September 1, 2009 • 2:34 AM 0
Every year since we’ve been at our house we’ve had an annual bonfire and star party. We get some of the neighbors and our friends together, build a small fire and make some smores. We do it right around the time of the annual Perseid meteor shower. We tend to miss the peak by a few days, but we always seem to see a few. And, as we always do, we got out my two telescopes and showed the neighborhood a few night sky objects.
This year Jupiter was the only early evening planet visible; but it is my favorite. (Saturn’s close — but setting too early in the evening this year’s August). Here’s a photo of how Jupiter looked for us through my Meade ETX 125, courtesy of another amateur using the same scope as I have. Jupiter is great because the kids (and parents) can immediately identify it. It was really appropriate this year, the 400th anniversary of Galileo’s first astronomical use of the telescope. The kids kept asking what the stars were that surrounded Jupiter. They loved the fact that they were Jupiter’s moons. They even suffered through me talking about the volcanism of Io, the oceans under the surface ice of Ganymede and Europa and how Galileo confirmed the Copernican world view by asking the same question that they had.
Even with the city lights, we were able to get a few deep sky sights in scope. After a little star hopping (aided by a new friend to our family – Tom – a geek like me who likes amateur astronomy), we were able to get the great Hercules cluster in my larger 8″ home built dobsonian scope. The cluster (M13) is a globular cluster with about 200,000 stars sitting in the halo of our Milky Way Galaxy. In the scope it looks like a dandelion fluff. Impressive when you think that it contains that many stars — but a bit less identifiable than Jupiter. Here’s what it looks like in a scope like mine after a few minutes exposure. As I said, in my scope, with city lights and lower magnification — more of a smudge.
I was also able to get M39, an open cluster, in my larger scope. Unfortunately, by the time I got it in focus, most of our guests had taken off. I wish I had gotten it in view earlier, because it probably would have gotten more of a response than the Hercules cluster. The stars in the open cluster are gorgeous in the scope, almost like jewels. Here’s a picture of them through a much larger telescope — certainly not what they look like through mine — but it very much catches the effect.
Most important to me, my kids got a kick out the the evening. They didn’t last that long — my youngest was going to bed only just after sun set. Noelle got to see most of the sites. And, of course, she had her fair share of smores. I’m already looking forward to next year.
August 23, 2009 • 6:23 PM 0
A few noteworthy podcasts/links of the week:
Diane Rehm Show. On Thursday, hosted Jill Tarter, Director of the Search for Extraterrestrial Intelligence Institute’s Center for SETI Research. Jill Tarter also has a neat little presentation when she recently received the TED prize. I’ve posted on TED talks before. Discussion around SETI @ 50 years!
Diane Rehm Show. On Wednesday, hosted Maxwell Mehlman, professor of law and bioethics at Case Western Reserve University and the author of “Wondergenes”; “The Encyclopedia of Ethical, Legal, and Policy Issues in Biotechnology”; and “Access to the Genome” and one of my old professors. The conversation is about his recent book, Price of Perfection.
The Lost Decade. What’s been the economic growth rate over 1999 – 2009 and how does it compare to others during the modern post-War period. Ouch.
Co-Ops. What are they and are they a bridge to bipartisan healthcare reform?
Recession bottoming out? One of the two steel blast furnaces in Cleveland are finally firing up again. “[W]e are restarting C-5 blast furnace, a steel shop, hot mill, pickle line, tandem mill and galvanizing line at ArcelorMittal Cleveland…However, we do not expect demand to return to the levels seen in 2008 for sometime yet and remain cautiously optimistic for a low and progressive recovery.” When both furnaces were turned off (I think late last year), it was a signal of the unusual depth of this ‘Great Recession.’ I’ve been watching to see when they’d fire up again. This is a good sign.
