Welcome to the Thanksgiving Cavalcade. It’s an exciting time to be hosting because risk is a hot topic right now. Insurance and healthcare risk, as well as monetary policy and finance, etc.
First, the Healthcare Economist’s Jason Shafrin brings us a detailed account of the proposals put forth by the National Commission on Fiscal Responsibility and Reform to reduce the federal deficit and lower the risk of the US facing bankruptcy in the coming decades. Jason gives his own thoughts on the proposals to cut discretionary spending, reform the tax code and social security, and decrease healthcare spending.
Jaan Sidorov, the analytical mind behind the Disease Management Care Blog, brings us a piece about the new helical CT scanning technique being used to detect lung cancers before they can be found using conventional chest x-rays. Although the news media got quite excited about the helical CT scans and the 20% reduction in lung cancer deaths associated with their use, Jaan notes that the absolute reduction in deaths was only 0.4% (four out of a thousand), and the total screening costs to save one life ends up being $180,000. He questions whether this is a good use of health care dollars, and his logic is quite convincing.
Julie Ferguson of Workers’ Comp Insider reminds us of one more debt we own to our veterans. Medical technologies designed to treat war injuries are often on the cutting edge of medicine, and the research done to treat veterans means that injured civilians end up with access to better care.
David William of the Health Business Blog explains how sensitive data from pharmaceutical trials can potentially be leaked to hedge funds, and the process is quite disturbing to read about. A doctor was recently arrested for sharing data with a hedge fund, but from David’s description, it sounds like this could be much more common than one might think.
The Silicon Valley Blogger, writing at The Digerati Life, explains how you can use sites like e-healthinsurance to find health insurance coverage that’s appropriate for your situation. Of course, the price will be the same whether you use a do-it-yourself site like e-healthinsurance or contact a licensed broker who can help you through the process…
Budget Life’s Miranda Marquit tells us how to avoid scams in the life insurance market. As with most services, there will always be unscrupulous life insurance agents out there, and buyers do need to be aware that not all agents will be acting in the buyer’s best interests. Indeed, not all “agents” are even licensed, and buyers are always advised to check with their state’s Division of Insurance to make sure that the person or agency they are working with is licensed and in compliance with state laws. And as with any contract, it pays to read the fine print before signing anything.
The Dough Roller explains that while money market accounts typically pay higher interest rates than traditional savings accounts, they are not FDIC insured, which does expose the depositor to a potential – although very low – risk.
InsureBlog’s Hank Stern questions the idea that the British NHS is better than the US healthcare system, citing an article that explains that while Americans are much more likely to have chronic illnesses later in life, we also do a better job of treating those illnesses, resulting in 65 year olds here living a few months longer than their counterparts across the pond. When comparing life expectancy at birth, however, the Brits live 1.2 years longer than we do, with lower overall healthcare costs. Definitely some points to ponder here.
Investing Thesis brings us a detailed interview with Highwater Capital Management’s Mohsin Bashir, CFA, about managing risk while maximizing returns. The interview covers topics that aren’t always well understood in the world of investing, including options, covered calls and preferred shares.
Free Money Finance gives some compelling reasons for purchasing long term care insurance, and reminds readers that most of us have no desire to ever be a burden on our children in our later years. Long term care insurance – or at least some sort of strategy to prepare for the potential cost of long term care – is an important part of any estate planning process.
Staying with the insurance topic, but this time for pets, Jeff Rose of Good Financial Cents brings us a detailed analysis of whether pet health insurance is a good way to mitigate risk or a waste of money. We had insurance on both of our pets for several years, but found that the policies rarely covered much on the few occasions when our pets needed care, so our strategy now is to save money on our own to cover potential future bills.
Now have a Happy Thanksgiving and remember to manage your risks wisely. From driving to grandma’s in the snow to having that extra helping of potatoes and gravy.
{ 20 comments… read them below or add one }
Now that’s a LOT of food for thought!
Great job – Thanks for hosting!!
Thanks for including us, Louise.
