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Tilting at Windmills

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September 18, 2006
By: Kevin Drum

THE HEALTHCARE BOOM....Business Week's cover story in their current issue tells us that healthcare inefficiency is what's keeping the American economy afloat:

The very real problems with the health-care system mask a simple fact: Without it the nation's labor market would be in a deep coma. Since 2001, 1.7 million new jobs have been added in the health-care sector, which includes related industries such as pharmaceuticals and health insurance. Meanwhile, the number of private-sector jobs outside of health care is no higher than it was five years ago.

.... The U.S. unemployment rate is 4.7%, compared with 8.2% and 8.9%, respectively, in Germany and France. But the health-care systems of those two countries added very few jobs from 1997 to 2004, according to new data from the Organization for Economic Cooperation & Development, while U.S. hospitals and physician offices never stopped growing. Take away health-care hiring in the U.S., and quicker than you can say cardiac bypass, the U.S. unemployment rate would be 1 to 2 percentage points higher.

....Both sides can agree that more spending on information technology could reduce the need for so many health-care workers. It's a truism in economics that investment boosts productivity, and the U.S. lags behind other countries in this area. One reason: "Every other country has the payers paying for IT," says Johns Hopkins' Gerard Anderson, an expert on the economics of health care. "In the U.S. we're asking the providers to pay for IT" and they're not the ones who benefit.

I'm not sure what to think about this. In one sense it's just statistical trickery: at any period in American history, if you remove the single fastest growing industry from the picture then the rest of the economy is going to look pretty anemic. In fact, that's true of nearly any statistical analysis: remove the highest scorers or the highest earners or the highest anything else, and by definition, what's left over looks a lot gloomier.

On the other hand, deliberately running an entire industry less efficiently than the rest of the world is a helluva thin reed on which to base an economy. As Anderson says, since taxpayers are the ones footing the bill for healthcare in other countries, they're more willing to pay for technologies that cut costs. In America, doctors bear the burden of adopting IT enhancements but don't make any money from them (they might make less, in fact), so they're pretty unmotivated to bother with the whole thing.

The fact that this inefficiency means we employs a lot more people than we would if we had a rationally run system is hardly a great rallying cry for the status quo. A national healthcare system, besides being tremendously beneficial for the actual consumers of healthcare, would also align market incentives more reasonably and reduce costs considerably. I'm willing to take the risk that we'll somehow figure out what to do with all the jobs and money we save along the way.

Kevin Drum 4:30 PM Permalink | Trackbacks | Comments (100)

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Comments

How about a tax on insurers that funds the necessary IT nationally for all to use?

Posted by: john on September 18, 2006 at 4:33 PM | PERMALINK

On the other hand, deliberately running an entire industry less efficiently than the rest of the world is a helluva thin reed on which to base an economy.

Similarly, deliberately running an entire state's electricty industry at higher prices than the rest of the country just to reduce consumption (which, as Coyote Blog pointed out, completely explains Drum's electricy post from a couple of days ago, although Kevin never acknowledged that) is a helluva thin reed on which to base an energy policy.

Posted by: Al on September 18, 2006 at 4:36 PM | PERMALINK

We could put all the extra employees in developing new energy technologies!

Posted by: Rachelle on September 18, 2006 at 4:36 PM | PERMALINK

Yep, Just think of all of those folks employed by insurers, HMO's etc. whose jobs are dependent upon denying coverage. Jesus, millions are employed doing that!

Posted by: angryspittle on September 18, 2006 at 4:37 PM | PERMALINK

Why not just have everyone's medical records on punch card, and hire ten times as many secretaries to complete each task? The unemployment rate would drop even more. And to think we mocked Japan for funding bridges to nowhere because they kept people employed.

Posted by: SP on September 18, 2006 at 4:39 PM | PERMALINK

Hmm, maybe all those small business owners that Bush is so fond of could take the money they're getting jobbed out of now and spend it on, oh, I dunno, employees.

Posted by: Seth on September 18, 2006 at 4:43 PM | PERMALINK

Doctor's don't make money from the technology improvements?Who do you think are the partners in the local MRI facility?

Posted by: TJM on September 18, 2006 at 4:43 PM | PERMALINK

Kevin,

You are right to be suspicious of this article. The idea that an inefficient health care sector is a _good_ thing betrays a deep ignorance of basic economics. If the health care sector were more efficient costs would go down, allowing other sectors of the economy to take those savings and invest them in something else job creating. The only time deliberate inefficiency makes sense is in something like the Great Depression when make-work helped to lift the economy out of the depression.

Posted by: Jim on September 18, 2006 at 4:45 PM | PERMALINK

Since I stopped taking higher level economics classes a year ago, I am not familiar with the specific theories. Nevertheless, there has to be one, or a combination of some, that say once we eliminate inefficiency, we can put what resources were going to inefficient ends to better uses, making us all better off in the end. In other words, isn't there a theory, or a combination of some, that says we could take the hit in unemployment for a certain period of time if in the end it brought us a better economy (more jobs, wealthier people, etc.)? It's easier said than done, of course, but as long as the downturn wasn't too long, I imagine it couldn't be that difficult. I certainly imagine it's easier than revolutionizing the health care system as a whole.

Posted by: Brian on September 18, 2006 at 4:48 PM | PERMALINK

Most doctors' offices have a small army of people responsible for processing the insurance company paperwork. However, the reason they need so many and that automation won't work is because they are basically engaged in a war with the insurance people: getting payment isn't simply a matter of filling out the forms correctly. It often involves getting on the phone and yelling, figuring out clever ways of classifying the patient's condition to maximize revenue, etc.

Posted by: Joe Buck on September 18, 2006 at 4:50 PM | PERMALINK

My gut tells me that this is a version of the Broken Windows Fallacy.

Posted by: Avram on September 18, 2006 at 4:53 PM | PERMALINK

On the other hand, deliberately running an entire industry less efficiently than the rest of the world is a helluva thin reed on which to base an economy.

Wrong, Kevin. It's becoming ever clearer that by not rationing healthcare in a fashion similar to other nations, America is preserving its economy from harm.

Would anyone deem it a sound idea to have the government reduce the amount of money that can be spent on, say, leisure, or tourism, or consulting, or financial services? Of course not. And yet such service sector areas of economic activity are the hallmarks of advanced economies, and typically rise as a percentage of GDP as a nation grows richer with time. Just like healthcare. Unless, of course, you're foolishly monkeying around with draconian rationing. And if you are, it should be no wonder to you that you can't grow your economy as fast as America.

Posted by: 99 on September 18, 2006 at 4:53 PM | PERMALINK

I can't top SP's comment above, but I'll add: Wouldn't a system that's not a confusopoly end up hiring more people to do all the preventative treatment we hear is being so shockingly neglected?

