This post is sort of a response to a post a Vjacks. For some reason my long comments there weren't getting through (perhaps he hates me?), but I thought perhaps they were good enough as an actual blog post anyway. I think the very largest problem with this so-called debate about healthcare is that a huge amount of conflation keeps happening...on both sides.

Health care technology is not the same thing as a health care system.

Its that simple. Seems obvious, so how come these morons can't keep the debate focused on the right thing? The debate should only be about the latter and should not include the former.

Health Care Technology
There is little doubt and little debate (at least amongst Americans) that America has the best health care technology in the world. Better than that, we export, and make tons of money on this very technology. This technology with respect not not only life saving procedures, but also effective drugs and treatments for non-life threatening issues like chronic stomach pain, restless leg syndrome, impotence, etc.

I don't want to ignore the contribution in many areas that come from other countries, I do recognize some amazing work that comes out of France and Japan that I am familiar with. I'm sure significant contributions come from other countries, I am just only familiar with these two (sorry if I left your country out). Even my vasectomy that I had, was done with a Thai procedure (but I got it here).

But in the end, I think we can safely say that America does in fact, provide the world with more of what we call "western medicine" than any other country. We also can say that we have studied the efficacy of this work (from USA and other countries), and found that we have made great strides in cancer treatment, prevention of transmissible diseases, and other health areas.

Even if the science was attained through completely unethical means, and the efficacy of the treatment is proven, it is still healthcare technology and not part of the system under debate. That is not an endorsement of unethical behavior, its simply a fact that if a treatment is verified to work, its simply a fact that it does, which is a different issue than the means by which this fact was attained.

One more fact about our medical technology that is almost universally considered unsurpassed. The great majority of it was developed through a so-called 'socialist' mechanism. Yes folks, I'm sorry to say you have this wonderful healthcare technology due to a giant wealth redistribution system that takes money from citizen and aims billions of dollars of it towards medical research to the tunes of tens of billions of dollars annually.

30 billion from the National Institute of Health.

More than 80% of the NIH's funding is awarded through almost 50,000 competitive grants to more than 325,000 researchers at over 3,000 universities, medical schools, and other research institutions in every state and around the world.

6 billion redistributed dollars from the CDC

The CDC awards nearly 85 percent of its budget through grants and contracts to help accomplish its mission to promote health and quality of life by preventing and controlling disease, injury, and disability.

The Health and Human Services has a budget of 76 billion.

The HHS grant portfolio is the largest in the federal government with more than 300 grant programs operating under its annual grant budget that amounts to approximately 60% of the Federal government's grant dollars.

These tax dollars get doled on in a competitive peer reviewed process (as do grants for the DoD and DoE etc) in the form of phased grants. Sometimes the a Small Business Innovation Research (SBIR) grants. Sometimes they are grand challenges, and sometimes they come in other forms.

Compare these values to the paltry 10 billion or so dollars that venture capitalists invest every year. Conservatives seem to think that venture capitalists can do this, but I have sad news for them. Basic research rarely pays off directly, but it forms a foundation for the items that do pay off. VC tend to invest after the preliminary work has already been done, when the product has been fleshed out, even when some early units have shipped. They have almost no tolerance for the very early work. There are exceptions: Drug companies do invest lots of money in a new drug for example, but they get their returns in getting a formula retweaked as long as possible rather than doing the basic research for something truly novel (Viagra was found by accident and will get tweaked as the patent's time limit arrives, much like you see Claritin coming in a new form).

To sum up this part... The healthcare technology in the USA is possibly the best in the world. It also got this way through largely socialist means (but not totally) while the money is being made through capitalist means.

Health care system
A health care system is the mechanism by which the technology gets distributed to the people. Most, if not all, countries with longer lifespans (we rank 50th or 35th depending on where you look) and greater healthcare satisfaction (17th) have a socialized healthcare system. The citizens are taxed, the money is pooled and healthcare is delivered to everyone in the nation.

Our healthcare system works by letting companies compete to provide better healthcare to their customers. At least that is the theory. In reality healthcare costs for customers of any of these companies average out to be far higher than in any other country, without the benefit of longer lifespans or better satisfaction.

Liberal like me can't see how we can expect a company, with an inherently smaller pool of customers than a socialized system would provide, can possibly deliver competitive costs with respect to other countries. Never mind the fact that the profit motive necessarily raises costs even if it as little as 3.3%. Never mind the anti-trust issues and unethical recision and all the other bad practices that they do, each company necessarily has a miniscule insurance pool by which to couch the payouts. Insurance works best when you have lots of healthy people paying into it. The whole country as an insurance pool is better than breaking it up into 50 smaller pools.

Anyway, regardless of my opinions of our system. The debate would go a lot easier if we stuck to discussion about a health care system rather than the state of our health care technology.

Here is a video going around. Both of these men perform the very conflation I am talking about.

File Under: Medicine, Politics

Healthcare Conflation

2009-10-12T22:47:00-07:00

Techskeptic

Medicine|Politics|

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