• What is economics Introduces economics and "the economic problem." (Slow internet connection version.)
• Stocks and flows Dry, but helps with the next one. It also helps with understanding monetary policy, such as why the Federal Reserve can push a lot of money out to banks ("print money") during a recession and not spark price inflation.
• The Gross Domestic Product Go through for a general discussion of how this important economic statistic is conceived.
• U.S. National Health Spending in 2009:
• Lecture notes I talk you through the most recent numbers for the size and shape of the U.S. health care system.
  
• Data source: The U.S. Centers for Medicare and Medicaid Services economic statistics. Optional. Go here if you want to get more technical explanation or more numbers.
• Pie charts showing where health care money comes from and where it goes. Glance at this.
• Much of the growth in health care spending from 1987 to 2000 was for expanding care for five conditions A quick look at this is OK. Here is the summary table of the fastest-growing diseases. Fastest growing in terms of spending, that is.
• In class, I'll show these diagrams, that are based on an article that we'll read later: Health spending and infant mortality, health spending and nurses, health spending and CT scanners.
• Meredith Minkler, Esme Fuller-Thomson, and Jack M. Guralnik, "Gradient of Disability across the Socioeconomic Spectrum in the United States," N Engl J Med, 355:7, Aug. 17, 2006. Alternative PDF link A little economics of health, rather than just the economics of health care.
• Paul Krugman, Live Long and Prosper, August 13, 2010. The prosperous live longer, so the poor lose the most when the Social Security eligibility age is raised. A diagram. The CBO report.

• Cost, opportunity cost; total, fixed, variable, and marginal cost Especially for those new to economics or needing a review. Go through this lecture for a introduction to these basic economics concepts.
  Cost slideshow:
  Cost.pptx
  Cost.ppt
  Cost.pdf
• Interactive tutorial on fixed, variable, and marginal cost Also for those who are new to economics or needing a review.

• Reinhardt, U.E., "Perspective: Spending More Through 'Cost Control': Our Obsessive Quest to Gut the Hospital," Health Affairs, Summer 1996, 15(2), pp. 145-154. A worthwhile article. You see how a top-notch economist thinks. Relevant for this week is how the author uses the "incremental cost" (marginal cost) concept.

• External cost and benefit Read this brief run-down of these concepts.
• The Center for Disease Control's Morbidity and Mortality Weekly Report, August 22, 2008, said that measles outbreaks in the U.S. were spreading more than they used to because fewer children are getting vaccinated.

• Discounting the future This tutorial and the next are valuable for this course and for courses in finance.
• Internal Rate of Return

Optional:
• Perils of the Internal Rate of Return

• Cost-benefit analysis, including comments on the Axnick reading's methods and ethics. (Axnick is the first reading in the Blackboard section just below.) Go through this.
• The Colbert Report, July 14, 2008, on the declining value of life in the U.S. in the 2000s. Colbert talked about what is called a "hedonic" life value. Rather than a life value based on the present value of expected future earnings, a hedonic life value is based on the difference between what dangerous jobs pay and what safer jobs pay. If you're curious, skim the 1976 article that originated the hedonic life value method. (Original.) Which jobs in the U.S. are most life-threatening?

• Axnick, N.W., Shavell, S.M., Witte, J.J., "Benefits Due to Immunization Against Measles," Public Health Reports, August 1969, 84(8), pp. 673-680. Read. See how the authors use the idea of discounting future spending. See what they include as the costs and benefits of measles immunizations, especially how they value lives saved.
• Meghan L. Stack, Sachiko Ozawa, David M. Bishai, Andrew Mirelman, Yvonne Tam, Louis Niessen, Damian G. Walker, and Orin S. Levine, "Estimated Economic Benefits During The "Decade Of Vaccines" Include Treatment Savings, Gains In Labor Productivity," Health Affairs June 2011 30:1021-1028
• The Social Cost Of Adverse Medical Events, And What We Can Do About It John C. Goodman, Pamela Villarreal, and Biff Jones Health Aff April 2011 30:590-595; doi:10.1377/hlthaff.2010.1256
• The $17.1 Billion Problem: The Annual Cost Of Measurable Medical Errors Jill Van Den Bos, Karan Rustagi, Travis Gray, Michael Halford, Eva Ziemkiewicz, and Jonathan Shreve Health Aff April 2011 30:596-603;

• Cost-effectiveness analysis, including comments on the Neuhauser reading's methods and ethics. Go through this. If it doesn't load properly, try the no-sound version.
• Notes on the Blackboard readings below. There is a no-sound version will load faster.

• Neuhauser, D., Lewicki, A.M., "What Do We Gain from the Sixth Stool Guaiac?" N Engl J Med, July 31, 1975, 293(5), pp. 226-228. Read pretty thoroughly. The notes (see above) will help with this.
• Eddy, D.M., "Screening for Cervical Cancer," Annals of Internal Medicine, August 1, 1990, 113(3), pp. 214-226. More technical. Don't get bogged down in technical detail. See the notes for help with this.
• Fries, J.F., Koop, E., et al, "Reducing Health Care Costs by Reducing the Need and Demand for Medical Services," N Engl J Med, July 29, 1993, 329(5), pp. 321-325. The authors are renowned public health leaders. This is conventional wisdom. But is it right?
• Russell, L.B., "The Role of Prevention in Health Care Reform," N Engl J Med, July 29, 1993, 329(5), pp. 352-354. Worth a fairly careful read. What is the basis of Russell's disagreement with the conventional wisdom?
• Huntington, J., Connell, F.A., "For Every Dollar Spent -- The Cost-Savings Argument for Prenatal Care," N Engl J Med, Nov. 10, 1994, 331(19), pp. 1303-1307. Also questions conventional wisdom.
• Eddy, D.M., Oregon's Methods: Did Cost-effectiveness Analysis Fail?. JAMA, Oct. 16, 1991, 266(15), pp. 2135-2141. See the notes for background and explanation.

• Beyond PAP tests: A study of the potential cost-effectiveness of HPV vaccine. The study gives results with and without the discounting of benefits that Eddy does in his PAP test study. Cost-effectiveness is judged by dollars saved per quality-adjusted year of life saved. That compares the vaccine with all efforts to save lives, rather than comparing the vaccine specifically with other methods to control HPV transmission or cervical cancer.
• Jane J. Kim, and Sue J. Goldie, "Health and Economic Implications of HPV Vaccination in the United States," New England J Med Aug 21 2008;359:821-32
• Report on the Net Cost of Smoking in the Czech Republic, July 2001. Large type version.In cost-effectiveness analysis, you have to be sure you know whose costs you are weighing. Read quickly for main ideas.
• Audio of discussion of the report's economics, politics, and ethics on NPR Planet Money, July 16, 2010. It starts at 3:52 in the recording.
• Chicken pox immunizations save $100 million in annual hospital cost. Is that enough to make immunizations a net saver of health care cost? Glance at this. Here is a vaccine price list.
• A Washington Post story from 2007: "For the Want of a Dentist"
• Prevention can save lives, and this one may save money, too: Finland reduced deaths from strokes and heart attacks by 75%, by working with the food industry to reduce salt. If that also meant fewer strokes, angina, and infarctions requiring surgery, health care spending would be less, too. The New England Journal of Medicine, Sept. 1. 2009, has an article about hypertension in the U.S., where salt intake per person has increased 50% in the past 30 years.
• Donna Richter, Prevention Key to Health Care Reform, The State, August 29, 2009. During 2009's health care reform battle, a version of the Fries-Koop argument.
• Arguments like that weren't just a distraction from the campaign to enact health insurance reform, they may have fed the paranoia about "death panels" that the opposition exploited. If you'd like a reminder of that craziness, here is Jon Stewart interviewing Betsy McCaughey (pronounced "McCoy") on the Daily Show August 20, 2009: Part 1 | Part 2.
• Republicans pushed fear for the 2010 election. On July 23, 2010, Rachel Maddow showed U. S. Representative Louie Gohmert (R - TX) fretting that the government will penalize people with high cholesterol who buy bacon.

• The Context of Studying Supply and Demand, a segue from cost-benefit analysis to market analysis. Go through this and the next two. They are like a class lecture without the talking head.
• Markets, supply, and demand
• Supply and demand
• Demand tutorial
• Notes on need and demand, and on elasticity
Elasticity notes for class display
• Elasticity concept interactive tutorial
• Elasticity calculation interactive tutorial

• Bodenheimer, T., Grumbach, K., "Paying for Health Care," JAMA, August 24/31, 1994, 272(8), pp. 634-639.

