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Showing posts with label Healthcare. Show all posts
Showing posts with label Healthcare. Show all posts

Saturday, April 18, 2020

Death rates

In the news, we are told that Covid-19 has killed 37,841 people as of 4/18/2020.  While the rate has varied, it seems to be about 2100-2200 people per day.  So let's get some context around that.
The population of the US is approximately 330 million people.  The average life expectancy is 78.5 years.  This means that each year, 4.2 million people die.  That is 11,517 people per day.  So what we are saying seems to be that an extra 20% of death is being handed out?  Not necessarily.  Later, government statistics will come out to determine whether Covid-19 was killing people in addition to normal causes of death, or rather instead of normal causes of death.
Repeating the calculation for Oregon, with the same life expectancy and a population of 4.2 million, normally 147 people die each day.  Currently, the number of deaths from Covid-19 seems to be about 4 or 5 people per day.  This is a much lower rate in comparison to the national picture.  Here one might argue that it is much more likely that people are being killed by Covid-19 rather than some other causes such as traffic and gun accidents because of social distancing measures.  In other words, probably Covid-19 is not adding to the death toll, people are dying at the same rate as before but for different reasons.  Unfortunately, data compilation, validation and publishing take time, so resources such as CDC's Wonder are not going to answer just what kind of effect Covid-19 has had on the country until later.
Just also want to note that I have way simplified the subject.  There are regional and seasonal variations.  The short term effect of social distancing may be very hard to determine vs. the effect of the Covid-19 infection rate.  Assumptions of paribus ceteris may be invalid for many reasons.  Also, it is not clear that we have reached the peak of the mortality curve for the US or the deaths from Covid-19 could possibly remain level for some weeks.  In the case of a doubling of the daily death rate or a sustained high level, then clearly the virus is adding marginally to the death rate and the life expectancy will go down when they calculate the statistics.  For example, if we assume that 2200 daily deaths are indeed on top of the normal national death rate, then this would reduce the life expectancy to 65.9 years which is a pretty significant reduction.
Again, I want to stress that we won't be able to figure out the actual effects until all the data has been gathered and analyzed but it sure is fun to speculate about it.

Saturday, January 26, 2019

Executive Order 13824: Sports, Fitness, and Nutrition

What the Executive Order Says

Executive Order (EO) 13824 is entitled "President's Council on Sports, Fitness, and Nutrition" (note the Oxford comma) and has 2 sections.  It was issued in February of 2018.

Section 1

This section revokes EO 13545 which the previous President used to establish his "President's Council on Sports, Fitness, and Nutrition."

Section 2

With EO 13545 having been revoked, EO 13265 comes back into force, but this section makes a number of changes to the text of it.  However, technically, the changes listed interfere with each other.  Section 5 is changed by (c), then renumbered by (d) and then further changed by (a) (b) (c) which are under (d).

My commentary

So I characterized this as word soup.  It is so hard to read documents that are created this way.  You have to be able to access the original plus the list of changes and then work through the integration of the changes into the original.  Having pieced together what the final version is, it creates a council and, depending on whether the administration and the council take the charge seriously, it could do some good things or not.
One point made in the purpose section is that team sports participation by children has declined.  I have to ask what is so special about team sports.  I have found these kinds of organized leagues and teams to be expensive and a proportion of the people involved petty and vindictive.  There is the cliché of the one kid who is on the team but never gets to play.  It's a cliché because it does happen even though it really should not.  Physical exercise need not be an organized sport, whether team or individual.  The real justification here should have been statistics about children's and young adult's health.  But talking about that would get into the third rail of "HealthCare" and Republicans simply do not have a defendable alternative to the current system to offer.  But the statistics show there is room for improvement.
Further, this is one of the things that it seems that Presidents use to play one-upmanship games with.  We've seen a couple of these kinds of EO's issued in our review.  Here, EO 13824 revokes EO 13545 which itself largely modified EO 13265 which itself revokes EO 12345.  The President's council can be reviewed here.

