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February 26, 2010

Comments

Too late the Villagers declared it a tie, which is good news for Republicans.

Eric,

Durbin's "impressive" statement contained not one sentence that has not been written on ObWi more than once. Okay, maybe the factual details about his own experience and the particular example of the woman whose face got burned were uniquely his own, but I doubt those things are what impressed you.

Don't get me wrong: I watched that bit live on C-Span, and I swear to you I applauded as he finished. I was impressed too.

But the sad fact is that what's "impressive" is that a Senator said things that bloggers and commenters have been saying for a long time and often more eloquently.

--TP

Agreed.

yeah, what Ugh said.

GOP wins all ties. not falling off their own chairs counts as a tie.

This "summit" doesn't matter because the Democrats still have overwhelming majorities in both Houses of Congress and can pass anything significant that hasn't already made it through the Senate via reconciliation.

The problem is, and remains, the Democrats themselves.

The media and the Republicans are just a sideshow and a continuing convenient excuse for inaction.

This "summit" doesn't matter because the Democrats still have overwhelming majorities in both Houses of Congress

I think Obama is using the summit to get some commitment out of the Congressional Democrats. Or hoping, anyway!

Meanwhile, Teh Gop Response: Let Them Eat Applesauce

But Eric, I thought you were straight ...

DS: I never showed such commitment ;)

Will the Democrats ever be able to walk away from the trial lawyers. Quoting self-serving studies from trial lawyers does little for credibility.

How will lowering the pay in healthcare and making it a career field for first generation immigration and the poor make improve the quality of health care? How will making health care workers fill out more forms improve care.

I guess the party of the nitpickers cannot give up the idea of nitpicking others. When you realize that President Obama is so scared of being blamed for the eventual failure of health care reform, one has to wonder why he believes everyone else should be held responsible.

superdestroyer,

Just about everything you have written in your comment is wrong and really ill considered nonsense, but this particular statement:

Quoting self-serving studies from trial lawyers does little for credibility.

is mostly just puzzling. The figures on malpractice claims costs relative to the cost of healthcare are not in dispute. They are a very small fraction of those costs. Moreover the CBO is not a trial lawyer organization. Please try to pay closer attention.

Brent,

No study ever considers most of the costs of malpractice. The costs include insurance, the administrative costs of risk management, defensive medicine, legal bills (in-house and out sourced), and then the legal settlements.

Tort reform has been ineffective because all of the proposed reforms have been written by lawyers and are designed to be failures.

How are health care providers suppose to keep paying malpractice premiums if the government is going to cut reimbursement rates?

No study ever considers most of the costs of malpractice.

if only the dummies who do these studies would seek the advice of pseudonymous internet commenters!

While superdestroyer isn't correct on all the particulars, it is true that most studies include only the costs of settlements and plaintiff verdicts. They typically do NOT include the costs of defending the case for a defense verdict, nor do they include the costs of defending a case which leads to a trivial 'please go away and this will cost less than defending to a defense verdict' settlement.

And those costs are large as well (as pretty much any practicing trial lawyer knows).

it is true that most studies include only the costs of settlements and plaintiff verdicts.

Does the CBO analysis that Durbin cites include the other things you mention? Or not?

I'll put a point on my question.

The CBO analysis can be off by a factor of five -- the cost savings we could have from medical malpractice tort reform could be *five times greater* than what the CBO analysis predicts -- and we would still be talking about approximately 1% of health care costs in the US.

It might be low-hanging fruit, but it's not very big fruit. Not unless the analysis is off by orders, in the plural, of magnitude.

And to get that low-hanging fruit punitive damages for any malpractice, no matter how egregious -- having your face burned off, frex -- will be capped at $250K, and another 4800 people a year will die from malpractice.

Tell me which side of that cost/benefit analysis you land on.

That's the first item on the Republican agenda. Item number 1, ahead of extending coverage, ahead of recission, ahead of denying coverage for pre-existing conditions, ahead of extending COBRA for folks who lose their jobs, ahead of portability of coverage if you lost your job or need to change jobs.

Ahead of every other issue that's on the table.

Tort reform. To "save costs", when it's one-fifth of one percent of total healthcare costs. That's the first thing out of their mouths.

Seriously, I don't understand people like that. I don't get how they look at themselves in the mirror in the morning. I don't mean to be perjorative, I just don't get it.

That's my two cents, to each his own.

Russell, I come down on the side that says the President and everyone else that talks about HCR is necessary or we will go bankrupt, yet, there isn't a single thing in your list that does anything about the actual cost of healthcare.

No study ever considers most of the costs of malpractice. The costs include insurance, the administrative costs of risk management, defensive medicine, legal bills (in-house and out sourced), and then the legal settlements.

