Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

"Life Expectancy" Doesn't Measure How Long You're Expected To Live

blog.edwardmarks.com

Post reply on HN
Print view View original

81–89 of 89 posts

Re: "Life Expectancy" Doesn't Measure How Long You're Expected To Live

#81

Post by barry-cotter »

philwelch wrote: post #62
tptacek wrote: post #42

Earlier quoted context omitted.

Correlate the cancers in which the US is ahead of 2 out of 3 of France, Germany, and the UK, to the cancers that kill the most people (incidence and mortality). Pull out lung cancer, for which there is a clear causal explanation. Now compare that result to life expectancy rankings. That's the point I'm making.

Do Europeans really smoke less than Americans? I was under the impression that the US was unusually anti-smoking.

Cigarette advertising is still legal in the USA right? And a packet of cigarettes costs less than an hours work at minimum wage because the taxes aren't that high, right?

Re: "Life Expectancy" Doesn't Measure How Long You're Expected To Live

#82

Post by ableal »

barry-cotter wrote: post #80
makomk wrote: post #73

Earlier quoted context omitted.

Surely the rate of death from both accidental injuries and violent crime is affected by access to emergency medical care, though? You can't disentangle the two that easily.

That's right. If trauma medicine was still at the levels of the 70's the US murder rate would be about five times higher than it is.

That quiet little phrase may be the most intriguing thing I read all year.

Looking at things like http://en.wikipedia.org/wiki/Crime_in_the_United_States, it implies that the US murder rate would have doubled, rather than halved.

I'd suggest it is worth a separate post.

Re: "Life Expectancy" Doesn't Measure How Long You're Expected To Live

#83

Post by ableal »

yummyfajitas wrote: post #6
tptacek wrote: post #4

This is a great post. Because I'm a nerd, I'm compelled to make an orthogonal point: Life expectancy is not entirely medical and is not a particularly good way to compare countries. Consider that among the top causes of death in the US are "accidents" (predominantly motor vehicles) and suicide, both of which are anomalously high in the US. Consider also that if you go to the top US cause of death (heart disease, clea…

Slight nitpick - accidents are not a top cause of death in the US, they are merely a top cause of early death. But this has a disproportionate effect on low life expectancy, because early death has a disproportionate effect on life expectancy stats. 1 person dying at age 20 (instead of 80) has the same effect on life expectancy as 60 people dying at age 79 (instead of 80).

Well, then the upcoming self-driving vehicles will give us another bump up in the life expectancy figure.

Probably some part of the vehicle deaths will "leak" over to other categories, but there should be an overall reduction.

Re: "Life Expectancy" Doesn't Measure How Long You're Expected To Live

#84

Post by Tyrannosaurs »

ef4 wrote: post #16
Tyrannosaurs wrote: post #3

Earlier quoted context omitted.

I think you're overestimating the number of people who benefit from even a major advance. In the UK (population 70 million), 28,000 heart bypass operations happen per year. The number of people who will have one is in the low single digits as a percentage of the population. Even for those people who do have one there is no guarantee that it will have a significant impact on their lives. Yes for some it will but for o…

> I can see it might not be constant over an extended period, but I don't think there are many, if any, things that would cause a significant spike. While it's hard to predict, I personally wouldn't bet against a game changing spike in the coming decades. It's only very recently that medicine has started riding Moore's law. Robotics and miniaturization are speeding up basic research by orders of magnitude. I don't th…

Interestingly I think the one thing that would cause a spike happened outside the last two decades - the discovery / development of antibiotics.

You may be right but there will still be bottlenecks in the process around patient trials and the more "manual" stages of any treatment.

I think the next big improvement will likely not register on life expectancy because it will be in response to a specific problem. The next generation of anti-biotics for instance will have a massive impact but will likely only cancel out the negative impact of drug-resistant strains of bacteria.

Re: "Life Expectancy" Doesn't Measure How Long You're Expected To Live

#85

Post by yummyfajitas »

tptacek wrote: post #77
yummyfajitas wrote: post #75

Earlier quoted context omitted.

The problem is that the US health care system routinely bankrupts patients. This is unclear as well. This stylized "fact" only became a talking point in the last election, and is drawn almost exclusively from a deeply flawed study by Elizabeth Warren. http://www.theatlantic.com/business/archive/2009/06/elizabet... http://www.theatlantic.com/business/archive/2010/12/will-hea... Among other flaws, the study doesn't mea…

Here is a list, I feel like it's fairly representative, of conditions that will generate an "automatic decline" for a regional health insurer. I chose it because it was the first on the Google SERP; I can be more rigorous if I need to be: http://echealthinsurance.com/health-insurance-advisor/wp-con... The fun stuff starts on age 18. A huge number of Americans have conditions with a "D" in the right-hand column, which…

Why do you have a hard time believing that our health care system needlessly bankrupts people?

I'd like to see good evidence that it's a significant problem. You haven't provided any. No one I've asked has provided any, beyond Elizabeth Warren's study and the claim that it's "obvious".

