the data seem misleading. cancer survival rates vary greatly depending on the cancers. and different countries have radically different profiles in terms of what cancers are prevalent. in the u.s. the most prevalent cancers are skin cancers which are rarely fatal. in asia, long cancers are more common, and also more deadly. the telegraph gets into this a little bit, but the chart you post has essentially no useful information in it. To be useful you must do apples-to-apples comparisons, of, for example, lung cancer-to-lung-cancer survival rates for different countries.
it also is important what the age distribution of the uninsured is. if most uninsured are young, they are at low risk for cancer to begin with. thus it may be likely that most cancer sufferers are insured patients. or else bear the out-of-pocket expenses of cancer treatment.
you are also ignoring data contrary to your position, such as that described here.
Since France has typically had the highest five year cancer survival rates in Europe, it's a significant omission.
So either the insured are getting incredibly good care, so good it outweighs the alleged 50 million uninsured who would supposedly die from lack of treatment if they got cancer, or the uninsured are in fact getting treated.
The significantly lower 5 year cancer survival rates for the near-poor in the U. S., bibliography here, suggests that the former is the case here.
Dave, it doesn't make a great deal of difference. We're over-investing in health care here. It's unsustainable. The implication of that is that touting the benefits of our (non-sustainable) system is a red herring.
Note that I'm not on the universal coverage bandwagon. I think that's a red herring, too. Four or five states constitute a much larger proportion of the uninsured than their populations would warrant. That's a local problem that calls for a local solution.
The real, genuine, inescapable problem is that our present healthcare system in which something like 60% of every dollar comes from government in one way or another, costs too darned much, costs are rising too fast, and is unsustainable.
A single-payer system, by taking excess administrative costs i.e. the profits of the insurance company is the short-sighted solution favored by many. It would help. For a couple of years. After that we'd be on the same treadmill.
My preferred solution is a dramatic increase in the supply of health care. To do that we'll need to break the cartel that controls the supply.
in the u.s. the most prevalent cancers are skin cancers which are rarely fatal. in asia, long cancers are more common, and also more deadly.
There aren't any Asian countries listed, so you don't have any point here.
if most uninsured are young, they are at low risk for cancer to begin with.
Which doesn't matter to this dataset, because this is a chart of cancer survivability, not cancer rates.
thus it may be likely that most cancer sufferers are insured patients. or else bear the out-of-pocket expenses of cancer treatment.
In other words, we're rationally allocating health care to the people that need it most. Yay! We rock!
you are also ignoring data contrary to your position, such as that described here.
I'm not ignoring it, I's saying it's wrong. Look how subjective the categories and ratings are in that "data." It's a very poorly argued Soros-funded polemic for socialism.
While I think I have the same basic policy prescription as Dave....
We're over-investing in health care here.
It's only an over-investment if someone else is spending your money for their healthcare.
If it's your own money and your own healthcare, it's not an over-investment, it's a choice.
Priorities (and what level of investment is appropriate) always vary from person to person which is why one-size fits all solutions can theoretically never be optimal.
Not quite, jody. It's over-investing when government subsidies are required to bring the expenditures up to the present level. Since government subsidies account for roughly 60% of all health care dollars, it's pretty clear we're over-investing.
The over-investing is resulting in all sorts of wonderful things, no doubt. It's also an unsustainable mis-allocation of resources which is creating a palpable drag on the remainder of the economy.
The significantly lower 5 year cancer survival rates for the near-poor in the U. S., bibliography here, suggests that the former is the case here.
No, the former is just a silly strawman I set up. The poor obviously aren't going to get better survivability than the non-poor; that's practically the definition of "poor." The fact that overall rates still beat every country in Europe shown suggests two things: the poor are getting fairly good treatment, and socialist systems drag down the survivability for everyone else too much to justify any improvement in treatment for the poor.
As for sustainability, it doesn't really relate to data at a point in time; whether we keep increasing healthcare as a % of GDP is a separate issue from evaluating what we have now. And I'm not sure I buy that 60% number.
Overspending is a problem, but it's largely a function of the quasi-socialist nature of private insurance, which ensures doctors and patients are both insulated from cost decisions; a true socialised system will either dictate costs, destroying quality as in Britain, or (more likely) exacerbate the problem by further insulating patients and doctors from costs. Also, we're considerably wealthier than nearly all other major countries -- we spend more than anyone else on most other stuff too.
Medicare, Medicaid, the VA, governments' portions of government employees' healthcare plans, patents on pharmaceuticals and medical devices, the medical deduction from individual income taxes, state subsidies on healthcare and medical research (which aren't included in Medicare or Medicaid expenses), and anti-competitive measures on the part of local governments are all subsidies to health care. Medicare, Medicaid, and the VA alone are 40% of the total bill.
As for sustainability, it doesn't really relate to data at a point in time
Poppycock, Dave. If you win $100,000 in the lottery you can have the most extravagant lifestyle in town until the money runs out. Sustainability is crucial.
Not poppycock. It's the difference between winning $100,000 in the lottery and making $100,000 a year. One creates a sustainable lifestyle, one does not.
The sustainability problem with healthcare isn't how much we're spending now, it's that the increase in the future is faster than incomes rise. Eventually, because of the increases, too great a proportion of income will be spent on healthcare.
Yes, but you're counting money twice there: once when it goes into government as taxes, and again when it comes out as welfare (which is not the same as subsidy).
I wasn't arguing asia, I'm using it as an example. Different countries have different cancer profiles which is still something that this chart does nothing to address. Why again is my point not valid?
Cancer rate vs. age is a relevant data point here. Your contention is that survival rates are high despite a large number of uninsured. My point is that if the uninsured rarely get cancer (due to age dependent insurance profiles) then cancer survival rates won't tell us much about how the uninsured are doing in the health care system as a whole (for which cancer is only one part).
