HealthCare -- What is quality?

It should be amazing that the following is not discussed more often. It is a meaningful, and perhaps the most meaningful measure of "quality of healthcare." Too often "life span" is a measure, but convenience has to be more relevant measure.

In addition I often hear "16% of GDP is too much to spend on healthcare!" Too much for whom? By what measure? What is the appropriate amount? Is 16% too much of a spend for flat screen TVs or electronics? What about transportation? Education? -- Blank out. No Answer, just ignore the obvious question. No questions from our journalistic 'watchdog' media.

A recent "Investor's Business Daily" article provided very interesting statistics from a survey by the United Nations International Health Organization.

Percentage of men and women who survived a cancer five years after diagnosis:

U.S. 65%
England 46%
Canada 42%

Percentage of patients diagnosed with diabetes who received treatment within six months:

U.S. 93%
England 15%
Canada 43%

Percentage of seniors needing hip replacement who received it within six months:

U.S. 90%
England 15%
Canada 43%

Percentage referred to a medical specialist who see one within one month:

U.S. 77%
England 40%
Canada 43%

Number of MRI scanners (a prime diagnostic tool) per million people:

U.S. 71%
England 14%
Canada 18%

Percentage of seniors (65+), with low income, who say they are in "excellent health":

U.S. 12%
England 2%
Canada 6%

Republican Budget Items

I think this list needs some more detail to be considered legitimate, but I assume it is close. (i.e. what it needs is to clarify how much savings over what time frame, which is offered for some items but not for all).

These are all the programs that the new Republican House has proposed cutting. Read to the end.
· Corporation for Public Broadcasting Subsidy. $445 million annual savings.
· Save America 's Treasures Program. $25 million annual savings.
· International Fund for Ireland . $17 million annual savings.
· Legal Services Corporation. $420 million annual savings.
· National Endowment for the Arts. $167.5 million annual savings.
· National Endowment for the Humanities. $167.5 million annual savings.
· Hope VI Program.. $250 million annual savings.
· Amtrak Subsidies. $1.565 billion annual savings.
· Eliminate duplicative education programs. H.R. 2274 (in last Congress), authored by Rep. McKeon, eliminates 68 at a savings of $1.3 billion annually.
· U.S. Trade Development Agency. $55 million annual savings.
· Woodrow Wilson Center Subsidy. $20 million annual savings.
· Cut in half funding for congressional printing and binding. $47 million annual savings.
· John C. Stennis Center Subsidy. $430,000 annual savings.
· Community Development Fund. $4.5 billion annual savings.
· Heritage Area Grants and Statutory Aid. $24 million annual savings.
· Cut Federal Travel Budget in Half. $7.5 billion annual savings
· Trim Federal Vehicle Budget by 20%. $600 million annual savings.
· Essential Air Service. $150 million annual savings.
· Technology Innovation Program. $70 million annual savings.
· Manufacturing Extension Partnership (MEP) Program. $125 million annual savings.
· Department of Energy Grants to States for Weatherization. $530 million annual savings.
· Beach Replenishment. $95 million annual savings.
· New Starts Transit. $2 billion annual savings.
· Exchange Programs for Alaska , Natives Native Hawaiians, and Their Historical Trading Partners in Massachusetts. $9 million annual savings
· Intercity and High Speed Rail Grants. $2.5 billion annual savings.
· Title X Family Planning. $318 million annual savings.
· Appalachian Regional Commission. $76 million annual savings.
· Economic Development Administration. $293 million annual savings.
· Programs under the National and Community Services Act. $1.15 billion annual savings.
· Applied Research at Department of Energy. $1.27 billion annual savings.
· FreedomCAR and Fuel Partnership. $200 million annual savings.
· Energy Star Program. $52 million annual savings.
· Economic Assistance to Egypt . $250 million annually.
· U.S. Agency for International Development. $1.39 billion annual savings.
· General Assistance to District of Columbia . $210 million annual savings.
· Subsidy for Washington Metropolitan Area Transit Authority. $150 million annual savings.
· Presidential Campaign Fund. $775 million savings over ten years.
· No funding for federal office space acquisition. $864 million annual savings.
· End prohibitions on competitive sourcing of government services.
· Repeal the Davis-Bacon Act. More than $1 billion annually.
· IRS Direct Deposit: Require the IRS to deposit fees for some services it offers (such as processing payment plans for taxpayers) to the Treasury, instead of allowing it to remain as part of its budget. $1.8 billion savings over ten years.
· Require collection of unpaid taxes by federal employees. $1 billion total savings.
· Prohibit taxpayer funded union activities by federal employees. $1.2 billion savings over ten years.
· Sell excess federal properties the government does not make use of. $15 billion total savings.
· Eliminate death gratuity for Members of Congress.
· Eliminate Mohair Subsidies. $1 million annual savings.
· Eliminate taxpayer subsidies to the United Nations Intergovernmental Panel on Climate Change. $12.5 million annual savings
· Eliminate Market Access Program. $200 million annual savings.
· USDA Sugar Program. $14 million annual savings.
· Subsidy to Organization for Economic Co-operation and Development (OECD). $93 million annual savings.
· Eliminate the National Organic Certification Cost-Share Program. $56.2 million annual savings.
· Eliminate fund for Obamacare administrative costs. $900 million savings.
· Ready to Learn TV Program. $27 million savings..
· HUD Ph.D. Program.
· Deficit Reduction Check-Off Act.

