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It’s Surprising How Few Countries Have National, Single Payer, Health Care Systems

"The details of last week's fiasco about American health care are for my colleagues over on that desk to deal with. My purpose here is just to point out that the economic structure of health care in other places just isn't what all too many people think it is. There's a large part of the American political class insisting that this is just obvious. We should have a national, single payer, health care financing system. And the amazing thing about this is that so few countries actually do that. And most of those countries who are thought to have better health care systems than the US don't do that either.

There are indeed national health care systems out there--but they tend not to be single payer. And there are single payer systems out there, or close enough at least--but they tend not to be national. Which is something that we really ought to be thinking about, no?

Take it as read that the US system isn't as good as it could be. And also that we might want to propose something to make it better. So, we're agreeing that something must be done. My point here is just that the economics of what we should do might well not be the same as the economics of that national single payer system we're urged to implement."

Uninsured Rate, 2008-2015

This chart shows the uninsured rate for the United States, California, Texas, New York and Florida from 2008-2015. Thanks for the Affordable Care Act, many more families are able to afford health insurance, especially in the states that expanded Medicaid.

Data Source: US Census Bureau, Health Insurance Coverage Status and Type of Coverage by State--All Persons: 2008 to 2015.

Over the past few months I’ve posted several graphics and charts about heroin abuse in our state. I thought it would be good to put together a brief synopsis, of the various graphs and maps I’ve done.

Heroin abuse doesn’t effect all counties equally, indeed some counties are particularly hard hit.

3 Yr Average For Visits To ER For Opioid Overdoses Per 10k Population

[Full Screen] or [KML]

Overall in the past decade, heroin deaths are up dramatically across the state.

Heroin and Opiods Deaths, 2003-2014

Indeed, heroin is the fastest growing reason people are checking themselves into drug rehab facilties in our state.

Chemical Dependence Treatment Program Admissions by Drug Type, 2007-2015

The growth of heroin has displaced the abuse of cocaine and crack in our state.

Services Delivered for Cocaine Users in New York State

Despite common myth, drug possession arrests nationally follow closely the racial breakdown, at least in 2015.

Race of those Arrested for Crimes (2015)

The Health-Care Debacle Was a Failure of Conservatism

"The fact is that the health-care industry, which makes up about a sixth of the American economy, isn’t like the market for apples or iPhones. For a number of reasons (which economists understand pretty well), it is riven with problems. Serious illnesses can be enormously costly to treat; people don’t know when they will get ill; the buyers of health insurance know more about their health than the sellers; and insurers have a strong incentive to avoid providing their product to the sick people who need it the most.

Since the days of Otto von Bismarck, most developed countries have dealt with these problems by setting up a system in which the state provides medical insurance directly, or else mandates and subsidizes the purchase of private insurance, setting strict rules for what sorts of policies can be sold. Obamacare amounts to a hybrid model. It supplements employer-provided insurance, the traditional American way of obtaining health care, with a heavily regulated (and subsidized) individual insurance market and an expanded Medicaid system.

It is far from perfect. But, in combining mandates with subsidies, regulation, and access to a state-administered system for the poverty-stricken and low-paid, it is intellectually coherent. (Many of the problems it has encountered arose because the mandate to purchase insurance hasn’t been effectively enforced, and not enough young and healthy individuals have signed up.) Since it leaves in place the basic structure of private insurance and private provision, Obamacare is also conservative. As is well known, parts of it resemble a proposal that the Heritage Foundation put forward in 1992."

Explaining The Rising Death Rate In Middle-Aged White People

"In 2015, when researchers Ann Case and Angus Deaton discovered that death rates had been rising dramatically since 1999 among middle-aged white Americans, they weren't sure why people were dying younger, reversing decades of longer life expectancy."

"But whites with college degrees haven't suffered the same lack of economic opportunity, and haven't seen the same loss of life expectancy. The study was published Thursday in Brookings Papers on Economic Activity."

Services Delivered for Cocaine Users in New York State

Much fewer people are seeking services for cocaine use in the past few years, compared to years past. Heroin has become the drug of choice, largely offsetting use of other drugs like alcohol, cocaine, and marijuana.

NYS Office of Alcoholism and Substance Abuse Services (OASAS) certified chemical dependence treatment programs report admissions of people served in programs throughout NYS. This dataset includes the number of admissions to NYS OASAS certified treatment programs aggregated by primary substance of abuse group.
Data Source: