I found this piece by Scott Atlas on improving healthcare for minorities and the poor at RealClearPolitics interesting. The article itself is a sort of grab bag of complaints about the U. S. healthcare system and, particularly, Medicaid. Here’s a snippet:
The goal should be to increase access to high-quality health care and improve health, not simply to label people as “insured.†But Medicaid patients fare worse than patients using private insurance in study after study – even after standardizing for medical differences among patients. Those bad outcomes include more frequent complications and more deaths in treated cancers, heart procedures, transplants, and major surgeries. A 2013 Oregon randomized study’s most striking conclusion was that Medicaid fails to improve physical health beyond no insurance at all.
and here’s an example of what he’s complaining about:
Infant mortality rates have been improving in the U.S. since 1995, with the lowest in history for all races recorded in 2020, but infant mortality rate by race of the mother for blacks (10.38) remains double to triple that of infants born to whites (4.4), Hispanics (4.69), or Asians (3.14). Similarly, Hispanic Americans and whites have a life expectancy six years longer than blacks, not counting data since the pandemic.
That difference in health outcomes has been put forth as a key reason to expand single-payer health insurance in the United States. An inexplicably ignored logical flaw in that argument is that those very same health disparities for minorities are seen in the countries with the longest history of single-payer healthcare systems. For instance, in the government-run system of Canada, Inuit and First Nation infant mortality was two to four times that of non-indigenous Canadians and Quebecois. The same goes for the United Kingdom, where black Caribbean and black African infant mortality rates are double those of whites.
Decreasing infant mortality is a worthy goal but achieving it is not trivial. The very examples cited above illustrate the problems. Under the British system everyone is insured under the same system of national health. If the black mothers in the UK experience the same level of infant mortality as they do here in the States, it calls into question bringing everybody under the same system as a solution. Canada, where insurance is handled by the provinces, has problems on roughly the same scale. The infant mortality rate among Hispanics is roughly the same as among whites regardless of income.
There appears to be a pretty close correlation between low birthweight babies and infant mortality and there appears to be a correlation between substance use in pregnancy and low birthweight babies. Could it be that social issues have more to do with it than care or genetics?
Genetics, which Atlas either ignores dogmatically or which he never once heard of. Considering the current state of our education system, I’ll bet on the later.
By the way, a major complicating factor is obesity. Well over half the population is obese, more like two-thirds in my county, and black women seem more likely to be obese than others, and very often spectacularly, morbidly obese.
Obesity is so extremely common nowadays, actually the expected norm, that there must be something very wrong in our diet, something that especially pernicious tp black women.
I think that obesity is undoubtedly a factor but I don’t think that the cause of obesity is primarily genetic. I think that behavior is a much more important factor.
Just for the record I think that obesity is multi-factorial including genetics, behavior, environmental, etc. But I think that behavior is the most important factor. A complicating factor is that it’s not fair. You and I can eat the same things and do the same things as you and it will make me fat while you remain slender. That doesn’t mean it’s not behavior. It just means that it takes more for me to remain slender.
The Oregon study was statistically flawed. The pts were healthier than expected so you weren’t going to see much improvement as there weren’t a lot of people to improve.
While I agree the goal should be medical care and not just pronouncing them insured insurance is how health care is paid for. There are a lot of reasons Medicaid pts dont do as well, among them that many are rural or if they are urban they live in areas with poor access. You just arent going to have a top quality tertiary care hospital in the middle of Montana or next to the Inuit igloos. Also, Medicaid is the insurance that covers disabled people so a lot of them are sicker to begin with, just poor protoplasm.
But let’s take Atlas at his word (LOL) and look at private insurance. It’s not covering wigs or in vitro fertilization that runs up costs. Just like all of medicine its chronic care and serious acute care episodes like heart surgery or cancer care. Private insurance is more expensive than Medicaid and it pays more. It also covers a healthier population ie those well enough to work full time.
So there is no realistic way to have private insurance and have it cost less. Well, unless you go back to the kinds of insurance we had before the ACA. The kinds that dont pay for chronic care or acute medical care. He is correct that HSAs can be cheaper, but really only if you are healthy. A high deductible plan where you have to pay the high deductible every year want cost less. So let’s see the details of the “Atlas plan”. I am betting I know where he is going and the plan is to not insure poor people then claim they have insurance.
Bonus- I am betting that the Medicaid pts when shifted to the new Atlas plan will do just as badly or worse.
Steve
I don’t think there’s any way for healthcare to cost less period without a Wayback Machine.
I think it can be done if you are willing to make people unhappy. There is some low hanging fruit I think, but on personnel costs, a big part of it I wouldn’t try to quickly cut costs but limit growth for a while.The ortho surgeon making $900k a year is going to whine but not get a lot of sympathy I think.
Steve
Even limiting growth would be tough. There would need to be no “cost of living” increases for several years. IMO that would be difficult to realize.
A key problem is that when healthcare is 18% of the economy increases in the cost of healthcare become a major driving force of inflation. Indeed, that seems to be happening now. It’s a positive feedback situation.
If Medicaid resembles Medicare I’m not surprised it’s not effective.
Long wait times and single issue office visits, diagnostic tests at the other end of town.
If Holistic is the word I’m looking for I can understand that it is advice for living that should be given by the family but since government has effectively replaced the family for the poor then they should fill that gap as well. Moderate diet, moderate exercise, tobacco, alcohol, fentanyl, all in moderation.
Who’s going to tell people that, when all around them they see excess.