Posted by: Minivet on September 18, 2006 at 4:58 PM | PERMALINK

Look at it this way:

Rather than employ 10K health care workers inefficiently in a hypothetical country, hire 8K people efficiently, pay 2K extra people the remainder of the salary kitty, and let the extra 2K people, o I don't know, teach K-12 / build levees in Louisiana / re-train laid off Ford employees...

Posted by: JohnnyD on September 18, 2006 at 5:00 PM | PERMALINK

The really interesting point here is that /The Economist/ is arguing that lower productivity is necessary in order to maintain lower unemployment, or, conversely, that higher productivity in that sector would produce higher unemployment. Arguments in favor of /lower/ productivity in order to reduce unemployment are usually restricted to fringe figures. Does "The Economist" realize just how radically it's breaking with economic orthodoxy here?

Posted by: Jason Stokes on September 18, 2006 at 5:01 PM | PERMALINK

Al said:
--------------
Similarly, deliberately running an entire state's electricty industry at higher prices than the rest of the country just to reduce consumption (which, as Coyote Blog pointed out, completely explains Drum's electricy post from a couple of days ago, although Kevin never acknowledged that) is a helluva thin reed on which to base an energy policy.
---------------

I think the point is that robust economic growth can be sustained without increasing electricity consumption. It's a useful counter-example to anyone who says that an x% increase in electricity costs would spell ruin.

Besides, in a free market, the only way to reduce consumption of something is to make it more expensive. Would you prefer ration chits? The great thing is that the ingenuity of the free market is so great that small changes in prices can induce all kinds of innovation in response. As the cost of electricity rises, the returns to efficiency technologies rise in step. The result is that businesses invest in efficiency rather than spending on electricity and get the same output for around the same costs. California electricity is Exhibit B. Exhibit A is the hugely successful market in emissions credits for certain kinds of pollutants. Hopefully Exhibit C will be the nascent CO2 exchanges.

Posted by: Jim on September 18, 2006 at 5:03 PM | PERMALINK

GOP: What are your bona fides to make such a claim about the state of the healthcare delivery system in this country?

Posted by: Global Citizen on September 18, 2006 at 5:11 PM | PERMALINK

Medicine is a guild/cartel that limits membership and competition. They don't need to be efficient since they are the only game in town.

Posted by: MonkeyBoy on September 18, 2006 at 5:15 PM | PERMALINK

Jason Stokes: It's Business Week, not the Economist. Still exposes the general intellectual bankruptcy of economics, or at least economists.

Posted by: Minivet on September 18, 2006 at 5:17 PM | PERMALINK

Kevin's post makes sense, based on anecdotal experience. Went from Kaiser to Blue Cross, with a world-famous medical school as the provider. The medical school's back office *sucked*: it seriously impacted my experience as a consumer: what's the point of having world-class doctors if you can't communicate or get an appointment with them?

Was overjoyed to go back to Kaiser, who have one of the best medical IT systems around.

Posted by: Urinated State of America on September 18, 2006 at 5:17 PM | PERMALINK

Sometimes, only looking at the bottom line can keep you from seeing the whole equation.

Posted by: Memekiller on September 18, 2006 at 5:20 PM | PERMALINK

Americans know there is absolutely nothing wrong with the U.S. healthcare system.
Posted by: GOP on September 18, 2006 at 5:04 PM | PERMALINK

The loony left (75% of all American Adults who favor Universal health insurance):
http://www.harrisinteractive.com/harris_poll/index.asp?PID=608

Posted by: Osama_Been_Forgotten on September 18, 2006 at 5:20 PM | PERMALINK

Al,

You're always one to confuse nonsense with facts.

What Americans spend on electricity is a drop in the bucket compared to the cost of their healthcare.

Now take that metaphorical bucket and stick it over your head and scream Republican talking points...don't worry about being understood...the kool aid crowd will agree with you even if they can't understand a word you are saying.

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Posted by: S Brennan on September 18, 2006 at 5:27 PM | PERMALINK

I don't think that was the real GOP.

This, on the other hand:

99: Unless, of course, you're foolishly monkeying around with draconian rationing.

is the genuine fear-mongering deal. "draconian rationing"? puh-lease.

Posted by: craigie on September 18, 2006 at 5:29 PM | PERMALINK

Doctor's don't make money from the technology improvements?Who do you think are the partners in the local MRI facility?

Posted by: TJM on September 18, 2006

So far, except in the area of billing, nobody has found a way for Insurance companies, and doctors to make money by being more efficient in processing your paper work. The fancy hardware might be first class, but until we apply the same information technology to the medical field that drives the rest of our industry we are going to suffer higher and higher costs.

Right now your medical provider probably creates a paper, instead of electronic, medical record for you to carry to a new provider. Why? It is just not cost effective for good old Dr. Smith to buy one of those fancy newfangled electronic medical record systems that talk to other electronic medical record systems just to let other people have his work product. If they could many doctors wouldn't provide their competators (collegues) any information. Their ethical standards require it. They get little out of it they can use to buy the new condo.

The situation is changing, but the change is glacial. The VA is the best example of how an electronic patient record system might work, but there the payors (you and me) are funding the system.

BTW there is no incentive for your health care insurer to force the change either. What do they care. They don't even fund preventive activities. They are paid a percentage of premiums earned. The less efficient the doctors the higher the premiums and the more they can take out of the system.

Posted by: Ron Byers on September 18, 2006 at 5:31 PM | PERMALINK

I spent my first career in medicine, starting as a paramedic and eventually becoming a Clinical Lab Scientist and a member of the American Society of Clinical Pathologists.

When I criticize healthcare delivery, I know what the snap I am talking about.

When the senate majority leader's family owns one of the largest for-profit healthcare chains in the country, every family dinner is a conflict of interest.

That for-profit chain is the same one that, two years ago here in the Kansas City area had a Neonatal ICU with three babies infected with MRSA (Methycillin Resistant Staph Aureus, or "flesh eating bacteria"). I know this to be true, because I was the Microbiology tech at the flagship hospital (Research Medical Center) who verified the diagnosis of the lab tech at Overland Park Regional. MRSA is a nosocomial (hospital acquired) infection that kills a lot of people every year, and it spread through that NICU one of two ways: Either nurses were not taking the time to properly wash hands; or environmental services was not properly cleaning the isolettes. Either way, it is an issue of staffing.

