The End of the Japanese Miracle… and the American One
Scott Alexander at Slate Star Codex has a very good post on cost disease. It definitely betrays a strong libertarian or conservative bias, but is nevertheless, worth reading.
The piece that resonates with me is posted below. It has some good insights, one or two that are questionable (for anyone not firmly ensconced on the right), but overall it methodically works its way to one hell of a punch-in-the-gut truth in last sentence.
Imagine if tomorrow, the price of water dectupled. Suddenly people have to choose between drinking and washing dishes. Activists argue that taking a shower is a basic human right, and grumpy talk show hosts point out that in their day, parents taught their children not to waste water. A coalition promotes laws ensuring government-subsidized free water for poor families; a Fox News investigative report shows that some people receiving water on the government dime are taking long luxurious showers. Everyone gets really angry and there’s lots of talk about basic compassion and personal responsibility and whatever but all of this is secondary to why does water costs ten times what it used to?
I think this is the basic intuition behind so many people, even those who genuinely want to help the poor, are afraid of “tax and spend” policies. In the context of cost disease, these look like industries constantly doubling, tripling, or dectupling their price, and the government saying “Okay, fine,” and increasing taxes however much it costs to pay for whatever they’re demanding now.
If we give everyone free college education, that solves a big social problem. It also locks in a price which is ten times too high for no reason. This isn’t fair to the government, which has to pay ten times more than it should. It’s not fair to the poor people, who have to face the stigma of accepting handouts for something they could easily have afforded themselves if it was at its proper price. And it’s not fair to future generations if colleges take this opportunity to increase the cost by twenty times, and then our children have to subsidize that.
I’m not sure how many people currently opposed to paying for free health care, or free college, or whatever, would be happy to pay for health care that cost less, that was less wasteful and more efficient, and whose price we expected to go down rather than up with every passing year. I expect it would be a lot.
And if it isn’t, who cares? The people who want to help the poor have enough political capital to spend eg $500 billion on Medicaid; if that were to go ten times further, then everyone could get the health care they need without any more political action needed. If some government program found a way to give poor people good health insurance for a few hundred dollars a year, college tuition for about a thousand, and housing for only two-thirds what it costs now, that would be the greatest anti-poverty advance in history. That program is called “having things be as efficient as they were a few decades ago”.
I should note that the spending examples cited in the above paragraphs have numerical support earlier in Alexander’s post. But the problem with the post is the lack of a satisfactory answer to the question it raises: what caused the massive declines in efficiency we saw in many vital parts of the US economy?
And here I am pleased to say I can help. I actually provided an answer to that question in a post I wrote six years ago explaining why Japan grew so rapidly after WW2 and what policy changes led to the end of its rapid rise.
I encourage you to read my post, but it comes down to this: the Japanese Miracle ended when its fabled bureaucracy became far less of a test- and performance-based meritocracy. This was done with the noble cause of broadening inclusion, which of course, was severely lacking in the old system. But the baby was thrown out with the bathwater. The new system ended up just as unfair as the old one, but in very different ways. Unfortunately, it also became a lot less efficient. Test scores turned out to be positively correlated with performance. Highly correlated. It didn’t take long for the public to notice the change. The deference once afforded to entities like MITI dwindled and died. Soon the ministries could no longer command the respect they needed to actually run the economy, much less the competence to do it well. But the now enfeebled bureaucracy could still influence events. It went on to buy into Reaganomics (tax cuts, smaller government, and a trade policy that was less export oriented). Put another way: Japan Inc. started hiring suckers, and predictably the suckers got suckered.
The parallels with the US are obvious. That isn’t to say all is doom and gloom for either Japan or the US. Both countries remain rich, prosperous, and innovative. But Japan no longer inspires the world as it once did. The Japanese Miracle ended decades ago. And I have a real fear that America’s best moment may also in the past. Policies that elevate mediocrity achieve just that. And they are awfully hard to reverse.
Every developed country in the world — Canada, UK, France, Germany, Italy, and yes, Japan — has figured out how to provide health coverage for 100% of their populations at half the cost of the U.S.
