Health Insurance and Amenable Mortality

Here’s an article by Ellen Norte and C. Martin McKee that tries to compare mortality rates for incidents which might be prevented by health care intervention:

The concept of amenable mortality was developed in the 1970s to assess the quality and performance of health systems and to track changes over time. For this study, the researchers used data from the World Health Organization on deaths from conditions considered amenable to health care, such as treatable cancers, diabetes, and cardiovascular disease.

Between 1997–98 and 2002–03, amenable mortality fell by an average of 16 percent in all countries except the U.S., where the decline was only 4 percent. In 1997–98, the U.S. ranked 15th out of the 19 countries on this measure—ahead of only Finland, Portugal, the United Kingdom, and Ireland—with a rate of 114.7 deaths per 100,000 people. By 2002–03, the U.S. fell to last place, with 109.7 per 100,000. In the leading countries, mortality rates per 100,000 people were 64.8 in France, 71.2 in Japan, and 71.3 in Australia.

The largest reductions in amenable mortality were seen in countries with the highest initial levels, including Portugal, Finland, Ireland, and the U.K, but also in some higher-performing countries, like Australia and Italy. In contrast, the U.S. started from a relatively high level of amenable mortality but experienced smaller reductions.

The researchers estimated the number of lives that could have been saved in 2002 if the U.S. had achieved either the average of all countries analyzed (except the U.S.) or the average of the three top-performing countries. Using this formula, the authors estimated that approximately 75,000 to 101,00 preventable deaths could be averted in the U.S. "[E]ven the more conservative estimate of 75,000 deaths is almost twice the Institute of Medicine’s (lower) estimate of the number of deaths attributable to medical errors in the United States each year," the authors say.

To restate: everybody’s amenable mortality rate has improved, but USA’s rate of improvement is so small that USA is now dead last in it.

Ed from Gin and Tacos wonders why conservatives are so satisfied with their health insurance:

My puzzlement is complete and my question is simple: what insurance do these people have and where can the rest of us sign? What the hell is this fantasy world in which medical decisions are “between patients and doctors” without the interference of panels of dour bean-counters, a labyrinthine and faceless bureaucracy, and actuarial tables? These columnists, screaming protesters, and talk radio audiences apparently live in 1923. Their doctor makes housecalls with his leather bag of Olde Tyme medical instruments and is paid for his services in cash or To Kill a Mockingbird style with bags of apples left on his porch. Or if they do have health insurance, it is a silent and unobtrusive entity that lingers in the background for the sole purpose of shelling out money without question for whatever procedure Chuck Norris desires.

This isn’t remotely about patients’ rights or the sanctity of the doctor-patient relationship. It is, as wingnuts so often fail to grasp, about preferences. A panel of government bureaucrats denying coverage for a procedure deemed experimental is an image worthy of pant-shitting rage; a panel of “reviewers” at Cigna or Aetna doing the same is fine. Having to ask an Obama-appointed bureaucrat for permission to recieve certain procedures is unthinkable; that we routinely do the same thing with our HMOs and PPOs is irrelevant. The mental gymnastics of defending the status quo require either dubious reasoning about why Aetna red tape is better than Uncle Sam red tape or, as is the case with so many demagogues, fabrication of their own curious reality in which we are infinitely free to do as we please and in total control of decisions which affect our lives

Gin and Tacos really nails it about the problem with libertarian philosophy: it depends on reliable information being distributed equally.

The good libertarian relies on the free market to solve problems on its own. Take a couple of hamburger chains, for instance. The one that makes bad food will go out of business. Customers won’t eat there! Thus the market, left alone, will punish those who fail to provide what people want. How cute. Let’s leave the airline industry alone – bust the unions, abandon all regulation, let the market set whatever wage it will, let the pilots be on for 36 hours at a crack – and let the same process go to work. Markets will force airlines to keep their planes safe, otherwise no one will pay to fly with them!

In order for the market to punish the backsliders, consumers must be made aware that Airline X is unsafe. Since we don’t have regulations and inspections, how will we know? Well, look up. We will know which airlines shirk on maintenance and safety when we see their planes plunging out of the sky. Here’s where my Mises Institute friends come in.

As market acolytes, I believe that they should volunteer to be on the plane(s) that serve the purpose of communicating this essential information to all of us. In the airline industry, the market’s way of telling us who is inferior involves a lot of people dying. The system works really well – let airlines be, see who fails, and punish them with one’s wallet – for everyone except the people on the plane.

See also: Mark Thompson’s takedown of libertarianism with Monty Python quotes.

Perhaps I’ve never been a full-fledged libertarian, but I’ve always been a free market enthusiast in general. But the last year has really shaken my political beliefs. Namely:

  1. The financial crisis of 2008 shows the extent to which major lenders will game the political system to extract political concessions. (This may not be a criticism of libertarianism per se, but some might say that more aggressive legislation might have prevented the catastrophe).
  2. The science for global warming is established and growing more urgent, and yet a significant portion of the population doesn’t want to face this fact. The problem with libertarianism here is that a)people don’t see proof of climate warning until the effects are upon us, and 2)private lawsuits intended to recoup damages from global warming are unlikely to happen soon enough (especially if it wreaks permanent damage on your habitat).
  3. In health care reform, libertarians refuse to provide a workable alternative to solve the free rider problem and the fact that certain individuals will be discriminated against because of their health condition.
  4. The American media landscape gives a lot of power to certain political viewpoints which  are friendly to  advertising. I see more similarities than differences between CNN and Fox. He-said/she-said journalism makes it easy for corporations to drown out negative news stories….so much that it begins to seem that a captive audience is more likely to see a Swift Boat attack than a news story debunking it.
  5. More importantly, how much ability do corporations  (and their mouthpieces) have to motivate individuals to become politically active?  Bernard Chazelle believes that in the  “A empowers B to elect C to serve A” paradigm, A= corporations, B=individual voters and C=politicians. Even if this is reductive analysis, I can think of many cases where this paradigm did play out; can individuals be persuaded to act on behalf of the corporation’s self-interest even if it goes against their own? At some point, will this misguided passion turn against the corporations that engendered it?  If astroturf campaigns are effective sometimes, does this imply that democracy itself is fundamentally  a sham?







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