posted
I guess this is what Mr. Silver does in the off-seasons between elections. (Personally, I enjoyed 538-dot-com even more than I do now before the New York Times contracted Nate.)
posted
Really gets to heart of the true problem of health care not being as much about coverage (though it is) from an economic standpoint as it is about cost. Republicans talk about shifting costs off of government on to people, Democrats tend to talk more about coverage than cost at all. But few people in government ever seem to want to talk about how to lower overall costs. Otherwise you're just shifting the figures around, but no actual money is being saved.
Something has to be done to make healthcare dramatically cheaper. Every other conversation that anyone wants to have about government spending is a smokescreen for this real problem that no one wants to talk about.
Posts: 21898 | Registered: Nov 2004
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posted
Is it really that bad to spend a bunch of money on health care? Money will generally be spent on something, and the value of health care is pretty undeniable compared with a lot of other things we might spend it on.
The US does need to improve the cost-effectiveness of our health care, but that could also be done by improving outcomes.
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posted
I'm not saying we should be rationing care, I'm saying we should be getting more value for our money. We're overpaying for basic services into a bloated system fat on basic inequalities in the system.
We should be able to get everything we currently do for half of what it currently costs, and for that matter, we should be getting care much better than what it currently is. I'm hoping the advisory panel set up by Obamacare will be a step in that direction.
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quote:Originally posted by Lyrhawn: I'm not saying we should be rationing care, I'm saying we should be getting more value for our money. We're overpaying for basic services into a bloated system fat on basic inequalities in the system.
Yeah. We are so interested in preserving a free market ideal that we are stuck with a bloated, expensive, bad healthcare system as a result. For now anyway.
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posted
The thing that ultimately annoys me about the unwillingness of people to support paying for health care is the externalities associated with leaving people high and dry.
Posts: 1757 | Registered: Oct 2004
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posted
Even if it cost more to make sure everyone was covered well, it would be worth it because of the additional protection it provides society against transmittable illness and the reduction in our susceptibility to a serious endemic disease, and it keeps uninsured people from being vessels that create drug resistance for antibiotics and such.
But it doesn't cost more. It costs less. But we will stick with it and apparently also death by meteorite just as long as taxes aren't raised. Or something.
Posts: 805 | Registered: Jun 2009
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quote:Originally posted by Destineer: Is it really that bad to spend a bunch of money on health care? Money will generally be spent on something, and the value of health care is pretty undeniable compared with a lot of other things we might spend it on.
The US does need to improve the cost-effectiveness of our health care, but that could also be done by improving outcomes.
Yes. It's horrible, because of HOW we spend it on healthcare, and how inefficient we spend it.
Also, showing the breakdown proves that all of the rhetoric about our of control spending is false. Healthcare costs have skyrocketed in past 20 years, and the vast majority of increases in so called entitlements is due to that, not doe to the many other safety net programs in place.
Posts: 15082 | Registered: Jul 2001
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posted
Increasing coverage to 100% I believe would reduce costs in that going to see the doctor for checkups could catch problems before they occur; prevention is better than cure.
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posted
One of the ways they try to reduce costs in the UK (which has nevertheless had to do some terrible cuts in this economic climate) is try to improve the health of the general population. For example, having a population that smokes less, eats less and drinks less alcohol means fewer people develop disease that needs to be treated.
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posted
That would be great, Teshi, except Americans take any mention of "take better care of yourselves" from the government as a threat. I'm not sure why we do that.
Posts: 1069 | Registered: Feb 2005
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posted
It's our right to be as much a drain on the system and shorten our own life spans as much as we want to.
Posts: 21898 | Registered: Nov 2004
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posted
I'm going to be my own person, up until the point where you guys get to take care of me. Suckers!
Posts: 1069 | Registered: Feb 2005
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Libertarians may not WANT the government to pay for meteorite defense and health care, but my point is that they aren't actually getting their way on the asteroid front. It currently gets funded both through the defense end AND the basic research end. As it turns out, Astronomy is relevant to the military, and we as a people haven't lost our senses entirely and stopped funding basic research. Though libertarians would be happy to find out that I know a scientist who got a grant from an insurance company to study hazardous asteroids.
Now if libertarians could not get their way on the health care front. Posts: 1757 | Registered: Oct 2004
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quote:Originally posted by Destineer: Is it really that bad to spend a bunch of money on health care? Money will generally be spent on something, and the value of health care is pretty undeniable compared with a lot of other things we might spend it on.
Wrong. Money spent on doctors is basically wasted.
Posts: 10645 | Registered: Jul 2004
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quote:Originally posted by Destineer: Is it really that bad to spend a bunch of money on health care? Money will generally be spent on something, and the value of health care is pretty undeniable compared with a lot of other things we might spend it on.
Wrong. Money spent on doctors is basically wasted.
quote:Originally posted by Destineer: Is it really that bad to spend a bunch of money on health care? Money will generally be spent on something, and the value of health care is pretty undeniable compared with a lot of other things we might spend it on.
Wrong. Money spent on doctors is basically wasted.
This ought to be good. Do explain.
Posts: 805 | Registered: Jun 2009
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posted
Hopefully Nate will do a parallel piece on government revenues, which I think would be illuminating when taken in concert with the spending piece.
Posts: 10886 | Registered: Feb 2000
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posted
Wow, that is a very well argued essay with no holes in it whatsoever.
quote:Am I being too allegorical? Then let me speak plainly: our main problem in health policy is a huge overemphasis on medicine. The U.S. spends one sixth of national income on medicine, more than on all manufacturing. But health policy experts know that we see at best only weak aggregate relations between health and medicine, in contrast to apparently strong aggregate relations between health and many other factors, such as exercise, diet, sleep, smoking, pollution, climate, and social status.
"Aggregate relations" = correlation. As opposed to causation. Sick people are going to go to the doctor more often. Thus, people who go to the doctor more often are likelier to be sick. Thus explaining the weak correlation between going to the doctor and being healthy, without any implication that going to the doctor doesn't do wonders for your heath.
posted
Perhaps you'd like to click through to the actual studies, which randomly assigned people to either get free healthcare, or not. Go on, tell me that people who get free healthcare by a random coin-toss are sicker than the ones who don't, and that this explains why the two groups have the same mortality rates.
Posts: 10645 | Registered: Jul 2004
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Blayne Bradley
unregistered
posted
Obviously having seeing the doctor for checkups being freed is obviously better, but someone does need to pay them.
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quote:Originally posted by King of Men: Perhaps you'd like to click through to the actual studies, which randomly assigned people to either get free healthcare, or not. Go on, tell me that people who get free healthcare by a random coin-toss are sicker than the ones who don't, and that this explains why the two groups have the same mortality rates.
Comes up in the response article I linked:
quote:It gets even worse.
"At a 7% significance level they found that poor people in the top 80% of initial health ended up with a 3% lower general health index under free medicine than under full-priced medicine."
Why exactly did Hanson exclude the bottom 20% of people? The sicker people in the sample were the ones who were going to benefit from access to free medicine. If you take healthy people and spend more on their health, of course the benefits will be marginal.
Now you’ll have to excuse me a moment. I’m going to talk statistics. It won’t be hard and it will be worth it, I promise. When Hanson talks about a “7% significance level,” what he means is that there is a 7% chance that the findings are a fluke rather than a sign of an actual process taking place. To put it another way, there is a 93% chance that this finding is due to an actual effect rather than chance alone. This is not the terminology that scientists use. A scientist would say that the p value was 0.07, but it means the same thing. Now 93% confidence might sound good, but in scientific circles, findings are not considered positive unless they reach at least the 95% confidence level, and in the case of extremely controversial hypotheses and certain study designs, 99% or even 99.9% confidence is the accepted standard. This may seem harsh, but there is a very good reason for it. It you accept a 95% confidence level, that means there is a 5% chance that positive findings are due to chance. To put it another way, one in twenty positive findings at 95% confidence are due to chance. This is why, by the way, scientists are never in a rush to accept “exciting new hypotheses” that only have one or two published papers of marginal significance in their favour.
quote:And yet again Hanson is busy looking at the patients who had six months to live. Again, this could only have been known in hindsight. Essentially what Hanson is saying is that if you look at people who died, any money spent in the last few months of their life was unlikely to make a difference. Is anyone surprised? By his choice of data cutoffs, he has excluded by definition those who would have benefited most from the extra $1000.