Gee, maybe the U.S. could learn something from the rest of the world, But the doctors, hospitals, medical device companies, pharmaceutical companies and insurance companies are very powerful lobbies and they are not willingly going to give up their economic rents.
It has nothing to do with your BS hypothetical loss of meritocracy. Crony capitalism is working exactly as it was designed.
Balderdash. Here in the United States, health care is as much as meritocracy as it has always been. Yet prices have soared — drug prices, provider costs, everything.
For some things, the reason is obvious. Drugs have become an oligarchy where a few incredibly wealth companies coop-pete rather than com-pete, and drive out of business any new company that comes along and attempts to compete through the Walmart strategy of slash prices to the bone until the upstart runs out of money, then raise prices even higher. But for other things, like higher education and hospital costs? The reason for the higher prices is COMPETITION. Specifically, they’re all competing to have the best facilities, the best amenities, the best basketball team, the best. Because see, here’s the thing: Education determines your future. And everybody wants the best future they can afford, so everybody tries to get into the best colleges, which in turn allows those colleges to raise their tuition. And the colleges that are *not* the best spend money like water to try to move themselves up into that “best” ranking — hiring “name” professors for big bucks, building spiffy new facilities filled with the latest greatest (and most expensive) equipment, and so forth. Because if they get to be “the best”, then they get into that gravy train too where people are clamoring to get in and they can justify the price hikes.
Same deal with hospital facilities. Cost literally is irrelevant if you have a life threatening illness. Are you going to go somewhere with bare-bones equipment that isn’t the latest and greatest for treating your illness that has a lower chance of curing your life-threatening illness? Or are you going to go to the place with the best of everything, that has the best chance of curing your life-threatening illness? If you can swing it, you’re going to go for the best, because you don’t want to die. So every health care provider is competing to be the best by buying the latest equipment, the shiniest facilities, and so forth, even if they’d all be vastly underutilized if not for ordering unnecessary diagnostics. Underutilized = inefficient. But they’re competing to be best, and efficiency be damned.
The point being that the profit motive itself is what’s causing this here in the United States, whether it’s the oligarchs who run the drug oligopoly, or the individual providers all competing to be the best rather than the cheapest (because cheapest is no good if you’re dead, I know if I got cancer, I’d want the best, not the cheapest, ’cause I don’t wanna be dead!). There are well known efficiencies that can be wrung out of the system — look at McAllen TX vs El Paso TX for an example, same laws in both places, similar populations in both places, vastly different per-capita healthcare costs because the providers in El Paso came together and agreed to some basic efficiencies and agreed to quit competing based on who had the latest and greatest gadgets. They make less money than doctors in McAllen though, so overall, as a nation, we look more like McAllen than like El Paso.
We aren’t going to fix this cost issue until we realize that competition is the problem, not the solution. Because these aren’t things where people buy based on cost. They’re things where people buy based on their future — whether they’ll have one at all (in the case of health care), or whether they’ll have a decent one (for higher education). There’s a saying that economists know the price of everything and the value of nothing. This is a pure example of that. Economists know the price of education and the price of health care. But somehow, they seem to have forgotten the value of these things — a value which is literally infinite in the eyes of those who are ill in the case of health care for life-threatening diseases (which is the vast majority of healthcare spending). Because what use is saving money if you’re *dead*?
Badtux:
It is a pretty reply looking at the cost of capital involved with delivering perceivably good healthcare. We are an economics blog and Mie is a doctorate as well as some other people who write and wander into this space; however, other people would more than likely not understand your point or argument. When I am seriously ill, I do not go to the best as I do not have time. I go to the closest one. This worked in Ohio where I was working at the time and after going through a month of chest pains which were mild causing me to think it might be a reoccurrence of pneumonia. I even had an EKG at my PCD which showed I had a heart and a well functioning one at that. This occurred about 3 months after having gall bladder surgery in the same mid-sized Ohio hospital. I knew the way. Wandered in and politely told them I was having mild chest pains. The door opened magically and I was taken into the ER. Some blood drawn and an imagining and suddenly I had a catheter in my groin going up to my heart with a pump. My heart was fluttering, hence the pain. Sears best rotary saw and three arteries bypassed. Just for the record, cholesterol was 104. The same as my gall bladder I went to the closest in a time of need because I trust doctors.