July 29, 2009 • 3:06 AM 2
I tend to like it when David Brooks meanders away from the politics of present takes a little cerebral detour through a philosophical tangent. From his most recent:
“What would happen if a freak solar event sterilized the people on the half of the earth that happened to be facing the sun? If you take an individualistic view of the world, not much would happen immediately….But, of course, we don’t lead individualistic lives. Material conditions do not drive history. People live in a compact between the dead, the living and the unborn, and the value of the thought experiment is that it reminds us of the power posterity holds over our lives…Without posterity, there are no grand designs. There are no high ambitions. Politics becomes insignificant. Even words like justice lose meaning because everything gets reduced to the narrow qualities of the here and now… The scenario is unrelievedly grim. An individual who does not have children still contributes fully to the future of society. But when a society doesn’t reproduce there is nothing left to contribute to… But, of course, …[t]here are no sterilizing sunspots. Instead, we are blessed with the disciplining power of our posterity. We rely on this strong, invisible and unacknowledged force — these millions of unborn people we will never meet but who give us the gift of our way of life.”
Brooks attributes his thoughts on this to a blog he follows, Marginal Revolution. Never heard of, but I’ve subscribed to see if they are as erudite as Brooks says. (Impress, guys, or I’ll dump you like week old kung po chicken in my fridge. Too much to read already).
This is, of course, not a totally novel thought experiment. See, for example, the novels Children of Men and the The Handmaiden’s Tale. (I recommend, of course, the books over the movies, but whatever you like; Children of Men is not a bad movie, but deviates significantly from the novel). These works contemplate either universal unexplained sterilizationor at least wide-spread infertility, in the case of The Handmaiden’s Tale. They work equally well as fictional counterparts to Brook’s essay. They are profoundly sad worlds.
I think, however, a scenario that would affect only a specific widespread geography (e.g., half the earth) would be the more interesting exploration for a work of speculative fiction. Anyway, foder for someone’s next science fiction story or composition on the nature, and need, of human posterity.
July 26, 2009 • 9:58 PM 0
The Boston Globe’s big picture does it again with some amazing photographs remembering the Apollo 11 mission. Take a look. The one photo (Earth-rise) was on my wall in my bedroom growing up. Gorgeous.
July 25, 2009 • 12:45 PM 0
I was catching up on reading and spotted this pretty good (and pretty short) summary from Health Affairs of some of the pro/con arguments concerning a publicly administered health insurance option as part of health care reform. It’s worth a read and I think fairly and intelligently gives a high level summary of the debate.
For another view of the public plan option, which argues that a public plan option is necessary due to significant consolidation in the health insurance and hospital markets, see the Urban Institute’s paper entitled Is the Public Plan Option a Necessary Part of Health Reform? http://www.urban.org/UploadedPDF/411915_public_plan_option.pdf This is one of the prominent arguments that I have heard the Obama administration make. This might seem a paradoxical argument — i.e., you need direct government participation in the insurance market to make it more competitive. Query, given this line of argument and whatever else occurs, if it forbodes future antitrust enforcement in the healthcare insurance and delivery sectors.
PostScript 7/27/2009: Saw this Modern Healthcare discussion of healthcare antitrust enforcement giving some additional color on how healthcare reform and antitrust enforcement may tie together.
June 29, 2009 • 3:27 AM 0
Bad Astronomer frequently links to The Boston Globe’s period “The Big Picture Show.” These pictures are breathtaking and take a look. All are from taken from the International Space Station and show an eruption of Sarychev Peak Volcano (spectacular), the waning gibbous moon through the Earth’s atmosphere, Mt. Fuji and other amazing shots. Note that most of the detail shots also have a googlemaps link. Recent scenes from the ISS – The Big Picture – Boston.com. Here’s a lower resolution of the eruption:
June 28, 2009 • 10:20 PM 0
A BNet article, Reform Moves Stir Talk of Bundled Payments, discusses healthcare reformers’ conceptualizing bundling payments to align physician and health system/hospital outcome interests. The article has a number of cites to other reports, discussions and administration statements. It also points out what I find facinating about the trend — what did not occur in the 1990s may be coming through healthcare payment reform today. But are today’s integrated delivery systems (and the regulatory environment) prepared for risk in any format other than PPS payments?