I was a shift supervisor at Research. Within 15 months of HCA (Hospital Corporation of America) taking over the financially-ailing Health Midwest system, I saw my weekend phlebotomy crew cut to two people. In a 600-bed hospital, that is absolutely not adequate staff to assure timely collection of timed and stat specimens, and cover the traumas that come in at a good clip. I have personally seen two choppers on the pad and five ambulances in the bay, all unloading bleeders, massive MI's, strokes - every one a patient in dire need. I have been so busy that I literally worked my entire shift and realized I hadn't had time to go to the restroom, let alone take my breaks - then got called on the carpet for racking up 30 minutes of overtime.

HCA killed a woman named Shirley Keck by understaffing at Wesley Medical Center in Wichita. Google Shirley Keck and Alison Goodman, R.N. and after you inform yourself on that tragedy, tell me about how there is nothing wrong with healthcare in this country.

Full disclosure: Alison Goodman is more than just a name to me. Al is, I am proud to say, one of my best friends for over two decades now. (My daughter is in San Diego visiting her daughter even as I type. She flew out yesterday, pissed about having to check a bag for a three-day stay.)

Posted by: Global Citizen on September 18, 2006 at 5:32 PM | PERMALINK

Doctor's don't make money from the technology improvements?Who do you think are the partners in the local MRI facility?

Posted by: TJM on September 18, 2006

So far, except in the area of billing, nobody has found a way for Insurance companies, and doctors to make money by being more efficient in processing your paper work. The fancy hardware might be first class, but until we apply the same information technology to the medical field that drives the rest of our industry we are going to suffer higher and higher costs.

Right now your medical provider probably creates a paper, instead of electronic, medical record for you to carry to a new provider. Why? It is just not cost effective for good old Dr. Smith to buy one of those fancy newfangled electronic medical record systems that talk to other electronic medical record systems just to let other people have his work product. If they could many doctors wouldn't provide their competators (collegues) any information. Their ethical standards require it. They get little out of it they can use to buy the new condo.

The situation is changing, but the change is glacial. The VA is the best example of how an electronic patient record system might work, but there the payors (you and me) are funding the system.

BTW there is no incentive for your health care insurer to force the change either. What do they care. They don't even fund preventive activities. They are paid a percentage of premiums earned. The less efficient the doctors the higher the premiums and the more they can take out of the system.

Posted by: Ron Byers on September 18, 2006 at 5:33 PM | PERMALINK

Why in this country do you need to have a bake sale or some other huge fund raiser just because you are unfortunate and become ill?

Anyone who thinks the healthcare system in the US is working does not really use it. And it is amazingly inefficient. Not to mention cruel.

Posted by: roscoe on September 18, 2006 at 5:45 PM | PERMALINK

It would be very interesting to have a discussion of whether or not healthcare should even be a for-profit industry. After all its pretty hard to make a profit without cutting back on costs and therefore quality of care.

Arguably, good health care should fall under the same category of being "essential" as police and fire, and those are both non-profit governmental entities.

Posted by: mfw13 on September 18, 2006 at 5:48 PM | PERMALINK

Having not read any of the earlier comments, I'll just make this comment:

Suppose that health care spending fell from its current 16% or so of GDP to, say, 10% of GDP--a decline of about $700 billion. Don't you think that the people who now spend $700 billion less on health care might--just might--spend it on something else? And if they spent on something else, don't you think that might--just might--create some jobs elsewhere?

Full employment is full employment Health care spending doesn't move us toward full employment any more than spending on movie admissions does. So supporting inefficient health care spending because it "creates jobs" is just stupid.

Posted by: Donald A. Coffin on September 18, 2006 at 5:51 PM | PERMALINK

You seem to be pushing the broken window fallacy, but on steroids. It cannot be that such a huge industry that is so intertwined with everyone's lives is propping up the economy by its inefficiency. One could say that it could be more efficient, but your implication seems to be that making health care more efficient would make the economy worse. That's insane. It's so economically wrong-headed I don't even know where to start explaining it in a comment thread.

By the way, almost no industry that I know of has ever automated before it had people do the jobs first. The article seems to imply that having people in jobs that could somehow be automated is some kind of purposeful collusive conspiracy. In fact, that's how industries always evolve. Cars were made by hand in garages before they were made on assembly lines. Oil was refined in labor intensive processes in big vats before we had refineries. And anyone who has been through a massive business systems automation process knows that it is something to fear.

Posted by: coyote on September 18, 2006 at 5:55 PM | PERMALINK

You forgot the Defense Industry boom during this time.

Posted by: gregor on September 18, 2006 at 5:55 PM | PERMALINK

Recalling my years of service in the HCA system unleashes a torrent of memories, most of which make me cringe.

Research Medical Center, flagship hospital of the HCA Midwest Division is located at Meyer Blvd. and Prospect Ave. in Kansas City Missouri. Research sits in the zip code with the highest incidence of Type II Diabetes in the nation. Many of the patients served by RMC are poor, black and diabetic. (From the small-world chronicles, a head nurse on 5-East, the diabetes floor, went to high school with my husband, so I have been privy to a lot of justified bitching and moaning and know more about the nursing problems than most lab rats.)

HCA promised that there would be no significant changes in the delivery of healthcare services for at least five years. But within a year, they closed the outpatient dialysis clinic at Research because it wasn't profitable. To the credit of myself, that head nurse I just mentioned, and a few other dedicated professionals, we started a campaign and got employees to make donations of an hour a pay-period to re-open the dialysis clinic, and it is operating to this day. I no longer work for HCA, but every month I take a check for two hours of my wages at the time I left HCA's employ to the dialysis clinic and drop it off. Just because I left healthcare does not mean I abdicated responsibility to my patients. And any patient reliant on HCA as their provider needs all the oputside help from people like me that they can get.

Posted by: Global Citizen on September 18, 2006 at 5:55 PM | PERMALINK

The left hand doesn't know what the right hand is writing about at Business Week. A few weeks ago, another BW article on "Top 50 companies for careers" included almost no health care companies. If health care companies are where all the growth is, then quite a few of them should have made the list of best companies for careers.

Posted by: Phil on September 18, 2006 at 5:56 PM | PERMALINK

A long article in yesterday's LA Times couldn't be more appropriate. Here is just a small sampling:

When Steve and Leslie Shaeffer's daughter, Selah, was diagnosed at age 4 with a potentially fatal tumor in her jaw, they figured their health insurance would cover the bulk of her treatment costs.

Instead, almost two years later, the Murrieta, Calif., couple face more than $60,000 in medical bills and fear the loss of their dream home. They struggle to stave off creditors as they try to figure out how Selah can keep seeing the physician they credit with saving her life.

"We're in big trouble," Leslie said.

Shortly after Selah's medical bills hit $20,000, Blue Cross stopped covering them and eventually canceled her coverage retroactively, refusing to pay for treatment, including surgery the insurer had authorized in advance.

The company accused the Shaeffers of failing to disclose in their coverage application an undiagnosed bump on Selah's chin and physician visits for croup. Had that been disclosed, the company said in a letter, it would not have insured Selah.

The Shaeffers say they weren't trying to hide anything. When they applied for coverage, Selah did not have a tumor, at least as far as they or any physician knew. The doctor visits occurred after Leslie filled out the paperwork, and they seemed routine, the Shaeffers say. They believe Blue Cross was looking for any excuse to dump their daughter and dodge her bills.

Apologist's for the current "system" are a joke.  Something like this is unimaginable in the rest of the industrialized world. 

Posted by: gesund in Deutschland on September 18, 2006 at 5:59 PM | PERMALINK

I worked this industry a wee bit and doctors would indeed love to have established standards, and there are some. Medical coding standards are a bit complicated but widely accepted. There are interoperability standards which in fact work.

The problem is the multitude of insurance companies and the variations in coverage. The standardization that is missing are the level of coverage. Instead of 10 there needs to be 3 or four. If that problem is fixed, doctors can look at the category of coverage and immediately inform the patient of any possible cash payments they might need for uncovered procedures.

Posted by: Matt on September 18, 2006 at 5:59 PM | PERMALINK

A national healthcare system, besides being tremendously beneficial for the actual consumers of healthcare, would also align the market incentives more reasonably and reduce costs considerably.

that would be nice if anyone proposed and backed such a scheme. The proposals that I have seen remove market incentives completely.

Posted by: republicrat on September 18, 2006 at 6:03 PM | PERMALINK

Why in this country do you need to have a bake sale or some other huge fund raiser just because you are unfortunate and become ill?

The issue raised by this question is entirely separate from the question of rationing. It's perfectly feasible for a government to guarantee all its citizens robust access to healthcare and at the same time eschew rationing. It's just not cheap to do it that way. American essentially does this already, it's just that the American government's guarantee isn't extended to all citizens, but only to those over a certain age (or to those who are very, very poor). Liberals love to laud the Medicare system, and tout it as a shining example of single-payer that works well. Well, it does work well, except for one of the central tasks cited by liberals as a rationale for single payer in the first place: holding down costs. America rightly makes sure old people get good healthcare. America also rightly makes sure the system is lavisly funded. It's a pity voters in other rich countries aren't as demanding as America's electorate. If they were, they too could have a robust private healthcare sector as a driver of economic growth. But as it stands most governments in other rich counties choose to starve their healthcare sectors and settle for lower growth. This is yet another example of American exceptionalism and superiority.

Posted by: 99 on September 18, 2006 at 6:03 PM | PERMALINK

It is absolutely a perversion of values that for-profit healthcare even exists in this country. It is capitalism run amok when life-saving procedures and medications are denied to people based on their ability to pay. It is antithetical to the values we as a nation (most of us, anyway) proclaim to profess.

Posted by: Global Citizen on September 18, 2006 at 6:05 PM | PERMALINK

Globial Citizen

It isn't even capitalism. The apologists for the current system are defending a perversion of the market.

That said, I don't know how the market would ever truly work in health care.

BTW, I would be a little more circumspect in picking on Research Medical Center. A lot of folks read this board, and some members of the Frist family might take offense. Not that I disagree. My personal physician practices at Research. My daughter was born there. My first wife went to their nursing school. I have heard lots of stories about the hospital, some not so good. On the other hand, at least in the old days it was a really good hospital.

Posted by: Ron Byers on September 18, 2006 at 6:12 PM | PERMALINK

Suppose that health care spending fell from its current 16% or so of GDP to, say, 10% of GDP--a decline of about $700 billion. Don't you think that the people who now spend $700 billion less on health care might--just might--spend it on something else?

Depends on how such a scenario transpired. If healthcare's portion of GDP declined gradually due some unforeseen development (breakthroughs in, say, stem cell research that effectively made alzheimer's and cancer mild, easily cured conditions), then no -- no economic damage would accompany such a shrinkage.

But if the reason healthcare's share of the pie dropped is that government decided to starve this sector, then, yes, we'd certainly see negative economic effects.

This notion that healthcare is a terrible economic "black hole" that must be minimized at all costs is simply absurd. Healthcare -- likely more than any sector of the economy -- is about enhancing the quality of life. Naturally in a healthy, free market economy like America's, it is a sector that is growing. That is a good thing.

Posted by: 99 on September 18, 2006 at 6:16 PM | PERMALINK

I hope they do. I have been spoiling for a fight with HCA since they left. I have boxes of documentation to back up everything I say, with identifying patient data redacted to comply with HIPPA. HCA has thus far declined all provocations on my part because I know where the bodies are buried. That is usually just an expression, but in this case, it is literal.

Posted by: Global Citizen on September 18, 2006 at 6:16 PM | PERMALINK

Sorry, 99. My remark about the bake-sale was in response to GOP's claim that there is nothing wrong with the US healthcare system. Clearly there is. (And there already is rationing. If there were not you would not need the fund raisers.) Perhaps GOP was being fatuous.

One item that you overlook re holding down costs: the massive duplication of systems in the US makes delivery of healthcare unnecessarily expensive. It's the adminstration of care that is streamlined in Medicare and the VA programs. Single payer would do this for the rest of us.

While we're at it, it might be time to get the insurance companies out of the equation.

Posted by: roscoe on September 18, 2006 at 6:18 PM | PERMALINK

Hear Hear for Global Citizen! All of your posts were right on the money. I salute your efforts to make health care work for people.

I've designed back end systems for insurance companies and I can attest to the huge inefficiencies built into the system. Something as simple as letting Medicare process all insurance paperwork could save 10-15% of the total health care bill for the country. They operate at under 3% administrative overhead as opposed to 15% or more for most HMO's. That's a potential savings of a couple hundred billion dollars. Plow that money back into underserved inner city health clinics and we could make a huge dent in covering the uninsured.

I'd prefer the full "Kaiser for everyone" model, but I don't think that's going to happen.

Posted by: Common Sense on September 18, 2006 at 6:20 PM | PERMALINK

In the old days, Research was a shining example of what healthcare could - and should - be. Now, not so much.

I ended up at Research after starting out at Independence Regional - a most excellent hospital in it's own right back in the day (Pre-HCA) and went to Research a couple of years later, after the sale was finalized by the states of Kansas and Missouri. My friend Alison spoke to the Missouri lege about the sale and had a meeting with the AG of MO to lobby against the sale.

Hey, I just got a call from the computer store, and my new one is ready - back in a couple of hours.

Posted by: Global Citizen on September 18, 2006 at 6:21 PM | PERMALINK

I just completed a five-week course of readiation for a melanoma removed from the back of my neck, the cost of which was exactly $9,443.62. The medical and surgical fees were approximately another $2,000. After the isurance paid its supposed share, my out-of-pocket expense is close to $3,000.

Not that I'm trying to mitigate the seriousness of melanoma, but let's get real -- this $11,500 was spent for a relatively minor out-patient surgical procedure and subsequent out-patient therapy.

Just looking at my example, one can easily see why exponentially escalating health care costs are one of the leading causes of -- excuse me, but thanks to the GOP's recent and punitive bankruptcy "reform" legislation, were one the leading causes of personal bankruptcy. Now, they just take your house and retirement savings.

Posted by: Donald from Hawaii on September 18, 2006 at 6:25 PM | PERMALINK

Slightly off topic rant, but the LA Times story mentioned above hit a nerve. Is it just me, or do insurance companies, as general policy, always try to gouge and squeeze their customers. I've heard tons of stories like this related to health insurance and I've heard tons of stories like this about insurance companies trying to screw over Katrina victims.

Where are the state insurance commissioners when you need them?

Posted by: mfw13 on September 18, 2006 at 6:28 PM | PERMALINK

Funny article. It's like saying we should close public schools in the inner cities to help boost job growth in the prison industry.

But if this is going to be the new false dilemma talking point, I would be perfectly happy to pay those same people to stay home and watch daytime soaps in exchange for a functional health care system.

Posted by: s5 on September 18, 2006 at 6:30 PM | PERMALINK

It almost goes without say: A more efficient health care system would automatically release a burst of purchasing power creating enormous demand in all industries across the board and spuring a quantum leap in economic growth.

For the next democrat that comes to power, implementation of universal single payer health care, either private (similar to the phone system or utility company, profit, not-for-profit, or non-profit) or government will create the greatest economic growth since Clinton.

Healthcare is the real Death Tax in America and a tax upon our entire economy.

90% of what you pay in healthcare, and the estate that you accumulated all your life will go to health care companies at the end of your life and not your descendents.

Most economic growth comes from reducing transaction cost (see Ronald Coase in Wikipedia) - 2/3rds of the economy is in consumption and services.

Single payer, universal health will cause the economy to grow, lifespan to grow, bankruptcies to drop enormously, and wealth to be more broadly distributed as health care companies won't be stealing the remander of peoples estate right before their death.

We do this and give people $10/hr min wage and quality of life will improve greatly in this country. We may even approach that of a first world country.


Posted by: Bubbles on September 18, 2006 at 6:30 PM | PERMALINK

It is absolutely a perversion of values that for-profit healthcare even exists in this country.

Nonsense. Food and shelter are just as necessary as healthcare. Why don't you bemoan the profit motive's presence in these vital sectors?

The fact is, healthcare is far too critical to be denied the quality enhancing-power of the profit motive.

Posted by: 99 on September 18, 2006 at 6:31 PM | PERMALINK

One other thought on the broken window fallacy so visible here:

Economics is a science, too. And the left's willful ignorance of this science is no more attractive, and probably more destructive, than conservatives' scientific ignorance on ecolution or the morning after pill.

Posted by: coyote on September 18, 2006 at 6:32 PM | PERMALINK

Independence Regional is in the process of being closed. It and another local hospital are being relocated by HCA to a new building next door to a shopping center. I am told the new hospital is more convenient for the consumers. By that I don't mean the patients, but the doctors. The old Independence Regional location was good for patients in the older more urban parts of Independence and in eastern Kansas City. Those poor folks don't have much money any so who gives a rip. Got to cater to the rich suburbs--got to make sure the docs are closer to the first tee, and to home.

Posted by: Ron Byers on September 18, 2006 at 6:32 PM | PERMALINK

Another oddity is that having our expensive, inefficient but still basically domestic medical system probably saves at least 2% of GDP from being spent overseas. That's about 40% of the premium of 5% GDP that we spend on health care compared to other western industrial states. Where would that go otherwise, except to purchase the goods we want but don't make? So, you're not enabling an HMO, but striking a blow for taming our trade deficit.

Posted by: Peter Cohen on September 18, 2006 at 6:36 PM | PERMALINK

mfw13: "Where are the state insurance commissioners when you need them?"

If any of them are like former California Insurance Commissioner Chuck Quackenbush, then I'd suggest that you first look in the insurance companies' pockets. He and those providers he was supposedly elected to regulate colluded to screw over the victims of the 1994 Northridge earthquake in Southern California.

Posted by: Donald from Hawaii on September 18, 2006 at 6:36 PM | PERMALINK

99,

Stop with the slogans already. Tell us, pray tell us, how is the market supposed to work in the area of health care?

Posted by: Ron Byers on September 18, 2006 at 6:37 PM | PERMALINK

coyote: "Economics is a science, too."

And taking your point to its logical conclusion, so is figuring out the odds on this weekend's college football games.

Posted by: Donald from Hawaii on September 18, 2006 at 6:41 PM | PERMALINK

Eliminating for-profit healthcare, and replacing it with a more efficient single-payer system would not eliminate healthcare jobs per se. It would eliminate jobs in the insurance sector.

Many of them would, of course, be replaced by the civil service jobs created to handle the new healthcare system. Some of them might also be replaced by an increase in the number of healthcare workers - physicians, nurses, aides, and the like. The net result wouldn't be especially devastating to employment levels.

It would kick the crap out of a lot of overpaid healthcare insurance executives, though.

I say, let's go for it.

Posted by: cmac on September 18, 2006 at 6:44 PM | PERMALINK

99: Have you ever been denied essential medical treatment?

Sure food is critical, but relatively speaking, it's cheap. Healthcare is not a commodity. We're not buying apples and televisions here.

Finally, if you're healthy, the odds increase that you will be able to find a job (and do lots of other useful things).

I'll stop posting. I think you are not serious.

Posted by: roscoe on September 18, 2006 at 6:46 PM | PERMALINK

I have concluded that there is nothing the matter with any opponent of single payer that could not be solved simply by seeing to it that THEY are the ones who are denied healthcare.

Posted by: Thinker on September 18, 2006 at 6:51 PM | PERMALINK

Yes, Virginia, it's true...though the health care industry doesn't have a monopoly on useless vocations. Most "jobs" in America employ the unemployable by creating positions requiring no real skills. Paper pushing and "data" have rendered most American s0-called "service" industries innefective, inefficient and ultimately relative failures in delivering the needed services. Health care is the most glaring example of this.

But these useless positions employ millions whose job it is to get in your way, connect you to yet another extension, put you on hold, and generally waste your time until the person who can REALLY help you is free to do so, or you simply give up, whichever comes first.