My wife and kids came down to Ohio. Looked up the hospital between Columbus and Cleveland and found MedCentral had two former Cleveland Clinic surgeons on staff. We decided to stay rather than move my carcass around. Again, it was the doctor’s reputations which convinced us to stay put. These heart surgeons in this hospital gave it the reputation of being in the top 5% nationwide for this operation. People trust doctors.
Atul Gawande writes about doctors and the immense amount of trust we place in them. I pulled this out of “New Yorker” as Dr. Gawande makes a point as to what is wrong with healthcare today. Dr. Gawande does quite a few lectures on healthcare. I know of him because of my association with Maggie Mahar of Health Beat. Here is what he had to say:
Your comment lays the groundwork for what I will say next. Healthcare today is a business, a business of selling services with little regard for the outcome quality. In many cases, it does not take the latest technology to cure an illness or fix a disorder as there may be other proven ways to do so having a higher percentage of better outcomes. Stents versus medicine treatment is one example of such (I had not choice and would not recommend this for a week’s stay in the hospital. I sneezed the first day after and thought my chest was going to explode). Hospitals push the use of that expensive equipment when it is installed to pay for it over time when maybe it was never need. There is the cost of capital and potentially the cost of in-needed services. Healthcare industry today is in the business of selling services and without regardless for the quality of the outcome.
Another issue Atul brings up is the ability to test patients. As he states, doctors have the ability to walk-about or look-around a patient’s body more now than ever before. “Why not take a look and see if anything is abnormal? People are discovering why not. The United States is a country of three hundred million people who annually undergo around fifteen million nuclear medicine scans, a hundred million CT and MRI scans, and almost ten billion laboratory tests.” One reason why these tests might not be needed is the cost. ~$3-$5,000 for an MRI? Another reason is the tests may be harmful in them selves. Additional testing when there are no serious symptoms add no useful information. Many times, the tests are fishing expeditions. The availability of the fanciest equipment in town makes it easier for a doctor to sent the patient over for that $5,000 MRI when it probably was not needed. I can see your point on the capital side; but, it is the doctors which sway patients as more than likely we go by word-of-mouth from the same doctors.
Here is the 2015 New Yorker article by Dr. Atul Garwande Overkill, An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? Philip Longman’s “Best Care Anywhere” is another good one on healthcare. In the beginning, he discusses the care his wife received, Timothy Noah’s wife received, the confusion over the treatments, and how they were blocked from reading the reports. Thank you for commenting on Angry Bear. Good to see you here.
BillB,
A good theory applies to a lot of data points. And healthcare is not the only industry facing this massive cost disease. Try to buy an F-22 or an F-35 and tell me how many competitors there are for fifth generation fighter planes. Or have the city of Boston try to dig a hole in the ground. Heck, what happens if your town decides to build a new high school. Will it be cheaper than the old high school?
Badtux,
So the folks admitted to medical school are those with the best scores on MCATs? And the managers at the insurance companies are distinguishable from people in other industries by higher GMAT scores? Higher SAT scores?
And anyway, I disagree with your premise another way. The bleeding edge drugs and equipment in medicine (and other industries) typically comes from tiny companies that get bought out (and ruined) by the big boys. The bleeding edge innovator is usually a meritocracy. The dinosaur that buys the bleeding innovator is not.
To use the example I noted above – what happens when your town decides to build a new high school? Is it typically more expensive or less expensive than the high school it replaced?
From what I can tell, we still produce great tech and materials work.
Run,
At one point I dated a woman who taught in a medical school but was primarily a researcher in some field of medicine I cannot remember. But I do remember the gist of a comment she once made about MRIs: “there is no way I am going to lie there and let a machine point every cell in my body in the same direction.”
