WHO's Fooling Who? The World Health Organization's Problematic Ranking of Health Care Systems

The World Health Report 2000, prepared by the World Health Organization, presented performance rankings of 191 nations' health care systems. These rankings have been widely cited in public debates about health care, particularly by those interested in reforming the U.S. health care system to resemble more closely those of other countries. Michael Moore, for instance, famously stated in his film SiCKO that the United States placed only 37th in the WHO report. CNN.com, in verifying Moore's claim, noted that France and Canada both placed in the top 10. Those who cite the WHO rankings typically present them as an objective measure of the relative performance of national health care systems. They are not. The WHO rankings depend crucially on a number of underlying assumptions -- some of them logically incoherent, some characterized by substantial uncertainty, and some rooted in ideological beliefs and values that not everyone shares. The analysts behind the WHO rankings express the hope that their framework "will lay the basis for a shift from ideological discourse on health policy to a more empirical one." Yet the WHO rankings themselves have a strong ideological component. They include factors that are arguably unrelated to actual health performance, some of which could even improve in response to worse health performance. Even setting those concerns aside, the rankings are still highly sensitive to both measurement error and assumptions about the relative importance of the components. And finally, the WHO rankings reflect implicit value judgments and lifestyle preferences that differ among individuals and across countries

In the Flesh and the Gothic Pharmacology of Everyday Life; or Into and Out of the Gothic

One of the key questions facing Gothic Studies today is that of its migration into and out of its once familiar generic or symbolic modes of representation. The BBC series In the Flesh addresses these concerns against the background of a neoliberal medical culture in which pharmaceutical treatments have become powerful tools of socio-economic normalization, either through inducing passivity or in heightening productivity, generating chemically adapted biomachines tuned to think and produce. But the pharmakon has always been a risky form of normalization, its poisonous mechanisms threatening to undo its helpful patterns by stealth. This essay discusses the pharmacological and medical contexts of the series in which zombies are subjected to medical management and normalized as “PDS sufferers,” thereby locating In the Flesh in terms of an already gothicized neoliberal pharmacology of everyday life. It also enquires how the proximity of the symbolic pharmacology of the series to neoliberal medical discourses and practices actually challenges traditional representational patterns of the Gothic and whether the Gothic can still have a role as an alternative cure to society’s ills

Does Barack Obama Support Socialized Medicine?

Democratic presidential nominee Sen. Barack Obama (IL) has proposed an ambitious plan to restructure America's health care sector. Rather than engage in a detailed critique of Obama's health care plan, many critics prefer to label it "socialized medicine." Is that a fair description of the Obama plan and similar plans? Over the past year, prominent media outlets and respectable think tanks have investigated that question and come to a unanimous answer: no. Those investigations leave much to be desired. Indeed, they are little more than attempts to convince the public that policies generally considered socialist really aren't. A reasonable definition of socialized medicine is possible. Socialized medicine exists to the extent that government controls medical resources and socializes the costs. Notice that under this definition, it is irrelevant whether we describe medical resources (e.g., hospitals, employees) as "public" or "private." What matters-what determines real as opposed to nominal ownership-is who controls the resources. By that definition, America's health sector is already more than half socialized, and Obama's health care plan would socialize medicine even further. Reasonable people can disagree over whether Obama's health plan would be good or bad. But to suggest that it is not a step toward socialized medicine is absurd

FASB: Making Financial Statements Mysterious

Since the passage of the Sarbanes-Oxley Act in 2002, the Financial Accounting Standards Board has passed rules that it promises will make corporate accounting more transparent. In fact, its revised Generally Accepted Accounting Principles have made it difficult for investors -- or even CEOs -- to understand a company's financial report. The first step in the wrong direction came when FASB mandated that companies list "intangibles" such as "goodwill" as corporate assets, artificially inflating balance sheets. After that, FASB meddled with the revenue recognition rules, in some cases not allowing companies to report revenue from cash payments received from a customer for a delivered product. Finally, and worst by far, FASB mandated punitive and nonsensical rules for so-called expensing of stock options. These accounting burdens, combined with the onerous yet ineffective mandates of the Sarbanes-Oxley Act, are starting to take a real toll on American businesses and markets. In 2007, only $8.5 billion or 7.7 percent of the total$109 billion in issuances of Initial Public Offerings were launched on U.S. stock exchanges, down from 60.8 percent a decade ago

Gomez v Allegheny Health

USDC for the Eastern District of Pennsylvani

How Did We Get into This Financial Mess?

