[extropy-chat] Health data

[Rafal Smigrodzki]

On 6/16/06, Damien Sullivan <phoenix at ugcs.caltech.edu> wrote:
> On Fri, Jun 16, 2006 at 12:02:14PM -0700, Eliezer S. Yudkowsky wrote:
> > ...didn't Robin Hanson just get through presenting the evidence that
> > increased healthcare spending does squat to decrease mortality?
>
> Yep.
>
> Did that cause anyone to decide to not go see the doctor the next time
> they're sick?  Will you, Eliezer, skip the doctor's office?  Will Robin
> refrain from taking his children there (assuming his wife would let
> him)?
>
### I think you are missing the point, Damien. Eliezer is not
necessarily saying that healthcare spending makes no difference in
health (which is the extreme part of Robin's opinion). Instead, he
says that the marginal spending on healthcare makes no difference, and
I heartily agree with him (and Robin).

As I previously argued on this and other lists, after paying for
vaccinations, blood pressure medications, kidney dialysis, and a few
other interventions with very good cost-to-benefit ratios, there is a
whole lot of therapies, and a humongous number of diagnostic tests,
with almost no impact on health or survival. As a purely intuitive
assessment based on the observation of my own practice patterns, this
spending may account for at least 1/3 of the total spending, and could
easily surpass the 50% mark. You could cut at least 2/3 of the imaging
studies I order daily by the dozen (well, almost) and there would be
only a small difference in survival. The amount of money spent without
paying attention to the cost-benefit ratios is immense.

I see two conclusions from the above:

1) Do go the doctor if you want to stay healthy but if you happen to
pay for it yourself, be very, very demanding about justifications for
every 1000$ that the good doc may have you spend on his salary. Of
course, if the other insured or the taxpayers pay, indulge yourself,
since there ain't no free lunch anywhere else.

2) All attempts to justify one's own idea of social justice by
comparing national spending patterns and outcomes are silly. Most of
the spending is useless anyway, and the overall impact of medicine is
further obscured by quite substantial differences in lifestyle factors
and other issues.

Socialists like to compare the US with Sweden but it's useless since
both countries are rich enough to pay for the useful, basic
healthcare, and differ only in the amount of fluff they offer on top
of that and in their ethnic makeup. Instead, if you want to see real
differences relevant to healthcare spending levels, try to compare the
socialized medicine in Sweden with the socialized medicine in Russia,
or maybe North Korea, or maybe Saudi Arabia.

Rafal