Recreational use of medical technology does drive up costs tremendously and may even worsen outcomes.
FWIW, in my career, I find that the older (more experienced), the more I am able to accomplish with simple tools. Occasionally you need the whizz bang, but in general, I suspect the better one is at one’s job, the fewer fireworks are required. (Of course, the older I get, the more technologies that used to be complicated has been made simple too.) I suspect the same is true in medicine.
Mike:
What, she did not like mutants? Professor Charles Xavier will not be happy with her.
When it comes to medicine, there is no doubt that the overriding interest of the providers is not achieving the best result for the lowest cost, but rather to run up the bill and avoid being sued. And the grifting extends to all parts of our economy–education, industry, military, legal services. I know the most about legal services and can assure you that it remains a meritocracy, but one where the most successful lawyers are the ones who can convert their expertise into the most dollars. While they undoubtedly want their clients to come out well–that is how they keep them–they want to do so at the highest possible cost. Like medicine, that results in many procedures which are not “efficient” but which increase the cost of the service. In much of the economy, lack of efficiency is a feature not a bug
Also interesting is the interaction between higher education costs and healthcare costs. Doctors now graduate with huge amounts of debt that can only be paid back via unnecessary tests and procedures. They get into the habit of doing so and continue the habit after they pay off the debt. Then add in information asymmetry. Virtually nobody can tell you exactly what a procedure will cost or whether a procedure is *really* necessary or there’s a lower-cost alternative (for example, gall bladder surgery? Or a change in diet to dissolve gallstones? They’re equally effective, but guess which one makes more money for the surgeon?). People are left looking for proxies for quality because outcomes information is virtually impossible to find.
Why looking at proxies such as university and internship location? Simple. Meritocracy. The most selective universities and internships get the highest rated students. As you go down the tiers of med schools you get lesser and lesser students, the ones who weren’t good enough to make it into the better med schools. The notion that there is no meritocracy is the cause of the loss of efficiency in health care doesn’t pass the laugh and giggle test for anybody even remotely familiar with health care economics, there is enormous competition for the limited number of available residencies, for example, and merit is the principal mechanism for awarding them. It’s not lack of meritocracy causing the problem. Information asymmetry and the fact that people just want to be cured and aren’t looking at price (even if price were available, which it isn’t) combined with providers who are comfortable “churning” tests and procedures to raise their own profits create a perfect storm. McAllen TX vs El Paso TX is the perfect comparison there, as I mentioned before — similar populations, same laws, vastly different health care costs because vastly different “health care” cultures.
In short: When inefficiency causes higher profit, you will get more inefficiency.
Duh.
Badtux:
Sorry, quality outcomes are not that difficult to find; however, the industry is not looking to better and proven outcomes as much as selling more services. It appears your word of the day is “meritocracy” for you. Doctors graduating with a “yuuge” amount of debt is moving in a different direction than what you started out with and that was paying for the capital investment of hospitals when they bring in new equipment and build new “yuuge” buildings a few miles down the road (if that far) to house the new equipment.
Change the philosophy on the delivery of care. Give better information on what treatment is needed and look to its effectiveness. The price of care and procedures in a hospital and in a clinic is also unavailable. It is called the Charge Master.
Well, I had to do a google search for “MITI”, having no idea what it is or was, and found its Wikipedia entry, at https://en.wikipedia.org/wiki/Ministry_of_International_Trade_and_Industry.
“As late as the 1980s, prime ministers were expected to serve a tenure as MITI minister before taking over the government. MITI worked closely with Japanese business interests, and was largely responsible for keeping the domestic market closed to most foreign companies.
“MITI lost some influence when the switch was made to a floating exchange rate between the United States dollar and yen in 1971. Before that point, MITI had been able to keep the exchange rate artificially low, which benefited Japan’s exporters. Later, intense lobbying from other countries, particularly the United States, pushed Japan to introduce more liberal trade laws that further lessened MITI’s grip over the Japanese economy. By the mid-1980s, the ministry was helping foreign corporations set up operations in Japan.
