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Hard Times in the Country
The AP recently reported onthe disappearance of maternity wards in rural areas: Alisha Alderson placed her folded clothes and everything she needed for
the last month of her pregnancy in various suitcases. She never imagined
she would have to leave the comfort of her home in rural eastern Oregon
just weeks before her due date. But following the abrupt closure in
August of the only maternity ward within 40 miles, she decided to stay
at her brother ’s house near Boise, Idaho — a two-hour drive through a
mountain pass — to be closer to a hospital. . . .A growing number of rural hospitals have been shutt...
Source: Stayin' Alive - September 22, 2023 Category: American Health Source Type: blogs
The next bumper sticker: political science
As usual, Ramaswamy ' s glib slogans aren ' t self-explanatory, but I think we can figure out what he ' s pretending to be thinking about with this one:There are three branches of the U.S. government, not four.One would guess that this is a reference to the bullshit concept of the " Deep State. " What that actually means is of course the career civil service -- federal employees who don ' t get replaced wholesale every time the party in power changes, and who have legal protections to make sure that doesn ' t happen. Sometimes it also includes the military. (Sometimes it ' s the Deep State that ' s persecuting Ronald...
Source: Stayin' Alive - September 9, 2023 Category: American Health Source Type: blogs
Gdp
Yesterday I discovered that a huge tree limb had fallen on my property. It came from an oak tree so tall I couldn ' t actually see the scar where it had broken off. It would have been a pretty big tree all by itself. I heat with firewood so on the one hand, this was a bonanza, but on the other hand it was complicated and laborious to clean it up. I ' ve been harvesting firewood and cleaning up deadfall since I was a kid, and I have have the necessary fixed capital - two chainsaws, a tractor with a loader, a peevee. There ' s a lot of knowledge, skill and judgment involved to do it safely. You have to start by removing...
Source: Stayin' Alive - August 4, 2023 Category: American Health Source Type: blogs
The corporatization of medicine: Part two
2016 was in fact the first year in which fewer than half of
physicians had an ownership stake in their practice, based on a survey by the
American Medical Association.[i] The
pace of acquisition of practices by hospitals and health systems during this
period was astonishing. From 2014-2018, just four years, corporate ownership of
practices increased from 24.1% to 45.6% of all physicians in a nationally representative
sample. After selling out, physicians actually experienced a reduction in their
income.[ii]The evidence that increasing concentration of medical
services is associated with higher prices is consistent and exte...
Source: Stayin' Alive - July 21, 2023 Category: American Health Source Type: blogs
The corporatization of medicine: Part One
This will be a multi-part series. The days of independent community hospitals and small
physician practices are just about over. Paul Starr ’s famous book The Social
Transformation of American Medicine tells the story
of rise of a “sovereign” medical profession, consisting largely of
entrepreneurs who owned their own individual or small group practices and made
their living as independent business people. They were generally suspi cious of
alternative models such as large group practice and salaried employment. But recent
decades have been marked by one overarching trend: the consolidation of the
medical institu...
Source: Stayin' Alive - July 20, 2023 Category: American Health Source Type: blogs
Mindlessness
Academy Health is the rather oddly named society for health services researchers. They sent me a press release which I excerpt: Today, the House Appropriations Committee released a
breathtakingly reckless bill that decimates federal research, science,
and medicine programs, and puts the health of all Americans at risk. It
is so extreme that many pundits presume it has zero chance of becoming
law, but that very extremism requires that we respond quickly and
unequivocally. . . . " This bill would eliminate the Agency for Healthcare
Research and Quality (AHRQ) in its entirety. AHRQ supports r...
Source: Stayin' Alive - July 14, 2023 Category: American Health Source Type: blogs
This and that
Responding to some of the responses to my last post on global carbon emissions, yes, we agree on the facts, the issue seems to be the implications. It is correct that at this moment, the U.S. accounts for about 15% of global greenhouse gas emissions, and we have been heading downward; while China in particular has been going in the wrong direction and is the largest emitter. Maybe " fairness " is an issue here, since the U.S. is responsible for far more cumulative emissions and China ' s emissions per capita are not as large, but given the crisis facing humanity I think that ' s pretty much beside the point. What matters i...
Source: Stayin' Alive - June 26, 2023 Category: American Health Source Type: blogs
The cost of costs
The reason insurers impose deductibles and copays is to discourage utilization. They believe, no doubt correctly, that if people have to spend their own money they may choose not to get as many medical services or buy as many medications. The problem with this reasoning is that people aren ’t wise shoppers for medicine. Now, I’ll be the first to shout it from the rooftops that as a nation, we spend far too much on medical services that are low value or worthless. In fact, I will do so (metaphorically) later in this book. But it’s not because consumers of medicine aren’t wise s hoppers, and making them pay out...