About the British life expectency at birth, and other comparisons:
The usual claim that US healthcare costs more but delivers less comes from statistics by the UN World Health Organization. The WHO health statistics are biased. The WHO itself ranks the US #1 in health care delivery that is important to patients. It issues another ranking of 37th because this quality of care costs more and is not delivered by government in a “fair” way! Critics of US health care always refer to the ranking at 37th. That is a political judgement by the WHO.
There can be a political discussion about the subsidized distribution of healthcare, but advocates of socialization intentionally confuse the issue by implying that US health care as delivered is worse than the care delivered by socialized systems. They imply that US health care is both more expensive and worse than in socialized systems. US healthcare costs more and is better, so socialization is not a no-brainer.
The arguments offered against the quality of US health care are based on flawed infant mortality and life expectancy comparisons.
Just two points, with more at the link:
(1) The US follows the WHO definitions exactly for counting a live birth, “even one breath”. Other countries do not count premature births or babies with severe birth defects. The increased deaths of these children raises US numbers for infant mortality and decreases average US life expenctancy accordingly.
(2) The US has far more death from auto accidents and violent crime, but higher survival for cancer and other chronic diseases. Overall mortality is not a good statistic for judging health care effectiveness or population health.
Link – USA Healthcare is First – Infant Mortality is Low
Ugh. Andrew, I click on your “link” to check out your references. All it has is two links back to insureblog. Okay, let me scrape some more to find some valid data in the insureblog posts…. all I find are some far right leaning articles – like “pajamas media”. The only real links to valid, non-partisan data I find aren’t meant to back up the point. The pajamas media article uses data, they just don’t seem to say where they got it. Why?
Not saying I don’t believe you, but can you make it obvious to see your point by giving me a direct link to your references so they can be seen in context? No FOX News, pajamas media, Rush Limbaugh, etc?
This might help: http://en.wikipedia.org/wiki/Infant_mortality#Comparing_infant_mortality_rates
“The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.”
There are many valid, unbiased sources on that page, but the data source for that quote is here:
http://www.cdc.gov/nchs/data/databriefs/db23.htm
I think that last link might be the best, most valid reference for your point? I think both sides could cherry pick data or quotes from there to support their argument.
Andrew – Your claims are incorrect. The infant mortality stuff is a rehash of a 2005 study that has been debunked repeatedly.
In addition, the WHO ranking studies do not include any factors related to ‘fairness’ nor does ‘quality care’ cost more – at least not in other countries. In fact is costs much less.
For comparison purposes, infant mortality statistics should be calculated using the same definitions for all countries, with very few exceptions (specifically a couple former USSR satellites, the Czech Republic and Poland). It is possible that other countries ‘report’ their data differently, but for comparison purposes, a standard definition is used. Fortunately, infant mortality rates are reported using WHO standards, which do NOT include any reference to the length of the infant, duration of the pregnancy, but do define a ‘live birth’ as a baby born with any signs of life for any length of time. For a detailed explanation of WHO data definitions, and more on this issue see http://www.joepaduda.com/archives/001276.html
Finally, there are many other studies that find the US health care system has significant gaps in quality and costs far too much. I posted on the most recent one today at http://www.joepaduda.com/archives/001964.html
The biggest problem with our health care system is it is so expensive many cannot afford to access care – even those with insurance. Among the study’s findings are:
- Adults in the United States are far more likely than those in 10 other industrialized nations to go without health care because of costs, have trouble paying medical bills, encounter high medical bills even when insured, and have disputes with their insurers or discover insurance wouldn’t pay as they expected.
- One third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs, compared to as few as 5 percent to 6 percent in the Netherlands and the U.K.
- One-fifth of U.S. adults had major problems paying medical bills, compared to 9 percent in France, the next highest country, 2 percent in the U.K., 3 percent in Germany, and 4 percent in the Netherlands.
You can stand up and pound your chest about how great we are, or you can acknowledge that we have problems and work to fix them. But using refuted studies and hoary old memes as support for your positions won’t convince those who can’t afford the care they need of the wonders of the US health care ‘system’.
Ugh. Jay, your reply is superficial. I provide at least 8 links in my post, some to CDC and WHO reports, most provided by the authors of the quoted material. That is a minor point, but speaks to your glossing over what is presented.
