Comments on: No. 2 in an occasional series: Alex Tabarrok on France-US comparisons (with minor editorial changes) http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/ Out of the crooked timber of humanity, no straight thing was ever made Mon, 13 Feb 2012 12:02:35 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: glenn http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-156124 glenn Thu, 18 May 2006 11:05:27 +0000 http://crookedtimber.org/?p=4659#comment-156124 Victoria - is there any other way to have a steak? Otherwise, you're eating charcoal... Victoria – is there any other way to have a steak?
Otherwise, you’re eating charcoal…

]]> By: theCoach http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-156086 theCoach Wed, 17 May 2006 19:31:06 +0000 http://crookedtimber.org/?p=4659#comment-156086 Let's think of a metric for the overall effect of the education system. My guess would be productivity/hour. Let’s think of a metric for the overall effect of the education system.

My guess would be productivity/hour.

]]> By: Victoria Férauge http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155972 Victoria Férauge Tue, 16 May 2006 19:26:11 +0000 http://crookedtimber.org/?p=4659#comment-155972 To determine what is "best" we would all have to agree upon on how to rank the different healthcare systems. Yes, we can look at mortality rates, cost, and so on but I doubt that it would satisfy us all. The previous post talked about infrastructure problems in the Italien system, I can speak to the French system which has both infrastructure problems (check out the public hospital in Nanterre, near Paris) and incentive problems. The system is not really set up to encourage the average person to be a partner in his/her well-being. In some ways it's glorious for someone like me who smokes like a chimney and really enjoys a two hour lunch with a very rare steak, a glass of Bordeaux and a "Fondant au chocolat" to top it all off. And rarely a word from my doctor who simply (and mildly) counsels me to practice a bit more "moderation" in my vices... Would I trade this system for an American doctor who would tell me that it's really time for me at 40 to stop smoking and watch the alcohol and cholesterol intake and who, at the first sign of trouble, slaps a "pre-existing" condition on my medical file? Of course not. To determine what is “best” we would all have to agree upon on how to rank the different healthcare systems. Yes, we can look at mortality rates, cost, and so on but I doubt that it would satisfy us all. The previous post talked about infrastructure problems in the Italien system, I can speak to the French system which has both infrastructure problems (check out the public hospital in Nanterre, near Paris) and incentive problems. The system is not really set up to encourage the average person to be a partner in his/her well-being. In some ways it’s glorious for someone like me who smokes like a chimney and really enjoys a two hour lunch with a very rare steak, a glass of Bordeaux and a “Fondant au chocolat” to top it all off. And rarely a word from my doctor who simply (and mildly) counsels me to practice a bit more “moderation” in my vices…

Would I trade this system for an American doctor who would tell me that it’s really time for me at 40 to stop smoking and watch the alcohol and cholesterol intake and who, at the first sign of trouble, slaps a “pre-existing” condition on my medical file?

Of course not.

]]> By: glenn http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155910 glenn Tue, 16 May 2006 10:38:03 +0000 http://crookedtimber.org/?p=4659#comment-155910 This is a pretty absurd debate. I've lived in the US and I now live in Italy. I've been to hospitals in both, but if I were sick, I'd much prefer to get treatment in the US (in fact, just the threat of having to go to an Italian hospital has made me live more healthily. But I will say that the main failings are with the infrastructure; the doctors here seem excellent). That being said, there are pros and cons to each system. There is no 'one best' system; there are just different failings in each. While being far from an expert, I've been spendng an inordinate amout of time thinking about healthcare systems and increasingly I'm of the mind that the healthcare system is inconsistent with capitalism. That is not to say, though, that all aspect of healthcare should under control of the government, and it's not even the same as saying the government could do the best job. Which country has THE BEST healthcare system in the world? Let's start with that, and then improve upon it... This is a pretty absurd debate. I’ve lived in the US and I now live in Italy. I’ve been to hospitals in both, but if I were sick, I’d much prefer to get treatment in the US (in fact, just the threat of having to go to an Italian hospital has made me live more healthily. But I will say that the main failings are with the infrastructure; the doctors here seem excellent).

That being said, there are pros and cons to each system. There is no ‘one best’ system; there are just different failings in each.

