Chapter 2: Health Care & Mental Health - Flint Hills Regional Council: Fill & Download for Free

Statistics, engineering, and computer science are all good! Everyone working with data should know the basic principles of statistics and programing. And engineers are awesome problem solvers (as I learned from my father, Stan Angrist, a mechanical engineer; The Next Page: This engineers’ career got off to a rocky start, recalls Stan Angrist). The sister disciplines of economics and econometrics build on the many contributions made by statisticians, engineers (especially in operations research), and computer scientists. But economics brings something unique.Economic insight is especially valuable in matters of public policy. I grew up in the 1970s, against the backdrop of the “energy crisis.” We’re running out of oil! Engineers at MIT and elsewhere worked on schemes to squeeze more energy out of each barrel and to find alternatives to oil. There’s been some success here, no doubt. But the world is awash in oil today and real (inflation-adjusted) oil prices, while volatile, hover around the post-war average. Surpise! Yet, economists are not surprised by this because we take it for granted that people respond to incentives. Indeed, this is the organizing principle of economics.As oil got more expensive, consumers used less of it (driving smaller cars, turning the heat down, and yes, as Jimmy “Cardigan” Carter advised, by wearing sweaters in the winter.) Also, as energy costs rose, suppliers went in search of more oil and new energy sources. The upshot was a wealth of new energy resources and moderating US demand as we became more efficient. The OPEC oil cartel that shook the world in 1973 still exists. But the image of oil in an hourglass running out (from the cover of Time magazine, 1976), now seems quaint (check it out: Energy Crisis). Economists are often skeptical of the Cassandras of resource crises. This is one we got right.A contrast between econometrics and other quantitative disciplines is also visible in the debate over health care. It’s a statistical fact that Americans without health insurance rely on hospital emergency departments (EDs) for much of their primary care and that they’re sicker, perhaps as a result. ED care is also inefficient because EDs are relatively expensive providers of treatment for colds and flu. The problem here is surely lack of insurance: properly insured Americans have a family doctor who plays the role of primary care provider and guides them through our byzantine health care system. Any ML algorithm worth its bytes will also identify insurance status as a key predictor of health outcomes.Once again, econometricians and health economists raise the red flag of selection bias. Most Americans are insured by virtue of having good jobs with good benefits, including, of course, generous health insurance. But those with such jobs tend to be healthier for all sorts of reasons distinct from their insurance (we’re more educated and have higher incomes, for example). As recounted in chapter 2 of Mastering ‘Metrics (The Path from Cause to Effect), random assignment of otherwise similar Americans to more or less-generous health care insurance plans does not much affect their health. And randomly assigning health insurance to otherwise uninsured low-income Americans increases ED visits.What else might you learn via an econ degree besides clear thinking about economic incentives and the dangers of selection bias? I hope you’ll learn to write expository essays like this one.

So, this is a defibrillator. Know what? All over the world, health care professionals are being taught to use this when someone’s heart stops.Are you shocked?I didn’t think so. Almost no one is and I can’t understand why. There are frequent disputes among professionals as to what is or is not healthy. Lots of medical theory is on much shakier ground than the theory of evolution. Yet no one protests against doctors being taught about the use of defibrillators in medical school even though the “correct” technique is clearly spelled out in 1 Kings 17:17–22 and again in 2 Kings 4:32–35. It is clearly stated in two independent accounts that you are supposed to get a holy man to lie down on top of the victim and call on the Lord. Repeat until a full recovery takes place.Where are all the outraged fundamentalists who surely ought to be demanding changes in the medical school curriculum? Why is there no Elisha/Elijah-ist theory of resuscitation?If defibrillation is not a big deal, why is evolution? Could it be that the issue is not religion per se but rather the sin of pride? Is the insistence that the theory of evolution cannot be correct due to a desperate need to feel special? Is it really a case of people needing to feel apart from and above the rest of the animal kingdom? If adherence to the Biblical principles were important, then when creationists found mold in their houses, they would fight it with scarlet thread, hyssop and the blood of a bird as specified in Leviticus chapter 14.Believe in miracles if you want. Really - I have absolutely no objection. But realize that miracles are not science. Believe that Joshua made the sun stand still, but don’t insist that it be taught in an astrophysics course. Believe that Jesus turned water into wine, but don’t make it part of a chemistry class. Believe that the world was created six thousand years ago or that humans were a special act of creation or that the development of our species was influenced by supernatural means. Just don’t pretend that this is science or insist that it be taught as such.ADDENDUM:I didn't expect this answer to generate so many responses. Accordingly, I feel some explanations and corrections are called for.Easy stuff first.Defibrillators are not for starting stopped hearts: they are for stopping heart fibrillations. Thanks to those who have enlarged my knowledge on the subject. My mistake. I take some comfort knowing that I am not alone in not realizing health care can be so complicated.“Defibrillator”. “Shocked”. Hahaha. Yes, I have a childish weakness for wordplay. Sorry.And the religion thing. Although it is true that the OP did not mention religion, I think my assumption was reasonable. If not, I hope the OP will edit the question to clarify and I can change my answer.Lastly, I am not trying to mock or deny religious beliefs. Science uses experimentation and observation to develop explanations for natural phenomena. That's all it does. If you believe in a God who can't be scientifically observed and experimented on then if that God acts you should expect that the result will be something outside of science. Think of it, if you like, as God being too big to be contained by a science classroom.

