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Thread: the marginal benefit of health care

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    the marginal benefit of health care

    Premise:
    1. Lack of insurance does not affect health outcomes
    http://healthaffairs.org/blog/2009/0...emature-death/

    http://meganmcardle.theatlantic.com/..._from_lack.php

    2. The reality is that few medical treatments actually prolong life
    http://www.amazon.com/Last-Well-Pers.../dp/0773527958

    Question: Outside of ER visits for trauma, antibiotics, and vaccines... does modern medicine actually improve health outcomes, or does it just treat symptoms, sometimes causing worse outcomes merely by treating?

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    there's some more at the atlantic on this
    http://meganmcardle.theatlantic.com/..._really_th.php
    I think it is possible that the lack of insurance has no effect on aggregate mortality statistics. I do not think that this is likely, but I think it's possible. What I think is likely is that the effect is not that large, because if it were large, it would be very surprising to see so little effect on the mortality of an elderly population with a high mortality rate, or to have a study that samples 600,000 people and finds no effect.

    Mostly what I think is that the statistics are really, really flawed. Not because the authors are bad social scientists, but because this stuff is so hard to tease out. Natural experiments are rare, and data sets often hard to come by.

    ...

    I'm much more convinced by the benefits of health insurance for certain subpopulations, particularly people with diseases we're very good at treating. HIV seems to pretty convincingly respond to offering public treatment--which also has a pretty compelling public health rationale. (I don't want to hear anything about spears mounted on steering wheels, thank you very much). Medicaid expansions provide some pretty good natural experiments, IMHO, indicating that you can improve infant mortality. Poor people with hypertension get better blood pressure control pretty consistently.

    But this doesn't imply a large effect in the macro data if we extended health coverage, precisely because not that many people under the age of 65 die of things we can treat. That whole age group is only about a quarter of deaths, and some of them are from things like metastatic cancer or auto deaths, in which more health care coverage can at best eke out moderate further improvements. (That may not be true in the future. It is now, sadly.)

    Obviously, this matters. If 45,000 people die a year, this makes a more urgent case for overlooking the drawbacks of single payer than if 1,000 people die a year--there are probably more cost-effective ways to control those deaths

    ...

    But the core question for me is not whether there's any effect--I'm willing to consider the possibility there isn't, but I tend to assume there is. The question is, how big? Because if it exists, but it's too small to measure, it might not be the issue our government should be most focused on. Particularly when you consider that there are costs, as well as benefits, to a national health care system.

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    I personally never had a problem with the death panel idea.

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    Quote Originally Posted by Dr Fear
    I personally never had a problem with the death panel idea.
    haha, amen!

    Its weird, I actually find it liberating to think that medical care really doesn't make a huge difference in mortality. Except for the possibility of dieing in an accident, you pretty much get dealt your hand and that's that. The reality is that there are very few treatments that work, and those that are claimed to work frequently do things like raise your 5 year survival chances from 95% to 97.5%.

  5. #5
    So the modern medical industry is a giant sham?

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    I think you're asking the wrong question. It ain't dying I'm talking about, it's living.
    Big difference.

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    Quote Originally Posted by MaximumBarnes
    So the modern medical industry is a giant sham?
    Maybe. The industry is built to treat the SYMPTOMS and not the CAUSES of health problems.

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    Quote Originally Posted by MaximumBarnes
    So the modern medical industry is a giant sham?
    Well, we have come to a point where most major diseases have been virtually eliminated in the 1st world thanks to vaccinations and antibiotics. Then you have treatment of the more difficult diseases like AIDS and cancer which only prolong life to some extent. Heart disease is largely only treatable by prevention. So have all the easy health problems been solved and only the difficult ones remain?

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    its not a sham, exactly. Its just that out of $100 that first $5 buys a ton of the benefits, and the next $5 picks up much of the rest.

