In 2020, the U.S. had done a bit worse than average among its OECD peers. In 2021, when pandemic outcomes were often determined by the relative uptake of American-made vaccines, the U.S. did much, much worse than that. In country after country in Europe, the pandemic killed a fraction as many last year as it had the year before. In the U.S., it killed more. A year ago, it was possible to defend the American record as merely below average — worse than it should have been but not, judging globally, cataclysmically bad. Today, it is cataclysmically bad, which is both outrageous and ironic, given that it is largely American vaccine innovation that has changed the pandemic landscape for the rest of the world — the rest of the rich world, at least...
How did this happen? The answer is screamingly obvious, if also, in its way, confusing: The U.S. drove an unprecedented vaccine-innovation campaign in 2020, which empowered much of the world to turn the page on the pandemic’s deadliest phases, then, in 2021, utterly failed to take advantage of its power itself. But what is perhaps even more striking is that American vaccination coverage isn’t just bad, by the standards of its peers, but getting worse. About two-thirds of Americans have received two shots of vaccine, a level that is in line with Israel and not far off from the U.K., though below many other wealthy countries. (And even in the U.K., vaccination was more effectively directed toward the old.) But over the last six months, the country has had an opportunity to make up that gap with boosters and has simply not taken it. Only 29 percent of Americans have had a booster shot of vaccine, which puts us behind Slovenia, Slovakia, and Poland and means that less than half of those people happy to be vaccinated a year ago have chosen to get a third shot through Delta and Omicron. Booster campaigns seem like an obvious opportunity for easy public-health gains, yet remarkably few Americans seem to think it’s worth the trouble.
My own hunch is that “remarkably few Americans have adequate healthcare in our disaster of a health system (which is systematically broken (due to various modes of regulatory capture (because of visceral contempt for normal Americans by elite Americans)))”...
...however the article does a pretty decent job of dancing around offending anyone by saying too much that is too controversial.
Whatever the causation, as a practical upshot, it does seem worthwhile to notice that, in terms of Bravery Debates, it seems plausible to me that the median American probably still would be helped by hearing and being convinced that it would cost relatively little and lower the chances of serious symptoms (up to and including death or brain damage) to get their FIRST booster.
Most of my uncertainty about what might actually help people… is based on the possibility that quite a few people in the US have probably had no vaccine, but multiple covid infections, and I have a gap in my model about the “personalized healthcare outcome predictions” for subpopulation more like this than like the people I usually interact with in my social bubble (who have mostly already boosted, with many also not yet having definitely had covid even the once).
Are people really not getting boosters because we have a bad healthcare system? Boosters are free and available pretty much everywhere. It is not hard to get a booster, even if you’re poor.
I think the lack of booster uptake has more to do with political and social attitudes than our bad healthcare system.
I admit that there’s an element here of the question involving “macrofacts” and a sort of game of chicken between stupid voters and evil politicans.
My claim is something like: if the health care system’s main challenges weren’t trust, paperwork, followthrough, adherence, price discrimination, and other essentially economic and communication problems (which the US sucks at)...
...then the main problem might finally about medical technology (which the US is good at), and the is/ought gap between possible and actual health outcomes would be smaller, and achieved for a smaller percent of GDP.
I don’t blame the wage slaves, I blame the wage masters.
If you built a causal model, I think it would be possible to DO() some variables (that represent either or both of the choices of the wage slaves vs the wage masters) to CAUSE better aggregate outcomes.
But I think if you look back 20 years, or forward 20 years, total number and cost of the DO() operations to get better health outcomes would be minimized if we spend it on things like:
It would take more than 1 piece of structural legislation, I grant.
The cost in bribes and threats to change the behavior of various negligently oblivious congress critters (to make them redirect trillions from “pointless waste and fraud” to “something sane”) might be millions and millions of dollars.
And maybe the momentum has built up in the wrong direction and can’t be fixed in a single 5 year period?
Deciding that the problem is the stupid patients acting stupid is (to me) like deciding the government should elect a new people… it is fundamentally upside down.
The suffering of many people (which is, tragically, baked in at this point) should be used as the fuel to fix the bad laws that prevent us from building a new system while the old medical system burns to the ground.
It is a good one liner :-) I’m not sure how that unpacks into policies, or of those policies would cause more healthy life for less money. Is this a slogan for an extended idea that you can link to?
