Health Care Doesn't Affect Health (on the margin)(cato-unbound.org)
cato-unbound.org
Health Care Doesn't Affect Health (on the margin)
http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-in-half/
31 comments
Is "local wise-woman" an euphemism for a woman of negotiable affections? I don't understand how a woman possessing wisdom can help your fever.
Read "witch" or "herbalist" or "evidence-based medical practitioner unwilling to go by fads and humours".
There are four levels of health: how healthy you are, how much health care coverage you get, how much health care coverage insurance you have, and what percentage of the population has insurance.
We've been arguing that increasing the percentage of those with a certain level of health care coverage insurance would be good for aggregate health.
My intuition is that removing corn subsidies would have a greater effect - and the aggregate health of the world would drastically increase if you consider the African sugar farmer who can't sell to western markets because of regulations and subsidies. Ohh, and it would make money, not cost money.
We've been arguing that increasing the percentage of those with a certain level of health care coverage insurance would be good for aggregate health.
My intuition is that removing corn subsidies would have a greater effect - and the aggregate health of the world would drastically increase if you consider the African sugar farmer who can't sell to western markets because of regulations and subsidies. Ohh, and it would make money, not cost money.
> My intuition is that removing corn subsidies
Heck, why not go ahead and remove tobacco subsidies!
Heck, why not go ahead and remove tobacco subsidies!
Corn syrup isn't addictive. I think the cigarette market would be fine without subsidies. Of course, I agree completely to remove those limits.
I find it's like solving global warming like painting a roof white, or working from home - extremely cheap and obvious ways to change things. That governments don't choose these options is likely because their goal is power, not progress.
Removing subsidies, lowering regulation, legalizing pot, etc., would all be revenue generators and add to the public good.
I find it's like solving global warming like painting a roof white, or working from home - extremely cheap and obvious ways to change things. That governments don't choose these options is likely because their goal is power, not progress.
Removing subsidies, lowering regulation, legalizing pot, etc., would all be revenue generators and add to the public good.
> I find it's like solving global warming like painting a roof white, or working from home - extremely cheap and obvious ways to change things.
Except for the part that they don't work. For example, painting your roof white saves energy in some climates but not others.
> That governments don't choose these options is likely because their goal is power, not progress.
That's half correct. The goal is power but progress isn't something that govt opposes, it's something that doesn't matter either way.
Except for the part that they don't work. For example, painting your roof white saves energy in some climates but not others.
> That governments don't choose these options is likely because their goal is power, not progress.
That's half correct. The goal is power but progress isn't something that govt opposes, it's something that doesn't matter either way.
There are four levels of health: how healthy you are, how much health care coverage you get, how much health care coverage insurance you have, and what percentage of the population has insurance.
Uh, the last three aren't levels of health at all. Further, you neglect "How much stress is in your life, how much exercise do you get, how well do you eat, how many infectious diseases are you exposed to, and how many dangerous activities do you engage in". These are factors that can sometimes determine how likely you are to need specific health care in the future - ie, whether you remain healthy.
But this shows how far the current debate about "health care" is from the question of society encouraging general health and well-being.
Plus read the article! It offer some analogies for this situation.
Uh, the last three aren't levels of health at all. Further, you neglect "How much stress is in your life, how much exercise do you get, how well do you eat, how many infectious diseases are you exposed to, and how many dangerous activities do you engage in". These are factors that can sometimes determine how likely you are to need specific health care in the future - ie, whether you remain healthy.
But this shows how far the current debate about "health care" is from the question of society encouraging general health and well-being.
Plus read the article! It offer some analogies for this situation.
Yeah, 'levels of health' is an awkward phrase. I would agree with you, and that's part of the point - we're debating issues that aren't closely coupled to what we're supposed to value.
It wouldn't surprise me if the health of the average person is not significantly affected by the amount spent on medical care. So what? The whole point of insurance is to protect the policy-holder from the risk of outcomes that are much worse than average.