“The decline of MITI was described by Johnstone:
‘… by the early 1980s, when Western analysts first became aware of MITI, the ministry’s glory days were over. In 1979 MITI lost its primary instrument of control over Japanese firms — allocation of foreign currency. The power, that is, to decide who could — and who could not — import technologies. [For example] … MITI bureaucrats attempted to deny fledgling Sony the $25,000 the company needed to license transistor technology from Western Electric.[1]’
“However MITI still continued to benefit industry, especially in semiconductors, where, to overcome resistance to a new technology, it forced every electronic company to have at least one CMOS project going.
“The declining significance of MITI to Japanese companies made it a less powerful agency within the bureaucracy, and by the end of the 20th century, it was folded into a larger body. In 2001, it was reorganized into the Ministry of Economy, Trade, and Industry (METI).”
The ”inclusion” that caused the decrease in stature of the MITI (which has not existed since 2001) turns out to be inclusion of a floating exchange rate and inclusion of more liberal trade policies. Assuming, of course, that the current Wikipedia entry is accurate.
If it’s not, maybe Mikey can edit it to show that the agency’s loss of stature and ultimate demise—along with the Japanese Miracle—was due to affirmative action in Japanese schools, universities and industry and general tech research. Cuz everything else stayed static, including that Japan has maintained its postwar speed of economic and tech-research transition.
Just like the U.S., whose postwar period of massive economic expansion and innovation ALSO ended cuz of affirmative action!
That a blog that bills itself as an economics blog allows this outright false statement of fact about the MITI and Japan’s postwar economic expansion and innovation highpoint to be posted on it is, I suppose, in perfect keeping with the Trump era. Alternative facts are just as good as actual facts. Better, even!
As for affirmative action in medical schools being the culprit in the spiraling cost of healthcare, why, I couldn’t agree more! After all, it’s a known alternative fact that there is a clear correlation between the SAT and MCAT scores of physicians who received their MDs at U.S. medical schools and the number of unnecessary tests and prescription drugs they prescribe, and even clearer alternative documentation showing a correlation between those admitted to college and med school under affirmative action and wrong diagnoses and surgical screw-ups requiring additional medical treatment.
But what REALLY increases the cost of healthcare is ALL THOSE INCOMPETENT DOCTORS WHO ATTENDED COLLEGE AND MEDICAL SCHOOL OUTSIDE THE U.S. and don’t even HAVE SAT and MCAT scores. These people come into this country and take medical residencies here and THEN ARE ALLOWED TO STAY HERE TO PRACTICE MEDICINE BECAUSE OF THE SHORTAGE MEDICAL SCHOOLS AND MED SCHOOL SLOTS IN THIS COUNTRY. And then THEY ORDER EXPENSIVE TESTS AND PRESCIBE EXPENSIVE MEDICATIONS FOR THEIR PATIENTS!
You know what, folks? Mike Flynn was a lifelong Democrat and completely normal person until he underwent a bizarre change in ideology, becoming an extreme Islamophobe and alt-right-conspiracy-theory fan, taking his friends, former colleagues and acquaintances by surprise. http://www.politico.com/magazine/story/2017/02/who-told-flynn-to-call-russia-214782
But his former colleagues and acquaintances didn’t go into denial mode and pretend this hadn’t occurred.
Kimel’s said on a few occasions that he voted for Obama twice but supported, would vote for, and then did vote for Trump. He’s as obsessed with white supremacy in all its terms—anti-immigration, anti-black, anti-safety-net (which he views, incorrectly, as a non-white thing: https://www.washingtonpost.com/news/wonk/wp/2017/02/16/the-biggest-beneficiaries-of-the-government-safety-net-working-class-whites/?utm_term=.1ae9cf70b75a)–as Flynn is with Islam and Muslims.