Source: Stayin' Alive - June 17, 2023 Category: American Health Source Type: blogs
The Republican Study Committee Budget on the Key Drivers of Spending and Debt
Romina BocciaThe House and Senate both have budget committees. And yet, neither chamber has released a budget this year. Against this backdrop, it’s refreshing to see the Republican Study Committee (RSC) continue its nearly 30‐year tradition of producing an alternative conservative budget proposal. Titled “Protecting America ’s Economic Security, ” the RSC under chairman Kevin Hern (R‑OK) and Budget and Spending Task Force chairman Ben Cline (R‑VA) proposes to balance the federal budget, cut taxes, slash red tape, and boost work.The growth in the federal debt is directly tied to increases in spending for...
Source: Cato-at-liberty - June 16, 2023 Category: American Health Authors: Romina Boccia Source Type: blogs
A massive national failure
Over the decades, the U.S. has built a Rube Goldberg contraption out of employer provided health insurance, Medicare, Medicaid, the Affordable Care Act, and some smaller bits and piece that has resulted in, officially, about 90% of Americans having insurance.Great news! That means we can all afford the medical services we need and nobody has to go broke because they get sick or are injured in a car crash or shot by somebody exercising their Second Amendment rights! Err, no. Sadly it does not mean that. As a matter of fact, four out of ten insured adults surveyed in 2023 said they had skipped or delayed some type of care in...
Source: Stayin' Alive - June 16, 2023 Category: American Health Source Type: blogs
In An Ironic Twist, the AMA Seeks Alternatives to the Residency Matching Program
Jeffrey A. SingerLast weekend the American Medical Association House of Delegates passed a resolution tacitly claiming that the National Residency Matching Program (NRMP) is likely anti ‐competitive and a violation of the Sherman Antitrust Act of 1890. The resolution concluded:RESOLVED, That our American Medical Association study alternatives to the current residency and fellowship Match process which would be less restrictive on free market competition for applicants. (Directive to Take Action)This is quite surprising, given that the AMA was a co‐defendant, along with the Association of American Medical Col...
Source: Cato-at-liberty - June 14, 2023 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Increased Medicaid Coverage Is Not Improving Low Birth Weight
Marc JoffeWith so many people obtaining Medicaid coverage in the wake of the Affordable Care Act and during the pandemic, it is worth investigating whether this expanded eligibility is improving health outcomes. Overall, decreases in theproportion of uninsured individuals over the last decade are not being matched by improved life expectancy. Indeed, life expectancy at birth in 2021was lower than it was when the Affordable Care Act passed. But this fact tells us little about the benefits of Medicaid coverage since the decline has been driven in large part by COVID-19 deaths among elderly patients (often not on Medicaid) as...
Source: Cato-at-liberty - June 13, 2023 Category: American Health Authors: Marc Joffe Source Type: blogs
New Evidence That Prescribing Psychologists Can Save Lives
Jeffrey A. SingerRemoving barriers to prescribing psychologists (RxPs) saves patients the inconvenience and added expense of seeing a psychiatrist or other health care practitioner that states license to prescribe psychiatric medications. Such practitioners include family physicians, nurse practitioners, physician assistants—even general surgeons like me. Now comes a study showing that it also saves lives.InEffects of Giving Psychologists Prescriptive Authority: Evidence From a Natural Experiment in the United States, researchers publishing in the journalHealth Policy used data from the National Vital Statistics Sys...
Source: Cato-at-liberty - June 7, 2023 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Not Indentured: Most H ‑1Bs Starting Jobs in 2022 Switched U.S. Employers
David J. BierCritics of the H ‑1B visa for skilled foreign workers often claim that the status amounts to “indentured” servitude. Indentured servitudeis a contract to work for a single employer for a predetermined periodwithout pay. H ‑1B workers are not only paid—they receive wagesin the top 10 percent of wage earners in the United States. As importantly, although they face more obstacles to changing jobs, H ‑1B workers are not tied to a single employer, and they change jobs regularly.In fact, H ‑1B workers are leaving their initial H‑1B employers more than ever. Figure 1 shows the number of H‑1B ...
Source: Cato-at-liberty - June 7, 2023 Category: American Health Authors: David J. Bier Source Type: blogs
Affirmative Action in College Admissions
This article appeared onSubstack on May 30, 2023, and an earlier version appeared under Jacob Winter ’s byline in theHarvard Undergraduate Law Review.In a few weeks, the Supreme Court will announce its decision in two cases it heard last fall, one against Harvard and the other against the University of North Carolina. Both suits challenge race‐based affirmative action in college admissions. In each case, a group called Students for Fair Admiss ions (SFFA) argues that the universities’ admissions policies unlawfully discriminate against Asian Americans.The case against UNC rests on two issues. Under the Fourteen...
Source: Cato-at-liberty - May 30, 2023 Category: American Health Authors: Jeffrey Miron, Jacob Winter Source Type: blogs