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    Quote Originally Posted by MaximumBarnes
    So the modern medical industry is a giant sham?
    no not at all, not even close. they're just saying deaths didn't really go down much when seniors were put on medicare. As my link speculated
    How could mortality approve at the micro level, and not at the macro level? Increasing utilization of health services is not all mortality enhancing. As I note in the column, health care can kill as well as heal--one estimates puts the death from nosocomial (treatment-induced) infections at 80,000 a year. So while it's entirely possible--indeed certain--that some number of people are saved by having insurance, it's also very likely that some number of people are saved by not having it, or having less generous insurance, because they don't go in for a treatment that would have killed them.

    The 20009 paper was looking at a small subset of conditions that are urgent, and which we're relatively adept at treating. But it may be washed out by the people who die having knee surgery.
    and really we're not even sure about this because the statistics are very very difficult to produce on such specific causes. and mortality is certainly not the end all be all of medical effectiveness.

  11. #11
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    Quote Originally Posted by Dr Fear
    Quote Originally Posted by MaximumBarnes
    So the modern medical industry is a giant sham?
    Well, we have come to a point where most major diseases have been virtually eliminated in the 1st world thanks to vaccinations and antibiotics. Then you have treatment of the more difficult diseases like AIDS and cancer which only prolong life to some extent. Heart disease is largely only treatable by prevention. So have all the easy health problems been solved and only the difficult ones remain?
    Well, that's always going to be the case, regardless of what progress is made. Until we come up with an immortaility pill, there will always be a "top 5 causes of death list." It's what comprises those lists that changes with modern medicine. In developed countries we no longer die from acute diarrhea as children, but we're still prone to dying from heart disease and cancer--two diseases that are pretty much inevitable the longer you live. We'll work on fixing those, but there will always be something else there killing people. In a way, medicine doesn't get credit for all it has done simply because we take for granted that we'll live to 80 now.

    Medicine has made huge advances in recent years. Hell, if you watch an ER episode in its first season or two, you'll see AIDS patients depicted who wouldn't expect to live more than a few years. The average lifespan for someone who contracts HIV now is over 25 years and rising. Gleevec has revolutionized CML and stromal tumor treatments, and other molecular designer drugs are in the works.

    I guess I'm rambling, but my point is this: the medical industry is not a sham, and it certainly does treat the causes of problems when it can.

  12. #12
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    Quote Originally Posted by ousuxndallas
    Maybe. The industry is built to treat the SYMPTOMS and not the CAUSES of health problems.
    This statement is simply wrong. If you're talking about the pharm industry I think you would have a better chance at making the point I think you're trying to make. But as it stands, it's wrong on so many levels.

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    HIV is now a manageable, chronic disease that you can survive for decades with. When the disease was new, I routinely saw 5-10 end stage AIDS patients a week, guys that were clearly close to death. I've seen maybe one in the whole last year, and I've been working in Los Angeles and San Francisco, the epicenter of the "AIDS epidemic".

    Keep in mind that the average lifespan during the industrial revolution (just about when the first antibiotic was discovered, and well before it was widely available) was in the 40's. Even by the time Social Security was founded, the expected lifespan was SHORTER than the SS retirement age at the time, which was 65. The government instituted this plan on the assumption that the average American wasn't going to live long enough to even begin collecting benefits.

    Don't tell me that modern medicine hasn't lengthened our lives. This one is easy to measure.

  14. #14
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    Yes, but after antibiotics, ER trauma care, and vaccines, how much does medicine lengthen our lives?

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    Quote Originally Posted by CleverNickname
    Yes, but after antibiotics, ER trauma care, and vaccines, how much does medicine lengthen our lives?
    HIV isn't treated with antibiotics. So if you'd ask a friend of mine who got HIV from a needlestick injury, I'd guess she'd say it's lengthened her life by 15 years so far. My grandmother's life was lengthened by a good 30 years by kidney transplant. My dad, who had his triple bypass going on 20 years now, would likely be dead without his medical care.

