Google recently added an interesting new feature to their online empire, Google Health. It has the making of a useful and helpful tool for many people that want a place to keep track of their medical history and required prescriptions. You can enter your personal information, update your existing conditions, and even import your medical history and records from a variety of sources. It can also be used to find a doctor in your area or to seek online medical help.
One area where it is woefully insufficient is on social determinants of health. It would seem a more appropriate name for the site would be Google Medical, because that is its sole focus. The social determinants of health have been found to play a significant and varied role in individual health. Factors that are social determinants of health include things like where you live, what type of social capital the area you live in has, what is inequality like, how much income do you make, what kind of discrimination do you face, etc. However those critical factors are completely absent from Google Health. This reinforces the myopic medical view of health that divorces the health of the individual from the health of others. All health is patterned. Even things we consider random and tragic, like cancer, follow social patterns and gradients across factors like income. Ignoring these issues on a health site is at best ignorant and at worst neglectful of a whole host of factors many people may not be aware of.
Thursday, May 22, 2008
Wednesday, April 30, 2008
More Folly than Fact
John McCain's proposed health care policy is another example of irrational faith in a market that has already failed millions of Americans, particularly the 50 million without any health insurance. The problem is that "the market" and health have an extremely poor track record in all countries that have implemented market-oriented measures. The costs in each of the countries has increased without an increase in the actual services provided or quality of the care. This is the reason (as mentioned at length in previous posts) that Americans spend the most per capita on health but have among the poorest health outcomes for OECD countries. The U.S. government currently covers health for the two groups most prone to health problems: the poor and the elderly. By bringing all Americans into a national health system, the higher risk of these groups could be shared across a larger pool. This would bring down costs per patient overall in the U.S. and would reduce the overhead and bureaucracy needed to run the system. While both Barack and Hillary have imperfect plans for health care they are vastly superior than the "faith-based" plan from McCain. While government may not be the perfect provider of health, we have plenty of examples of more successful programs run by other countries that we could draw lessons from.
Monday, March 10, 2008
Peace Through Torture
It is difficult, if not impossible, to fathom at this point how the Bush administration can justify the actions they have taken. The most recent disgusting example of rampant disregard for the safety of Americans is the veto of the interrogation limits for detainees. While intelligence experts and interrogators continually identify the ineffectiveness of torture, overwhelmingly Americans fail to understand this. This disconnect is dangerous because it has been shown that torture can increase similar acts of violence from those on the other side of the conflict. The American people and those around the world must not let these actions continue. A concerted effort to hold those responsible for torture could be one positive step in creating sustained change.
Another aspect that has been identified as playing a role in the veto is executive power. Like many of the actions taken during his term, Bush has continually attempted to enhance the power of the executive generally and the presidency specifically. This is in direct contrast to the rhetoric of big government as a pariah on society. It is hard to imagine trying to secure your legacy by making the world less safe and free through torture. History will not look positively on the wasteful War On(of) Terror that has been undertaken during this administration. It is even more disgusting that McCain gives the Bush administration nearly a free ride in his discussion of their actions. I have a campaign slogan for him "Making America Less Safe for only Three Trillion a War!" I guess it may be a little too long...
Another aspect that has been identified as playing a role in the veto is executive power. Like many of the actions taken during his term, Bush has continually attempted to enhance the power of the executive generally and the presidency specifically. This is in direct contrast to the rhetoric of big government as a pariah on society. It is hard to imagine trying to secure your legacy by making the world less safe and free through torture. History will not look positively on the wasteful War On(of) Terror that has been undertaken during this administration. It is even more disgusting that McCain gives the Bush administration nearly a free ride in his discussion of their actions. I have a campaign slogan for him "Making America Less Safe for only Three Trillion a War!" I guess it may be a little too long...
Thursday, February 28, 2008
Possible Turning Point
A recent ruling in California on rescinding health insurance will hopefully have a industry wide impact on the way health insurance cases are managed. As the article notes the woman was diagnosed with breast cancer and was undergoing treatment for it. Midway through treatment, the company, Health Net Inc., canceled her policy leaving her with hundreds of thousands of dollars in debt. The reason given was that there was some weight discrepancies on her application and possibly missing information about a heart condition. This type of health care is deplorable and just another example of the dangers of for-profit health care.
The current system has Americans paying the most per capita for health care by a wide margin. (see table below). This massive discrepancy between what is spent in the U.S. and the level of health that is attained is a fundamental contradiction of our system. The fact that 50 million Americans go without health insurance (which often means going without health care) helped to increase this discrepancy. When people without insurance go for care they pay up to four times as much as those with insurance.
Source: uscs.edu
Administrative costs are also a significant reason for this vast discrepancy in spending. The bloated insurance company system makes health care less efficient as opposed to the "common sense" notions that are typically expressed around issues of public versus private. Using simplistic theories from economics may give particular policy prescriptions, but the empirical data often indicates something much different.