In our current landscape we’ve got an insurance/banking regulator in every state, plus DC and Puerto Rico. Then there’s the US DOL, that regulates self-funded employer plans (ERISA). Then there are local, state, and federal employee/retiree plans. Then Medicare and Medicaid, which fall under CMS. Finally there’s the wild west of plans offered by religious employers, which aren’t under the jurisdiction of any administrative agency (if you exhaust your internal appeals your only recourse is the courts). This state of affairs is largely due to the McCarran-Ferguson Act, which asserted that insurance was the exclusive jurisdiction of the states (in response to a SCOTUS decision that said otherwise). So we’re left with an insanely inefficient patchwork in which large insurance companies shop for jurisdictions that make it as easy as possible for them, and as opaque as possible for customers. I think if we simplified regulation of insurance, we’d have less of a pressing need for single payer.
I would perhaps also add that the first booster (which will be the third jab for many) seems to actually be important in the US?
I haven’t fact checked the details (which come from a journalist maintained statistical model that I don’t see how to access) but David Wallace-Wells of The Intelligencer writes:
My own hunch is that “remarkably few Americans have adequate healthcare in our disaster of a health system (which is systematically broken (due to various modes of regulatory capture (because of visceral contempt for normal Americans by elite Americans)))”...
...however the article does a pretty decent job of dancing around offending anyone by saying too much that is too controversial.
Whatever the causation, as a practical upshot, it does seem worthwhile to notice that, in terms of Bravery Debates, it seems plausible to me that the median American probably still would be helped by hearing and being convinced that it would cost relatively little and lower the chances of serious symptoms (up to and including death or brain damage) to get their FIRST booster.
Most of my uncertainty about what might actually help people… is based on the possibility that quite a few people in the US have probably had no vaccine, but multiple covid infections, and I have a gap in my model about the “personalized healthcare outcome predictions” for subpopulation more like this than like the people I usually interact with in my social bubble (who have mostly already boosted, with many also not yet having definitely had covid even the once).
Are people really not getting boosters because we have a bad healthcare system? Boosters are free and available pretty much everywhere. It is not hard to get a booster, even if you’re poor.
I think the lack of booster uptake has more to do with political and social attitudes than our bad healthcare system.
I admit that there’s an element here of the question involving “macrofacts” and a sort of game of chicken between stupid voters and evil politicans.
My claim is something like: if the health care system’s main challenges weren’t trust, paperwork, followthrough, adherence, price discrimination, and other essentially economic and communication problems (which the US sucks at)...
...then the main problem might finally about medical technology (which the US is good at), and the is/ought gap between possible and actual health outcomes would be smaller, and achieved for a smaller percent of GDP.
I don’t blame the wage slaves, I blame the wage masters.
If you built a causal model, I think it would be possible to DO() some variables (that represent either or both of the choices of the wage slaves vs the wage masters) to CAUSE better aggregate outcomes.
But I think if you look back 20 years, or forward 20 years, total number and cost of the DO() operations to get better health outcomes would be minimized if we spend it on things like:
DO(“congress passes and the president signs a repeal of the Kefauver-Harris amendment”) and
DO(“the insurance industry and medical diagnosis processes and hospital systems are jointly reformed”),
and DO(“we delete the CDC that works on ‘whatever public health means to them now’ and instead ‘actually fight communicable diseases’ by testing people at the border n’stuff”)?
It would take more than 1 piece of structural legislation, I grant.
The cost in bribes and threats to change the behavior of various negligently oblivious congress critters (to make them redirect trillions from “pointless waste and fraud” to “something sane”) might be millions and millions of dollars.
And maybe the momentum has built up in the wrong direction and can’t be fixed in a single 5 year period?
Image source.
Deciding that the problem is the stupid patients acting stupid is (to me) like deciding the government should elect a new people… it is fundamentally upside down.
The suffering of many people (which is, tragically, baked in at this point) should be used as the fuel to fix the bad laws that prevent us from building a new system while the old medical system burns to the ground.
Every time I hear someone start preaching to be about single payer, I want to say “Good idea, but maybe we can start with single regulator?”
It is a good one liner :-) I’m not sure how that unpacks into policies, or of those policies would cause more healthy life for less money. Is this a slogan for an extended idea that you can link to?
In our current landscape we’ve got an insurance/banking regulator in every state, plus DC and Puerto Rico. Then there’s the US DOL, that regulates self-funded employer plans (ERISA). Then there are local, state, and federal employee/retiree plans. Then Medicare and Medicaid, which fall under CMS. Finally there’s the wild west of plans offered by religious employers, which aren’t under the jurisdiction of any administrative agency (if you exhaust your internal appeals your only recourse is the courts). This state of affairs is largely due to the McCarran-Ferguson Act, which asserted that insurance was the exclusive jurisdiction of the states (in response to a SCOTUS decision that said otherwise). So we’re left with an insanely inefficient patchwork in which large insurance companies shop for jurisdictions that make it as easy as possible for them, and as opaque as possible for customers. I think if we simplified regulation of insurance, we’d have less of a pressing need for single payer.