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	<id>tag:business.theatlantic.com,2009://3/tag:business.theatlantic.com,2009://3.21190-</id>
	<updated>2009-11-03T19:57:07Z</updated>
	<title>Comments for Innovations, Pets, and Health Care Reform</title>
	
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		<id>tag:business.theatlantic.com,2009://3.21190</id>
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		<published>2009-07-13T19:52:01Z</published>
		<updated>2009-07-13T20:06:25Z</updated>
		<title>Innovations, Pets, and Health Care Reform</title>
		<summary><![CDATA[Two pieces worth reading on health care innovation.&nbsp; First, Glenn Reynolds on his family:President Obama talks about the importance of prevention in a way that suggests that when people have heart attacks it's their own fault. But my wife, a...]]></summary>
		<author>
			<name>Megan McArdle</name>
			
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		<category term="Promo" />
		
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			<![CDATA[Two pieces worth reading on health care innovation.&nbsp; First, Glenn Reynolds <a href="http://www.washingtonexaminer.com/opinion/columns/OpEd-Contributor/The-hidden-cost-of-national-health-care-7952906-50469092.html">on his family</a>:<br /><br /><blockquote><p>President Obama talks about the importance of prevention in a way
that suggests that when people have heart attacks it's their own fault.
But my wife, a longtime vegetarian and marathon runner, had a freak
heart attack at the age of 37.</p></blockquote>]]>
			<![CDATA[<blockquote><br /><p>It wasn't from too many Big Macs. After some rough patches, she's
now doing well, thanks to an obscure and expensive anti-arrhythmic drug
called Tikosyn, and an implantable cardioverter/defibrillator. Not too
long ago, she'd have been largely bedridden. These medical innovations
made the difference between the life of a near-invalid and a life
that's close to normal.</p><p>My mother had a hip replacement. Her hip didn't break - she
basically wore it out with exercise. When the pain got too bad, she got
it replaced, and now she's moving around like before, only painlessly.
Not too long ago, she would have been chairbound.</p><p>My father had prostate cancer; his doctor suggested waiting but on
biopsy it turned out to be pretty aggressive. It was treated with
radioactive "seed" implants. He's now been cancer-free for several
years, without the side effects of earlier treatments -- or, worse, of
cancer.</p><p>My daughter had endoscopic sinus surgery this spring. She had been
sickly and listless, complaining of constant migraine headaches,
missing a lot of school, and generally looking more like a zombie than
a teenager. Several doctors dismissed her problems, or prescribed
antibiotics that didn't help much, until we found one who took the
extra step.</p><p>A head CT scan done on a fancy new in-office machine showed a nasty
festering infection, the surgeon cleaned it out, and now she's like a
normal kid again. Before laparoscopy, her condition would probably have remained untreated, and she would have been another "sickly" kid. Better to be well.</p><p>The normal critique of socialized medicine is to point out that
people have to wait a long time for these kinds of treatments in places
like Britain. And that's certainly a valid critique. I'm sure my mom
and daughter would still be waiting for their treatments, while my
father and wife would probably be dead.</p><p>The key point, though, is that these treatments didn't just come out
out of the blue. They were developed by drug companies and device
makers who thought they had a good market for things that would make
people feel better.</p></blockquote>







<p>This is something I've been saying for a while.&nbsp; But it touches on
something else I've been thinking about--the way in which our attempts
to measure health care innovation are going to bias our health care
output towards things that can be measured.</p><p>The death of Dr.
Helen would have shown up in any system's statistics.&nbsp; It's a hard fact
which is easy to measure, hard to game.&nbsp; But if she had merely been
bedridden, the loss that represents would be hard to measure, and easy
for the system to "improve" by deciding that being bedridden wasn't so
bad, after all.&nbsp; An old woman waiting for a hip replacement (or not
getting it at all?)&nbsp; A daughter whose health was sort of permanently
dragged down by a lingering infection?&nbsp; The system rarely looks for
ways to fix things that the system doesn't measure.</p><p>Meanwhile, The Enterprise blog has one of the more <a href="http://blog.american.com/?p=2991">fascinating health care charts</a> I've seen in a while:</p><span class="mt-enclosure mt-enclosure-image" style="display: inline;"><a href="http://meganmcardle.theatlantic.com/vetspending2.jpg"><img alt="vetspending2.jpg" src="http://meganmcardle.theatlantic.com/assets_c/2009/07/vetspending2-thumb-500x332-11255.jpg" class="mt-image-center" style="margin: 0pt auto 20px; text-align: center; display: block;" height="332" width="500" /></a></span><p>Veterinary
spending is rising just about in line with human medical spending.&nbsp;
Kudoes to AEI for publishing a graph that seriously undercuts one of
the major conservative arguments about health care:&nbsp; that the main
problem is consumers who don't bear their own costs.&nbsp; Veterinary
spending is subject to few of the perversities that either left or
right suppose to be the main problems afflicting health care spending.&nbsp;
Consumers pay full frieght most of the time.&nbsp; They are price sensitive,
and will let the patient die if keeping him alive costs too much.&nbsp;
There is no adverse selection.&nbsp; There is no free riding on mandatory
care.&nbsp; Government regulation is minimal.&nbsp; Malpractice suits are
minimal, and have low payouts.&nbsp; So why is vet spending rising along
with human spending?</p>Two reasons, presumably:&nbsp; technological
change and rising income.&nbsp; As we get wealthier, we spend more of our
income on former luxuries, like keeping our pets healthy--nineteenth
century veterinary care for sick cats consisted of a sack and some
stones to weight it down with.&nbsp; And improvements in health care
technology are giving us more things to spend that money on.&nbsp; With the
help of my family, I bought my dog five extra years of life with an MRI
that diagnosed his slipped disk; without it, we'd have had to put him
to sleep when he was three.&nbsp; Worth it?&nbsp; I think so.&nbsp; But in 1950, I
couldn't have afforded it, even if it had been available.<br />]]>
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		<id>tag:business.theatlantic.com,2009://3.21190-comment:225104</id>
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		<title>Comment from Andrew Biggs on 2009-07-14</title>
		<author>
				<name>Andrew Biggs</name>
				<uri></uri>
		</author>
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				<![CDATA[<p>Megan,</p>

<p>I appreciate the kudos but I think your praise is misplaced (that is, I'm not THAT honest...). The key distinction here is between the rate of growth of spending and the level of spending (or as growth economists would say, the growth rate and the growth path). The tax exclusion for employer-provided health care and third party payer mechanisms push health spending up to a higher level, but once done that level increases based on rising incomes and new technologies. </p>

<p>My broader point is that the growth rate is due to factors that aren't really wasteful, while the growth level does encompass a large amount of waste. If we focus too hard on the growth rate (as the administration sometimes seems to do) we may miss opportunities to improve efficiency. </p>

<p>Best,<br />
Andrew Biggs</p>]]>
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		<published>2009-07-14T15:01:43Z</published>
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