Two medical disorders that owe their existence to political advocacy: Crack babies (via Reason and Slate ), and Alzheimers .

Crack babies are now not just exploded theory, but unhip and superseded by meth babies.  That decade old Mother Jones article is eloquent on its popularity:

The crack-baby myth was so powerful in part because it had something for everyone, whether one's ideological leanings called for enhancing public programs to meet the crisis, or for punishing the drug-addicted mothers seen as responsible for it.

Eventually it folded in the face of controlled blind trials (grad students observation, not controlled feeding of crack to babies). Alzheimer's, by contrast, has enough clinical evidence to thrive as a disorder, though there's still dispute over where the line should be drawn, and how common or natural are its distinctive postmortem brain plaques, still the only way to diagnose it.

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Should we have a health topic?

The Economist has some figures of health spending as a percent of GDP.

Health spending as % GDP in 2002. I think the figures are taken from this WHO report ;

• 14.6% USA (government expenditure is 44.9%)
• 11.5% Lebanon (government expenditure is ~30%)
• 11.2% Switzerland (government expenditure is 57.9%)
• 10.2% Germany (government expenditure is ~79%)
• 9.8% Canada (government expenditure is 52.9%)
• 9.7% France (government expenditure is 76%)
• 9.5% Greece (government expenditure is ~70%)
• 9.2% Sweden (government expenditure is 85.3%)
• 7.9% Japan (government expenditure is ~82%)
• 7.7% UK (government expenditure is 83.4%)
• 7.3% Finland (government expenditure is ~76%)
• 6.1% India (government expenditure is ~21.3%)
• 5% Egypt (government expenditure is ~30%)
• 5% Korea (government expenditure is 52.9%)
• 4.3% PNG (government expenditure is 88.6%)
• 4.2% Fiji (government expenditure is ~64%)
• 3.8% Malaysia (government expenditure is 53.8%)
• 3.2% Indonesia (government expenditure is ~36%)

America's figures are before the Medicare Bill of a couple of years ago which 600 billion plus 12 trillion in unfunded liabilities. Ouch.

Australia's spending on health has been constantly increasing as well;

• 8.7% 1998
• 8.9% 1999
• 9.2% 2000
• 9.3% 2001
• 9.5% 2002

Government percent of this expenditure is;

• 68.3% 1998
• 69.8% 1999
• 69.1% 2000
• 68.3% 2001
• 67.9% 2002

From these figures it seems that the Treasury will run the Health system, and raises the question; Is a healthy nation possible, or affordable, without social health care?

To the polls ->

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The Productivity Commission released a report, Australia's Health Workforce on January 19th. It is 435 pages and I don't quite have the time to go right through it. As a consequence I don't dig much deeper than the recommendations, sorry.

Some of their critical points;

It is critical to increase the efficiency and effectiveness of the available health workforce, and to improve its distribution.

Health costs are increasing and consuming a greater amount of Australia's GDP. Health professionals are also scarce in regional areas.

The Commission's objectives are, therefore, to develop a more sustainable and responsive health workforce, while maintaining a commitment to high quality and safe health outcomes. It has proposed a set of national workforce structures designed to:

- support local innovations, and objectively evaluate, facilitate and drive those of national significance through an advisory health workforce improvement agency;

- promote more responsive health education and training arrangements through: the creation of an independent advisory council; and a high-level taskforce to achieve greater transparency (and appropriate contestability) of funding for clinical training;

- integrate the current profession-based accreditation of health education and training through an over-arching national accreditation board that could, initially at least, delegate functions to appropriate existing entities, based on their capacity to contribute to the objectives of the new accreditation regime;

- provide for national registration standards for health professions and for the creation of a national registration board with supporting professional panels; and

- improve funding-related incentives for workforce change through: the transparent assessment by an independent committee of proposals to extend MBS coverage beyond the medical profession; the introduction of (discounted) MBS rebates for a wider range of delegated services; and addressing distortions in rebate relativities.

One of their recommendations is to create a national accreditation board. More anti-federalism? A new layer of anti-state bureaucracy? or a justified centralised efficiency?

The best way to bring down salary costs and scarcity of skills is to create an over-supply. The Doctor is far too specialised in terms of knowledge and education time to be used a general practitioner. To commoditise the health industry the government should create new levels of health Professionals that can do quick check ups and handle health problems that do not require surgery or specialists.

This would create an over-supply of GP level health professionals, ensuring a greater distribution in regional areas, reducing costs and enabling greater innovation as Health Practitioners seek to differentiate themselves in the marketplace.

Time to stick the boot into the AMA and sideline them as a political lobby group.

