Health Care: What Is It Good For?

Brian Doherty | September 19, 2007

A lot less than you probably think, says economist Robin Hanson.

While we are thinking about Hillary Clinton's latest plan that promises to get more health care to more Americans, let's ask: What's so damn great about health care anyway?

Here's part of what Hanson's saying, over at Cato Unbound:

Our main problem in health policy is a huge overemphasis on medicine. The U.S. spends one sixth of national income on medicine, more than on all manufacturing. But health policy experts know that we see at best only weak aggregate relations between health and medicine, in contrast to apparently strong aggregate relations between health and many other factors, such as exercise, diet, sleep, smoking, pollution, climate, and social status. Cutting half of medical spending would seem to cost little in health, and yet would free up vast resources for other health and utility gains. To their shame, health experts have not said this loudly and clearly enough.

Non-health-policy experts are probably shocked to hear my claims. Most students in my eight years of teaching health economics have simply not believed me, even after a semester of reviewing the evidence. Heroic medicine is just too central to our culture, a culture where economists like me have far less authority than doctors. Worse, even most standard textbooks in health economics fail to make the point clearly....

So I want to say loudly and clearly what has yet to be said loudly and clearly enough: In the aggregate, variations in medical spending usually show no statistically significant medical effect on health. (At least they do not in studies with enough good controls.) It has long been nearly a consensus among those who have reviewed the relevant studies that differences in aggregate medical spending show little relation to differences in health, compared to other factors like exercise or diet. I not only want to make this point clearly; I want to dare other health policy experts to either publicly agree or disagree with this claim and its apparent policy implications.

The most important such policy implication is: we should be spending less on medicine as a nation--perhaps even half as much.

How should we cut medical spending? There are many possibilities, and I may prefer some possibilities to others. But I do not want such preferences to distract from the main point: most any way to implement such a cut would likely give big gains.

After giving detailed accounts of many of the studies and data that support his controversial contention--read the whole thing--Hanson knows you are wondering: Why is almost everyone so mistaken on such a vital matter?

If you wonder how the usual medical literature could give such a misleading impression of aggregate medical effects on health, I will point to funding and publication selection biases, statistical tests ignoring data mining, leaky placebo effects, differences between lab and field environments, and the fact that most treatments today have no studies. If you wonder how medicine could suffer so much more from such problems than other subjects, I’ll point you to my forthcoming Medical Hypotheses article, wherein I suggest humans long ago evolved a tendency to use medicine to “show that we care,” rather than just to get healthy.

Back in 2000, before I was familiar with Hanson's arguments, I made a similar point in comedic form over at Suck.com

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Bill Pope|9.19.07 @ 10:54AM|#

This is not really surprising as a hugely disproportionate amount of health care dollars are spent on elderly patients during the last months of their lives. The trouble is, would you say no to such treatments when you or someone you love is the patient?

|9.19.07 @ 10:55AM|#

I bet this post was very interesting, but I did not read it because I could not read the whole thing. The website's designers have apparently decided to have ads for Fred Thompson and celebrations of Ayn Rand ON TOP OF the text, instead of off to the side.

I do not like to guess at what the covered-up words are. It makes reading the post take too long.

|9.19.07 @ 10:56AM|#

"Heroic medicine is just too central to our culture...."

If we treated Doctors more like plumbers, health care would improve, and prices would fall. My new solution; money-back guarantees.

|9.19.07 @ 11:01AM|#

I've long contended that the real, unsung heroes of 1st world's increased life expectancy are the engineers and workers who designed and built modern water and sewage systems. Extrapolating that to the 3rd world raise the question, are the World Health Organization and similar charitable agencies spending the dollars wisely?

Dave Woycechowsky|9.19.07 @ 11:04AM|#

If you just have to hate on professionals, perhaps it is time to take some of that hatred of lawyers and put it on doctors instead. They are the ones actually getting your money for little utility in return.

. . . "publication selection biases": Paging, T. If you won't listen to me, hopefully Robin Hanson can get thru. This is an especially important point for you in particular.

|9.19.07 @ 11:04AM|#

"many other factors, such as exercise, diet, sleep, smoking, pollution, climate, and social status."

The last three problems are ones with no easy short-term solutions. The first four may be treated with preventive care, i.e. going to the doctor for a regular check-up may prevent more costly medical problems later on.

Student of Public Health|9.19.07 @ 11:07AM|#

Anyone remember the phrase "an ounce of prevention is worth a pound of cure"? Public health professionals would readily tell you that preventive health care is often less expensive and more effective than traditional curative medicine.

|9.19.07 @ 11:12AM|#

I don't see any way to stop the coming explosion in health care spending. HRC is most likely to be the next POTUS. No matter how strong Hanson's thesis is, no politician will ever dare acknowledge it.