And he keeps using this blog, and his supposed economics expertise, to push outright falsehoods, as he did here—presumably permitted to do so because he used to be a progressive and the people who operate this blog haven’t noticed that he’s now using it, and them, to push flat-out falsehoods of act.
Do these people care that this contributor’s representations of fact here re Japan’s MITI and end to Japan’s postwar economy are outright lies? This is not a rhetorical question.
“The price of care and procedures in a hospital and in a clinic is also available. It is called the Charge Master.”
Uhm, no it isn’t. There are listed posted prices, and there are negotiated prices, and there are prices that are imposed by Medicaid or Medicare, and there are third party prices that aren’t even on the so-called “Charge Master”. The price for any given procedure or hospitalization depends upon your insurer, the charges charged by third party providers such as radiologists and anesthesiologists who aren’t on any rate sheet at a given facility and who may be either in-network or out-of-network (different rates for each), so on and so forth. And all of this is negotiable. I had an out-of-network radiologist charge me full price. I negotiated with his office and got him to agree to take the Blue Cross price because the service was provided at an in-network Blue Cross facility even though he was out-of-network. The point is that I never even *saw* this radiologist, much less got the chance to ask him what the price was for his services or ask him whether he was in-network or out-of-network, before he actually performed the service. The emergency room took the x-rays, the ER doctor did the initial scan of the x-ray to see whether I had a broken neck, but nobody asked me whether that x-ray was going to be sent out or gave me any chance to ask what the price of the radiologist was going to be. There’s virtually no — zero — price transparency in the health care world. Nobody actually providing the care can tell you how much it’s going to cost to do a procedure, they shrug and say “it’s whatever the back office can get out of your health insurer.” Plus whatever third party providers can get out of you or your health insurer.
And outcomes information is *not* easily accessible to ordinary people. They aren’t doctors. If a doctor tells them “you need surgery to remove your gall bladder”, how would they know that probably a change of diet would solve their gallstone problem?
Again: When inefficiency is profitable, you will see more inefficiency. Removing a gallbladder is profitable. Telling the patient to change his diet is not. For most people both are equally effective but one is more profit for the provider. Which one is the provider going to say you should do? You do the math. Inefficiency is more profit, so inefficiency it shall be.
Badtux:
Sorry, meant “Unavailable.” Was in a hurry this afternoon.
I already know the rest of what you are saying. My UHC policy included a negotiation format in the policy for out of network doctors to see if they would take the negotiated rate if the insured had no choice(emergency). I pushed personnel to include it. It was one of the things I made sure the company had. All of the radiologists were out of network.
Of course outcome info to patients is not readily available so what is your point??? Your statement here “If a doctor tells them ‘you need surgery to remove your gall bladder’, how would they know that probably a change of diet would solve their gallstone problem?” reiterates my point that people depend on doctors. Doctors tell people and people follow. Change the system so as there is a steady trend by doctors towards using result based procedures and meds. Medicare will slowly evolve to this. The VA has done so as they have changed some of my meds to cut costs.
Usually by the time a person goes to the hospital with a gall bladder issue, it is coming out. My diet was good.
Here is my other point and I will reiterate it again: Change the philosophy on the delivery of care. Give better information (doctors) on what treatment is needed and look to its effectiveness. The price of care and procedures in a hospital and in a clinic is also unavailable. It is called the Charge Master.
Quit selling more services. I think you are conflating inefficiency as if the sell of more services is the result of a poor process. I see this in a different light, one of which to sell the service whether needed or not. To me this is not inefficiency. Thank you and sorry about the “unavailable.”
Beverly,
I suggest you follow the link to my post. You’ll find that I quoted liberally on the decline of Japanese bureaucracies from the US Army’s Country Area Studies and B C Koh’s book on the Japanese bureaucracies. Admittedly the Army had little reason for or interest in understanding Japan and few resources to do it. Worse, Professor Koh had clearly strayed from his usual bailiwick, East Asian bureaucracies, when he wrote the book about Japanese bureaucracies that I quoted so heavily.
Badtux,
Excellent point.
