Sunday, February 9, 2014

U.S. Health System Quotients

Relative to what?

Typical skeptical response  to controversial statement

If someone says to you,  “America has a lousy health system!”, you might  respond, “Relative to what?,” or, “Compared to what?”  

That is  logical response.   Everything human is relative.  Some countries have healthier health statistics than others.  Some people are  healthier than others.    It's all relative.

I call this the theory of health care relativity.   The theory of relativity, of course, is an expression Albert Einstein made famous.

I am no Einstein, but using quotients to measure relative reality makes sense.  Quotients are quantitative. Numbers are good.  Numbers are nonpartisan.  According to my dictionary, a quotient is a quantity arrived at by dividing one quantity by another and comparing it to another quantity.

I also have a theory of quotients when applied to health care.   In ObamaCare, a quotient is the number of times showing how many times a sum of money belonging to one person changes hands before it ends up as government taxes.    

This theory  has become known in conservative quarters as the Redistribution of Health and Wealth Quotient (HQWQ).  Money changes hands frequently  in our Trickle-Down, Trickle-Up  Health System - from down from government to health plan, to employer, to employee, to hospital, to doctor, to taxpayer,and back up again.  If one accepts a recent poll indicating that 74% of Americans think Big Government is the biggest threat to America,  while 26% see it as no threat, and 50% represents how the average American should think,  then the HQWQ is 52 with the average being 80 to 120.  More on the basis of this quotient calculation below.

In any case, understanding quotients is easy because quotients reflect relative values.


Take Intelligence Quotient (IQ).  IQs average 100 in any population.  An IQ of 80 is low.  An IQ of 120 is high.  An IQ of 200 approaches Einstein levels.  As your IQ rises, your chances of getting into college or becoming a doctor rises.  As your IQ rises, as a health consumer or patient, you can make more intelligent decisions. 


Or take Emotional Quotient (EQ). EQs also average 100.  If your EQ is 80 and you are a doctor, you are not likely to have a good bedside manner or to feel compassion or empathetic towards the sick.  If your EQ is 120 or more,  you may become someone like Albert Sweitzer or Doctor Paul Farmer, an American physician who caters to the sick in Haiti and in the rest of the underdeveloped world. You can write intelligent and emotional  books on health and health systems (Paul Farmer, To Repair the World, 2013).


Consider Health Quotient (HQ).   This is a term I came up in 1985 when I developed a quantitative clinical algorithm to compare one’s health compared to another person’s health.  I reasoned if you compared blood pressures,  cholesterol/lipid levels,  glucose levels,  body mass indices,  waist measurements, and so forth to ideal levels , you could measure a person’s health.   If your HQ was 80, you were in subnormal health and could stand improvement.  If your HQ was 120 or above,   you were doing something right, eating the right foods, exercising properly,  and maintaining the right body weight. I measured the HQ of over 4000 sedentary  state government employees and found that  their average HQ to be 88.  Many with low HQs were obese  and had diabetes, and were predictable  candidates for heart attacks.

OQ, DQ, CQ, and JQ

Now let’s calculate the ObamaCare Quotient (OQ).   The OQ  is based on average poll numbers.    An OQ of 100 indicates that an equal number of people favor ObamaCare and an equal number oppose  it.  An OQ of 100 is dead center in the court of American public opinion.  An OQ of 80 reflects deep dissatisfaction and OQ of 120 would indicate overwhelming favorability. At the moment,  last week’s Gallup poll shows 39% of Americans oppose ObamaCare.   This translates into a 78 OQ (39/50 X 100), with 100 being the center point of American public opinion. From this, you may conclude that Americans are retarded in their appreciation of the health law.

Take a similar approach to other poll approval ratings translated into public favorability quotients and you will find the following.   Direction Country (DQ), 58, significantly retarded, Congressional (CQ), 25.4, severely retarded; and Job(Economic) (JQ), 86.6, dull,  could stand improvement.

Tweet:  If one uses quantitative quotients to measure the health of the American economy and its health system, America is in ill health.

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