My seven-year-old son has a friend with hemophilia; if he didn't get regular infusions of clotting factor and similar treatments, he might live for another ten years--fifteen, tops. The quality of his health coverage certainly has an effect on his health. And he is exactly the sort of patient that the insurance companies will drop like a hot rock at the earliest excuse.
My seven-year-old son has a friend with hemophilia; if he didn't get regular infusions of clotting factor and similar treatments, he might live for another ten years--fifteen, tops. The quality of his health coverage certainly has an effect on his health. And he is exactly the sort of patient that the insurance companies will drop like a hot rock at the earliest excuse.
You are arguing against a point the article isn't making. There are two types of treatments:
1. Marginal treatments, or treatments you will not pay for out of pocket, but will consume if they are free. These comprise 30% or more of treatments.
2. Non-marginal treatments, which you will buy regardless of whether insurance pays for them.
Your son's friend's hemophilia treatments sound like they fall into category 2. The article argues that category 1 treatments are useless (equally likely to harm or help you).
1. Marginal treatments, or treatments you will not pay for out of pocket, but will consume if they are free. These comprise 30% or more of treatments.
2. Non-marginal treatments, which you will buy regardless of whether insurance pays for them.
Your son's friend's hemophilia treatments sound like they fall into category 2. The article argues that category 1 treatments are useless (equally likely to harm or help you).
This strikes me as a false dichotomy, especially since I believe the hemophilia treatments fall into the first of two additional categories:
3. Treatments you will pay as much as possible for. This category may not be distinct from category 2 for a single adult with no family.
4. Treatments which have a high enough out-of-pocket cost, that it is a factor in the consumption decision.
A personal example falls into category 4. Two migraine aborting treatments work for me, rizatriptan in tablet form and sumatriptan in injection form. The first requires about 3 hours for full effect, whereas the second takes under an hour. The differences in cost between insurance an no insuranceare around $25 and $100, respectively.
In the context of missing a full day of work, even the $100 falls into category 2. However, during unemployment, on a weekend or an evening, even $25 is enough that it's not "free," but even the $100 isn't so much that I wouldn't pay for it out of pocket, depending on the circumstances.
These treatments may well reduce my "health" by any objective measure, including lifespan, but they certainly improve my productivity and quality of life, something the article seems to ignore.
3. Treatments you will pay as much as possible for. This category may not be distinct from category 2 for a single adult with no family.
4. Treatments which have a high enough out-of-pocket cost, that it is a factor in the consumption decision.
A personal example falls into category 4. Two migraine aborting treatments work for me, rizatriptan in tablet form and sumatriptan in injection form. The first requires about 3 hours for full effect, whereas the second takes under an hour. The differences in cost between insurance an no insuranceare around $25 and $100, respectively.
In the context of missing a full day of work, even the $100 falls into category 2. However, during unemployment, on a weekend or an evening, even $25 is enough that it's not "free," but even the $100 isn't so much that I wouldn't pay for it out of pocket, depending on the circumstances.
These treatments may well reduce my "health" by any objective measure, including lifespan, but they certainly improve my productivity and quality of life, something the article seems to ignore.
For every patient like him, there's probably 10 or more being treated for conditions they could have avoided entirely through better diet and exercise. Nearly all cases of diabetes, heart disease, osteoporosis, and most cancers are preventable, just to name a few.
I think the point is that if we focused more on health (i.e. long term preventative health) instead of on medicine alone, there would be far more available resources to handle the genuine medical needs.
I think the point is that if we focused more on health (i.e. long term preventative health) instead of on medicine alone, there would be far more available resources to handle the genuine medical needs.
Most cancers preventable? Lung cancers maybe (and only maybe), but on the whole (and as far as we know) cancer isn't affected all that strongly by lifestyle factors.
it's affected by dietary factor: cancers are caused by animal-based protein such as meat, fish, milk, and egg
cancers are not only preventable, but also reversible -- see ch3 turning off cancer, especially starting from the indian report on rat studies given aflatoxin in 'the china study' by collin campbels, hosted on google books for reference: http://books.google.com/books?id=FIRLLcLjyC8C&lpg=PA74&#...
solution? whole-plant-based diet, no, not vegetarian nor vegan diet. basically non-processed food (marketing does play trick saying, correctly, sugar/hfcs is natural plant-based because it's made from cane/corn -- but we know it's harmful)
why whole-plant and not vegan? because one can eat fried potatoe, chewing candies, drinking sodas, sipping alcohol, smoking cigarretes ... and still claim (validly) to be vegan, but s/he probably isn't healthy
cancers are not only preventable, but also reversible -- see ch3 turning off cancer, especially starting from the indian report on rat studies given aflatoxin in 'the china study' by collin campbels, hosted on google books for reference: http://books.google.com/books?id=FIRLLcLjyC8C&lpg=PA74&#...
solution? whole-plant-based diet, no, not vegetarian nor vegan diet. basically non-processed food (marketing does play trick saying, correctly, sugar/hfcs is natural plant-based because it's made from cane/corn -- but we know it's harmful)
why whole-plant and not vegan? because one can eat fried potatoe, chewing candies, drinking sodas, sipping alcohol, smoking cigarretes ... and still claim (validly) to be vegan, but s/he probably isn't healthy
Some sources:
http://wholehealthsource.blogspot.com/2008/07/cancer-among-i... http://wholehealthsource.blogspot.com/2008/07/cancer-in-othe...
http://wholehealthsource.blogspot.com/2008/07/cancer-among-i... http://wholehealthsource.blogspot.com/2008/07/cancer-in-othe...
"Dr. Albert Schweitzer examined over 10,000 traditionally-living natives in Gabon (West Africa) in 1913 and did not find cancer. Later, it became common in the same population as they began "living more and more after the manner of the whites." "
Well, there's your problem. They didn't find a lot of things back in 1913, and the ability to detect cancer back then was about as advanced as their ability to detect neutrinos. All of the studies cited are more than 40 years old, with questionable methods or tools used.
Well, there's your problem. They didn't find a lot of things back in 1913, and the ability to detect cancer back then was about as advanced as their ability to detect neutrinos. All of the studies cited are more than 40 years old, with questionable methods or tools used.
Cancer was given its current name by Hippocrates and first described in the surviving medical literature over a millennium before him. Neutrinos were first detected in the 1950s.
I'd love to see newer studies on the few surviving traditionally-living populations. Here's one: http://www.medsci.org/v04p0053.htm
While I'm a layman and would like to be enlightened (how should they have done these studies? What evidence would make you think there's something to look into?), I don't think you're fair to the linked sources. Like, "One of these physicians was captain George B. Leavitt. He actively searched for cancer among the traditionally-living Inuit from 1885 to 1907. Along with his staff, he performed 50,000 examinations a year for the first 15 years, and 25,000 a year thereafter. He did not find a single case of cancer. At the same time, he was regularly diagnosing cancers among the crews of whaling ships and other Westernized populations. It's important to note two relevant facts about Inuit culture: first, their habit of going shirtless indoors. This would make visual inspection for external cancers very easy. Second, the Inuit generally had great faith in Western doctors and would consult them even for minor problems. Therefore, doctors in the arctic had ample opportunity to inspect them for cancer."
I'd love to see newer studies on the few surviving traditionally-living populations. Here's one: http://www.medsci.org/v04p0053.htm
While I'm a layman and would like to be enlightened (how should they have done these studies? What evidence would make you think there's something to look into?), I don't think you're fair to the linked sources. Like, "One of these physicians was captain George B. Leavitt. He actively searched for cancer among the traditionally-living Inuit from 1885 to 1907. Along with his staff, he performed 50,000 examinations a year for the first 15 years, and 25,000 a year thereafter. He did not find a single case of cancer. At the same time, he was regularly diagnosing cancers among the crews of whaling ships and other Westernized populations. It's important to note two relevant facts about Inuit culture: first, their habit of going shirtless indoors. This would make visual inspection for external cancers very easy. Second, the Inuit generally had great faith in Western doctors and would consult them even for minor problems. Therefore, doctors in the arctic had ample opportunity to inspect them for cancer."
