<font size="4">我的博客：</font><a href="http://danielyoung.blog.sohu.com/" target="_blank"><font size="4">http://danielyoung.blog.sohu.com/</font></a><p><font face="Arial" size="4">曼昆澄清几个观点。他认为危险的观点不是错误的观点而是正确的观点（数据），但人们不知道这些数据的含义。曼昆共举了三个这样的数据。</font></p><p><font face="Arial" size="4">1，&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 美国人的预期寿命比加拿大短，婴儿死亡率比加拿大高。预期寿命短的原因更多的是关于社会因素：美国人事故率和谋杀率更高；美国人更容易发胖，从而更容易患心脏病等疾玻婴儿死亡率更高的原因包括婴儿体重更低，而这是由于少年母亲更多，而这又是由于美国人的性选择。</font></p><p><font face="Arial" size="4">2，&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 有四千七百万的美国人没有医保。这其中有1千万人不是美国citizen,其中有很多是非法移民。有很多人有资格享受政府医疗资助，但没有申请。有很多人拒绝了雇主提供的医保。</font></p><p><font face="Arial" size="4">3，&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 医疗保健的支出在1950年的时候只占国民收入的5%，现在却占到了16%。随着经济发展、收入增长，花更多的钱在医疗保健上面是很正常的事情。</font></p><p><font face="Arial" size="4">曼昆的分析当中，我觉得第一点最精彩。这其实也是“谬误相关”的一个例子。加拿大有着全民医保，美国没有。加拿大的人均预期寿命更长、婴儿死亡率更低。注意这里讲的是相关关系，不是因果关系。因为这里有着严重的严重的遗漏变量偏误：没有控制事故率、谋杀率、肥胖率、少年母亲占所有孕妇比例等等。</font></p><p><font face="Arial" size="4"></font></p><p><font face="Arial" size="4">克鲁格曼对曼昆的反驳：</font></p><p><font face="Arial" size="4">1，&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 没有参加医保的人数。没有医保的人作为一个人群是不断变化的。也就是说今天张三有医保，明天没有，后天又有了。这样的事情对李四也发生。简言之，拥有或没有医保都不是永久的状态。在2006-2007，有三分之一以上的在美国的人经历过没有医保。（注意，这里克鲁格曼用的是“在美国的人”（people in america）。是否 “在美国的人”又包括了非法移民等医保本来就无法覆盖的群体？）他继续讲到急症室才知道自己有没有资格享受政府的医疗救助和一直都享有医疗保险是很不同的。另外四分之一的“非老年”（nonelderly）美国人的医保都不充分。</font></p><p><font face="Arial" size="4">2，&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 美国的医疗支出是其他发达国家医疗支出的6倍。肥胖和其它与生活方式相关的疾病在医疗费用当中所占比例很校（我的疑问是，美国的人口不是比加拿大等国多很多吗，这里的“6倍”是总量还是人均？如果是总量的话可能意义就小很多。关于生活习惯在医疗费中所占比例很小的事，如果是真的，倒还可以算是较为有利的论据，但这究竟是怎么衡量的，不清楚。）</font></p><p><font face="Arial" size="4">3，&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 2007比1950好。这里的核心观点还是，美国花的钱比其他发达国家多，但是效果没有其他国家好。我的疑问仍然是，有绿卡的美国人人均医疗费用比其他发达国家多了多少？效果没有其他国家好（“get worse results”）。到底是怎么衡量的。预期寿命等问题到底有多大程度能归因于全民医保？</font></p><p><font face="Arial" size="4">其实这里我的关注起于阅读郭凯的一篇关于这个问题的博客文章。今天有空特地把这两篇原文找出来，读一读。还有几点感受：</font></p><p><font face="Arial" size="4">1，&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 美国大选的开支确实很大，但是这或许是很有必要的。能够引发对社会重要问题的理性辩论就是好处之一。</font></p><p><font face="Arial" size="4">2，&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 经济学家在大多数的辩论中都担任着重要的角色，看来不仅在中国是这样，在美国也是这样。曼昆的研究领域主要是宏观经济学是新凯恩斯主义的代表人物之一，而克鲁格曼研究似乎集中在国际经济学，尤其是国际贸易领域（读他们的论文太少，说得可能不准确）。但是他们关于医改的观点显然在美国社会有着重要影响。经济学家在社会中，尤其是社会辩论中扮演的角色很令人感兴趣。</font></p><p><font face="Arial" size="4">3，&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 经济学家的观点可能代表某个政党，这没什么不好，关键我们能够通过自由的新闻听到不同的观点，从而对问题形成一个相对全面的认识。这场辩论中，克鲁格曼显然是站在民主党的立场上面，而曼昆却是代表的共和党的立常双方观点的交锋让我们对问题的了解更进一步。</font></p><p><font face="Arial" size="4">4，&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 最后把两位大师的原文附上(都发表在纽约时报上面)。思想家的战斗也是一场思想的盛宴埃</font></p><p><font face="Arial" size="4">Economic View </font></p><h1><font face="Arial" size="4">Beyond Those Health Care Numbers </font></h1><p><font face="Arial" size="4"></font></p><div><div><div><ul><li><font face="Arial" size="4">&nbsp;</font>
<ul><li><font face="Arial" size="4"></font></li></ul></li></ul></div></div></div><p><font face="Arial" size="4"></font></p><div><font face="Arial" size="4">By N. GREGORY MANKIW</font></div><p><font face="Arial" size="4"></font></p><div><font face="Arial" size="4">Published: November 4, 2007</font></div><div><!--Element not supported - Type: 8 Name: #comment--><p><font face="Arial" size="4">WITH the health care system at the center of the political debate, a lot of scary claims are being thrown around. The dangerous ones are not those that are false; watchdogs in the news media are quick to debunk them. Rather, the dangerous ones are those that are true but don’t mean what people think they mean.</font></p><div><div><a href="http://www.nytimes.com/2007/11/04/business/04view.html?scp=1&amp;sq=Beyond+Those+Health+Care+Numbers#secondParagraph" target="_blank"><font face="Arial" color="#ff6600" size="4">Skip to next paragraph</font></a><font face="Arial" size="4">