Actually the CBO did consider the cost of malpractice on a much wider scale than you seem to be aware of. I suggest you read the analysis. But even if they are wrong in their assessment, they are not wrong because they are trial lawyers putting out a self interested study. Again, if your intention is to discuss this issue seriously, I would suggest you actually try a bit harder to grasp the details of the work that has actually been done.

While superdestroyer isn't correct on all the particulars, it is true that most studies include only the costs of settlements and plaintiff verdicts.

I think the issue of what various studies show and do not show is a far more complex matter than that. However, it is most certainly not true in the case of the CBO analysis that it completely elides these considerations which is precisely what Durbin is discussing.

Also, what Russell said.

Brent,

I looked at the CBO. The costs analysis were due to tort reform are addressed at (http://cboblog.cbo.gov/?p=389) and covered:

Typical legislative proposals for tort reform have included caps on awards for non-economic and punitive damages, rules allowing the introduction at trials of evidence about insurance payments and related sources of income, statutes of limitations on suits, and replacement of joint-and-several liability with a fair-share rule.

Are you really going to proposed that when most people think about tort reform that is all they are proposing. Do you really believe that less than 0.5 of all medical procedures are due to defensive medicine.

If a kid falls down and hits their head, the EM doc will order a CT exam because that is the standard of care due to malpractice. I doubt if the CBO (controlled by Democrats and staffed with Ivy league lawyers and Ivy league economist) is going to consider all of the costs. The Democrats are bought and paid for by the trial lawyers and never will go anything to harm them. If tort reform is so insignificant, why not pass it tomorrow and take the argument away from the Republicans?

Also, the proposals for HCR are going to lower medical wages and pay without lowering malpractice insurance costs. How is that going to work?

The costs include insurance, the administrative costs of risk management, defensive medicine, legal bills (in-house and out sourced), and then the legal settlements.

I think you are doing a bit of double-counting here. Insurance premiums are intended to cover administration, legal bills, and settlements. So the costs are only insurance premiums and defensive medicine.

And from a social point of view the system is wasteful only to the extent that these costs exceed the harm incurred by malpractice victims, or the settlements are misdirected.

Russell, I come down on the side that says the President and everyone else that talks about HCR is necessary or we will go bankrupt, yet, there isn't a single thing in your list that does anything about the actual cost of healthcare.

Marty, the healthcare bills being considered actually include many different efforts at reducing health care costs. You would benefit I think from reading this article. You may also wish to read the opinions of health care experts, including some that worked for the Bush administration, praising the cost containment measures of the current bill here. I think you'll find that reading these documents will be a far better use of your time than wondering why russell failed to include a complete description of all aspects of the health care reform bills under consideration in a blog comment.

Are you really going to proposed that when most people think about tort reform that is all they are proposing.

ok. i give up. what else are they proposing ?

I doubt if the CBO (controlled by Democrats and staffed with Ivy league lawyers and Ivy league economist) is going to consider all of the costs. The Democrats are bought and paid for by the trial lawyers and never will go anything to harm them.

Okay, so now you are claiming that the CBO is, in essence, working for the trial lawyers. Their analysis, which is quite typically relied upon by Congressional representatives of all political stripes, you contend, is therefore less reliable than your "pulled out of your ass" analysis because it comes from people educated in the Ivy Leagues. This is a very persuasive position you have taken but I am going to have to continue to disagree.

Your arguments are a mess, consistently mixing up different claims regarding different issues ending in a pileup of assertions with no evidence. For example:

Do you really believe that less than 0.5 of all medical procedures are due to defensive medicine.

The answer is, no I don't, and so its a good thing that I and indeed no one has actually made such a claim.

If tort reform is so insignificant, why not pass it tomorrow and take the argument away from the Republicans?

How about because its a complicated issue that is very difficult to manage without harming patient's rights? That would seem to be obvious enough to go without saying but here we are.

Sebastian,

it is true that most studies include only the costs of settlements and plaintiff verdicts. They typically do NOT include the costs of defending the case for a defense verdict, nor do they include the costs of defending a case which leads to a trivial 'please go away and this will cost less than defending to a defense verdict' settlement.

And those costs are large as well (as pretty much any practicing trial lawyer knows).

Some of us who aren't lawyers at all know that too.

I think it's one thing to say that our malpractice system could stand improvement. It's quite another to say that the key is limiting pain and suffering awards. My understanding is that the evidence from states that have done that suggests it does not has a significant effect on premiums. And it will inevitably lead to some severe injustice. I'd like those who advocate these limits to make a list of bad outcomes from medical procedures and tell us what they would accept to suffer these outcomes voluntarily.