The Extispicator|9.19.07 @ 11:16AM|#

To hell with all these "studies" and "data."

When I get the sniffles, I want to go to the emergency room and have a person with 20 years of education tell me to eat some chicken soup, take some NyQuil, and - if I'm pushy enough - give me antibiotics that are completely ineffective for the virus I have.

Cost? Who cares how much it costs! Gimme my amoxicilin!!

|9.19.07 @ 11:24AM|#

After everything is said and done in this election, a few insightful folks may soon recognize the Iraq War as the most serious thing threatening the future of the USA. I hope your readers have read New Mexico Governor Bill Richardson's op/ed piece from the Washington Post on how and why we must get out of Iraq, from about 11 days ago.If not, here it is, in full, after a few introductory remarks by me:

There is a much larger scale confrontation with Bush from the candidates regarding the Iraq War and the problems it is continuing to cause, after six years of Halliburton and Brown and Root and Blackwater corporate kleptocracy. Only one candidate, it is abundantly clear to me, is really slamming the truth and providing the logistics and rationale for ending this disastrous war: Bill Richardson. This article was printed in the Washington Post about 10 days ago, and please take the time to read it:

_______________________

Why We Should Exit Iraq Now

By Bill Richardson
Saturday, September 8, 2007; A15

Hillary Clinton, Barack Obama and John Edwards have suggested that there is little difference among us on Iraq. This is not true: I am the only leading Democratic candidate committed to getting all our troops out and doing so quickly.

In the most recent debate, I asked the other candidates how many troops they would leave in Iraq and for what purposes. I got no answers. The American people need answers. If we elect a president who thinks that troops should stay in Iraq for years, they will stay for years - a tragic mistake.

Clinton, Obama and Edwards reflect the inside-the-Beltway thinking that a complete withdrawal of all American forces somehow would be "irresponsible." On the contrary, the facts suggest that a rapid, complete withdrawal - not a drawn-out, Vietnam-like process -would be the most responsible and effective course of action.

Those who think we need to keep troops in Iraq misunderstand the MiddleEast. I have met and negotiated successfully with many regional leaders,including Saddam Hussein. I am convinced that only a complete withdrawal can sufficiently shift the politics of Iraq and its neighbors to break the deadlock that has been killing so many people for so long.

Our troops have done everything they were asked to do with courage & professionalism, but they cannot win someone else's civil war. So long as American troops are in Iraq, reconciliation among Iraqi factions is postponed. Leaving forces there enables the Iraqis to delay taking the steps to end the violence. And it prevents us from using diplomacy to bring in other nations to help stabilize and rebuild the country.

The presence of American forces in Iraq weakens us in the war against al- Qaeda. It endows the anti-American propaganda of those who portray us as occupiers plundering Iraq's oil and repressing Muslims. The day we leave, this myth collapses, and the Iraqis will drive foreign jihadists out of their country. Our departure would also enable us to focus on defeating the terrorists who attacked us on Sept. 11, those headquartered along the Pakistan-Afghanistan border - not in Iraq.

Logistically, it would be possible to withdraw in six to eight months. We moved as many as 240,000 troops into and out of Iraq through Kuwait in as little as a three-month period during major troop rotations. After the Persian Gulf War, we redeployed nearly a half-million troops in a few months. We could redeploy even faster if we negotiated with the Turks to open a route out through Turkey.

As our withdrawal begins, we will gain diplomatic leverage. Iraqis will start seeing us as brokers, not occupiers. Iraq's neighbors will face the reality that if they don't help with stabilization, they will face the consequences of Iraq's collapse - including even greater refugee flows over their borders and possible war.

The United States can facilitate Iraqi reconciliation and regional cooperation by holding a conference similar to that which brought peace to Bosnia. We will need regional security negotiations among all of Iraq's neighbors and discussions of donations from wealthy nations - including oil- rich Muslim countries - to help rebuild Iraq. None of this can happen until we remove the biggest obstacle to
diplomacy: the presence of U.S. forces in Iraq.

My plan is realistic because:

It is less risky. Leaving forces behind leaves them vulnerable. Would we need another surge to protect them?

It gets our troops out of the quagmire and strengthens us for our real challenges. It is foolish to think that 20,000 to 75,000 troops could bring peace to Iraq when 160,000 have not. We need to get our troops out of the crossfire in Iraq so that we can defeat the terrorists who attacked us on Sept. 11.

By hastening the peace process, the likelihood of prolonged bloodshed is reduced. President Richard Nixon withdrew U.S. forces slowly from Vietnam - with disastrous consequences. Over the seven years it took to get our troops out, 21,000 more Americans and perhaps a million Vietnamese, most of them civilians, died. All this death and destruction accomplished nothing - the communists took over as soon as we left.

My position has been clear since I entered this race: Remove all the troops and launch energetic diplomatic efforts in Iraq and internationally to bring stability. If Congress fails to end this war, I will remove all troops without delay, and without hesitation, beginning on my first day in office.

Let's stop pretending that all Democratic plans are similar. The American people deserve precise answers from anyone who would be commander in chief. How many troops would you leave in Iraq? For how long? To do what, exactly? And the media should be asking these questions of the candidates, rather than allowing them to continue saying, "We are against the war . . . but please don't read the small print."

The writer is governor of New Mexico and a candidate for the Democratic presidential nomination.

I can see how it's possible to spend too much on health care. Imagine the extreme case of getting a full body MRI every week as a check up and working 12 hours per day 7 days a week to pay for it. The stress from work and the lack of exercise time would do more damage than the weekly MRI could offset.

|9.19.07 @ 11:26AM|#

The website's designers have apparently decided to have ads for Fred Thompson and celebrations of Ayn Rand ON TOP OF the text, instead of off to the side.

There are ads on this site? May I introduce you to Firefox and Adblock?

fyodor|9.19.07 @ 11:27AM|#

There's really nothing shocking (or shouldn't be for anyone not living under a rock) about the notion that lifestyle choices play a major role in one's health. That said, I haven't generally heard this concept pitted against the use of health care assets in the way Mr. Hanson has done, which, along with his advocacy of cutting health care spending, is what raises the eyebrow. But then, maybe it's for good reason that I haven't heard these matters juxtaposed in such a way because it would seem they have little to nothing to do with each other. While it's true that I cannot go to the gym and the doctor simultaneously, there's no drop in their value if I go to them alternately. I don't see the either/or or why skipping a doctor's visit would improve my diet. As for the effect of cutting health spending to "free up resources," how is this to be accomplished? If he means cutting public, tax-supported health care spending, he would certainly have supportors here, though I don't know if our reasoning would be the same. And if he doesn't mean that per se, how does he propose to limit private spending? Whatever decisions an individual makes that affects his health however much more greatly than whatever happens once he decides he wants to see a doctor, an individual with a serious disease will want whatever resources are necessary and available (whereever they come from!) to be used to make him better!

Edward|9.19.07 @ 11:36AM|#

Aha, I see. If a guy gets cancer, he doesn't need a doctor. He needs to work on the factors--bad life style, low social status, bad climate, and polution--that gave him cancer in the first place. Fuck, let's just wait for the Messaiah, er, I mean Libertopia.

|9.19.07 @ 11:39AM|#

Mister Fox:

Please take your political spam and stick it in yer ass.

|9.19.07 @ 11:42AM|#

I wonder how much extra, ineffective medicine is utilized by people without health insurance who didn't go to the doctor regularly and ended up in the emergy with an advanced form of a disease which would have been cheap and easy to treat if found early?

Here's another heresy, healthy lifestyle education is a waste of money as well.

Smoking is bad for you.
Exercise is good for you.
A balanced diet is good for you.
Excessive recreational drug use is bad for you.
Wearing dark clothing while walking down the road is bad for you.
Working in coal mines is bad for you.
There's more, but you all know what they are.

Those adults who are unaware of these facts will hopefully die before they breed.

SPD|9.19.07 @ 11:44AM|#

Don't worry; when the Christian Scientists take over, medicine will be a thing of the past!

|9.19.07 @ 11:45AM|#

Mister Fox:

Please take your political spam and stick it in yer ass.

Seconded.

fyodor|9.19.07 @ 11:46AM|#

I should add that most of the lifestyle choices one can make that can affect one's health prospects cost very little (going to a gym being a relatively bad example), and that's another reason why I see little to no crowding out effect or interdependence between the two areas. It's not like people maintain bad health habits in order to save up money for seeing the doctor!

Your teacher|9.19.07 @ 11:46AM|#

Excessive recreational drug use...

...is a contradiction in terms.

|9.19.07 @ 11:47AM|#

"99% of patients get better in spite of treatment."

This was one of my father's favorite sayings and was perhaps his keenest observation of the observations of the medicine he practiced for the better part of half a century.

fyodor|9.19.07 @ 11:49AM|#

|9.19.07 @ 11:53AM|#

This could be self correcting, like most of our big problems, when the boomer population has dwindled. Right now we spend all of our money on old people and there are ever increasing numbers of old people. That won't always be the case.