    Such cases aren't exactly rare.

    And why pick out trauma care and antibiotics? That stinks of aggy, with their selective time periods and excuses like, "Yeah, but they can't win the big one without a Vince Young". Discounting the most effective treatments just because it fits your argument better is dishonest logic.

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    Quote Originally Posted by CleverNickname
    Yes, but after antibiotics, ER trauma care, and vaccines, how much does medicine lengthen our lives?
    I guess lengthening lives is the original point to the main article, but that speaks nothing to the improvement in the quality of life that medicine often provides.

    New monoclonal antibody treatments for autoimmune conditions such as Crohn's and ulcerative colitis both improve quality of life and decrease the incidence of complications such as malignancy, and perforation--both of which can cause death. Those treatments aren't listed as abx, trauma care, or vaccines, and they both improve QOL and lengthen lifespan.

    And what about chemo and cancer treatments (surgery, radiation, etc)? When those cure, say, breast cancer--that sure as hell lengthens life.

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    HIV is a special case, of course. Not many diseases have been so successfully arrested. More interesting are actual health outcomes for aggressive cancers and heart disease. Most stents do nothing at all - they don't even prevent angina. There are cancers that can basically be cured, things like certain leukemia. Aggressive cancers kill you, and chemo doesn't do anything. But a lot of studies have shown that often there isn't much difference in the outcomes for those treated for prostate and breast cancers, and those who weren't. Its likely the cancers we consider "wins" are the cancers someone could have lived with for decades. Add back in the complications caused by treatments (catching something at a hospital, etc) and the margins are further narrowed. I don't think its unfair to exclude ER medicine... this isn't a screed against all medicine, just a discussion on the marginal benefits of additional health care beyond the "basics". I freely (and gladly!) admit that the lessons learned in vietnam and ww2 have saved countless lives. The advancements in neonatology have saved lots and lots of premies.

  18. #18
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    Quote Originally Posted by CleverNickname
    Yes, but after antibiotics, ER trauma care, and vaccines, how much does medicine lengthen our lives?
    you don't know any cancer survivors, i take it.

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    Totally cured? Zero.

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    more from meaghan.

    I want to talk a bit more about why I dislike the Himmelstein et. al. study that found more than half of all bankruptcies were due to medical reasons.
    Now, given the quality of the data they had, this is way, way, way too strong a statement of what they found. This was also true of their earlier study, which defined everyone with medical bills over $1,000 as having a "medical bankruptcy". Somehow, the parameters they choose always give rise to the conclusion that the medical system is wreaking catastrophe on the maximum number of people.

    I find it very hard to trust the studies they do because of this. In general, I'm really skeptical of papers from activist groups, which is why you rarely see me do more than pluck a very basic data set based on government or similar figures from any advocacy group or think tank that agrees with my ideological priors.
    interesting she just ends it with the bold part. her reasoning is lacking.

    the link

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    Quote Originally Posted by CleverNickname
    its not a sham, exactly. Its just that out of $100 that first $5 buys a ton of the benefits, and the next $5 picks up much of the rest.
    In economics, the marginal utility of a good or service is the utility gained (or lost) from an increase (or decrease) in the amount available of that good or service.


    the link

  22. #22
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    Quote Originally Posted by CleverNickname
    Totally cured? Zero.
    You serious, Clark? There are many of cancers that are totally curable besides leukemias (just because you mentioned them earlier).

    Another point I was thinking about: how can you forget diabetics? Type I diabetics (though it only makes up 10% of diabetes) would basically be dead early in life without proper insulin therapy. And type II diabetics (though most of it comes from being fat) are living way longer because of therapies like metformin, glipizide, PPAR agonists, GLP-I analogs--not to mention dialysis, which extends life in those with end-stage renal disease.

    I understand that medicine--and the decision to treat in complicated circumstances--can sometimes bring about unwanted results (especially with nosocomial infections and medical errors). But I think it's ridiculous to make such a broad statement and say that modern medicine doesn't really prolong life.

  23. #23
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    But actual expense of insulin monitoring and control is very low. That's that first $5 thing.

  24. #24
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    Quote Originally Posted by MaximumBarnes
    So the modern medical industry is a giant sham?
    the cost it takes to get treated damn sure is.

    Whether that's more related to the actual providers or the insurance industry matters not to me, but the actual $'s are ridiculous.

    example: My son went to ER, and had to be transported from The Woodlands to TCH in downtown Houston. We received the bill and there was an actual charge of $90 per mile for "fuel."

    WTF was the ambulance running on?

    That's just one example, but very illustrative of what I am saying. The costs are so freaking crazy, that even WITH health insurance, the charges are still bull$#@!.

  25. #25
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    http://www.cato-unbound.org/2007/09/...icine-in-half/
    So I want to say loudly and clearly what has yet to be said loudly and clearly enough: In the aggregate, variations in medical spending usually show no statistically significant medical effect on health. (At least they do not in studies with enough good controls.) It has long been nearly a consensus among those who have reviewed the relevant studies that differences in aggregate medical spending show little relation to differences in health, compared to other factors like exercise or diet. I not only want to make this point clearly; I want to dare other health policy experts to either publicly agree or disagree with this claim and its apparent policy implications.
    Let me now consider some objections.

    What about studies suggesting larger benefits in particular areas, e.g., immunization, infant care, and emergency care?

    Yes, there are categories of medicine where larger benefits seem plausible, and where empirical studies support such claims. (See, for example, Filmer & Pritchett Social Science and Medicine 1999 and Joseph Doyle 2007.) And I have no problem supporting policies to increase spending for such medicine relative to other kinds of medicine. But if your argument is that we must spend lots on medicine overall in order to gain benefits from these particular categories, then I think you have missed the whole point here. We already knew some medicine is more helpful and some more harmful than average. It doesn’t really help to know which part is which unless we are willing to somehow act on that information, and treat better parts differently from worse parts.

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    Quote Originally Posted by CleverNickname
    But actual expense of insulin monitoring and control is very low. That's that first $5 thing.
    as a parent of a type I child, it ain't as cheap as you'd think (at least not with my $#@!ty insurance). still, I get your point.

  27. #27
    Somebody pointed out on a cloakroom thread that the difference btwn median lifespan in Mexico, which was one of the worst in the "developed" world, and the US was only like 6 years.

    No doubt the vast majority of the increase in lifespan from pre WWI to now is due to improved hygiene, nutrition, and antibiotics, all of which are relatively cheap. Hell, even add in the cost of the infrastructure improvements required to achieve good sanitation and the cost of adequate diet to "health care" costs, and you don't move the needle much.

    But to extrapolate that to this guy's conclusion is close to absurd. What our added healthcare dollars (per capita) afford us are treatments for things that individuals could not otherwise afford on their own and that do not affect a significant enough portion of the population to be part of any generalized outlay like adequate sewage, water treatment stations, community vaccination efforts, and WIC.

    Just a few examples:

    Pediatric blood dyscrasias and sarcomas were essentially 100% fatal prior to chemotherapy; long-term remission rates for some types of leukemia now approach 100%; those for sarcomas are better than 75%

    Adult malignancies can often be cured, despite the fact that clever has never met anyone cured of one. Prostate, cervical, and colorectal ca come to mind, as well as many types of breast ca.

    Treatment for diabetes, statins for cholesterol, beta blockers for hypertension, and renal dialysis all unquestionably extend the lives of those afflicted with these conditions.

    Transplants, while many may argue cost too much to make sense economically, also irrefutably prolong life.

    We can also talk about improved quality of life, which is perhaps more important than lifespan to most people, but is much harder to measure and then put a dollar amount on.