From another point of view, I'm not convinced that the limit will do much to reduce defensive medicine. Doctors don't want to be sued, for a number of excellent reasons. Many of those reasons are unrelated to potential award size.

To the extent they now order marginal tests because of the fear of a lawsuit, I doubt they will often shrug and say, "Well, I guess I don't have to worry about it, because pain and suffering awards are limited."

Superdestroyer,

You, like many people who claim to advocate medical tort reform, don't seem to understand what it entails. Aside from a half-dozen sociopaths, I'm not aware of anyone who is saying that doctors and hospitals should not be held to any standard of professional care and accountability. The overwhelming cost of dealing with medical malpractice arises because there is malpractice. Not all of the cost of malpractice is recovered from doctors. Many patients are suffering today because of medical malpractice and they got nothing for it. That will not disappear unless doctors start to clean up their act.

Yes, it is troubling that pain and suffering tends to be the euphemism for legal bills. Yes, there may be a few cases that had runaway juries. It doesn't matter. Reform would need to include direct recovery for legal costs. It needs to make sure that the victim of medical malpractice is made whole. The states that tried reform didn't see much change in the cost of medical malpractice insurance.

By the way, doctors who claim to be over-treating because they are 'afraid of being sued' are either incredibly ignorant or totally dishonest. Treating to the standard of care is a defense in a malpractice case. It's not always a perfect defense because it may turn out that the local standard of care is not adequate and that others do much better. Over-treating is almost always to improve the doctor's bottom line. I would not believe any doctor who told me that he routinely over-treated because he was afraid of being sued. I wouldn't even go to such a doctor.

I could've sworn we'd exhaustively gone over tort reform here before.

Yawn. The conservative contribution to the national discussion on HCR is starting to resemble a somewhat unimaginative Mad Lib.

"I think you are doing a bit of double-counting here. Insurance premiums are intended to cover administration, legal bills, and settlements. So the costs are only insurance premiums and defensive medicine."

Right, but the studies never just take the cost of insurance premiums. They typically only count the settlements and verdicts. Which is to say they aren't capturing the entire legal cost (which isn't even addressing the defensive medicine cost).

Now this cost probably isn't *the solution* to our medical costs problem. So from that point of view, fine. The fact that the most likely solutions are of course A) having the government restrict care far more than insurance companies do now, or B) have the government slash doctor compensation, probably won't go over well. But there we are.

There are some solutions that have been overlooked in this debate:

1. End Medicare and all insurance regulation. Unquestionably the overall cost of health care will be reduced--many doctors, few patients with money to pay. Insurance companies all race to the bottom and finally go out of business. Added kicker: Balanced budget. Pete Peterson Foundation reduced to attacking Social Security for being "unnatural".

2. Shoot the doctors. No care, no costs. Simple.

Sebastian -

As far as I am aware, there is no proposal about medical malpractice tort reform that would abolish all recovery in the event of malpractice. The only question that exists is how close we are to the minimum cost that is or should be acceptable. How much insurance would go down for doctors with caps on non-economic damages seems to be a matter of religion rather than solid foundation for the GOP advocates.

I strongly support a reform that works the way workers' compensation was intended to work. If something goes wrong while you are in the hospital or being treated by a doctor, there will be an investigation. You will not be held responsible for any costs related to the problems whether or not the doctor or other professionals behaved in an irresponsible manner. Rather than award something called pain and suffering, an award would be made for permanent or temporary harm done, again, in the manner that workers' compensation was originally envisioned.

The investigation will be used to improve procedures and only in cases in which the health care professionals refuse to cooperate or were flagrant in their refusal to follow standard protocols would they be punished by suspending or revoking their license or other appropriate action.

Sebastian,

Right, but the studies never just take the cost of insurance premiums. They typically only count the settlements and verdicts. Which is to say they aren't capturing the entire legal cost (which isn't even addressing the defensive medicine cost).

Fair enough. And if you want to propose reforms to malpractice law I'm all ears. Indeed, the question of whether malpractice issues are a major contributor to health care costs is a red herring. If the system does a poor job then it needs to be changed regardless.

But I don't see how anything you've said supports the idea that limiting pain and suffering awards is the way to go. Further, I don't see why the GOP continues to insist that that particular provision will make a big difference in our health care costs. It won't.

Do the same insurance companies that sell "health insurance" to the public also sell malpractice insurance to physicians?

What is the typical "legal loss ratio" for malpractice insurers, and how does it compare to the medical loss ratio of health insurers?

Do malpractice insurers refuse coverage to physicians with "pre-existing conditions" or rescind policies for doctors who get sued?

I don't know the answers to any of these questions. I just wonder whether physicians get milked by insurance companies the way ordinary people get milked by insurance companies.