All of this reminds some observers of the rapid formation of integrated delivery systems during the ‘90s, when many hospitals and physicians were circling the wagons to fend off the expected onslaught of capitated managed care plans. That never materialized in most places, but many systems retained all or some of their employed primary-care physicians. Now, partly in expectation of healthcare reform, they’re also stepping up their hiring of specialists.
“The handwriting is on the wall,” Bill Jessee, MD, president and CEO of the Medical Group Management Association, tells BNET. “The push is going to be towards more integration of physicians, hospitals, home health, and other services. And Medicare or a private insurer may put the provider at risk, instead of the insurer being at risk. It’s not explicit, but it’s implicit in a lot of the reform discussions that that’s the direction they’d like to move. The bundled payment demonstrations are a manifestation of that.”
June 28, 2009 • 3:47 PM 0
In a follow-up to one of my prior posts (Birds or Pigs?; Pigs Have It), I spotted (thanks to the WSJ Health Blog and Bloomberg) that the The World Bank issued a recent report on the global recovery, entitled Global Development Finance: Charting a Global Recovery. In it it discusses the potential impact of H1N1 on economic recovery, estimating that by next season the impact of H1N1 is likely to be at least as severe as the Hong Kong Flue of 1968-69. It also cites other studies to give a range of potential impact on world-wide GNP between 0.7% and 4.8%. The impact on Mexico, where H1N1 has had a severe effect on tourism and has shut down large sectors of its economy at the start of (or at least the realization of) the outbreak, has been severe. Estimates are a second quarter 2009 decrease in that country’s output by appoximately 2.2%.
Simulations of the potential economic and human costs of a global pandemic undertaken for the 2006 Global Development Finance report in the context of avian influenza (Burns, van der Mensbrugghe, and Timmer 2006, 2008) suggest that the costs of a global influenza pandemic could range from 0.7 to 4.8 percent of global GDP depending on the severity of the outbreak. The lower estimate is based on the Hong Kong flu of 1968–69, while the upper bound was benchmarked on the 1918–19 Spanish flu. In the case of a serious flu, 70 percent of the overall economic cost would come from absenteeism and efforts to avoid infection. Generally speaking, developing countries would be hardest hit, because higher population densities, relatively weak health care systems, and poverty accentuate the economic impacts in some countries.
June 8, 2009 • 3:51 AM 0
An interesting article in the NYT about CT scans of our departed troops. The use of the data has led to practical applications. For example, after noting that tubing to inflate collapsed lungs was not long enough due to the larger size of many of the troops, new protocol were adopted for longer tubes – perhaps saving lives. Of course, also, better information on armor for troops may have saved lives.
This reminds me of a puzzler on one of the Car Talk shows on NPR (if you are uninitiated, take a listen, Tom & Ray have a lot of fun, but they know there stuff). The puzzler is about British bombers in WWII and engineering decisions concerning how to armor their undersides in face of anti-aircraft fire. Quite similar in a way, despite the application in an entirely different war.
May 2, 2009 • 2:34 AM 1
I just love these TED talks. I previously have postedabout TED. I first discovered it when Pogue (NYT columnist) was talking about the conference and the wonderful web site. This talk is by Hans Rosling who was confronted by a dilemma. There’s tons of great data out there that tells wonderful stories about the world that can inform policy, destroy myths, demonstrate compelling trends, affect both our views of the world and what we have done and can to to improve. But tables and non-interactive graphs are just incredibly boring — and the underlying stories can be completely missed. Take a look at his presentation and then take a visit to his site. Kudos to Health Economist blog to turning me onto this. Really neat stuff. I’m trying to think how I could use something like this in a presentation (even being a lawyer — has to be something creative I can glom onto here). About Hans Rosling from TED:
Even the most worldly and well-traveled among us will have their perspectives shifted by Hans Rosling. A professor of global health at Sweden’s Karolinska Institute, his current work focuses on dispelling common myths about the so-called developing world, which (he points out) is no longer worlds away from the west. In fact, most of the third world is on the same trajectory toward health and prosperity, and many countries are moving twice as fast as the west did.