Posted by: marblex on September 18, 2006 at 7:35 PM | PERMALINK

wouldn't this partly explain Hack Greenspan's reported painless productivity gains of the past 20 years. All those jobs lost to productivity improvements must have ended up somewhere other than on the shrapnel end of an IED.

Posted by: pluege on September 18, 2006 at 7:40 PM | PERMALINK

Ironically, I bet we could employ more people, better, with national healthcare.

Posted by: Crissa on September 18, 2006 at 7:43 PM | PERMALINK

PS - Bet you'll love that Kaiser suppport until you actually become chronically ill.

Then they'll be just as quick to cut you off.

Many things aren't solved with a lifetime maximum of a half dozen clincal appointments.

Posted by: Crissa on September 18, 2006 at 7:49 PM | PERMALINK

Ron byers,I'm not sure what your quoting me was for in your early comment.Those MRI enters that take business from hospitals,are often owned by doctors.They cn make money here and keep their rights at local hospitals,too.They make money from the technology.
Doctors also benefit,depending on their practice,by hospitals paying them to move from one hospital to another.Doctors with specialities like orthos or heart,are paid large sums to switch.What the hospitals can't do,because of Medicare and Medicaid reimbursement rules,is to contractually require the doctors to only admit patients to that hospital.
Hospitals bear a large part of the costs of delivery due to overhead.
HIPAA,as earlier noted,restricts the sharing of patient info.

Posted by: TJM on September 18, 2006 at 7:58 PM | PERMALINK

Is this happening because the industry is deliberately running less efficient or no one knows what the @#$%#!!! hell they are doing because profit and the medical insurance industry comes first?

1. At my local hospital which just merged with two other hospitals it has become impossible to speak to a doctor or to make an appointment on the phone. They have a brand new answering system which is shared with a group of private practice doctors in various medical centers in the surrounding area. Call up and get a menu which then transfers you to a operator which will take your message and someone will get back to you eventually.

2. There is a shortage of nurses and aids but the only hiring done seems to be for more clerical help to handle the paperwork.

3. I just went to a private practice doctor who has his own office. He has one medical assistant and 4 extra people to do the paperwork.

4. There are all these ads for training medical billers with no high school degree required. I wonder who hires them.

5. Now there is a new machine that prints prescriptions to lessens handwriting errors. But it takes longer to use taking precious minutes away from too shorten (but so called efficient) doctors visit.

If the current medical system continues life spans will drop. You could then buy a life insurance policy along with no "death tax" your heirs can clean up. So maybe it all works out in the end.

Posted by: Place W on September 18, 2006 at 8:13 PM | PERMALINK

Is this happening because the industry is deliberately running less efficient or no one knows what the @#$%#!!! hell they are doing because profit and the medical insurance industry comes first?

1. At my local hospital which just merged with two other hospitals it has become impossible to speak to a doctor or to make an appointment on the phone. They have a brand new answering system which is shared with a group of private practice doctors in various medical centers in the surrounding area. Call up and get a menu which then transfers you to a operator which will take your message and someone will get back to you eventually.

2. There is a shortage of nurses and aids but the only hiring done seems to be for more clerical help to handle the paperwork.

3. I just went to a private practice doctor who has his own office. He has one medical assistant and 4 extra people to do the paperwork.

4. There are all these ads for training medical billers with no high school degree required. I wonder who hires them.

5. Now there is a new machine that prints prescriptions to lessens handwriting errors. But it takes longer to use taking precious minutes away from too shorten (but so called efficient) doctors visit.

If the current medical system continues life spans will drop. You could then buy a life insurance policy along with no "death tax" your heirs can clean up. So maybe it all works out in the end.

Posted by: Place W on September 18, 2006 at 8:15 PM | PERMALINK

Any system that forces the clipboard-brandishing administrators to find alternative work is one that gets my vote. If an individual had the bureaucratic flab of the American system, he/she would be put on an emergency diet by any reputable physician.

Posted by: ahem on September 18, 2006 at 8:21 PM | PERMALINK

Sayeth Kevin:

On the other hand, deliberately running an entire industry less efficiently than the rest of the world is a helluva thin reed on which to base an economy.

I don't know... Wal-Mart is a helluva lot more efficient at getting groceries and other basic items out to the public at the cheapest possible price than many other businesses, yet every time it moves into an area the Liberals have a hissy fit.*

The left-side of the political spectrum shouldn't be arguing against the inefficiencies in ANYTHING. If you want "efficient", stand back and let the market figure it out.


* Now, that's not to say that there aren't potentially valid reasons for placing restrictions on, or having issues with, Wal-Mart in an area --- but recognize what you're doing for what you're doing: arguing against the most "efficient" solution in exchange for some sort of externality (fewer jobs at higher pay provided by Vons/Ralphs/Albertsons, for example).

Posted by: J.C. on September 18, 2006 at 8:28 PM | PERMALINK

HIPAA,as earlier noted,restricts the sharing of patient info.

Posted by: TJM on September 18, 2006 at 7:58 PM

I quoted you earlier TJM to point out that physicians will quickly adopt technology that will make them money. Information technology of the kind needed to improve our health care and lower costs is not the kind of technology physicans are likely to adopt on their own. There is simply no market pressure for them to adopt the better technology.

I quote you now to tell you that you are both right and wrong. Privacy is enhanced by HIPAA, without doubt, but the kind of exchange of information we badly need in medicine is not prohibited, or even seriously slowed, by HIPAA. In fact HIPAA was drafted with advancing information technology in mind. Too bad medicine hasn't caught up.

Posted by: Ron Byers on September 18, 2006 at 8:35 PM | PERMALINK

...yet every time it moves into an area the Liberals have a hissy fit.

Hahaha.

Yep. Label anything Liberal.

Maybe you should look more closely at who's fighting Wal-Mart in the heartland...

...It isn't Liberals, though we prefer to have companies actually perform the things they say they will - you know, health care, community support, reinvestment, etc. I dunno what you have against jobs which actually have, I dunno, sustainable wages?

Of course, you're against healthcare and pro-Wal-Mart.

So I guess you just hate doctors and healthy populations.

Posted by: Crissa on September 18, 2006 at 8:59 PM | PERMALINK

I think it's ironic that my Game Boy can do handwriting reading on a screen the same size as a prescription, a data cartridge big enough to hold several volumes of diagnostic handbooks and the prescription emcyclopedia,and has wireless networking...

...But there's nothing a physician can buy that does just that.

What gives?

Posted by: Crissa on September 18, 2006 at 9:04 PM | PERMALINK

There are medical info systems that use portable tablets and soforth.

"The Answer" really has nothing to do with technology though. "The Problem" is social, political, and economic.

