8/28/09 6:09 PMScience and Health with Key to the Proper Design of Socio-Political-Economic Systems

Page 1 of 6http://delong.typepad.com/sdj/2009/08/science-and-health-with-key-to-the-proper-design-of-socio-political-economic-systems.html

Grasping Reality with Both HandsThe Semi-Daily Journal of Economist Brad DeLong: A Fair, Balanced, Reality-Based, and More than

Two-Handed Look at the World

J. Bradford DeLong, Department of Economics, U.C. Berkeley #3880, Berkeley, CA 94720-3880;

925 708 0467; delong@econ.berkeley.edu.

Weblog Home Page

Weblog Archives

Econ 115: 20th Century Economic History

Econ 211: Economic History Seminar

Economics Should-Reads

Political Economy Should-Reads

Politics and Elections Should-Reads

Hot on Google Blogsearch

Hot on Google

Brad DeLong's Egregious Moderation

August 19, 2009

Science and Health with Key to the Proper Design of Socio-Political-

Economic Systems

Megan McArdle thinks that any health care reform that might reduce pharmaceutical company

profits is bad:

Health Care: A Lesson in Practical Philosophy: I think that taking someone's money is a real

violation of property rights that shouldn't be done unless you're achieving major good. I think

keeping people alive is a major good. I don't think keeping people equal merits the case....

[G]eometric progressions are a bitch. If the innovation spurred by the private sector could save

1% of the people who currently die each year, the number of people we'd be killing along with

the private sector would necessarily be hugely larger than the number of people we'd save by

implementing such insurance, since the most grotesquely exaggerated estimates released by

interest groups pin the latter figure at around 0.8% of deaths in America (a much smaller

number than the number who are estimated to be killed by access to the system--nosocomial

infections and treatment side effects). That's even before you consider the people in other

countries who would be saved by these advances. When I talk about the utilitarian calculus of

weighing the good of current uninsured against the good to people who are currently, and in the

future, untreatable without further innovation...

I am not so sure.

Robert Waldmann, meanwhile, directs us to the Partnership for Public Service writing about that

bureaucratized socialist hellhole that is the National Institutes of Health:

[Thomas] Waldmann['s] dedication to public science kept him at NIH. "I thought I was going to

be here for two years, but I became so excited with the opportunities to do research and the

ability to develop our own drugs and... do my own clinical trials.... It was not matched, not in

industry, not in academia."... [T]he field of cytokines... molecules that control human immune

8/28/09 6:09 PMScience and Health with Key to the Proper Design of Socio-Political-Economic Systems

Page 2 of 6http://delong.typepad.com/sdj/2009/08/science-and-health-with-key-to-the-proper-design-of-socio-political-economic-systems.html

industry, not in academia."... [T]he field of cytokines... molecules that control human immune

responses.... Zenapax, which has been associated with complete remission in over 60 percent of

patients with Hodgkin's lymphoma who did not respond to any other treatment.... "The

challenge to get the product to meet quality control standards is extremely hard, but Tom has

been unwavering.... He did it all himself.... He paved the way for others," Katz said. Katz said

that Waldmann, throughout his long career, has been "committed to using science for the

betterment of humanity."... 78, Waldmann has no plans to retire because he believes there are

many medical breakthroughs on the horizon "We have just begun," he said.

And Susan Madrack directs us to an (unconfirmed by me: but Susan is careful) account of life in the

utopia that is America's health insurance system today:

Suburban Guerrilla: Late this afternoon I was gobsmacked by a Facebook announcement that a

high school friend had died. I tracked down the story, and it is an absolute textbook example of

everything that’s wrong with our health care system - so knowing that we share a passion for

this topic, I’ll share it with you.

She was 49 years old and in good health, other than a propensity to develop bronchitis. A

couple of weeks ago, after a trip to Disneyland, she came down with a terrible flu. After running

a high fever for four days she knew she should see a doctor, but she didn’t - no insurance. Her

husband, who owns his own business, had cancer a year and a half ago and is not insurable on

his own. She originally had insurance through her job, but had been placed on disability after

developing carpal tunnel syndrome (she was a transcriber). Eventually she was no longer

eligible for insurance through her employer, other than COBRA, which she could in no way

afford - her husband’s business had been hard hit in the recession.

So. She waits six days before finally dragging herself to an urgent care clinic, but the wait is so

long and she feels like shit on a stick so she goes back home. Eventually ends up in ICU with

pneumonia, and, as it ends up, tested positive for H1N1. By then the infection had gone too far,

her organs started failing, and after a week in the hospital she died this morning, leaving a

teenage daughter and a husband who don’t know what hit them. As though grieving isn’t

enough of a burden, imagine the hospital bills they’re going to face. This man is certain to lose

his business, his home, and anything else he ever had - on top of losing his wife.

It’s heartbreaking, completely unnecessary, and absolutely infuriating.

And Nathan Newman tries to take his wife to the doctor:

Thank God for Private Medicine - irony alert: We went to the emergency room because she had

intense pains, fever and other symptoms that her doctor said on the phone had a chance of

being fatal if not treated immediately. So we ran to the local hospital-- luckily only two blocks

from our home, one of the best in New York City (Columbia Presbyterian). With our lovely

private health insurance --also one of the better ones (Oxford) -- the results were: a long wait to

even see the triage nurse, and then being told my wife would have to wait EIGHT HOURS to

see someone. The triage nurse didn't disagree with her doctor's diagnosis of the possibility of

the fatal condition, but that was the timeline for everyone who wasn't basically bleeding to death

on the spot.

8/28/09 6:09 PMScience and Health with Key to the Proper Design of Socio-Political-Economic Systems

Page 3 of 6http://delong.typepad.com/sdj/2009/08/science-and-health-with-key-to-the-proper-design-of-socio-political-economic-systems.html

I basically did what everyone knows you have to do with our screwed up system-- bargain and

beg folks to jump the line. Which I did, getting her past the eight hour queue, but finding that

there was another indeterminate queue even in the next internal waiting room. At that point,

our 2-year old daughter was getting too anxious for me to stay; we asked whether my wife could

rest at home and get a call when a doctor was available, since we were just a block or so away.

But no, she had to stay, sitting up, suffering in pain, waiting.

I took our daughter home to put her to bed and my wife eventually got home, untreated,

because it was unclear whether they would ever see her. So she decided that getting some sleep

and rest trumped the CHANCE to see an emergency room doctor.

Now, she'll hopefully be able to see her regular doctor today, but I've had plenty of frustrations

on care on day-to-day medicine that the emergency room insanity seemed to me not an

aberration but pretty indicative of a system that spends crap loads of money but is not there for

people when you need it, even if you have decent insurance. Some of the problems in emergency

rooms we know are do precisely to the fact that many people don't have insurance, so they end

up piling into emergency rooms as their only care-giving system. Which highlights once again

what everyone, insured or not, has to gain from more universal coverage.

And yet we'll still have media cycles dominated by discussions of "death panels" even as the

incredible number of stories of pain and suffering under our present system, most far worse

than what I described above, gets downplayed. The insanity of the health care debate would be

amusing, if it wasn't so deadly serious for so many people.

And nonpartisan tax professor Daniel Shaviro is finally driven by the Republican slime machine in

the health care debate to join the Ancient, Hermetic, and Occult Order of the Shrill:

Start Making Sense: Healthcare reform: The current debate's lack of coherent content has been

quite startling, and indeed dismaying insofar as one naively hoped for better.... In 1993, I was

unsympathetic to the Clinton plan, but since then my view of how well the U.S. healthcare

market functions has darkened. More on that in a moment. Unfortunately, I don't think the

Administration has conveyed any clear sense of what it is trying to do, or why.

Concerning the other side in the debate, perhaps the less said, the better. I really can't say

anything temperate at this point....

So we have a terrible healthcare system that surely could be vastly improved. I take the

Administration to be addressing the adverse selection problem by extending health insurance to

the uninsured population. Also, it may want to address under-treatment... which I think of as a

distributional issue.... The Administration would also perhaps like to address the moral hazard

problem.... Unfortunately, addressing it really requires bipartisanship, since cutting benefits is

politically unpopular. And the Republicans couldn't make any clearer their unwillingness to

cooperate in any sort of good faith effort to address waste and put healthcare outlays on a

sustainable path.

One of the many offensive and odious aspects of the Republicans' hateful lying about death

panels and the like is that they are actually the ones who want to provide less treatment. For

those among them who are sane and believe in civil society, this mainly reflects concern about

moral hazard and/or a libertarian distributional view. The rest, apparently a large majority of

8/28/09 6:09 PMScience and Health with Key to the Proper Design of Socio-Political-Economic Systems

Page 4 of 6http://delong.typepad.com/sdj/2009/08/science-and-health-with-key-to-the-proper-design-of-socio-political-economic-systems.html

moral hazard and/or a libertarian distributional view. The rest, apparently a large majority of

their number, do not bear discussing.

Welcome, Dan! Phnglui mglwnafh Cthulhu Rlyeh wgahnagl Ftagn!! Shaviro Ftagn!!

The deep-fried shoggoth tentacles are on the right. And the 65 million B.C. vintage of the

chardonnay is from Hastur the Unspeakable's private cellars...

RECOMMENDED (5.0) by 5 people like you [How?]

2 more recommended posts »

Brad DeLong on August 19, 2009 at 09:33 AM in Economics, Economics: Health, Obama

Administration, Political Economy, Political Economy: Social Democracy | Permalink

TrackBack

TrackBack URL for this entry:

http://www.typepad.com/services/trackback/6a00e551f0800388340120a504d3a9970b

Listed below are links to weblogs that reference Science and Health with Key to the Proper Design of Socio-

Political-Economic Systems:

Comments

You can follow this conversation by subscribing to the comment feed for this post.

Brad, I've actually been shrill for a long time (probably 2002 or 2003), although admittedly I try to suppress it in my

blog most of the time.

Posted by: Daniel Shaviro | August 19, 2009 at 09:44 AM

"I think that taking someone's money is a real violation of property rights that shouldn't be done unless you're

achieving major good."