Your complaint is that my post is not a research paper with links and authors acceptable to you. But, you say “Not saying I don’t believe you”, then imply that I am cherry picking data. No, I am contesting the broad indictment of US healthcare made by a cherry picking of available data, such as the infant mortality statistics.
If you think that a substantive point is mistaken, I would be happy to discuss it. I think that there is much in the post that properly questions conventional wisdom.
Jay, you noted a quote from Wikipedia, which I have put into context in this separate comment, because of the length of excerpts. Emphasis is mine.
Wikipedia – Comparing Infant Mortality Rates
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However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States’ high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[6][9][10] The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.
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November 2009 – Behind International Rankings of Infant Mortality: How the United States Compares with Europe
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In 2005, the United States ranked 30th in the world in infant mortality, behind most European countries, Canada, Australia, New Zealand, Hong Kong, Singapore, Japan, and Israel. There are some differences among countries in the reporting of very small infants who may die soon after birth. However, it appears unlikely that differences in reporting are the primary explanation for the United States’ relatively low international ranking.
In 2005, 22 countries had infant mortality rates of 5.0 or below. One would have to assume that these countries did not report more than one-third of their infant deaths for their infant mortality rates to equal or exceed the U.S. rate. This level of underreporting appears unlikely for most developed countries. [Unlikely, but they don't know. -amg]
The United States compares favorably with Europe in the survival of infants born preterm. Infant mortality rates for preterm infants are lower in the United States than in most European countries. However, infant mortality rates for infants born at 37 weeks of gestation or more are generally higher in the United States than in European countries.
The primary reason for the United States’ higher infant mortality rate when compared with Europe is the United States’ much higher percentage of preterm births. In 2004, 1 in 8 infants born in the United States were born preterm, compared with 1 in 18 in Ireland and Finland. Preterm infants have much higher rates of death or disability than infants born at 37 weeks of gestation or more (2-4, 6), so the United States’ higher percentage of preterm births has a large effect on infant mortality rates.
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Infant mortality is a stand-in for broad-based, direct measurements of medical care and outcomes. The WHO uses infant mortality because it has often been the only data available for poorer countries.
The above quotes tell me that infant mortality is not a simple or clear statistic which can be used to give a fine grade to a country’s level of health care. Correlation is not causality.
Andrew – I apologize, but I only see two links in your post and both of them are to insureblog. Both of them written by Hank. Here is where I went:
http://easyopinions.blogspot.com/2009/01/usa-healthcare-is-first-infant.html#Blog1
Andrew,
Maybe there are differences in how various countries report infant mortality. But doesn’t the fact that the US has a much higher rate of premature births indicate a problem with our health care system, specifically in terms of how we provide care to women of child-bearing age, and pregnant women in particular?
Jay – no need to apologize, Andrew is cherry picking data, and even when he uses that cherry-picked data, his use refutes his own contention that “The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.”
What that statement says, Andrew is that reporting differences are UNLIKELY TO BE THE PRIMARY explanation for our crappy rating. So, despite your contention that some countries (albeit few) report their data differently, WHO uses a standardized definition which takes that into consideration.
Other factors likely include poor neonatal care for the poor, lousy diet for many young mothers, high diabetes risk due to obesity and related birth complications, drug use, alcohol use, and other primary-care related factors.
As for cancer survival, it’s easy to pump up your survival rates when you screen far too many people and then treat cancers that should never be aggressively treated and then claim ‘success’ when the patients end up dying of something else. PSA tests are the poster child for our paranoia about cancer, a test frowned upon in other smarter countries.
To Jay 6:08 pm,
You are certainly looking at my post. It begins with two stand-alone links to InsureBlog posts. There are many other inline links provided by those posts or or by me to sources, and those sources are usually documented with links for the points that they make.
If you disagree with a fact or statement and don’t find support, please give me the details.
Andrew,
Again, I apologize, but I don’t know what an “inline link” is, so I don’t know what documented sources you’re referring to. I could not find any in your or Hank’s articles that seemed to support your position when taken in context. So can you please make it easy for me and just provide the links to the sources you’re referring to in your reply? I would like readers to be able to click directly from your reply to the source to read it in context. The sources from Hank’s posts actually seemed to contradict your positions. The pajamas media article just cherry picked some quotes that weren’t consistent with the data. That’s probably why they didn’t include a link?