    A pacemaker can take a person who is bed-bound and make them a marathon participant. Same with coronary and peripheral arterial stents

    Internal fixation of fractures allows limb salvage and return to normal function rather than a lifetime on a walker or in a wheelchair, same with total joint replacement for chronic degenerative joint conditions.

    I could go on and on, with examples such as drug thrapy for autoimmune diseases, neuromuscular diseases, dementia, etc.

    So I guess I'm not really sure what point this guy is trying to make. Is he trying to say the absolute cost of health care in dollars does not justify the absolute increase in median lifespan? If that is his argument, I think he is missing the point completely.

  28. #28
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    Actually the life expectancy for Mexico is only 2 years of difference. Per capita annual health expenses in Mexico: $800, per capital in US: $7200. So half a million over your lifetime to get 2 more years in your late 70s. Color me unimpressed. Now surely that number is a bit out of whack due to differences in hourly wages of techs, nurses, and docs. But its easy see how one could argue $800/yr buys up 77 years, the next $6400x77 buys 2 more years, and think what a huge waste all it is. Heck, just modern food safety practices, lack of manual labor injuries, clean drinking water, and elimination of many childhood illnesses means the theoritic life expectancy of someone with essentially 0 health care might be north of 70 in this country. The reality with a lot of cancers is that aggressive breast & prostate cancers kill you regardless of what intervention is taken. And those that aren't particularly aggressive could be ignored, and the likelihood is that you'd die from something else before it killed you. Some cancers are cured, true. But one could theoretically demonstrably prove that a $1 billion dollar treatment cures a 1 in 300 million disease 100% of the time. So what? Insulin, statins, and beta blockers are all fairly cheap. Some research has shown statins don't do jack $#@! - they only help the "high risk". Turns out beta blockers don't even extend the life of those with hypertension. I will grant you pacemakers (but how many pacemakers are put into folks who only live another 2-3 more years anyway), but stents are basically completely pointless... they have proven to neither prolong life nor prevent heart attacks. Diminishing marginal returns are bound to exist, the only question is where does the inflection point exist where each additional dollar is not worth it. Its very possible that inflection point is far closer to $0 than it is to $7200 per year. And that's not even taking into account the life reducing effects of type II medical malpractice.

    stents:
    http://query.nytimes.com/gst/fullpag...52C0A96F9C8B63
    statins:
    http://www.nytimes.com/2008/01/29/health/29well.html
    beta blockers:
    http://eurheartj.oxfordjournals.org/.../full/24/6/487
    cancer:
    http://query.nytimes.com/gst/fullpag...57C0A96F9C8B63

  29. #29
    Your understanding of cancers is woefully inadequate. While "aggressiveness" is important, it is actually a benefit in pediatric cancers, and only matters in adult malignancies if they are not caught quickly; early detection is the norm now for colorectal, prostate, and cervical ca, and is improving all the time for breast and some others.

    If you really think most cancers are ones you live with and die from other things, you need to find some better sources for your medical info. Women in their 30's routinely died horrible deaths from cervical cancer and men and women in their 50's and 60's from colorectal ca.

    I never said stents improve longevity or even prevent MI's; there is no question they improve functional status and thereby quality of life for patients who have them placed for symptomatic angina

    edit -- unfortunately I am too busy providing sham care to people with musculoskeletal conditions who would be no worse, actually far better in fact, had they just stayed home, to play the statistics game with you. also, you might look for some peer reviewed articles rather than the NYT for your sources.

    Maybe I need to go to law school, so I can actually help people.

    Well, I guess if you are so convinced that modern medicine is a crock, I would recommend you and your loved ones go off the grid with regards to healthcare. See how that works out for you.

    Is modern medicine expensive? Is there waste in the system? no one anywhere as far as I can tell is trying to say ithere isn't. But to insinuate it is for the most part a sham, which is what the guy from cato is doing, is farcical.