Posted by: jefff on September 18, 2006 at 10:09 PM | PERMALINK

Where is Mike K? Usually he dismisses me as a "disgruntled former employee" when I go off on HCA.

Posted by: Global Citizen on September 18, 2006 at 10:09 PM | PERMALINK

I have worked in healthcare for approx. 15 yrs. I don't know the exact percentage but I believe something like 60 cents of every heatlhcare dollar is from the government. I see more folks working in healthcare that ever before(easy to see the people in scrubs) and you can bet most of this part of the economy is not productive like, say, a manufacturing plan. I think about this every so often and wonder how long the US can afford to feed such a huge non productive sector.

Posted by: hcaz on September 18, 2006 at 10:27 PM | PERMALINK

hcaz I think about this every so often and wonder how long the US can afford to feed such a huge non productive sector.

As long as the companies riding the gravy train can make it last!

SP And to think we mocked Japan for funding bridges to nowhere because they kept people employed.

Well, everyone economy has its sectors that are particularly unproductive. For Japan it's construction. For the US, it's healthcare (won't go into that other rather spectacularly unproductive sector, the armaments industry) I kinda think though that the multiplier effect of those bridges to nowhere beats that of the 5% or so of GNP you spend unnecessarily on health-industry paperwork. (And actuallly, I'm kind of shocked at the poor state of the infrastructure each time I visit the States - there's certainly work to be done here!)

Posted by: snicker-snack on September 18, 2006 at 10:50 PM | PERMALINK

Minivet on Jason Stokes: It's Business Week, not the Economist. Still exposes the general intellectual bankruptcy of economics, or at least economists.

Bollocks, it exposes the superficial idiocy of journalists without proper training in economics writing about economics. Business Week is not a serious, analytical publication. It is the People Magazine of the business publication world.

Posted by: The Lounsbury on September 18, 2006 at 10:57 PM | PERMALINK

The only real story there is tonight is the one about this: Halliburton promises wounded employees in Iraq help getting medals and other honors for their service ... if they agree not to sue Halliburton.

-- Josh Marshall

And the Huffington Post article by Rick Jacobs - and also, Lou Dobbs of CNN talked about all this horrot tonight too.

I dont know who the people are that consist of the Vulcans, and if you remember, those were the people that groom todays presidential face, dear little criminal Duby, but I do know exactly what they are. The Vulcans are the very face of organized, syndicated crime - mobsters to be exact. The Mafia moved into the Whitehouse. The face of Halliburton is the face for all those so-called Christian right-wingers. There truly is nothing Christian at all about the Christian right, is there?

I watched Norm Coleman (R) on the news tonight, talking about how awful the "food for oil" program was. But that I want to know is exactly how much of Iraqi oil actually profits Iraqis? I bet Bush could make those stories about the "food for oil" scandal look like simple acts of petty theft. I dont believe Bush is giving Iraqis back any of their oil profits and I'd like to know where the heck the press is on this profit that nobody talks about.

Posted by: Cheryl on September 18, 2006 at 11:09 PM | PERMALINK

a sad blue state story:

http://article.nationalreview.com/?q=NWY5ZmMyNjRhMjEwOWJiMjcyMDE5MTI2MWVhNTg1ODc=

the only state not hit by Katrina to lose jobs in the year ending Sept 2005? Perhaps it's just the cold winter.

Posted by: republicrat on September 19, 2006 at 12:02 AM | PERMALINK

Liberals supporting efficiency in an industry? That's new.

Where were you when the shipping companies were trying to automate the container process over the screams of the dockworker unions? When automation was unemploying thousands? When computers were making huge sectors of white collar employees redundant?

Posted by: luddite on September 19, 2006 at 12:18 AM | PERMALINK

My husband had a hip replacement this summer. I stayed in his hospital room all day, helped him to the bathroom, helped him eat, and provided personal care all day, for two days. Then I drove him home, 120 miles, helped him into the house, and nursed him for weeks until he was well. I am sure the bill for his "care" will be close to $50,000. Medical procedures cost a fortune, but no real care is provided unless the patient is lucky enough to have a family member or friend willing to help. Nursing used to mean bedside care; now it means doing paperwork.

Posted by: applecrisp on September 19, 2006 at 1:14 AM | PERMALINK

"In one sense it's just statistical trickery: at any period in American history, if you remove the single fastest growing industry from the picture then the rest of the economy is going to look pretty anemic."

Is that really true? I'm not being facetious.

The later 1990s were certainly an exceptional time, but wasn't there fairly robust growth in multiple sectors, from IT to health care to real estate? Wasn't there even reasonable growth in manufacturing?

Posted by: Linus on September 19, 2006 at 1:23 AM | PERMALINK

Actually, it's getting to the point where it can make more sense to fly to India, Thailand, Malaysia, and other countries and get treated there for - say - one fifth of what the same procedure would cost in the United States.

This is called "medical tourism."

According to the Pittsburgh Post-Gazette:

Bruce Pearson was leading a gardening tour in Thailand early last year when his chronic back pain got so bad that his friends convinced him to check into a local hospital.

After half a day in a private room with the doctor himself massaging his sore back, Mr. Pearson, like any good American, shuddered to think what his bill would be.

The bottom line? $12.

In December, the Boynton Beach, Fla., nursery owner was told by his American doctors that he would need spinal fusion surgery. The price he was quoted was close to $70,000, and under his American States individual health insurance policy, he would be responsible for $14,000 of the tab.

So Thailand beckoned again.

This time, Mr. Pearson, who just turned 60, checked in to the sleekly modern Bumrungrad International Hospital in Bangkok, where he received a less radical form of spinal surgery that has made him feel like a new man.

The second bottom line? For the surgery, a four-day hospital stay, an extra week in a recuperation center and round-trip plane tickets for himself and a partner, the total bill came to just under $7,000.

Procedures in India cost one-third to one-tenth what they would in the United States $6,000 for typical cardiac surgery, versus $30,000.

So our inefficient medical system may be heading for some competition and actually wind up on the receiving end of some free competition for a change.

Posted by: Duncan Kinder on September 19, 2006 at 1:27 AM | PERMALINK

Here is a question: why aren't manufacturers (who spend a good deal of lobbying Congress [to no avail] re: Asian currency manipulation) and retailers more concerned about stagnant middle class incomes?

Posted by: Linus on September 19, 2006 at 1:58 AM | PERMALINK

Linus --

One word: Short-termism!

"My" money today, to hell with your tomorrow. That short term view lies right across our society today, permeating every sector. Hence the lack of negotiation and compromise. We are losing our social cohesion skills, deliberately even if unconsciously.

Well, for all you know, you could be raptured tomorrow! Or not!