What sets Rosling apart isn’t just his apt observations of broad social and economic trends, but the stunning way he presents them. Guaranteed: You’ve never seen data presented like this. By any logic, a presentation that tracks global health and poverty trends should be, in a word: boring. But in Rosling’s hands, data sings. Trends come to life. And the big picture — usually hazy at best — snaps into sharp focus.
Rosling’s presentations are grounded in solid statistics (often drawn from United Nations data), illustrated by the visualization software he developed. The animations transform development statistics into moving bubbles and flowing curves that make global trends clear, intuitive and even playful. During his legendary presentations, Rosling takes this one step farther, narrating the animations with a sportscaster’s flair.
Rosling developed the breakthrough software behind his visualizations through his nonprofit Gapminder, founded with his son and daughter-in-law. The free software — which can be loaded with any data — was purchased by Google in March 2007. (Rosling met the Google founders at TED.)
Rosling began his wide-ranging career as a physician, spending many years in rural Africa tracking a rare paralytic disease (which he named konzo) and discovering its cause: hunger and badly processed cassava. He co-founded Médecins sans Frontièrs (Doctors without Borders) Sweden, wrote a textbook on global health, and as a professor at the Karolinska Institut in Stockholm initiated key international research collaborations. He’s also personally argued with many heads of state, including Fidel Castro.
April 30, 2009 • 4:40 AM 1
I found this article interesting as it is local in flavor and surrounding what some might think is a morbid topic. I disagree, and can see why dissection of a cadaver would be a central experience in the education of medical student. When I was in high school, I interned at the Cuyahoga County Morgue and observed an autopsy. There I learned that Quincy (yeah, I’m that old and way before CSI) was not really how it worked. I became an attorney, of course.
CWRU’s Allen Memorial is putting on an exhibition of photos from a century or more ago showing medical students with their cadavers. Many of the exhibits and photos are from the recently published book, Dissection, Photographs of a Rite of Passage in American Medicine 1880-1930 by James Edmonson from Case Western Reserve University and John Harley Warner from Yale University. As is discussed in the link to the photo below, during this era there was limited access to cadavers for anatomical teaching. So, learning, for many students, required a bit of self help. We’ll leave it at that. The link on the photo at left has some of these photos.
I find the photos fascinating. Here we are, seeing photos of these student in the prime of their life exhibiting their anatomical subjects, that they treat well, humorously or in poor taste, but that all recently lost of the spark of life. And these students, too, are now long, long since passed. From the Plain Dealer article:
Long before “Tales from the Crypt ” “The Twilight Zone” and horror author Stephen King there were medical students. Students who at the turn of the 19th-to-the-20th century posed for photos with bodies they had dissected in their studies; who gathered in groups around flesh-peeled cadavers and skulls like hunters displaying trophies…Dissection portraiture had its heyday from 1880 to 1930…The photos were a visual representation of a rite of passage dissection to a new identity a “boundary-crossing experience that left the participant forever changed ” as Warner wrote in the book…Back then there was no legal means of obtaining bodies for dissection. Some were unclaimed bodies but many were provided by grave-robbers known as “professional resurrectionists.” … Warner described most of the photos as almost “reverential” in the treatment of the subject some bearing such phrases written on the dissection tables as “Know Thyself ” “Man s usefulness endeth not with death” and “Her loss is our gain.” But he noted that others the gag photos and macabre images almost seem to revel in the transgression — posing human remains in outlandish poses or providing such accompanying table-epigraphs as “Such the vultures love ” “Rest in pieces” and “The Lord giveth We taketh away.”
April 29, 2009 • 3:54 AM 0
Interesting presentation by Futurist Jim Carol. He asks, what will we learn if we look back to today’s health care system from the vantage point of 2020? Many of these concepts are not completely novel, so it reminds me of the science fiction writer William Gibson who observed that “the future is here; it’s just not evenly distributed yet.”