Truly a visionary mind is required to box studies up this neatly and decide what is and isn't medicine for the purposes of telling us how ineffective medicine is.
In other news when you only look at businesses that went out of business in the next six months, the money spent on those businesses was hardly effective at all. Maybe we should cut the economy in half!
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quote:Why exactly did Hanson exclude the bottom 20% of people?
He didn't. The study he's quoting did. And obviously the result is random; that's the point. When people go looking for effects of healthcare, this is what they find: If you look through enough data points, some of them will fluctuate into statistical significance. And, of course, about half those data points will make healthcare look bad. This is exactly what you would expect if healthcare had no effect at all. The quoted results are completely compatible with the hypothesis that the healthcare in question is just amusing the patients while they either get better or not. In other words, wasted.
Posts: 10645 | Registered: Jul 2004
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quote: Essentially what Hanson is saying is that if you look at people who died, any money spent in the last few months of their life was unlikely to make a difference.
Right, and as that is where most healthcare money is in fact spent... most healthcare money is wasted. Which is the point Hanson was making.
Posts: 10645 | Registered: Jul 2004
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posted
So, see no general glaring weaknesses in that essay? Let's start with a gimme. Do you agree with the essay author when he discounts vision correction and eyeglasses as not being part of medicine?
Posts: 805 | Registered: Jun 2009
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posted
That entire article is terrible, to be honest. Some people merely massage statistics; this guy is running a statistics prostitution ring. You have to be supremely talented at it to read data about the myriad efficiency failures and waste spike points of the american actuarial model of health care, miss pretty much every important data-driven conclusion, and instead settle on a direct efficiency model that purports the solution is a much more completely actuarial model.
Effectively, the dude sounds like he's hypothesizing that the solution to our healthcare woes is to switch to a model for humans that mimics the same efficiency motivators as how we prioritize and manage livestock medicine. It's like what you would get if you asked an autistic robot from some futurist society how to solve the human-system-life-preservation-algorithm.
The best credit I can give him is that the article is dated 2007. With luck he's since rubbed the sleep out of his eyes and sorta figured out his pet theory on medicine reform is going to go nowhere, because it's stupid and wrong.
quote:But it has long been obvious that eyeglasses help people see, and eyeglasses are basically physics, not "medicine."
This sentence alone just really shows how out of his depth this guy is when he talks about "Medicine." The application of splints to broken legs, stents to arteries, or moving a scalpel across connective tissue to sever bonds in the weaker material like one would do in, say, an appendectomy, aren't those all basically physics too sciencebro, why are we calling them "medicine"
Posts: 15421 | Registered: Aug 2005
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posted
And the research and development of chemical compounds to mask symptoms or correct bodily ailments is just chemistry. Why are we calling them "medications"?
Posts: 1357 | Registered: Mar 2002
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Zillions of dollars spent on those last few months, and generally, the person dies.
But we learn from it. Breakthroughs happen.
You are confusing cancer research with existing cancer treatments. The last-few-months of treatment are very expensive, generally extend life by a few weeks or months, and we don't "learn from it" because the research has already happened.
quote:a model for humans that mimics the same efficiency motivators as how we prioritize and manage livestock medicine.
With livestock, we get the results we want at a price we're willing to pay. With humans we don't. Mood affiliate much?
quote:Exclude sick people, and BOOM!
Which part of "randomly assigned" is unclear?
quote:Do you agree with the essay author when he discounts vision correction and eyeglasses as not being part of medicine?
