To Explain Longevity Gap, Look Past Health System

[ARubberChickenWithAPulley]

Hadn't seen this article posted anywhere. This topic has been discussed in great detail in a few threads, so I figured this would be fodder for some good discussion.

http://www.nytimes.com/2009/09/22/science/22tier.html

If you’re not rich and you get sick, in which industrialized country are you likely to get the best treatment?

The conventional answer to this question has been: anywhere but the United States. With its many uninsured citizens and its relatively low life expectancy, the United States has been relegated to the bottom of international health scorecards.

But a prominent researcher, Samuel H. Preston, has taken a closer look at the growing body of international data, and he finds no evidence that America’s health care system is to blame for the longevity gap between it and other industrialized countries.

Here is a link to the paper itself (it is also linked in the article).

Just to be clear (not trying to be a thread Nazi here), the subject of the thread is about this study on longevity and the health system. The article itself doesn't address, one way or the other, whether the U.S. health system is efficient, equitable, or fair.

 

[Beerina]

IIRC, Japan's having more heart problems now that McDonalds and beef in general are getting cheaper over there.

In 1990 I lived in Europe. There were McDonald's, but you needed to pay about 2x what you'd pay in the US for the equivalent meal. "Two Big Macs", fries and pop, was about $8. Big Macs were something like $1.25 back then, and many places still had extended 99 cent specials.

Differences are laid on the doorstep of the difference between socialized medicine and the US's freedom system. But that always seemed kind of like religion saying, see, small evolution flaw therefore Goddidit. Oooh, US behind, therefore their non-socialized system diddit.

 

[Beerina]

And by the way, massive heart disease problems in the US are driving forth heart and artery medical technology at lightspeed thanks to the massive profits to be made. Everything from giant assembly-line catheterization machines to clotbusters to Pfizer's sadly failed $800 million testing of a natural artery-clearing chemical some people happen to be born with.

...but the whole world benefits from these developments.

 

[fls]

Hadn't seen this article posted anywhere. This topic has been discussed in great detail in a few threads, so I figured this would be fodder for some good discussion.

http://www.nytimes.com/2009/09/22/science/22tier.html

Here is a link to the paper itself (it is also linked in the article).

Just to be clear (not trying to be a thread Nazi here), the subject of the thread is about this study on longevity and the health system. The article itself doesn't address, one way or the other, whether the U.S. health system is efficient, equitable, or fair.

I've said this same thing several times already. And prior comparisons looking at specific medical conditions also find that there isn't really any consistent under-performance of the US medical system.

I think the take home message (from comparing life expectancy) is more like, "spending twice as much on health care obviously doesn't actually buy you any more health."

Linda

 

[fls]

And by the way, massive heart disease problems in the US are driving forth heart and artery medical technology at lightspeed thanks to the massive profits to be made. Everything from giant assembly-line catheterization machines to clotbusters to Pfizer's sadly failed $800 million testing of a natural artery-clearing chemical some people happen to be born with.

...but the whole world benefits from these developments.

What is interesting is that medical advances have trivial effects compared to those brought about by access to health care and socioeconomic status. For example the difference in life expectancy between a native indian living in an urban area vs. a remote area in Canada is greater than the effect curing all cancers would have on life expectancy.

Linda

 

[Praktik]

Differences are laid on the doorstep of the difference between socialized medicine and the US's freedom system.

I can't tell if the use of "freedom system" is a jibe at people who ascribe such labelling to die-hard supporters of the current system, or if it represents the true feelings of the poster.

 

[Beerina]

What is interesting is that medical advances have trivial effects compared to those brought about by access to health care and socioeconomic status. For example the difference in life expectancy between a native indian living in an urban area vs. a remote area in Canada is greater than the effect curing all cancers would have on life expectancy.

Linda

That's like a throwback to the industrial revolution. The real issue isn't access to health care, but leaving a poverty-stricken, old-school lifestyle. That's a big fat win for capitalism, for those taking notes.

I wouldn't expect bushmen to live very long, either, and they don't. Their kids happily put on Coke T-shirts and move to the city and "magically" start living a lot longer, and it ain't because there's some doctor they can go to once every five years.

