Commonplace Book

draft post on health

http://www.overcomingbias.com/2007/06/total_vs_margin.html
http://www.darrenbarefoot.com/archives/2007/06/sicko-is-moore-at-his-best-and-worst.html#comment-193779

Nobody wants to say it so much, but even as bad as the health care system in the US is (for a substantial minority of its citizens, it should be said, as opposed to the well-covered ones), no country’s medical care system (at least the parts where the US differs substantially from the rest of the world) makes much of a difference.
What separates the developed world life expectancies from undeveloped-world life expectancies is mostly stuff like child immunization, clean drinking water, and effective treatments for diarrhea (ORT, which is pathetically cheap and incredibly effective).

What separates Cuba (and other nations, mostly in the “developing” category) from the US is probably the availability of enough, but not too much food (and not a lot of meat). Thus the average Cuban is on a calorie-restricted but not starvation diet.

The average American or Canadian or European? Not so much.

Meanwhile, the health care spending makes people healthier in relatively marginal ways: the rare young cancer patient benefits if we can extend their life by 30+ years, but they are rare. We can give you knee surgery and hip replacements, but those don’t make you live longer, they just make you able to play golf at age 60.

Unfortunately, all these marginal treatments are really pricey. As has been noted in the field, the last six months of a patient’s life are often the most expensive, medically speaking. This is because, well, we can’t always be sure they’re going to die, but without medical intervention we’re pretty sure they will.

Then they do, and all we have to show for our dramatic medical intervention is a lot of public health expenses.

This is NOT my argument against having a big complicated single-payer medical system. I like having extensive access to the best medical system money can buy.

But any serious examination of modern health care systems needs to be clear-eyed about what they can and cannot do for the money.