Cancer types and rates have varied dramatically over time in populations and between populations. Ergo cancer is driven by lifestyle factors.
This article reminds me a lot of conspiracy theorists and their "anomaly hunting" - throwing out as many anomalies as possible leaving little chance to consider/rebut them before moving onto the next thing, and claiming victory when no one bothers. I'm not an expert on many of the things listed, but many stick out as just not making any sense:
First of all, holy special pleading batman! Pretty much right at the beginning he redefines health care to exclude things he admits work - diet, exercise, sleep, not smoking, etc. Who does he think figured out that smoking was bad? Or how much exercise and sleep is enough, and how much is too much? Or what foods are good for you and which are bad?
He also claims that there are "dozens of studies of the aggregate health effects of medicine", but most of the studies he describes are very specific - several only studying the last six months of people's lives, ignoring how many cases of people living extra years because of medicine? He also admits that increased social status improves health while claiming that increased medical spending does not. But it's well known that the rich can afford better health care, and doesn't explain how to (or cite any papers that) control for this.
Lastly, he only considers length of life and totally ignores quality of life. I take an antidepressant for my anxiety, and while it probably will not affect the length of my life, it sure as hell is worth every penny in improving the quality of my life!
First of all, holy special pleading batman! Pretty much right at the beginning he redefines health care to exclude things he admits work - diet, exercise, sleep, not smoking, etc. Who does he think figured out that smoking was bad? Or how much exercise and sleep is enough, and how much is too much? Or what foods are good for you and which are bad?
He also claims that there are "dozens of studies of the aggregate health effects of medicine", but most of the studies he describes are very specific - several only studying the last six months of people's lives, ignoring how many cases of people living extra years because of medicine? He also admits that increased social status improves health while claiming that increased medical spending does not. But it's well known that the rich can afford better health care, and doesn't explain how to (or cite any papers that) control for this.
Lastly, he only considers length of life and totally ignores quality of life. I take an antidepressant for my anxiety, and while it probably will not affect the length of my life, it sure as hell is worth every penny in improving the quality of my life!
I strongly suggest you read the article before commenting.
Pretty much right at the beginning he redefines health care to exclude things he admits work - diet, exercise, sleep, not smoking, etc.
No he doesn't. That was a bad choice of title on my part when I submitted the article. I should have titled it "Medical Care Doesn't Affect Health (on the margin)". But like most people, I use the terms "health care" and "medical care" interchangeably.
The bigram "health care" does not appear once in the article.
He also admits that increased social status improves health while claiming that increased medical spending does not. But it's well known that the rich can afford better health care, and doesn't explain how to (or cite any papers that) control for this.
This is simply not true. He cites a number of cross section studies which compare rich/poor/etc people receiving more medicine to rich/poor/etc people receiving less. He also cites the RAND experiment which was actually a randomized trial addressing the same question.
Lastly, he only considers length of life and totally ignores quality of life...
False. The RAND experiment studied various health measures, not mortality.
Pretty much right at the beginning he redefines health care to exclude things he admits work - diet, exercise, sleep, not smoking, etc.
No he doesn't. That was a bad choice of title on my part when I submitted the article. I should have titled it "Medical Care Doesn't Affect Health (on the margin)". But like most people, I use the terms "health care" and "medical care" interchangeably.
The bigram "health care" does not appear once in the article.
He also admits that increased social status improves health while claiming that increased medical spending does not. But it's well known that the rich can afford better health care, and doesn't explain how to (or cite any papers that) control for this.
This is simply not true. He cites a number of cross section studies which compare rich/poor/etc people receiving more medicine to rich/poor/etc people receiving less. He also cites the RAND experiment which was actually a randomized trial addressing the same question.