From Jim Carol’s presentation “It’s January 15, 2020: What Have We Learned About Healthcare in the Last Decade?”, he discusses a number of trends that he thinks will reshape health care. A few:
- Focus on preventive medicine reshapes healthcare delivery and finance, and by 2020 patients are treated for the conditions we know they are likely to develop, rather than principally for those that they already have.
- Focus on “customer service” as job #2 (#1 always the efficient and effective delivery of care) reshapes healthcare delivery and rebuilds the entire philosophical underpinning of the system, so that “customer focused, friendly, fast, subject to expectation metrics makes it more consistent with other economic industries.”
- “When Silicon Valley got involved in a big way, everything changed” launching “new products, new business models, scientic discovery tools, bio-informatics platforms that provided the foundation for diagnostic medicine, and many other incredible items.”
- “Bio-connected devices — home health care medical monitoring, diagnosis and treatment devices — [will] provid … a renaissance” in the modality of care. “A good proportion of both critical and non-critical care patients [will] receive …at home… [causing a] transition to a virtual community oriented caregiving strategy which has resulted in cost reductions and a refocus of critical health care spending” away from inpatient services.
- “[T]he role of medical packaging [will] transition from being a passive protector of the product, to becoming an active component of the overall effectiveness of the particular medication” — prescription bottles will have internet enabled RFID tags with bio-sensors, providing specific information to patient’s provider and general information to pharmecutical clinical trials about patient’s current condition and the efficacy and interactions of the drug.
- By 2020, “the average doctor and nurse [will need to] refresh their entire knowledge base every 18 months [due to the velocity of innovation, knowledge growth and change]. The result [will be] that the relationship between medical colleges and students [will] change, from a period of short term, concentrated knowledge delivery, to one of lifelong, ongoing replenishment and rejuvenation of knowledge.”
April 27, 2009 • 3:38 AM 0
|And Justice For All||We The People Stories|
|Senator George McGovern on Abraham Lincoln||We The People Stories|
|Using Tiny Particles To Answer Giant Questions||NPR: Science Friday Podcast|
|It’s All Politics April 9 2009||NPR: It’s All Politics Podcast|
|NYT: Science Times for 4/07/2009||Science Times|
|CIA Interrogation Memos, Possible U.S.-Cuba Talks Top Week’s News||NewsHour with Jim Lehrer Podcast | PBS|
|EPA Finding Opens Door to Regulating Greenhouse Gases||NewsHour with Jim Lehrer Podcast | PBS|
|Newly-released Memos Detail Harsh CIA Interrogation Tactics||NewsHour with Jim Lehrer Podcast | PBS|
|Fighting America’s ‘Financial Oligarchy’||NPR: Fresh Air Podcast|
|Kristin Chenoweth Is ‘A Little Bit Wicked’||NPR: Fresh Air Podcast|
|NPR: 04-17-2009 Fresh Air||NPR: Fresh Air Podcast|
|‘Hey I’m Dead!’ The Story Of The Very Lively Ant||NPR: Hmmm…. Krulwich on Science Podcast|
|#354: Mistakes Were Made||This American Life|
|#378: This I Used to Believe||This American Life|
|The American Presidency||We The People Stories|
|From Revolution to Evolution||We The People Stories|
|The Future of the Republican Party||We The People Stories|
|Legacy of 1808: Deconstructing Reconstruction||We The People Stories|
|The NAACP Centennial||We The People Stories|
|Better Brewing Through Synthetic Biology||NPR: Science Friday Podcast|
|Green DIY Projects To Reduce, Reuse, Recycle||NPR: Science Friday Podcast|
|Harnessing Nanoparticles For Targeted Cancer Treatment||NPR: Science Friday Podcast|
|Is Missile Defense Ready For Prime Time?||NPR: Science Friday Podcast|
|Skunked? Tomato Juice Is Not The Answer||NPR: Science Friday Podcast|
|Shields, Brooks Mull Torture Memos, Obama’s Leadership||Shields and Brooks | NewsHour with Jim Lehrer Podcast | PBS|
April 26, 2009 • 3:47 PM 2
We’ve had a lot of stories the past several days about the swine flu outbreak in Mexico and smaller groupings of confirmed cases in New York, California and elsewhere in the United States. There has been years of discussion on the H5N1, so called avian flu, pandemic risks. We all remember the impact of SARS. And we’ve been rocked, recently, by what some have tagged a ‘depression’ but all of noted as the largest economic downturn since The Great Depression. The losses associated with this ‘Great Recession’ are still playing out.