• Risk
• Risk Aversion
• Insurance concepts

• Arrow, K., "Uncertainty and the Welfare Economics of Medical Care," American Economic Review, December 1963, 53(5), pp. 941-973. Important. But difficult. The notes (see below) will help.

• Uwe Reinhardt's August 2010 comment on Arrow's ideas, part 1.
• Uwe Reinhardt's August 2010 comment on Arrow's ideas, part 2.
My notes and comments on the Arrow reading:
• What makes health care special Summarizes the main ideas.
• Detailed notes on the Arrow reading with page references.
• An audio clip from Car Talk (9/10/05) about letting people choose anyone they want to be their doctor. Is this a great idea?
• Uwe Reinhardt's August 2010 follow-up about how economists use the term "efficiency" differently from the common understanding of that term.

These readings show that people do get less health care when they have to pay more. Theory of demand does apply. There is a demand curve for health care generally and there are demand curves for specific types of health care. These demand curves slope down from left to right. To use the jargon, the demand for health care has some elasticity. The elasticity is pretty low, especially for people seeking care for serious symptoms, but it's not 0.

The articles go on to investigate whether people who buy less care, because they have to pay more, are worse off as a result. If the answer is No, then letting people get care without paying out of pocket is wasteful. Or is it? Are all the costs being considered? How good are people at determining what care they can do without?

• Brook, R.H., et al, "Does Free Care Improve Adults' Health? Results from a Controlled Trial of Cost Sharing in Health Insurance," N Engl J Med, December 8, 1983, 309, pp. 1426-1434.
Worth a fairly careful read.
• Shapiro, M.F., Ware, J.F., Sherbourne, C.D., "Effects of Cost Sharing on Seeking Care for Serious and Minor Symptoms," Annals of Internal Medicine, February 1986, 104, pp. 246-251.
Read quickly for the main ideas.
• Rasell, M.E., "Cost Sharing in Health Insurance -- A Reexamination," N Engl J Med, April 27, 1995, 332(17), pp. 1164-1168.
This article and the Gladwell pieces from the web argue against cost sharing as a cost control strategy.

• The Moral-Hazard Myth, by Malcolm Gladwell, The New Yorker, August 29, 2005. 2005 was during the Bush Administration. This was written before Obama and the Affordable Care Act of 2009.
• Malcolm Gladwell, interviewed about "The Moral-Hazard Myth" on the Al Franken Show (radio), August 25, 2005: A 19-minute mp3. The ideas in the article, with more implications drawn out. For those who like to hear, as well as read.
• Gladwell said that the reason we don't have universal health insurance is that our leaders think that we're better off without it. Listen carefully to then-President Bush's "objective" for our health care system, from July 2007. It's in the first 20 seconds of the clip.
• Mark Pauly, "The Truth about Moral Hazard and Adverse Selection," Maxwell School of Syracuse University Policy Brief No. 36/2007. Mr. Moral Hazard replies.

• Price and output under competition "Competition" is another word that economists use differently from the usual.
• Price and output under monopoly

First, some context. Traditionally, fee-for-service was how doctors and hospitals got paid. Providers charged for each service rendered, setting prices according to what they thought they could or should get. By the 1980s, we could see that prices had gotten seriously out of whack with costs.

• Roe, B.B., "The UCR Boondoggle: A Death Knell for Private Practice?" N Engl J Med, July 2, 1981, 305(1), pp. 41-45.
• Reinhardt, U.E., "Resource Allocation in Health Care: The Allocation of Lifestyles to Providers," The Milbank Quarterly, 1987, 65(2), pp. 153-176.
The allocation of resources was also out of whack.
• Brown, M.L., Kessler, L.G., Reuter, F.G., "Is the Supply of Mammography Machines Outstripping Need and Demand?" Annals of Internal Medicine, October, 1, 1990, 113(7), pp. 547-552. Excess capacity did not lead to falling prices.
• Pattison, R.V., and Katz, H.M., "Investor-Owned and Not-for-Profit Hospitals: A Comparison Based on California Data," N Engl J Med, August 11, 1983, 309, pp. 347-353. More differences with the competitive model: Some providers (for-profit hospitals, in this case) can charge more than other providers for the same services.

• DRG and RBRVS Lecture notes
Treatment changed ...
• Qian X, Russell LB, Valiyeva E, Miller JE. "'Quicker and sicker' under Medicare's prospective payment system for hospitals: new evidence on an old issue from a national longitudinal survey." Bulletin of Economic Research, 2011, 63(1):1-27.

