[ExI] Health care in the USA

[Damien Sullivan]

On Sun, Jun 28, 2009 at 12:15:08AM -0500, Max More wrote:

Yeah I'm late.

> better. (Although I'm not yet very familiar with it, the Swiss system 
> seems to be a good step in the right direction.)

The most expensive system outside the US, FWIW.

> are world class, including its best hospitals. The US has been the leader 
> in medical innovation. Waiting times are lower (for the insured and 

Because we'r emore capitalist, or because we're the biggest developed
country and have lots of government/university basic research, which
will tend to provoke commercial followup research for simple proximity?
What's the proper null hypothesis?

> others who can pay)--see below. Cutting-edge drugs and treatments are 

Some drugs and treatments may be.  Beta blockers weren't, though that's
the FDA.  But I've seen claims of other treatments where we're still
behind

so who's ahead in medical innovation
http://www.fivethirtyeight.com/2009/06/is-it-schlocky-to-compare-life.html#comment-1544514792743231363
http://www.fivethirtyeight.com/2009/06/is-it-schlocky-to-compare-life.html#comment-3917696977840885411
we do best in what Medicare covers
http://www.fivethirtyeight.com/2009/06/is-it-schlocky-to-compare-life.html#comment-2952612357548536066
cancer biases
http://www.fivethirtyeight.com/2009/06/is-it-schlocky-to-compare-life.html#comment-7645106338937392051

And we're pretty behind in unified electronic record management (apart
from the VA system, which is an innovator).  Which saves lives, not just
money.  (The VA can also do some cool research by looking at its
datasets and discovering dangerous drug trends quickly, and of course
getting people off those drugs in a unified way.)

> The Independent Review, if higher U.S. accident and homicide rates are 
> taken into account, our life expectancy numbers match those of Britain. 

I'm somehwat surprised and skeptical that those rates are high enough to
make much of a difference.  But even granting that, woo.  You can adjust
US rates so that we catch up with a country at the bottom of the
"socialized medicine" rankings and *spends half as much*.  We're tied
for almost-last place while spending twice as much?  That's nothing to
crow about.

http://mindstalk.net/socialhealth/

Now, if we compare to Sweden, we get to look really embarassing...

> In the JAMA study about twice as many Americans said that they?ve had 
> cancer than Britons, but the cancer incidence rates are not all that  
> different. Part of answer to the paradox of sick Americans versus healthy 
> Britons is that by resorting to more testing and more aggressive  
> doctoring we Americans get diagnosed with something more frequently. 

One thing I've heard is that the US tests for and treats prostate cancer
far more than other countries.  Thing is, most people with a small
prostate cancer are likely to die of something else first.  It's
unnecessary profit-driven procedures.

(Also see
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
)

> uninsured as being on an infinite wait. This just isn't right. Note that 
> about one third of Americans without health insurance have incomes over 
> $50,000. Many or all of them can get medical procedures, with the usual 
> very short US wait times. You don't HAVE to have insurance to get  
> treatment, you just have to pay up when you need it.

Which doesn't help much if the treatment costs $250,000.

> "Breast biopsy and hip replacement. Hospital executives were asked for 
> their perceptions of waiting times for breast biopsy and hip replacement 
> (Exhibit 3
> Go
> ). For both, U.S. executives reported by far the shortest waiting times, 
> followed by Australia."

Oddly, hip replacements are mostly paid for by Medicare.  Go-go US
government health care.

-xx- Damien X-)