It's possible that physicians blame greedy patients and their shady lawyers for the high malpractice premiums they pay. But they pay those premiums to insurance companies. If I were a doctor, I'd save at least a bit of my suspicion, if not my wrath, for those.

Of course, if I were a Republican, I would not blame the poor, put-upon malpractice insurers any more than I blame the poor, put-upon health insurers for high "health care" costs.

--TP

The real problem I have with tort reform is that it's so easy to throw it out into a discussion like this one and derail it completely. It's so complicated that anyone can bring up any number of facets that take far too much time to explain or refute. One knot head with "an idea" requires an army of trained accountants to evaluate.

The bills we have written have much to recommend them. There are still more good ideas out there. Instead the obstructionist trolls have us talking about fraking tort reform.

I just wonder whether physicians get milked by insurance companies the way ordinary people get milked by insurance companies.

I know the answer to this one: yes. It's not necessarily the same companies, but it's the same racket. Anybody heard of 'claims made' malpractice insurance? It's becoming the more common type, since it's cheaper on the front end (sort of like a balloon mortgage) for the groups or companies who hire physicians, but that cost-saved is simply shifted onto the individual doctors when they leave that company. The doctors need to buy what's called 'tail' insurance to cover any claims made after they leave that practice. And it's a *lot* of money. These days, other professionals - like financial planners - are often in the same position when they move or retire.

Who wins and who loses in this setup? Is this some sort of windfall, or the result of a windfall, for trial lawyers? HA.

The macro picture is what you would expect: insurance companies - and *their* lawyers - win, always.

BTW, although I know this isn't an open thread, I have to mention that I've finally gotten around to reading 'Road to Serfdom'. Not done yet, but I am struck by the extent to which it renders, by comparison, the current American 'conservative' movement - which constantly cites it - as utterly, and laughably, fraudulent. When referring to the GOP and so-called 'movement conservatism', I've been putting quotes around the term 'conservative' for a few years; my list of reasons for doing so is now getting longer and more detailed.

It reminds me of finally reading Adam Smith myself, and noticing how carefully some things Smith said are always elided by 'conservatives'....

Tony P. -

It is very unlikely that a specific insurance company would be selling both med mal and health insurance but a group like Berkshire, Liberty or AIG may own companies that do both.

Medical loss ratios, particularly group, are designed to be higher than any other sort of insurance loss. 75-80% is common. Loss adjusting expenses are far lower in medical claims and group policies are far cheaper to sell than medical malpractice policies.

Med mal loss ratios are generally low and doctors complain about them a lot. Often doctors in an area will set up their own mutual company or risk retention group (if allowed) because they think that they are being badly treated in the commercial market, but the costs of these tend not to be much cheaper for the doctors unless they are part of a medical group or hospital that has a very active quality program to keep the actual incidence of malpractice down.

Underwriting on med mal is like auto insurance. The price goes up for the kind of practice and the experience of the company with you. It goes down as you show that you are a careful doctor.

It reminds me of finally reading Adam Smith myself, and noticing how carefully some things Smith said are always elided by 'conservatives'....

Such as Smith's endorsement of a progressive system of taxation.

Yeah.

Adam Smith.

And, of course, Adam Smith was very distrustful of businessmen. He would never have supported the Clinton financial deregulations.

Adam Smith believed in competition. Not the corporatism that animates politicians on both sides. (You can't get regular political donations from a company for 15 years in a row if there is a strong possibility that their competitiors will take over). The typical way around that is for the top two or three to donate to make rules to shut out competitiors. (See US car companies 1960s to present; phone companies, cable companies, etc.).

The problem with trying to discuss tort reform is that the discussion almost never differentiates between two very different issues:
1) the level of care and level of evidence needed to win a malpractice suit, and
2) the incredible size of at least some awards (especially for "pain and suffering").

In my experience, an enormous portion of the proponents of tort reform are motivated, to a very large degree, by the latter. While the defenders of the current system consistently point to the former.

I thought the summit was one of President Obama's best moments.

The President had command of the issues and command of the room. He took charge and, by contrast, the Republicans -- none more so than John McCain (drives me mad when I hear some of my co-workers say we'd be better off with McLame) -- looked liked dimwits and assholes.

The whole thing was a shrewd move by President Obama, putting the GOP on the spot and putting the onus on the Blue Dogs.

While this was a made-for-TV event, it showed how much transparency is needed for such landmark and essential legislation. We need more accountability.

I couldn't help think how President Obama wasted a whole year on his domestic agenda by not taking charge earlier -- say, last May or July or September.