The wikipedia excerpt you provided with your own emphasis… how does it support your position? To me, it also seems to do the opposite.
To Paduda,
You have proposed a blizzard of claims that I am wrong, but I would appreciate you telling me in a few cases what I claimed that is wrong, and who says so. I would appreciate being set right.
Here are your first three objections:
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Paduda The infant mortality stuff is a rehash of a 2005 study that has been debunked repeatedly.
AMG What exactly do you object to about my statements about infant mortality? Then, summarize the debunking, but please be specific.
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Paduda The WHO ranking studies do not include any factors related to ‘fairness’ nor does ‘quality care’ cost more – at least not in other countries. In fact it costs much less.
AMG Which ranking are you referring to? The article by John Stossel discusses the factors that lead the WHO to rank the US #1 in health care “responsiveness” but #37 in overall rating. The lower rank is due to expense and availability, according to the WHO. Stossel also mentions some of the factors that make US healthcare more expensive. Mandates by State and Federal regulation are part of it.
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Paduda For comparison purposes, infant mortality statistics should be calculated using the same definitions for all countries, with very few exceptions (specifically a couple former USSR satellites, the Czech Republic and Poland). It is possible that other countries ‘report’ their data differently, but for comparison purposes, a standard definition is used.
AMG You say “should be calculated”. But, they aren’t, from what I have seen reported. Medical data reporting varies widely by country and hospital. How exactly can the WHO get bad data, but magically compare according to a standard definition? Do you have a specific reference? This is at least a confounding factor to keep in mind, right?
I found a possible answer in this report by the Centers for Disease Control
Recent Trends in Infant Mortality
My summary: One percent of all births in 2002 resulted from reproductive therapy, and many of these are multiple births of low birth weight. More premature infants are delivered earlier by ceasarian, and more are saved (and lost) by applying modern treatments to save babies at ever earlier stages of gestational development.
Ironically, infant mortality can go up by attempting to save babies at ever earlier stages of development.
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More than half of Multiple births are born preterm and/or low birthweight. This has contributed importantly to recent increases in preterm and LBW rates. Between 1990 and 2002 the multiple birth rate climbed 42 percent (a 3-percent rise was reported between 2001 and 2002). In 2002, nearly one-fourth of all LBW infants were born in a multiple delivery.
The increased use of assisted reproductive therapies (ART) such as in-vitro fertilization has been strongly associated with the growth in multiple gestation pregnancies and may also be associated with an increased risk of LBW among singletons. One percent of all 2001 births were the result of ART procedures.
The management of labor and delivery has increasingly used medical technologies like ultrasound, and more aggressive management of premature rupture of the membranes (PROM). Induction of labor and cesarean delivery occur more often at earlier gestational ages, and is used much more often in recent years.
Recent declines in infant mortality have been attributed to improvement in birthweight and gestation-specific infant mortality rates, not to the prevention of preterm or LBW births.
The decline in birthweight and gestation-specific mortality has been attributed primarily to improvements in obstetric and neonatal care such as pulmonary surfactants for preterm infants.
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An inline link is one or more words which are highlighted as a link to another document. For example these words link to my post.
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In my comment at 5:58, I emphasized the statement that you made, and also other parts of the report you referred to.
The statement that “it appears unlikely that differences in reporting are the primary explanation” is someone’s offhand opinion. There are many variations in medical reporting. Also, there are other factors that confound using these rankings. As I said there “The above quotes tell me that infant mortality is not a simple or clear statistic which can be used to give a fine grade to a country’s level of health care. Correlation is not causality”.
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You write “I could not find anything in your or Hank’s articles that seemed to support your position”. Really, I don’t know what you mean by “my position”. There are many points, and a discussion needs both sides to be specific.
I suggest that you be specific about something you question, disagree with, or think is unsupported. I probably don’t support everything to your taste. People have different ideas about what is believable, likely, or relevant. If you can provide some other information, correction, or source, I’ll appreciate it.