We don't "allocate" health care, we supply it to those who can pay for it. It so happens that most catastrophic health crises occur later in life when one is typically most well equipped financially to deal with the costs. But there are arguments suggesting that encouraging health care participation for nominally healthy people throughout their life can reduce the risk of catastrophic illness later in life, and thus reduce the per-capita health care expenditures that Dave S notes are growing unsustainable.
I don't know where you pulled Soros from, or why you think the data are very subjective. There's more detail in Drum's links where they go into what questions were asked to determine the numbers and rankings his chart summarizes.
In any case I think my point is largely similar to Dave S's. Namely that we pay significantly more on average for our health care than other industrialized countries for substantially similar (in some metrics better, in some metrics worse) quality of care. Therefore we can't have the best system since at the least it is not efficient as other models. Where that means we should head is a matter of opinion about which reasonable people can disagree. But I think it's fatuous to suggest that an apples-to-oranges comparison of cancer survival rates is somehow the bedrock on which a case for the status quo can be made.
Different countries have different cancer profiles which is still something that this chart does nothing to address. Why again is my point not valid?
Because it doesn't matter, unless you can prove the U.S. gets more survivable cancers (which is probably corrected for in the statistics, anyway; it's most likely weighted to correct by each cancer's survivability, as that would be the typical way to lump together disparate elements of that type).
We don't "allocate" health care
Sigh. It's just a term that means how we are distributing it.
It so happens that most catastrophic health crises occur later in life when one is typically most well equipped financially to deal with the costs.
Then we are allocating it rationally. Yay us!
I don't know where you pulled Soros from
Heh. Didn't know the Commonwealth people were part of Soros' group?
, or why you think the data are very subjective.
Because it is! It's measuring vague tripe like "efficiency" and "quality" and for God's sake "healthy lives." Those have no quantitative meaning. And "access" is just restating the fact that some people don't have insurance, ignoring all the alternatives mentioned in my post. "Equity" is just "Access" restated a different way.
The whole "study" is polemic crap, as the cancer survivability numbers (actual numbers, not vague misleading surveys) prove.
Namely that we pay significantly more on average for our health care than other industrialized countries for substantially similar (in some metrics better, in some metrics worse) quality of care. Therefore we can't have the best system since at the least it is not efficient as other models
Not remotely true, and that's easy to prove.
Do you know which countries have the most efficient health care systems? The poorest countries! Why? Because the first $100 spent on health care (basic immunizations, etc.) goes much, much further than the $100 between $4,900 and $5,000.
By the "efficiency" argument, we should adopt Chad's health care system.
It's over-investing when government subsidies are required to bring the expenditures up to the present level.
Leave it at "the probability and magnitude of misallocation increases with increasing government involvement" and we see eye-to-eye.
TallDave:
Eventually, because of the increases, too great a proportion of income will be spent on healthcare.
I believe that people are generally utility maximizers and that people generally have different utilities. If you accept those premises and if people were spending their own money, then no matter what the proportion of income, I don't think you can say that it's too great a proportion.
Also, do you know why America's system is so inefficient? It's because we do far more diagnostics than other countries, esp. socialist countries. That only sounds bad till it's you on the operating table.
Say for instance you have a chronic headache, but it's not really cost-effective to give you an MRI to check for tumors. Most countries won't do it, or at best have long waiting times. In America, you're much more likely to have the test, efficient or not. Which may be bad for the system overall, but most people aren't going to forego the test for the greater good.
I saw nothing to suggest that there was any normalization for different forms of cancer. I'm not stating definitively that the U.S. gets more survivable cancers, but I am stating that it is something that this chart totally ignores. And since cancer rates can and do vary widely between different contries this seems to be a significant oversight. I'm perfectly happy to be corrected on this, though.
sigh. we aren't distributing it. and we aren't making a rational choice here. we aren't "deciding" to get sick when we're old, that's just how it usually works out. and we clearly aren't allocating our resources most effectively because we are spending so much more per capita on health care than other countries.
Heh. where are they part of Soros' group?
Effeciency, access, quality, they are all labels which you can call subjective if you like. But they represent quantitative data, as shown in the Fund's chartpack. You can disagree with their data, but don't suggest that they picked some feel-good words and assigned each country a ranking arbitrarily.
Good post. One fly in the ointment, though. Previously, the breast cancer people were questioning the "5-year survival rate" as the wrong metric to determine success in the War on Cancer.
Myself, I would look at mortality rates per 100,000 people to determine whether or not we're making progress in cancer.
but I am stating that it is something that this chart totally ignores.
And until you prove it matters, it's not much of an argument.
sigh. we aren't distributing it.
Yes, we are; every good and service is distributed. Some people are getting certain amounts of health care, other people are getting different amounts. The fact the people who need the most health care are most able to pay for it suggests our system allocates health care rationally, as opposed to a socialist system where everyone gets the same amount. Where did you get the idea rational allocation implies some guy is deciding what goes where?
Heh. where are they part of Soros' group?
Heh. Google is your friend. Check their major donors.
but don't suggest that they picked some feel-good words and assigned each country a ranking arbitrarily.
No, they arbitrarily picked terms they could use to pretend American healthcare is worse than other countries, and naturally their data turned out to prove exactly what a pro-socialism group set out to prove. And they only looked at a very small number of countries. It's a crap study.
untrue. the correct comparison is money spent for equal care.
The data as presented is incomplete. For example, if the insured get extremely aggressive early screening and are more likely to have healthy lifestyles (both of which are probably true) while the uninsured are more likely to die in accidents or of infections, heart disease, and other non-cancer causes (also likely the case, since most fatal cancers occur in older people and poorer people die young) you don't really know what these numbers say.
Also, even ignoring that the poorest countries are the most efficient, the study clearly shows Americans get much better health care than Europeans, so you're wrong there too.
Anyways, the question is not who's more efficient, it's how much more are we willing to pay (efficient or not) for better care? That's a question that goes beyond the efficient use of dollars and cents. Maybe that MRI isn't cost-effective, but that extra money America spends means you're getting it (and the slim chance that it saves your life) while the European doesn't.
metric to determine success in the War on Cancer.
Sure, but that's a different question than Euro socialism vs American capitalism.
I downloaded the actual paper (Recent cancer survival in Europe: a 2000–02 period analysis of EUROCARE-4 data) and here’s the cancer by cancer breakdowns between the Euro-4 average (the countries listed in the original articles) and the US average (5 yr survival percentages) for all the cancers considered in the paper.
Cancer | Euro Av | US
Stomach | 24.9 | 25.0
Colorectal | 56.2 | 65.5
Lung | 10.9 | 15.7
Soft-tissue | 61.2 | 65.1
Skin | 86.1 | 92.3
Breast | 79.0 | 90.1
Cervix | 60.4 | 65.8
Uterine | 78.0 | 82.3
Prostate | 77.5 | 99.3
Testicular | 97.3 | 95.4
Kidney | 55.7 | 62.6
Thyroid | 83.2 | 93.5
Hodgkin’s | 81.4 | 80.6
NH-Lymphoma | 54.6 | 62.0
Acute Mye Leuk | 14.8 | 13.9
Chronic Mye Leuk | 32.2 | 36.0
All men | 47.3 | 66.3
All women | 55.8 | 62.9
Also FYI, France did have some numbers in there (just not a lot so their gender average wasn’t computed).
Cancer | France | US
Stomach | 20.7 | 25.0
Colorectal | 59.9 | 65.5
So for what was reported for France, the US did much better.
Dean: since most fatal cancers occur in older people and poorer people die young) you don't really know what these numbers say.
They say they took age into account.
For all cancers, age-adjusted 5-year period survival improved for patients diagnosed in 2000–02, especially for patients with colorectal, breast, prostate, and thyroid cancer, Hodgkin’s disease, and non-Hodgkin lymphoma.
Thanks, nice work. Note the levels are higher for the U.S. in nearly every instance.
This is probably due to the fact we mostly ignore efficiency and over-test people, meaning we tend to diagnose them sooner, when treatment is more effective and they are likely to survive longer.
This is probably due to the fact we mostly ignore efficiency and over-test people, meaning we tend to diagnose them sooner, when treatment is more effective and they are likely to survive longer.
Cancer experts blamed late diagnosis and long waiting lists.
...
His co-researcher, Prof Ian Kunkler from the Western General Hospital in Edinburgh, said waiting lists for radiotherapy were partly to blame.
"Although there has been a substantial investment in radiotherapy facilities, there is still a shortfall," he said.
We have good evidence that survival for lung cancer has been compromised by long waiting lists for radiotherapy treatment."
So earlier diagnosis is only part of the story. The other part is the treatment. The europeans spend less on treatment, so waiting lists are longer and people die which has the secondary benefit of saving treatment costs - dead men don't rack up hospital bills.
thanks for that. it settles the main quibble i had with the study. out of curiosity, does the paper assign p-values?
on what basis are you stating that america really does offer better healthcare when our life expectancy is so low?
and we choose not to set our standard at chad's level because we've decided it's unacceptable. it's like shopping for a digital camera, and although you could probably pick up a 1MP camera for peanuts, you really want an SLR. So the question is which SLR is the best combination of performance and value? Chad is the 1MP camera, it's just not relevant.
dave,
i googled ""commonwealth fund" soros" at your first suggestion and didn't come up with anything...any suggestions?
i also think your comparison between private and government run health care runs aground. people in canada or england don't "get the same health care." they get the level which their health condition demands, same as here. it just costs less. i mean if you want to put it in terms of economics, as you seem to be trying to drive the language that way, 100 people buying 1 unit of health care doesn't equal 1 person buying 100 units. even if you consider that the only players in the private health care marketplace are the uninsured plus the major insurance companies, there are still enough insurance companies out there that volume discounts could still be improved by consolidating.
and...how again does chad win? the point is that other countries are getting similar standards of care to the u.s. at significantly less cost. the only way chad enters this debate is to ask how much it would cost for them to offer a person the u.s. standard of care.
Sure, but if you wanted the most efficient camera, you'd buy the 1MP. You get more picture-taking ability for the first $100 than the increase from $400-500. That's why efficiency is a red herring; as you say, it's not relevant.
The second Google result mentions funding links. The third mentions Vachon, a Soros flunky who sits on CWF's board. Need I go on?
The principle of socialism is that everyone has the same amount of health care available to them. The principle of capitalism is you can get as much health care as you can afford. If people who need more health care tend to have more money, then capitalism is allocating health care rationally.
and...how again does chad win?
Because they spend health care dollars most efficiently, and your complaint was the U.S. was inefficient. You can't toss out the most efficient system just because you don't like the fact it destroys your argument.
Every next health care dollar is less efficient than the one before. That's why efficiency is a red herring argument.
on what basis are you stating that america really does offer better healthcare when our life expectancy is so low
Life expectancy is a measure of the health care system's output. However, the outputs of any system are a function of the inputs and the system itself. If you drive two different systems with two different inputs, you can't really compare the outputs.
For instance, if I have an amplifier (sorry, EE - that's just the way I think) that takes in a -80 dBm signal and returns a -50 dBm signal, the process (amplifier) has added 30 dB. If I take a different amplifier and input a -60 dBM signal and get out a -45 dBm signal, do I have a better amplifier? Maybe, the output is higher. However, the gain is less. Then again, maybe both amplifiers saturate at -45 dBm. To make a true comparison, I'll need to have the same input signals.
For the health care system, there's massive variation in inputs. Blacks are more prone to all sorts of diseases than whites. Japanese just live freakishly long (but are more susceptible to lung disease).
In order to compare which health care system is better, you need to supply both systems with common inputs.
For example, take a person diagnosed with cancer. More or less, that's where someone would enter the health care system and it's more or less a neutral measuring point.
As this thread illustrated, with the common input of "cancer diagnosis", you're much better off being in the US.
So in general, if any person gets sick, they'll do better in the US than anywhere else in the world. This is why I say the US has better healthcare
True, but in limited circumstances. We have (probably) the best ER care in the world. If you're hit by a bus, bleeding in the street, I'd much rather be in the US, than any other country. You'd have a fighting shot.
We don't "allocate" health care, we supply it to those who can pay for it.
That's called "freedom." The fact that America is a free country is why so many of us love her so.
TallDave wrote:
Say for instance you have a chronic headache, but it's not really cost-effective to give you an MRI to check for tumors. Most countries won't do it, or at best have long waiting times. In America, you're much more likely to have the test, efficient or not. Which may be bad for the system overall, but most people aren't going to forego the test for the greater good.
This is exactly how health care should work in a free country. If I am sick, or suspect that I am, I should be able to walk into a hospital and receive the best diagnostics and treatment that I can afford.
Zach again:
and we choose not to set our standard at chad's level because we've decided it's unacceptable.
No, "we" don't choose anything. "I" choose how to allocate my health care dollars in the manner I calculate will provide me the most health. Many other people do the same. What falls out statistically is the summation of those individual choices, but that does not make it a collective choice.
More government involvement in healthcare in general -- and a single-payer system in the extreme -- takes my money from me against my will on threat of violence and spends it on someone else's healthcare, leaving me in the lurch. I don't really care whether the "system" is more efficient or not. It's unfree, and that's the most damnable adjective there is.
Hank: I agree that the we kill far too many of our own. I think I've complained about that in the comments on this site actually. It's also why I avoid going to the hospital or any doctor unless I either think I would die without going or unless it's something rather simple.
But what's the rate of doctor caused deaths in other countries? That's needed to make a comparison.
But what's the rate of doctor caused deaths in other countries? That's needed to make a comparison
It's not just death either, it's also maiming. Just in that Reason thread, there is one victim of British health care who permananently lost central vision in his eye becauser they don't do the dye test that American optometrists do, and another whose Brit doctor said he wouldn't operate on a man's shattered heel because of the risk of infection, even though that would have left the man a clubfooted cripple. Fortunately, he was an American and came home and got it fixed, but most Britons don't have that option.
This is exactly how health care should work in a free country. If I am sick, or suspect that I am, I should be able to walk into a hospital and receive the best diagnostics and treatment that I can afford.
Right, the only flaw in my argument, ffrom that perspective, is that most people really aren't paying directly, but only indirectly through elevated insurance premiums. Arnold Kling has called it a crisis of abundance, but lately I wonder if American behavior would really change much if we paid an higher percentage of those costs.
I wonder if American behavior would really change much if we paid an higher percentage of those costs
Personally, I believe there would be greater incentive to innovate and rapid reduction in costs and improvements in quality. Sorta like what happened with laser eye surgery.
I'm not trying to construct any indestructible argument. I don't really have strong opinions on the health care industry in general. I'm not in favor of single payer or multipayer systems. However, I still think that you misinterpreting my argument about efficiency doesn't mean that it's "destroyed." I still maintain that other countries are providing standards of care approximately on par with the u.s. while spending less money. if you don't think that's an efficiency question then that's not my problem. I'm not arguing for the most efficient system. I'm arguing for the most efficient system that produces the output we desire. otherwise you'd just choose to spend $.00 on everyone, since even $.01 is infinitely more expensive without providing infinite improvement in health.
sorry for not knowing who michael vachon is. i don't really follow soros' inner circle as closely as you seem to. but call me crazy, the second result is some site called "drugwonks" whose front page is new enough to be different from the chopped sentence google gives you. and that sentence doesn't exactly provide the "funding connections" you state. so yeah, i think you probably need to go on. more than that, I don't really care if the commonwealth fund is soros-funded. as if taking money from him means you're an ipso facto bad actor. if you have a problem with the report, just say it. if not, don't waste time with innuendo.
I still maintain that other countries are providing standards of care approximately on par with the u.s. while spending less money
And again, they clearly aren't.
if you don't think that's an efficiency question then that's not my problem. I'm not arguing for the most efficient system.
Again, you're missing the point: efficiency is irrelevant. It's a red herring. The more money spent, the less efficient the healthcare system is going to be. That's just the nature of the service being provided; you can only make people live so much longer.
It's a lot like network reliability. You could build a really crappy, unreliable network, let's say 90% reliability, and do so very cheaply. As you spend more money, you can get uptime upwards of 99.999% -- but for a lot more money; those last 9.999% cost way more than the first 90%. Now, in terms of dollars per bit, which is more efficient? The cheap, crappy one, course. But efficiency is a red herring here; most people would rather have their network up 99.999% of the time --- and most people woould rather not die.
sorry for not knowing who michael vachon is. i don't really follow soros' inner circle as closely as you seem to.
Sheesh, it's right on the front Google page results. It's not exactly a secret Soros funds and mingles with all kinds of pro-socialist organizations, so I'm not sure why the assertion bothers you so. Did you think they were some sort of unbiased, non-ideological foundation?
I don't really care if the commonwealth fund is soros-funded. as if taking money from him means you're an ipso facto bad actor.
No, but it does make you ipso facto pro-socialist.
if you have a problem with the report, just say it. if not, don't waste time with innuendo.
