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Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

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Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#211

Post by yummyfajitas »

Fomite wrote: post #206
yummyfajitas wrote: post #200

Earlier quoted context omitted.

Halting a clinical trial when the result is clear is very different from skipping the clinical trial on the basis of a correlation study or two. Your comparison is so nonsensical that either you are being deliberately disingenuous or you don't understand statistics at all. Either way, no point in continuing this.

While we're on the topic, Bayesianwitch.com's description: "Your new homepage goes viral, but you aren't sure what copy is converting. Hook that copy up to BayesianWitch and only converting copy will be showing. No waiting days for the answers from an A/B test." Seems to imply a reliance on "correlational" data. Is there some hidden randomization in there? Or are you giving your clients a lower standard of evidence?

We are using a lower standard of evidence than medical decisions. The goal is to get as many clicks/conversions as possible in aggregate, most of the time. I.e., if you have a call to action ("3 day sale", "spring sale", "march sale") that dies in 3 days, we'll do the best we can to increase your conversions in those 3 days.

Similarly, if you have 10,000 seo-optimized microsites, each with traffic too low for a per-site A/B test, we'll improve your conversion rate across the 10,000 microsites.

If you want to make a long term change (e.g., logo, button color, feature) for a high traffic site (your one and only landing page) you are better off using a traditional A/B test.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#212

Post by lutusp »

saraid216 wrote: post #109
sehr wrote: post #61

Earlier quoted context omitted.

A lot, I hope! Strangelove is pretty well known for the most part across the internet. Fantastic movie

I watched it. I wasn't blown away. I don't remember it with enough detail to recognize random quotations.

> I watched it. I wasn't blown away.

Like many films, it hasn't aged very well. It relies on the atmosphere that existed at the height of the Cold War, and a certain atmosphere of darkness and paranoia that's less popular as a plot device in modern times. Also, for a modern audience it would have required better special effects, using methods that didn't exist at the time.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#213

Post by yummyfajitas »

Fomite wrote: post #207
yummyfajitas wrote: post #191

Earlier quoted context omitted.

A randomized controlled trial where we deprive people of health insurance? Yes. Before instituting Obamacare/Romneycare/$POLICY, we should have run a pilot program based on random assignment with clear predefined success metrics. But that's politically dangerous - after all, what if the experiment shows that $POLICY doesn't work? We did that, by accident, in Oregon (google Oregon Health Experiment). There were no sta…

If you refer to Table 2 of the NEJM article 'The Oregon Experiment — Effects of Medicaid on Clinical Outcomes', while none of the results are statistically significant, most of the effect measures are headed in the right direction. Someone who works for 'Bayesianwitch' should know better than to rely on p = 0.05 as the sole basis on which to evaluate something.

I also know better than to change the criteria after the study starts. A study was proposed. None of the critics of the study had anything negative to say about it until after the results were in - that's probably because they thought it would vindicate the 45,000 number.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#214

Post by Fomite »

yummyfajitas wrote: post #213
Fomite wrote: post #207

Earlier quoted context omitted.

If you refer to Table 2 of the NEJM article 'The Oregon Experiment — Effects of Medicaid on Clinical Outcomes', while none of the results are statistically significant, most of the effect measures are headed in the right direction. Someone who works for 'Bayesianwitch' should know better than to rely on p = 0.05 as the sole basis on which to evaluate something.

I also know better than to change the criteria after the study starts. A study was proposed. None of the critics of the study had anything negative to say about it until after the results were in - that's probably because they thought it would vindicate the 45,000 number.

Actually looking at the results isn't "changing the criteria", it's looking at the results in a more nuanced way than null hypothesis testing.

I would have said that looking at chronic health outcomes after just a few years was probably a losing proposition, and asked to see some power calculations, or a longer term analysis plan.

I've done so for other studies. Was actually grousing about one in a meeting...two weeks ago?

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#215

Post by XorNot »

protomyth wrote: post #181
rdl wrote: post #173

Earlier quoted context omitted.