Many recent polls indicate contradictory factors in people's perceptions of health care. While approximately two-thirds of Americans support the idea that the government is responsible for providing health care to everyone, only forty percent would like to see the system changed to a single payer system.
The thing that I fail to understand is how Americans don't make the connection between the per capita spending and the cost of a single payer system. When we are paying significantly more for health care and receiving less benefits, it is hard to justify the current system. Due to the cultural fear of taxes present in the U.S., it is difficult to imagine an increase in taxes being a possible method of funding health care. It must shown that an increase in taxes would actually save Americans money. What they pay to insurers as well as the decreased direct pay that they receive due to the cost of company provided health care likely exceeds the tax increases that would be required to fund this system. Overall the expenditures of Americans on health care would decrease under a single payer system for a variety of factors including the ones mentioned above, but also other factors (ability to practice preventative medicine, decreased cost for prescription drugs, and increased risk sharing to name a few).
While the road to a single-payer system is neither simple or clear, it stands as the most likely and successful measure. While many countries are repealing aspects of their health care system, it is largely at the behest of those who stand to make profit. Those who require health care are often the first to decry these cut-backs. Though a single-payer health system would impose problems of its own, it is hard to imagine that it could be anywhere near as bad as the current system for the fifty million Americans without insurance and the tens of millions who are underinsured or likely to be dropped if they do get sick.
The current system has Americans paying the most per capita for health care by a wide margin. (see table below). This massive discrepancy between what is spent in the U.S. and the level of health that is attained is a fundamental contradiction of our system. The fact that 50 million Americans go without health insurance (which often means going without health care) helped to increase this discrepancy. When people without insurance go for care they pay up to four times as much as those with insurance.
Source: uscs.edu
Administrative costs are also a significant reason for this vast discrepancy in spending. The bloated insurance company system makes health care less efficient as opposed to the "common sense" notions that are typically expressed around issues of public versus private. Using simplistic theories from economics may give particular policy prescriptions, but the empirical data often indicates something much different.
Many recent polls indicate contradictory factors in people's perceptions of health care. While approximately two-thirds of Americans support the idea that the government is responsible for providing health care to everyone, only forty percent would like to see the system changed to a single payer system.
The thing that I fail to understand is how Americans don't make the connection between the per capita spending and the cost of a single payer system. When we are paying significantly more for health care and receiving less benefits, it is hard to justify the current system. Due to the cultural fear of taxes present in the U.S., it is difficult to imagine an increase in taxes being a possible method of funding health care. It must shown that an increase in taxes would actually save Americans money. What they pay to insurers as well as the decreased direct pay that they receive due to the cost of company provided health care likely exceeds the tax increases that would be required to fund this system. Overall the expenditures of Americans on health care would decrease under a single payer system for a variety of factors including the ones mentioned above, but also other factors (ability to practice preventative medicine, decreased cost for prescription drugs, and increased risk sharing to name a few).
While the road to a single-payer system is neither simple or clear, it stands as the most likely and successful measure. While many countries are repealing aspects of their health care system, it is largely at the behest of those who stand to make profit. Those who require health care are often the first to decry these cut-backs. Though a single-payer health system would impose problems of its own, it is hard to imagine that it could be anywhere near as bad as the current system for the fifty million Americans without insurance and the tens of millions who are underinsured or likely to be dropped if they do get sick.
Saturday, February 23, 2008
An Anticlimactic Ending
The recent departure of Castro from the position of president of Cuba fails to represent the 49 year rule that began with a thunderous revolution. While the results of his rule have been mixed, the Castro doctrine represented a fundamentally different way of viewing the world. It is hard to imagine that Cuba will not end up plodding along within the current globalized economic system much like other countries of Latin America. Their gains in social capital represent a real possibility for facilitating sustained development (in the sense of the capability approach). Hopefully the U.S. will give up our historically messy legacy now that Castro has stepped down. Removing the embargoes and travel restrictions would create the best possible opportunity for allowing actual change to take place in Cuba. Most important for Cuba at this time, in my view, is an implementation of a more democratic and representative system of governance. With it's spiritual and political figurehead out of office this seems more possible than it has in decades. Cuba is already highly globalized with its dependence on tourism and trade in sugar. By identifying and implementing appropriate legal and political changes it could take advantage of the years of progress in social capital that it has sustained.
It will be interesting to see what Castro's legacy will be. Beginning his reign as a fiery orator and general to stepping down decades too late. The gains made in Cuba in areas of health and poverty were often overshadowed by stories of repression and abuses of power (jailing homosexuals and dissidents comes to mind). Will Castro be seen as a revolutionary character that sustained Cuba? Or a petty dictator that kept Cubans from attaining a better standard of living? I assume the polemics will eventually fade and a more nuanced and ambivalent account will be the one taught in years to come. In the battle of "Socialismo O Muerte!" it appears a withering death of Cuban socialism will be the final result of Castro's grand experiment.