As I said, it's a crap study that doesn't measure anything meaningful and is tendentiously misleading in the things it does measure. That's exactly what you would expect from a study from a foundation funded by the same people who brought us MoveOn.org.
you've discounted the study providing exactly zero rational basis other than that the george soros might sort of kind of maybe possibly have some influence on their agenda. the labels assigned to various metrics in the study have meaning because the numbers behind them have meaning. if you disagree with those numbers, then say so and explain to me why. as of yet you've refused to do it.
and again, I think we must be talking past each other here. efficiency isn't a red-herring because if you stipulate a certain level of care, there are efficient and inefficient methods of obtaining that level of care. is that really so difficult to understand? jody has put to bed the questions i had about the study, so i'm happy to admit that the u.s. is beating europe in cancer survival. great! that's one aspect of health care. what about other diseases? if you integrate over all of the health care services, is the u.s. beating europe on all of these metrics? on most of them? it's well known that they spend less money per capita on health care. what sort of service do they get for that money? are we doing better? and, leaving aside europe, could we be doing exactly what we're doing more efficiently? those are the questions i'm interested in knowing the answer to. maybe it's far afield from your post, and if so, sorry for threadjacking. it just seems to me that you're claiming that superior cancer survival rates are the only factor we need to consider. the one-and-only nail the coffin requires. i'm just not so sure.
8.25.2007 4:04pm
Commenting on Dean's World is a privilege, not a right. Dean is your host, you are his guest, and you should behave in that fashion. Dean is not your babysitter, nor is he your punching bag. Please remember this. In general, you are free to disagree with anyone on any subject you wish, but abusive behavior will not be tolerated.
Of course we all lose our tempers now and then. Dean freely admits to being imperfect in this regard, which is why regulars to this establishment will generally be cut more slack than people who we don't know very well.
Still: behave like an adult, or go find somewhere else to play. Thanks.
the data seem misleading. cancer survival rates vary greatly depending on the cancers. and different countries have radically different profiles in terms of what cancers are prevalent. in the u.s. the most prevalent cancers are skin cancers which are rarely fatal. in asia, long cancers are more common, and also more deadly. the telegraph gets into this a little bit, but the chart you post has essentially no useful information in it. To be useful you must do apples-to-apples comparisons, of, for example, lung cancer-to-lung-cancer survival rates for different countries.
it also is important what the age distribution of the uninsured is. if most uninsured are young, they are at low risk for cancer to begin with. thus it may be likely that most cancer sufferers are insured patients. or else bear the out-of-pocket expenses of cancer treatment.
you are also ignoring data contrary to your position, such as that described here.
The significantly lower 5 year cancer survival rates for the near-poor in the U. S., bibliography here, suggests that the former is the case here.
Dave, it doesn't make a great deal of difference. We're over-investing in health care here. It's unsustainable. The implication of that is that touting the benefits of our (non-sustainable) system is a red herring.
Note that I'm not on the universal coverage bandwagon. I think that's a red herring, too. Four or five states constitute a much larger proportion of the uninsured than their populations would warrant. That's a local problem that calls for a local solution.
The real, genuine, inescapable problem is that our present healthcare system in which something like 60% of every dollar comes from government in one way or another, costs too darned much, costs are rising too fast, and is unsustainable.
A single-payer system, by taking excess administrative costs i.e. the profits of the insurance company is the short-sighted solution favored by many. It would help. For a couple of years. After that we'd be on the same treadmill.
My preferred solution is a dramatic increase in the supply of health care. To do that we'll need to break the cartel that controls the supply.
There aren't any Asian countries listed, so you don't have any point here.
if most uninsured are young, they are at low risk for cancer to begin with.
Which doesn't matter to this dataset, because this is a chart of cancer survivability, not cancer rates.
thus it may be likely that most cancer sufferers are insured patients. or else bear the out-of-pocket expenses of cancer treatment.
In other words, we're rationally allocating health care to the people that need it most. Yay! We rock!
you are also ignoring data contrary to your position, such as that described here.
I'm not ignoring it, I's saying it's wrong. Look how subjective the categories and ratings are in that "data." It's a very poorly argued Soros-funded polemic for socialism.
We're over-investing in health care here.
It's only an over-investment if someone else is spending your money for their healthcare.
If it's your own money and your own healthcare, it's not an over-investment, it's a choice.
Priorities (and what level of investment is appropriate) always vary from person to person which is why one-size fits all solutions can theoretically never be optimal.
The over-investing is resulting in all sorts of wonderful things, no doubt. It's also an unsustainable mis-allocation of resources which is creating a palpable drag on the remainder of the economy.
No, the former is just a silly strawman I set up. The poor obviously aren't going to get better survivability than the non-poor; that's practically the definition of "poor." The fact that overall rates still beat every country in Europe shown suggests two things: the poor are getting fairly good treatment, and socialist systems drag down the survivability for everyone else too much to justify any improvement in treatment for the poor.
As for sustainability, it doesn't really relate to data at a point in time; whether we keep increasing healthcare as a % of GDP is a separate issue from evaluating what we have now. And I'm not sure I buy that 60% number.
Overspending is a problem, but it's largely a function of the quasi-socialist nature of private insurance, which ensures doctors and patients are both insulated from cost decisions; a true socialised system will either dictate costs, destroying quality as in Britain, or (more likely) exacerbate the problem by further insulating patients and doctors from costs. Also, we're considerably wealthier than nearly all other major countries -- we spend more than anyone else on most other stuff too.
Medicare, Medicaid, the VA, governments' portions of government employees' healthcare plans, patents on pharmaceuticals and medical devices, the medical deduction from individual income taxes, state subsidies on healthcare and medical research (which aren't included in Medicare or Medicaid expenses), and anti-competitive measures on the part of local governments are all subsidies to health care. Medicare, Medicaid, and the VA alone are 40% of the total bill.
Poppycock, Dave. If you win $100,000 in the lottery you can have the most extravagant lifestyle in town until the money runs out. Sustainability is crucial.
Not poppycock. It's the difference between winning $100,000 in the lottery and making $100,000 a year. One creates a sustainable lifestyle, one does not.
The sustainability problem with healthcare isn't how much we're spending now, it's that the increase in the future is faster than incomes rise. Eventually, because of the increases, too great a proportion of income will be spent on healthcare.
Yes, but you're counting money twice there: once when it goes into government as taxes, and again when it comes out as welfare (which is not the same as subsidy).
I wasn't arguing asia, I'm using it as an example. Different countries have different cancer profiles which is still something that this chart does nothing to address. Why again is my point not valid?
Cancer rate vs. age is a relevant data point here. Your contention is that survival rates are high despite a large number of uninsured. My point is that if the uninsured rarely get cancer (due to age dependent insurance profiles) then cancer survival rates won't tell us much about how the uninsured are doing in the health care system as a whole (for which cancer is only one part).
We don't "allocate" health care, we supply it to those who can pay for it. It so happens that most catastrophic health crises occur later in life when one is typically most well equipped financially to deal with the costs. But there are arguments suggesting that encouraging health care participation for nominally healthy people throughout their life can reduce the risk of catastrophic illness later in life, and thus reduce the per-capita health care expenditures that Dave S notes are growing unsustainable.
I don't know where you pulled Soros from, or why you think the data are very subjective. There's more detail in Drum's links where they go into what questions were asked to determine the numbers and rankings his chart summarizes.
In any case I think my point is largely similar to Dave S's. Namely that we pay significantly more on average for our health care than other industrialized countries for substantially similar (in some metrics better, in some metrics worse) quality of care. Therefore we can't have the best system since at the least it is not efficient as other models. Where that means we should head is a matter of opinion about which reasonable people can disagree. But I think it's fatuous to suggest that an apples-to-oranges comparison of cancer survival rates is somehow the bedrock on which a case for the status quo can be made.
Because it doesn't matter, unless you can prove the U.S. gets more survivable cancers (which is probably corrected for in the statistics, anyway; it's most likely weighted to correct by each cancer's survivability, as that would be the typical way to lump together disparate elements of that type).
We don't "allocate" health care
Sigh. It's just a term that means how we are distributing it.
It so happens that most catastrophic health crises occur later in life when one is typically most well equipped financially to deal with the costs.
Then we are allocating it rationally. Yay us!
I don't know where you pulled Soros from
Heh. Didn't know the Commonwealth people were part of Soros' group?
, or why you think the data are very subjective.
Because it is! It's measuring vague tripe like "efficiency" and "quality" and for God's sake "healthy lives." Those have no quantitative meaning. And "access" is just restating the fact that some people don't have insurance, ignoring all the alternatives mentioned in my post. "Equity" is just "Access" restated a different way.
The whole "study" is polemic crap, as the cancer survivability numbers (actual numbers, not vague misleading surveys) prove.
Not remotely true, and that's easy to prove.
Do you know which countries have the most efficient health care systems? The poorest countries! Why? Because the first $100 spent on health care (basic immunizations, etc.) goes much, much further than the $100 between $4,900 and $5,000.
By the "efficiency" argument, we should adopt Chad's health care system.
Efficiency is a red herring of the first water.
It's over-investing when government subsidies are required to bring the expenditures up to the present level.
Leave it at "the probability and magnitude of misallocation increases with increasing government involvement" and we see eye-to-eye.
TallDave:
Eventually, because of the increases, too great a proportion of income will be spent on healthcare.
I believe that people are generally utility maximizers and that people generally have different utilities. If you accept those premises and if people were spending their own money, then no matter what the proportion of income, I don't think you can say that it's too great a proportion.
Say for instance you have a chronic headache, but it's not really cost-effective to give you an MRI to check for tumors. Most countries won't do it, or at best have long waiting times. In America, you're much more likely to have the test, efficient or not. Which may be bad for the system overall, but most people aren't going to forego the test for the greater good.
Right, I agree. The problem is people are NOT spending their own money.
I saw nothing to suggest that there was any normalization for different forms of cancer. I'm not stating definitively that the U.S. gets more survivable cancers, but I am stating that it is something that this chart totally ignores. And since cancer rates can and do vary widely between different contries this seems to be a significant oversight. I'm perfectly happy to be corrected on this, though.
sigh. we aren't distributing it. and we aren't making a rational choice here. we aren't "deciding" to get sick when we're old, that's just how it usually works out. and we clearly aren't allocating our resources most effectively because we are spending so much more per capita on health care than other countries.
Heh. where are they part of Soros' group?
Effeciency, access, quality, they are all labels which you can call subjective if you like. But they represent quantitative data, as shown in the Fund's chartpack. You can disagree with their data, but don't suggest that they picked some feel-good words and assigned each country a ranking arbitrarily.
By the "efficiency" argument, we should adopt Chad's health care system.
untrue. the correct comparison is money spent for equal care. it's on this metric we fail against other industrialized nations.
Interesting little aside - even within the US, more expensive health care gets you better care. See here.
Good post. One fly in the ointment, though. Previously, the breast cancer people were questioning the "5-year survival rate" as the wrong metric to determine success in the War on Cancer.
Myself, I would look at mortality rates per 100,000 people to determine whether or not we're making progress in cancer.
HankBarnes
And until you prove it matters, it's not much of an argument.
sigh. we aren't distributing it.
Yes, we are; every good and service is distributed. Some people are getting certain amounts of health care, other people are getting different amounts. The fact the people who need the most health care are most able to pay for it suggests our system allocates health care rationally, as opposed to a socialist system where everyone gets the same amount. Where did you get the idea rational allocation implies some guy is deciding what goes where?
Heh. where are they part of Soros' group?
Heh. Google is your friend. Check their major donors.
but don't suggest that they picked some feel-good words and assigned each country a ranking arbitrarily.
No, they arbitrarily picked terms they could use to pretend American healthcare is worse than other countries, and naturally their data turned out to prove exactly what a pro-socialism group set out to prove. And they only looked at a very small number of countries. It's a crap study.
untrue. the correct comparison is money spent for equal care.
Either way, Chad wins.
Anyways, the question is not who's more efficient, it's how much more are we willing to pay (efficient or not) for better care? That's a question that goes beyond the efficient use of dollars and cents. Maybe that MRI isn't cost-effective, but that extra money America spends means you're getting it (and the slim chance that it saves your life) while the European doesn't.
metric to determine success in the War on Cancer.