• Simborg, D.W., "DRG Creep: A New Hospital-Acquired Disease," N Engl J Med, June 25, 1981, 304(26), pp. 1602-1604.
• Baker, S.L., Kronenfeld, J.J., "Medicaid Prospective Payment: Case-Mix Increase," Health Care Financing Review, Fall 1990, 12(1), pp. 63-70.

• Hsiao, W.C., Braun, P., Dunn, D., Becker, E.R., DeNicola, M., Ketcham, T.R., "Results and Policy Implications of the Resource-Based Relative-Value Study," N Engl J Med, September 29, 1988, 319(13), pp. 881-888.
• Hsiao, W.C., Braun, P., Yntema, D., Becker, E.R., "Estimating Physicians' Work for a Resource-Based Relative Value Scale," N Engl J Med, September 29, 1988, 319(13), pp. 835-841.

• Reinhardt, Uwe E., "The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy," Health Affairs, January/February 2006; 25(1): 57-69.

• Reinhardt, Uwe E., Is Medicare Raising Prices for the Privately Insured? Oct. 16, 2009.

  If this interests you enough to want to write a page about it for 10 points on the midterm, skim these, which are referred to in Reinardt's post:

  • http://www.gnyha.org/8845/File.aspx , which argues that there is such cost-shifting
  • http://theincidentaleconomist.com/the-health-care-cost-shifting-myth/ and
  • http://theincidentaleconomist.com/price-differentials-are-not-evidence-of-cost-shifting/ which reinforce Reinhardt's point.

• Wennberg, J.E., McPherson, K., Caper, P., "Will Payment Based on Diagnosis-Related Groups Control Hospital Costs?" N Engl J Med, August 2, 1984, 311, pp. 295-300. People living in different areas get very different care. This article created a whole area of health services research.
A notorious example of the abuse of supply-sensitive care (see the Dartmouth Atlas readings below for what "supply-sensitive care" is)
• Hillman, B.J., Joseph, C.A., Mabry, M.R., Sunshine, J.H., Kennedy, S.D., Noether, M., "Frequency and Costs of Diagnostic Imaging in Office Practice -- A Comparison of Self-Referring and Radiologist-Referring Physicians," N Engl J Med, Dec. 6, 1990, 323(23), pp. 1604-1608.

• A 2009 article from Wennberg's Dartmouth Medical School team about Medicare geographic cost variation.
• The Dartmouth Atlas, http://www.dartmouthatlas.org/, has extensive data and analysis on medical practice variation. They argue that there are three categories of medical care. Here they are, with links to reports:
  1. Effective care, which is clearly indicated for the diagnosis
  2. Preference-sensitive care, for which risks and benefits to the patient should be weighed
  3. Supply-sensitive care, for which the benefits are to the providers, not the patients
• Atul Gawande, The Cost Conundrum: What a Texas Town Can Teach Us about Health Care, The New Yorker, June 1, 2009. President Obama had all his policy people read this.

• Himmelstein, D.U., Woolhandler, S., "Cost Without Benefit: Administrative Waste in U.S. Health Care," N Engl J Med, February 13, 1986, 314, pp. 441-445. Letters and authors' rejoinder, N Engl J Med, October 16, 1986, 315, pp. 1033-1035.
• Grumet, G.W., "Health Care Rationing Through Inconvenience: The Third Party's Secret Weapon," N Engl J Med, August 31, 1989, 321(9), pp. 607-611.
• Woolhandler, S., Himmelstein, D.U., "The Deteriorating Administrative Efficiency of the U.S. Health Care System," N Engl J Med, May 2, 1991, 324(18), pp. 1253-1258.

• Woolhandler, Campbell, and Himmelstein, Administrative cost update 2003.
• California HMOs rejected one-fifth of submitted bills during 2002-2009.
• Uwe Reinhardt, New York Times Economix, Oct. 14, 2011. Work to comply with insurance rules is GDP without real benefit.

• Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., Zelevinsky, K., "Nurse-Staffing Levels and the Quality of Care in Hospitals," N Engl J Med, May 30, 2002, 346(22), pp. 1715-1722. An example of quality variation that the market does not solve. Read for the main ideas.