The elderly (>65, or >62 in some cases, etc.) are already covered by medicare and social security. The disabled were covered by medicaid and ssi. Underemployed (part time, whatever) or sort-of-poor and not disabled people in their 50s are a major segment who can't pay the real cost of their medical care, though. Or, people with lifelong expensive illnesses in the 0-64 age range (who are often making a lot less money…

Medicare does a good job with hospital visits but has some serious holes in the drug buying. Those in their 50's should have had some cash built up from earlier savings, but they spent it all on premiums instead of building up a hedge. Lifelong illnesses are something that we should just acknowledge as bad for insurance and deal with otherwise. Insurance should be for events and not continuous medical conditions. We…

The elderly don't suffer from "being old". They are simply more likely to suffer from various events, and have more complications, then younger people.

Being old is just a series of increasingly severe health events till one of them kills you.

Even people with dementia don't typically last longer then 10 years (which is the sort of time frame you're looking at for people who recover from cancer to stop racking up bills).

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#216

Post by arrrg »

twistedpair wrote: post #151
Crito wrote: post #56

Earlier quoted context omitted.

Hospitals do "let" uninsured people die because they are not obligated to provide the full extent of their care capabilities to people who cannot afford it. Come in with a hole in your abdomen, and for sure they'll patch you up even if you don't have insurance. Come in riddled with cancer? Don't expect the same as they would give somebody who could pay themselves or had insurance. This said, it is still a shoddy use…

> Come in riddled with cancer? Don't expect the same as they would give somebody who could pay themselves or had insurance. Ah, yes, the classic American healthcare problem. The poor person just gets to go to hospice and keel over. The rich person gets to limp along, endure 3 rounds of chemo, and spend the few remaining months of her life hooked up to machines in what is arguably a Pyrrhic victory and even lower qual…

Many people survive cancer or can at least add many years to their life with relatively high quality of life.

Many others don’t survive, obviously, but the chance of survival of many cancers really isn’t so bad.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#219

Post by shubb »

yummyfajitas wrote: post #191
Fomite wrote: post #186

Earlier quoted context omitted.

> It did not control for many factors that may be relevant (e.g. smoking). From the abstract: "After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use" > On the authors of the correlation study, who should never have studied this question without looking at extensive control variables or without mor…

A randomized controlled trial where we deprive people of health insurance? Yes. Before instituting Obamacare/Romneycare/$POLICY, we should have run a pilot program based on random assignment with clear predefined success metrics. But that's politically dangerous - after all, what if the experiment shows that $POLICY doesn't work? We did that, by accident, in Oregon (google Oregon Health Experiment). There were no sta…

Sorry, you seem to be suggesting that having insurance (access to non-emergency medical treatment) has no effect on life expectancy.

Which might be the case. You argue that Oregon showed that. Doesn't that paint medicine as a huge fraud, regardless who is paying for it?

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#220

Post by yummyfajitas »

shubb wrote: post #219
yummyfajitas wrote: post #191

Earlier quoted context omitted.

A randomized controlled trial where we deprive people of health insurance? Yes. Before instituting Obamacare/Romneycare/$POLICY, we should have run a pilot program based on random assignment with clear predefined success metrics. But that's politically dangerous - after all, what if the experiment shows that $POLICY doesn't work? We did that, by accident, in Oregon (google Oregon Health Experiment). There were no sta…

Sorry, you seem to be suggesting that having insurance (access to non-emergency medical treatment) has no effect on life expectancy. Which might be the case. You argue that Oregon showed that. Doesn't that paint medicine as a huge fraud, regardless who is paying for it?

No, it doesn't paint medicine as a huge fraud. For example, suppose people without insurance already do have access to non-emergency medical treatment. Then giving them insurance will not make them healthier - it will only make them wealthier.

So that's part of what happened - if you look at the data, both the control and treatment group did consume medicine. You don't need insurance to get treated. But medical consumption increased in the treatment group - it just didn't improve health. That suggests medicine has a point of diminishing returns, and people without insurance already consume enough to reach that point.

(Also, a caveat: the Oregon Experiment was too short to measure an effect on life expectancy. They measured several other proxy health measures instead.)

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