[ExI] Transhumanism and Politics

[J. Andrew Rogers]

On Jan 26, 2008, at 1:10 PM, BillK wrote:
> On Jan 26, 2008 8:44 PM, J. Andrew Rogers wrote:
>> It is an inconvenient truth that healthcare outcomes as a function of
>> income follow the same general distribution across the healthcare
>> models of the industrialized world.  The solution is not to attempt  
>> to
>> equalize outcomes, which would almost certainly be futile or reduce
>> mean outcomes, but to maximize the average outcome given the  
>> resources
>> at hand.
>>
>> The US has the best average outcomes in the world by substantial
>> margin; an interesting question is whether or not the European  
>> systems
>> would produce similar outcomes if they had as much money to spend per
>> capita.
>>
>
> I'd be interested in how you measure this claim.


Healthcare outcomes i.e. disease and injury survival rates, diagnostic  
accuracy, etc.  Direct measures of medical performance.  A favorite  
point in discussions of healthcare economics is that cancer survival  
rates in the US are commonly 20-40% higher than in Europe almost  
across the board, and no single European (or other) country comes  
close.  This same pattern holds for a lot of other healthcare  
statistics.

The US healthcare model may be Byzantine and inefficient -- I do not  
think anyone disputes that -- but the one thing it has going for it is  
that it leaves the competition in the dust when it comes to diagnosing  
and treating serious medical conditions for the average person.  Since  
that is what I am actually paying the medical system to deliver, it  
cannot be casually waved away.


> I haven't noticed the people who do the stats like the UN, WHO, etc.  
> agreeing.
>
> It is certainly not in average life expectancy, where the US is No. 45
> in the table.


Those do not control for demographic, genetic, or environmental  
factors and are therefore useless for determining the effectiveness of  
medical care.  Direct statistics of medical outcomes show a very  
different picture.

- Asians in industrialized Asia have the longest life spans in the  
world -- except for Asians in the US.  This is a common pattern.

- Average life expectancy is significantly skewed in the US due to the  
atypically high incidence of automobile accidents and a few other  
environmental factors that do not reflect medical care per se.  If you  
remove these environmental factors from the statistics, Americans have  
an atypically high life expectancy in the industrialized world (the  
highest in fact, depending on how you measure it).

- Infant mortality rates in the industrialized world, along a similar  
lines, are almost purely a function of ethnicity and genetics, and  
some ethnic groups have integer factor higher *genetic* predisposition  
for miscarriage.  The US has much higher concentrations of high-risk  
genetic groups in its population than other industrialized countries,  
and the country-wide statistics pretty closely reflect the ethnic  
distribution.

To make it plainer, if you look at individual US states, you find that  
the US contains among the very highest and lowest life expectancy and  
infant mortality rates in the industrialized world, again following  
the distributions expected due to demographic, genetic, and major  
environmental factors.  The US rate is the average of a very broad  
distribution.


In short, the UN and WHO are not measuring healthcare outcomes, they  
are measuring demographics and environmental factors, and medical care  
is only a small contributing factor.  In fact, the US would have poor  
outcomes if it was not for the fact that US healthcare outcomes  
compensate by substantially outperforming the rest of the  
industrialized world.

Remember, I am talking about *healthcare outcomes* i.e. how well does  
the medical establishment deliver the products we are paying them to  
deliver.  Metrics like life expectancy and infant mortality only  
capture that very poorly because in many countries those are a  
function of things that have nothing to do with medical care.

Cheers,

J. Andrew Rogers