While being far from an expert, I’ve been spendng an inordinate amout of time thinking about healthcare systems and increasingly I’m of the mind that the healthcare system is inconsistent with capitalism. That is not to say, though, that all aspect of healthcare should under control of the government, and it’s not even the same as saying the government could do the best job.

Which country has THE BEST healthcare system in the world? Let’s start with that, and then improve upon it…

]]> By: james http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155849 james Mon, 15 May 2006 19:04:55 +0000 http://crookedtimber.org/?p=4659#comment-155849 It would be interesting to know how the US health care would compare with European systems if both systems paid the same costs. Is it possible that the US system costs more, not because of inefficiency, but because it simply pays more for the same goods and services? How much does the US system save if the cost of wages, services, and drugs are fixed to the prices paid in say France? Could the French system stay solvent and pay US prices? Single payer vs. the US mess does very little to address the actual costs of healthcare. It would be interesting to know how the US health care would compare with European systems if both systems paid the same costs. Is it possible that the US system costs more, not because of inefficiency, but because it simply pays more for the same goods and services? How much does the US system save if the cost of wages, services, and drugs are fixed to the prices paid in say France? Could the French system stay solvent and pay US prices? Single payer vs. the US mess does very little to address the actual costs of healthcare.

]]> By: Sebastian Holsclaw http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155831 Sebastian Holsclaw Mon, 15 May 2006 18:11:33 +0000 http://crookedtimber.org/?p=4659#comment-155831 "In effect, cost containment and quality at the VA is sustained with subsidy from other health care providers." I would be completely unshocked to find that is true. But my point in mentioning UCSD was that the VA here should not be thought of as some out-of-the-way awful old institution. It is modern, has access to excellent doctors and nevertheless appears not to be preferred. “In effect, cost containment and quality at the VA is sustained with subsidy from other health care providers.”

I would be completely unshocked to find that is true. But my point in mentioning UCSD was that the VA here should not be thought of as some out-of-the-way awful old institution. It is modern, has access to excellent doctors and nevertheless appears not to be preferred.

]]> By: eudoxis http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155805 eudoxis Mon, 15 May 2006 17:03:24 +0000 http://crookedtimber.org/?p=4659#comment-155805 "with a good VA hospital closely affiliated with the well respected UCSD Medical School" Most VA medical centers are associated with large, academic teaching institutions. The VA Medical system in Los Angeles, for example, is associated with, among others, UCLA. Staff from UCLA rotates through the VA. In effect, cost containment and quality at the VA is sustained with subsidy from other health care providers. (Just as low cost Canadian pharmaceuticals are subsidized by higher prescription prices in the US.) “with a good VA hospital closely affiliated with the well respected UCSD Medical School”

Most VA medical centers are associated with large, academic teaching institutions. The VA Medical system in Los Angeles, for example, is associated with, among others, UCLA. Staff from UCLA rotates through the VA. In effect, cost containment and quality at the VA is sustained with subsidy from other health care providers. (Just as low cost Canadian pharmaceuticals are subsidized by higher prescription prices in the US.)

]]> By: Sebastian Holsclaw http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155792 Sebastian Holsclaw Mon, 15 May 2006 16:06:01 +0000 http://crookedtimber.org/?p=4659#comment-155792 I can think of a relatively easy way to measure patient satisfaction with the VA. The VA provides care to veterans and their dependents. For people who can choose between the VA and other health care plans (which is to say most veterans with full time jobs), find out if they use the VA (which they have largely already paid for by military service) or if they use their job's health care (which if they have dependents they have to pay much more for). Anecdote not data of course, but in San Diego (with a good VA hospital closely affiliated with the well respected UCSD Medical School) with veterans whose medical choices I have some idea about (four) all prefer to use the insurance provided by their companies instead. Two have Scripps which makes it understandable, but two have Kaiser which despite their rather slick marketing campaign, at least in San Diego (local health insurance markets may vary so I figure I will give as much information as possible), has a not-so-thrilling reputation for being stingy and otherwise annoying. It seems to me that if people who have a choice and have experienced both choices consistently choose the non-VA option, that should be a good hint that the VA isn’t so wonderful. Is there somewhere we can get such statistics on a large scale? If not, maybe one of our academic friends could get a grant. :) I can think of a relatively easy way to measure patient satisfaction with the VA. The VA provides care to veterans and their dependents. For people who can choose between the VA and other health care plans (which is to say most veterans with full time jobs), find out if they use the VA (which they have largely already paid for by military service) or if they use their job’s health care (which if they have dependents they have to pay much more for). Anecdote not data of course, but in San Diego (with a good VA hospital closely affiliated with the well respected UCSD Medical School) with veterans whose medical choices I have some idea about (four) all prefer to use the insurance provided by their companies instead. Two have Scripps which makes it understandable, but two have Kaiser which despite their rather slick marketing campaign, at least in San Diego (local health insurance markets may vary so I figure I will give as much information as possible), has a not-so-thrilling reputation for being stingy and otherwise annoying. It seems to me that if people who have a choice and have experienced both choices consistently choose the non-VA option, that should be a good hint that the VA isn’t so wonderful. Is there somewhere we can get such statistics on a large scale? If not, maybe one of our academic friends could get a grant. :)