Couldn't help but wonder how his administration would be viewed -- certainly as more competent -- if he had done so, and if he had showed similar leadership on the jobs and foreclosure crises that still have the economy running as fitfully as a Toyota recall.

Adam Smith believed in competition.

Like Adam Smith, I "believe in" competition, and not just in the sense of the wag who said of infant baptism: "Believe in it? Why, I've actually seen it done!"

I really do believe that competition among suppliers in a free market results in lower prices for better goods and services. Many goods and services, anyway.

Now, health insurance is a particular form of service. And I would like to know this: if two or more insurance companies were competing to provide me that service, on what grounds would they compete?

Surely, they cannot compete by offering me a lower probability to get sick. Once upon a time, my ancestors might have sacrificed a chicken every month or a bull every year, to some particular god, in order to avoid disease. But we now know that sacrificing a few hundred dollars a month or several thousand dollars every year, to some particular insurance company, does not prevent disease any better than the old way. "Paying premiums to us will make you healthier" seems an unlikely sales pitch.

So, maybe insurers would compete for my business on the basis of price? That seems more sensible. If two companies offer me the exact same policy terms, but one of them charges a lower premium, great! But HOW does the lower-cost company do it? By paying doctors and hospitals less? By taking a smaller profit? By employing fewer customer-service reps or claims processors? By being more clever about selecting its customers?

I suppose I should not care HOW one insurer can offer me the same coverage at lower premiums than its competitor, any more than I care how one supermarket manages to sell me the same 2-liter bottle of caffeine-free Diet Coke for less than its competitor. Same stuff; lower price; why should I care how?

But I'm incurably curious. Much as I want to "believe in competition", I'd still like to know how it's supposed to work in the health insurance market specifically.

So, can somebody please explain it to me? Use small words and simple sentences. Employ easy-to-grasp illustrations like Adam Smith's pin factory. Tell me what insurance companies, in as free a market as you care to imagine, would actually do to compete for my business.

--TP

if he had done so, and if he had showed similar leadership on the jobs and foreclosure crises that still have the economy running as fitfully as a Toyota recall.

no, see, you don't understand. the Toyota recall is part of an Obama-led conspiracy to prop-up GM.

And Obamacare is just the cover for taking away your http://www.alan.com/2010/02/26/gun-paranoids-believe-obama-care-is-step-toward-refusing-you-a-gun/>guns.

"no, see, you don't understand. the Toyota recall is part of an Obama-led conspiracy to prop-up GM."

or just another way to distract from the government takeover of the mortgage industry

I suppose I should not care HOW one insurer can offer me the same coverage at lower premiums than its competitor, any more than I care how one supermarket manages to sell me the same 2-liter bottle of caffeine-free Diet Coke for less than its competitor. Same stuff; lower price; why should I care how?

I'd like free-market absolutists to keep in mind the simplicity of camparing two bottles of soda relative to the simplicity of comparing insurance policies when answering this.

Tony's question needs to be answered by anyone who claims that competition in health insurance will solve all the problems.

Sure, some firms will be more efficient than others in various ways, and competition should help with that, (unless "efficiency" means fighting claims). But ultimately this business, like other financial services, is constrained by the realities of finance and probabilities.

You can invent a million different kinds of soft drink, or make clothes in any number of styles, designs, and materials, and hope enough people will buy your product to make it profitable. Similarly, if you sell electronic devices the room for new features, gizmos, shapes, and so on is limitless.

But with insurance, what can you do? Sell different-colored policies? You can vary deductibles and copays, and levels of coverage, but even there you run into asymmetric information problems. I'm not saying there's no room for competitive variation, just that there's not enough to save us all.

"no, see, you don't understand. the Toyota recall is part of an Obama-led conspiracy to prop-up GM."

We've had quite a few snow days lately. Channel-surfing at home, I saw this spin on the Fox business channel and was amused.

Here's Fox, usually all red-white-and-blue and Made In America, declaring sympathy for Toyota and the so-called unfair treatment it has been getting (never mind that people have died from the mysterious acceleration problem) while essentially bashing GM and, of course, President Obama.

Just struck me as odd that Fox was coming off as so pro-Toyota (never mind it was glossing over the facts).

Meanwhile, I must have missed it. But Barack Obama not only is CEO of General Motors but he also is to blame for designing faulty acceleration systems for Toyota. Guy gets around more that Forrest Gump.

One thing I think Fox, and other outlets, have missed is how important regulation is. The financial crisis has demonstrated that loud and clear. And not saying tighter regulation would have prevented the Toyota situation -- but it might have lessened the problem or certainly brought it to light sooner.

