A tale of two covariates: Why OWID and company are wrong about US healthcare • Hacker News Board

Re: A tale of two covariates: Why OWID and company are wrong about US healthcare

#21

Post by jedharris » Sun, Dec 08, 2019, 11:17 PM UTC

jorblumesea wrote: post #17

jedharris wrote: post #2

Very long and well argued review of sources of excess mortality in developed countries. Bottom line: Obesity! and other non-medical factors like automobiles. Big implications about how we should spend money to increase life expectancy.

> Obesity! and other non-medical factors like automobiles Socialized medicine and other forms of "planned state healthcare" seem to do a better job promoting lifestyle changes and preventative medicine, which reduces the costs of these externalities.

Makes sense to me, but I would like to have specific data that would help me understand: - How much money work needs to be invested for what incremental effect? - What kinds of investments are most effective? - How much does effectiveness depend on specific cultural factors, vs. being culture independent?

And many more similar questions.

Re: A tale of two covariates: Why OWID and company are wrong about US healthcare

#22

Post by rcafdm » Sun, Dec 08, 2019, 11:23 PM UTC

jorblumesea wrote: post #19

s1artibartfast wrote: post #11

Earlier quoted context omitted.

I think the controversial idea is that the USA healthcare system is operating on the same efficiency curve as other developed nations. That is to say, a socialized healthcare system with the same spending is unlikely to provide any improvements in life expectancy.

> socialized healthcare system with the same spending is unlikely to provide any improvements in life expectancy. That's probably not true, because as the author pointed out, Obesity is considered an "external factor" but many countries with socialized medicine have programs to tackle these issues. Americans lack "preventive maintenance" programs that are a given in Europe. I think we all agree throwing money at the…

US also has "programs" and generally spends more on preventative medicine. Further, actual medical evidence suggests medicine doesn't have good treatments for obesity (getting people to lose much weight and keep it off), save the surgical inventions (which aren't used often enough to explain much). It's also clear that obesity rates are rising throughout the developed world despite rising spending.

https://i1.wp.com/randomcriticalanalysis.com/wp-content/uplo...

Re: A tale of two covariates: Why OWID and company are wrong about US healthcare

#23

Post by hdlothia » Sun, Dec 08, 2019, 11:30 PM UTC

rcafdm wrote: post #22

jorblumesea wrote: post #19

Earlier quoted context omitted.

> socialized healthcare system with the same spending is unlikely to provide any improvements in life expectancy. That's probably not true, because as the author pointed out, Obesity is considered an "external factor" but many countries with socialized medicine have programs to tackle these issues. Americans lack "preventive maintenance" programs that are a given in Europe. I think we all agree throwing money at the…

US also has "programs" and generally spends more on preventative medicine. Further, actual medical evidence suggests medicine doesn't have good treatments for obesity (getting people to lose much weight and keep it off), save the surgical inventions (which aren't used often enough to explain much). It's also clear that obesity rates are rising throughout the developed world despite rising spending. https://i1.wp.com/…

What about the financial costs to the patients? Are other countries able to get the same outcomes at lower costs to the patient?

Re: A tale of two covariates: Why OWID and company are wrong about US healthcare

#24

Post by allovernow » Sun, Dec 08, 2019, 11:36 PM UTC

whatshisface wrote: post #8

hdlothia wrote: post #6

Earlier quoted context omitted.

Can you explain the conclusion of this article to me? I don't fully understand what he is trying to say.what are the implications? That the only improvement we can make on the american healthcare system is to fight obesity better?

By far the biggest health improvements that could be made in America would be reductions in obesity and reductions in vehicle fatalities. Whether that's the best area of focus depends on the relative difficulty of the improvements - if one second and one penny could save one person, that would be a higher priority than spending a million dollars and one year to save a thousand (even though both would be on the list f…

Honestly, if our biggest barrier to healthy longevity has been reduced to automobile accidents, society is in pretty damn good shape considering how safe modern vehiclular travel is.

Re: A tale of two covariates: Why OWID and company are wrong about US healthcare

#25

Post by rcafdm » Sun, Dec 08, 2019, 11:52 PM UTC

hdlothia wrote: post #13

rcafdm wrote: post #9

Earlier quoted context omitted.

No, but this is addressed in my post. Australia's obesity rate is substantially lower, plus they suffer from lower homicide, drug abuse, and the like. More generally, the diminishing returns to health spending imply there's very little to believe the higher expenditure the US makes is likely to purchase appreciably better outcomes (even with different healthcare regimes).

Are you the original author? Have you done an evaluation on the financial consequences of both healthcare systems as well? Do people suffer medical bankruptcies at similar levels in our peer nations?

Yes, I'm the author of the blog (RCA). No, I haven't studied this narrow question, though it's somewhat tangential to the arguments I've advanced (outcomes; prices; aggregate costs; etc). I have, however, seen several studies that suggest "medical bankruptcies" have very little to do with medical debt and much to do with the effects of their health on their employment/earned income (also similar patterns in Canada and some other comps in the available data...)

https://www.nejm.org/doi/pdf/10.1056/NEJMp1716604

Re: A tale of two covariates: Why OWID and company are wrong about US healthcare

#26

Post by Ididntdothis » Mon, Dec 09, 2019, 12:21 AM UTC

rcafdm wrote: post #7

Ididntdothis wrote: post #3

This starts with saying that there is a popular telling that the more money a country spends the better life expectancy will be. Especially looking at the US I thought most people know that US doesn't get much value compared to the money spent. Was that really controversial?