Lastly, he only considers length of life and totally ignores quality of life...
False. The RAND experiment studied various health measures, not mortality.
>Lastly, he only considers length of life and totally ignores quality of life...
>
>False. The RAND experiment studied various health measures, not mortality.
That may be the case, but the author makes it clear enough that, even in this case, it is mortality with which he is concerned:
"The RAND experiment was not quite large enough to see mortality effects directly, and so the plan was to track..."
I must agree that there is a distinct absence of focus on quality of life, which I believe is the crux of the issue, especially at the expensive margins, near the end of life.
That may be the case, but the author makes it clear enough that, even in this case, it is mortality with which he is concerned:
"The RAND experiment was not quite large enough to see mortality effects directly, and so the plan was to track..."
I must agree that there is a distinct absence of focus on quality of life, which I believe is the crux of the issue, especially at the expensive margins, near the end of life.
He's talking about health care spending. It doesn't cost money to not smoke, to select certain more healthful food options or to walk five blocks instead of driving. All of these can and should be considered health care, but aren't usually measured in studies of health care spending or availability of health care.
Quick summary - from the article:
"If you would not pay for medicine out of your own pocket, then don’t bother to go when others offer to pay."
Overall a well argued article.
"If you would not pay for medicine out of your own pocket, then don’t bother to go when others offer to pay."
Overall a well argued article.
I would say the quick summary would be:
"In the aggregate, variations in medical spending usually show no statistically significant medical effect on health."
"In the aggregate, variations in medical spending usually show no statistically significant medical effect on health."
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Good article but your quote does not summarize it well at all - it's just a side point the author makes on the way to the main point.
Real Summary: The author eloquently argues that an emphasis on medical spending has caused health care resources to be misdirected to the point that such spending is generally counter-productive.
Real Summary: The author eloquently argues that an emphasis on medical spending has caused health care resources to be misdirected to the point that such spending is generally counter-productive.
I don't think the article went into the fact that most of people's medical spending happens in the last couple months of life.
Per capita medical costs will just keep ballooning until as a society we change our attitude and approach to dying of old age. We simply can't afford every called for treatment for every dying geriatric. There has to be some rationing mechanism whether it's the market and individual wealth, insurance bureaucrats, or government death panels.
"Old Age" isn't even a cause of death anymore for statistical purposes. Sorry, but when a 90 year old dies the cause of death is old age, regardless of whether it was heart failure or cancer.
Per capita medical costs will just keep ballooning until as a society we change our attitude and approach to dying of old age. We simply can't afford every called for treatment for every dying geriatric. There has to be some rationing mechanism whether it's the market and individual wealth, insurance bureaucrats, or government death panels.
"Old Age" isn't even a cause of death anymore for statistical purposes. Sorry, but when a 90 year old dies the cause of death is old age, regardless of whether it was heart failure or cancer.
Robin's got a lot more on medical care at http://www.overcomingbias.com/tag/medicine .
You need to go back a few months or more to get stuff like this essay though; most of his newer stuff is on status signalling and medicine.
Bad analogy. Most automotive defects lead to breakdowns, not serious crashes. Most serious automotive crashes aren't caused by mechanical defects. When your car DOES breakdown, you buy a new one. Preventative medicine and lifestyle practices extends life in lieu of the option of replacing your body
Indoor plumbing matters, as does garbage pickup and food and water safety.
"Some of my best friends have been doctors, and excellent people they were, most knowledgeable about the minds of men, whom they see when the poets do not. But doctors are taught their laws, and they keep those laws if it kills you. Some of them here in Sicily come asking how a wanderer like me has kept such good health to past fourscore. I tell them this or that. It would be uncivil to say that whenever in my travels I get a touch of fever, I go quietly to bed and send for the local wise-woman."
Pretty good advice today, too.
I'd like to see Robin's point of view get a wide hearing. I'm afraid he's trying to paddle against a powerful current the other direction, though.