The point of social health is to set a standard of access to health care that no-one is denied. I do not have a problem with a wealthy society making that distinction and bearing the consequences of implementing it. I have experienced the Australian and American systems of health. Both have their pros and cons - both are superior in some areas and inferior in others. Despite what ideological extremes claim, neither will cause the end of the world.

With all that being said, this article is typical mass media drivvle that does nothing to address the issues over the arguments between private vs public health systems.

From the article;

PATIENTS in the wealthiest areas are collecting a dramatically higher share of the $280 million in Medicare safety net payments than people in low-income areas.

The safety net scheme, designed to help families cover high medical bills, has benefited residents in Wentworth, covering well-off eastern suburbs of Sydney, at more than 10 times the rate of those in low-income areas such as Throsby, south of Wollongong.

That style of writing is supposed to touch my outrage bone . I think these are the reports that the Herald got the figures from. Neither the article or figures add much to the debate. Researchers will probably like the data to do trending though.

Health Services

Health services can be broken down into two areas;

• Preventative
• Catastrophic

Health is unusual in that family, social, cultural and even economic health are influenced by the health of an individual. So there are advantages to group responses and collective action on health. This is born out by the number of charities and social support groups which focus on a single issue in health. Alcoholics Anonymous is a good example of the latter.

The two forms of health services also respond best to different economic models. The catastrophic form of health care is best with an insurance model. While the preventative model is best with a user-pays system.

One of the inefficiencies in the American model of health care is that all aspects of it are covered by insurance. Even minor check ups that cost no more than $50 USD. As a result the insurance company's administration has to process large numbers of small claims. Administration costs for health in the US is much higher than in social health countries .

Preventative health care is most efficient when the skills and regulations required for it are minimised - essentially it should be a commodity business where health outlets compete on price and quality.

Barriers to this in Australia's case are the AMA running a closed shop where doctors are required to deliver commodity health services. This monopoly will need to be broken by government regulation to expand the definition of qualified health workers in the area of preventative medicine.

The states are the best level to run health. As an example, the problems of Peter Beattie in Queensland insulate the other states from the same problems. This would not be the case in a federally run system.

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In the Australian Flying Corps officers tended to die in violent deaths, either in combat or crashes. This was because they made up the large majority of the flying crews. Squadrons have high tail to tail ratios and many servicemen make up the support crews and services that enables a flight to get into the air each morning. Servicemen were more likely to die due to ill health and disease than violence.

The photo above shows Alan Runciman Brown on the far left. He is a bag of bones. His clothes are hanging off him. He is not healthy at all in that photo.

1 Sqn Australian Flying Corps [AFC] operated in the Middle East which brings its own issues in relation to health. Richard Williams relates the humorous story:

Some time before a scab, such as develops following a smallpox vaccination, appeared on my forehead. I consulted the RFC medical officer who said he did not know what it was but tried two or three medical treatments without result. He then suggested that I might have to move to a different climate to get rid of it.

I did not like the idea and took an opportunity which offered to consult one of our Australian medical officers with the Light Horse. He said, "Oh! yes, that's a fatty tumor, you will probably have that all your life". I asked him if there was any treatment and he said, "Iodoform".

Having obtained some iodoform and applied it I went over to the mess for lunch. Soon after Alan Murray Jones, who was a chemist, came in, took a sniff and said, "Who has syphilis - I can smell iodoform."

I admitted to the use of iodoform but not to the complaint he mentioned. That was the end of that treatment, good or bad.

Medical science was not what it is today either and pilots that would have been grounded today flew again in WWI. The idea the Manfred von Richthofen [the Red Baron] should not have been flying after his head wound constantly pops up.

Another example if Harry Taylor of No.2 Sqn AFC who suffered a severe head wound in a landing accident. His medical report said, "Should be dead." He rejoined the squadron later in the month after the accident, but was still suffering illness and other effects from the severe concussion he sustained. He later flew as an instructor in England.

In WWI illnesses such as Pneumonia and Flu could be killers at pandemic levels, something which does not happen today with modern medicine. Modern food and logistics are also much better meaning the sustained nutrition of those on deployment are better than they were in WWI as well.

I mirror this concern that the US health care system has no price transparency. When I had my shoulder operated on I tried to find out what my liabilities were. The hospital and other places were able to tell me what percentage my co-pay was but none could give me even a ballpark figure as to what my surgery would cost. I essentially had the operation not knowing what I would be up for.

As a private system it fails in price transparency. As a consequence ringing around other hospitals and other surgeons to price shop was not possible. I could not judge or rate the services based on cost.

The Affordable Care Act that was passed by Congress was a bit confusing as a lot of things came in over many years. This website has a run down of them year by year.