Regarding preventive medicine, I wonder what all that entails. I mean, not smoking, exercising, and not eating like crap have to be the dominant considerations in improving public health. None of those things change with some sort of institutionalized preventive care regime.

|9.19.07 @ 12:00PM|#

JasonL,

*snap*

OK, now just relax, breath easily, and try not to think about "Deliverance."

There's some preventive medicine for ya!

|9.19.07 @ 12:01PM|#

It would be interesting to see if the correlation is any stronger or weaker in other countries.

|9.19.07 @ 12:06PM|#

How come people think its so hard to fix this?

Get rid of Medicare/Medicaid and tax health insurance the same as other income. Problem solved.

rho|9.19.07 @ 12:17PM|#

I've long contended that the real, unsung heroes of 1st world's increased life expectancy are the engineers and workers who designed and built modern water and sewage systems.

Between clean water, waste disposal and electricity, mere tradesmen have saved a bunch of lives.

A response to Hanson's article demonstrates that yes, 50% waste isn't that crazy an idea. Overly defensive medicine and administrative overhead are responsible for about 35% of cost overruns alone.

The non-stop yammering about "health care" and how the government is supposed to "fix" it is making me sick.

|9.19.07 @ 12:19PM|#

...health policy experts know that we see at best only weak aggregate relations between health and medicine, in contrast to apparently strong aggregate relations between health and many other factors, such as exercise, diet, sleep, smoking, pollution, climate, and social status.

A reason for this could be the strong emphasis that allopathic medicine places on treating the effects of disease, instead of emphasizing the importance of not becoming afflicted with avoidable diseases in the first place.

stoneymonster|9.19.07 @ 12:21PM|#

The non-stop yammering about "health care" and how the government is supposed to "fix" it is making me sick.

Perhaps you should see a doctor?

|9.19.07 @ 12:24PM|#

stoneymonster -
brilliant!

stuartl|9.19.07 @ 12:25PM|#

A serious flaw in the article is that it seems to only care about death rates, mortality, and overall spending. What about quality of life? I take allergy medications and get desensitization injections to make my life more enjoyable. Admittedly I wouldn't die if I didn't take them, but it makes my life better.

Why the hell should Hanson (or Hillary) be making decisions about my health or my use of medicines?

|9.19.07 @ 12:30PM|#

"But health policy experts know that we see at best only weak aggregate relations between health and medicine, in contrast to apparently strong aggregate relations between health and many other factors, such as exercise, diet, sleep, smoking, pollution, climate, and social status. Cutting half of medical spending would seem to cost little in health, and yet would free up vast resources for other health and utility gains"

What an amoral piece of shit. As Fyodor rightly points out, spending on prevention does not preclude spending on treatment. The assumption of the argument seems to be that the whole point of healthcare is to increase life expectancy so that we can all live longer and be better amoral corporate drones like this guy. I would argue that health care also serves the function of alieviating people's suffering and improving the quality of people's lives. Spending money on medicine to reduce nausia for people taking chemotherapy doesn't do a thing for thier life expentancy but it sure as hell increases their quality of life. Same goes for pain medicine. Treating someone with arthtritis or chronic pain is not going to extend their life expenancy. It just helps them live a better life.

What this guy is really saying is "why the hell spending all of this money treating sick people who are going to die anyway when we would be better off letting them die and saving the money?". I guess if you are totally amoral and completly indifferent to human suffering, that is a pretty compelling argument. For those of us who are human beings, however, it is pretty thin gruel.

|9.19.07 @ 12:32PM|#

I've long contended that the real, unsung heroes of 1st world's increased life expectancy are the engineers and workers who designed and built modern water and sewage systems.

Spot on, not to mention improvements in transportation, specifically referigerated transport, which makes fresh meat and produce available year round.

|9.19.07 @ 12:34PM|#

One other point. Treating anyone over the age of 50 or so for a serious illness will never pay for itself. If I get cancer when I am 55 and it takes a couple of million to put it into remission allowing me to live say another 15 years until I am 70 and die of other causes or a reoccurance of cancer, it is very unlikly my productivity for society will ever equal the amount of resources it took to save me. By Hanson's logic, society should have saved the money and let me die. Make if amoral corporate creeps like Hanson were ever allowed into any position of authority, those kinds of calculations would be made and if you had the misfortune of being sick and old, you would be screwed.

|9.19.07 @ 12:47PM|#

John -
WTF? That's not at all what he's saying. His premise is that medicine is mostly a feel-good-about-ourselves mechanism. On his own blog he argues how it's similar to the monkey trap, where you put food in a small hole in a coconut. We can't let go of the idea that medicine makes everyone better off even if the evidence says otherwise. It just feeds the "we need to do something!" mentality, even if doing something doesn't actually do anything.