Here's Fox, usually all red-white-and-blue and Made In America, declaring sympathy for Toyota ... while essentially bashing GM and, of course, President Obama.

allegiance to and promotion of the GOP is the highest priority - everything else serves that goal. Fox has all the intellectual honesty of RedState.

there isn't a single thing in your list that does anything about the actual cost of healthcare.

Allow me to expand my list.

Direct hospital care, physician and clinical services, and retail Rx represent 31%, 21%, and 10% of medical costs, respectively.

So, 50+% of all US medical dollars spent are spent of direct patient treatment in the hospital, doctor's office, or clinic. Another 10% is spent on prescription drugs.

Who is getting this treatment?

From here:

People with chronic conditions are the most frequent users of health care in the U.S.

They account for 81% of hospital admissions; 91% of
all prescriptions filled; and 76% of all physician visits.

What are we talking about when we say "chronic disease"?

Heart disease, cancer, diabetes, hypertension, pulmonary illness.

How many people have them?

About 45% of the population.

Are these diseases avoidable?

From the same document cited above:

The U.S. Centers for Disease Control and Prevention (CDC)16 estimates that eliminating three risk factors – poor diet, inactivity, and smoking – would prevent: • 80% of heart disease and stroke; • 80% of type 2 diabetes; and, • 40% of cancer.

Among the reasons US health care costs are high is that almost half of us suffer from chronic illnesses that are very expensive to manage on a purely medical model, but which are highly preventable and manageable with simple lifestyle changes.

Here are some simple suggestions I'd offer for addressing this:

1. Pay people to walk. Pay them a dollar a mile. Set up walking paths in parks and at malls with checkpoints where they can get a ticket timestamped to keep them honest, and pay them a buck a mile to walk around.

2. Subsidize local agriculture, especially market farming that can be sold directly to consumers or local markets. Provide direct financial incentives for farmers to, basically, do what the Amish do, and what they've done for hundreds of years, and what they make a very nice living at.

3. Make fresh food available in underserved areas. Cities, areas that don't have a good local agricultural base.

4. No f**king soft drinks, candies, or processed baked goods in schools. None. If kids want to bring it in from home, fine. None for sale in schools or offered as part of school food programs.

5. Set up publicly sponsored programs in community colleges to teach people how to shop for, purchase, prepare and cook food from fresh ingredients.

6. Spend some public money on the rails to trails program. Convert unused rail beds, canal rights of way, and other unused properties into trails for biking and hiking.

Make decent food accessible, teach people how to cook it, and get them out of the damned house and walking around.

That's my program. It's chock full of personal responsibility, doesn't cost a lot, doesn't point fingers at anybody, and it's fun.

Americans pay a lot of health care because Americans are unbelievably unhealthy. They could amazingly healthier for free.

Eat vegetables and take a walk every day. That's the russell health care reform plan.

Some folks will have bad habits that will be hard to change. Incentivize them. Cut them a check for walking and eating vegetables if that's what it takes. It'll be short money.

If you want to take it a step further, I'll recommend that we quit subsidizing corn, which turns into corn syrup and cheap, unhealthy cow and hog feed, I'll recommend that we stop letting drug companies advertise their wares on broadcast media and print, and I'll recommend that doctor's not be allowed to refer patients for treatment to facilities in which they have a financial interest.

But that's all probably way too lefty for y'all, and probably wouldn't save all that much money.

Get people to eat vegetables and take a walk.

When I was a kid, everybody smoked, and nobody wore seat belts. Now, not that many people smoke, and most people wear seat belts.

We know how to get people to change their habits. And it's freaking cheap. Compared to letting health care go to 20% of GDP, it's freaking free money.

Watch this.

Especially, watch through to the part about the family in WV whose kids are probably going to die before they're 25 because they're obese, completely due to the food they eat.

Also watch the part where he brings some vegetables into a grade school class and asks them what they are. The kids could not identify a cauliflower, an eggplant, and a tomato.

Grade school age kids, and they did not recognize a f**king tomato.

Tort reform is a cute idea, but it's not going to make anybody in this country one bit healthier.

Americans pay a lot of health care not least because they eat crap industrial products, and they get no exercise.

Eat vegetables and take a walk every day. Cheap, easy, and fun.

My two cents.

Hey, I though of another one!

7. 50% federal tax on any edible product where either sugar or corn syrup are one of the first five items in the list of ingredients.

Do that for 10 years and we'll see Type II diabetes go away as a significant chronic illness. And we'll raise a lot of federal revenue doing it.

Good posts, russell. One thing I'd add: although I love the idea of supporting local agriculture and do so with my own dollars, making fresh food accessible is a bigger issue than that. There are major cities in this country that don't have any grocery stores. None. There needs to be meaningful subsidies for grocery stores to operate in urban areas. (Ideally, local farm coops could provide a large portion of the food there.)