  30. #30
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    Take things personal much, doc? Check the National Center for Health Statistics death rate stats in that last link above. In the last 60 years cancer death rates have dropped all of 5%. For all our money and advances, cancer outcomes aren't much different than they were in the 1950s. You keep pointing to specific instances, and I keep pointing to aggregate data.

    I never said modern health care was a scam, just floated the idea that the diminishing marginal returns might not be worth what we currently spend. The Hanson guy just says that 50% of what we spend on it gives us nothing for it. That's not even a controversial statement. I'd gladly take mexico life expectancy & heath care and put $6k a year in my pocket. I could buy a very nice level of term life to make sure my family is taken care of if bad luck should strike, make my entire Roth retirement contribution, and still have some money left over to spoil my kiddo. Heck, I might even buy a critical illness policy that would pay a few hundred grand should I get cancer, money I'd spend on whatever I wanted. Maybe treatment, or maybe just college for my kids and ever nephew and niece I have.

  31. #31
    sounds like you should do just that clever. Keep us posted on how it works out for you.

    From this month's Cancer:

    Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates.
    Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede SL, Ries LA.

    Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.

    BACKGROUND.: The American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the United States. This year's report includes trends in colorectal cancer (CRC) incidence and death rates and highlights the use of microsimulation modeling as a tool for interpreting past trends and projecting future trends to assist in cancer control planning and policy decisions. METHODS.: Information regarding invasive cancers was obtained from the NCI, CDC, and NAACCR; and information on deaths was obtained from the CDC's National Center for Health Statistics. Annual percentage changes in the age-standardized incidence and death rates (based on the year 2000 US population standard) for all cancers combined and for the top 15 cancers were estimated by joinpoint analysis of long-term trends (1975-2006) and for short-term fixed-interval trends (1997-2006). All statistical tests were 2-sided. RESULTS.: Both incidence and death rates from all cancers combined significantly declined (P < .05) in the most recent time period for men and women overall and for most racial and ethnic populations. These decreases were driven largely by declines in both incidence and death rates for the 3 most common cancers in men (ie, lung and prostate cancers and CRC) and for 2 of the 3 leading cancers in women (ie, breast cancer and CRC). The long-term trends for lung cancer mortality in women had smaller and smaller increases until 2003, when there was a change to a nonsignificant decline. Microsimulation modeling demonstrates that declines in CRC death rates are consistent with a relatively large contribution from screening and with a smaller but demonstrable impact of risk factor reductions and improved treatments. These declines are projected to continue if risk factor modification, screening, and treatment remain at current rates, but they could be accelerated further with favorable trends in risk factors and higher utilization of screening and optimal treatment. CONCLUSIONS.: Although the decrease in overall cancer incidence and death rates is encouraging, rising incidence and mortality for some cancers are of concern. Cancer 2010. (c) 2009 American Cancer Society.
    Lies, damn lies, and statistics though, right?

  32. #32
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    Quote Originally Posted by sawbonz
    Maybe I need to go to law school, so I can actually help people.
    Hey man. little contrarian viewpoint on perhaps the #1 public policy issue currently being discussed in this country might be worth of posting here. I happen to think that laypersons were capable of objectively - and perhaps even ought to be encouraged - questioning how 1/6th of our GDP gets spent.

    Re: that study. Yes, a statistic that shows aggregate death rates for all cancer has decline. Can you copy-paste how big of the decline that statistic shows? I'm not seeing a number in the abstract that actually shows the actual change in rate. Interestingly of the incidence of the big 3, it seems to a layperson like me that at least 2 if not all 3 of those declines is could be due to lifestyle factors, such as smoking.

  33. #33
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    This is an example of a study with over-reaching conclusion based on results, which are, in turn, due to poor study methodology. Then, people who don't know how to apply critical thinking skills take their conclusions at face value (not mentioning anyone in particular, just in general).

    Clever:

    What about obstetrics? Has nothing to do with Medicare and everything to do with preventative medical care. Before the modern obstetrics era, death as a result of pregnancy complications was rare. Now, there are less than 1000 maternal deaths worldwide in developed nations.