Mike Laursen|9.19.07 @ 12:53PM|#

My new solution; money-back guarantees.

Some TV show I was watching the other day claimed that Chinese tradition is to pay the doctor only if he cures you. I saw it on TV, so it's probably true.

|9.19.07 @ 12:55PM|#

A reason for this could be the strong emphasis that allopathic medicine places on treating the effects of disease, instead of emphasizing the importance of not becoming afflicted with avoidable diseases in the first place.

It's unfair to put all the blame on the physician. Most of primary care is preventive medicine and psychiatry, with a little dermatology thrown in. One of the reasons that preventive medicine has problems is because people don't go to the doctor until they get sick. A lot of available preventive care is simply not utilized by people who take their health for granted until something goes wrong.

|9.19.07 @ 12:56PM|#

Some TV show I was watching the other day claimed that Chinese tradition is to pay the doctor only if he cures you. I saw it on TV, so it's probably true.

I thought it was Chinese tradition to pay the doctor only when you continued to be well, and he worked for free when you were sick.

|9.19.07 @ 12:57PM|#

"Cutting half of medical spending would seem to cost little in health, and yet would free up vast resources for other health and utility gains."

As judged by what? In Hanson's view it is judged strictly by life expectancy. That is bullshit. Yes, we could save money by stopping throwing away resources on hopeless cases. But how much money? and what cases?

miche|9.19.07 @ 12:59PM|#

I've not read all the comments yet, but as the wife of a practicing physician, I can attest to the fact that there are unrealistic expectations on the part of patients. They go to the doc with an ailment that should just run its course, but get pissed if the doc doesn't prescribe some sort of medication to cure the ailment. Then the patient heads to Walgreens to fill the Rx that is really unneeded but isn't compliant with the med course anyway. Insured patient thinks this costs $30. Uninsured patient sees the true cost but is now pissed that somebody got a "better deal" for the care. Congress gets involved but nobody is looking at the real problem. The ailment required no f'ing medical treatment.

Everybody involved is complicit in skyrocketing costs and new little resistant strains of germs. And that is just one facet of brilliant cut problem.

I'm so happy that my husband only sees acutely ill patients; ones that are hospitalized and truly need medical intervention. He is not part of the problem.

|9.19.07 @ 1:00PM|#

"I've long contended that the real, unsung heroes of 1st world's increased life expectancy are the engineers and workers who designed and built modern water and sewage systems."

I've used this idea to the shock of my school teacher girlfriend's compatriots whenever they have moaned on about not being paid in accordance to their worth to society. They never seem to be able to grasp the idea that if people were paid in accordance to their importance to society that the garbage men and sewage treatment plant operators would be among the best paid of all workers.

People, if they managed to live past twelve, used to live nearly as long as they to today 300 years ago; the heroic treatment that extends an eighty year olds life another year is statistically insignificant. Having clean water that allows a one year old to not die of dysentery and live to 65 has a dramatic effect on the "median life expectancy from birth" statistic.

|9.19.07 @ 1:07PM|#

"As judged by what? In Hanson's view it is judged strictly by life expectancy. That is bullshit. Yes, we could save money by stopping throwing away resources on hopeless cases. But how much money? and what cases?"

John,

I wonder the same thing. My son has cystic fibrosis and is a hopeless case in the long-term. I wonder at what point Hanson would suggest that the treatment be cutoff to my son. He's not quite twenty now and with treatment he is unlikley to see 50, without treatment 30. Should we cut our losses and stop spending money on him now?

There are a number of comments that are making some assumptions:
"Preventive care will save money"
There have been quite a few sudies written on the subject. There are specific public health interventions that give remarkable returns - vaccines, clean water, discouraging smoking. But health insurance is not one of them. For example, a study of diabetics found that more intervention not only did not save money, but resulted in MORE amputations
2. "Health care is good" Most people do not have the day to day experience and education to understand that many medical interventions are of extremely dubious utility. Remember treating menopause with estrogen? Vioxx? tonisilectomies? It isn't only because of self interest in pecuniary gain, but more profound - who doesn't, when they are sick or dying, want to believe that an intervention won't help? Look at the amount of money spent on supplements.
I think national health insurance is coming, and like religion, if that gives comfort to the sick and dying, I'm all for it. But when I look at objective fact, it is doubtful that it will have any positive affect.

|9.19.07 @ 1:12PM|#

It's hard to get anoyone to show up for preventive care visits, free or not, and this is worse for people in lower socioeconomic classes who have jobs that are less flexible and tend to be, to put it bluntly, less educated about health issues. The issues with preventive care are more cultural than financial in the United States. We just don't like to go to doctors until we get sick.

|9.19.07 @ 1:18PM|#

"They go to the doc with an ailment that should just run its course, but get pissed if the doc doesn't prescribe some sort of medication to cure the ailment."

