Friday, April 18, 2008

What’s wrong with our health care delivery

Ezra Klein quotes these three paragraphs from Shannon Brownlee’s excellent Washington Monthly article on the Gingrich Republicans emasculation of the Agency for Health Care Policy and Research, a government group that had the potential to control health care costs. He says they’re as clear an example as any of what’s wrong with our health care delivery system—as distinct from insurance:

Last year, we spent more than $16 billion on back surgeries, and, in the past decade, surgeons have been performing spinal fusions at a furious rate, even though there still has never been a rigorous, independently funded clinical trial showing that going under the knife is superior to cheaper, less invasive remedies. At the same time, the nation’s total health care bill continues to skyrocket, propelled in no small measure by procedures that are equally as questionable as spinal fusion. In 2000, America spent $1.3 trillion, a figure that nearly doubled to an estimated $2.1 trillion by 2006. In the view of Peter Orzag, head of the Congressional Budget Office, this has put the U.S. on “an unsustainable fiscal path.”

Of course, some of our money is going toward new treatments and tests that help Americans live longer and healthier lives. However, as much as 30 cents on every health care dollar is spent on unnecessary care-or “overtreatment,” in medicalspeak. That may sound odd after all we’ve heard from people like Michael Moore about how everybody from your hospital to your insurer is getting rich by denying you care you need. Yet both problems exist simultaneously. All too often, patients don’t get necessary medical treatment. At the same time, we risk being given stuff that not only doesn’t improve our health but which may actually harm us. One estimate suggests that as many as 30,000 Medicare recipients die prematurely each year from unnecessary care.

This overtreatment is due in part to an excess supply of medical resources-hospital beds, intensive care units, specialists, CT scanners-in many parts of the country. But it is also the result of our national failure to fund the research that could show what works in medicine, what doesn’t, and for which patients-and then to train doctors to understand that research and use it. Our current fee-for-service payment system, which pays hospitals and doctors for each hospitalization, office visit, procedure, test, and surgery performed, simply gives providers an incentive to adopt anything that’s well reimbursed, regardless of whether it actually helps patients. Medicare pays for practically anything that physicians deem “medically necessary,” much of which, from spinal fusion to a fancy new imaging scan for Alzheimer’s, remains unproven by anything resembling good scientific evidence.

Read the whole thing.

Handwriting holds no clues to personality

Remember that pricy personality test I had done by a popular Manhattan handwriting analyst?

Lest there was any doubt science has conclusively proven… [to my satisfaction...] it’s all bunk!

Geoffrey Dean has reviewed two hundred different studies into whether graphology can tell us anything about personality (Dean, 1992). Adding up the effect of each of these studies showed that graphology has a combined power of about...wait for it...zero. Well, not quite zero but still very, very small - so small as to be insignificant.

Richard Thompson Ford for Obama Attorney General

Carlin Romano had a terrific review of Richard Thompson Ford’s THE RACE CARD: How Bluffing About Bias Makes Race Relations Worse in The Philadelphia Inquirer yesterday:

Ford’s overarching argument rides on his firm belief that there are fewer racists today, leaving a society of “racism without racists” - a legacy more than a subgroup.

That leads him to reject Kanye West’s “race card” attack on Bush. Katrina produced disproportionate black victims not because of racism, Ford argues, but because racist history left New Orleans’ blacks in lower-lying areas, with many too poor to afford cars.

Ford brings a similar independent angle to Cornel West’s complaint that racist cab drivers discriminate against black Americans. Ford largely attributes the decision to fear of putatively high-crime areas, a fear he suggests West shared by parking what West called his “rather elegant” car in a “safe parking lot” on the East Side, before cabbing to Harlem.

At this point, you may wonder: Is Ford simply another aggressive black conservative? He’s not - he considers himself an old-fashioned liberal, favoring integration and affirmative action, though less friendly to diversity quotas. He skewers figures from both the right and left.

Ford seeks, it seems, a sensible middle. He fears that a “national patois” of racism rhetoric blinds us to the real thing, stoking counterproductive results. Even worse, it stirs advocates of other allegedly oppressed interest groups, such as obese people, to model their complaints on laws forged to fight racism, a “racism by analogy” strategy.

You can surmise Ford’s attitude toward it from his tart phrase that “Fat is not the new black.” He questions, albeit fair-mindedly, the animal rights movement’s invocation of slavery and the Holocaust in its attacks on the meat industry, the gay rights movement’s analogies to laws against miscegenation, and the smokers rights movement’s allusions to Jim Crow.

Does Ford believe racism no longer exists in American society? Not at all. Accusations of racism should be kept to such cases. But social problems that stem from multiple factors call for an eye on the big picture, not single-cause reductionism.

Romano notes that Ford and Obama are both Harvard Law Class of ‘91 graduates and proposed that “on the evidence of this book, Ford would make an incisive attorney general.” What a nifty notion!

He goes on to conclude by wondering, “is there any academic out there ready to take on the ‘elitism’ or ‘bitterness’ cards? It might be nice to weed them from the deck before they catch on.” Hear! Hear!

RELATED: NYTimes reviews are here and here; excerpts here, here and here; the first chapter here; purchase it here. Ford interviewd by Stephen Colbert here.

Gay scientists isolate Christian gene

At last…

No Internet - toggled the input - I’m back!

Technical difficulties kept me from posting yesterday. After some time I finally figured out that my router went bad. All I had to do was toggle the input (plug the modem directly into the computer) to get back up and going. Too bad I didn’t have Hillary here to help me out!

Colbert was masterful!