Sunday, January 20, 2019

Executive Order 13822:Supporting Veterans

What the Executive Order Says

Executive Order (EO) 13822 is entitled "Supporting our veterans during their transition from uniformed service to civilian life" and it has 3 sections.  This EO was issued in January 2018.

Section 1

This section defines the policy which is that veterans need better access to mental healthcare services including suicide prevention resources.

Section 2

This section has 3 subsections.  (a) directs the Secretary of Defense, Secretary of Veterans Affairs and the Secretary of Homeland security to do something.  Doesn't really say what they should do.  (b) mandates that the group mentioned need to submit within 60 days a Joint Action Plan.  (c) mandates that a follow-up report on the progress of implementation of the Joint Action Plan be issued within 180 days.

Section 3

This section includes general provisions that limit the authority of the EO to ensure that it does not overstep legislative and constitutional limits.

My Commentary

I have looked on the internet for the Joint Action Plan and follow-up report since due to the age of this EO, it clearly should be available.  On the Veterans Affairs website, I found this updated action plan.  This plan defines 16 actions to be implemented that will support the reduction in suicides and mental health incidents for veterans.  I found this status update report dated July 9, 2018 although it is watermarked "DRAFT".  I would like to think that this had made a difference in at least some veteran's lives.  But it is not clear that there has been much success and since there does not seem to be any mandated report to follow up the implementations (while most of the 16 actions were "On track", none were expected to be completed until mid-2019), we may never know.

Thursday, November 23, 2017

Executive Order 13765:Prelude to ACA repeal

What the Executive Order Says

Executive Order (EO) 13765 is entitled "Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal" and was issued on January 20th, 2017.  This was the first EO signed by the current administration and it has 6 sections.

Section 1

This section defines the policy and frames the repeal of Obamacare as being motivated by individual freedom and States rights issues.

Section 2

This section directs the Secretary of Health and Human Services (HHS) and other agency heads to exercise all and any discretion defined in the PPACA so as to "waive, defer, grant exemptions from, or delay the implementation" of the PPACA.

Section 3

This section directs  the Secretary of HHS and other agency heads to exercise all and any discretion available to them in the PPACA to push decisions on implementation to the States.

Section 4

This section directs the Secretary of HHS and others to take actions, if possible to allow interstate commerce in the Health Care Insurance market.

Section 5

This section indicates that the usual rules for rulemaking apply.

Section 6

This section includes the usual legal fine print to assure the constitutionality of the EO.

My Commentary

It was to be expected that the administration would make repealing Obamacare a priority.  It was not expected that 11 months into the administration, we still have Obamacare in place and that there is discussion and debate amongst Republicans whether to include repeal of the individual mandate in the tax reform bill.
I think that there is a bit of a contradiction between sections 3 and 4.  If one considers that the efficiency and stability of insurance plans gets better as the pool of participants in the plan grows, then in reality, the larger the pool, the better it is for not only the participants, but also for health care providers.  To get bigger pools, then one really needs to consider groups on a national level.  However, as was discussed during some of the debates, each state is different and ultimately is their own unique marketplace and the health insurers would probably need to customize a plan for each state to take into consideration any State laws and regulations.  So these two priorities conflict.  If the States stipulate what they feel are the priorities of their citizens with respect to healthcare (exercising States' rights) then it largely makes interstate commerce impossible.
In thinking about the healthcare issue, recognizing that the whole country is not going to suddenly wake up one day and say "We should just adopt the Canadian system", one rule that might shift the thinking on how health insurance works and should work is what I would call the Healthcare neutrality rule.  Similar to Net Neutrality, it shouldn't matter if you are in or out of network, coverage, co-pays, etc. should be exactly the same.  This will give consumers more choices and defining which doctors can be used has always been a rallying cry against government run health care.  It would strongly promote transparency in pricing as well.