</font><div><div><a href="http://blog.sohu.com/manage/entry.do?m=edit&amp;id=76441807&amp;t=shortcut#" target="_blank"><font face="Arial" color="#ff6600" size="4">Enlarge This Image</font></a></div><a href="http://blog.sohu.com/manage/entry.do?m=edit&amp;id=76441807&amp;t=shortcut#" target="_blank"><font face="Arial" color="#ff6600" size="4"><img height="143" alt="图片点击可在新窗口打开查看" src="http://graphics8.nytimes.com/images/2007/11/04/business/04view.1901.jpg" width="190" border="0" style="CURSOR: pointer;"/>
</font></a><div><font face="Arial" size="4">David G. Klein</font></div><p><font face="Arial" size="4"></font></p></div></div></div><a target="_blank" name="secondParagraph"></a><p><font face="Arial" size="4">Here are three of the true but misleading statements about health care that politicians and pundits love to use to frighten the public:</font></p><p><font size="4"><font face="Arial"><span>STATEMENT 1</span>
<span>The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance.</span></font></font></p><p><font face="Arial" size="4">The differences between the neighbors are indeed significant. Life expectancy at birth is 2.6 years greater for Canadian men than for American men, and 2.3 years greater for Canadian women than American women. Infant mortality in the United States is 6.8 per 1,000 live births, versus 5.3 in Canada. </font></p><p><font face="Arial" size="4">These facts are often taken as evidence for the inadequacy of the American health system. But a recent study by June and Dave O’Neill, economists at </font><a title="More articles about Baruch College" href="http://topics.nytimes.com/top/reference/timestopics/organizations/b/baruch_college/index.html?inline=nyt-org" target="_blank"><font face="Arial" color="#ff6600" size="4">Baruch College</font></a><font face="Arial" size="4">, from which these numbers come, shows that the difference in health outcomes has more to do with broader social forces.</font></p><p><font face="Arial" size="4">For example, Americans are more likely than Canadians to die by accident or by homicide. For men in their 20s, mortality rates are more than 50 percent higher in the United States than in Canada, but the O’Neills show that accidents and homicides account for most of that gap. Maybe these differences have lessons for traffic laws and gun control, but they teach us nothing about our system of health care.</font></p><p><font face="Arial" size="4">Americans are also more likely to be obese, leading to heart disease and other medical problems. Among Americans, 31 percent of men and 33 percent of women have a body mass index of at least 30, a definition of obesity, versus 17 percent of men and 19 percent of women in Canada. Japan, which has the longest life expectancy among major nations, has obesity rates of about 3 percent.</font></p><p><font face="Arial" size="4">The causes of American obesity are not fully understood, but they involve lifestyle choices we make every day, as well as our system of food delivery. </font><a href="http://www.nber.org/papers/w9446" target="_blank"><font face="Arial" color="#ff6600" size="4">Research by the </font></a><a title="More articles about Harvard University." href="http://topics.nytimes.com/top/reference/timestopics/organizations/h/harvard_university/index.html?inline=nyt-org" target="_blank"><font face="Arial" color="#ff6600" size="4">Harvard</font></a><font face="Arial" size="4"> economists David Cutler, Ed Glaeser and Jesse Shapiro</font><a target="_blank"></a> concludes that America’s growing obesity problem is largely attributable to our economy’s ability to supply high-calorie foods cheaply. Lower prices increase food consumption, sometimes beyond the point of optimal health.</p><p><font face="Arial" size="4">Infant mortality rates also reflect broader social trends, including the prevalence of infants with low birth weight. The health system in the United States gives low birth-weight babies slightly better survival chances than does Canada’s, but the more pronounced difference is the frequency of these cases. In the United States, 7.5 percent of babies are born weighing less than 2,500 grams (about 5.5 pounds), compared with 5.7 percent in Canada. In both nations, these infants have more than 10 times the mortality rate of larger babies. Low birth weights are in turn correlated with teenage motherhood. (One theory is that a teenage mother is still growing and thus competing with the fetus for nutrients.) The rate of teenage motherhood, according to the O’Neill study, is almost three times higher in the United States than it is in Canada.