As policymakers confront the ongoing U.S. financial crisis, it is important to take a step back and understand its origins. Those who fault "deregulation," "unfettered capitalism," or "greed" would do well to look instead at flawed institutions and misguided policies. The expansion in risky mortgages to underqualified borrowers was encouraged by the federal government. The growth of "creative" nonprime lending followed Congress's strengthening of the Community Reinvestment Act, the Federal Housing Administration's loosening of down-payment standards, and the Department of Housing and Urban Development's pressuring lenders to extend mortgages to borrowers who previously would not have qualified. Meanwhile, Freddie Mac and Fannie Mae grew to own or guarantee about half of the United States' $12 trillion mortgage market. Congressional leaders pointedly refused to moderate the moral hazard problem of implicit guarantees or otherwise rein in their hyperexpansion, instead pushing them to promote "affordable housing" through expanded purchases of nonprime loans to low income applicants. The credit that fueled these risky mortgages was provided by the cheap money policy of the Federal Reserve. Following the 2001 recession, Fed chairman Alan Greenspan slashed the federal funds rate from 6.25 to 1.75 percent. It was reduced further in 2002 and 2003, reaching a record low of 1 percent in mid-2003 - where it stayed for a year. This set off what economist Steve Hanke called "the mother of all liquidity cycles and yet another massive demand bubble." The actual causes of our financial troubles were unusual monetary policy moves and novel federal regulatory interventions. These poorly chosen policies distorted interest rates and asset prices, diverted loanable funds into the wrong investments, and twisted normally robust financial institutions into unsustainable positions

Freddie Mac and Fannie Mae: An Exit Strategy for the Taxpayer

The Fannie Mae-Freddie Mac crisis may have been the most avoidable financial crisis in history. Economists have long complained that the risks posed by the government-sponsored enterprises were large relative to any social benefits. We now realize that the overall policy of promoting home ownership was carried to excess. Even taking as given the goal of expanding home ownership, the public policy case for subsidizing mortgage finance was weak. The case for using the GSEs as a vehicle to subsidize mortgage finance was weaker still. The GSE structure serves to privatize profits and socialize losses. And even if one thought that home ownership was worth encouraging, mortgage debt was worth subsidizing, and the GSE structure was viable, allowing the GSEs to assume a dominant role in mortgage finance was a mistake. The larger they grew, the more precarious our financial markets became. Regulators should contemplate freezing the mortgage purchase activities of the GSEs while at the same time loosening the capital requirements for banks to hold low-risk mortgages. The result would almost surely be an industry much less concentrated than the current duopoly. A housing finance system that does not rely so heavily on Freddie Mac and Fannie Mae will be more robust. We have to assume that sooner or later some of the institutions involved in mortgage finance will fail. The policy should be to promote a housing finance system where mortgage risk is spread among dozens of institutions. That way, the failure of some firms can be resolved through mergers and orderly restructuring, without exposing the financial system to the sort of catastrophic risk that is represented by Fannie Mae and Freddie Mac

Rails Won't Save America

Rising gas prices and concerns about greenhouse gases have stimulated calls to build more rail transit lines in urban areas, increase subsidies to Amtrak, and construct a large-scale intercity high-speed rail system. These megaprojects will cost hundreds of billions of dollars, but they won't save energy or significantly reduce greenhouse gas emissions. Although media reports suggest that many people are taking public transit instead of driving, actual numbers show that recent increases in transit ridership account for only 3 percent of the decline in urban driving. Also, contrary to popular belief, rail transit does not save energy. Many light-rail operations use more energy per passenger mile than the average sport utility vehicle, and almost none uses less than a fuel-efficient car such as a Toyota Prius. People who respond to high fuel prices by taking transit are not saving energy; they are merely imposing their energy costs on someone else. Rail transportation is also much more heavily subsidized than other forms of travel. Where highway subsidies average less than a penny per passenger mile, and subsidies to flying are even lower, Amtrak costs taxpayers 22 cents per passenger mile and urban transit costs 61 cents per passenger mile.Even if rail transport did save energy, spending more money on rail will get few people out of their cars. People who want to save energy should plan to buy more fuel-efficient cars and encourage cities to invest in traffic signal coordination, which can save far more energy at a tiny fraction of the cost of building new rail transport lines

Does the Doctor Need a Boss?

The traditional model of medical delivery, in which the doctor is trained, respected, and compensated as an independent craftsman, is anachronistic. When a patient has multiple ailments, there is no longer a simple doctor-patient or doctor-patient-specialist relationship. Instead, there are multiple specialists who have an impact on the patient, each with a set of interdependencies and difficult coordination issues that increase exponentially with the number of ailments involved. Patients with multiple diagnoses require someone who can organize the efforts of multiple medical professionals. It is not unreasonable to imagine that delivering health care effectively, particularly for complex patients, could require a corporate model of organization. At least two forces stand in the way of robust competition from corporate health care providers. First is the regime of third-party fee-for-service payment, which is heavily entrenched by Medicare, Medicaid, and the regulatory and tax distortions that tilt private health insurance in the same direction. Consumers should control the money that purchases their health insurance, and should be free to choose their insurer and health care providers. Second, state licensing regulations make it difficult for corporations to design optimal work flows for health care delivery. Under institutional licensing, regulators would instead evaluate how well a corporation treats its patients, not the credentials of the corporation's employees. Alternatively, states could recognize clinician licenses issued by other states. That would let corporations operate in multiple states under a single set of rules and put pressure on states to eliminate unnecessarily restrictive regulations

Anti-Anti-Anti-Paternalism

Is government justified in being paternalistic? To some, the answer is yes - government sometimes knows better than people do what is best for them. If people are allowed unfettered free choice, they will not always be acting in their own best interests. Others, with a more libertarian bent, object that people know what is best for them and, in any event, should be able to do what they choose to do