My point is that there's very little to suggest US healthcare is uniquely ineffective. There rapidly diminishing returns to health spending and US outcomes are badly handicapped by factors like obesity and homicide. Maybe try actually reading it though?

"Maybe try actually reading it though?"

Your first sentence is "In the popular telling, there is a strong and reasonably constant relationship between health spending and life expectancy.". My comment was that I am not aware of this being the popular telling. But instead from what I can tell most people agree that the US doesn't deliver better results despite much higher spending.

Otherwise I think you have dug up a good and useful amount of data although I think some of your conclusions are debatable. This is probably to be expected if you analyze such a complex system.

Re: A tale of two covariates: Why OWID and company are wrong about US healthcare

#27

Post by hdlothia » Mon, Dec 09, 2019, 12:29 AM UTC

rcafdm wrote: post #25

hdlothia wrote: post #13

Earlier quoted context omitted.

Are you the original author? Have you done an evaluation on the financial consequences of both healthcare systems as well? Do people suffer medical bankruptcies at similar levels in our peer nations?

Yes, I'm the author of the blog (RCA). No, I haven't studied this narrow question, though it's somewhat tangential to the arguments I've advanced (outcomes; prices; aggregate costs; etc). I have, however, seen several studies that suggest "medical bankruptcies" have very little to do with medical debt and much to do with the effects of their health on their employment/earned income (also similar patterns in Canada an…

Why do you feel that aggregate cost is more relevant than cost to patient? If other systems are able to have the same outcome at more affordable rates for the average patient, isn't that better.

Re: A tale of two covariates: Why OWID and company are wrong about US healthcare

#28

Post by hackeraccount » Mon, Dec 09, 2019, 12:31 AM UTC

hdlothia wrote: post #6

jedharris wrote: post #2

Very long and well argued review of sources of excess mortality in developed countries. Bottom line: Obesity! and other non-medical factors like automobiles. Big implications about how we should spend money to increase life expectancy.

Can you explain the conclusion of this article to me? I don't fully understand what he is trying to say.what are the implications? That the only improvement we can make on the american healthcare system is to fight obesity better?

So I just skimmed but I think the point he's making is that Public Health and Healthcare are 2 different things. Public Health is - get some exercise. Don't drink. Keep a reasonable weight. Don't do drugs. Avoid getting shot. Get vaccinated. Don't drive a lot.

Almost all of these things aren't really "Healthcare". I don't need to go to a Dr. to know I should lose 10 lbs. Maybe - maybe, maybe - a Dr. can help me quit heroin (frankly I doubt it) and certainly a Dr. can give me a flu shot.

Most of "healthcare" money has nothing to do with longevity. If my buddy had a heart attach you can spend $500,000 on treatment. Heck, you can give him a new heart. It's all great. Who would say no? Not me. (He's my buddy after all).

At population scale though that does nothing for longevity. At population scale you'd be better off setting the speed limit to 40mph. Taxing alcohol to high heaven. Playing tons of old Erol Flynn movies (To encourage people to get into sword fights instead of gun fights.)

None of that stuff is sexy though. Even the non-crazy version of that list is un-sexy. It probably doesn't cost a lot of money but it royally pisses off people. People also vote. They don't like it if you try to run their lives for them - even if you would technically do a better job then those idiots do. Except for me. And I'm going to lose that 10 lbs. really soon.

Re: A tale of two covariates: Why OWID and company are wrong about US healthcare

#29

Post by xixixao » Mon, Dec 09, 2019, 12:34 AM UTC

I feel like this is a great article, but is very hard to digest for someone without statistical background and working knowledge of its jargon. Pretty sure it could be amended only slightly, using common language terms, for larger audience to appreciate it.

Re: A tale of two covariates: Why OWID and company are wrong about US healthcare

#30

Post by hackeraccount » Mon, Dec 09, 2019, 12:34 AM UTC

rayiner wrote: post #10

hdlothia wrote: post #6

Earlier quoted context omitted.

Can you explain the conclusion of this article to me? I don't fully understand what he is trying to say.what are the implications? That the only improvement we can make on the american healthcare system is to fight obesity better?

There are two points to the article. 1) Healthcare spending has rapidly diminishing returns, not only comparing the US to Europe, but comparing countries within Europe (such as the Netherlands versus Spain). 2) The lower life expectancy in the US can be explained mostly by higher obesity. US states with similar obesity to European countries have similar life expectancy.

I haven't looked at the numbers. Barely read the article. I bet he's wrong though. I would think it'd be a love affair with firearms (Fuck Yeah. ) and a lot of driving.

Every time I read about weight the dangers of an extra 10 lbs. seem to be pretty ambiguous. Though I'm totally going to drop that 10 lbs. I only had 2 donuts today.