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healthcare

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tweet - 19 March, 2020

Well, life was quite a bit different the last time I wrote down anything here. Here we are, in the midst of the worst global pandemic since the Spanish Flu of 1918.

Forgive my poor writing, the parts of my brain that handle reading, writing, and higher order thinking have been exhausted. Here’s a synopsis…

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BernieCare

Why Bernie Sanders’ single-payer push is great policy and even better politics:

The United States, by contrast, is very rich, and already dedicates way more than enough resources to set up the world’s most generous health-care system, and a lot more besides. We spend $3.2 trillion per year — literally twice as much as the OECD average as a share of the economy. We pay enough in health-care taxes alone — that is, the government revenue that goes to Medicare, Medicaid, the VA, and a few other things — to cover a Canada-style Medicare-for-all system for the whole U.S., and then that much again in private money. In other words, if we could simply copy-paste Canada’s universal health-care system into America, taxes would actually go down.

All that means is that America doesn’t have to worry much about costs; it has to worry about allocating existing spending properly. We already have a gigantic pool of resources dedicated to health care — about half private and half public. We just have to adjust that spending so it can support a single-payer system.

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Can Not Learn

Sometimes I don’t write because so many others do it better. For example, Umair Haque, in his essay What Do You Call a World That Can’t Learn From Itself?:

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Swedish Welfare

If Americans never understand what a social welfare system is, how it salves wounds of our gross economic inequality, why it is one of the most humane, advanced, amazing efforts we as humans can band together and work on, then this country will continue to go down the toilet.† Here is an exceptionally well-written, non-exceptional story, copied out of a tweetstorm by Alison Gerber — you’ll find that link to be dead, likely because Ms. Gerber’s thoughts attracted tons of attention, and in this toilet bowl internet era we live in, likely lots of death threats. Or worse: requests to do television interviews. Anyway:

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Gladwell on Economics

If you want to understand corporate America and/or nationalized healthcare it is critical that you read this four year-old-piece. Three years before GM went bankrupt, Malcolm Gladwell clearly articulated their problem in his New Yorker article “The Risk Pool”:

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Better

Just got done reading Atul Gawande’s book Better: A Surgeon’s Notes on Performance. First off, it’s a fantastic title: it reflects the simplicity of Gawande’s language and the complexity he manages to express with those words. The book explains how, through “diligence”, “doing right”, and “ingenuity”, surgeons can improve. The anecdotal essays are fascinating and well-written… and the ideas are inspiring. The idea is, the greatest gains we will see in the delivery and efficacy of healthcare lie not in the raw advances in science, but in the persistent, thoughtful efforts of those “on the ground” fighting the same problems every day. Here’s a bit where Gawande describes the thinking of a surgeon turned malpractice lawyer:

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Dr. Brent James Healthcare Reform

Remember the landmark Atul Gawande article about healthcare providers disregarding the costs of tests and procedures, leading to more medicine, not better medicine? This article takes that idea as a given, and offers some practical solutions, still in testing: If Health Care Is Going to Change, Dr. Brent James’s Ideas Will Change It:

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McAllen, Texas Healthcare

In the healthcare article of the year, Dr. Atul Gawande has done some outstanding reporting: he has described the core problems of the United States’ healthcare system. He has also pointed out beacons for reform to pursue — the foremost being the Mayo Clinic right here in Rochester, Minnesota:

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Improving journalism

The 3 key parts of news stories you usually don’t get at Newsless.org makes so much sense to me. I always thought that I didn’t understand a lot of current events reporting because I wasn’t rabidly following every minor detail — that the onus was on me to put the article in context. In the aforelinked article, Matt Thompson argues that news becomes more engaging, more useful, better, when put into context. Thompson uses a recent, spectacular Atul Gawande article in the New Yorker as an example of journalism done right:

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Insurance

How did we manage this one? “The United States is alone among developed nations with the absence of a universal health care system.”

Insurance HELP

Paul Krugman is right about health care. Please allow me the liberty of bolding portions of his piece, HELP Is on the Way, with which I strongly agree:

Now, about those specifics: The HELP plan achieves near-universal coverage through a combination of regulation and subsidies. Insurance companies would be required to offer the same coverage to everyone, regardless of medical history; on the other side, everyone except the poor and near-poor would be obliged to buy insurance, with the aid of subsidies that would limit premiums as a share of income.

Employers would also have to chip in, with all firms employing more than 25 people required to offer their workers insurance or pay a penalty. By the way, the absence of such an “employer mandate” was the big problem with the earlier, incomplete version of the plan.

And those who prefer not to buy insurance from the private sector would be able to choose a public plan instead. This would, among other things, bring some real competition to the health insurance market, which is currently a collection of local monopolies and cartels.

The budget office says that all this would cost $597 billion over the next decade. But that doesn’t include the cost of insuring the poor and near-poor, whom HELP suggests covering via an expansion of Medicaid (which is outside the committee’s jurisdiction). Add in the cost of this expansion, and we’re probably looking at between $1 trillion and $1.3 trillion.

There are a number of ways to look at this number, but maybe the best is to point out that it’s less than 4 percent of the $33 trillion the U.S. government predicts we’ll spend on health care over the next decade. And that in turn means that much of the expense can be offset with straightforward cost-saving measures, like ending Medicare overpayments to private health insurers and reining in spending on medical procedures with no demonstrated health benefits.

So fundamental health reform — reform that would eliminate the insecurity about health coverage that looms so large for many Americans — is now within reach. The “centrist” senators, most of them Democrats, who have been holding up reform can no longer claim either that universal coverage is unaffordable or that it won’t work.

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Paternity Ward

Nicholas D. Kristof - Crisis in the Operating Room:

Outside, her husband, Allahdita, was grieving but philosophical. “It is God’s will,” he said, shrugging. “There is nothing we can do.”

That’s incorrect. If men had uteruses, “paternity wards” would get resources, ambulances would transport pregnant men to hospitals free of charge, deliveries would be free, and the Group of 8 industrialized nations would make paternal mortality a top priority. One of the most lethal forms of sex discrimination is this systematic inattention to reproductive health care, from family planning to childbirth — so long as those who die are impoverished, voiceless women.

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