Hacker News Folks Get Long Overdue Thanks • Hacker News Board

Re: Hacker News Folks Get Long Overdue Thanks

#91

Post by mixmax » Sat, Jul 20, 2013, 9:51 PM UTC

refurb wrote: post #89

mixmax wrote: post #49

While this is a great and heartbreaking story that makes me proud to be an active member of HN it's also a symptom of the totally broken US healthcare system. From wikipedia: The United States life expectancy of 78.4 years at birth, up from 75.2 years in 1990, ranks it 50th among 221 nations, and 27th out of the 34 industrialized OECD countries, down from 20th in 1990. Of 17 high-income countries studied by the Natio…

I know I must sound like a broken record, but life expectancy is a poor proxy for quality of healthcare. There are many factors which impact life expectancy which have nothing to do with healthcare. For example, if you correct for the number of car accidents (which is high in the US due to the number of cars on the road), the US comes out near the top in terms of life expectancy. The other thing is that to say that t…

I just copied the first paragraph from the Wikipedia article, which happpened to be about life expectancy which is often seen as a proxy for quality of healthcare. Fair or not.

Here are some other excerpts from the article:

- The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population.

- lack of health insurance causes roughly 48,000 unnecessary deaths every year in the United States

- In 2007, 62.1% of filers for bankruptcies claimed high medical expenses.

- A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence.

These quotes are just from the first paragraph of the article... There are many more if you read it through.

For an outside observer it's blatantly obvious that you have a broken system, and it's inexlicable why you keep defending it.

Re: Hacker News Folks Get Long Overdue Thanks

#92

Post by DanBC » Sat, Jul 20, 2013, 10:01 PM UTC

kallekalle wrote: post #88

tptacek wrote: post #70

Earlier quoted context omitted.

The UK has notoriously poor cancer outcomes. http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-sur...

From those top tens for females and males, five out of ten are countries with populations less than 12 million each. It would be interesting to see the US statistics by state. Smaller networks (small population of a country, or by state) could be a factor here. Could you find the original study?

Is it this one?

(http://www.ncbi.nlm.nih.gov/pubmed/18639491)

Re: Hacker News Folks Get Long Overdue Thanks

#93

Post by WasimBhai » Sat, Jul 20, 2013, 10:09 PM UTC

drone wrote: post #57

WasimBhai wrote: post #22

I have often wondered given the kind of cost involved in good health care in USA, along with college fees, why don't more Americans move to Europe for health care and education where it is probably free most of the time? P.S.: I am from Pakistan.

Don't most of those "free" public health care systems only apply to citizens? I recall a story about a foreigner in Germany having to pay for their care, even if the price was reduced. Non-emergency care in the UK, for example, requires legal residency, which may be hard to come by for someone too poor to afford health care in the US. France requires non-EU citizens to have insurance for care in France to get a visa,…

Yes, of course. But then I am talking more about the whole life, not only in the case of emergency etc.. I mean for someone like me, from what I have read about American healthcare and education system, I will choose Europe any day over America. And even though, I really don't have that choice with my passport. But in the case of US citizens, the choice seems realtively easy.

Re: Hacker News Folks Get Long Overdue Thanks

#94

Post by drpgq » Sat, Jul 20, 2013, 11:15 PM UTC

twstws wrote: post #18

This is truly a wonderful story. But it makes you wonder how many others in a similar situation weren't so fortunate. I lived in the US for two years, and I never understood the aversion to government healthcare. The Canadian system is far from perfect, and I know there are failures. But it's still a lot better than soliciting for online charity on a case by case basis. I'm impressed and humbled that it worked in thi…

Would this have worked out in Canada? I'm not sure. This seems like a special case where the US system works better.

Re: Hacker News Folks Get Long Overdue Thanks

#95

Post by Noxchi » Sat, Jul 20, 2013, 11:16 PM UTC

bencollier49 wrote: post #82

ippisl wrote: post #56

Earlier quoted context omitted.

Nurse practitioners are used in many countries with great results. Why is using them illegal ? of course it's because of regulatory capture and the general power doctors hold, which is probably the biggest reason why healthcare is so expensive(and also not very good). You see it in million places: The limited number of medical schools, The lack of nurse practitioners doing the simple routine jobs in most specialties(…

Number 3, absolutely. That's true in the UK too. In fact, if AI consulted the patient, it would catch a lot of things which doctors miss, simply by asking enough pertinent questions. When I have challenged doctors about this, they tend to say "Ah, but you're focused on data, we focus on diagnosing the patient", which is basically gibberish.

http://en.akinator.com/

That web app can name any person you think of by asking 20 or so questions. Just imagine what you could do if you made that but for diseases.

Re: Hacker News Folks Get Long Overdue Thanks

#96

Post by FireBeyond » Sun, Jul 21, 2013, 12:07 AM UTC

fixxer wrote: post #84

lifeisstillgood wrote: post #63

Earlier quoted context omitted.