To Rebecca:
(My comment above at 10:24 PM should have started with this introduction.)
You asked “Doesn’t the fact that the US has a much higher rate of premature births indicate a problem with our health care system, specifically in terms of how we provide care to women of child-bearing age, and pregnant women in particular?”
I found a possible answer in this report by the Centers for Disease Control
Recent Trends in Infant Mortality
(continued at the above comment at 10:24)
andrew – in my post which was referenced and a url provided there is a complete dissection of the data around infant mortality. All sources are referenced in my post. Don’t quote stossel as a source – the guy is not credible and is not a primary source. And neither is the source for your data, which appears to be the 2005 article penned by noted bastion of scientific objectivity, the Discovery Institute (for those unfamiliar with these folks, their primary mission is to promote creationism/”intelligent design”, perhaps that’s why their science is so faulty)
the WHO report standardizes the data for ranking purposes – as I pointed out. I don’t know why you don’t understand this – the basis for ranking is the SAME for all countries, regardless of the countries’ internal reporting methodologies.
you have an agenda which blinds you to understanding. that’s unfortunate, as you’d rather argue than understand. Your loss.
To Paduda,
You offer slurs but no specifics. Please present some information here, in this forum. Present your data or source, or rely on people to go “read your blog”. You haven’t deigned to respond to my questions about your first three points. So far, it seems you don’t want a discussion.
My comments here are not about creationism, merely the difficulty in collecting statistics and how reports on those statistics should be taken skeptically.
The WHO reportedly takes data prepared by individual government’s, based on that government’s criteria: it doesn’t typically compile the information itself. Therefore, if different governments use even slightly different criteria in compiling their data, there will be differences: for instance, it’s been reported in the Wall Street Journal (certainly not a “far-right” newspaper, unless you make a habit of reading Media Matters) that Germany uses a different criteria for live births than other countries, specifically the U.S. – ergo, this translates into an ‘apples to oranges’ comparison that skews results in ways that may favor one over the other.
Further, the WHO is on record as favoring single-payor, government-run health care, and downgrades the United States for having a private care system. Anyone who critically examines WHO reports can see this.
But hey, what do I know? Trying to win this argument is like trying to debate global warming (and yes, the fact that both issues have been subject to “propaganda”, masquerading as fact, is eye-opening, isn’t it?)
Here is a link to a very thorough review of the WHO and it’s ranking data. Well-documented, thoroughly foot-noted, and with quite a few academic sources listed:
http://www.cato.org/pubs/bp/bp101.pdf
Some will dismiss it as being from the CATO Institute, but the CATO Institute is libertarian, not “right-wing” (whatever that means, which is usually “if it isn’t in the New York Times and then regurgitated across the dominant liberal mass media, it must be “right-wing”). This report, written in 2008, is a source for much of the dissent against the WHO and its various reports that purport to show that the United States, somehow, has an inferior health care system to, say, Cuba, or, North Korea, which to me is completely daft.
Rick,
Thanks for the good info. The CATO institute describes itself as: “Promoting public policy based on individual liberty, limited government, free markets, and peaceful international relations.”
The discussion is about comparing socialized medicine against a limited government, free market system. For you to try to sell the idea that their data is unbiased would be disingenuous at best. Before I even look at the Cato data, I bet I can guess what they say.
Your claim that “WHO is on record as favoring single-payor, government-run health care” – do you have the source to where they went on record with that stance? If you do, I think that would make their data equally as unreliable as the CATO data. I would like to see it.
I would be curious to see your link to the Wall St Journal data. However, they’re owned by Rupert Murdoch, so I think you could see how that could hurt their credibility?
And climate change? “Propaganda masquerading as fact” ??
“No scientific body of national or international standing has maintained a dissenting opinion about climate change.” 97% of climatologists agree that climate change is occurring and is a result of human activity. If you happen to be somebody that doesn’t agree with those 97% of qualified scientists and there isn’t a single scientific body that agrees, I would assume that is very frustrating.
http://en.wikipedia.org/wiki/Scientific_opinion_on_climate_change