But I was wondering — what if the Swine Flu became a pandemic at this time? All indication (including the CDC site) indicate that aside from some serious implications for Mexico City’s public health, the cases in the United States have been mild, with no hospitalizations. The 1918 flu pandemic that took 20m lives world-wide, however, is the standard modern example of potential personal and economic costs of a flu pandemic. Not to minimize the terrible pain and suffering that such a pandemic would cause by putting an economic slant on it– but I was wondering what might be the economic impact to our already tottering United States economy if a pandemic struck.
So I took a look at a study the CDC had commissioned in 1999. It showed the potential U.S. economic impact of a pandemic. The CDC used this as a way to assist the public policy discussion in light of strategies regarding flu immunization — i.e., which immunization policy could provide the best net value in the case of flu pandemics of differing severity. It’s beyond this post (or its author) to analyze the article and it’s conclusions. But I thought the numbers were notable and summarize the potential economic exposure (without vaccination). And, of course, this looks at U.S. exposure only. A pandemic would have a far reach. Look how quickly in this age of easy travel the virus spread from Mexico to the United States and even potentially exposed the President of the United States during his trip. From the CDC’s study:
Without large-scale immunization, the estimates of the total economic impact in the United States of an influenza pandemic ranged from $71.3 billion (5th percentile = $35.4 billion; 95th percentile = $107.0 billion) (gross attack rate of 15%) to $166.5 billion (5th percentile = $82.6 billion; 95th percentile = $249.6 billion) (gross attack rate of 35%) (Table 6). At any given attack rate, loss of life accounted for approximately 83% of all economic losses. Outpatients, persons ill but not seeking medical care, and inpatients accounted for approximately 8%, 6%, and 3%, respectively, of all economic losses (Table 6) (Appendix II).
* * * *
If it cost $21 to vaccinate a person and the effective coverage were 40%, net savings to society would result from vaccinating all age and risk groups (Figure 2). However, vaccinating certain age and risk groups rather than others would produce higher net returns. For example, vaccinating patients ages 20 to 64 years of age not at high risk would produce higher net returns than vaccinating patients ages 65 years of age and older who are at high risk (Figure 2). At a cost of $62 per vaccinee and gross attack rates of less than 25%, vaccinating populations at high risk would still generate positive returns (Figure 2). However, vaccinating populations not at high risk would result in a net loss (Figure 2).
There’s also an interesting Congressional Budget Office (CBO) assessment (and see generally the goverment web page) of possible economic effects of an avian flu pandemic. That study concludes that a pandemic involving a highly virulent flu strain (such as the one that caused the pandemic in 1918) could produce an impact worldwide similar in depth and duration to an average postwar recession in the United States — but citing studies ranging from a .5% to 6% decrease in GDP. Query, of course, what impact if such a pandemic hit during an ongoing recession.
April 24, 2009 • 1:54 AM 0
A recent IMF report increases the total write-downs that are anticipated wordwide as a result of the current financial crisis. These numbers are just simply staggering:
[T]he International Monetary Fund estimates that banks and other financial institutions face aggregate losses of $4.1 trillion in the value of their holdings as a result of the crisis…[F]inancial institutions would have to write down an estimated $2.7 trillion in loans and securities originating in the United States from 2007 to 2010…Banks are expected to shoulder about two-thirds of the write-downs…though other institutions, like pension funds and insurance companies, also face heavy losses…Banks have raised about $900 billion in fresh capital since the crisis began…, but that is far outweighed by $2.8 trillion in credit-related losses. The fund estimates that the banks have already taken about one-third, or $1 trillion, of those write-downs….United States…banks reported $510 billion in write-downs by the end of 2008 and face an additional $550 billion in 2009 and 2010. In the euro zone, banks reported just $154 billion in write-downs by the end of last year and still face $750 billion. British banks are in somewhat better shape: having written down $110 billion, they face $200 billion more, the fund said.
