• How Big Is the Underground Cost of Health Care?

    I should preface this post by saying that it’s serious. This is not just a rant of some kind.

    For some time I’ve been wondering about the cost of health care in the US vs. other similar countries. As we all know, the US has by far the highest cost among rich countries:

    This is bad enough. But it includes only the money cost of professional health care provision. As such, it misses a big part of the picture.

    I was finally prompted to write about this because I’ve had a higher than usual engagement with the health care system over the past few weeeks. It’s gone the way it always goes: it’s massively inefficient and prone to errors, most of which end up falling on patients to fix. There’s the hours spent on hold making appointments. There’s the constant checking for medication errors. There’s the endless arguing with insurance companies. There’s the back-and-forth process of telling doctors what some other doctor said because they never talk to each other. There’s the miscommunications caused by the fact that doctors typically know nothing about the actual operation of their own industry. Etc.

    These are all things we’re familiar with, and they’re basically elements of the health care system that are outsourced to patients themselves. It never gets accounted for, but for all practical purposes the health care system relies on the unpaid labor of patients to keep itself in operation. It’s a real cost, but it’s hard to measure.

    I have never seen a study that tries to compare this underground cost among countries. This makes me curious: Is the US system unusually inefficient? Does it produce more work for patients compared to other countries? Or is this just the nature of dealing with a big and highly complex industry?

    It would be difficult to study, but probably worth it. Who would be a good candidate?

  • Republicans Blow an FBI Source Again

    Stefani Reynolds/CNP via ZUMA

    Donald Trump has been on a rampage for months to prove that the whole Russia investigation was just a big hoax. Central to this has been an endless effort to show that the FBI’s probe was driven by the infamous Steele dossier. This is despite the fact that the Steele dossier played no role in launching the investigation and only a small role in one small part of the investigation months later.

    But no matter. Trump nonetheless wants to declassify anything he can that reflects poorly on the dossier, regardless of the damage it might do. And guess what? Attorney General Bill Barr forced the declassification of an FBI document last week that ended up exposing a source who had contributed to the dossier:

    The F.B.I. had approached the expert, a man named Igor Danchenko, as it vetted the dossier’s claims. He agreed to tell investigators what he knew with an important condition, people familiar with the matter said — that the F.B.I. keep his identity secret so he could protect himself, his sources and his family and friends in Russia.

    But his hope of remaining anonymous evaporated last week after Attorney General William P. Barr directed the F.B.I. to declassify a redacted report about its three-day interview of Mr. Danchenko in 2017 and hand it over to Senator Lindsey Graham, Republican of South Carolina and chairman of the Senate Judiciary Committee. Mr. Graham promptly made the interview summary public while calling the entire Russia investigation “corrupt.”

    ….Transcripts of recordings released in April resulted in the identification of a confidential F.B.I. informant who had agree to wear a wire when talking to George Papadopoulos, a former Trump adviser who was convicted of lying to the F.B.I. Other released transcripts of a Russian diplomat’s conversations with former national security adviser Michael T. Flynn revealed that the bureau was able to monitor the phone line of the Russian Embassy in Washington even before a call connected with Mr. Flynn’s voice mail.

    The Steele dossier is the 2020 version of Benghazi, yet another Republican obsession related to national security. And like the Benghazi circus, Republicans really don’t care what damage they do as long as they can release continuous dribs and drabs of confidential information that might—maybe!—produce something that hurts Democrats.

    So now the FBI has the task of convincing future sources that a promise of secrecy won’t be undermined the next time a Republican thinks it might gain them a momentary political advantage. But why should anyone believe them?

  • Which Is Better: Lots of Cheap, Lousy COVID-19 Tests or a Few Really Good Tests?

    Which is better: a highly accurate PCR test for the coronavirus or a cheap strip test that’s not especially accurate at low virus loads? Alex Tabarrok compares the two, but his comparison has lots of words and stuff and you might not bother reading it. So I’d like to present you with a simplified version:

    • PCR test: You take the test, and a week later you get the results. In the meantime you’ve been infecting everyone nearby. Conclusion: it’s pretty useless.
    • Cheap strip test: It can’t be any worse, can it?

    Believe it or not, this is actually a fairly good summary. For something a little more official, here’s a chart from a recent paper that compares testing regimes. The pink bars are similar to what you get with a PCR test, while the gray bars represent a less accurate test:

    If reporting delays are the same, the accurate test is always better. But if, say, the accurate test takes a week to return results then it won’t be as good as a cheaper test that returns results in one or two days. Note that this chart is based on a model, and in real life the cheap test won’t perform as well as the gray bars suggest. But it will still do better than the expensive test. The cheap strip test may not always work, but you can easily test yourself every day and there’s a good chance that if you’re infectious you’ll find out within 15 minutes.