• The Institute of Medicine's Quality Chasm series. Glance at the PDF's of a couple of these. The first one, with the eye-popping estimate of the extent of error, is at http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
• An estimate of lives lost due to medical error.
• U.S. hospitals have to be pressured to adopt proven infection-control methods. What wasn't market competition enough?
• The Sept. 23, 2007, New York Times featured an article about quality falling dramatically at some nursing homes after they were bought by investment companies. What happened to the market? Why didn't the patients all switch to competing nursing homes that offered better quality for the money?
• 2010 update: "Temporal Trends in Rates of Patient Harm Resulting from Medical Care," Christopher P. Landrigan, et al, N Engl J Med 2010; 363:2124-2134, November 25, 2010. 20% of patients were harmed. Half of those were preventable.

• Brennan, T.A., Sox, C.M., Burstin, H.R., "Relation Between Negligent Adverse Events and the Outcomes of Medical-Malpractice Litigation," N Engl J Med, December 26, 1996, 335(26), pp. 1963-1967. The skinny: There is not much relationship.
• Studdert, D.M., Mello, M.M., Gawande, A.A., Gandhi, T.K., Kachalia, A., Yoon, C., Puopolo, A.L., Brennan, T.A., "Claims, Errors, and Compensation payments in Medical Malpractice Litigation," N Engl J Med, May 11, 2006, Vol. 354, No. 18, pp. 2024-2033.
• Jena, A. B., Seabury, S., Lakdawalla, D., Chandra, A., "Malpractice Risk According to Physician Specialty," N Engl J Med 2011; 365:629-636 August 18, 2011

• Frivolous malpractice suits are a small portion of all suits. This is a press release for the Studdert article above.
• The business cycle determines malpractice insurance premiums.
Also:
• Public Citizen's Congress Watch, The 0.6 Percent Boogeyman, July 1, 2009. Medical malpractice tort costs have been falling (inflation-adjusted), and are down to 6/1000th of national health spending.

• Marcia Angell, "The Truth About the Drug Companies," New York Review of Books, Volume 51, Number 12, July 15, 2004 Read for the main ideas.
• Marcia Angell, "Your Dangerous Drugstore," New York Review of Books, Volume 53, Number 10, June 8, 2006 Read for the main ideas. What is Dr. Angell's complaint? Price? Quality? Lack of innovation? More than one of the above?
• Marcia Angell, "Drug Companies and Doctors: A Story of Corruption," New York Review of Books, January 15, 2009.
• Malcom Gladwell, "High Prices How to think about prescription drugs," The New Yorker, October 25, 2004. Answers Angell. Does he blame consumers for high drug spending?
• National Institute for Health Care Management Research and Educational Foundation, Prescription Drugs and Intellectual Property Protection Finding the Right Balance Between Access and Innovation, July 24, 2000. Available at: http://www.nihcm.org/pdf/prescription.pdf Read quickly for the main idea, which is illustrated in Figure 1.
• NPR report on Parke-Davis allegedly promoted Neurontin for uses not approved by the FDA, from June 2002. Follow-up reports: Oct. 2002, Nov. 2002, Dec. 2002, Jan. 2003. May 2004: Pfizer (which had acquired Parke-Davis) pled guilty and agreed to pay fines totalling $430 million. The report includes details of the marketing effort by a participating doctor. Worth a listen.
• NPR All Things Considered report on conflict of interest in pharmaceutical benefits management, August 22, 2003. Worth a listen.
• Pharmaceuticals' political contributions Before you glance at this, guess which party gets the most from the drug industry. You can also get the contributions breakdown for others industries and groups. Check out nurses' contributions.
• Riding The Rollercoaster: The Ups And Downs In Out-Of-Pocket Spending Under The Standard Medicare Drug Benefit, by Bruce Stuart, Becky A. Briesacher, Dennis G. Shea, Barbara Cooper, Fatima S. Baysac and M. Rhona Limcangco, in Health Affairs, 2005, Vol 24, Issue 4, 1022-1031.
• A British Medical Journal article argues that countries (like Britain) that negotiate lower drug prices are not free riders benefitting from U.S.-consumer-financed industry research without paying for it.
• Pfizer and Abbott Labs earned all of their 2010 profit outside the U.S., according to Bruce Bartlett.
• Colbert makes fun of drug companies that create new drug combinations just so they can get a new patent. Skip to 3:09 if you want to avoid some tasteless jokes.

These next two may require a subscription. Don't worry if you can't access them.