]]> By: lemuel pitkin http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155790 lemuel pitkin Mon, 15 May 2006 15:26:53 +0000 http://crookedtimber.org/?p=4659#comment-155790 On teh VA: 1. Costs, particularly administrative costs, are very low compared with the rest of the health care system. The fact that doctors and other professionals who are very highly compensated by the private systehm would prefer not to work for the VA is not, in my mind, a strike against it. The opposite, even. 2. The vets I know are generally happy with the care they get through the VA. On K-12: If you know anything at all about K-12 education in the US, you know that the very best schools are public schools in affleunt suburbs. By any metric, the quality of education in a good public school system is higher tahn at any but a tiny handful of the most elite private schools. Various commetners have noted that the difference between good and bad universities in America does not track the public-private divide. The same thing is even more true of K-12. On teh VA:

1. Costs, particularly administrative costs, are very low compared with the rest of the health care system. The fact that doctors and other professionals who are very highly compensated by the private systehm would prefer not to work for the VA is not, in my mind, a strike against it. The opposite, even.

2. The vets I know are generally happy with the care they get through the VA.

On K-12:

If you know anything at all about K-12 education in the US, you know that the very best schools are public schools in affleunt suburbs. By any metric, the quality of education in a good public school system is higher tahn at any but a tiny handful of the most elite private schools. Various commetners have noted that the difference between good and bad universities in America does not track the public-private divide. The same thing is even more true of K-12.

]]> By: eudoxis http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155789 eudoxis Mon, 15 May 2006 15:03:33 +0000 http://crookedtimber.org/?p=4659#comment-155789 Because the US does not have a single universal health care system, it is ludicrous to compare the aggregate of US health systems to individual health care systems in Europe. Single models in the US should be compared to single models in Europe. Just the first sentence in Henry's post highlights the strange comparisons so common in these discussions. First, comparing insurance systems to health care systems, and, second, comparing the whole "most deplored health insurance systems in the world" to the VHA which happens to be part of that whole. Jet, comparison studies in quality of care have been done between the VHA and commercial managed care systems. That's a far cry from comparing the VHA to premier US medical centers. Hospital ratings that include all hospitals don't have VA hospitals high on the list. The patient satisfaction surveys are not rigged; they are just not properly controlled. Crudely put, VA patients are a different population from the general population. Still, the VHA has improved dramatically compared to 15 years ago. Canada, for instance, looks to the VHA to see how they can improve their health care system. Because the US does not have a single universal health care system, it is ludicrous to compare the aggregate of US health systems to individual health care systems in Europe. Single models in the US should be compared to single models in Europe. Just the first sentence in Henry’s post highlights the strange comparisons so common in these discussions. First, comparing insurance systems to health care systems, and, second, comparing the whole “most deplored health insurance systems in the world” to the VHA which happens to be part of that whole.

Jet, comparison studies in quality of care have been done between the VHA and commercial managed care systems. That’s a far cry from comparing the VHA to premier US medical centers. Hospital ratings that include all hospitals don’t have VA hospitals high on the list.

The patient satisfaction surveys are not rigged; they are just not properly controlled. Crudely put, VA patients are a different population from the general population. Still, the VHA has improved dramatically compared to 15 years ago. Canada, for instance, looks to the VHA to see how they can improve their health care system.

]]> By: jet http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155783 jet Mon, 15 May 2006 14:22:05 +0000 http://crookedtimber.org/?p=4659#comment-155783 Barry, If they compared it against expensive hospitals who's clientale were usually older, then it would look like very expensive treatment was being given whith worse results. If they were going to compare it to the worst hospitals available, they'd compare it to BIA hospitals, another government ran, single payer, health care system. And I'm sure the BIA hospitals would make even VHA healthcare look like a healthcare utopia. Barry,
If they compared it against expensive hospitals who’s clientale were usually older, then it would look like very expensive treatment was being given whith worse results. If they were going to compare it to the worst hospitals available, they’d compare it to BIA hospitals, another government ran, single payer, health care system. And I’m sure the BIA hospitals would make even VHA healthcare look like a healthcare utopia.

]]> By: SamChevre http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155776 SamChevre Mon, 15 May 2006 13:06:50 +0000 http://crookedtimber.org/?p=4659#comment-155776 Comment #4 is key; doctors in the US make a LOT more than doctors in other countries (IIRC, average income for a Primary Care Provider in the US is 2.5x that of a PCP in France, and the disconnect is even greater for specialists.) Comment #4 is key; doctors in the US make a LOT more than doctors in other countries (IIRC, average income for a Primary Care Provider in the US is 2.5x that of a PCP in France, and the disconnect is even greater for specialists.)

]]> By: Barry http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155770 Barry Mon, 15 May 2006 11:09:56 +0000 http://crookedtimber.org/?p=4659#comment-155770 jet, as usual you're a bi, uh, jet-like in your logic. To rig a study to prove the VHA better, one would compare it to the worst hospitals available, not the best. In addition, it'd still make sense for the VHA to contract out some things, unless it was necessary to build those capacities into the system. jet, as usual you’re a bi, uh, jet-like in your logic. To rig a study to prove the VHA better, one would compare it to the worst hospitals available, not the best. In addition, it’d still make sense for the VHA to contract out some things, unless it was necessary to build those capacities into the system.

]]> By: jet http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155746 jet Mon, 15 May 2006 03:38:27 +0000 http://crookedtimber.org/?p=4659#comment-155746 The VHA may have made a tremendous turnaround from the early 90's, but it is still below par. The VHA relies heavily upon non-VA hospitals and then pays VA rates for the service. This can take months to schedule and then years to negotiate the final price, and which the patient will carry the debt until the VA pays. From the veterans I know (yeah yeah yeah, antedote doesn't make date), I'd be extremely skeptical of any study claiming the VHA was doing a better than the over all system. Probably rigged anyway, with the VHA being compared to an elite (expensive) set of hospitals catering to old rich people. The VHA may have made a tremendous turnaround from the early 90’s, but it is still below par. The VHA relies heavily upon non-VA hospitals and then pays VA rates for the service. This can take months to schedule and then years to negotiate the final price, and which the patient will carry the debt until the VA pays.

From the veterans I know (yeah yeah yeah, antedote doesn’t make date), I’d be extremely skeptical of any study claiming the VHA was doing a better than the over all system. Probably rigged anyway, with the VHA being compared to an elite (expensive) set of hospitals catering to old rich people.

]]> By: Barry http://crookedtimber.org/2006/05/13/no-2-in-an-occasional-series-alex-tabarrok-on-france-us-comparisons-with-minor-editorial-changes/comment-page-1/#comment-155701 Barry Sun, 14 May 2006 22:16:38 +0000 http://crookedtimber.org/?p=4659#comment-155701 "The VHA has made a tremendous turnaround from it’s low point in the early 90’s. " Hmmmm. Just like FEMA. I wonder what happened in the early 1990's, in the federal government, which could have caused two such programs to improve so dramatically. “The VHA has made a tremendous turnaround from it’s low point in the early 90’s. ”

Hmmmm. Just like FEMA. I wonder what happened in the early 1990’s, in the federal government, which could have caused two such programs to improve so dramatically.

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