[ExI] Health care in the USA

Damien Sullivan phoenix at ugcs.caltech.edu
Tue Jul 28 07:28:47 UTC 2009

On Mon, Jul 27, 2009 at 12:56:47AM -0500, Max More wrote:

>> 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
> Well, no doubt. Our FDA is probably more restrictive than agencies in  
> most other countries. Yet, the USA STILL does far more medical  
> innovation. Why is it so hard for you to admit that?

Because I have no particular reason to believe it is true.  It gets said
a lot, usually without any sourcing; your post was a rare exception.
And you said, IIRC, 75% of cancer drugs are developed or tested here.
Cool -- what about cardiac drug,s anti-depressants, surgical procedures,
etc.?  Is the cancer bit representative or cherry-picked?  I don't know,
and I generally don't have reason to believe that claims of overwhelming
US dominance are backed by evidence rather than naive belief in US
exceptionalism.  Conversely, I know that 6 of the top 8 pharm companies
are European
and that, off the top of my head, Ru-486 is a foreign-developed drug.  I
used to have another example but have forgotten it.

Then, of course, there's still the question of what such dominance would
mean if it were true -- as I said, there's unusual size and government
research backing to continue.  Also how many of individual drug
developments are real progress rather than trying to extend patent
monopolies with slight variations.

>> We're tied for almost-last place while spending twice as much?  That's 
>> nothing to crow about.
> I never said it was. The US system could and should be much better.

Well, yes, and one way it could be better is in imitating other
countries.  There's a couple dozen different variations by now.

Or we could try some novel high-market version.  Not impossible, but
there's a high bar to argue that it would not only work but would work
better than any of the existing models of universal health care.

>> Now, if we compare to Sweden, we get to look really embarassing...
> But that's just not a sensible comparison. There are vast demographic  
> differences between Sweden and the USA. Just one of those is the  
> difference in immigration from poorer and less healthy countries.

Point.  OTOH, Sweden's been taking in a lot of immigration from such
countries.  And the US doesn't look that good even when you look just at
white Americans -- as I think you yourself noted, and as I found when I
collected my own statistics, doing so just lets us catch up with the UK
or Germany, at the low end of the socialized medicine performance scale.

Now, there's always lifestyle stuff -- we smoke less, but are fatter,
and perhaps more importantly may be less fit, eat less fish, etc.
(Denmark is rather lower than Norway and Sweden.)  OTOH, given all the
research on the bad effects of chronic stress and low socioeconomic
status (even controlled for spending) I was seeing a while back, simply
having universal health care, or more generally a strong social
democracy, might itself be a relevant lifestyle difference.  Simply
knowing that one would be taken care of if sick, and not at risk of
bankruptcy, might help prevent people from getting sick.

(Not to mention that I always found it odd to counter "US health
care is broken" with effectively "no, it's great, but the entire way of
life is broken[1]" instead.)
[1] Probably a good point to note that we're only talking a spread of
3-4 years of life expectancy.  Though 5-6 years in "healthy life
expectancy".  Still, the strong point is not "we're broken" but "we
spend far too much while underperforming, while socialized medicine of
various stripes seems to work just fine.")

-xx- Damien X-) 

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