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

randomcriticalanalysis.com

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

#51

Post by s1artibartfast »

smt88 wrote: post #42
rayiner wrote: post #10

Earlier quoted context omitted.

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.

Re: #2, my understanding from friends at the CDC is that lower life expectancy is due to lower incomes (meaning food, medicine, and doctor visits are unaffordable even with health insurance), suicides, and the opioid crisis. Suicides and obesity can also be caused by low income and drug abuse, so it sounds like the author may be seeing causation where correlation is more accurate.

Causation isn't mutually exclusive. The relationship between obesity and heart disease is clearly causative. Any causation between income and obesity does not negate this..

This is an important distinction.

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

#52

Post by s1artibartfast »

nradov wrote: post #47
hackeraccount wrote: post #30

Earlier quoted context omitted.

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.

An extra 10 lbs isn't the issue here. The average American man is now 23 lbs overweight.

It is much worse than that. 40% of american men are obese, which,for the average body type, is ~50 lbs above normal.

From wikipedia: >The National Center for Health Statistics at the CDC showed that 39.6% of US adults age 20 and older were obese as of 2015-2016 (37.9% for men and 41.1% for women).[1] Obesity in an adult is defined as a BMI of 30 and above.

The Average american male is 5'10. A "normal healthy" BMI of 22 is 153 lbs. A BMI of 30 is 209 lbs. [2]

[1] https://en.wikipedia.org/wiki/Obesity_in_the_United_States [2] https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi...

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

#53

Post by s1artibartfast »

hdlothia wrote: post #23
rcafdm wrote: post #22

Earlier quoted context omitted.

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?

Broadly speaking, yes. The post suggests that we are operating in a regime where outcomes are insensitive to cost.

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

#54

Post by xyzzyz »

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.

The socialized medicine in my home country does pretty much nothing to promote healthy lifestyle. People generally are healthy and not obese, but socialized medicine have nothing to do with it, it’s rather the culture at large that’s responsible.

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

#55

Post by IAmEveryone »

rgbrenner wrote: post #41
atomic_rabbit wrote: post #33

The blog Random Critical Analysis has made a good argument that Americans spend so much on healthcare simply because Americans spend so much on everything. Healthcare isn't exceptional in this regard. If you replace the usual GDP per capita measure of income by a measure of actual individual consumption, the US lies right on the trend line, just with higher healthcare spending and higher overall consumption than ever…

The US healthcare system is not a free market. The pricing system--critical to any free market--is broken when it comes to healthcare. Customers are unable to shop on price (even for non-emergency care).. but also the AMA limits the number of doctors; and hospitals require a certificate of need (giving competitors a veto over new businesses), for example. It isn't just that we spend more... if that was the only issue…

Your argument is circular: You are assuming a "free-market system" to be better than the US health care system. Then, you use this assumption to "prove" that US health care is suboptimal. Which in turn you're using to argue for a "free market" system.

They are making an empirical argument that pricing in the US is not actually out of line when compared to the correct base. This would imply that the US system is about as efficient as all others. And considering the differences between vastly different systems are almost negligible, it is also an argument that these systems are rather efficient. Because if there were easy wins with any specific measures, you would expect some systems to improve relative to others with skill or just luck.

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

#56

Post by koolba »

nradov wrote: post #45
rgbrenner wrote: post #41

Earlier quoted context omitted.

The US healthcare system is not a free market. The pricing system--critical to any free market--is broken when it comes to healthcare. Customers are unable to shop on price (even for non-emergency care).. but also the AMA limits the number of doctors; and hospitals require a certificate of need (giving competitors a veto over new businesses), for example. It isn't just that we spend more... if that was the only issue…

Please stop posting misinformation about the AMA. It does not limit the number of doctors. The actual bottleneck is in residency slots, and the AMA is actually advocating to increase funding there. https://www.ama-assn.org/press-center/press-releases/ama-fun... Most patients are able to shop on price. The majority of insurers now provide web sites where their members can obtain estimates of out-of-pocket expenses for…

Bullshit. Trying to get prices from an insurance company requires hours of time, researching individual billing codes, and at best leads to a ballpark guess.

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

#57

Post by smt88 »

s1artibartfast wrote: post #51
smt88 wrote: post #42

Earlier quoted context omitted.

Re: #2, my understanding from friends at the CDC is that lower life expectancy is due to lower incomes (meaning food, medicine, and doctor visits are unaffordable even with health insurance), suicides, and the opioid crisis. Suicides and obesity can also be caused by low income and drug abuse, so it sounds like the author may be seeing causation where correlation is more accurate.

Causation isn't mutually exclusive. The relationship between obesity and heart disease is clearly causative. Any causation between income and obesity does not negate this.. This is an important distinction.

That's true and I agree, but if you're asking why people are dying, you're going to be most interested in the root cause (which should be the variable that is least dependent on the others).

While obesity likely does reduce income somewhat (due to stereotypes), income can be considered an independent variable here.

Relatedly, we know that obesity is very hard to treat, while poverty is incredibly easy to treat on an individual level. The only reason we don't is because people see treatment of poverty as unfair, while treatment of obesity is not seen that way.

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

#58

Post by pjc50 »

> The problem is GDP is not even particularly a good proxy for the income of households (individuals). GDP is designed to measure how much value add is produced within domestic (territorial) boundaries. It usually does a fairly decent job of this, but it does not directly tell us about the household perspective, as in, the average level of real incomes or real consumption enjoyed residents of a country (a.k.a. “material living conditions“). Most importantly, it is an increasingly unreliable proxy for this concept.

Would someone care to explain how this works? What's the factor causing divergence between the two? Is it the proportion of GDP being returned to overseas investors? Or a mis-counting which includes GDP of US multinationals produced by workers overseas?

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

#59

Post by Angostura »

hackeraccount wrote: post #28
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?

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…

In the UK now, if you go to the GP with an ailmentr, you are quite likely to be prescribed joining the local Parkrun group, or other 'public health' measures.

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

#60

Post by PunchTornado »

pjc50 wrote: post #58

> The problem is GDP is not even particularly a good proxy for the income of households (individuals). GDP is designed to measure how much value add is produced within domestic (territorial) boundaries. It usually does a fairly decent job of this, but it does not directly tell us about the household perspective, as in, the average level of real incomes or real consumption enjoyed residents of a country (a.k.a. “mater…

one example that I often heard being made is that natural disasters have a positive outcome to the GDP. Houses and communities get destroyed, people are objectively much worse off, but due to the money pumped in reconstruction the GDP grows more than if no disaster had happened.
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