 

[Beerina]

I can't tell if the use of "freedom system" is a jibe at people who ascribe such labelling to die-hard supporters of the current system, or if it represents the true feelings of the poster.

Both. The benefit of freedom is you're not forced to go down anybody's concept of how to live your life. In this case, it means if Clinton Obama and a hundred million of his closest friends want to create a national health care system, go ahead. But don't demand I join or be put in jail. Or the doctor or hospital down the street, either.

In a free nation, you don't have to justify why you should be free. The very question is just not even a valid question because it presumes "potential to be controlled" is the natural state for a citizen. Everything is on the table, and any level of complete control is available to whoever can whip 50.1% of the population into a frenzy for a few seconds around an election.

 

[Leif Roar]

Both. The benefit of freedom is you're not forced to go down anybody's concept of how to live your life. In this case, it means if Clinton Obama and a hundred million of his closest friends want to create a national health care system, go ahead. But don't demand I join or be put in jail.

So how come you're not up in arms about being forced to partake in the communal fire service or the civil defence systems? Surely actual, ongoing limitations on your freedom has to be worse than potential, future ones?

 

[Rolfe]

Never mind the fire service (which I understand is manned by unpaid volunteers in rural larts of the USA), he's paying for public libraries!!! Parks! Roads! Refuse collection!

I can tell you, I'd rather have the NHS than any of these.

Rolfe.

 

[Ryokan]

And by the way, massive heart disease problems in the US are driving forth heart and artery medical technology at lightspeed thanks to the massive profits to be made. Everything from giant assembly-line catheterization machines to clotbusters to Pfizer's sadly failed $800 million testing of a natural artery-clearing chemical some people happen to be born with.

...but the whole world benefits from these developments.

How righteous of you Americans, putting your lives and your fat on the line for the rest of the world

So you belive that if, say, Norway had a massive increase in heart disease problems, we wouldn't do any research at all on it, because there was no one to profit on it? Do you believe no medical research at all is done in Norway, for the same reason?

 

[fls]

That's like a throwback to the industrial revolution. The real issue isn't access to health care, but leaving a poverty-stricken, old-school lifestyle. That's a big fat win for capitalism, for those taking notes.

I wouldn't expect bushmen to live very long, either, and they don't. Their kids happily put on Coke T-shirts and move to the city and "magically" start living a lot longer, and it ain't because there's some doctor they can go to once every five years.

Yeah, the differences in mortality/morbidity are seen in many countries among their indigenous populations who live under conditions closer to third-world, than first-world.

But surely you meant that it is (not "aint") because of access to doctors that they live longer? I thought it was your point that medical technology (which is accessed through doctors) saves millions who would otherwise die?

Linda

 

[ponderingturtle]

How righteous of you Americans, putting your lives and your fat on the line for the rest of the world

So you belive that if, say, Norway had a massive increase in heart disease problems, we wouldn't do any research at all on it, because there was no one to profit on it? Do you believe no medical research at all is done in Norway, for the same reason?

Of course. I mean everyone knows that the world wide web was never invented at some place like CERN. That is goverment funded big science, they can't develop anything, only private business can. So it is clearly a massive conspiracy that claims that it was invented there.

 

[ponderingturtle]

Yeah, the differences in mortality/morbidity are seen in many countries among their indigenous populations who live under conditions closer to third-world, than first-world.

But surely you meant that it is (not "aint") because of access to doctors that they live longer? I thought it was your point that medical technology (which is accessed through doctors) saves millions who would otherwise die?

Linda

Hey rember the case of Ivermectin. Sure it was know for years that it would cure river blindness in africa, but no one cared about blind africans. Then it was found to be effective against dogs having heartworm, and bingo a market enough to make manufacturing the drug make ecconomic sense. Now as that it is being manufactured it is easy for the company to do unethical thigns like donate large ammounts of it to cure blindness.

Of course spending less than a dollar to prevent an african from going blind is much less moral than spending 500,000 dollars to let some smoker wheeze one more day.

 

[WildCat]

Refuse collection!

