Monday, October 31, 2016

Healthcare As a Right, Healthcare as Business

The last article I linked caused me to check out some other articles by Megan McArdle. Here, she writes the following:

People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”. (There are some, to be sure, but this was never a widespread sentiment even when food was a lot scarcer and more expensive). Why is health care special?
As someone who thinks that the chief functions of the state should be to provide education, health and the rule of law, I must admit that I had never thought of it this way. Should the government also provide food?

Well in a sense, it already does - through food stamps. So perhaps, health care is not so special.

In other senses, there are profound differences between health care and food. Food is (relatively) plentiful and easy to provide. On the other hand, health care is both difficult to provide and expensive. Surely, preparing a burrito is easier than operating someone.

So, here are good questions to ask.

If food were as scarce and expensive as healthcare currently is (consider a post-nuclear dystopian future), would we want the state to make sure everyone has equal access to food?

Alternatively, if healthcare were as cheap and plentiful as food, would we find government's meddling in healthcare excessive?You can also post a similar question about education.

I guess when construing what kind of state we want, we can't ignore facts about cost and scarcity.

But this whole discussion also makes you think that if somehow we could make healthcare as cheap and plentiful as food, we could also accept that the state has less of a duty to provide it to its citizens.

Composition of Healthcare Costs in the U.S.

I dug up this CDC report on healthcare in the US. I encourage the interested reader to skim around the report. Here's the relevant info I was looking for.
Expenditures for hospital care accounted for 37.9% of all personal health care expenditures in 2014. Physician and clinical services accounted for 23.5% of total personal health care expenditures, prescription drugs for 11.6%, and nursing care facilities and continuing care retirement communities for 6.1%; the remaining spending was for other types of personal health care expenditures
So, a huge part of health care spending, 37.9% + 23.5% = 61.4%, in the US seems to be hospital care and clinical services. This seems to confirm this article's point that primary drivers of healthcare costs in the US are physician and nurse salaries.

Even if we accept that Big Pharma scam the American people, with prescription drugs constituting only %11.6 of total expenditures, drug costs are relatively little compared to hospital and clinical services.

There is of course another question that I'm curious about. With much greater healthcare costs, are the Americans getting better healthcare? In other words, they are paying more; but are they getting more in return relative to other countries?

Sunday, October 30, 2016

Healthcare Costs In the U.S.

This is a subject that I want to delve into more deeply in the future. I want to understand why healthcare costs are so high in the U.S. This website is a good place to start. Here's the money quote:
All-payer rate setting is a system in which insurers band together to negotiate rates collectively. We the people could shift our current “ObamaCare” based system to a single payer system with all-payer rate setting. This one move could take the power away from for-profit health care providers and put it in the hands of the American people.
You don't even need a single-payer system. You just need an all-player rate setting and even that would bring costs down.

Also, see this article, where the author argues that single payer wouldn't be enough to bring down health care costs. She doesn't discuss pharmaceuticals though.

"Fuck you, Wells Fargo"...

... is my interpretation of this Planet Money episode. I do hope the class action lawsuit for the ex-employees who were essentially fired for refusing to scam their customers succeeds. To my knowledge, there hasn't been much coverage of this class action in the news.

Intuitions, Math and Philosophy

The more I study mathematics, the less compelling philosophy becomes for me.

The reason is that certain intuitions you develop regarding a mathematical concept (say closed sets) can be overturned when you study them in a more general setting. (Properties one associates with closed sets of a familiar space, like the real line, fail to hold in more general topological spaces.)

I have specifically in mind the interactions between topology and real analysis - a topic that I may return to later - but to appreciate the point a bit, the reader need not know a whole lot of mathematics.

Quick intuition check: How many people do you need in a room so that with reasonable probability (say >%50)  two people have the same birthday?

If your intuitions are as naive as mine, before analyzing you might think it's some high number like 180. But with the correct analysis, one can show that it's actually 23.

In mathematics, there are systemic ways to defeat faulty intuitions. Not so much in philosophy. Actually, a philosopher will base their entire case on intuitions regarding a certain case - a thought experiment. Especially in analytical philosophy - but if you want to do philosophy, analytical philosophy is the only game in town. 

Here's one of the most famous thought experiments in the entire free will debate.

So the more I see my intuitions proven incorrect in mathematics, the more frustrated I become with philosophers' attempts to build cases based on speculative, intuitive thought experiments.

Aaron Swartz, may he rest in piece, essentially argued along similar lines here.