Badtux + Terry combined,
Inefficiencies as a feature, not a bug as a cost driver. Yup. And it isn’t something I considered here. But why has that gotten worse now?
I used to do some work for aerospace contractors in the ought. The old engineers were always grumbling that the satellites were more advanced (and so much more costly) NASA had largely lost the ability to pop them into orbit by itself.
Mike:
Doctors are selling services without regard for the outcome.
gee, can’t we all do just like Rand Paul and call up all the doctors in the yellow pages and ask them how much they are going to charge us?
[advertisement: people are not in a position to evaluate the reasonableness of the treatments they get, or the cost. The Federal government probably is. It’s not a questioin of “the government” paying for everything everyone “demands.” The people will still pay for it, but it is more sensible to do that by an insurance plan that contemplates they whole lifetime of the insuree… (so you pay at a steady rate your whole life for treatment you mostly wont get until you are old and don’t have any money). This of course is Medicare (or was until Medicare became semi welfare [make the rich pay].
Only none of it works unless the government oversees costs and outcomes. And this requires that the oversight be honest and not captive by the healthcare industry… etc. the details are left as an exercise to the student.
Kimel has a theory of everything that works by ignoring all the facts and factors that don’t fit.
and… fair disclosure… i have a doctor i like who won’t accept Medicare because they limit her choices which keep her from practicing best medicine. I don’t know what the facts are or what the answer is, but i am pretty sure that price shopping, or MCATs are not the answer. Obviously Atul Gowanda is a dark skinned foreigner and should not be allowed to practice medical commentary in this country.
and like Beverly i hope my ironic voice is understood.
Bev – You say:
After all, it’s a known alternative fact that there is a clear correlation between the SAT and MCAT scores of physicians who received their MDs at U.S. medical schools and the number of unnecessary tests and prescription drugs they prescribe, and even clearer alternative documentation showing a correlation between those admitted to college and med school under affirmative action and wrong diagnoses and surgical screw-ups requiring additional medical treatment.
Bev – I think you are making stuff up. What the hell is a, “Known alternative fact”??
I think you are pushing phony information. So please prove me wrong and provide some links to back up your claims.
But but but, Mike. The Japanese have been vigorously keeping out immigrants to the point that their total population has been declining now for over a decade. Shouldn’t this mean that they should be doing just great based on earlier posts of yours?
Krasting
you have fallen afoul of Beverly’s ironic voice.
as for a “known alternative fact..”: that was a genuine piece of wit i missed the first time around. thanks for pointing it out.
Oh, dear. And to think that I assumed Krasting follows Kellyanne Conway’s every utterance. And certainly her utterances that are the butt of jokes and the subject of scads of pundit and comedian comments for WEEKS.
Silly me, I guess.
” none of it works unless the government oversees costs and outcomes. And this requires that the oversight be honest and not captive by the healthcare industry…”
Yep. France does this. We don’t. Thus one reason why France’s system is 2/3rds the price as now despite equal access to advanced treatment options.
“But why now?”
Comparatively speaking, U.S. healthcare has not become less efficient compared to healthcare elsewhere in the world. Basically, U.S. healthcare has always been more expensive than healthcare in the rest of the world, But health care has become more expensive worldwide — not because it’s become less efficient, but, rather, because we’ve developed cures where, when I was a child, the Merck Manual (the standard diagnostics manual for health providers) said “send patient home with palliative care to die”. It was hard to rip off the system with bandaids and aspirin, all that the medical profession had for many diseases back then. Now we have all these new expensive / sophisticated treatments, suddenly it’s like providers are in this garden of delights.
In short, US healthcare has always been comparatively inefficient compared to countries with near-identical mortality rates. The ratio of inefficiency really hasn’t changed. But when it was 6% US GDP vs 3% Britain back in the 60’s, nobody cared, while when it’s 17% US GDP versus 8.5% Britain in 2013 because Britain has added new expensive treatments to their repertoire to save the lives of more Britons, people start to care. The ratio hasn’t changed. But the scale of the ratio has changed, and that’s really starting to hurt.
