Hacker News Folks Get Long Overdue Thanks • Hacker News Board

Re: Hacker News Folks Get Long Overdue Thanks

#131

Post by skue » Sun, Jul 21, 2013, 7:17 PM UTC

makomk wrote: post #99

tptacek wrote: post #67

Earlier quoted context omitted.

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…

Absolutely. It's called lead time bias, and there's a great illustration on Wikipedia:

http://en.wikipedia.org/wiki/Lead_time_bias

Gil Welch at Dartmouth is one of the experts in unnecessary medical screening and lead time bias. He's written numerous academic and media articles, especially regarding lung, breast, and prostate cancer screening. Also an amazing public speaker:

http://tdi.dartmouth.edu/faculty/h-gilbert-welch-md-mph

Re: Hacker News Folks Get Long Overdue Thanks

#132

Post by btilly » Sun, Jul 21, 2013, 7:38 PM UTC

parasubvert wrote: post #129

btilly wrote: post #41

Earlier quoted context omitted.

It gets worse. According to CBO estimates, the plan underestimated the costs of the original rollout severalfold. Republicans are gleefully attempting to guarantee failure by refusing to approve any additional funds for that purpose.

Citation please. As of February, it was about $130 billion off over 10 years (i.e. $1.3 trillion vs. $1.17 trillion). That is not 'severalfold'. http://www.californiahealthline.org/articles/2013/2/6/cbo-up... And insurance premiums on ACA exchanges are coming in 20% lower than expected: http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPre... I do agree Republicans believe this thing is going to fail and are t…

The figure that I was comparing is the initial cost of setting up the exchanges in the first place. From memory it was estimated by the CBO at about 6 billion, but only 1 billion was allocated for it. That is several-fold, though only a drop in the bucket compared to the 10 year figures once it is rolled out.

I can't easily find a citation for it right now though. But http://www.cbsnews.com/8301-250_162-57589988/smooth-on-time-... confirms that at this point the rollout is facing potential trouble and needs billions more.

Re: Hacker News Folks Get Long Overdue Thanks

#133

Post by inopinatus » Sun, Jul 21, 2013, 9:17 PM UTC

tptacek wrote: post #70

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…

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

I wondered for a moment, "why is this relevant?" until I saw that you're responding to the parent's nationality.

Re: Hacker News Folks Get Long Overdue Thanks

#134

Post by Wingman4l7 » Sun, Jul 21, 2013, 11:35 PM UTC

WasimBhai wrote: post #93

drone wrote: post #57

Earlier quoted context omitted.

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.

Being a US citizen doesn't mean that you can just waltz into Europe. Like other commenters said, you usually need to be a citizen or at least some sort of permanent resident to take advantage of European healthcare. Obtaining such status usually takes years and is only possible for the young and highly employable.

Packing up and moving is simply not an option for those who cannot afford to pay for healthcare in the US in the first place, and oftentimes logistics like family, employment, and language would prevent that anyway.

Re: Hacker News Folks Get Long Overdue Thanks

#135

Post by Wingman4l7 » Mon, Jul 22, 2013, 3:32 AM UTC

jarek wrote: post #55

Symmetry wrote: post #45

Earlier quoted context omitted.

Well, we do already spend more than the UK on providing health insurance (divided by total population), but we're just providing it to seniors and poor people. The problem is the morass of laws we've accumulated around healthcare over the years for various reasons that now interact in complex ways that nobody foresaw. Like the law designed to make Medicare or Medicaid (I forget which) drugs cheaper that ended up maki…

In slightly less words and with slightly less accuracy, you're unwilling or unable to wipe the slate clean and start from scratch. To an extent I wonder how much of that is due to lack of recent experience with starting from scratch. The United States hasn't had a revolution, a war on its territory, or a regime collapse in a long time.

What first-world country has?

Re: Hacker News Folks Get Long Overdue Thanks

#136

Post by Wingman4l7 » Mon, Jul 22, 2013, 3:35 AM UTC

RockyMcNuts wrote: post #59

raganwald wrote: post #21

Earlier quoted context omitted.

Single-payer or government provided healthcare? Pretty sure that no one would identify the government as the picture perfect example of efficiency. Plus, putting elected officials or their appointees in charge of handing out goods and services doesnt seem to be sustainable. It seems odd to me that so many Americans seem pessimistic about their own government. I could understand if the attitude was, "We could make uni…

Well, Americans don't really vote, they prefer the government stay far away (imagine someone in Wyoming viewing a Federal solution kind of like Brussels solving Greece's health care problem), moneyed interests/cartels have a lot of sway, and some groups don't like paying for other groups' healthcare. Local solutions don't really work for medical care, in terms of the legalities and economic structure, you have to req…

> size and diversity work against us

I really think that people don't appreciate this fully for a lot of problems that the US has which have been 'solved' in other countries -- usually smaller European ones. Mail delivery, rail transportation, healthcare, etc. The US has a very unique blend of very urban and very rural areas that makes it hard to scale lots of services easily to everybody.