If the advantages of a single-payer, national health system are as great as they seem to be described in answers on Quora, why haven't advocates in the US made these advantages, especially better care at lower cost, the center of their presentations?I’ll try to give a short answer to a very complex question.Profit.The current system, and the one before the ACA, is quite unique in western democracies. We do not consider health care a basic human right, rather we consider it a profit based service.That’s the short version.We have tasked employers with the burden of paying for health care insurance and we have built a patchwork of systems to take care of those that fall outside that system.The ACA (and let’s not forget the ACA was heavily inspired by previous Republican Efforts to Scuttle Clinton’s Single Payer attempt in the 90’s Is the ACA the GOP health care plan from 1993?) is essentially a continuation of the system we always had, with more government oversight. For instance terminating the cruel “pre-existing condition” loophole.However, it is still the same broken system with a coat of paint on it.During the hearing preceding the ACA passing, I saw a very disturbing trend: Democrats would ask for Republican input, change the bill to reflect those amendments and still did not receive any support. The ACA is and was a disaster, but I supported it because I hoped it would at least fix some of the more glaring injustices, such as someone paying a lifetime in premiums only to reach a “ceiling” or be denied, after a long illness, because of “pre-existing conditions” (a friend of mine was refused cancer treatment because he had not disclosed knee surgery he received as a teenager, in his application. He died in 2012) v.But as a solution? I thought the ACA was only marginally better than the status quo and too vulnerable to ideological torpedoing by the opposition.How did we come to this?Unfortunately, while the rest of western democracies instituted their Single Payer in times when Insurance Companies were not big players in the market and were not generating huge profits from health care, we let corporate profits take over our system and produced an Arm Race between Insurers and providers.Right now any serious Single Payer system would go against a very entrenched and powerful lobby that has essentially legally bribed politicians from both sides of the aisle to maintain the status quo.The fact remains that while the US spends more pro-capita than every other western democracy, we receive at best equal service, but in many cases far poorer care.List of countries by total health expenditure per capita - WikipediaNote the blue part of US expenses. It’s almost as high or higher than most of the other countries total.That’s because in essence in the US we already pay for Single payer, but we don’t reap the benefits, and then we and/or our employers pay premiums on top of it.BTW, this is from 2014, before the ACA went into full effect.Why are people against single payer?The sad truth is that most people work for a company that provides insurance and the vast majority do not need it. That makes it a non pressing issue for most of the electorate. The percentage of people getting sick and losing their job for health reasons (therefore discovering the draconian bureaucratic and corporate mess they have to navigate while too sick to work) is simply too small to count.If everyone had to deal with the worse of our system for a year of their lives, we would have single payer in a matter of months.I have been on all sides of the issue:I was uninsured and had to declare bankruptcy because of outrageous bills (my wife’s)I was insured and received a transplant, after which I had to declare myself unable to work and eligible for medicare benefits because otherwise I would not have been able to pay for the premiums, assuming that any insurance company would have covered me.I was on COBRA and found it a perverse system thought out by people that have excellent health care and never got too sick to work. I went from paying $400 a month for my entire family to paying $1100 a month for myself alone, leaving my wife uninsured. With COBRA when you are healthy and earning you don’t need it, but when you are sick and no longer earning, you pay more and you are buried in red tape and if you miss a deadline (once again, you are sick and may not know what day it is), then you are screwed and there is a vested interest by the insurance company to make you fail and get you out of their rolls.And at some point I was healthy and careless and at that time I really did not know what a perversion this system was. I had to get sick to really learn that one either has to be dirt poor or rich to be able to get sick in America.Ultimately, when it comes to single payer, we have to decide if health care is a right of the citizen or a profit center. So far, every proposal I have seen tends toward profit.Is it right that the profits of a few insurance companies can keep an entire people trapped inside a gigantic Russian roulette that becomes evidently unfair only after one gets to experience it from the ranks of the ill.I have met personally scores of people that absolutely hated single payer with ideological fervor but had the bad luck of getting sick. They changed their minds very quickly, but too late to make a change.The people that are for the current system simply have not experienced its ugly side yet. One of those ugly sides is that having insurance is an absolute necessity because the arm race between providers and insurers have placed all but the mildest forms of care outside the buying power of the average person.Our system is designed to take people from the working middle class to the indigent class.Here is a funny video that explain, in simple but well sourced terms, why health care is so expensive.Uninsured citizens cannot afford medical care. I have known people driven to divorce, others to abject poverty and a couple to death because a few corporation need to make a profit.This is not left/right, this is human right.I have been told the video is not playing. Go to youtube and then paste this:watch?v=CeDOQpfaUc8after the .com/it should play from youtube itself or search for:Adam Ruins Everything - The Real Reason Hospitals Are So ExpensiveI forgot to add an additional point (among many, I am sure):Ask the people living under a single payer system if they would trade with ours.As I noted, I have relatives in Italy and Canada. Most of them very conservative. Some of them lived both in the USA and their country of origin.Not a single one of them would trade their system with ours. They will tell you chapter and verse of every single annoying thing about their system, but when it comes down to“Would you rather have an American style health insurance system”Not one of them would trade.Call random citizen in any country with Single Payer and ask them if they would rather have our system or theirs.I did just that with Canada once, while having some very conservative friends over for dinner. We called about 10 people (more actually, but many didn’t answer). Given that the numbers were friends of a relative from a side of the Canadian family we would consider “rednecks” here in the US, I wasn’t that sure they would prove my point, but prove it they did. None of them would change. All of them loved their system.