Badtux
thanks for pointing that out. scale is content.
in part it’s a question of how much do we want to pay to live a little longer. and in part it’s a question of how much do we want to control that cost so providers aren’t living like kings while everyone else has medical care and nothing else.
and in part… i cut my thumb a year or so ago. thought it might need some stitches. which it did. provider billed Medicare over $4000. there was no high tech equipment involved. no sophisticated science requiring teams of doctors. just the stitches that would have cost maybe twenty dollars when i was a kid. call it about two hundred now.
and while i was there they put heavy pressure on me to get an operation. i didn’t need the operation. the thumb is fine. something criminal is going on.
put another way… it’s something else besides hiring equal opportunity persons with low test scores.
i am a very high test scorer myself and i would make a lousy doctor. there are other things that make a good doctor than test scores.
or maybe it’s all the high test scorers working for the industries that bought the government and invent clever ways to rob the people.
Wow, Kimel. I just read your 2011 post because I wondered how it would refute what Wikipedia says about the reason for the decline in importance and ultimate end of the MITI.
The answer: It doesn’t. At all. Your referring me to it as a refutation of the Wikipedia entry is–surprise!–another of your attempts to distract from the fact that you posted a post that made flatly false claims, in this instance about why the MITI lost its effectiveness and power and ultimately was closed. Currency rates and international trade accords were why.
Which isn’t the same as lowered standards for some jobs within the agency, although not for the top people.
Two separate, unrelated things, Kimel–only one of which caused the demise of MITI. And it wasn’t the one you say, outright, in your current post that it was.
one other thing that ought to be kept in mind regarding the end of the japanese miracle:
my daughter was a grad student in Japan during the lost years. she said the people weren’t suffering.
could it be that cancerous growth rates in the GDP are not necessary for human happiness?
by the way “miracles” don’t last forever. you wouldn’t like it if your kid kept growing at the rate he grew during his first two years.
OR
i like giant sequoias but i’d sure hate to have to pick the tomatoes growing on the top branches.
or wait… china has been growing pretty fast recently. maybe we should admit 30 million or so hard working chinese into the country. (for those of you who don’t remember the “yellow peril”)
or wait, wait, china’s growth has been slowing lately. must be all those african immigrants they’ve been admitting and giving equal opportunity jobs.
Beverly,
I quoted from an Army doc:
I’ll let you noodle out for yourself what the administrative reform policies were that kicked in right before the ministries lost their influence. OK. I won’t. Here’s a piece of what I quoted from Koh:
The Army doc notes that it was about this time that the ministries lost their control over corporations. It suggests this was because companies had become wealthy. But the ministries were famous for ordering around companies, including well off companies, before that point. Something else clearly changed.
Barkley,
When GW ran for office, he suggested the country needed tax cuts to return money to the people. When the country was in a recession, he suggested the country needed tax cuts to boost the economy. Essentially, for everything out there, it was tax cuts tax cuts tax cuts. I like to think I am capable of reasoning that there is more than one factor that has an effect on society.
“Recreational use of medical technology”
WTF is this supposed to mean?
[I] cut my thumb a year or so ago [and] thought it might need some stitches, which it did. [Provider] billed Medicare over $4000.”
Did Medicare pay it?
Warren
Medicare disallowed about half of it, and paid 80% of the rest… less my yearly deductible.
So the cost to me was probably only about twice what it reasonably should have been. The cost to you (taxpayer) was about ten times what it should have been. The pressure to get an operation was purely criminal.
My point was not “poor me,” but “something is rotten in the state of Denmark.” (and no that’s not about Denmark, it’s just a quote from Shakespeare.)
I still think a medicare-like plan is the sanest way to pay for health care. There appear to be problems, but the problems can be solved. There were/are problems in all the other schemes… that appear much harder to solve, and much much more painful to human beings.
Kimel’s alter ego is actually now an official in the WH: https://www.yahoo.com/news/michael-anton-is-the-most-interesting-man-in-the-white-house-211930901.html
Good grace.