</font></p><p><font face="Arial" size="4">Whatever its merits, a Canadian-style system of national health insurance is unlikely to change the sexual mores of American youth</font></p><p><font face="Arial" size="4">The bottom line is that many statistics on health outcomes say little about our system of health care.</font></p><p><font size="4"><font face="Arial"><span>STATEMENT 2 </span><span>Some 47 million Americans do not have health insurance. </span></font></font></p><p><font face="Arial" size="4">This number from the </font><a title="More articles about Census Bureau, U.S." href="http://topics.nytimes.com/top/reference/timestopics/organizations/c/census_bureau/index.html?inline=nyt-org" target="_blank"><font face="Arial" color="#ff6600" size="4">Census Bureau</font></a><font face="Arial" size="4"> is often cited as evidence that the health system is failing for many American families. Yet by masking tremendous heterogeneity in personal circumstances, the figure exaggerates the magnitude of the problem.</font></p><p><font face="Arial" size="4">To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had national health insurance, they would probably not be covered.</font></p><p><font face="Arial" size="4">The number also fails to take full account of </font><a title="Recent and archival health news about Medicaid." href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicaid/index.html?inline=nyt-classifier" target="_blank"><font face="Arial" color="#ff6600" size="4">Medicaid</font></a><font face="Arial" size="4">, the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.</font></p><p><font face="Arial" size="4">The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.</font></p><p><font face="Arial" size="4">Of course, millions of Americans have trouble getting health insurance. But they number far less than 47 million, and they make up only a few percent of the population of 300 million.</font></p><p><font face="Arial" size="4">Any reform should carefully focus on this group to avoid disrupting the vast majority for whom the system is working. We do not nationalize an industry simply because a small percentage of the work force is unemployed. Similarly, we should be wary of sweeping reforms of our health system if they are motivated by the fact that a small percentage of the population is uninsured.</font></p><p><font size="4"><font face="Arial"><span>STATEMENT 3</span>
<span>Health costs are eating up an ever increasing share of American incomes.</span></font></font></p><p><font face="Arial" size="4">In 1950, about 5 percent of United States national income was spent on health care, including both private and public health spending. Today the share is about 16 percent. Many pundits regard the increasing cost as evidence that the system is too expensive.</font></p><p><font face="Arial" size="4">But increasing expenditures could just as well be a symptom of success. The reason that we spend more than our grandparents did is not waste, fraud and abuse, but advances in medical technology and growth in incomes. Science has consistently found new ways to extend and improve our lives. Wonderful as they are, they do not come cheap.</font></p><p><font face="Arial" size="4">Fortunately, our incomes are growing, and it makes sense to spend this growing prosperity on better health. The rationality of this phenomenon is stressed in</font><a href="http://www.mitpressjournals.org/doi/abs/10.1162/qjec.122.1.39" target="_blank"><font face="Arial" color="#ff6600" size="4"> a recent article by the economists Charles I. Jones of the University of California, Berkeley, and Robert E. Hall of Stanford</font></a><font face="Arial" size="4">. They ask, “As we grow older and richer, which is more valuable: a third car, yet another television, more clothing — or an extra year of life?”</font></p><p><font face="Arial" size="4">Mr. Hall and Mr. Jones forecast that the share of income devoted to health care will top 30 percent by 2050. But in their model, this is not a problem: It is the modern form of progress.</font></p><p><font face="Arial" size="4">Even if the rise in health care spending turns out to be less than they forecast, it is important to get reform right. Our health care system is not perfect, but it has been a major source of advances in our standard of living, and it will be a large share of the economy we bequeath to our children. </font></p><p><font face="Arial" size="4">As we look at reform plans, we should be careful not to be fooled by statistics into thinking that the problems we face are worse than they really are. </font></p><div><p><font face="Arial" size="4">N. Gregory Mankiw is a professor of economics at Harvard. He was an adviser to President Bush and is advising Mitt Romney, the former governor of Massachusetts, in the campaign for the Republican presidential nomination.</font></p></div></div><p><font face="Arial" size="4">&nbsp;Op-Ed Columnist </font></p><h1><font face="Arial" size="4">Health Care Excuses </font></h1><p><font face="Arial" size="4"></font></p><div><div><div><ul><li><a href="http://blog.sohu.com/manage/entry.do?m=edit&amp;id=76441807&amp;t=shortcut#" target="_blank"></a><font face="Arial" size="4">&nbsp; </font></li><li><font face="Arial" size="4"></font></li></ul></div></div></div><p><font face="Arial" size="4"></font></p><div><font face="Arial" size="4">By PAUL KRUGMAN</font></div><p><font face="Arial" size="4"></font></p><div><font face="Arial" size="4">Published: November 9, 2007</font></div><div><!--Element not supported - Type: 8 Name: #comment--><p><font face="Arial" size="4">The United States spends far more on health care per person than any other nation. Yet we have lower life expectancy than most other rich countries. Furthermore, every other advanced country provides all its citizens with health insurance; only in America is a large fraction of the population uninsured or underinsured.</font></p><div><div><a href="http://www.nytimes.com/2007/11/09/opinion/09krugman.html#secondParagraph" target="_blank"><font face="Arial" color="#ff6600" size="4">Skip to next paragraph</font></a><font face="Arial" size="4">
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</font><div></div><p><font face="Arial" size="4">Paul Krugman. </font></p></div><div><div><a href="http://topics.nytimes.com/top/opinion/editorialsandoped/oped/columnists/paulkrugman/index.html" target="_blank"><font face="Arial" color="#ff6600" size="4">Go to Columnist Page &raquo;</font></a><font face="Arial" size="4">
</font><a href="http://krugman.blogs.nytimes.com/" target="_blank"><font face="Arial" color="#ff6600" size="4">Blog: The Conscience of a Liberal</font></a><font face="Arial" size="4">
</font></div></div></div></div><a target="_blank" name="secondParagraph"></a><p><font face="Arial" size="4">You might think that these facts would make the case for major reform of America’s health care system — reform that would involve, among other things, learning from other countries’ experience — irrefutable. Instead, however, apologists for the status quo offer a barrage of excuses for our system’s miserable performance. </font></p><p><font face="Arial" size="4">So I thought it would be useful to offer a catalog of the most commonly heard apologies for American health care, and the reasons they won’t wash.</font></p><p><font face="Arial" size="4">Excuse No. 1: <span>No insurance, no problem</span>. </font></p><p><font face="Arial" size="4">“I mean, people have access to health care in America,” said President Bush a few months ago. “After all, you just go to an emergency room.” He was widely mocked for his cluelessness, yet many apologists for the health care system in the United States seem almost equally clueless.