Tag Archives: Outcome

Commentary

Cato Institute destroys the myths of inferior health care in the USA

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The article is here by Michael Tanner of the prestigious Cato Institute.

Excerpt:

The Claim: Though we spend more, we get less.

The Facts: America offers the highest quality health care in the world. Most of the world’s top doctors, hospitals and research facilities are located in the United States. Eighteen of the last 25 winners of the Nobel Prize in Medicine either are U.S. citizens or work here. U.S. companies have developed half of all the major new medicines introduced worldwide over the past 20 years. And Americans played a key role in 80 percent of the most important medical advances of the past 30 years.

If you are diagnosed with a serious illness, the United States is the place you want to be. Tens of thousands of patients from around the world come to this country every year for treatment.

Critics of American health care often point out that other countries have higher life expectancies or lower infant mortality rates, but those two indicators are bad ways to measure the quality of a nation’s health-care system. In the United States, very low-birth-weight infants have a much greater chance of being brought to term with the latest medical technologies. Some of those low-birth-weight babies die soon after birth, which boosts our infant mortality rate, but in many other Western countries, those high-risk, low-birth-weight infants are not included when infant mortality is calculated.

Life expectancies are also affected by other factors like violent crime, poverty, obesity, tobacco, and drug use, and other issues unrelated to health care. When you compare the outcome for specific diseases like cancer or heart disease, the United States outperforms the rest of the world.

And one more myth:

The Claim: A government-run health-care system would expand access to care.

The Facts: The one common characteristic of all national health care systems is that they ration care. Sometimes they ration it by denying certain types of treatment altogether. More often, they ration indirectly, imposing cost constraints through budgets, waiting lines, or limited technology. One million Britons are waiting for admission to National Health Service hospitals at any given time, and shortages force the NHS to cancel as many as 100,000 operations each year. Roughly 90,000 New Zealanders are facing similar waits. In Sweden, the wait for heart surgery can be as long as 25 weeks. In Canada more than 800,000 patients are currently on waiting lists for medical procedures.

I wrote about US health care outcomes before in this post from the Hoover Institute at Stanford University.

Excerpt:

1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.2. Americans have lower cancer mortality rates than Canadians. Breast cancer mortality in Canada is 9 percent higher than in the United States, prostate cancer is 184 percent higher, and colon cancer among men is about 10 percent higher.

3. Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.

4. Americans have better access to preventive cancer screening than Canadians. Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate, and colon cancer:

  • Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent).
  • Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.
  • More than half of American men (54 percent) have had a prostatespecific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).
  • Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with fewer than one in twenty Canadians (5 percent).

5. Lower-income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report “excellent” health (11.7 percent) compared to Canadian seniors (5.8 percent). Conversely, white, young Canadian adults with below-median incomes are 20 percent more likely than lower-income Americans to describe their health as “fair or poor.”

6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

7. People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand, and British adults say their health system needs either “fundamental change” or “complete rebuilding.”

8. Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared with only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).

9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain. An overwhelming majority of leading American physicians identify computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade—even as economists and policy makers unfamiliar with actual medical practice decry these techniques as wasteful. The United States has thirty-four CT scanners per million Americans, compared to twelve in Canada and eight in Britain. The United States has almost twenty-seven MRI machines per million people compared to about six per million in Canada and Britain.

10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.

Dissenting commenters should be sure to link their assertions to reputable sourcesm, and quote specific passages where the source agrees with their assertion and rebuts some claim made by the Cato Institute or the Hoover Institute. Please don’t cite the New York Times or the United Nations.

Commentary

How teacher unions lobby government to block educational reform

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If you study software engineering management, you learned about the importance of measuring different quantities to asses the quality of the software being produced. For instance, we measure things like unit test coverage, coupling, cohesion and cyclomatic complexity. In fact, just today I had to add unit tests to some code in order to achieve over 90% test coverage. These unit tests ensure that the code will remain functional as more changes are introduced by other engineers.

There is a need for metrics in any enterprise in which the producers are trying to achieve a quality outcome for the customers. Education is no different. But sometimes educational bureaucrats and teacher unions block the collection of measurements so that no teacher or educrat will be singled out for lowering the quality of education being provided to the students.

Consider this story from City Journal (The Manhattan Institute). (H/T ECM)

Excerpt:

Data analysis is far from perfect, and no one argues that it should be used in isolation to make employment decisions. But modern techniques can help us distinguish between teachers whose students excel and teachers whose students languish or fail. There’s just one problem with the data revolution: it doesn’t work without data. States must develop data sets that track the individual performance of students over time and match those students to their teachers.

Unfortunately, New York has deliberately refused to take that step. The state already has a sophisticated system for tracking student progress, but it doesn’t allow this statewide data set to match students to their teachers. No technical or administrative factors prevent the state from doing so. Only political obstacles stand in the way. The premise underlying the policies favored by the teachers’ unions, which govern so much of the relationship between public schools and teachers, is that all teachers are uniformly effective. Once we can objectively distinguish between effective and ineffective teachers, the system of uncritically granted tenure, a single salary schedule based on experience and credentials, and school placements based on seniority become untenable. The unions don’t want information about their members’ effectiveness to be available, let alone put to practical use, and thus far they’ve successfully blocked New York State’s use of such data.

Along with its refusal to improve its data system, the state has kept cities from adopting reforms. When New York City hinted that it would use its own data system to evaluate teachers based on student test scores, the state legislature passed a law banning the practice. Fortunately, that law is set to expire next year and may never actually be enforced, thanks to the city’s new reading of it, which frees city officials to use test scores for tenure decisions this year. Still, the legislature’s actions illustrate its opposition to using data in any way that would identify ineffective teachers.

This lack of concern for the well-being of the children reminds me of all the spending that Obama is doing. That spending will have to be paid back by generations yet unborn, just as the teachers sacrifice the children’s interests for their own job security. And the worst part is that the children vote for the teachers unions and the government spending – what else could they do after coming through the public school system?

By the way, for those of you who are old-fashioned, like me, you may be interested in some films showed to school children growing up in the 1950s in order to develop their moral character! Boy, that sure was a different world than today.

News

New study reveals how school choice benefits the poorest students

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Article in the Wall Street Journal. (H/T Jay P. Greene)

Excerpt:

Opponents of school choice are running out of excuses as evidence continues to roll in about the positive impact of charter schools.

Stanford economist Caroline Hoxby recently found that poor urban children who attend a charter school from kindergarten through 8th grade can close the learning gap with affluent suburban kids by 86% in reading and 66% in math. And now Marcus Winters, who follows education for the Manhattan Institute, has released a paper showing that even students who don’t attend a charter school benefit academically when their public school is exposed to charter competition.

Mr. Winters focuses on New York City public school students in grades 3 through 8. “For every one percent of a public school’s students who leave for a charter,” concludes Mr. Winters, “reading proficiency among those who remain increases by about 0.02 standard deviations, a small but not insignificant number, in view of the widely held suspicion that the impact on local public schools . . . would be negative.” It tuns out that traditional public schools respond to competition in a way that benefits their students.

[…]One of the most encouraging findings by Mr. Winters is how charter competition reduces the black-white achievement gap. He found that the worst-performing public school students, who tend to be low-income minorities, have the most to gain from the nearby presence of a charter school. Overall, charter competition improved reading performance but did not affect math skills. By contrast, low-performing students had gains in both areas, and their reading improvement was above average relative to the higher-performing students.

Conservatives love choice and competition, especially in education. We oppose equalizing outcomes regardless of individual liberty and responsibility. Liberals want government to run everything to make sure that everyone gets the same crap level of service. This is what the lazy teacher unions prefer. But conservatives want teachers to be responsive to their customers – the children.