    So why not cover the country with cheap strip tests? Because they don’t meet the FDA’s minimum accuracy requirements, that’s why. Perhaps that deserves a second look?

  • Remote Work Isn’t the Future After All

    Joe Giddens/PA Wire via ZUMA

    Well knock me over with a feather:

    Four months ago, employees at many U.S. companies went home and did something incredible: They got their work done, seemingly without missing a beat. Executives were amazed at how well their workers performed remotely, even while juggling child care and the distractions of home….Some companies even vowed to give up their physical office spaces entirely.

    Now, as the work-from-home experiment stretches on, some cracks are starting to emerge. Projects take longer. Training is tougher. Hiring and integrating new employees, more complicated. Some employers say their workers appear less connected and bosses fear that younger professionals aren’t developing at the same rate as they would in offices, sitting next to colleagues and absorbing how they do their jobs.

    Months into a pandemic that rapidly reshaped how companies operate, an increasing number of executives now say that remote work, while necessary for safety much of this year, is not their preferred long-term solution once the coronavirus crisis passes.

    No kidding. Anyone with a room temperature IQ could see this coming, but we’re so enthralled with Silicon Valley boosterism that for a while it became conventional wisdom that Zoom was our future. I guess the prospect of making workers pay for their own office space (aka their homes) was so tantalizing that it wiped out common sense for a while. Welcome back to reality, American businesses.

  • Susan Rice for Vice President?

    Jay Godwin/Lbj Library/Planet Pix via ZUMA

    Jonathan Alter thinks Joe Biden should choose Susan Rice as his vice president:

    Yes, President Trump still has time to stage a comeback but the new state of the race suggests that Joe Biden is free to shift from a tactical to a strategic approach in choosing his running mate. Biden’s longstanding prerequisite —a “strong” vice president who is “ready to be president on Day One”—should now be more than a platitude….By that standard, Susan Rice is his best option. He already knows and trusts her (their offices were next door in the West Wing during Obama’s second term) and she possesses a cool, commanding gaffe-free public presence that can fairly be called “presidential.”

    This is a very mature approach to the vice presidency. I, however, am not as mature as Jonathan Alter. I could imagine Biden choosing Rice because it would send Republicans into spasms of indignation so severe it would probably cause a few radio hosts to have heart seizures. Fox News might literally melt down. That’s because, aside from Hillary Clinton, Susan Rice was probably the single biggest Democratic punching bag among Republicans during Obama’s second term. The conservative frenzy over Rice would be spectacular.

    She’s also very well qualified, and mature observers will certainly consider that more important. I’m just not feeling especially mature at the moment.

    POSTSCRIPT: It’s worth noting that choosing Rice would also give liberals a chance to redeem themselves for their lackluster defense of Rice over the Benghazi affair. This is not a matter of explaining her actions with additional nuance, either. She did absolutely nothing wrong. Ditto for the unmasking “scandal.”

    Nothing. Period.

  • The CDC Says We Can Reopen Schools, But There’s a Catch

    Is it time to reopen?Kevin Drum

    Donald Trump has gotten his wish: The CDC just released a note suggesting that schools should reopen next year. But check out the waffling in the section about the dangers of COVID-19:

    Scientific studies suggest that COVID-19 transmission among children in schools may be low. International studies that have assessed how readily COVID-19 spreads in schools also reveal low rates of transmission when community transmission is low. Based on current data, the rate of infection among younger school children, and from students to teachers, has been low, especially if proper precautions are followed.

    Even in a letter caving in to Trump’s school reopening demands, the CDC is only willing to say that it might be safe among younger children in areas where the virus is already under control. This is considerably less clear-cut than Trump might have hoped for, but you have to read carefully to see it. Put it all together and I’ll bet it applies to no more than about 5-10 percent of all schoolchildren in the country.

  • Health Update

    Everything is fine. My M-protein level was 0.4 last month and is down to 0.35 this month:

    On the other hand, this is perfect timing to whine about something else. You know how you’re not supposed to break a fall with your hands? I’ve internalized that advice and never do it, so hooray for me! The laws of physics being what they are, however, you have to break your fall with something, and in my case recently it was the left side of my chest near my left lung. I was sensible about the whole thing and checked into the ER for an X-ray, which showed that nothing was broken. But damn, it hurts. It also made me sleepy. Or something has, anyway. I think I slept about 15 hours yesterday.

    On the good news side of things, my mother is almost entirely recovered except for some weakness in her legs. We’re doing PT for that, but it looks like whatever the mystery disease was, it’s going away completely.