• www.nytimes.com 8/20/11 U.S. Scrambling to Ease Shortage of Vital Medicine
• www.nytimes.com 10/31/11 Obama Tries to Speed Response to Shortages in Vital Medicines

When HMOs were cool ...
• Mayer, T.R., and Mayer, G.G., "HMOs: Origins and Development" N Engl J Med, February 28, 1985, 312, pp. 590-594.
• Just added. I'll talk about this in class. Read it if you want to get more into why people thought HMOs were promising. Ware, J.E., et al, "Comparison of Health Outcomes at a Health Maintenance Organisation with Those of Fee-for-Service Care," Lancet, May 3, 1986, pp. 1017-1022.
• Siu, A.L., Leibowitz, L., Brook, R.H., Goldman, N.S., Lurie, N., Newhouse, J.P., "Use of the Hospital in a Randomized Trial of Prepaid Care," JAMA, March 4, 1988, 259, pp. 1343-1346.
• Just added. I'll talk about this in class. Read it if you want more on what HMOs do well or not so well. Ware, J.E., Bayliss, M.S., Rogers, W.H., Kosinski, M., Tarlov A.R., "Differences in 4-year Health Outcomes for Elderly and Poor, Chronically Ill Patients Treated in HMO and Fee-for-Service Systems: Results from the Medical Outcomes Study," JAMA, October 2, 1996, 276(13), pp. 1039-1047.
• Bodenheimer, T.S., and Grumbach, K., "Capitation or Decapitation," JAMA, October 2, 1996, 276(13), pp. 1025-1031. How the money flows in IPA HMOs
• Morgan, R.O., Virnig, B.A., DeVito, C.A., Persily, N.A., "The Medicare-HMO Revolving Door -- The Healthy Go In and the Sick Go Out," N Engl J Med, July 17, 1997, 337(3), pp. 169-175.

• Sicko, a film by Michael Moore, 2007. The DVD is available for $10 or less at Amazon.com. For $3, you can get a 24-hour pass to watch it on YouTube.
Optional, if you're interested in the industry's campaign against Sicko:
• One BlueCross braces against Michael Moore's Sicko
• CNN's "Reality Check" of Sicko Why Sanjay Gupta didn't get nominated to be Surgeon General
• Michael Moore responds and on Moore's website
• Follow-up on Larry King's show
• Michael Moore on Chris Matthews Hardball, July 23, 2007
• Health insurance P.R. campaign against Michael Moore and Sicko described by industry whistleblower Wendell Potter. Wendell Potter and Michael Moore. Part 2.

These articles substantiate or expand on the ideas in Sicko. Glance through them and read the ones that interest you.

• Tu, H. T., Rising Health Costs, Medical Debt and Chronic Conditions Center for Studying Health System Change, Issue Brief No. 88, September 2004.
• Himmelstein DU, Warren E, Thorne D, Woolhandler S., "Illness and Injury as Contributors to Bankruptcy," Health Affairs, 2005 Jan-Jun, 2005, Supplement Web Exclusives, pp. W5-73.
• A Wal-Mart executive's memo proposing that they "dissuade unhealthy people from coming to work at Wal-Mart" by increasing health insurance copayments and making all jobs physically demanding, Nov. 2005.
• A woman's being beaten by her husband is a pre-existing condition in some states and D.C.
• A Caesarian section delivery is a pre-existing condition.
• Dick Cheney Loses His Health Insurance, The Onion, September 7, 2005, 41•36. This article is satire.
• A July 2002 www.kaisernetwork.org report on underinsurance.
• The 2009 Kaiser Family Foundation report on employer health benefits.
• A distinction between managed care and "real HMOs"?
• People pay for health insurance, then Blue Cross (of California) revokes it when they get sick. This illustrates, in an extreme way, the lack of consumer sovereignty in the health insurance market, which compounds the problem of lack of consumer sovereignty in health care markets. Here's the story, from the L.A. Times.
• How Much Money Do Health Insurance Companies Make? Uwe Reinhardt, Sept. 25, 2009
• What Portion of Premiums Should Insurers Pay Out in Benefits? Uwe Reinhardt Oct. 2, 2009
• The following report is now available only to ACP members: No Health Insurance? It's Enough to Make You Sick, American College of Physicians-American Society of Internal Medicine, 2000. The Report and the References are in separate files.
• Instead, go to the summary page for the Institute of Medicine's 2009 report, America's Uninsured Crisis: Consequences for Health and Health Care. Read the Testimony to Congress or the Report Brief.
• http://www.kff.org/uninsured/upload/7806-03.pdf is a source for similar ideas.
• Census Web Page with link for Income, Poverty, and Health Insurance Coverage in the United States, Census Bureau statistics on the number of insured and uninsured.
• Comparing measures of the number of uninsured