  34. #34
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    is modern obstetrics a huge percentage of the costs in our current medical system?

  35. #35
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    Ultimately there is no cure for life. We all die. Doctors can keep some sick people alive (and potentially in good shape) for a certain length of time. But eventually they have to resort to more and more expensive procedures/medicine to do it.

    And while we can say that some people need to accept death, I'm sure its a different story when you have to make the decision about you. Or a loved one.

    I think of a scenario where someone held a gun to my head, and said that I had to turn over all of my assets or they would shoot. If I believed they would do it, and I would die as a result; the only logical action is to give away the assets.

  36. #36
    McArdle, who wrote one of the articles linked in the OP, is a hack who frequently cherry-picks things that support her argument while ignoring anything that doesn't.

    There's a pretty good response to her piece here.

  37. #37
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    Quote Originally Posted by bularry
    is modern obstetrics a huge percentage of the costs in our current medical system?
    does modern obstetrics have to be a HUGE percentage of the costs in our current medical system to argue against the premise of this stupid $#@!ing argument and the fact that you are a simple-minded ass$#@!?

  38. #38
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    Quote Originally Posted by oobe
    does modern obstetrics have to be a HUGE percentage of the costs in our current medical system to argue against the premise of this stupid $#@!ing argument and the fact that you are a simple-minded ass$#@!?
    Does it have to be, in order to demonstrate the pretty obvious truth of diminish marginal returns? Is it so crazy to think that the first 5-10% of health care spending (inclusive of clean water and sanitation) is responsible for the vast majority of health care outcomes, and that what remains is so dependent on genetics and environment, yet insensitive to medical treatment, that the bulk of our health care spending barely makes a difference?

  39. #39
    Clever, you don't get to choose to give away MY last two years of life. You can cut your own costs down significantly by going off the grid - decline those employer-sponsored health care benefits, don't go into state-supported hospitals, and ignore prescription drugs (should you ever need them). But you leave MY healthcare choices alone.

    I think the implicit assumption we're all making here is that ethics don't come into play. The critical difference between Mexico and the US is that Mexico likely CAN'T increase its incremental spending on healthcare, while we obviously can. If you have a technology, drug, or medical practice that can help .01% of our population, that's still 350,000 people. Don't we have an ethical duty to squeeze out every last drop of value? I guess what I'm asking is, who gets to choose? To use your numbers, clever - if the last $90 is less-than-effective, when do we get down to the tenth dollar? The ninth? Eighth? Who determines what "good-enough marginal utility" is?

    The answer? In our country, the market decides. If someone is willing to pay for those last two years, the system is set up to let them. I have cancer survivors in my family - two are multiple cancer survivors. We have 20 grandchildren on my mother's side, and not one single time did any of the mothers experience any sort of life-threatening obstetric issue. Yes, these are point-in-time snapshots and not aggregate data, but I choose to pay for my marginal healthcare.

  40. #40
    clever, sorry for the tone of my posts yesterday.

    I truly don't have time to dig out the statistics to refute his claims, but using overall death rates from cancer to argue that there have been no meaningful advances in cancer treatment is bull$#@!. His argument is that the SAME population of cancer patients that were dying of their disease 50 years ago are dying of their disease today, and over the same time interval. That assertion is prima facie false. Do you honestly think any insurance company would pay for a cancer treatment that showed zero benefit over the natural history of the disease? Use your brain, man.

    Is healthcare more expensive than it should be? of course, but to assert that the last 50% of dollars spent yields zero added benefit is patently absurd.

  41. #41
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    Quote Originally Posted by capnamerca
    Clever, you don't get to choose to give away MY last two years of life.
    This.

    I'd say when my dad had bypass surgery after a heart attack it sure prolonged his life. And when my brother in law had a brain tumor pulled out through his nose it sure prolonged his life.