</font></p><p><font face="Arial" size="4">We’re told, for example, that there really aren’t that many uninsured American citizens, because some of the uninsured are illegal immigrants, while some of the rest are actually entitled to Medicaid. This misses the point that the 47 million people in this country without insurance are an ever-changing group, so that the experience of being without insurance extends to a much broader group — in fact, more than one in every three people in America under the age of 65 was uninsured at some point in 2006 or 2007. </font></p><p><font face="Arial" size="4">Oh, and finding out that you’re covered by Medicaid when you show up at an emergency room isn’t at all the same thing as receiving regular medical care.</font></p><p><font face="Arial" size="4">Beyond that, a large fraction of the population — about one in four nonelderly Americans, according to a Consumer Reports survey — is underinsured, with “coverage so meager they often postponed medical care because of costs.”</font></p><p><font face="Arial" size="4">So, yes, lack of insurance is a very big problem, a problem that reaches deep into the middle class.</font></p><p><font face="Arial" size="4">Excuse No. 2: <span>It’s the cheeseburgers</span>. </font></p><p><font face="Arial" size="4">Americans don’t have a bad health system, say the apologists, they just have bad habits. Overeating and teenage sex, not the huge overhead of America’s private health insurance companies — the United States spends almost six times as much on health care administration as other advanced countries — are the source of our problems. </font></p><p><font face="Arial" size="4">There’s a grain of truth to this claim: Bad habits may partially explain America’s low life expectancy. But the big question isn’t why we have lower life expectancy than Britain, Canada or France, it’s why we spend far more on health care without getting better results. And lifestyle isn’t the explanation: the most definitive estimates, such as those of the McKinsey Global Institute, say that diseases that are associated with obesity and other lifestyle-related problems play, at most, a minor role in high U.S. health care costs.</font></p><p><font face="Arial" size="4">Excuse No. 3: <span>2007 is better than 1950</span>. </font></p><p><font face="Arial" size="4">This is an argument that baffles me, but you hear it all the time. When you point out that America spends far more on health care than other countries, but gets worse results, the apologists reply: “Sure, we spend a lot of money on health care, but medical care is a lot better than it was in 1950, so it’s money well spent.” Huh?</font></p><p><font face="Arial" size="4">It’s as if you went to a store to buy a DVD player, and the salesman told you not to worry about the fact that his prices are twice those of his competitors — after all, the machines on offer at his store are a lot better than they were five years ago. It is, in other words, an argument that makes no sense at all, yet respectable economists make it with a straight face.</font></p><p><font size="4"><font face="Arial">Excuse No. 4: <span>Socialized medicine! Socialized medicine! </span></font></font></p><p><font face="Arial" size="4">Rudy Giuliani’s fake numbers on prostate cancer — which, by the way, he still refuses to admit were wrong — were the latest entry in a long, dishonorable tradition of peddling scare stories about the evils of “government run” health care.</font></p><p><font face="Arial" size="4">The reality is that the best foreign health care systems, especially those of France and Germany, do as well or better than the U.S. system on every dimension, while costing far less money.</font></p><p><font face="Arial" size="4">But the best way to counter scare talk about socialized medicine, aside from swatting down falsehoods — would journalists please stop saying that Rudy’s claims, which are just wrong, are “in dispute”? — may be to point out that every American 65 and older is covered by a government health insurance program called Medicare. And Americans like that program very much, thank you.</font></p><p><font face="Arial" size="4">So, now you know how to answer the false claims you’ll hear about health care. And believe me, you’re going to hear them again, and again, and again.</font>
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