It is at any rate neither modern nor expensive. The technology has been around since the sixteen hundreds. I think it's fair to exclude it from a discussion of the increasing costs of healthcare.
Posts: 10645 | Registered: Jul 2004
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posted
I think that you can divide the success of medical treatment into a couple of categories: medical practice that is cheap and amazingly effective, and medicine that is expensive and less effective.
The medical/health principles that save the most lives are the cheap ones:
There are a few other massively important medical advances. But there is a funny thing in medicine where expense and actual helpfulness are almost inversely correlated. Give me those four basics over positron emission tomography any time.
Posts: 334 | Registered: Apr 2003
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quote:You are confusing cancer research with existing cancer treatments. The last-few-months of treatment are very expensive, generally extend life by a few weeks or months, and we don't "learn from it" because the research has already happened.
There are a few other massively important medical advances. But there is a funny thing in medicine where expense and actual helpfulness are almost inversely correlated.
With regard to the first two points, not only are they cheap and effective, they're both almost entirely predicated upon personal behavior and choices. Genetic predisposition and environment are much less influential in these areas. Meaning the health of the person is directly affected by how responsible they are and how active and engaged they are in maintaining their health. The problem with our society is that it's often portrayed as acceptable to engage in detrimental actions merely because they are convenient and/or pleasurable and to not engage in beneficial actions because its easier to seek expensive medical treatment when the negative consequences arrive. The incentives in this country are totally messed up.
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quote:With regard to the first two points, not only are they cheap and effective, they're both almost entirely predicated upon personal behavior and choices
Growing up in a place with a modern gravity and sewage system is predicated upon personal behavior and choices?
quote:The problem with our society is that it's often portrayed as acceptable to engage in detrimental actions merely because they are convenient and/or pleasurable and to not engage in beneficial actions because its easier to seek expensive medical treatment when the negative consequences arrive.
So if you think it is a problem with our society, you would disagree with someone saying "It's damn well my right to smoke, so don't give me crap about it".
Posts: 805 | Registered: Jun 2009
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quote:Originally posted by Parkour: Growing up in a place with a modern gravity and sewage system is predicated upon personal behavior and choices?
No. Modern sewage systems are an example of a technological advancement. Using the system properly and effectively is an example of personal behavior.
quote:So if you think it is a problem with our society, you would disagree with someone saying "It's damn well my right to smoke, so don't give me crap about it".
I wouldn't disagree with them at all, so long as they don't give me crap when they're suffering sever physical pain and can't afford medical treatment. It's their right to smoke and their right to die early because of it.
Posts: 570 | Registered: Sep 2009
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posted
The US health care system is the best in the world by exactly one, and only one, metric. -- It is by far the most profitable health care system in the world. That means that there are a bunch of wealthy powerful groups that have a vested interest in preventing any real reform -- at the top of that list are insurance companies, big pharm, and parasitic tort lawyers.
Thirty years ago, I would have put doctors and health care professionals on the list as well -- but most doctors and nurses started supporting major reform about 2 decades ago. They aren't united about what should be done, but they see first hand the problems with the current system and know that it's badly broken.
Posts: 12591 | Registered: Jan 2000
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quote:Originally posted by The Rabbit: The US health care system is the best in the world by exactly one, and only one, metric. -- It is by far the most profitable health care system in the world.
This is such a blatant fabrication that it sort of destroys your credibility.
You can make your points without lying. I promise. You really ought to do so.
Posts: 3580 | Registered: Aug 2005
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quote:Originally posted by The Rabbit: The US health care system is the best in the world by exactly one, and only one, metric. -- It is by far the most profitable health care system in the world.
This is such a blatant fabrication that it sort of destroys your credibility.
You can make your points without lying. I promise. You really ought to do so.
If what I said is untrue, then I am completely unaware of it. If you know of some reliable data that shows the US health care system is world leading in any other respect -- please share.
It's possible you and I may define "world leading health care" in different ways. If we are talking about "health care" then I think the appropriate metrics are those that look at the overall health of the population. I don't think that metrics that ignore outcomes or look at selective outcomes for a subset of diseases are all that useful, particularly if they don't take into account the prevalence of the diseases in the overall population.