And while I'm at it, lifestyles of working people should include occasional exercise and a nap during the workday.

Common pseudonyms for sugar on nutritional labels:

corn syrup
fructose
dextrose
maltose
maltodetxrin
malt extract
sucrose

If you want a somewhat grim grocery-store game, how many of these can you find on the label of a single product?

Yeah, pretty much anything with an "ose" suffix is a sugar IIRC from my high school biology classes.

Interestingly: Radley Balkso

But they thought this one might be different. “We expected the study to show an increase in obesity in communities with a Wal-Mart,” Carden says. “We know that Wal-Mart lowers the cost of food, but we figured it’s not always the best food for you.”

To their surprise, they found the opposite—there was a small but statistically significant reduction in obesity rates in communities with a Wal-Mart, perhaps because the store also sells fresh produce of good quality at a good price.

Broadening the study to big-box stores in general, the effect was even more pronounced. “People actually bought more produce, more fruits and vegetables,” Carden says. “Instead of just eating more, they ate a higher-quality diet—a lower-fat diet than the rest of the population.”

Wal-Mart didn’t escape the study completely unscathed. Carden and Courtemanche found an increase in alcohol purchases in communities with Wal-Mart Superstores, and increases in smoking in communities with a Sam’s Club. They also found that the presence of a Wal-Mart in the community correlates with less exercise. But the overall “Wal-Mart effect” on health was positive.

"Also watch the part where he brings some vegetables into a grade school class and asks them what they are. The kids could not identify a cauliflower, an eggplant, and a tomato."

russell: You make good points. However, as I understand it, good, fresh food can be quite expensive compared to cheap, processed food. Families on a budget (and let's say the poor in West Virginia) gravitate to the cheaper, not better.

I did not see the movie -- although I have seen lots of clips -- but I understand that the well-reviewed "Food, Inc." documents much of this.


Personally speaking, I love vegetables. Where I fail myself is not snacking on fruits. Uunlike my wife, who is always eating an apple or grapefruit or kiwi at night, I seek the comfort and pleasure of ice cream, a major weakness, or a sweet from Bing's Bakery -- poor discipline, I know.

there was a small but statistically significant reduction in obesity rates in communities with a Wal-Mart, perhaps because the store also sells fresh produce of good quality at a good price.

God bless 'em. I tip my hat. Maybe they've also stopped pumping their ground beef up with salt water.

Now if they'd pay their folks a living wage, we'd be all set.

as I understand it, good, fresh food can be quite expensive compared to cheap, processed food.

It depends. I suspect that the reason fresh stuff is more expensive is because we're set up to produce and sell everything but.

Doesn't have to be that way.

The cheapest place to buy produce in Boston is at the Haymarket farmer's market.

When I used to live in Philly Reading Terminal Market was pretty cheap. Lots and lots of fresh stuff, lots of it brought in by truck or rail from farms an hour or two away.

A lot of the supply chain for food in this country is set up to raise vegetables out west and then truck it every other place. There's good arable land near most big cities in the US, there's no reason that local sourcing can't become more normal.

There's no reason that lots of folks can't just grow their own stuff. Subsidize county level agricultural extension offices to hand out tomato and pepper seedlings.

Every dollar we spend getting people to eat fresh food and get a half hour of simple exercise a day is probably two dollars we don't spend on pumping them up with meds for the rest of their lives.

"poor discipline, I know."

Lots of people are healthy eaters and still have health problems. I'm completely in favor of everything russell says and suggests and believe that the results of policies to encourage healthy eating and walking and napping would pay huge dividends to the country's general welfare. That said, ice cream is delicious, and people with health problems didn't necessarily bring them on themselves.

Common pseudonyms for sugar on nutritional labels:

corn syrup
fructose
dextrose
maltose
maltodetxrin
malt extract
sucrose

But these aren't all synonyms, not according to the FDA. If your product is sweetened only with corn syrup, you cannot put "sugar" on the label, or any of those other things, either.

But these aren't all synonyms, not according to the FDA
More to the point, these substances are metabolized differently. Sugars are not equivalent, especially when thinking about metabolic syndrome.

To their surprise, they found the opposite—there was a small but statistically significant reduction in obesity rates in communities with a Wal-Mart, perhaps because the store also sells fresh produce of good quality at a good price.

Did they control for the fact that Walmart is not evenly distributed throughout the country? For example, you generally don't see Walmart in urban areas. To the extent that Walmart places new stores so as to avoid dealing with low socioeconomic status folk, it seems like one might find all sorts of interesting but meaningless correlations between their presence and customer attributes.

