Take MRI scans, which cost about $1500 in the US. In Japan, the fixed price for an MRI scan is around $100 (depending on body part). Now you'd think that Japanese doctors wouldn't do that many MRIs because they couldn't make any money off them. But no - just the opposite: Japan leads the world in MRIs. What happened is that Japanese doctors asked MRI manufacturers to develop an inexpensive MRI scanner. And they got a cheap machine so they can do cheap MRI scans and still make a little profit. Sometimes the heavy hand of regulation can be a spur to innovation. …I say this as a lover of capitalism, for whom the word "corporate" elicits a sigh of gratitude.
Between the government and private insurers, medical office personnel spend an inordinate amount of time processing bills. What is reimbursable, what is not? What type of documentation is required? What billing code should we use? How much can we charge? And that is one big reason the US spends so much on healthcare administration. Time is money.
Doctors typically get a cut of the profits and that provides incentives for expensive care and/or high premiums (in the case of HMOs). Add in the relative ease of gaming the billing system, and you've got a recipe for out-of-control healthcare spending. It doesn't matter if the medical bills are paid by Medicare or private insurers. If the system of payment can be gamed, it will be gamed.
Last post was about outpatient services, specifically how reimbursement rates and physician profit-sharing arrangements contribute to the cost of outpatient care in the US. This post will address the cost of pharmaceuticals…A recent JAMA study ( Papanicolas et al, 2018) found that annual per capita spending on pharmaceuticals in the US was $1443, compared to an average of $680 for ten other developed countries.
…Thus, if you want to understand why these procedures cost so much, follow the reimbursement rates. For instance, in 1997 Medicare raised reimbursement rates in certain parts of the country. On average, areas with a 2 percent increase in payment rates experienced a 3 percent increase in care provision. Physicians charge what they can, and then some.
Given that old people consume way more healthcare than anyone else, why do other rich countries spend so much less on healthcare than the US, when the US has comparatively fewer oldsters? Something is very wrong with this picture. What is all that money going? … A lot is paying for outpatient care and administration, which alone account for half of US healthcare expenditures
What does this actually mean, though? That permanent housing be available at the snap of one's fingers, anywhere in the US? Not realistic. Maybe in Finland, but not here. There is no basic right to live in the community of one's choice. Small town USA is off the hook here.
Unfortunately, residential hotels are becoming a relic of the past. For instance, San Francisco had 65,000 residential hotel units in 1910; today there are only around 19,000 units. If we really want to get serious about reducing urban homelessness in the US, we need to bring back residential hotels. Of course, I'm talking new, improved residential hotels, with support services available to all residents.
…For instance, single resident occupancy (SRO) rooms are just 80 square feet, enough for a bed, dresser and little else. San Francisco’s largest SRO hotel has 248 units. It would take 30 such SRO hotels to house the city’s current homeless population. That’s a lot of new buildings taking up a lot of valuable real estate in a city that doesn’t come close to meeting the housing needs of its low- and middle-income workers.
Homeless advocates are coalescing around a "housing first" approach to ending homelessness. The idea is to transition homeless people to permanent housing as soon as possible, ideally within a matter of weeks. Formerly homeless tenants would receive ongoing needs-based support, contributing a portion of their income to the cost of housing and services.
The big coastal cities, such as Los Angeles and New York, have contributed the most to this increase in homelessness. A large majority of the US homeless are individuals without children (e.g., 92% in San Francisco) and most are mentally ill, physically disabled, and/or abuse various substances.
Label creep: a gradual broadening of a category, often changing its meaning.
“Members of the public with the highest degrees of science literacy and technical reasoning capacity were not the most concerned about climate change. Rather, they were the ones among whom cultural polarization was greatest.” Kahan, Peters et al (2012)
For example, someone uninterested in higher education may not feel all that deprived compared to college graduates. Nor is it likely that a college undergrad would feel anger and resentment towards all those graduate students at her school if she considers the system for getting into graduate school to be fair and reasonable, expects to be a graduate student herself one day, and believes people who don't get accepted into graduate school have only themselves to blame.
We perceive social justice through a prism of intervening considerations, like how much:
...people have control over their circumstances
...luck figures in life outcomes
...the rules of the game are fair
...people deserve what they get.
…survey evidence showing the number of Americans endorsing anthropogenic climate change fell during the Great Recession, between 2007 and 2009. The authors' basic theory is that when people sense economic threat, they are more likely to value order and stability, which motivates them to justify the existing economic system and downplay evidence suggesting the system itself is a problem.
There's something about psychologizing that's invalidating. As if psychology was the science of human error. But does it have to be so? Humans are pretty good at tracking reality, thanks to biases and heuristics that work well most of the time. Error can be an ally in the search for truth.
In the bad ol' days of bureaucratic communism, psychiatrists contributed their diagnostic services to the state to help rein in trouble-makers. Take "sluggish schizophrenia", a diagnosis characterized by “pessimism, poor social adaptation and conflict with authorities” and frequently used to facilitate the psychiatric incarceration of political dissenters in the USSR and Eastern Bloc countries. Thanks to sluggish schizophrenia, the Soviet Union had three times as many schizophrenic patients as the US.
Most people accept that merit should be rewarded and bad behavior punished, but that doesn't tell us much. The difficult question is: how much? Part of the answer to that is: according to the rules of a legitimate system. And what makes a system legitimate?
Wealth is usually calculated as what the household owns that can be cashed in for future spending. But shouldn't external sources of future spending be counted as household wealth as well? Why not count the value of investments into which other entities pay but the household collects, like government- or employer-funded pensions? For example, the median pension benefit for newly retired teachers in California is $40K a year. That works out to $1 million over 25 years.