing at just the right time. This is going to be sweet.