Miche,

I lived in the UK for a significant part of my adult life and was treated on NHS. The problem you describe is even worse in the UK. While I won't argue with the scenario you paint, as what you write most definitely is true for many patients, think on how it would be if health care was "free."

I know what happens. Rather than go to the chemist shop (UK name for drug store) and by some Nyquil, go to bed and let their body take care of the cold, because there is no charge to see a doctor and no charge for the medicine, the patients plug the doctor's office getting their "free" Nyquil after wasting the doctor's time. Then, since the doctor's time is wasted on treating colds, the doctor's have no time to properly examine actually sick kids like mine with what I now know to be obvious symptoms and they end-up not being treated for a life-threatening disease for eleven years. The NHS suxs worse than Mayor Omalley.

|9.19.07 @ 1:31PM|#

Tacos mmm... :

You've hit the nail on the head there. I'm remiss in my resposibilty to get a complete physical as we speak. In the military, personnel are ORDERED to get preventive care because many won't on their own. Cost is obviously not an issue there.

fyodor|9.19.07 @ 1:38PM|#

Miche,

Thanks for contributing and I understand your point that people see doctors for problems that doctors cannot relieve and are thus wasting money.

But I wonder what can be done about this and whether criticizing people for wasting money on doctors is akin to criticizing them for buying pet rocks or any other expenditure that could be seen as a waste. In other words, if this is what people want, it's what they want, in lieu of wholesale changes in society wide beliefs and attitudes. I don't see any way to directly address this other than to pass laws that determine when people can see their doctor and when they can't because it would be a waste of money. Naturally I would oppose such laws for a variety of reasons. This may or may not be how Hanson would cut health spending in half, but if not, I don't know how else he would do it. If he thinks people are wasting money because their health care is subsidized, I'm with him, but I don't see that argument in the quoted passage.

|9.19.07 @ 2:11PM|#

I'd like to see transparency in health care pricing.

A recent ultra-sound procedure I had done has a list price of $713.00 US. My insurance company ended up paying them $ 50.00 US.

|9.19.07 @ 2:16PM|#

Reason has always lauded medical advances as do I. However, sometimes the benefits are not worth the costs. The market where insurance premiums create unnaturally high demands on treatments causes researchers to introduce more and more products, with less and less benefit.

Alice Bowie|9.19.07 @ 2:59PM|#

An ounce of prevention is worth a bound of cure.

Ur Not going 2 get people to:
-- Stop Eating Steak
-- Stop Eating Pizza
-- Stop Smoking Cigareets
-- Stop Driving dangerously
-- Start working out
-- Start Eating Health

Plus...Many diseases like Diabetes, Heart Disease, and even cancer are passed on by parents to kids.

The Last thing any of us need is some Smart-Ass pushing that Healthcare be CUT in half.

The real problem doesn't exist with goin 2 the Dr. too much for a Pill. The real problem exists when u r dying of Cancer...and the insurance company refuses to cover u, the bills skyrocket, you loose ur entire net worth, and u die b-4 wining any lawsuit against the insurance co.

|9.19.07 @ 3:00PM|#

I don't think it's actually costs that are a problem here, lots of people piss away money on unnecessary shit, just look at the Starbucks corporation.

The promblem is will I be forced to insure people who will piss away my money unecessarily?

One poster stated that perhaps this is taking the place of religion for the sick and dying, but my church gets ten bucks a week, not 5% per paycheck or whatever Hillarycare will cost.

|9.19.07 @ 3:11PM|#

Several changes in our whole health environment, which our system hasn't really caught up with.

It used to be that the reason most people went to the doctor was for acute problems (broken leg, disease, appendicitis, etc.)

What we're now seeing is more and more medication/physician care going to treat chronic symptoms due to lifestyle choices--diabetes, heart disease, etc. This hasn't been helped by the fact that on the whole, the average American lifestyle is awfully unhealthy. We have to deliberately re-engineer our lifestyles (scheduled hours at the sports club, avoidance of the cheap-and-easily-accessible food, etc) in order to get the sort of health benefits that are automatic in countries that have different environments. (Try being fat in Tokyo--difficult because you end up walking everywhere.)

Japan ends up dealing with the chronic symptoms problem within its NHS by a) making it almost impossible to avoid health check-ups if you are working in any entity of any size whatsoever, and b) exhorting people over and over to carry out certain behavior. Since Japan has very much of a communal mentality, this goes over much better than equivalent marketing would in the US.