Sure, but that's a different question than Euro socialism vs American capitalism.
Cancer | Euro Av | US
Stomach | 24.9 | 25.0
Colorectal | 56.2 | 65.5
Lung | 10.9 | 15.7
Soft-tissue | 61.2 | 65.1
Skin | 86.1 | 92.3
Breast | 79.0 | 90.1
Cervix | 60.4 | 65.8
Uterine | 78.0 | 82.3
Prostate | 77.5 | 99.3
Testicular | 97.3 | 95.4
Kidney | 55.7 | 62.6
Thyroid | 83.2 | 93.5
Hodgkin’s | 81.4 | 80.6
NH-Lymphoma | 54.6 | 62.0
Acute Mye Leuk | 14.8 | 13.9
Chronic Mye Leuk | 32.2 | 36.0
All men | 47.3 | 66.3
All women | 55.8 | 62.9
Also FYI, France did have some numbers in there (just not a lot so their gender average wasn’t computed).
Cancer | France | US
Stomach | 20.7 | 25.0
Colorectal | 59.9 | 65.5
So for what was reported for France, the US did much better.
Bottom line: we pay more, but we get more.
Well, these numbers compare countries, not income levels.
They say they took age into account.
Thanks, nice work. Note the levels are higher for the U.S. in nearly every instance.
This is probably due to the fact we mostly ignore efficiency and over-test people, meaning we tend to diagnose them sooner, when treatment is more effective and they are likely to survive longer.
Being more specific, the telegraph article reports:
So earlier diagnosis is only part of the story. The other part is the treatment. The europeans spend less on treatment, so waiting lists are longer and people die which has the secondary benefit of saving treatment costs - dead men don't rack up hospital bills.
thanks for that. it settles the main quibble i had with the study. out of curiosity, does the paper assign p-values?
on what basis are you stating that america really does offer better healthcare when our life expectancy is so low?
and we choose not to set our standard at chad's level because we've decided it's unacceptable. it's like shopping for a digital camera, and although you could probably pick up a 1MP camera for peanuts, you really want an SLR. So the question is which SLR is the best combination of performance and value? Chad is the 1MP camera, it's just not relevant.
dave,
i googled ""commonwealth fund" soros" at your first suggestion and didn't come up with anything...any suggestions?
i also think your comparison between private and government run health care runs aground. people in canada or england don't "get the same health care." they get the level which their health condition demands, same as here. it just costs less. i mean if you want to put it in terms of economics, as you seem to be trying to drive the language that way, 100 people buying 1 unit of health care doesn't equal 1 person buying 100 units. even if you consider that the only players in the private health care marketplace are the uninsured plus the major insurance companies, there are still enough insurance companies out there that volume discounts could still be improved by consolidating.
and...how again does chad win? the point is that other countries are getting similar standards of care to the u.s. at significantly less cost. the only way chad enters this debate is to ask how much it would cost for them to offer a person the u.s. standard of care.
The second Google result mentions funding links. The third mentions Vachon, a Soros flunky who sits on CWF's board. Need I go on?
The principle of socialism is that everyone has the same amount of health care available to them. The principle of capitalism is you can get as much health care as you can afford. If people who need more health care tend to have more money, then capitalism is allocating health care rationally.
and...how again does chad win?
Because they spend health care dollars most efficiently, and your complaint was the U.S. was inefficient. You can't toss out the most efficient system just because you don't like the fact it destroys your argument.
Every next health care dollar is less efficient than the one before. That's why efficiency is a red herring argument.
Cancer | Euro Av | US
Stomach | 23.7-26.2 | 23.8-26.2
Colorectal | 55.3-57.2 | 64.9-66.1
Lung | 10.5-11.4 | 15.3-16.1
Soft-tissue | 58.3-64.2 | 62.8-67.5
Skin | 84.3-88.0 | 91.5-93.1
Breast | 78.1-80.0 | 89.6 -90.5
Cervix | 57.7-63.2 | 64.1-67.6
Uterine | 76.2-79.9| 81.2-83.4
Prostate | 76.5-78.6 | 98.9-99.8
Testicular | 96.4-98.2 | 94.0-96.8
Kidney | 53.6-58.0 | 61.3-63.9
Thyroid | 80.9-85.6 | 92.2-94.8
Hodgkin’s | 78.9-84.1 | 78.8-82.4
NH-Lymphoma | 52.7-56.6 | 61.0-63.0
Acute Mye Leuk | 13.4-16.4 | 12.6-15.2
Chronic Mye Leuk | 29.0-35.7 | 33.1-39.1
All men | 46.8-47.8 | 66.0-66.6
All women | 55.3-56.2 | 62.6-63.2
Life expectancy is a measure of the health care system's output. However, the outputs of any system are a function of the inputs and the system itself. If you drive two different systems with two different inputs, you can't really compare the outputs.
For instance, if I have an amplifier (sorry, EE - that's just the way I think) that takes in a -80 dBm signal and returns a -50 dBm signal, the process (amplifier) has added 30 dB. If I take a different amplifier and input a -60 dBM signal and get out a -45 dBm signal, do I have a better amplifier? Maybe, the output is higher. However, the gain is less. Then again, maybe both amplifiers saturate at -45 dBm. To make a true comparison, I'll need to have the same input signals.
For the health care system, there's massive variation in inputs. Blacks are more prone to all sorts of diseases than whites. Japanese just live freakishly long (but are more susceptible to lung disease).
In order to compare which health care system is better, you need to supply both systems with common inputs.
For example, take a person diagnosed with cancer. More or less, that's where someone would enter the health care system and it's more or less a neutral measuring point.
As this thread illustrated, with the common input of "cancer diagnosis", you're much better off being in the US.
Given another common input - Japanese genetics. Japan has the longest living people in the world. That is, except for the Japanese living in America. See here.