As for "savvy way", it's paying in cash, up front. Prices magically drop when payment is convenient. In my experience, and those of the many uninsured people I know, it's that simple. I'm going to speculate that you don't know very many uninsured people...

(Sadly, there is little data on this. If you have some, I'd love to see it.)

Re: "Life Expectancy" Doesn't Measure How Long You're Expected To Live

#86

Post by manifold »

xm1994 wrote: post #2

Thanks for making me realize I've been using life expectancy tables incorrectly for most of my life. One comment regarding the yearly progress of the cohort rate. I would think this would fluctuate with significant medical advances (e.g. the first few years that bypass surgery/artificial hearts started to be used). I can't see how medical progression is perfectly linear at 1.0%/year.

It's not perfectly linear in the short term, though what tends to happen is a longer-term cyclical effect rather than spikes.

This makes sense - medical advances won't be widely adopted immediately, then there will be a gradual acceleration of adoption (and improvement rate) once its benefits are proven and costs come down, and then no further contribution to improvements once wide adoption is the norm.

What you also tend to see is that advances affect improvements by year of birth more prominently than by year of discovery. In the UK we have a 'golden cohort' for example, which you could Google for more info.

Spikes do tend to occur during and after big causes of death (spanish flu, world wars) as the improvement rate drops sharply and then recovers again.

Re: "Life Expectancy" Doesn't Measure How Long You're Expected To Live

#87

Post by philwelch »

barry-cotter wrote: post #81
philwelch wrote: post #62

Earlier quoted context omitted.

Do Europeans really smoke less than Americans? I was under the impression that the US was unusually anti-smoking.

Cigarette advertising is still legal in the USA right? And a packet of cigarettes costs less than an hours work at minimum wage because the taxes aren't that high, right?

No, and no. Also, it's invariably illegal to smoke indoors or within 10 feet of a building entrance. And there is constant anti-smoking propaganda. And people on the street will make negative comments about you smoking.

Re: "Life Expectancy" Doesn't Measure How Long You're Expected To Live

#88

Post by Retric »

lotharbot wrote: post #79
tptacek wrote: post #77

Earlier quoted context omitted.

Here is a list, I feel like it's fairly representative, of conditions that will generate an "automatic decline" for a regional health insurer. I chose it because it was the first on the Google SERP; I can be more rigorous if I need to be: http://echealthinsurance.com/health-insurance-advisor/wp-con... The fun stuff starts on age 18. A huge number of Americans have conditions with a "D" in the right-hand column, which…

I submit that the system does needlessly bankrupt some people, but there are also a number of alternatives which allow a large percentage of the uninsured to avoid such a fate. If I may submit two personal stories in place of rigorous data: my incredibly poor sister recently injured herself and was facing nominal charges of about $40,000. She was able to get that written down to a few grand and then get donations fro…

They might not call it heath insurance, but it still is de facto heath insurance. Also, nominal charges of 40k is small potatoes in the healthcare world, that can literally be a few days of moderate care in some hospitals. However, a lot of medical bankruptcys are around end of life care, where medicare forces people to 'go broke' before picking up the rest of the tab.

PS: I have awesome medical coverage, that limits out of pocket expenses to 2k per year with an unlimited sealing. However, many plans cap lifetime expenditures to 1million in coverage because people really do spend that much and far more.

Re: "Life Expectancy" Doesn't Measure How Long You're Expected To Live

#89

Post by lotharbot »

Retric wrote: post #88
lotharbot wrote: post #79

Earlier quoted context omitted.

I submit that the system does needlessly bankrupt some people, but there are also a number of alternatives which allow a large percentage of the uninsured to avoid such a fate. If I may submit two personal stories in place of rigorous data: my incredibly poor sister recently injured herself and was facing nominal charges of about $40,000. She was able to get that written down to a few grand and then get donations fro…

They might not call it heath insurance, but it still is de facto heath insurance. Also, nominal charges of 40k is small potatoes in the healthcare world, that can literally be a few days of moderate care in some hospitals. However, a lot of medical bankruptcys are around end of life care, where medicare forces people to 'go broke' before picking up the rest of the tab. PS: I have awesome medical coverage, that limits…

> "it still is de facto heath insurance"

But without "automatic decline" conditions, which were critical to tptacek's point.

> "nominal charges of 40k is small potatoes"

Sure. But the cover story of CHM's latest newsletter [0] is a woman with a $300k bill that was reduced to $20k. Elsewhere in the newsletter is a request for donations to cover about $60k of a bill that has had $200k of reductions. There are, occasionally, bills that break the $1 million mark, though they usually come with reductions in the $500k+ range. Point being, very substantial reductions and charitable donations are common.

Again, I'm not specifically defending the status quo. I'm just saying, there are definitely options that allow some people with pre-existing conditions or catastrophic illness to avoid bankruptcy.

[0] https://www.chministries.org/downloads/newsletters/CHMSeptem...

Post reply on HN