Re: Hacker News Folks Get Long Overdue Thanks

#137

Post by Wingman4l7 » Mon, Jul 22, 2013, 3:41 AM UTC

jw_ wrote: post #50

nwenzel wrote: post #11

Great story of compassion and triumph. So... How do we make it scale? Is it mandatory insurance? Insurance doesn't make everything affordable, but it probably wild have been helpful. Though maybe the co-pay would have been $50k. Universal tax-payer funded insurance? The term "tax payer" is interesting because politicians and pundits forget that we're all tax payers in one form or another. Granted some pay more, some…

Seriously, this is not an unsolved problem. The US spends more per capita than the rest of the world but has huge swaths of people denied basic care, and poor outcomes overall for an allegedly developed nation. There are a range of options available - look at any of the varied options successfully implemented by every other developed nation on Earth. Americans may choose to reject them based on ideological grounds, b…

> having your healthcare connected to your employment situation seems like insanity

It really is, although I don't think people realize it until you say it out loud. Precisely when you can least afford paying for a medical emergency -- when you're unemployed and thus have no income -- is precisely when it's most expensive. How broken is that? It would be insane in any other industry to charge your customer significantly more for the exact same service, simply because they're using a different payment method. Not to mention the horrible situation that arises if you acquire a medical condition so debilitating -- which usually also means it's expensive -- that it prevents you from working.

Re: Hacker News Folks Get Long Overdue Thanks

#138

Post by Wingman4l7 » Mon, Jul 22, 2013, 4:34 AM UTC

ippisl wrote: post #56

Symmetry wrote: post #46

Earlier quoted context omitted.

Part of the reason that the military is able to do a relatively good job providing healthcare is that they can do a lot of sensible cost-saving things that are illegal in most places. Like using nurse-practitioners instead of MDs where appropriate.

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(…

The lack of adoption of checklists has bugged me for a long time now. I actually haven't heard of them in regards to infection rates, but rather surgery mishaps (I think that was Gawande). It's really disappointing that something so simple, with such clearly positive results, has yet to become mainstream practice. We make our commercial pilots use them; I wish we would mandate that our surgeons used them, too.

Re: Hacker News Folks Get Long Overdue Thanks

#139

Post by jarek » Mon, Jul 22, 2013, 5:39 AM UTC

Wingman4l7 wrote: post #135

jarek wrote: post #55

Earlier quoted context omitted.

In slightly less words and with slightly less accuracy, you're unwilling or unable to wipe the slate clean and start from scratch. To an extent I wonder how much of that is due to lack of recent experience with starting from scratch. The United States hasn't had a revolution, a war on its territory, or a regime collapse in a long time.

What first-world country has?

Germany and Japan were rebuilt from the ground up after 1945, France is now on the fifth republic, Spain, Portugal, and Greece shed dictatorships in the 1970s, some of Eastern Bloc now qualify as first world and have undergone a major change in 1989-91...

Re: Hacker News Folks Get Long Overdue Thanks

#140

Post by parasubvert » Mon, Jul 22, 2013, 6:07 AM UTC

btilly wrote: post #132

parasubvert wrote: post #129

Earlier quoted context omitted.

Citation please. As of February, it was about $130 billion off over 10 years (i.e. $1.3 trillion vs. $1.17 trillion). That is not 'severalfold'. http://www.californiahealthline.org/articles/2013/2/6/cbo-up... And insurance premiums on ACA exchanges are coming in 20% lower than expected: http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPre... I do agree Republicans believe this thing is going to fail and are t…

The figure that I was comparing is the initial cost of setting up the exchanges in the first place. From memory it was estimated by the CBO at about 6 billion, but only 1 billion was allocated for it. That is several-fold, though only a drop in the bucket compared to the 10 year figures once it is rolled out. I can't easily find a citation for it right now though. But http://www.cbsnews.com/8301-250_162-57589988/smoo…

Thanks.

I have heard some republican state governors are pushing exchange setup to the Feds as part of their "gum it up" strategy, which may be pushing setup costs up. That said, as strange as it is to say, 5 billion is a relatively small number for the US government or the US economy.