And yes, we're caught here in the US between the hypochondriacs who want the latest-and-greatest for the season's sniffle, and the slug-a-beds who wouldn't go to a clinic for a check-up if it would roll up to the door.

Is a puzzlement.

David Woycechowsky|9.19.07 @ 3:24PM|#

A recent ultra-sound procedure I had done has a list price of $713.00 US. My insurance company ended up paying them $ 50.00 US.

Sounds like you got your transparency and what you would really like to see is competitive pricing by dint of less market power for insurance companies.

|9.19.07 @ 3:25PM|#

One of the biggest problems is the aged + hopeless population in hospitals. By that I mean elderly people who are chronically ill, and have no chance of getting better.

I'm certain that a substantial percentage of health care costs go towards keeping these people alive. Obviously, anyone trying to fix this would run up against having to make the decision to stop life-saving treatment, which would have to be anathema to anyone trained in medicine.

|9.19.07 @ 4:27PM|#

Obviously, anyone trying to fix this would run up against having to make the decision to stop life-saving treatment,[or alternatively place them on a waiting list, which is how the Brits and Canadians handle the situation]

fyodor|9.19.07 @ 4:59PM|#

One of the biggest problems is the aged + ho[m]eless population in hospitals. By that I mean elderly people who are chronically ill, and have no chance of getting better.

I've heard anecdoters say those folks get the plugged pulled mighty quickly in countries with national health care. And then there's former Colorado Governor Dick Lamm's "duty to die" stuff.

|9.19.07 @ 4:59PM|#

Cutting half of medical spending would seem to cost little in health, and yet would free up vast resources for other health and utility gains

I thought this was a libertarian forum; this sounds like a prescription for a top-down reallocation of "wellness" dollars.

Sure, here's an example of people making seemingly irrational choices. Healthy people spend a ton of money on health insurance that they really don't need, and end up subsidizing sick people with almost limitless resources. You can say that much of the money spent on health care is wasted treating hopeless cases and those that have compromised their health through poor lifestyle choices. It doesn't really matter, even health freaks usually face some kind of debilitating illness at some point in their lives. (Their lifestyle simply shifts the odds around so that it's probably going to be later)
Might a rational, health-conscious, healthy person in their 20's or 30's be willing to pay 15%+ of their income to health insurance of one kind or another in order to maintain continuous coverage, with the expectation that when that day came, they'd be able to call on the vast resources of modern medicine to try to extend and enrich their lives?
I can see a place for the health insurance companies to encourage good behavior by taking lifestyle risk into account in their policies, but other than that, I don't see how you're going to get people to give up modern medicine (flawed as it is) in return for improved "exercise, diet, sleep, smoking, pollution, climate, and social status" (Much of which involves adopting a more ascetic lifestyle)

|9.19.07 @ 5:02PM|#

I'm sure that the hundreds of patients my wife has made pain-free due to her performing elective surgery would be surprised to hear that health care didn't really help them.

I'm kind of surprised to hear that the doctor cutting a lump of cancer the size of my fist out of my armpit wasn't really advancing my health, that I'd be just as healthy if I were ... you know ... dead.

Yes, much of people's health problems are due to their personal choices. Anyone studying statistics about how residents of Utah are the healthiest in the nation can probably deduce that the high number of Mormons in the state not smoking and drinking, etc. has something to do with that. But to say that it doesn't help much to use medicine to minimize the consequences of those unhealthy decisions? Bah.

|9.19.07 @ 5:20PM|#

I'm certain that a substantial percentage of health care costs go towards keeping these people alive. Obviously, anyone trying to fix this would run up against having to make the decision to stop life-saving treatment, which would have to be anathema to anyone trained in medicine.

Not really. It doesn't take long for physicians to see the pointlessness of much of the non-palliative end-of-life care that they do. It's the families that usually insist that death be dragged out on the slim hope that grandma might live and return to the nursing home for a few days before bouncing back to the hospital.

DannyK|9.19.07 @ 5:34PM|#

Libertarians are being a little inconsistent if they use public health arguments against expanded medical care, but otherwise disregard public health entirely -- I've heard libertarians say, "there is no such thing as 'public health', it's a collectivist illusion like 'social justice'."

Also, which half of medical spending does he propose to cut? Is there a neat dotted line somewhere in the economy that we can snip along?

|9.19.07 @ 6:03PM|#

"Social Justice" isn't an illusion, its an oxymoron.

miche|9.19.07 @ 7:06PM|#

But I wonder what can be done about this and whether criticizing people for wasting money on doctors is akin to criticizing them for buying pet rocks or any other expenditure that could be seen as a waste.