    When it comes time for you to need a few more years, you might feel differently.

    Having said that, the system is $#@!ed up for sure but we sure have some pretty impressive treatments/procedures available these days.

  42. #42
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    Quote Originally Posted by oobe
    Quote Originally Posted by bularry
    is modern obstetrics a huge percentage of the costs in our current medical system?
    does modern obstetrics have to be a HUGE percentage of the costs in our current medical system to argue against the premise of this stupid $#@!ing argument and the fact that you are a simple-minded ass$#@!?
    simple-minded ass$#@!? what does that even mean? I guess I am simple-minded! ha ha ha ha

    I thought what I asked was a pretty simple, neutral question.

  43. #43
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    Quote Originally Posted by capnamerca
    Clever, you don't get to choose to give away MY last two years of life. You can cut your own costs down significantly by going off the grid - decline those employer-sponsored health care benefits, don't go into state-supported hospitals, and ignore prescription drugs (should you ever need them). But you leave MY healthcare choices alone.

    I think the implicit assumption we're all making here is that ethics don't come into play. The critical difference between Mexico and the US is that Mexico likely CAN'T increase its incremental spending on healthcare, while we obviously can. If you have a technology, drug, or medical practice that can help .01% of our population, that's still 350,000 people. Don't we have an ethical duty to squeeze out every last drop of value? I guess what I'm asking is, who gets to choose? To use your numbers, clever - if the last $90 is less-than-effective, when do we get down to the tenth dollar? The ninth? Eighth? Who determines what "good-enough marginal utility" is?

    The answer? In our country, the market decides. If someone is willing to pay for those last two years, the system is set up to let them. I have cancer survivors in my family - two are multiple cancer survivors. We have 20 grandchildren on my mother's side, and not one single time did any of the mothers experience any sort of life-threatening obstetric issue. Yes, these are point-in-time snapshots and not aggregate data, but I choose to pay for my marginal healthcare.
    this is a good point. however, I think b_c and others would say that our health care system is very far from "market" based, and in fact health care is not really subject to rational purchase decisions.

  44. #44
    Quote Originally Posted by bularry
    Quote Originally Posted by capnamerca
    Clever, you don't get to choose to give away MY last two years of life. You can cut your own costs down significantly by going off the grid - decline those employer-sponsored health care benefits, don't go into state-supported hospitals, and ignore prescription drugs (should you ever need them). But you leave MY healthcare choices alone.

    I think the implicit assumption we're all making here is that ethics don't come into play. The critical difference between Mexico and the US is that Mexico likely CAN'T increase its incremental spending on healthcare, while we obviously can. If you have a technology, drug, or medical practice that can help .01% of our population, that's still 350,000 people. Don't we have an ethical duty to squeeze out every last drop of value? I guess what I'm asking is, who gets to choose? To use your numbers, clever - if the last $90 is less-than-effective, when do we get down to the tenth dollar? The ninth? Eighth? Who determines what "good-enough marginal utility" is?

    The answer? In our country, the market decides. If someone is willing to pay for those last two years, the system is set up to let them. I have cancer survivors in my family - two are multiple cancer survivors. We have 20 grandchildren on my mother's side, and not one single time did any of the mothers experience any sort of life-threatening obstetric issue. Yes, these are point-in-time snapshots and not aggregate data, but I choose to pay for my marginal healthcare.
    this is a good point. however, I think b_c and others would say that our health care system is very far from "market" based, and in fact health care is not really subject to rational purchase decisions.
    And i would call that a very salient reply. I don't pretend to be smart enough to figure out how to best level-set pricing in our current health care market. I absolutely agree that it's WAY out of whack, and really the only people who profit are the insurance company execs. Of course, insurance companies only exist out of need - the need for doctors to defend themselves in our litigious society. Medicine is an inherently flawed pursuit - NO ONE is perfect. But wrong is wrong, and restitution is required. I don't know where I stand on the matter, honestly.

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