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quote:Originally posted by King of Men: With livestock, we get the results we want at a price we're willing to pay. With humans we don't. Mood affiliate much?
Livestock are being raised, sold, and killed as a consumable commodity. Is it "mood affiliating" to note that this makes cost and efficiency analyses between the two an extremely difficult leap? Who honestly thinks that the "results we want" with livestock — as well as the palatable costs incurred when attempting medical intervention with, say, beeves — do not transfer at all between a food product and a human being?
edit: this is sam
Posts: 805 | Registered: Jun 2009
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quote:Originally posted by The Rabbit: The US health care system is the best in the world by exactly one, and only one, metric. -- It is by far the most profitable health care system in the world.
This is such a blatant fabrication that it sort of destroys your credibility.
You can make your points without lying. I promise. You really ought to do so.
If what I said is untrue, then I am completely unaware of it. If you know of some reliable data that shows the US health care system is world leading in any other respect -- please share.
It's possible you and I may define "world leading health care" in different ways. If we are talking about "health care" then I think the appropriate metrics are those that look at the overall health of the population. I don't think that metrics that ignore outcomes or look at selective outcomes for a subset of diseases are all that useful, particularly if they don't take into account the prevalence of the diseases in the overall population.
Ah, so if you define the metrics by which "The US health care system" could be "the best in the world" to exclude any situation in which US medicine is, in fact, leading the way... then yes, your statement is correct. But there are plenty of things that could be measured, e.g. research, or expensive, experimental treatments, or similar.
quote:Originally posted by Parkour: edit: this is sam
posted
I don't see the US healthcare system as being worth anything is most of the population cannot access it outside of the emergency room, or those that do pay get service that people in any other industrialized country get for free.
quote:Originally posted by capaxinfiniti:
quote:Originally posted by BebeChouette: The medical/health principles that save the most lives are the cheap ones:
There are a few other massively important medical advances. But there is a funny thing in medicine where expense and actual helpfulness are almost inversely correlated.
With regard to the first two points, not only are they cheap and effective, they're both almost entirely predicated upon personal behavior and choices. Genetic predisposition and environment are much less influential in these areas. Meaning the health of the person is directly affected by how responsible they are and how active and engaged they are in maintaining their health. The problem with our society is that it's often portrayed as acceptable to engage in detrimental actions merely because they are convenient and/or pleasurable and to not engage in beneficial actions because its easier to seek expensive medical treatment when the negative consequences arrive. The incentives in this country are totally messed up.
Clean water? Clean air? Garbage collections? I think having free and convient access to those are equally important.
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quote:Ah, so if you define the metrics by which "The US health care system" could be "the best in the world" to exclude any situation in which US medicine is, in fact, leading the way... then yes, your statement is correct. But there are plenty of things that could be measured, e.g. research, or expensive, experimental treatments, or similar.
Wow, lying?
Anyway, Rabbit says 'look at overall health, and don't just measure by narrowly defined conditions and then lump them together.' And you're critical (to the point of outright calling her a liar) for excluding the US from the outset.
But your response is to *also* exclude a way of looking at the problem yourself-that is, overall health. What, is she doing too much excluding to the point that she's lying or something?
Serious question: you feelin' alright, man? I ask because it seems to me (and this is subjective and I could very well be radically misreading things) that the last couple of weeks a good bit of shine has come off your amiable but firm disagreement paint job, if that makes any sense. Aside from disputing the term liar, I also posted because I was quite surprised you said it. Anyway, just asking and if I'm misreading then I'm wrong and apologize for it.
Posts: 17164 | Registered: Jun 2001
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posted
What metrics can you look at which make the US health care system look good? Every time I ask this question the answer is usually from a different but related system which isn't "the US health care system", as in, the quality of the medical service that people get in the United States. But something else which is apparently supposed to make up for the fact that our health care system sucks is just appended to it. Like here it is "research".
Posts: 805 | Registered: Jun 2009
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