In the situation I described, the answer wouldn't involve limiting visits. It's about explaining that some things must simply run their course and, rather than forcing Americans to participate in a flawed pricing system, providing encouragement to take more responsibility for the cost. A big step in the cost arena would be getting away from employer and government sponsored healthcare coverage. For most people, it is less expensive to go, on their own, to an insurer for a plan that covers major events. The catch is this: you must plan for it. The deductibles aren't crippling and you can find something with OOPs as low as $1500. Insurance is designed to cover catastrophic events, not regular checkups.

It makes little sense to force people into a thousands of dollars per year plan for coverage of a $250 (before provider w/o) yearly gyno exam.

If we filed homeowner's claims every time we had to replace a doorknob or toilet stopper, we would see many people uninsured in that area too.

I know that this would not immediately work for every single person in this country, and those with sick children/spouses/parents have my sympathy. But forcing a change in the system and requiring others to participate in something not needed or desired because you are having a rough go at it isn't noble or sustainable.

Mike Laursen|9.20.07 @ 12:07AM|#

I've heard libertarians say, "there is no such thing as 'public health', it's a collectivist illusion like 'social justice'."

Rest assured that there are many libertarians that realize that epidemic diseases aren't stopped by political philosophizing. Of course, I'm talking about real diseases, not overblown nanny crusades.

|9.20.07 @ 3:48AM|#

It would be interesting to see if the correlation is any stronger or weaker in other countries.

Evra Klein has gone over this issue for a while (scroll down to April 2005 for some head-to-head comparisons). The thing that jumps out at you is that American health care spending is incredibly high compared to other developed nations (per capita $5,267 in 2002, compared to around $2,000-$3,000 for others), and yet Americans are not better off, healthwise, for all that spending (54th in fairness, 15th in goal attainment, and 37th in overall performance, 1997 WHO stats).

Americans are not getting a good deal for their money. It's as simple as that, and it is a mix of special interest lobbying, fear of change, confusion, and out-and-out pride that prevents us from changing course.

|9.20.07 @ 4:13AM|#

Anyone studying statistics about how residents of Utah are the healthiest in the nation can probably deduce that the high number of Mormons in the state not smoking and drinking, etc. has something to do with that.

As an aside, where can one find such statistics? I assume you do not mean a simple indicator like Average Life Expectancy, in which Utah ties Connecticut for the #3 spot (not to mention it also comes in behind those notorious smoking, drinking French and Germans).

I agree with you in specifics, however. We like to quote down-home jokes with made-up statistics like "99% of patients get better in spite of treatment," but oh, that 1%. It's the killer.

Good health care makes a difference. The question is, are Americans getting the best health care for the best price, and if not, why not?

|9.20.07 @ 6:16AM|#

fyodor & OMalleySux - I can believe the anecdotes, simply because the existance of a pre-determined course of action often makes it easier for people to make hard choices. Also, it protects the Docs in national health care systems against malpractice suits.

Tacos mmm - funny you should mention that. I remember when my grandmother passed at 84. She'd been very active until about 6 weeks before she died, and then after that she was bouncing back and forth between the hospital & nursing home. No one (including her) wanted to see her like that. The only thing I can think of about the "one more day" types is that a lot of people have unresolved issues they're deluding themselves can be solved with a deathbed conversation.

Somewhat OT, I also wonder how much of the aggregate figure of how much "Americans spend on health care" includes boob jobs, hair plugs, etc. I'm certain as a nation we WAY outspend eveyone else on elective, cosmetic procedures, and if these figures are included in with the health care totals, It could help provide a misleading idea of how inefficient american health care is.

|9.20.07 @ 7:06AM|#

joseph dietrich:

OK, perhaps I should have phrased it as "Utah is one of the healthiest, if not the healthiest, state because ..."

But, most measures of health you find will show Utah at or near the top of the health rankings, such as the link you provided, or this:

http://www.in.gov/itpc/files/research_90.pdf

Actually, time after time, when comparing statistics by state, and not just for health, Utah routinely winds up as an outlier near the top or bottom of the list, because the Mormon culture changes how people live their lives compared to more homogenized states.

Note that Hawaii topped the list you provided, with the AJAs leading the charge there. Eating a lot of fish and rice, and restricting calories, will tend to extend your lifespan.

Bottom line -- lifestyle matters greatly in determining your health.

|9.20.07 @ 5:11PM|#

Bottom line -- lifestyle matters greatly in determining your health.

Kind of. The most significant thing that the average person can do to improve their long-term health outlook is quit smoking. Most of the other measures that people take to improve their health are of such a small effect that they can only be measured statistically. Health, and lifespan in particular, mostly seems to be luck.

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