Also, I clicked through to the Balko article Sebastian linked, and from there to the cited study. It . . . does not appear to support what Balko says it does. From the study's "Conclusions" section (bolding mine)

This paper exploits the unique geographic pattern of Walmart Supercenter expansion to identify the effect of county-level Supercenter presence on individual BMI and obesity status. We find evidence that Supercenters increase both BMI and obesity, with effects that are largest for women, low-income married individuals, and those living in the least populous counties. The estimates imply that the proliferation of Walmart Supercenters explains 11% of the rise in obesity since the late 1980s, but that the increase in medical expenditures offsets only 6% of consumers’ savings from shopping at Walmart.

So where he's finding this small but statistically significant reduction in obesity rates is a mystery to me. Maybe I'm reading something wrong. Anyone?

I mean, it's been going on 25 years since I took a stats class, but I'm pretty sure that "increase" and "decrease" are opposites.

"When I used to live in Philly Reading Terminal Market was pretty cheap."

Great place. Anyone who visits Philadelphia should make a point to go there.

And they serve Bassetts Ice Cream. The best.

Technically, they're not pseudonyms for sugar, they're kinds of sugars. Fructose, for example, is fruit sugar, with a different chemical structure (two sets, takes longer to break down slightly, but just as many caloires, and doesn't taste as sweet), dextrose is a different kind of sugar, sucrose is table sugar, maltodextrin is a polysaccharide made up of glucose, basically, etc. Nutritionally though, they're junk.

When did superdestroyer switch from proclaiming the Democratic One Party State to the capping damages bandwagon?

Also, the cheapest way to prevent malpractice suits would involve doctors and hospitals following some kind of best practices thing, like the checklists, and avoiding common mistakes, and more openness with people who do have complications, so they don't have to sue to find out if it was a mistake or not.

But that doesn't give Republicans the ability to hate on trial lawyers, and might actually work, plus it'd probably be OMG SOCIALISM or something.

I've only been to Wal-Mart once -- five years ago on an impromptu, desperate search for Christmas lights -- and was completely unimpressed.

I take issue with its anti-union stance. I hate the way it sends so many small businesses in a community out of business. I dislike the way it overtakes so many formerly quaint and quiet open spaces.

Just not a fan.

They must have awesome bargains. Otherwise, I fail to see Wal-Mart's popularity.

A Walmart opened in the last year or so a few miles from my house. I had to pick up a prescription for my dad there a few weeks ago and was mildly and pleasantly surpised when one of the first things I saw after walking in the door was lots and lots of produce. Great story, huh?

So where he's finding this small but statistically significant reduction in obesity rates is a mystery to me. Maybe I'm reading something wrong. Anyone?

You're right, Phil. The report doesn't say that Wal-Mart makes you skinny; it says that the impact having a Wal-Mart super center near your home is that it makes you fatter, but not so much that the increased medical costs due to being more at risk offset the savings.

Which is an altogether different story. Dunno how Balko got that from the report, the entire text of which is downloadable.

Mostly unrelated, BMI is still a horrible metric.

According to BMI, I'm borderline obese. I'd like to have my doctor, who dings me about my BMI on a frequent basis, accompany me through a workout or two, to see if he could do it. And then we could spar.

HuffPo does not take a subtle approach.

Nevertheless, has Jim Bunning gone mad?

And is this something the Republican Party abides by?

has Jim Bunning gone mad?

Bunning has dementia - and I don't mean it figuratively. His dementia was on display before his last election. Nice work, people of KY!

Walmart tried to establish itself over here. The results were catastrophic - for Walmart.
The company could or would not recognize that their style was at least 170° off local customs and then came the crash with German laws. Some of the practices common in the US are simply illegal here and unlike there over here laws against such practices have a chance of getting enforced too. Unwilling to adapt Walmart effectively withdrew.

Tony P:

But I'm incurably curious. Much as I want to "believe in competition", I'd still like to know how it's supposed to work in the health insurance market specifically.

So, can somebody please explain it to me? Use small words and simple sentences.

I see nobody has yet answered this question. Allow me. Or, more to the point, allow Paul Krugman.

tgirsch,

Thanks for the link. Of course, Krugman's answer to my question is "It doesn't work", but he's a commie pinko anyway.

What I'm still hoping is that a good, sober, free-marketeer will explain to us how it's supposed TO work.

--TP

Tony P:

While you're at it, why don't you hope for a GOP Senator to argue in good faith and offer up a bona fide compromise which, if included, would cause him/her to vote in favor of the HCR bills being proposed. Or hope for a viable libertarian solution to pretty much any complicated problem. :)

As for Krugman's link, don't worry about what HE says. Click through to the abstract of the 45-year-old study he describes.

Mostly unrelated, BMI is still a horrible metric.

You should try ASCAP.

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