Heh, it would save a bunch of money if Chicago got out of the refuse collection business. On any given day, a third of them don't show up for work. Each truck has a crew of 3, each makes $60,000 per year.

Somehow, the private companies manage with 1 person per truck.

Workers on Chicago’s garbage pick-up crews spend about two hours a day loafing on the clock, according to a report released today by the city’s inspector general.

Between May and September, investigators for Inspector General David Hoffman spied on 77 garbage truck drivers and 145 laborers in 10 wards. They reported what they called "systemic, pervasive" waste and fraud.
In 10 weeks of surveillance, they "did not see a single laborer doing a full day's work," according to the report.

"The investigators found a remarkably consistent pattern throughout all the wards," the report said. "Although the crews were well paid to work 8 full hours a day, on average they only worked less than six hours a day."

...On July 25, investigators say they witnessed several laborers in one ward drinking beer on city time. A two-man crew allegedly didn’t begin working until 6:42 a.m. and stopped for the day at 10:55 a.m., even though the shift wasn’t supposed to end until 2:30 p.m.

After spending more than 90 minutes at their homes, the laborers met up again, parked on the street and drank beer out of plastic cups with two laborers assigned to a different garbage truck in the same ward.

"One of the laborers was observed urinating on the street before driving to the ward [Streets and Sanitation] yard to swipe out," according to the report.

And my favorite part:

The report placed much of the blame on non-union supervisors in Streets and Sanitation, and union leaders were quick to do the same.

FSM forbid you blame union members for loafing, drinking on the job, and pissing in the street. It's the supervisor's fault! The poor union members didn't know any better.

 

[ponderingturtle]

Heh, it would save a bunch of money if Chicago got out of the refuse collection business. On any given day, a third of them don't show up for work. Each truck has a crew of 3, each makes $60,000 per year.

Somehow, the private companies manage with 1 person per truck.

You know that no private company picks up from trash cans right? So we make everyone put a dumpster on their curb.

 

[WildCat]

Back to the study in the OP: If I'm reading it right, it only includes patients who remained in contact with their doctors until they either died or survived for 5 years? It seems to me that an uninsured patient may well simply disappear because he can't afford treatment, and thus not get counted in the study, especially if they have a cancer that is more advanced and difficult to treat. He dies, but is not included in this study.

I'd like to see a comparison of how many patients in the US drop out of the system and thus aren't counted in the study, compared to countries with UHC. Even an insured person with a long-shot chance of survival may well opt out of treatment out of financial consideration for his survivors, because even the insured can go bankrupt fighting cancer. Cancer patients in UHC countries don't have any financial incentive to give up the fight which has little chance of succeeding. Personally, I'm not spending my last cent in a fight with cancer I'm unlikely to win if it means my wife and kids have to live in poverty after I'm gone.

In summary, patients included in the US part of the study may be biased towards cancers which are easier to treat.

 

[WildCat]

You know that no private company picks up from trash cans right? So we make everyone put a dumpster on their curb.

We have alleys here, and the old garbage cans are a long-gone relic of the past. They are now carts on wheels with a metal bar a hook on the truck grabs and lifts into the bin on the truck.


3-man garbage truck crews are also a relic of the past when it would often take 2 men to lift a can into the truck.

The only reason that private companies use the large bins is because they only haul trash from buildings with 4 or more units, city crews pick up from buildings with 3 or fewer units. No reason at all they wouldn't use the garbage carts instead of dumpsters if they were allowed to pick up for smaller buildings.

 

[!Kaggen]

That's like a throwback to the industrial revolution. The real issue isn't access to health care, but leaving a poverty-stricken, old-school lifestyle. That's a big fat win for capitalism, for those taking notes.

I wouldn't expect bushmen to live very long, either, and they don't. Their kids happily put on Coke T-shirts and move to the city and "magically" start living a lot longer, and it ain't because there's some doctor they can go to once every five years.

A little bit more knowledge of the San would not be out of order. Bushman is a derogatory word for the San.

!Kung San life expectancy in the past

Current San life expectancy has declined since the '60's

Not that simple