Wow. Megan is actually arguing that potential future profits made under the existing laws and regulatory system

are, in fact, the present-day property of the pharmaceutical companies, i.e., that the pharmaceutical companies are

ENTITLED to those profits, and the state has no right to change those laws and regulations unless it does so for a

major good. That's an absurd position as it exalts the fictitious "rights" of fictitious entities that exist only by virtue

of the state over the real rights of real people.

Corporations are entitled to have the current laws and regulatory system remain unchanged? Really? Is that how

representative democracy works now? Corporate entitlements, good, human entitlements, bad?

America is truly an empire in decline.

Posted by: Tao Jonesing | August 19, 2009 at 10:46 AM

There is to my mind a McMegan Rule which is the rough mirror image of the Krugman Rule:

1. Megan McArdle's analysis is incorrect.

2. If you think that Megan McArdle's is correct, see rule number 1.

This neatly exempts her thinking on food, which does not fall under the category of 'analysis' in any rational

taxonomy. I have every reason to believe that she would make a fine food critic.

You might like:

Jonathan Chait Tells David Broder and All the Other Clubby, Groupthinking Mediocrities of the

Republican Press Corps What He Thinks of Them (this site)

Michelle Malkin and Larry Katz (Angry Bear)

8/28/09 6:09 PMScience and Health with Key to the Proper Design of Socio-Political-Economic Systems

Page 5 of 6http://delong.typepad.com/sdj/2009/08/science-and-health-with-key-to-the-proper-design-of-socio-political-economic-systems.html

taxonomy. I have every reason to believe that she would make a fine food critic.

Posted by: wcw | August 19, 2009 at 10:59 AM

McCardle has a strange notion of the efficacies of various kinds of treatments. She should compare the life

expectancy rates of the US and that of the crippled, impoverished, mis-run island of Cuba. They are practically

identical. The basic difference is that what health care there is in Cuba is available to all and so the sick take

advantage of it.

Calculus, my aunt Fanny.

Posted by: Jeffrey Davis | August 19, 2009 at 11:57 AM

Megan is simply echoing the Republican position. My 'representative', Mike Coffman, writes:

"Government can play an important role in fostering the continued prosperity of the private health insurance

market and the valuable services they provide."

This is how Mr Coffman believes we can solve health care problems - by ensuring the insurers' profits.

When he was Secretary of State for CO, his staff members sold voter databases to the Republicans. Profit is their

only god, and we shall have no gods before Profit.

Posted by: Doug K | August 19, 2009 at 03:14 PM

"since the most grotesquely exaggerated estimates released by interest groups pin the latter figure at around 0.8% of

deaths in America (a much smaller number than the number who are estimated to be killed by access to the system--

nosocomial infections and treatment side effects)."

Even for McMegan this is a travesty. There is no reason at all to compare these numbers. Does she actually think

that those without access to the medical care system are less likely to die because of that lack? I doubt even she

thinks that; but, if not, what is the sense of what she wrote.

Also, the meme that innovation in medicine comes from the private sector is almost entirely false; the idea that it

takes extortionate profits to drive it is entirely false. See Dean Baker for details.

Posted by: Reader | August 19, 2009 at 04:21 PM

While I am all for health care improvement - the more the better, preferably implementation of the German system

here in the US - I am not sure how anything from Grassley's current ravings to a full French system would help

Nathan Newman's wife: under any reform/system we in the US will still have a massive shortage of primary care

physicians and internists and still have organizational and cultural barriers in medical school recruitment and

sociology preventing us from getting many more.

Cranky

Posted by: Cranky Observer | August 19, 2009 at 05:29 PM

I don't understand why McArdle asserts that innovation will save lives at a constant geometric rate in the current

system. If you actually work out the implications of this claim, it is laughably unlikely. If this is the quality of

reasoning McArdle uses to justify her opinions, it is no surprise that she is so nutty.

Posted by: Patrick C | August 19, 2009 at 08:26 PM

Please, make her stop.

Posted by: Spectre | August 19, 2009 at 10:20 PM

Verify your Comment

Previewing your Comment

Posted by: |

This is only a preview. Your comment has not yet been posted.

Post Edit

8/28/09 6:09 PMScience and Health with Key to the Proper Design of Socio-Political-Economic Systems

Page 6 of 6http://delong.typepad.com/sdj/2009/08/science-and-health-with-key-to-the-proper-design-of-socio-political-economic-systems.html

Me: Economists:

Paul Krugman

Mark Thoma

Cowen and

Tabarrok

Chinn and

Hamilton

Brad Setser

Juicebox

Mafia:

Ezra Klein

Matthew

Yglesias

Spencer

Ackerman

Dana

Goldstein

Dan Froomkin

Moral

Philosophers:

Hilzoy and

Friends

Crooked

Timber of

Humanity

Mark Kleiman

and Friends

Eric Rauchway

and Friends

John Holbo

and Friends

Your comment could not be posted. Error type:

Your comment has been posted. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image

below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.

Continue

BlackBerry® Official SiteDiscover How Much More You Can Do With A NewBlackBerry Curve™ 8520www.BlackBerry.com/Curve8520

Prepare to be ShockedMillions have already taken this amazing test.What's your RealAge?RealAge.com