Edit: It has been (correctly) pointed out downthread that I have helped hijacking a very personal post for political point scoring - which I think is fair. However we lack a decent history function in HN so I leave it here otherwise the thread will read strangely. Thank you - as a Brit I read this too. I cycled through emotions - fear and sympathy for the diagnosis, hope as some of our best professionals consider new…

So long as you're not poor, health care in the US is good. If you live in a major city and are diligent about who takes care of you, it is great. I've had three MRIs. All were scheduled the same day they were prescribed. I've routinely scheduled appointments with renown specialists and waited less than 2 days to get in. My double hernia surgery was performed by the same guy who treats the Chicago Bears. My old chirop…

"So long as you're not poor..."

I had a kidney stone a few weeks ago. All told, the bills for dealing with that hit $34,000.

For a kidney stone.

That's not about being poor or not, that's highway robbery.

Re: Hacker News Folks Get Long Overdue Thanks

#97

Post by bencollier49 » Sun, Jul 21, 2013, 12:09 AM UTC

Noxchi wrote: post #95

bencollier49 wrote: post #82

Earlier quoted context omitted.

Number 3, absolutely. That's true in the UK too. In fact, if AI consulted the patient, it would catch a lot of things which doctors miss, simply by asking enough pertinent questions. When I have challenged doctors about this, they tend to say "Ah, but you're focused on data, we focus on diagnosing the patient", which is basically gibberish.

http://en.akinator.com/ That web app can name any person you think of by asking 20 or so questions. Just imagine what you could do if you made that but for diseases.

Let's do it. I had this idea that each medical field could have a sort of Global Subject Expert AI online to make diagnoses, and the more people using it, the more sublime it would become in its assessments.

Re: Hacker News Folks Get Long Overdue Thanks

#98

Post by wikiburner » Sun, Jul 21, 2013, 12:23 AM UTC

tptacek wrote: post #67

mixmax wrote: post #49

While this is a great and heartbreaking story that makes me proud to be an active member of HN it's also a symptom of the totally broken US healthcare system. From wikipedia: The United States life expectancy of 78.4 years at birth, up from 75.2 years in 1990, ranks it 50th among 221 nations, and 27th out of the 34 industrialized OECD countries, down from 20th in 1990. Of 17 high-income countries studied by the Natio…

On cancer outcomes, the US outranks many (most?) of the countries that beat it on life expectancy. And, as pointed out downthread, life expectancy is a dodgy stat; it's heavily weighted by infant mortality, which isn't uniformly measured, and by accidental and violent deaths which, while tragic and perhaps symptomatic of other US problems, don't implicate our health care system.

It would also be interesting to see the stats weighted to account for the much higher levels of obesity in the U.S., which has to bump heart disease and cancer deaths significantly.

Re: Hacker News Folks Get Long Overdue Thanks

#99

Post by makomk » Sun, Jul 21, 2013, 12:27 AM UTC

tptacek wrote: post #67

mixmax wrote: post #49

While this is a great and heartbreaking story that makes me proud to be an active member of HN it's also a symptom of the totally broken US healthcare system. From wikipedia: The United States life expectancy of 78.4 years at birth, up from 75.2 years in 1990, ranks it 50th among 221 nations, and 27th out of the 34 industrialized OECD countries, down from 20th in 1990. Of 17 high-income countries studied by the Natio…

On cancer outcomes, the US outranks many (most?) of the countries that beat it on life expectancy. And, as pointed out downthread, life expectancy is a dodgy stat; it's heavily weighted by infant mortality, which isn't uniformly measured, and by accidental and violent deaths which, while tragic and perhaps symptomatic of other US problems, don't implicate our health care system.

You have to be careful about cancer statistics, because in many cases the US diagnoses early-stage cancers that would never get recorded in other countries. Some of those cancers never progress to the point of being life-threatening, making the survival stats misleading. Others do but because they're recorded earlier US patients are recorded as surviving for longe when in fact they're just being diagnosed ealier and dying at the same time as similar patients in other countries.

Re: Hacker News Folks Get Long Overdue Thanks

#100

Post by makomk » Sun, Jul 21, 2013, 12:37 AM UTC

DanBC wrote: post #76

tptacek wrote: post #70

Earlier quoted context omitted.

The UK has notoriously poor cancer outcomes. http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-sur...

You understand we've done a lot since 2007, right? EDIT: specifically, "survival rate" is just "how many people lived for 5 years after diagnosis". Thus, you detect a lot of slow growing prostate cancer and your survival rates go up, even though nothing has been done to reduce the incidence of cancer, or stop any more people from dying of cancer. When you look at US cancer mortality rates they look pretty good, until…

I'd like to add to this that the US recommended screening PSA screeening for prostate cancer, whereas there's no screening program in the UK because the medical evidence suggests it does more harm than good. A huge proportion of older men have prostate cancer (30% of men over 50, apparently) but in most of them even without treatment it never progresses to the point of affecting them in any way before they die of something unrelated.

Similarly, the US screened women for breast cancer and cervical cancer earlier and more frequently than the UK, which again does more harm than good but improves the 5-year survival stats.

The US Preventative Screening Task Force has since recommended that screening should basically fall in line with what the UK's doing, but that happened well after that article was published.