Posted by: notthere on September 19, 2006 at 2:13 AM | PERMALINK

Duncan Kinder --

This has been going on for some time, you just haven't been looking for the ads. Mexicoand Singapore, S. Africa, etc., too.

Back pain (I can't now quote the recent research) long term outcome not so good; whether surgery done or not, the outcome -- pain, mobility -- does not vary much. So, on balance, the cheaper option would be the better.

And good luck to them. It might allow some of these countries to keep their best surgeons, doctors and staff rather than the West poaching them to our stretched, badly managed, poorly structured health systems.

Posted by: notthere on September 19, 2006 at 2:23 AM | PERMALINK

I wish these types of articles talked more about the hundreds of thousands of Americans who are not counted in the unemployment figures. Once you're off unemployment benefits, but still have no job, you're not included in the ranks of the unemployed. I'd take those figures with a grain of salt the size of Gibraltar.

Posted by: Rich on September 19, 2006 at 2:32 AM | PERMALINK

I just wanna hire Al to get in my giant hamster wheel, that powers my personal power grid, with a donut strung as the proverbial carrot and ass, and watch him run until he loses consciousness, then I would fire him and hire another Al.

What you guys think Al is worth 'bout 2-3 cents an hour mebbe?

Posted by: Dick on September 19, 2006 at 3:06 AM | PERMALINK

Liberals supporting efficiency in an industry? That's new. --azzklown

Yeh, haven't you heard what a smash up job Halliburton and the neo-liberals are doing?
Highly Effecient!! Great Water! Good Food!

Very Neo-Liberal! {wink wink}

Posted by: Dick on September 19, 2006 at 3:10 AM | PERMALINK

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Posted by: amr铃声 on September 19, 2006 at 3:26 AM | PERMALINK

Rich --

Huh. F***. Rich.

I've asked this question at least twice before.

I would really like to know. What is the real unemployment rate in the USofA? What are the distortions of the gov't? and their derivations?

In the Mid-West, I see . . . . ? same!

Posted by: notthere on September 19, 2006 at 4:32 AM | PERMALINK

If we can figure out how to surgically remove the health insurance industry from the health care equation, the efficiency ratios go up considerably. The problem with health care in the U.S. is very simple and very apparent - third party payors.

Posted by: The Conservative Deflator on September 19, 2006 at 5:36 AM | PERMALINK

Here's Krugman:


Why is the price of U.S. health care so high? One answer is doctors' salaries: although average wages in France and the United States are similar, American doctors are paid much more than their French counterparts. Another answer is that America's health care system drives a poor bargain with the pharmaceutical industry.

Above all, a large part of America's health care spending goes into paperwork. A 2003 study in The New England Journal of Medicine estimated that administrative costs took 31 cents out of every dollar the United States spent on health care, compared with only 17 cents in Canada.

Transforming US health care into something resembling, say, France's (with universal coverage, private insurers, private practitioners and excellent outcomes) would be very good for the US. Health care costs could drop from the current 16% of GDP to 10%. Everyday low prices.

But the transition would NOT be painless. Doctors would have to face more competition (and make a lot less money). And somewhere in the region of 3 million paperpushers would become redundant.

Posted by: jasper emmering on September 19, 2006 at 8:55 AM | PERMALINK

"A national health care system . . . tremendously beneficial to the actual consumers of health care"

Really? I fear that Kevin underestimates the capacity of Congress and the medical lobbies to waste money. After all, one reason our health costs are so high is because the doctor lobby and the hospital lobby made such a cash cow of Medicare. Almost two decades of serious exploitation. And there are still very serious problems.

Honest and determined interest in the problems seems to be grossly deficient. This constant citing of NEJM's claim of 31% administration costs --not good evidence there. Out in California the biggest abuser is WellPoint, the for-profit incarnation of Blue Cross/Blue Shield, costing a bit over 21%. On the other hand, administrative costs at Kaiser (big non-profit HMO) are less than Medicare's.

So I suggest that a very good way to reduce costs would be to do something about the monopoly power, and corporations like WellPoint. And take a much tougher look at the issue than is currently popular.

Posted by: iolanthe on September 19, 2006 at 9:37 AM | PERMALINK

"We employs," Kevin? Well, I guess trickle-down grammar works, even if the same sort of economics doesn't.

Posted by: Ace Franze on September 19, 2006 at 9:46 AM | PERMALINK

How many jobs have been lost in other sectors because of the soaring costs of medical care and insurance?

Ask GM, Ford, or any of the airlines how they like increasing costs for insurance. Ask any business that supplies a significant percentage of it's employees with health care how they like it. Why these businesses have not yet begun fighting for universal coverage is beyond me.

Posted by: tomboy on September 19, 2006 at 10:25 AM | PERMALINK

If we have a country that has basically legalized poverty (selective capitalism) then that country must have a social type healthcare system. You simply cannot have one without the other in my view.

The sooner the 'destroy the social structure for annual budget neo-cons' figure that out and stop this 'selective' capitalism maybe we will get to a workable health care solution or decent wages.

Posted by: Dick on September 19, 2006 at 11:35 AM | PERMALINK

Those other countries don't have any profit motive to join the health care sector. OTOH, in America people are incentivized to join a high margin market.

And this is confusing, how, exactly?

Posted by: Birkel on September 19, 2006 at 12:01 PM | PERMALINK

Kevin, you should have seen through this bunk right away and even known what to call it. The claim in Business Week is a shameful example of what economists (honest ones) call the "broken window fallacy." It leads to thinking that vandals breaking windows is good because that creats work for "otherwise unemployed" people to make and install new windows. Hence the idea that something that gets people working, even to pick up the pieces of something that destroys real value, is good. But, it's wrong, because in an efficient economy work would get allocated to genuinely productive work. The broken windows represent a loss of utility creation and maintainence and are inefficient in real terms. The man hours spent fixing broken windows represent wasted effort that could have been spent making things or providing services like education that aren't about fixing lost value.

Posted by: Neil' on September 19, 2006 at 12:03 PM | PERMALINK

Rich "Once you're off unemployment benefits, but still have no job, you're not included in the ranks of the unemployed."

Ummmm....No.

Unemployment statistics pay no attention to whether you are drawing benefits or not. They pay attention to whether or not you are looking for work.

In fact, technically, I suppose it's possible that if you're drawing benefits but *not* looking for work you would not count as unemployed...

Posted by: jsr on September 19, 2006 at 5:52 PM | PERMALINK

A recap, part 1 With Digital ID World in the books as a success, I always like to take a look back at "what I learned." As an organizer of the conference, Digital ID World is always a whirlwind experience for me, but I find that as I look back

Posted by: Johanson on September 20, 2006 at 12:30 AM | PERMALINK




 

 

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