April 19, 2009 • 3:36 PM 0
Regina Herzlinger (the McPherson Chair at Harvard Business School and author of Who Killed Health Care? (McGraw Hill, 2007); a health care adviser to John McCain’s presidential campaign) writes an interesting op-ed in the Atlantic. She argues that the Republicans need to seize the moment, realize that the “time for universal health insurance coverage has come” and that they should go to China, figuratively speaking. “Republicans should…seize the lesson of Nixon’s trip to China”, where in one swoop Nixon brought the middle Kingdom out of isolation and removed the issue from his political adversaries. [As Spock says in Star Trek VI, there’s an old Vulcan proverb that ‘only Nixon could go to China’ — perhaps only the Republicans can get sustainable health care reform passed?].
Ms. Herzlinger argues that there is a “a massive constituency behind [a potential Republican] policy” and her fellow republicans can do a “better version of universal coverage.” She highlights challenges with what appears to be the current Democratic plan to rely “on universal coverage through a government-controlled system like Medicare”: (i) distrust government’s ability to apply fiscal controls needed so that any plan would not bankrupt us as Medicare is appearing to do; (ii) concern that the government will control costs by rationing health care to the sick (citing the UK experience with cancer rate survival due to UK’s pathetic approval of new cancer drugs and therapies); (iii) government as a monopolistic buyer of health care could negatively affect the supply of doctors; and (vi) government-controlled system would likely impair the medically and economically important private investment — particularly in the emerging genomic sector.
The Republicans, she argues, should instead offer a “consumer-controlled universal coverage system, like that in Switzerland in which the people, not the government, control how much they spend on health.” The Swiss choose from 85 private health insurers. [I believe that the Swiss government causes a degree of plan standardization so that consumers can compare “apples to apples.”] In Switzerland, the poor shop for health insurance like everyone else, using funds transferred to them by the government. Rather than the “degraded” Medicaid program, the Swiss poor get the same insurance options that everyone else get. The Swiss taxing authority, according to Ms. Herzlinger, enforce the mandatory system and achieve 99% enrollment.
This consumer-driven, universal coverage system provides excellent health care for the sick, tops the world in consumer satisfaction, and costs 40 percent less, as a percentage of GDP, than the system in the US. The Swiss could spend even less by choosing cheaper, high deductible health insurance policies, but they have opted against doing so. Swiss consumers reward insurers that offer the best value for the money. These competitive pressures cause Swiss insurers to spend only about 5 percent on general and administrative expenses, as compared to 12-15 percent in the US. And unlike Medicare, the private Swiss firms must function without incurring massive unfunded liabilities. Competition has also pushed Swiss providers to be more efficient than those in the US. Yet they remain well-compensated.
She cautions that the Swiss system is not perfect, we can learn from it. It maintains some of the same problems we have with fragmented care and poor integration of payments between vertical provider groups for episodes of care.
She concludes by observing that movement to this model will have real economic impacts:
Republicans could enact Swiss-style universal coverage by enabling employees to cash out of their employer-sponsored health insurance. (Although many view employer-sponsored health insurance as a” free” benefit, it is money that would otherwise be paid as income.) The substantial sums involved would command attention and gratitude: a 2006 cash out would have yielded $12,000 — the average cost of employer-sponsored health insurance — thus raising the income of joint filers who earn less than $73,000 (90 percent of all filers) by at least 16 percent. Employees could remain in with an employer’s plan or use this new income to buy their own health insurance.