So in general, if any person gets sick, they'll do better in the US than anywhere else in the world. This is why I say the US has better healthcare.
True, but in limited circumstances. We have (probably) the best ER care in the world. If you're hit by a bus, bleeding in the street, I'd much rather be in the US, than any other country. You'd have a fighting shot.
But other things -- not so hot.
(See, Starfield, JAMA 2000)
That's called "freedom." The fact that America is a free country is why so many of us love her so.
TallDave wrote:
This is exactly how health care should work in a free country. If I am sick, or suspect that I am, I should be able to walk into a hospital and receive the best diagnostics and treatment that I can afford.
Zach again:
No, "we" don't choose anything. "I" choose how to allocate my health care dollars in the manner I calculate will provide me the most health. Many other people do the same. What falls out statistically is the summation of those individual choices, but that does not make it a collective choice.
More government involvement in healthcare in general -- and a single-payer system in the extreme -- takes my money from me against my will on threat of violence and spends it on someone else's healthcare, leaving me in the lurch. I don't really care whether the "system" is more efficient or not. It's unfree, and that's the most damnable adjective there is.
Mike
But what's the rate of doctor caused deaths in other countries? That's needed to make a comparison.
It's not just death either, it's also maiming. Just in that Reason thread, there is one victim of British health care who permananently lost central vision in his eye becauser they don't do the dye test that American optometrists do, and another whose Brit doctor said he wouldn't operate on a man's shattered heel because of the risk of infection, even though that would have left the man a clubfooted cripple. Fortunately, he was an American and came home and got it fixed, but most Britons don't have that option.
Right, the only flaw in my argument, ffrom that perspective, is that most people really aren't paying directly, but only indirectly through elevated insurance premiums. Arnold Kling has called it a crisis of abundance, but lately I wonder if American behavior would really change much if we paid an higher percentage of those costs.
Personally, I believe there would be greater incentive to innovate and rapid reduction in costs and improvements in quality. Sorta like what happened with laser eye surgery.
thanks for the yeoman's work here.
Dave,
I'm not trying to construct any indestructible argument. I don't really have strong opinions on the health care industry in general. I'm not in favor of single payer or multipayer systems. However, I still think that you misinterpreting my argument about efficiency doesn't mean that it's "destroyed." I still maintain that other countries are providing standards of care approximately on par with the u.s. while spending less money. if you don't think that's an efficiency question then that's not my problem. I'm not arguing for the most efficient system. I'm arguing for the most efficient system that produces the output we desire. otherwise you'd just choose to spend $.00 on everyone, since even $.01 is infinitely more expensive without providing infinite improvement in health.
sorry for not knowing who michael vachon is. i don't really follow soros' inner circle as closely as you seem to. but call me crazy, the second result is some site called "drugwonks" whose front page is new enough to be different from the chopped sentence google gives you. and that sentence doesn't exactly provide the "funding connections" you state. so yeah, i think you probably need to go on. more than that, I don't really care if the commonwealth fund is soros-funded. as if taking money from him means you're an ipso facto bad actor. if you have a problem with the report, just say it. if not, don't waste time with innuendo.
And again, they clearly aren't.
if you don't think that's an efficiency question then that's not my problem. I'm not arguing for the most efficient system.
Again, you're missing the point: efficiency is irrelevant. It's a red herring. The more money spent, the less efficient the healthcare system is going to be. That's just the nature of the service being provided; you can only make people live so much longer.
It's a lot like network reliability. You could build a really crappy, unreliable network, let's say 90% reliability, and do so very cheaply. As you spend more money, you can get uptime upwards of 99.999% -- but for a lot more money; those last 9.999% cost way more than the first 90%. Now, in terms of dollars per bit, which is more efficient? The cheap, crappy one, course. But efficiency is a red herring here; most people would rather have their network up 99.999% of the time --- and most people woould rather not die.
sorry for not knowing who michael vachon is. i don't really follow soros' inner circle as closely as you seem to.
Sheesh, it's right on the front Google page results. It's not exactly a secret Soros funds and mingles with all kinds of pro-socialist organizations, so I'm not sure why the assertion bothers you so. Did you think they were some sort of unbiased, non-ideological foundation?
I don't really care if the commonwealth fund is soros-funded. as if taking money from him means you're an ipso facto bad actor.
No, but it does make you ipso facto pro-socialist.
if you have a problem with the report, just say it. if not, don't waste time with innuendo.
As I said, it's a crap study that doesn't measure anything meaningful and is tendentiously misleading in the things it does measure. That's exactly what you would expect from a study from a foundation funded by the same people who brought us MoveOn.org.
you've discounted the study providing exactly zero rational basis other than that the george soros might sort of kind of maybe possibly have some influence on their agenda. the labels assigned to various metrics in the study have meaning because the numbers behind them have meaning. if you disagree with those numbers, then say so and explain to me why. as of yet you've refused to do it.
and again, I think we must be talking past each other here. efficiency isn't a red-herring because if you stipulate a certain level of care, there are efficient and inefficient methods of obtaining that level of care. is that really so difficult to understand? jody has put to bed the questions i had about the study, so i'm happy to admit that the u.s. is beating europe in cancer survival. great! that's one aspect of health care. what about other diseases? if you integrate over all of the health care services, is the u.s. beating europe on all of these metrics? on most of them? it's well known that they spend less money per capita on health care. what sort of service do they get for that money? are we doing better? and, leaving aside europe, could we be doing exactly what we're doing more efficiently? those are the questions i'm interested in knowing the answer to. maybe it's far afield from your post, and if so, sorry for threadjacking. it just seems to me that you're claiming that superior cancer survival rates are the only factor we need to consider. the one-and-only nail the coffin requires. i'm just not so sure.
Of course we all lose our tempers now and then. Dean freely admits to being imperfect in this regard, which is why regulars to this establishment will generally be cut more slack than people who we don't know very well.
Still: behave like an adult, or go find somewhere else to play. Thanks.