It will be interesting to see what Castro's legacy will be. Beginning his reign as a fiery orator and general to stepping down decades too late. The gains made in Cuba in areas of health and poverty were often overshadowed by stories of repression and abuses of power (jailing homosexuals and dissidents comes to mind). Will Castro be seen as a revolutionary character that sustained Cuba? Or a petty dictator that kept Cubans from attaining a better standard of living? I assume the polemics will eventually fade and a more nuanced and ambivalent account will be the one taught in years to come. In the battle of "Socialismo O Muerte!" it appears a withering death of Cuban socialism will be the final result of Castro's grand experiment.
Thursday, January 17, 2008
An Informed Discussion
As with much of American politics, the current immigration debate is filled mostly with polemics and demagoguery. It is often difficult to find a nuanced discussion of the issues and the wider context in which they exist. Luckily over the holiday break I was able to dive into two books on the subject, both of which provide a very contextualized account of central issues and controversies and where they reside in the course of debate.
The first one I read is They Take Our Jobs: And Twenty Other Myths About Immigration by Aviva Chomsky. It was a great book. Chomsky identifies key myths that are pushed about immigration from both pro and con positions. It places the immigration issue within the larger context of neoliberal reforms. While I wish some of the entries were longer, always good to leave the reader interested in finding out more, the book really stands out as a critically engaged account of the issues. One thing that particularly stood out was the role of marginalized labor and its place in the U.S. economy from the time of the American Revolution.
Ex Mex: From Migrants to Immigrants by Jorge Castañeda, a former foreign minister of Mexico, examines the historical context that situates the current debate. He also provides an excellent discussion of possible policies and the likely proponents and opponents to these policies. Examining the ways immigration from Mexico has changed, but also how it remains remarkably similar to previous decades, helps to identify that what we face is nothing new. Also noteworthy is that it provides a Mexican perspective on the issue, particularly from a person who has had a lot of influence and experience dealing with this issue at the highest levels of government.
While these are just two of many possible books that provide accounts of the current immigration debate, they are both very accessible and well-written. A proper discussion of immigration and its ramifications must start somewhere and these are good resources for that discussion.
The first one I read is They Take Our Jobs: And Twenty Other Myths About Immigration by Aviva Chomsky. It was a great book. Chomsky identifies key myths that are pushed about immigration from both pro and con positions. It places the immigration issue within the larger context of neoliberal reforms. While I wish some of the entries were longer, always good to leave the reader interested in finding out more, the book really stands out as a critically engaged account of the issues. One thing that particularly stood out was the role of marginalized labor and its place in the U.S. economy from the time of the American Revolution.
Ex Mex: From Migrants to Immigrants by Jorge Castañeda, a former foreign minister of Mexico, examines the historical context that situates the current debate. He also provides an excellent discussion of possible policies and the likely proponents and opponents to these policies. Examining the ways immigration from Mexico has changed, but also how it remains remarkably similar to previous decades, helps to identify that what we face is nothing new. Also noteworthy is that it provides a Mexican perspective on the issue, particularly from a person who has had a lot of influence and experience dealing with this issue at the highest levels of government.
While these are just two of many possible books that provide accounts of the current immigration debate, they are both very accessible and well-written. A proper discussion of immigration and its ramifications must start somewhere and these are good resources for that discussion.
Sunday, December 16, 2007
A People's Economist
A recent article by Joseph Stiglitz, a noted economist, provides a concise and directed critique of the havoc created by the Bush administration. He details the economic mismanagement and financial audacity that has damaged the U.S. and will require significant effort to redact. He provides a good starting point for a discussion of the steps to be taken to fix this problem.
As far as economists go, I find Stiglitz to be one of the one's I admire most. He doesn't accept many of the "facts" spun out by economists and has worked to increase nuance among economic analysis of the "invisible hand" by identifying informational asymmetries and their role in markets.
While he still represents a more mainstream view than I would ascribe to, I find value in his analysis and his work for social change and justice. His recent involvement in the independent film "The Big Sellout" was excellent. In this film he commented on the commodification of goods and the negative effects that it had on various countries. It was a really good movie and provided some clear examples where the Washington Consensus was failing those it claims to be "developing".
As far as economists go, I find Stiglitz to be one of the one's I admire most. He doesn't accept many of the "facts" spun out by economists and has worked to increase nuance among economic analysis of the "invisible hand" by identifying informational asymmetries and their role in markets.
While he still represents a more mainstream view than I would ascribe to, I find value in his analysis and his work for social change and justice. His recent involvement in the independent film "The Big Sellout" was excellent. In this film he commented on the commodification of goods and the negative effects that it had on various countries. It was a really good movie and provided some clear examples where the Washington Consensus was failing those it claims to be "developing".
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