· TOTAL SAVINGS: $2.5 Trillion over Ten Years

I think this shows how things get into the budget. Something as small as $10MM dollars is not taken seriously. That, in addition to the process in Washington, means this is how our rulers play the game. They play power politics with our money. Think about the taxes you paid last year -- would you be pleased to know that your entire tax bill went to pay for a subsidy to Ireland?

Mark Steyn on Demographics and Decline

This post from Mark Steyn caught my eye. Enjoy.

Steyn on Culture
TUESDAY, 24 MAY 2011
Mitch Daniels has wrapped up his "To be or not to be" routine, and, according to Paul Rahe, left the GOP looking like a hamlet without a prince. Paul is upset. I'm less so. As I said on the radio some months back, one should never underestimate the Republican Party's ability to screw up its presidential nomination. The GOP had a grand night last November only because the entire party establishment was more or less absent from the 2010 election dynamic. It would be unreasonable to expect that luck to hold, and a presidential year requires a single frontman for the party that makes election season less friendly to decentralized insurgency Tea Party-style.

And in any case doesn't last November seem an awful long time ago? A transformative Tuesday night, followed by an entirely untransformed Wednesday morning after. There is the Paul Ryan plan, but last year's hero Scott Brown has come out against it. And he won't be the last if NY-26 goes south. And the Ryan plan itself is, in the grand scheme of the looming abyss, extremely minimal and cautious.

Governor Daniels' long tease over the Presidential race will be remembered mainly for one thing - the "truce" he called for over so-called "social issues". This was depressing on two fronts: First because Republicans spend too much time pre-emptively conceding and agreeing to play on the left's turf - and, if ever there were an electoral cycle when that should be unnecessary, it's this one. And secondly because the social issues are not separate from the debt crisis. The collapse of the American family is a fiscal issue: Unwed women are one of the most reliable voting groups for big government.

Steven Hayward suggests Daniels proposed the wrong truce, and that the one implicit in the Ryan plan is closer to what's needed: Both Republicans and Democrats accept the current obligations of the welfare state, and figure out a way to make them work. I'm inclined to agree with Michael Tanner at the Cato Institute - that the GOP would get suckered:

T]here is no evidence that if conservatives agree not to try to roll back the welfare state, liberals will agree to restrain its growth. More likely, conservatives will simply become involved in a bidding war, in which they will inevitably look like the less caring party.

You don't need to hypothesize about that. In essence, it's the "truce" accepted by so-called "right-of-center" parties (Jacques Chirac) in post-war Europe. And all it means is that the troika of permanent bureaucracy, government unions, and a vast dependency class gets to carry on bankrupting the nation even under nominally "conservative" government.

Out there in Insolvistan life goes on. Detroit, a city that has the functioning literacy rate of a West African basket case, has just renovated its library with designer chairs from Allermuir costing $1,000 apiece. Any books to go with the chairs? Who cares? "How about the young mother with several children that looks forward to a weekly trek through the snow/sleet to improve their reading skills and are hopeful that a spot near the fireplaces will be open, because the warmth provided is greater than what they experience at home?" argues Allermuir sales rep Paul Gingell in a Dickensian vignette that warms the heart of my bottom almost as much as his chairs do. God forbid any Detroiter should be required to "improve their reading skills" without a thousand-dollar seat to sink their illiterate posteriors into. What matters is to keep spending at all costs. Three chairs for Detroit!

Who will pay for Detroit, and California, New York and the rest? New Hampshire? Wyoming? Mitch Daniels can demand a "truce" from conservatives on social issues, and Democrats can demand a truce from Republicans on the welfare state, but the real fault-lines on which this nation will fracture are not half so clubbable. How many citizens of the remaining relatively solvent states are prepared to pick up the tab for Detroit's Allermuir chairs for the privilege of keeping 50 stars in the flag? The spendaholics are setting up conditions for serious secession movements.

What of those states that feel at home in a spendaholic America? Mainly as a result of government policy, the south-west has undergone one of the fastest and most dramatic demographic transformations ever seen in a settled, self-governing nation. As a consequence, there is a widening divergence between young and old in states such as California: The old are very white (with some black), and the young are very Hispanic (with some Asian). The principal beneficiaries of the mid-20th century entitlement programs are honky geezers. The fellows expected to fund them are increasingly Latino. That doesn't sound a recipe for social tranquility. The welfare state developed in small ethnically homogeneous northern European nations with a strong sense of intergenerational solidarity. That model applies less and less on an Islamizing Continent, and it makes just as little sense for southern California. When the Democrats' dependency culture collides with their immigration policies, it isn't going to be pretty. Eighty-three per cent of Medicare recipients are white; 70 per cent of births in Dallas' biggest hospital are Hispanic. The speed of transformation represented by those numbers would be difficult to manage at the best of times. In the brokest nation in history, the chances of pulling it off smoothly are zero.

Daniels' "truce" is irrelevant measured against the likelihood of any truce between solvent and insolvent states, young and old, private sector and government retiree. We're approaching the point of no return. If you scuttle the Ryan plan, the next one will be far more convulsive. Assuming there is a "plan" at all, rather than simply societal disintegration. From Scott Brown to Mitch Daniels, from the post-November business-as-usual to a potential Democrat upset in NY-26, it's starting to look as if the political institutions of the republic are impervious to course correction. I always cite the Milton Friedman argument: What matters is not electing the right people (Scott Brown was "the right people" just a year ago), but creating conditions whereby the wrong people are forced to do the right thing - ie, whatever squishes and opportunists emerge as the Scott Browns of November 2012, we've moved the meter sufficiently in the broader public discourse. Otherwise, the president who takes office in January 2013 will be presiding over the early stages not of American decline but of collapse.