• The Kaiser Family Foundation's web page on the U.S. health care reform. Specifically,
  • A cute video: http://healthreform.kff.org/the-basics.aspx
  • A slideshow: http://www.kaiseredu.org/Tutorials-and-Presentations/A_I/Health-Reform-Overview.aspx
  • A paper: http://www.kff.org/healthreform/upload/8023-R.pdf
  • Medicaid is a big part of the health insurance expansion. http://www.kaiseredu.org/Tutorials-and-Presentations/A_I/Health-Reform-How-Will-Medicaid-Change.aspx
• Peter R. Orszag and Ezekiel J. Emanuel "Health Care Reform and Cost Control," New Engl J Med, June 16, 2010.
• Massachusetts has a functioning exchange, and has gotten the uninsured down to 1.9% of the population.

• Baseline Scenario blog post Nov. 8, 2011, draws on the data used in the articles below.
• It's The Prices, Stupid: Why The United States Is So Different From Other Countries by Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey, and Varduhi Petrosyan . Higher health spending but lower use of health services adds up to much higher prices in the United States than in any other OECD country. The title refers to James Carville's guidance ("The economy, stupid") to Bill Clinton's Presidential campaign of 1992.
• Health Spending in the United States and the Rest of the Industrialized World, by Gerard F. Anderson, Peter S. Hussey, Bianca K. Frogner, and Hugh R. Waters, Health Affairs, 2005, Vol 24, Issue 4, 903-914. A USC campus computer may be required to download this. This article shows how much more the U.S. spends on health care than other countries. The article debunks some myths that are dear to the anti-reform crowd, particularly (1) that people in other countries wait longer and get less service than Americans do, and (2) that big malpractice tort awards are why U.S. health care costs so much.
• Are we spending so much because we're sicker? More bad habits? Maybe for 1¼% of our health care spending.
• David Blumenthal and William Hsiao, Privatization and Its Discontents — The Evolving Chinese Health Care System, New Engl J Med, Sept. 15, 2005.
• Bill Hsiao interviewed about the Taiwan health insurance system, which he helped design.
• Canada-US comparison slide show (671Kb)
• In Canada, lower income people access primary care doctors just as much as higher income people. Education is positively related to utilization of specialists. There is no relationship between income and use of specialists in Canada, separate from education.
• "T.R. Reid: Looking Overseas For 'Healing Of America'". Well worth listening to. Reid's book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care gives even more insight into health care system alternatives around the world, and is fun to read.
• Paul Krugman gives the 700-word version in "The Swiss Menace," by Paul Krugman, New York Times, August 16, 2009.

• Arnst, C., "The Best Medical Care In The U.S., How Veterans Affairs transformed itself -- and what it means for the rest of us," Business Week, July 17, 2006. To find this article, go to www.businessweek.com and type "The Best Medical Care In The U.S." in the search box. Then look down the list for this July 2006 article. For a more academic treatment, see Jonathan B. Perlin, Robert M. Kolodner, and Robert H. Roswell, "The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care," The American Journal of Managed Care, November 2004, pp. 828-836.
• A Time magazine article about the V.A.
• Lately, the VHA has been stretched.
• Successful socialized medicine? Can't have that!
• The above is the blog entry. Here is the column.

• Elliott S. Fisher, Douglas O. Staiger, Julie P.W. Bynum and Daniel J. Gottlieb, "Creating Accountable Care Organizations: The Extended Hospital Medical Staff," Health Affairs, 26, no. 1 (2007): w44-w57 online.

• Accountable Care Organization Prototypes: Winners And Losers? Harris Meyer Health Aff July 2011 30:1227-1231
• ANALYSIS & COMMENTARY: The Accountable Care Organization: Whatever Its Growing Pains, The Concept Is Too Vitally Important To Fail Francis J. Crosson Health Aff July 2011 30:1250-1255;

• Pauline Chen, "Nurses' Role in the Future of Health Care," New York Times, November 18, 2010.
• Atul Gawande, "The Hot Spotters," The New Yorker, January 24, 2011. Another Gawande gem. A few patients incur much of health care cost. Well-organized primary care can achieve big savings.